A Matter of Death and Life – Irvin Yalom

I was born in Washington, D.C., June 13, 1931, of parents who immigrated from Russia (from a small village named Celtz near the Polish border) shortly after the first world war. Home was the inner city of Washington—a small apartment atop my parents’ grocery store on First and Seaton Street. During my childhood, Washington was a segregated city, and I lived in the midst of a poor, black neighborhood. Life on the streets was often perilous. Indoor reading was my refuge and, twice a week, I made the hazardous bicycle trek to the central library at seventh and K streets to stock up on supplies.

No counseling or direction was available: my parents had virtually no secular education, never read books and were entirely consumed in the struggle for economic survival. My book choices were capricious, directed in part by the library architecture; the large, centrally placed bookcase on biography caught my attention early, and I spent an entire year going through that bookcase from A (John Adams) to Z (Zoroaster). But it was mainly in fiction where I found a refuge, an alternate, more satisfying world, a source of inspiration and wisdom. Sometime early in life I developed the notion—one which I have never relinquished—that writing a novel is the very finest thing a person can do.

To the ghetto mentality of my day, career choices for young men were limited or perceived as limited. All of my peers either went into medical school or into business with their fathers. Medical school seemed closer to Tolstoy and Dostoevsky, and I entered upon my medical training already having decided to go into psychiatry. Psychiatry proved (and proves to this day) endlessly intriguing, and I have approached all of my patients with a sense of wonderment at the story that will unfold. I believe that a different therapy must be constructed for each patient because each has a unique story. As the years pass, this attitude moves me farther and farther from the center of professional psychiatry, which is now so fiercely driven by economic forces in precisely opposite directions—namely accurate de-individualizing (symptom-based) diagnosis and uniform, protocol-driven, brief therapy for all.