There is a long and respected tradition of clinicians writing about the complexities and nuances of their work with clients. Freud, in his case studies, was the forerunner with his classic essays that have guided and intrigued us for years. For me, they were a welcome breath of fresh air during graduate school and held out the possibility that the field of psychology contained more depth and interest than B.F. Skinner’s experiments with pigeons. Freud’s reflections on Dora, etc. were followed by Robert Lindner’s *The Fifty Minute Hour, *and then the writings of Oliver Sacks and Irvin Yalo…
There is a long and respected tradition of clinicians writing about the complexities and nuances of their work with clients. Freud, in his case studies, was the forerunner with his classic essays that have guided and intrigued us for years. For me, they were a welcome breath of fresh air during graduate school and held out the possibility that the field of psychology contained more depth and interest than B.F. Skinner’s experiments with pigeons. Freud’s reflections on Dora, etc. were followed by Robert Lindner’s *The Fifty Minute Hour, *and then the writings of Oliver Sacks and Irvin Yalom. This narrative tradition has continued to evolve as media has changed, and we can now learn about psychotherapy with compelling TV programs such as "Couples Therapy" with Orna Guralnik and insightful, thoughtful podcasts with Esther Perel.
These assorted studies are helpful for both clinicians and clients. Because of issues of confidentiality, the therapy work is often shrouded in secrecy. The narrative form of teaching can help clinicians gain new insights as well as help clients feel less alone as they try to understand their symptoms and the dynamics that may have created them.
In the past year, a gripping book, The Art of Binding People, has emerged on the scene from Italian psychiatrist Paolo Milone. I heard about this book not from clinical colleagues, but from Zen teachers that I study with in California. One of the reasons the book has such an unusual reach, I think, is that Milone’s memoir is full of compassion for human suffering. It reads like poetry, and it is one of the most powerful books on mental illness that I’ve read in my more than 40 years of practice. In many ways, the clinical vignettes have the surprising power of short stories by the writer O’Henry.
Milone’s stories take place in a hospital in Genoa. I expected a compelling read, but I didn’t expect to be haunted by his cases. I am roughly the same age as Milone. After finishing my doctorate in psychology at Harvard, I spent a post-doc year working in an inpatient fellowship at a Harvard teaching hospital.
A sentence from Milone’s book has taken me back to 1985: “I know…the first suicide is the worst.” As I have been reading the book, I came to realize that so much of my training was unresolved, partly because what we experienced was never processed. Within the first month, a young patient who was on 15-minute checks (which means that the staff checked in with this person every 15 minutes) managed to kill themselves. *How was this possible? *I wondered naively.
Milone wrestles with the suicides he has experienced and tries to understand as well. The wisdom he recounts is invaluable, and I wish I had found him decades ago. An older psychiatrist tells him that very few people kill themselves by choice, and then adds, “in time you’ll understand.”
He writes this memoir as he looks ahead to retirement. His thinking resonates with my sentiments as I look back on 40 years of clinical work. “In this job, we are always working on suicide.”
His focus, unlike so many other narratives, is vast. He brings in the entire staff and the impact we all have on each other. It radiates with the inner experience of the clinician. He writes about falling in love with a patient, and how distressing this was for him. So many of his topics are usually shrouded in silence.
Toward the end of my training, one of my professors was admitted to the unit. I had studied with this professor for years and was stunned. The mental illness was a well-kept secret. One afternoon, this professor went out on a pass to visit a relative. They never returned.
More than 40 years later, I still reflect on this death. I know that I’m not alone with the impact that suicide has.
I hope that our training programs can turn toward topics that we often avoid. It is one way to avoid burnout in our field.
This book is profoundly original, and I will suggest that my trainees read it. He writes about topics that we need to discuss.
*If you or someone you love is contemplating suicide, seek help immediately. For help 24/7, dial 988 for the 988 Suicide & Crisis Lifeline, or reach out to the Crisis Text Line by texting TALK to 741741. To find a therapist near you, visit *the Psychology Today Therapy Directory.
References
Milone, Paolo. (2023). *The Art of Binding People. *New York: Europa Editions