Richard C. Friedman and the Quelling of My Depression
In 1995, I was severely depressed and embarked halfheartedly on the process of selecting a psychotherapist. I met with at least a dozen, recounting my story over and over in what came to feel like a studied monologue. I was drawn to Richard C. Friedman in part because of my intense desire for clarity and order. My most stable friend’s therapist had highly recommended him. But I didn’t feel the warmth from him that I thought I wanted. There was someone else in the running who had industrial-strength empathy and a captivating personal style. After I had met with Friedman a few times, I told him that he was one of the finalists. He said matter-of-factly, “You have a severe mental-health condition. I’m quite important in my field, and you’re lucky that I have time and willingness to take you on.” I was surprised by this seeming display of hubris, but I was also curiously reassured by it. My own confidence lay shattered around me, and he seemed to be certain he could treat me. I was a year out from a traumatic experience with a psychoanalyst who had shuttered her practice abruptly, and I didn’t want to endure another therapeutic crisis. I felt that I could trust Friedman, that he knew what he was doing. I didn’t need to charm him, and he was not going to beguile me for my fee. He saw something in me that was worth his time. I didn’t know what it was; I couldn’t see it myself. But I instinctively knew that he could help me actualize whatever he perceived. I left the other finalists by the wayside.
I little imagined that I would go to his office every Thursday for the next quarter century, from the time I was thirty-one to the time I was fifty-six. I believed in psychodynamic therapy, but I wasn’t up for full-fledged psychoanalysis again. We agreed on a weekly double session of ninety minutes. We wouldn’t have made it past six months if I hadn’t so enjoyed his company. He was funny and generous of spirit, but the magnetic force that kept me in his orbit was his inexorable acumen. No one else had seen me as clearly as he did. I try to write and live honestly, but I also construct myself in all my human relationships, and I did so less with Friedman than with anyone else. Over time, I began to refer to him, affectionately, as Dr. F.
He was funny and generous of spirit, but the magnetic force that kept me in his orbit was his inexorable acumen. No one else had seen me as clearly as he did.
I spent the first few years carapaced by previous difficulties that prevented me from opening up. He seemed unfazed by my reserve. Unlike my previous analyst, Dr. F was never seductive. She had been given to flights of lyricism in an exquisite office; he was given to intellectual discourse in a yellow room full of papers in nearly squalid chaos, lit primarily by an unflattering chandelier. I, myself, have hidden in lyricism too often. Even as I erected defenses in my sessions with Dr. F, he was unwavering, equipped with ground-penetrating radar that could detect the subterranean foundations of structures long ago destroyed. I wanted him to like me; I wanted everyone to like me. Yet even in the throes of transference, I knew in those early days that his liking me was of little interest to him.
He seemed to have a will of steel, an unyielding determination, and he often spoke with a shocking certainty. As a major in the Army, he had encountered extreme situations that galvanized him. The anguish and pain of soldiers returning from Vietnam gave him a new appreciation for what the human psyche can endure, and persuaded him that even those in the direst straits could be helped. He seldom proposed anything as a possibility; he talked in absolutes. Yet he also appreciated conditionality. I have often wanted to sort people into polar categories, to delineate the good and bad guys. He would have none of it. While I tried to achieve singular revelations that would expose someone’s whole character, Dr. F would say, repeatedly, “You’re talking about a person. People aren’t simple. They are full of nuance and contradiction.”
In my early thirties, I considered myself a tragic person whose life would never work out. A few years in, Dr. F. said, “If you want to build a constructive love relationship, you have what it takes.” He had been so circumspect until that time that his confidence gave me pause. I couldn’t pretend that he romanticized or overestimated me, because he had withheld reassurance about so many things on so many occasions. He now averred that I had the resilience for a good life, that I would meet someone, that I could have children if I wanted and would love them if I had them, that my writing could find its audience and would help others.
I seldom cried with Dr. F. He had a box of tissues right next to the big Eames chair in which I sat on all those Thursdays. But I didn’t feel the need to punctuate my stories with tears. We talked about my not crying. I had assumed it was a defense, but he thought otherwise. He was helping me to turn neurotic grief into common sorrow, and we often processed things about which I’d already cried elsewhere. He had little room for sentimentality. His purpose wasn’t to tease more extreme emotions out of me, as my previous analyst had done, but to lay bare the networks of ambivalence behind every feeling I had — and ambivalence is not, in general, a tearful state. I theatricalize my own life, and he was the exacting dramaturg of my extravagance. Over time with him, I became less extreme. He had described me as “highly reactive,” and we worked on my being less so.
