Transference

By Jeff Tannen

Dr. Gerald Rusk is known by everyone in his community to be a brilliant, award winning, psychiatrist and devoted husband. But following his mother’s death, a storm is gathering. Troubled by new smells and violent memories of war force him to question his worth. All around him, sinister forces gather to undermine his success and sanity. But who is behind these malicious enterprises intent on destroying his hard earned happiness? Rusk suspects everyone; his colleagues, friends, even his wife may be plotting his downfall. He knows that there is no one he can trust.
When Andrew Carter walks into Dr. Rusk’s office for the first time, seeking a safe harbor from his own perfect storm of psychological distress, Gerald feels a bond with him that will change both of their lives forever.

• Language: English
• Publisher: Lulu Publishing Services
• Release date: Apr 24, 2014
• ISBN: 9781483408910

Book preview

TRANSFERENCE

A NOVEL

JEFF TANNEN

Copyright © 2014 Jeff Tannen.

Many thanks to: Julie Eckert for a brilliant cover design.

Special thanks for content editing by Adam C.Smith.

Photo by Winston Burris.

Promotional acknowledgement to Stephen M Bassett.

Synopsis by Adam C. Smith.

All rights reserved. No part of this book may be reproduced, stored, or transmitted by any means—whether auditory, graphic, mechanical, or electronic—without written permission of both publisher and author, except in the case of brief excerpts used in critical articles and reviews. Unauthorized reproduction of any part of this work is illegal and is punishable by law.

Any people, places or things depicted in this story that are actual are only used to add realism and are well intended.

ISBN: 978-1-4834-0890-3 (sc)

ISBN: 978-1-4834-0892-7 (hc)

ISBN: 978-1-4834-0891-0 (e)

Library of Congress Control Number: 2014903126

Because of the dynamic nature of the Internet, any web addresses or links contained in this book may have changed since publication and may no longer be valid. The views expressed in this work are solely those of the author and do not necessarily reflect the views of the publisher, and the publisher hereby disclaims any responsibility for them.

Lulu Publishing Services rev. date: 4/14/2014

CONTENTS

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EPILOGUE

To my mother Florence Klinger 1919–2014.

I love you. Rest in peace

— Transference, a phenomenom characterized by unconscious redirection of feelings from one person to another —

1

N o one should have to see these things. I’ll surely die here. I must not show them fear. His buddy turns back with a worried expression on his face. Be strong, keep going.

A phone jangles and awakens him. His hand hovers over the receiver. He attempts to answer its abrasive ring but he does not touch it. It stops ringing. He is fully awake now and is suddenly aware of a peculiar smell that reaches his nostrils. That wasn’t here yesterday. It is right here in this stuffy office.

Just moments prior he had nodded into a disturbing dream: It is days before the fall of Saigon. The swamps in the south of Vietnam are chest high following the monsoons. It is twilight as he wades through the perilous swamp of Cantigny, a popular staging area for battalions. The water is infested with snakes of every size and color, and the mosquitoes relentlessly bite, causing welts on any exposed skin. All around, explosions split his ears. They come from nearby, just after the swamp ends and turns to marsh. He holds his bayonet rifle with both hands as high as his arms will rise. Images of death haunt him and he is about to cry out to his buddy yards ahead. Be strong. Don’t show fear; keep going; then he scribbles a note for maintenance to check the smell. and tosses it onto a pile on his desk.

Dr. Gerald Rusk has treated every psychiatric disorder imaginable. He works from instinct, experience, and a great deal of compassion. He is at the apex of his career. Journals of psychiatry want his abstract papers. Many of them send him around the world on lecture circuits. No psychiatrist at the institute has been honored for pro bono charity work with various organizations more often than him.

Much of his reputation is due to his kind, and empathetic demeanor. He can mollify the rage filled, quiet the disparaging, and soothe the loneliest with his perfectly pitched voice that many patients describe as hypnotic.

Lately, he has not been in the mood for them. He vacillates between various interpretations and doubts his every insight. He is grieving for his mother who passed away after a long illness. It has only been three days since her funeral. His relief is dampened by a heavy cloud of depression. Often, he sits alone in the winter light, cloistered in grief. Foreboding drags at him constantly, constricting his crisp, analytic facilities. Everything his patients say feels like a grating, intolerable complaint.

The new smell brings memories of her deterioration. How he sat, like a puppy, at her bedside, exhausted from the smell of her fetid breath, the ticking of the morphine drip, the death gaze in her eyes, and its little red broken blood vessels. Worst of all is the smell of the antiseptics used to clean her syringes.

His six foot tall body appears shrunken. His piercing eyes appear dimmer, and the once strong features seem cast into melancholy. He is not yet ready to accept that her beauty, considerable intellect, and athletic agility is gone forever like a shoreline, once pristine then washed away by the tides.

