Tales from the Couch

Seeing the patient from psychiatry’s perspective

Dr. Melfi and Me

What does a therapist do when a patient wants to reveal a mob secret?

 

You think Dr. Melfi had it rough with Tony Soprano? Listen to this:

 As a Manhattan psychiatrist in the 70s, I had a thriving practice on the Upper East Side. With a lobby-entrance office in a posh building, the office was a comfortable place where my patients could air their troubles. Over the years, I treated an enormous array of people with vastly different problems and backgrounds.

One day in June, 1979, I received a call from a young man who’d been referred to me by a former patient. (I’ll call the new patient, John). When John and I met, he talked about the problems he had with his father, for whom he worked at the Fulton Fish Market. His dad was a rough-hewn man who belittled and humiliated John, and his self-esteem was crumbling with each passing week. 

Though he was in his mid-thirties, John was unmarried and still living at home in Brooklyn with “Mom and Dad”.  I soon realized that as much as John disliked being his father’s lackey, he was completely dependent on him in many ways. I was sure John could very likely benefit from increased insight about his neediness. It was really quite clear: despite his protestations, his wish was to remain a “boy.”

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By our fourth session, we’d established a good working relationship. John opened up more and more to me, and I could tell he trusted me. It soon became clear by what John told me that his father was a mob underboss in a Brooklyn crime family. I took this new information in stride, and naively thought it barely mattered. After all, John was here dealing with his problems of growing-up and leaving the nest. I should have been more wary, especially when John paid for each session with cold, hard cash, not wanting to be billed at the end of the month like everyone else who mailed a check.

John talked in a gritty Brooklynese way that was the patois of the mean streets. Sitting face-to-face and discussing his life in the neighborhood was reminiscent for me of my own Brooklyn upbringing. John told me one anecdote after another about his relationship with his father; and we were making some progress. It became evident that, despite the humiliation and resentment he felt toward him, John really fostered the situation with his dad.

One evening in mid-July, John entered the consultation room; sat in the chair facing me; and his lips curled into a knowing smile.

I waited, thinking something important—perhaps some kernel of insight—might emerge.

“You wanna know who clipped Carmine Galante…?” he began.

John was referring to a mob rubout that had occurred only a few days earlier, on July 12, 1979. Carmine “Cigar” Galante, an acting boss in the Bonanno crime family, had just finished lunch at the open-air patio at Joe and Mary’s Restaurant on Knickerbocker Avenue in the Bushwick section of Brooklyn. Suddenly, three ski-masked mobsters burst onto the patio and opened fire with shotguns and a handgun, killing Galante instantly. One bullet penetrated his eye.

Everyone in New York knew about the rubout, since Galante’s photo had been plastered all over the daily rags: it showed Galante—dead as a doornail—sprawled on the pavement with his upper back and head resting against a low brick wall. Stuck in the dead man’s mouth and still emitting smoke was his lit stogie.

John looked expectantly at me, waiting for my response.

Did I want to know who clipped Carmine Galante? Hell, no!

It struck me that I was in one hell of a situation. Did John’s father know he was visiting a psychiatrist? If so, what did he think John was telling me? How much did—or would—I eventually learn, about the family business? After all, patients tell their psychiatrists things they would never tell their mothers, fathers, wives or husbands. We’re privy to the most deeply-held secrets. I suddenly realized that no matter what was—or wasn’t said in our sessions—someone in the “family” could arrive at the conclusion that I knew too much…about anything.

At that point, I had a brutally frank discussion with John.

            I can’t treat you anymore…”

            “Why not, Doc?”

            “Because I don’t know what your father or any of his associates think you tell me.”

            “It’s just between you and me.”

            “True. But other people know you come here, right?”

            “Yeah…”

            “And we don’t know what they think you tell me.”

He nodded his head and sighed. He got the point.

That was the last session I ever had with John.

For some time afterwards, I looked over my shoulder.

 

Mark Rubinstein, Author “Mad Dog House, Love Gone Mad and The Foot Soldier”

Mark Rubinstein, M.D., is a former professor of psychiatry at Cornell. His most recent book is the novel Mad Dog House.

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