Dr. F not only accepted that homosexuality was probably biological but also averred that it was not a deficit. Then he did something extraordinary: he praised the strength and vitality of gay people.
Early in his career, Dr. F had investigated the role that exhaustion plays in medical errors made by interns and residents. He demonstrated that punishing schedules damaged not only incipient doctors but also their patients, a revelation that revolutionized hospital practice. Then he developed an unlikely interest in “deviant sexuality,” writing Male Homosexuality, the book, from 1988, that destigmatized homosexuality within the field of psychoanalysis. It was not a popular topic among straight doctors, and his willingness to see gay people as equals packed a radical punch, even long after those views had entered the mainstream. Dr. F not only accepted that homosexuality was probably biological but also averred that it was not a deficit. Then he did something extraordinary: he praised the strength and vitality of gay people. He wrote in his book, “The contemporary clinician no longer need consider why homosexual men are paranoid, since there is no evidence that they generally are. It must now be asked why homosexual males are not more often paranoid. Homosexuality begins in childhood, and many gay people grow up in environments that are virulently homophobic and sexist. One might expect that as a result . . . homosexual males would tend to develop paranoid psychopathology. Since this does not occur with unusual frequency, we must ask whether unusually adept coping mechanisms coexist with homosexuality in many individuals.”
Because I had told him in our first meeting that I couldn’t bear another abrupt termination, he told me early on about his physical vulnerabilities. He required multiple cardiac procedures and was in treatment for it. Over the years, he missed sessions because of heart-related interventions, and he always told me what was going on. In that regard, we had reciprocal openness. He said that I deserved to know. He was private, sometimes even secretive, but also blunt. Knowing when he suffered a setback set me free to be unconcerned the rest of the time.
Unlike many therapists and analysts, he was very much a doctor, and he understood the brain and body and how they relate. For my own rather complex psychopharmacological needs, however, he referred me to his eponymous colleague, Richard A. Friedman, who has guided the biology of my brain ever since. They were professional collaborators and personal friends.
It was perhaps five years into our work together that I ended up in social conversation with another psychiatrist who told me about Dr. F’s troubled first marriage, and the children from whom he was estranged. I didn’t want to confront Dr. F with gossip, but I didn’t feel I could remain in therapy without expressing what I knew. So I told him what I’d heard. He said simply that he felt deep regret about the mistakes he had made, and that his personal life had no bearing on our work together. I was not so sure. A few weeks later, he said he wanted to tell me that he had a wonderful marriage, that his wife’s name was Sue, and that they had a grown son, Jeremiah, whom they adored. We opened up a surprising reciprocity that day, one that, he made clear, was not his usual way of interacting with patients. In the two decades that followed, he offered occasional, usually cheerful, glimpses into his marriage and personal experience. I came to know Dr. F’s life by proxy. By coincidence, I interviewed one of his close friends for a book I was writing. Norm Rosenthal adored Dr. F, and Dr. F talked about Norm enthusiastically. Of course, Dr. F controlled his side of our dialogue, and what I knew about his life was only what he chose to tell me, but it convinced me that he had built for himself the kind of life he was helping me build.
When I acknowledged that I was overreacting but complained that I couldn’t calm myself down, he said, “You have a reservoir of autonomous dysphoria that you attach to whatever life circumstances come your way.”
During our first decade together, I entangled myself in two romantic relationships that ended in devastation. In the aftermath of the second splintering, in 1999, I dove back into depression. I universalized relentlessly. I was certain that I was too damaged to make anything work. Dr. F thought things had foundered because I had made poor relationship choices, and that I could make better ones. I would huddle in the Eames chair, my knees up under my chin, awash in despair. He never told me to pull my socks up and get on with it, but he did say that my mistakes could be instructive. He was implacably calm. His calm annoyed me. While Richard A. Friedman worked intensely on my biochemistry, Dr. F simply said that I had survived other depressions and would survive this one. He gave me his home number, however, and said I should be in touch if I felt like the depression was escalating. When I was depressed, he would be in contact with my father (when I was younger) or with my husband (in later years), and tell them how to keep an eye on me. We agreed that patient privacy during a crisis was terribly overrated.
