The First 3 Letters

LETTER ONE

AN INVITATION

Dear Amanda,

First of all, let’s get something straight—you don’t need to say a word to me when you are in my office.  Talking is not the only way for two people to communicate with each other, to make contact with each other, to get to know each other.  In fact, talk can sometimes interfere with understanding—that’s one of the reasons that I’m writing to you, because I’ve found, over the years, that the written word often carries greater meaning and authenticity than the spoken word.  Also, in looking over the clinical charts that the hospital sent over to me prior to our first session, I couldn’t help noticing the consistent A’s and B’s in English that you have earned throughout your middle school and high school career, which no doubt means that you, too, already have a pretty good comfort level with reading and writing. 

So here’s the deal—you can be as silent as you want to be during our sessions, but I’d like to see if we can establish a conversation through writing to each other if we’re not going to be talking to each other.  I will write to you after each appointment with some of my thoughts and observations, and I’d like you to write back with yours—it’s that simple.

My proposal may leave you wondering why we have to have any sessions at all if most of our dialogue is going to take place outside of those sessions.  The answer is that I still want to get a look at you, even if you have nothing to say—people are always communicating, even if they’re not saying anything—and also because I want to leave open the possibility for us to talk to each other, should you ever find that there is a reason for us to do so.  Also, I’m still going to want to schedule meetings with you and your parents together, so that I can hear what’s on their minds, and so that we can discuss any matters that might affect the family as a whole.

Don’t misunderstand me—I am not asking you to be happy about this arrangement.  In fact, I’m quite convinced that coming to appointments, and reading to and responding to a therapist’s letters, are not high on any sixteen year old’s list of fun activities.  But I’m equally convinced that you are aware of the fact that your frequent suicide attempts have worried many people—your family, your friends, your teachers—so you’re kind of stuck with me for now, at least until you can prove to everyone that you no longer need to be worried about.  Being that you’re stuck with me, we might as well see if we can make the best of the situation, and learn what we can from each other.

Once you’ve given this letter some consideration, let me know what you think, and then we’ll take it from there. 

Best regards,

Dr. Sachs

LETTER TWO

WHY BOTHER?

Dear Amanda,

I appreciated your response to my letter, which I received yesterday.  I was glad that you took the risk of being straight with me about your unwillingness to be “shrunk”, about your unhappy history with previous therapists who not only have not helped but who have, at times, been downright insensitive, and about your lack of enthusiasm for any further psychological treatment.  Frankly, I’d be a little skeptical if you had sounded chipper and optimistic at this point—after all, in looking over your chart, I counted up five different therapists whom you have already had to meet with over the years—so it’s no wonder that you’re not exactly turning cartwheels at the prospect of signing up with Number Six.

You wrote that you can already tell that I’m “just like all the others”, and that may, in fact, be true.  I certainly don’t know that I am going to be all that different from any of your other therapists.  On the other hand, the fact that you were so clear about what made these clinicians ineffective—their desire to “change” you, their wish to “help” you, their belief that they “understood” you, their insistence that they “know what you’re going through”—does at least give me the chance to avoid repeating some of their mistakes, and perhaps try something new (or at least make some new mistakes).

If you want to know the truth, I’m not interested in changing you, I’m not sure you need or want my help, I don’t understand you, and I really have no idea what you’re going through.  I do have to confess to being interested in you, and curious about what has prompted you to consider ending your life when it’s clear, based on my conversations with your family and other people who have gotten to know you, that you have a wide range of abilities and talents.  But I don’t think it’s really my job to determine for you how you should live your life as a young adult, and to tell you what I think is best for you.  Those conclusions and decisions are ones that you need to arrive at, and that are always the result of a process of self-discovery, rather than of being told what to do. 

On the other hand, however, I would be lying if I didn’t admit that I’d like you to stay alive long enough to make it through adolescence and see how things turn out—there are always some surprises along the way, and I wouldn’t want you to miss out on any of them.

In any case, I was pleased that you made the time to write back, and to express yourself so honestly, and look forward to our unfolding conversation.

Best regards,

Dr. Sachs

LETTER THREE

WHY SHOULD I GO ON?

