Despite the clarity with which Otto answered each of my questions about his personal history, it became increasingly clear that he had little connection to the information he presented. The information seemed to be true, and it seemed to hang together, but there was something wrong with it. I asked him whether it was difficult to tell me so many apparently painful memories: "All of what I have told you did happen to me, but I have come a long way from who I was in those days. I suspect that what you are picking up in me is that I see or recall those incidents as if I were viewing them through the wrong end of a telescope." Nothing in his personal history triggered enough affect to warrant or sustain continued discussion, and we began to pay more attention to his increasingly troubled relationship with Sally. Whenever he tried to discuss how he felt about her, or what he felt during any of the interactions he described, Otto talked very slowly, as if he was becoming increasingly unable to put his thoughts into words. Using his imagery, I suggested he use his magic telescope to give him whatever sense of distance it provided.
The good part of the relationship was their sexual adjustment; he saw Sally as sexually free and entirely comfortable with her sexual self. Nevertheless, at no time did he show any understanding of her sexual needs within the relationship---crucial to him seemed to be her understanding of his needs and her willingness to provide him with whatever gratification might make him happy. He was sure that she was entirely satisfied with his approach to lovemaking, and in the 3 years they had been together, she had never offered any complaints.
Yet he found much wrong with her. Sally was described as "childlike," unable to handle even the most mild corrective instruction without bursting into tears. A year earlier, when he noticed that she had used some of the household food money to buy herself stockings, Otto accused her of "stealing" and she responded by attempting suicide with the Valium prescribed by her psychiatrist. Sally had been in therapy with a succession of psychologists and psychiatrists for more than 10 years, but, according to Otto, remained flighty, unpredictable, unusually sensitive to criticism, and with no warning would shift from an attitude of complete adulation to vivid denuciation of him. Otto had accompanied her to a couple of her therapy sessions, but saw no reason to include her in any of our work, despite my preference that she be brought into the therapeutic process.
At first he seemed interested in my suggestions that he might be more responsive to her affect; we discussed the fact that humans are born with these physiological precursors to emotion and the reality that each of us must learn to modulate our emotions as individuals and within a relationship. Quickly I learned that he was not interested in doing anything that required him to change within the relationship, and that she had now become not only uninteresting but repugnant to him. "I recognize that I should understand these things about Sally, and about myself, but I am afraid that whatever I learn will have to be of use in my next relationship." Sally screamed and cried when he suggested the relationship was over, and Otto became increasingly stone-like and unwilling to be involved with her emotions. He searched for and found an apartment for her, packed her belongings in cartons that he began to move to the new apartment, and took her out to dinner to celebrate this "new phase of the relationship."
Throughout this period of our work in therapy it was clear that Otto was living at the edge of his ability to handle his own emotions. It was my job to hold him together while he made these "necessary" changes in his external life. He could tolerate none of my attempts to link his current discomfort with his childhood in Austria, and brushed aside any of my comments about his way of maintaining distance within supposedly intimate relationships. Nevertheless, interspersed among his evasions and self-protective digressions, he asked me a great number of questions about the attitudes and behavior of "normal people." Both he and I knew that Otto intended to adjust his behavior to make it seem more normal, and that he was going to use his next "serious" relationship to try out these new ideas.
Sally did leave, did move into the new apartment, and did accept the end of their relationship. Otto mused about her seeming inability to profit from therapy: "She has gone to therapists for so long with no change. Some people simply do not know how to take advantage of their situation." A successful single man in the center of a major city, Otto was more than a little pleased and surprised at the number of women who wanted to fix him up with their friends. Yet he refused all of these invitations for several months. I commented that even in his sessions, he seemed to stand apart from life, commenting on it rather than experiencing it directly. He grew silent for a moment, and then told me about a 3-month relationship that he terminated because the woman wanted to have a baby. A few sessions later it became clear that Otto had once again become comfortable with himself, and was considering the purchase of a sports car---"I wonder what the girls will think of me in a red convertible?" We agreed that it was time to stop our regular sessions but to meet again whenever a relationship threatened his equilibrium. A year later he returned for a couple of sessions to discuss a new woman with whom he had been involved for a few weeks. He was puzzled by her disclosure that her childhood had been characterized by severe physical and sexual abuse, and wondered whether he had some sort of invisible flag over his head that told damaged people he was available.
Three years later I bumped into Otto during my lunch break---his office is, after all, quite near mine---and he asked if he could join me for a few minutes. Over soup and salad, Otto told me with great relief that the suit had been withdrawn. It took me a moment to remember that he had come to me right after the altercation in the street with the man who had harrassed Sally at their club. From the fragments of the story that fell from his mouth, I realized that Otto's initial presentation of self had been a matter of two separate factors. Yes, he had been destabilized by the trip to Austria and the disturbing interaction with a Sally equally destabilized by the event at the club. But, in addition, he was aware that his own behavior in the street made him actionable---in his rage, he had actually kicked the other man in the groin and suit had been filed. Nothing I learned about him in the months after his brief hospitalization explained why he might have become so terrified. And in this brief lunch, it became quite clear that he had exaggerated his symptoms to the point where I would be forced to hospitalize him, and that he had intended to use the record of this hospitalization as part of his legal defense. Unaware that his acute illness was mostly factitious, the hospital staff was left with no alternative but the diagnosis of a "Brief Reactive Psychosis."
"I got a lot more than I bargained for," said Otto on our last meeting. "You have taught me a great deal. Actually, I have taken to heart a lot of what you told me about people. You are right that I live at some remove from people, but it is the only way I can be comfortable. All the questions you asked me in the beginning of the therapy were fascinating, things I never would have put together in any order or any sort of organization. I like the way I have turned out, despite the way I was launched on my journey. I don't think I will make the mistake of living with a woman again, even though I go out with women and have some enjoyable times. There is a limit to which one can push oneself, isn't there? Would it be all right if I paid for lunch?"
I have not heard from him since.