1118 Am J Psychiatry 163:6, June 2006

BOOK FORUM

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The Schopenhauer Cure: A Novel, by Irvin Yalom, M.D.New York, HarperCollins, 2005, 368 pp., $24.95.

Some 30 years ago, when I was beginning my psychiatricresidency, Irvin Yalom, M.D., came to speak at a departmentalgrand rounds. I still remember a pithy comment from his pre-sentation: Psychotherapists tend to neglect the topic ofdeath. This comment had the ring of truththe subject ofdeath is far more difficult to discuss in therapy than sex, ha-tred, or money. Dr. Yalom has since spent much of his profes-sional life redressing this neglect. In his group psychotherapyefforts with cancer patients, he found it impossible to avoidthe specter of the Grim Reaper. In his classic text, ExistentialPsychotherapy (1), he underscored the life-affirming value oflooking death squarely in the eye. As Dr. Yalom gravitated to-ward fiction later in his career, themes of mortality and finite-ness appeared in novels such as When Nietzsche Wept (2). Inhis most recent work of fiction, The Schopenhauer Cure, theproblem of living with the certainty of death is once again atcenter stage.

As the novel begins, psychiatrist and group therapist JuliusHertzfeld, a typical Yalom protagonist, is struggling with ac-cepting the death sentence that accompanies his diagnosis ofmetastatic melanoma. With a year to live, he must decide howto spend his time in a way that makes him feel that he has notwasted his last moments on earth. He chooses to contactPhilip Slate, a man he treated for sex addiction 23 years ago,with the ostensible aim of seeing how he is doing. His formerpatient explains to him that he was not helped by 3 years ofindividual psychotherapy with Dr. Hertzfeld, but he an-nounces that he cured himself by studying the writings ofArthur Schopenhauer. He is now, in fact, a philosophicalcounselor who needs supervision, so Julius offers him super-visory experience if he will agree to be a patient in group ther-apy with him.

The conceit of the novel is that Julius learns aboutSchopenhauer at the same time that Philip masters the con-cept of human relatedness. In this arrangement, the authorexplores another of his favorite themes: mutuality and reci-

procity in the psychotherapeutic relationship. How much ofones self should one use as a psychotherapist? When doesself-disclosure advance the process? When does disclosingtoo much personal detail burden the patient by disturbing theasymmetry of the psychotherapeutic contract?

Dr. Yalom ingeniously juxtaposes a chapter on Schopen-hauers life between each chapter that advances the plot. Thereader is thus allowed to gain some familiarity with an ab-struse European philosopher in a relatively painless manner.We learn that Schopenhauer was a miserable, erratic, con-temptuous, woman-hating, darkly pessimistic misanthropewho makes Samuel Beckett look like a Pollyanna. His solutionto the fundamental existential dilemmas of the human condi-tion was to eschew all attachments and to retreat into a schiz-oid withdrawal from life. Like Lacanian psychoanalysts today,Schopenhauer targeted the problems inherent in desire. Henoted that when one obtains what the heart desires, the ful-fillment does not bring the expected rewards along with it.

The group therapy sessions thus become a convenient nar-rative device in which the characters explore the dread ofdeath, the pros and cons of Zen-like detachment from desire,the inevitable ambivalences associated with human relation-ships, and the ultimate futility inherent in a search for a satis-fying solution. The intellectual discourse that emerges fromthese dialogues is stimulating and provocative and, alone,makes the book a worthwhile read. Dr. Yalom is less success-ful in constructing a narrative structure that can bear theweight of the ideas that he presents. At times, the develop-ments within the plot seem more driven by the needs of histhemes than by the psychological dimensions of the charac-ters. Nevertheless, psychiatrists and psychotherapists willfind much to ponder in this new Yalom contribution, and Iheartily recommend it.

References

1. Yalom I: Existential Psychotherapy. New York, Basic Books,1980

2. Yalom I: When Nietzsche Wept. New York, Basic Books, 1992

GLEN O. GABBARD, M.D.Houston, Texas

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