Dear Amanda,

My letter to you today will mostly consist of my clumsy attempt to answer the question that you began and ended your most recent letter to me with:  “Why should I go on?”  It’s a simple question, a profound question, in some ways the most elemental of all questions, the question that you have every right to ask, based on how much pain you have already had to encounter in your young life—and because of this, it’s a question that deserves to be addressed.

The first answer that comes to mind, I must somewhat sheepishly admit, is “I don’t know.”  That’s not to suggest that you shouldn’t go on, of course, that you should just toss in the towel and embark on one final suicidal mission.  It’s more of an acknowledgment of what you’ve already come to know, and what anybody with an open mind and a big heart comes to know—that life is hard, that life is a struggle, and, that, as many have joked, no one gets out of it alive.

But when life is filled with despair, with anguish, with hopelessness, as yours currently is, it’s fair to wonder what the point of continuing really is.  To slog your way through this misery only to encounter more misery must seem futile, indeed.  I’m sure that plenty of people have tried to answer this question by enthusiastically telling you that “there’s so much to live for”, and you’ve probably concluded that they would have to be out of their minds to say this, completely incapable of understanding the depth of your suffering.  Nonetheless, with all due respect for the state of mind that prompts you to pose this “life-and-death” query, here is my response:

The best reason to go on is because you cannot assume that your life is always going to feel the way it feels now.  Adolescence, as you probably already understand, is an extremely complicated phase of life—the changes in one’s mind, body, and soul are oceanic ones, and it’s impossible to make it through without long, frequent and difficult periods of confusion, upset, anxiety and sorrow.  On the other hand, adolescence is still a phase, and phases come and go.  While you may feel absolutely whipsawed by your life right now, you cannot assume that the current state of affairs will remain constant—the nature of life is that it will always ebb and flow. 

The main reason that you’re struggling so much right now is because adolescence, surprising as this may sound, is a time of loss.    This is something that many adults and teenagers don’t understand.  After all, adults are constantly telling teenagers that “This should be the best time of your life” or “Youth is wasted on the young” or “I wish I could go back in time and live those years over again.”  And of course teenagers, like yourself, are either left feeling badly about the fact that they’re not enjoying their lives as much as they’re “supposed to”, or find themselves wondering why any adult in their right mind would possibly want to return to such a tortured time of life.

When I talk about adolescence as a time of loss, the question you’re probably asking is, “What am I losing?”.  I suppose the best answer to that question is, “Your childhood.”  Because we can never become a successful adult until we say goodbye to being a child, and that’s exactly what is happening during adolescence—we’re trying to find a resting place, a burial ground, for the child that we used to be, and trying to mourn her passing so that we can move on.

This is a task that is quite challenging, because there’s always sorrow when there’s a death, and we lose a lot when we lose our childhood, even though we get a lot more in return.  Perhaps the main thing we are losing is our precious treasure-chest of childhood fantasies—fantasies that may have us convinced that we are the center of the universe, that we will always be taken care of, that everything will be better when we’re older, that we can do anything we want, that we are invulnerable, that everything that is dear to us is within reach, that we will live forever.  In releasing these fantasies we lay the groundwork for a real life—as a poet once said, “The best way to make dreams come true is to wake up”—but it can still be a lot easier to live in a fantasy world than in the real world. 

I think one of the reasons that adolescents find themselves thinking a lot about death—even stalking death, as you appear to have been doing—is because, at some level they’re aware of, and trying to confront, the death of their childhood.  The suicidal thoughts and attempts are not just efforts to relieve pain—to put yourself out of your misery—but also a way to acknowledge that some part of us needs to die if some new part of us—our adult identity—is to be born.  Of course, the irony of using suicide to deal with this issue is that it makes that very birth impossible—it’s the  “Final Solution”, as they say, the solution that you can never return from.  But it’s important to consider the possibility that the desire to end your life is not something to be feared or vanquished, but something to be welcomed and understood—just not something to be acted upon.

So rather than seeing your suicide attempts as some sort of symptom—a sign that you are emotionally disturbed or mentally ill or psychologically unbalanced—I would  rather we think about them as part of your energetic effort to make the passage from childhood to adulthood.  And maybe in subsequent meetings and letters we can discuss some other ways to make this passage that do not jeopardize the very life that is beginning to blossom.

With respect for your courage,

Dr. Sachs