In 2001, I met John. Our relationship had a rocky start, but Dr. F believed this one would work — and that if it didn’t, I would find another. He coached me along, and I went through a phase of longing for Thursdays, when I could air the grievances that I had to forbear mentioning at home. Dr. F often took John’s side in the arguments I recounted, which was aggravating but sobering. John and I did some couples therapy, but I often found I could accept what had been said by our counsellor only after it had earned Dr. F’s imprimatur. One way or another, we made it through the rough period, and through the negotiation about having a family. My life began to take shape. When John and I married, in England, in 2007, I invited Dr. F, who deserved a great deal of credit for my getting to this moment. I was comforted by having him there, and seated him next to the rabbi who blessed the union. That was the sacred table.
Over the years, I would write down things he said that were especially witty or perceptive. One Thursday, I was nearly hysterical about an injustice from someone I had trusted. When I acknowledged that I was overreacting but complained that I couldn’t calm myself down, he said, “You have a reservoir of autonomous dysphoria that you attach to whatever life circumstances come your way.” When I talked about someone who I felt had treated me grudgingly, he said, “He’s one of those people who feels drained by loving someone else, not increased by it. He’s not someone who feels that loving other people enhances him; he believes it depletes him, and that’s how he acts.” I complained that someone wanted to throw me under the bus; Dr. F said, “You are under the bus already. Just try to be Gumby and deal with the impact.” And when I said I didn’t feel it was worth prolonging an argument with someone who had hurt me badly, he said, “Don’t allow good judgment to be upstaged by altruistic masochism.”
While I tried to achieve singular revelations that would expose someone’s whole character, Dr. F would say, repeatedly, “You’re talking about a person. People aren’t simple. They are full of nuance and contradiction.”
Dr. F was amused by my habit of recording such statements on the index cards he kept beside the chair where I sat in his office. “But what are you planning to do with them?” he would ask, and I’d tell him about the novel I was going to write, set in a psychiatrist’s office. It never occurred to me that his aphoristic remarks would make their first showing in a remembrance such as this one. When someone had treated me badly, I said that the situation made me want to commit suicide. “Why don’t you kill him and leave out the middleman?” Dr. F said. When I described the disruptions in an acquaintance’s marriage, he said, “He thought he could use his wealth to make her do what he wanted; she thought she could use his wealth to do what she wanted. They have both been disappointed.” But it would be a mistake to suggest that our relationship was predicated on repartee. Late in our work, I said that I was in chaotic depression and felt like I was melting away. He looked at me for a minute, then said, “If you turn into a pool of water, I’ll find a glass.”
Some people go into therapy because they want to be released from their constraints. I wanted to break out of some of mine, and I did — but what I really wanted was containment. When I discovered and achieved ways to break free, he consistently found the glass. At other times, when I felt my mental health was stable, I questioned the utility of spending so much time in treatment. I sometimes wanted my Thursdays for other purposes. But when I was feeling even momentarily unhinged, I could go to Dr. F and tell him what was going on, and the very nature of his listening smoothed out the jagged line of my emotional life. He acknowledged that I had a very broad emotional range and discouraged my occasional wish that it be narrower. “You live more of life than most people,” he once said. He didn’t think I had to feel less to be healthier; he thought I had to learn how to corral my feelings by understanding their origins more clearly. Our work was intensely psychodynamic in that regard; I checked what I felt by understanding its origins, and so defanged the anguish and terror that besieged me when I was unwell. We both knew that I had core instabilities, but he did not believe, as I did at first, that they were uncontrollable; he believed that they could be regulated. Our work was insight-oriented, in the jargon of our day; I couldn’t imagine what therapy would be for if it weren’t for insight. Dr. F’s discernments helped me to be less angry, to compass my own sadness, to see the people around me as clearly as Dr. F saw me. Insight lay behind his mordant wit. His insight made him kind to me when I was unkind to myself. He made me think even when I didn’t want to. He believed that feelings were facts.
