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Book Review   |    
Momma and the Meaning of Life
Nancy Glimm, C.S.W.
Psychiatric Services 2000; doi: 10.1176/appi.ps.51.11.1460
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by Irvin D. Yalom, M.D.; New York City, Basic Books, 1999, 247 pages, $24

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Psychotherapist Irvin Yalom's new book, Momma and the Meaning of Life, is a collection of six short stories that range from the personal factual account of his relationship with his own mother to narrative, clinically focused stories. The final two accounts are fictional. Dr. Yalom's skills as a storyteller and teacher are abundant. He is self-revealing throughout his tales. This act of personal generosity allows the reader to see into Dr. Yalom's life work and his roles as a son, husband, teacher, psychotherapist, and writer. Often what is revealed is exceedingly human.

Dr. Yalom's vulnerability is evident in his relationship with his mother. This relationship is described in the first story, from which the book's title is taken. His desire to communicate with his mother and to have her appreciate their separateness is continuously assaulted by her desire to create closeness through a claustrophobic overidentification. She was an uneducated woman who devoted her life to the care of others. In return, she apparently demanded attention and loyalty on her terms. Dr. Yalom reflects ten years after her death that he may still be motivated by a desire to please her. "Momma, how'd I do?" is a refrain from childhood that may still be actively influencing his behavior. He is aghast at the possibility that it may be so. He appears to have difficulty coming to terms with this relationship.

The reader may feel for both him and his mother, in their separate, powerful, and contrasting needs. One senses that Dr. Yalom might still be affected by her tremendous limitations, despite his tremendous accomplishments.

The other five stories carry varied themes of struggle between men and women. "Travels With Paula" tells the true story of one of the first cancer support groups in this country, developed by a breast cancer survivor and Dr. Yalom. Apparently this grassroots group was the inspiration for the use of group support in a wide range of cancer care today. Dr. Yalom's story is about a complex shift in power, as his group changes from a patient-leadership model to a group led by doctors. He describes the decline in his relationship with his co-leader Paula, a woman with advanced breast cancer, when he brings in a female doctor to lead the group and unwittingly usurps Paula's defined purpose in life.

A moment of clarity and contact between Dr. Yalom and a psychiatric inpatient is described in the next story. The doctor is engaged in a usual activity, leading an inpatient psychotherapy group while being observed by residents, when something truly therapeutic occurs. After the group ends, he realizes that he and a patient he says a good-bye to have been touched on the deepest level.

The longest story in the book is about Irene. It describes her journey through the untimely death of her husband, Jack, to the resolution of her bereavement. It is an account of a harrowing, complex psychotherapy and an excellent illustration of Dr. Yalom's treatment skills, his dedication, and at times his exasperation with an extremely challenging patient.

In a slightly jolting transition, the final two short stories depart from fact and present fanciful, fictional accounts of dilemmas therapists may only dream about. After finishing them, the reader may feel the collection is somewhat disjointed. A brief author's note sums up Dr. Yalom's overall goal to be both storyteller and teacher and is helpful in pulling together themes.

The author mentions his Web site, where he has posted an afterword providing further references to the professional literature used in writing these stories. The Web afterword also expands on some of the teaching and technical aspects illustrated in the six stories, such as patient confidentiality, the boundary between fiction and nonfiction, the therapeutic relationship, and therapist transparency.

It is easy to revel in Dr. Yalom's creativity and intelligence. He ably communicates his gifts as a teacher, healer, and creative writer. One hopes that the depth and care in practice that Dr. Yalom shares with us will not be lost forever in the rush to speed psychotherapy treatments and limit psychotherapy encounters and in the belief that behavioral change is our only concern as caregivers.

Ms. Glimm is a psychiatric social worker with the child and adolescent team at the Bronx Mental Health Center of the Health Insurance Plan of New York.




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