I had a delightful moment today, practicing tele-psychiatry with a sweet ADD-ish patient who recently moved cross country and wants me to continue prescribing for her. It’s a jerry-rigged set-up, so we’ll see. Meanwhile, after we struggled to get her on Zoom and ended up using the phone, I ascertained that she was doing quite well. Her anxiety had abated. I checked my notes and saw that we’d scrubbed the sleep med that wasn’t working. She’d been having a terrible time, a vicious spiral of anxiety, insomnia and musculoskeletal pain. Sounded like fibromyalgia. So I suggested we switch to a homeopathic dose of the first antidepressant ever invented, amitriptyline. Presto change-o, anxiety, insomnia AND pain vanished! She pauses and realizes that she had totally forgotten about the pain. Being that she is a Jew and so am I, I could not resist the marvelous Purim lesson at hand. I told her she had proven herself a good Jew by forgetting Amalek, the hereditary enemy, the pain that bit at her heels when she was most vulnerable. She laughed. It doesn’t get any better. Not only is the pain gone, but also forgotten. How often does that happen?
More often it’s just the opposite. Remember the joke about the thirsty old lady on the New York bus? The short version: The long-suffering bus driver is driven mad by a steady chorus from the old lady at the back of the bus complaining bitterly, “Boy am I toisty!” He screeches the bus to the curb, dashes into a convenience store, runs back with a bottle of water and shoves it at the lady and goes back to driving. She guzzles it down. Mere seconds later, the brief silence is broken by the lady as she cranks up a new chorus, “Boy was I toisty!” Or a bit more poetically, take the song lyrics of Paul Simon–
In the clearing stands a boxer,
and a fighter by his trade
And he carries the reminders
Of every glove that laid him down
or cut him ‘til he cried out
in his anger and his shame
“I am leaving, I am leaving”,
but the fighter still remains.
You get the picture. The delicious need to keep kvetching, or the desperate need to keep fighting the same fight, ad nauseum.
At the end of the day I had a session with another Jewish patient in which I unfortunately failed to avail myself of the didactic opportunities afforded by Amalek. This young researcher found himself time and again in the same hellish scenario in a series of academic settings–an ogre-boss who hinders his career in spite of his impressive research work. And more often than not a woman. So it’s happened again and the guy feels “like my insides are shredded.” Inflammatory bowel disease makes it all the more real. You see, his mother, though she had good qualities, was intolerant of disagreement and would eviscerate him, albeit verbally, if he disagreed with her. Even though as an adult his relationship with his mother has matured, he still enshrines within his head the ‘ogre-Mom’ from those encounters. And this memory is called up in every confrontation with an ‘ogre’ boss. It saps his strength, weakens his sinews and “shreds his insides.” Although he could leave his job and make use of other skills, if push comes to shove, he feels trapped. To a large extent because ‘ogre-Mom’ lives ‘rent-free’ in his head, as they say in the 12-Step programs. The price of long-lived resentment.
All this is not to say we should deny trauma or ignore the past. Jean Paul Sartre tells us that we may err in either of two directions, two types of “bad faith.” In the one, we are so imprisoned by the facts of our existence, what he calls “facticity” by way of Heidegger, that we abjure even the possibility of choice. Psychological determinism. The other error is to claim that we are completely unaffected by our circumstances and free to make any and all choices at a given moment. In short, manifest self-deception. On the one side you have the eternal “traumalogue”, Richard Nixon’s saga of serial misfortunes or even Hitler’s Mein Kempf, my struggle. The enshrinement of the adversary in a place of prominence serves many purposes. But it does not serve healing. On the other side you have the New Age vogue of ‘affirmations’ rooted in the self-transcendent theology of Norman Vincent Peale. One needs merely stare lovingly at oneself in the mirror and announce, “I want to be prosperous!” Or whatever the desired outcome may be. Plaster of Paris on a rotting wall. The Orange Menace in the White House. The societal woulda-coulda-shoulda’s magic lantern. But there I go, forgetting to remember to forget.
Zen and the Art of Jewish Memory. We are big story tellers. So big that our particular book of stories has launched several major world religions, including our own. And these stories are both staggeringly life-like in the depictions of human frailty, and artfully transcendent in their mythic heights. And usually in the same story. Maimonides warns us of Sartre’s two types of error, anticipating the French philosopher by almost a millennium, in the field of Biblical exegesis: slavish literalism versus pure symbolism. The art is to walk the knife edge that is between the two. And Purim is the perfect opportunity. A holiday I admit I used to hate, used to read as the Jewish ethnic cleansing holiday. It still makes me wince a little. But wait! Isn’t it just a children’s holiday for eating sweets, playing carnival games, dressing in weird outfits and yelling at somebody while they’re trying to tell the story? And yet, and yet. The Shabbat immediately preceding Purim is dubbed Shabbat Zachor, The Sabbath of Remembrance. Remember what? Remember to forget! Forget what? Amalek! It’s right there in the biblical text of the day, Deuteronomy 25:17-19,
You shall remember what Amalek did to you on the way, when you went out of Egypt, how he happened upon you on the way and cut off all the stragglers at your rear, when you were faint and weary, and he did not fear God. Therefore, it will be, when the Lord your God grants you respite from all your enemies around you in the land which the Lord, your God, gives to you as an inheritance to possess, that you shall obliterate the remembrance of Amalek from beneath the heavens. You shall not forget!
