Case Studies, Phone Sex and the Rabbi: Discovering the Normal in the Deviant

Article excerpt

CASE STUDIES By Michele Scheinkman

Phone Sex and the Rabbi Discovering the normal in the deviant

Rabbi Isaac Kramer walked slowly into my office, looking stiff and drained. His long, wavy hair was disheveled, and he was clad in a khaki army jacket and heavy work boots, a full keychain hanging from his belt. Tall and lanky, he was bent to the right to balance a heavy shoulder bag overflowing with books and files. He looked worn out, and his clothes gave him the appearance of a graying, 48-year-old Boy Scout.

He introduced himself: "I'm bipolar." He went on to give me a lengthy history of his "mental illness." His lethargy, I soon learned, was from the cocktail of medications he was taking, including high dosages of Lithium, Prozac, and Ambien. He described periods of severe depression since adolescence and a progressive deterioration of his condition in the last 20 years. At the time of our first meeting he was living a marginalized life, and his identity had become that of a professional mental patient.

Kramer had been in four long-term psychoanalytic treatments with different psychiatrists and an additional one-year course of cognitive-behavioral therapy. He'd been hospitalized several times, experimented with multiple combinations of medications, and was finally declared by his psychiatrists as having a "treatment-resistant depression." As a result of his mounting psychiatric failures, in his last hospitalization, he was crowned with electroconvulsive therapy (ECT). Since the in-patient series didn't eliminate his depressive episodes, he chose to continue receiving bilateral ECT maintenance treatments on a monthly basis and had been doing so for two years. The ECT left him with serious memory loss that he compensated for by writing himself reminders in a small notebook he carried in his shirt pocket.

By the time he'd come to see me, he'd been out of a job for 10 years and was living on disability and savings. He lived alone, was nearly cut off from his friends, and distant from his family. He'd never married and hadn't had a conventional love relationship in decades. He spent his time reading, attending mood-disorder support groups, and going to classes and lectures on mental health or Jewish-related issues. He occasionally worked on community projects with his colleague, Bruce.

I was daunted by Kramer's psychiatric history and puzzled about why my colleague Rebecca, who referred him to me, thought I could help him. I was concerned that he and I were an unlikely match. He's religious; I'm secular. He's American; I'm Brazilian. He was used to a remote, analytic type of therapy; I practice a conversational and interactive style. He often teased me about the spare, modern look of my office. An admitted pack rat, he lived with a year's worth of magazines and old newspapers and piles of books everywhere. He could not part with his valuables, and lived with a sense of burgeoning chaos in his home.

In spite of our differences, we established a bond. What broke the ice, I believe, was that early in the therapy, Kramer made racy jokes about sexy Brazilian women in my waiting room and I cracked up, laughing with him. But, more important, he told me months later, I was the only therapist to show curiosity about the demise of intimate relationships in his youth and the mysterious disappearance of his sexuality. He told me that my persistence in asking about his romantic life, combined with my openness to his provocative sense of humor, was what allowed him to invite me into a secret world he'd never shared with anyone.

Kramer's Life

The oldest of five children, Kramer described his father as a reticent stockbroker with a penchant for sudden rages. His immigrant Russian mother, who was loving but submissive, couldn't protect him or his siblings from his father's nasty put-downs. He learned to fend off his father's criticisms by hiding in his room with a pile of science-fiction thrillers by his bedside. …