November 12, 2009


by Irving Yalom, (PhD)
384 pages; BasicBooks (HarperCollins)

Review by Anthony Barker

It’s my view that Reality is unexplainable. Fiction is the explanation.(1)

Our species lacks both the data,(2) and the requisite smarts,(3) to make valid judgments about Reality. Nor can we readily communicate what little we discover.(4) If the truths we take to be self evident are often wrong, then the explanations based thereon are bound to be iffy,(5) especially if the subject is ‘Psychology’, a ‘science’ whose important hypotheses cannot be tested, and whose ‘data-base’ is dreams, fantasies and memories.

We make stuff up as we go—the ‘internal movie’ of our individual lives. I glance out the kitchen window. The neighbor’s baby daughter toddles across their yard. Age seven: she goes to Disneyland. She waves as she walks to middle school, an armload of books clasped to her budding chest. Last week she left for college. A completely serene and uneventful childhood. God only knows what life-story she has constructed, or how it might be reconstructed in therapy. Either way, it’s fiction, two different ways of making sense of randomness.

I keep these opinions to myself. I don’t know a damn thing about Psychology.

Another way of making sense of inadequate and random data is the intentional fictions of writers and other artists. What they create largely depends on what they see from where they are. Leo Tolstoy looking down on Russian history? Awesome! Woody Allen looking sideways at New York? Hah!

Or how about Irvin D. Yalom, MD ‘...crossing the line from psychiatry to fiction... ’(6)

In Lying on the Couch, the author tracks the decline of the Freudian canon. It is the 1990’s about sixty years after the great man’s death. The discipline is fractured and disintegrating. Starved by the health insurance industry, poisoned by psycho-pharmacology, prey to malpractice lawyers, it continues an enervating fight against the great heretics (Jung, etc.) and the California whimsies (Ikebana therapy, etc.). Worst of all, the profession must confront novelty and schism, some members preaching new revelations—others intent upon excommunication.

Dr. Ernest Lash has come late to psychoanalysis. Overweight and overanxious, his eagerness to please is exploited by his seniors who use him to destroy a rival, and clear some room at the top. Dr. Seymour Trotter has been charged with sexual touching of a female patient. Lash makes his investigation and testifies as expected, with the expected result.(7) Nevertheless, he is moved by the therapist’s eloquence and cannot shake off Trotter’s plea that the ‘transference’ and ‘counter-transference’ involved was as therapeutic for his patient as for himself.

Dr. Lash switches from drug therapy to talk therapy, vowing never to make Trotter’s mistake. But like Trotter, he becomes progressively more creative and experimental. Time passes. Lash engages in a lengthy and unproductive consultation with Justin, a man too timid to leave his awful wife. Lash tries to build him up, but Justin will not act. When finally Justin’s new girl friend tells him to move in with her, he does so, blaming Lash for five wasted years and $80,000 in fees.

Meanwhile, Justin’s wife, Carol, concludes that husband and doctor have been conspiring against her for five years. She wants revenge, and decides to become Lash’s patient under a pseudonym, seduce him, and put him through the same miseries he inflicted upon Dr. Trotter.

Under psychoanalytic rules, Lash must be ‘supervised’ by a more senior therapist who reviews his cases, and psychoanalyses him. Dr. Marshal Streider, is Lash’s opposite in temperament: doctrinaire, manipulative, a careerist, envious of the wealthy, and a retailer of hackneyed interpretations.(8) His approach to students, patients, colleagues, and himself, is essentially disciplinary.

He and Lash do not agree, but afraid to confront Streider, Lash often withholds information, and sometimes lies, about his consultations. Similarly, Carol begins her treatment with lies, trying to coax Lash into a compromising intimacy. Streider, too, is fooled by patients with ulterior motives, who take advantage of his various weaknesses.

The characterizations, complications, revelations, plot twists, and their resolution, are extraordinarily deft—and as readers we ‘get’ what is happening before the ‘smart-guy’ psychiatrists. It’s quite satisfying.

Does it tell us much about the present state of psychotherapy?

It must. Yalom obviously knows his subject. On the other hand, it’s fiction (of the intentional sort) so it’s possible that an entire book full of patients intending to outsmart their clinicians is an exaggeration. Parts of it are a bit frenetic, like an up-tempo production of The Importance of Being Earnest. Perhaps that’s the line that Yalom mentioned—between psychiatry and fiction.

Or maybe it’s the part where lawyers actually listen to counselors, and counselors accept from lawyers advice that they would scorn from another psychiatrist.

Well, but, is it any good?

Yes. It’s humane, sometimes poignant (even sharp enough to hurt) trenchant, articulate, witty, even wise.

Cool and refreshing.

But mainly…funny.


(1)Or, you could say, “Explanation is fiction.”
(2)Our sensory capabilities are too restricted—we don’t have the ‘bandwidth’ to detect anything close to the full range of cause and effect.
(3)Even if we could download the data, we lack the computing power, or the programming, to process it.
(4)Words are inadequate. Equations help some people, sometimes—but dismay the rest of us. Eye contact is good but hard to come by. Tears? Laugher? Useful but often misleading. Pheromones? Who knows?
(5)For example—the Ptolemaic explanation of why Venus goes forward, then backward, then forward again, in its circuit around the earth—an explanation so elegant and ingenious that it fairly boggles the mind—but which would only be correct if Venus were, in fact, circling Earth.
(6)“Wouldn’t that be an invisible line?” I asked, “How can you tell which side you’re on?” (It took me awhile to realize that this was Yalom’s joke, not mine.)
(7)Trotter is drummed out of the corps—but by an ingeniously comic plot twist, Love (perhaps) conquers all.
(8)After silently listening to an hour of childhood memories he offers: “... the toy truck that melted when you stuck it in an electrical socket was your own ‘truck’ which you wanted to stick in mommy’s socket.”

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