Two seemingly contradictory instructions, diametrically opposed, remember and obliterate remembrance. And just to double down–after all, the meaning of purim is the casting of lots–a second injunction not to forget! Now, there is no historic evidence of a people called Amalek, so either we were very successful at this obliteration biz or there’s something else going on. Here’s my take. Amalek is the symbolic stand-in for every glove that’s laid us down. The evil-minded SOB’s that hit us in our weak spots. AND we’re supposed to obliterate the memory. How the heck are you supposed to do that? Well, my first patient taught it to me in the purest form: after the pain ends, fuggedaboutit. But that’s not always possible, or even desirable. As problem-solvers, we are committed to the idea that it is possible to prevent certain classes of bad outcomes by understanding the dimensions of the problem. But sometimes the problem is actually the reaction to a challenge, like ‘cytokine storm’ in COVID-19. That’s what actually landed a lot of folks in the ICU, the host immune response. We’re still working on that one, but steroids do produce a kind of immunologic amnesia.
The main thing is, when you recover, don’t keep fighting the same damn enemy. And for sure don’t enshrine your assailant in a place of prominence in your memory if you can help it. Move on. You can tell the story of what happened from the point of view of having survived and entered your Promised Land, whatever that might be. And each particular avatar of Amalek is NOT the point of the story. Each particular boss of my second patient is NOT salient to solving the problem. Yes, those things did happen, and that sort of crap happens in academia all the time. But the toxicity is in the reaction. The yawning bear-trap in the memory banks that re-presents the foe at its most formidable, a form it took when you were truly helpless and vulnerable. Another instruction for Purim may be the most metaphysical–get drunk! So drunk that you can’t tell our mortal enemy Haman from the beloved hero of the Purim saga, Mordechai. A state of consciousness in which we begin to see our enemy and our savior as one and the same. Pretty weird?
So this takes us to one more injunction for Purim: help the needy and send out tasty treats to friends, mishloach manot. Compassion pure and simple, local and more general. The Book of Esther, I have been persuaded by my resident scholar, is a palace farce written by someone who certainly knew the ins and outs of Persian palace doings in the Fourth Century BCE. And he damn well knew no Persian King could have had a Jewish wife. Not possible. So it’s a farcical revenge fantasy, think of every Jackie Chan movie ever made. Take your time. It’s a popular feel-good genre with a bit of an edge. But the ones that really feel good, at least to me, are the ones that end with nothing really bad happening to anyone. We might even feel sorry for the comic villain. Empathy anyone? And of course good guys morphing into bad guys or vice-versa is Hollywood stock in trade. Purim may even have a hint of the same message as the Bhagavad Gita, The Song of God, a jewel in the center of the Hindu epic Mahabharata.
We see the hero, Arjuna, about to lead a massive army into battle against his evil cousins, the Kauravas. Every chapter of the epic has made it clear, the Kauravas are definitely up there with Haman as no-goodniks. But on the eve of the battle, Arjuna paces the no-man’s land between armies and loses heart. He realizes that he has dear uncles and teachers on both sides, many of whom will undoubtedly die in the battle royale. How can he do this thing? His chariot driver just happens to be the god Krishna in disguise. The Gita is Krishna’s long lesson to Arjuna, that he can’t really know the supernal machinations at work here and what he sees is an illusion. He must accept this transcendent interpretation of reality and at the same time discharge his responsibilities in the theater of facts on the ground. So too must we, though hopefully with less carnage. The Purim story and the context of its observance teach us a similarly complex lesson. We can’t really know the ultimate workings of history’s machinery, nonetheless there are certain problems that are ours to address, and a little compassion goes a long way. Perhaps Arjuna and Krishna should have just gotten shiker together, good old Yiddish drunk. Just don’t forget to remember. To forget.
The quantum configurations of the heart. A game of chance. The casting of lots. Purim. I wonder what odds the Persian handicappers were giving Queen Esther when she entered King Ahasueras’ chamber. Death or mercy. The Fourth Century Persian application of Schrödinger’s cat. All configurations are possible, but when you take the measure of the situation all the possibilities collapse into one. That’s what may happen when we examine our hearts about a really complex problem, one that’s been dogging us for more time than we’d care to admit, one that’s sunk into our bones. In Chinese Medicine the best possible class of procedure for a lasting cure is vaporization of phlegm. Problem solved. Permanently. It happens, albeit rarely. Can’t count on it, but can’t say it’s impossible. A wise and kindly Taoist priest once said, “Tell your patient to be gullible.” We all laughed. But isn’t that what we’re doing on Purim? Willing suspension of disbelief. One such procedure is the Meditation of the Yellow Court, an energetic center at the solar plexus where all the acupuncture meridians send ‘messengers’ to plead their cases before the ‘Emperor’, the heart. The mystery of self-compassion.