Marjorie, his mother, took him to the symphony, whispering and pointing with her elegantly manicured finger at the pianist saying, listen to how he handles the cadenza. Then she would close her eyes and drift off into bliss. She taught him to appreciate the opera and art museums; how to look through her eyes and see the bustled French society woman in the white light that fused the entire work. She showed Gerald the world: Paris, Madrid, London, and the countryside where Gerald could look out for miles at the rolling hills dotted with puffy white lambs. His father refused to travel, so their trips were sacred intervals in which Gerald had his mother’s full attention.

She demanded perfection from everyone. Mediocrity would never do. She often struggled with hysterical fits, which gathered as dark tropic clouds passing across the sun before pouring their rains. She did this until she was cleansed and when bloated with grandiosity, she became placid. In the later stages, when the unforgiving disease had possessed her brain, she would take to bed, unable to reconcile the disparity of her legs, and the mind that no longer willed them.

Challenged at the crossroads of tenderness and conflicted emotions, Gerald’s father, Ned, brought her bouquets of dandelions from the garden without cleaning them. He stuck them clumped with dirt into plastic Wal-Mart vases. By caring in this way, as well as holding her in his arms and uttering loving words, he felt that he attended to her outbursts.

Still, though, Ned became parched inside throughout the final year of her illness, as if crawling along a desert floor, cracked and dry. Without her love to hydrate him, he felt that he was in bed with the aura of death, as if it was an illicit lover competing with him. By this time, she was merely a wisp of her former self.

Ned walked hunched, his arms dangled, apelike. He developed Trigeminal Neuralgia in his cheek when he was thirty-five. It was an exquisitely painful condition of the cheek that caused it to twitch with the precision of an egg timer. Gerald used to watch it move when forced to sit near his father and confront him. He hated the tic as he hated his father for leading a life that seemed to be a series of architectural renderings. Nothing was spontaneous; life was a design for living with only measured steps and lines which formed shapes. There were few if any shades of either grey or impracticalities.

When Gerald missed a fly ball in a lonely corner of right field during his time in Little League, his self esteem suffered horribly. His father’s degradation of him was omnipresent like a dark shadow. My son is a sissy, he would mutter within ear shot and it continued past Gerald’s teenage years and shaped Gerald’s tendency to ruminate on unimportant things…

His father, at seventy-two, is rapidly losing thoughts. When he was more robust, he would say with exactness, how many times have I showed you how to tuck in the corners of a bed? Do you know the importance of making a bed fit for a soldier? The sheets have to be tight around the corners. Now, Ned’s bed goes unmade and the sheets grow grimy.

Ned had served in the military and reveled in the exalted images of a moment in 1945 when, near Lupao Luzon in the Philippine Islands, several of his men fell wounded thirty-five yards away from him in a roadside ditch and lay there besieged by five Japanese tanks, machine guns, and a platoon of riflemen. He crossed the road under a hail of gunfire and moved them one by one to safety. For this, Ned received a medal of distinguished valor.

Sometimes he was tolerable, but rarely without a dramatic shift in mood. One distressing event occurred the summer he helped Gerald with algebra. Gerald was sixteen at the time and they were sitting at the dining room table. No, that isn’t right, his father shrieked. What is it going to take for you to get this? Ned seethed, his eyes turning inscrutable, his tic fulminating with rage as he hammered away. Finally, perplexed, Gerald drove his pencil point to breaking on the tabletop.

Gerald, like his father, had served in the military. More than anything he wanted to please his father who keeps photographs of him in his combat uniform if only to prove that Gerald actually served. These are the only ones Ned keeps near his bedside. The rest are disregarded in a suitcase, gathering dust in the attic.

2

I t is dusk and light fades from the corner windows of the office as Gerald turns on the lamps to add some coziness to the room. He listens to the heating element cycling on and off. Then the little red call light lights up. This light signals that Andrew Carter, his next patient, is waiting outside for his second session. Gerald is not eager to see him or anyone, but is intrigued with th e case.

He settles into a wingback chair, given to him by his mother when he redecorated five years ago. It was an heirloom that came packed in bubble wrap with a card reading: Dear son, this is for you to sit, to dream, to listen to others dream and to fulfill your hearts desire. With all my love, Mother. It is an antique that he often imagined her sitting in. How soft and tranquil she must have looked as a young child in his grandmother’s house.

When Andrew enters it seems that he has come to vent his concerns and seek enlightenment, but still he appears nervous. Gerald settles into his chair then picks up his notepad and reading glasses which are more of a prop than a necessity. With them he can easily slide into the facsimile of a late night television host who converses and captivates easily.

As dusk turns to darkness, Gerald is certain that he is off his game. Andrew is struggling with feelings toward his own father, and sexual confusions that Gerald finds intriguing. The discussion quickly turns to Andrew’s daughter, Jenny, and how he fears that his choices may affect her.

