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experienced you as a consistent part of her life, she would have had to grieve all that she didn’t have as a child,” one of my professors commented in my final weeks of school when I presented the case—which had by that time spanned three years.
    I saw many clinic patients during my four years in graduate school. They arrived with their problems and their stories, and because I was being educated in the psychoanalytic tradition, I learned to begin by asking myself two questions. First, what was their developmental level? At what point in their emotional development had things begun to go awry—the earlier it had been, the worse off they were. Second, what was their character organization? In what ways did they tend to distort reality in an attempt to feel less pain? Together these answers provided an important if gross starting point for every treatment. A patient’s developmental level was psychotic, borderline, or neurotic; his character organization within that level masochistic or obsessive or narcissistic or depressive—the list goes on some—depending on the constellation of defenses he tended to favor. (Myself, I was neurotic, and my own character style a tinge masochistic with stronger undercurrents of depressive: having felt from quite a young age that painful experiences with my parents were my fault, I believed I was so bad. I was not unlike other psychotherapists in that regard. What better way to alleviate a constant and nebulous sense of guilt than to devote one’s life to helping others?)
    These two dimensions shed light on the patient’s internal experience, on how he organized and perceived his life. What had become more popular in the world at large, under the rubric of cognitive-behavioral therapy, or CBT, was an emphasis on discrete symptoms, say social phobia or panic attacks, that could supposedly be alleviated in short, rote burstsof ten sessions or fewer. At my school patients came to us for long-term work and character change, to alleviate troubling thoughts and behaviors and then some, as true well-being is more than just the absence of symptoms.
    In class, semester after semester, we worked our way through a hundred years of psychoanalytic theory in the order it was written. Outside class I sat with patients and supervisors and tried to figure out how to apply my book learning to my clinical work—the most difficult part of becoming a therapist. As I relaxed through those years into the reassurance of my teachers’ formulations about the people who arrived to see me weekly, I came to grasp why I had finally chosen to study psychology. Having early on found myself in a world where the attitudes of others confused and pained me, I needed badly to make sense of people, to order them, like my patient with her dolls.
    But it was not an auspicious moment for nuanced thought, and while I did not fully realize it yet in those first years of graduate school, neither was it a good time for psychology as a field. As if the pernicious hostility toward the psychoanalytic way of working were not enough to threaten the best chance people had for richer lives, the confluence of cultural forces, the advent of pharmaceutical commercials, and a general human aversion to deep consideration of complication had over the course of many decades swayed the conventional wisdom: psychological problems were nothing more than chemical occurrences in the brain, something one caught, like a cold, or was born with, like color blindness. If Descartes’s four-hundred-year-old error had been the separation of mind and body, of rationality and emotion, the modern equivalent, at least in the popular consciousness, seemed to be a separation between brain and mind, in some cases leading to the disappearanceof the mind altogether. The medical establishment did not dismiss talk therapy completely, but it seemed to have come to believe that its primary utility was not to make meaning but rather to convince people to take their