For my fortieth birthday, he gave me a Steuben glass heart. When my son George was born, he gave me a small porcelain box with a “G” on it; I put a lock of hair from George’s first haircut in it, and it sits on the desk in our bedroom. Once, he gave me a set of CDs of Bach’s complete piano music, and I often listen to that music while I write; I am listening to it now. I gave him occasional Christmas gifts, carefully selected ones. We enjoyed these material exchanges. I am a bit of a dandy, while Dr. F was not a man of breathtaking personal style. He did, though, have a remarkable collection of neckties, and I complimented him on my favorites. Our point of contact was intellect, but the physical worlds we inhabited, though different in appearance, shared a modicum of substance. In 2016, his son, Jeremiah, had a daughter, Tess, Dr. F’s first grandchild. He talked about what a marvel she was. He showed me pictures, but when I gave him a baby present, he seemed flummoxed.
I asked him whether our relationship transcended the transactional. He said, “Of course it does. We’ve built something very real over these years. We love each other.”
Two years ago, Dr. F had shingles and took almost four months off. I knew that he was devoted to his work; in the previous twenty-three years, he had missed only a handful of sessions. When we finally met again, he shook slightly and held onto his desk when he stood. He described terrifying neuropathic pain that had persisted for months. He had been prescribed fentanyl, he told me, but one day, realizing that he was becoming addicted but not achieving analgesia, he ripped off his patch and resolved to do without it. He was still in pain when we met, but nothing essential in him had changed. He spoke about Sue’s care for him with something near rapture. She had been unflagging; he would not have survived without her.
It was in the months that followed that I asked him whether our relationship transcended the transactional. He said, “Of course it does. We’ve built something very real over these years. We love each other.” I said, “That’s what I thought, but I wanted to be sure,” and he chuckled in his characteristic way. I took to signing some e-mail messages “With love, Andrew” — but his always ended “Warm regards, RCF, MD.” He said I could call him Rick, but I was so used to Dr. F that I never made the switch. Apropos of a prominent psychiatrist with whom I had crossed paths, Dr. F told me that he could have had a bigger, more public career if he had “played the game” — a game he thought I played more than he did. I asked him whether he regretted his choice. He sighed and said, to my surprise, “Yes, Andrew, I do regret it.” Then he paused and added drily, “I couldn’t have done it that other way without enormous psychic strain. It wasn’t worth it to me. But I regret it anyway.”
Latterly, he guided me through a family crisis, and stared down a stiff depression that came for me in 2018. I often supposed he held my sanity in his hands. But he also sometimes laughed at me, which I found distressing. I would make what I thought was a reasonable statement, and he would sit in that chair of his and give one of his full-throated guffaws. I would tell him that he was making me angry, trivializing what I was trying earnestly to reveal. About half the time, he made me laugh, too, in the end. About half the time, I left his office swearing I’d never go back.
I should note that while Dr. F’s insight was spectacular, his practical advice could be inept. He advised against certain relationships that turned out to be sustaining ones. He suggested courses of action with my family that could only have led to disaster. He proposed that a relative who showed some challenges be hospitalized immediately; the person in question just needed some therapy. He questioned things on which I spent money in a way that seemed to align with his financial values rather than mine. But he also proposed extravagant expenditures that were clearly out of my league. “Why don’t you hire someone to handle that?” he would ask, or, “Why don’t you get a plane?” He thought my lower-back pain was catastrophic, while I thought it was merely annoying, and suggested an uptown gym where Chinese prizefighters could instruct me on how to eliminate it through the use of acrobatic calisthenics. He told me that the best way to lose weight was to drink two Bloody Marys every night and skip dinner. He occasionally tried to foreclose my writing about personal difficulties, though writing about such difficulties is the essence of what I do.
He never told me to pull my socks up and get on with it, but he did say that my mistakes could be instructive. He was implacably calm.
More disturbingly, he projected homophobia onto people to whom it didn’t apply, and did so so consistently that I began to wonder what homophobia lingered in him. When my brother didn’t invite me to his apartment for a while, he suggested it might be because he didn’t want people in the lobby exposed to his gay sibling. When my father disappointed some expectations, he thought it was homophobia again, even as we explored what seemed to me like more plausible motives. As he asked me naïve questions about gay practices and proposed inept suggestions about my intimate life, I had to remind myself that Dr. F observed gay life and had gay patients, but was outside gay culture.
My mental health will always be somewhat precarious, but, in many ways, I have the life I hoped for when I first sat in that Eames chair. I am happily married, have children whom I love, enjoy reasonable career success. I have a balanced relationship with my family of origin. I once said to Dr. F that if I had been able to see one day of life in my fifties when I first entered his office, I wouldn’t have had to go through so much anguish and peril along the way. He replied that if I hadn’t gone through so much anguish and peril along the way, I wouldn’t have ended up with the life I had.
