This 50-year old Austrian-born businessman called for his first appointment saying that he needed to see me with some urgency and that he had chosen me from the Medical Directory because my office was around the corner from his. I was able to see him that very day.
Stiff, formal in his presentation of self, and terribly ill at ease in the presence of a psychiatrist, he clearly had made the decision that the best way to handle something terrible like the disclosures he was about to make was to tell me everything much as one might approach a lawyer or an accountant with full disclosure of what makes no sense to an uninitiated adult.
In response to my question "What is the problem that has led you to call me?" he said "Well, it all started a few weeks ago when I returned from Vienna."
"I have lived with a woman from 3 years in a totally monogamous relationship. Six weeks ago I went to Vienna as a representative of a group of Americans interested in rebuilding their link with Austria; I was the delegate for the Eastern United States. It was an exhausting trip. We worked in conferences nearly every day all day, with typical Austrian dinners late into the night. I was totally involved in the process.
"When I returned home to Philadelphia, Sally seemed distant. She didn't greet me the way I hoped, didn't make me feel that she understood what I had just gone through. Three days later I was so disturbed at her treatment of me (and I was still exhausted from the jet lag and the stress of the trip) that I told her in no uncertain terms how disappointed I was with her. She began to cry and then told me for the first time that something had happened while I was away.
"While I was in Vienna, Sally went out to dinner at our club every night, sitting with a couple who have been our best friends. One evening, a divorced man who we both know slightly joined them at the dinner table (he's a member of the club, too) and, while the other couple was distracted with the menu, whispered in her ear."
Over the years I've been in the practice of psychotherapy, I've noticed that the print media have recognized that within a session, people use street language rather than that of polite literature; people in therapy are encouraged to speak in ways that convey best what they feel. (Intense feelings demand intense language.) At this point in our initial interview, Otto Freund felt he had to tell me exactly what this relative stranger said to his life partner. As a man who had erased all possibly of vulgarity from his presentation of self, the mere quotation of the other man's words was awful to him. Even though the exact phrase he used is heard commonly in the movies, and most likely was chosen as a direct quotation from the remark made by Alex Portnoy ("Portnoy's Complaint") to "the Monkey" on their first meeting, for the sake of Internet propriety I will remove the vulgarity intended for shock value by the attacker in question, and state that he indicated his wish to provide Sally with orogenital stimulation. In the novel, the Monkey replied with some satisfaction "Now that's the best offer I've heard in a long time." Sally, however, was deeply offended and ran from the dinner table.
Otto continues:
"I think she was afraid she had done something to make him think she was coming on to him. I mean, she's a very attractive woman and all that, but we've been perfectly loyal to each other and the very idea that she would play around while I was away was terrible to her.
"I have to be careful about my anger with women. Once, maybe 20 years ago when I was married to my ex-wife, I got mad at her and hit her, and I was shocked at how much she was hurt. So I've never gotten angry at a woman since. The guy who did that to her is scum. Since she told me about it I have checked up on him and found that he does this to lots of women. I bumped into him on the street and started to talk to him about it, but it sort of exploded into a real argument---people were starting to stare at us. For the past 3 weeks, all I can do is stew about this. I can't sleep. I wake up every half hour or so. My hands itch and I keep scratching them---look at these red marks where I've been scratching---and I can't get an erection. Nothing I can do seems to let this thing go, and I've come to you in hope that there is something you can do to let me get some peace."
The narrative I have presented so far was elicited in the space of 35 minutes. It was at this point that I made my first therapeutic intervention, which occupied us for the remaining 10 minutes of the session.