About the Book
I first saw Ryan sitting on a couch, hunched over, asleep, resembling the sagging duffle bag against which he leaned. Ryan, a freshman at Harvard, had been sent over from the university's health service for a psychiatric admission to McLean Hospital, the flagship psychiatric hospital for the Harvard Medical School. As resident on call, I was roused out of bed that cold night twenty-four years ago to attend to him. The two of us, both emerging from deep slumber, entered a consultation room at 4 A.M., to begin a journey into his mind. Ryan related that initially he was proud of his smooth adjustment to college life. But a few weeks into the semester, he started to fall behind in his work. He found he couldn't grasp concepts; he was getting distracted and having trouble sleeping. He fell even further behind and started to procrastinate. He was beginning to feel humiliated that this -- whatever "this" was -- was happening to him. He saw himself flunking out. Where would he go? What would become of him? What good would his hard-earned admission to Harvard be if he left in disgrace? Could he flip hamburgers? No, he would be incompetent at that too, he thought. His only talent was for being a genius, and that was failing him somehow. He felt a sense of doom, and I saw in him a look of despondency.
How was I to understand this young man, who a month earlier was on top of the world, a freshman at Harvard, dating a woman from Radcliffe, liked by his peers, on his way to becoming a scholar, but stopping first at McLean Hospital at four in the morning because he had been thinking seriously of killing himself? And how was I to help him?
He seemed to blame his distress mostly on hispressures at school, battered by his expectation of being exposed as a failure. The idea of the ensuing humiliation terrified and depressed him, making him unable to function adequately. But I observed that his very real expectation of failure and humiliation seemed to be based on something more than the facts and events of his current situation. Surely he had an innate capacity to succeed. It was the "idea" of failure that reduced and then impaired his abilities. Why did he have this idea? "Maybe I'm good at fooling people, " he offered, implying some core deficiency that the Harvard admissions committee failed to observe.
Ryan came under my care in 1976, during my second year of training at McLean. Freud was the mainstay of my training, and I found his writings beautiful and rich, but somehow imprecise, with a good deal of poetic license. Freud placed a great emphasis on long-repressed sexual impulses or conflicts, but as I spoke with Ryan, those issues didn't seem apparent, and as we sat together that November morning, the details of Freud's model of the mind only seemed to add to the chill in the drafty corner room, offering neither light nor warmth. I wanted something more tangible, more explicit, closely related to my actual situation -- something more like physics than poetry.
It would be a few years before the psychopharmacologists dominated the hospital, and many more years before the managed care insurance companies dominated them, so I was able to meet with Ryan four times a week until he was able to leave the hospital eight weeks later. For most of the sessions, we met in a consultation room on his hall, or later, when he had privileges to leave his hall, in myoffice. On pleasant days we would spend the hour walking together on the treelined paths and roads of McLean Hospital. McLean had been constructed on a verdant site overlooking hills and fields a hundred years earlier, to take advantage of its curative views at a time when neither pills nor theories could rescue the afflicted.
I learned that Ryan experienced his father, a mathematics professor at a small New England college, as aloof and harshly critical. Despite Ryan's lifelong efforts, he could never feel any affection or admiration from his father, a master at finding ways to ridicule or demean even the finest accomplishment. Although Ryan had succeeded in winning acceptance to Harvard College, he had failed to get an early admission, and he had also failed to gain entrance to Brown University, facts that his father's attention and energy lingered on. "I knew Brown had come to outrank it; Harvard's no longer what it used to be, " his father commented to Ryan.
Ryan experienced his mother as remote as his father, but in an entirely different way. She came across as somewhat detached, not at all like his father's aggressive, competitive self-centeredness, but rather through a meekness, an anxiety about all of the world and her place in it. Although she doted on Ryan, she seemed disconnected, as if she always held a bit of herself in reserve.
As we walked one afternoon, Ryan said reflectively, "I guess all of my life I felt I couldn't please t