Three weeks into the coronavirus shutdown, I got a call from Sue, a call I had always dreaded and for which I was nonetheless unprepared. Dr. F had died, apparently from complex metabolic issues and low blood pressure. We didn’t know if covid-19 had played a role. Sue had opted against an autopsy on grounds that there were more urgent purposes for medical personnel during the pandemic. His departure left me bereft not only of him but also of my own history and of some of my inner life. He had died very quickly, as people do these days. I would never again go into his office on Central Park West, where much of my emotional life had risen into language; never again feel mild irritation about the knots in the cord of his floor lamp; or the single, exhausted turquoise hand towel in his bathroom; never again provoke his sudden laughter. I would never again lay my coat over the books on his daybed; we would never again talk about Bach, Mozart, Freud. For twenty-five years, I looked at the wood grain on the side of his desk and saw anthropomorphic faces, but it never seemed like the right moment to show them to him. I never would.
His departure left me bereft not only of him but also of my own history and of some of my inner life.
It is acutely strange to have lost him during the coronavirus outbreak — harder, because we won’t be able to talk through my complex emotions around the pandemic, but also easier, because quarantine has meant shedding so many structures of external life. I forget sometimes that losing him is more permanent than the loss of everyone and everything sheltering in place. Then, all of a sudden, I feel shocked all over again. I had always been amused by his mustache, which looked like a hangover from the nineteen-seventies. Now I found myself growing a mustache: partly just to keep life amusing, and partly, perhaps, in the way that gang members honor fallen brethren by tattooing images of them on their bodies. Our attachment had been the silver lining in the cloud of my depression. As my father remained physically vigorous but diminished in his capacities at ninety-three, Dr. F, seventy-nine and physically frail, had remained exquisitely lucid; he was a different sort of father for me. We internalize our parents — but losing them is still devastating. Transference be damned, it felt like that.
We exist for ourselves in part by existing in the eyes of others, and when those others disappear, it can feel like we’re dissolving. Like many writers, I have sometimes felt that my life was an exercise in reportage, and had often thought, as I was living an emotionally complex experience, about how I would recount it to Dr. F. In telling him the week’s dramas, I made them into stories I could manage. Dr. F could not be hurt by what I said or did, could simply lay bare the story beneath my stories with his ruthless clarity. His death has mostly felt unreal — then it suddenly flares up again and I am shocked anew. I know that when we return to life in New York City after the coronavirus, it will all feel real again, that I will have to come to grips with the fact that I’ve lost everyone else only temporarily, but Dr. F permanently.
As friends eventually asked me about finding a new therapist, I have been forced to recognize that, in my fifties, there is a level of intimacy beyond which I don’t easily go with new people. I don’t keep big secrets from them, but there are certain wild vulnerabilities that I don’t have any longer and can’t pretend to. Dr. F helped make me who I am. At some level, I have become myself and won’t be changing fundamentally, short of tragedies. That’s the nature of middle age. I know I will do more psychotherapy; someone with my inbuilt instabilities needs a watchful eye. As Dr. F once said, “Andrew, we never forget in this room that you are fully capable of taking the express elevator to the bargain basement of mental health.” But while a new therapeutic relationship will doubtless be fashioned, it will never be like the one I’ve just lost. I can elicit confidences and secrets from myself in front of someone else, but I can’t be overwhelmed by them any longer. In the days that followed Sue’s call, I found myself imagining how Dr. F and I would be talking about it. There has been no major loss after my mother’s passing that I have not processed with him; I feel I should be discussing the matter with Dr. F, but Dr. F remains maddeningly unavailable to discuss his own death.
We internalize our parents — but losing them is still devastating. Transference be damned, it felt like that.
I keep imagining what I would have said if I had known that our final session was our final session. I don’t feel that we left much unsaid. He helped me find something to hold onto: not only an imaginable future but also a known past. I miss him with all my heart, but I know that what I feel is grief and not despair. As I continue to talk to him in my head, I hear the calm, steady way he used to reassure me that I could manage my own life. When I once said to him that I feared my marriage was foundering, he said with that wry smile, “Danger lurks, Andrew. Danger lurks. But you’re strong enough to face it.”