The final unbeatable Purim story I have to mention is a classic from the Talmud, the story of Rabba and Reb Zeir, AKA Biggie and Rabbi Small. Rabba invites Reb Zeir to come back to his place to get shiker together, i.e. drunk, for Purim. Reb Zeir accepts. They go on a real bender all night long, undoubtedly between textual analyses. At some point Rabba grabs a butcher knife and shechts, i.e. slaughters, his little friend and falls asleep in a drunken stupor. He wakes up and is horrified at what he sees. Quickly he performs a bit of kabbalistic magic, accompanied by fervent prayer. His little buddy reassembles and toodles off, no harm done. The next year at Purim Rabba sees Reb Zeir and proffers the same invitation. This time however, his friend demurs, “Thanks, but no thanks. You can’t always count on miracles.” A real knee slapper. At least for me. Transcendence versus facticity, big mind and little mind, both must be satisfied, both remain in eternal superposition, their ethereal configurations floating in the Yellow Court awaiting the discernment of the King. The principle of uncertainty, the forgetting that vaporizes Amalek. Believe in the possibility, AND don’t count on it.
One last patient vignette. I promise. I see her in a new light. She crossed my threshold when I was a newly minted psychiatrist still immersed in the arduous business of hospital work. A terrible story, sexual abuse at the hands of three family members. As the baby sister she bore the brunt. My first experience of what was then called Multiple Personality Disorder. It was all real, too real. Her memories and her symptoms. The most damaging part of her psyche was a sort of avatar of her abusive sister, a snarling internal menace that held the impulses for self-harm that she occasionally acted on. After a hospitalization for a suicide attempt, she revealed to me that she had made plans with an older patient to spend the summer at the other woman’s farm out in the country. The other woman had a bad rep on the unit, a repeat customer. My patient practically dared me to tell her not to go. I didn’t, but I told her we both knew it was likely that she and the woman would have a sexual affair. She smirked and said that wasn’t her intention. That is exactly what happened. It was a whirlwind romantic summer in the countryside. Her kids even visited and had fun there. She continued to drive three hours each way to see me for therapy every week. At the end of the summer the predictable occurred–she got dumped. However, instead of the dramatic meltdown that I might have expected she was merely sad. The sister avatar, no longer the snarling inner beast, expressed a gentle wistfulness about the relationship that had ended. I was stunned.
My patient went back to her family and her job. Within less than a year we tapered her off medications and brought the therapy to an end. Ten years later I had the unusual opportunity for long term follow-up. Her employer called to ask for security clearance. They grudgingly acceded to my requirement that I actually see the patient. Very sweet reunion. She had ended her dysfunctional marriage, was in a loving relationship with another man, had sent her two kids to college, moved into management at work, and reported a whole host of other impressive accomplishments in her personal life. It had not been all smooth sailing, especially when one of the abusers died, but she had managed through it all and actually thrived. I could not resist giving her my theory about the transformative effects of that summer romance. She listened patiently and then said, “No, I don’t think that’s it. I had a supportive church community, a good relationship with my kids and a very tough psychiatrist.” I could only smile and concede that there was a limit to the power of any explanation. I wished her well, said goodbye and did the security clearance in good conscience.
I’ve always kind of thought my theory was still right, but for whatever reason she reframed it the way she did. It’s only now that I think I understand, or at least have a new theory. She blotted out Amalek. Completely obliterated the remembrance of the monster that haunted her days and nights. Vaporized. In her discerning glance she had collapsed the wave function down to one and only one quantum configuration. And she saw that it was good. Healing through creative destruction. So maybe this is the healing God promises the Israelites a little earlier in the same Torah portion that introduces the battle with Amalek for the first time. Right after God tells Moses the ‘cure’ for bitter waters. The people are “put to the test”:
He said, “If you will heed the LORD your God diligently, doing what is upright in His sight, giving ear to His commandments and keeping all His laws, then I will not bring upon you any of the diseases that I brought upon the Egyptians, for I the LORD am your healer.”[Exodus 15:26]
A salient epithet for the Creator, unique in all of Torah. An alternate translation offered by Rashi, I am the Lord, your Physician. Yes, heed the moral code. But what does this medicine look like? What did Moses call the ‘tablet’ that God ‘pre-scribed’ for forgetting Amalek? “The Lord is my miracle.”[Exodus 17:15] As a seasoned psychotherapist I find myself more inclined these days toward therapeutic agnosticism. Or better, the apophatic position of the Rambam, and of the medieval Christian mystic and author of The Cloud of Unknowing, and in the injunction of the World War Two British psychoanalyst, Wilfred Bion, to enter every meeting “with neither memory nor desire.” Or, failing that, get a little shiker. Chag Purim sameach!