Jenny is going on six years old. She is blond, blue eyed and full of smiles like her mother Nicole, when she was that age. She has courage; more than both her mother and father. In seeking Dr. Rusk’s care, Andrew hopes to acquire some of this fortitude, but this is not the only reason for his investment in treatment.

He considers Dr. Rusk an ally and admires him, though the strong feelings he is developing create a dilemma. Andrew does not fully understand the process of psychotherapy; what is and is not an appropriate boundary. In his mind he thinks he feels love for Dr. Rusk, whom he has begun idolizing, but he doesn’t understand the difference between feelings and thoughts. Rusk knows this. Patients that fall in love with him will have a certain look of reverence about them. He imagines that all therapists must recognize this. This facial change is something in the eyes and the slight flush that blooms across their brow and at the tops of their cheeks. Andrew’s face is the perfect model of this.

During the history taking, Rusk has learned that Andrew’s world changed insidiously from behind the scenes when he was sixteen years and his father’s cancer metastasized. Tending emotionally to his father’s condition eroded his sense of security. His mother became the caretaker and faced her own chronic physical and mental exhaustion. His brother frequently wandered beyond the neighborhood into strange alleys in search of imaginary playmates. In later years, Andrew came to understand that this was the beginning of his brother’s battle with depression. Andrew was ill-equipped to understand or deal with the complexities of his father’s disease. He could not see, feel, or touch it. It was aberrant to Andrew, who was still a boy in a man’s body.

Andrew’s lips tighten into a loosely formed gash. He leans back and then forward, his black Irish features cast into a mask of anxiety. Rusk is familiar with this posture. It denotes that a patient wants to give emphasis to his words. I thought I knew what I was going to say, but now… I’m not so sure, Andrew says looking at the floor. Rusk is trying to focus, but he is distracted by the tick, tick, tick, of the many clocks, some of which have been retooled for precision. For some reason they seem louder today.

It’s as if I don’t know who I’m supposed to be… Andrew trails off.

Have you always felt this way? questions Rusk, trying to draw Andrew out. Andrew’s body shudders as if a quake has erupted inside of him. His hands clasp together, interlaced like a woven basket. His face points towards the floor as he cries quietly. Choosing his words delicately, Rusk modulates his tone, attempting to offer something to Andrew.

Your hands look like they’re forming a cup. Is that to catch the tears? he asks. With this Andrew let’s loose with wrenching sobs that shake him violently. He tries to speak, yet the words come out garbled. Rusk leans forward with a box of tissues knowing that he must stay grounded in sound judgment without blurring the boundaries of preferential emotions. I am a healer and a model of appropriate deeds, he reminds himself.

Dr. Rusk observes this attractive young man weeping before him. He realizes that his eyes, as well, have begun to well up with tears. As he wonders who these tears are for, he closes his eyes and lets his mind wander to a precise moment. A string of images play behind his eyelids. He is in Vietnam. A solider is lying next to him in a ditch. Fatigued with pain, his ears feel as if they will split from the percussive explosions which rattle his bones. He watches his best buddy, falling asleep, and he feels envious that Joe, his buddy, is able to somehow stem the current of his own emotions. His head falls against Gerald’s shoulder softly. Try to sleep, you need the rest, he tells himself. All of this, these memories unfold in a grainy moment as Andrew sheds his own tears across from him.

You need to cry, its ok. Look at everything you’re going through right now. You’ve told me about how you’re struggling with the idea of spending your life with your closest friend, Karen, but I know that you still have concerns about this. Then there’s your past; you’ve spoken about trysts with other women and you implied last week that there have been encounters with men as well. I understand that you’re confused. You want to feel so much, but yet you hold back. What makes this so? Rusk knows that Andrew probably doesn’t have an answer, but this line of questioning encourages his insight.

Silence follows as fear makes Andrew’s olive skin transform into something of a deeper shade. He feels dark and frightened and Rusk braces for what Andrew is most likely about to say, knowing that it will compress his own feelings that have been steadily evolving since their last session.

Andrew is still looking down at his hands. I don’t know how to say this. I’m embarrassed, he blurts out in a spontaneous need to purge. I— I think I’m falling in love with you.

Having predicted this response, Rusk leans in toward Andrew and, out of habit, composes his face into neutrality. Though his instinct is to shove what these words mean into a clinical compartment, the ticking of the clocks again intrudes upon him. All he can think about is whether the volume of the ticking has somehow been turned up. It is an unwelcome and illogical distraction. I can appreciate how difficult that must have been for you to say, Rusk says gently. I applaud your courage. Having said that, these feelings are quite appropriate at the moment. Tick... tock…

They are? questions Andrew, perplexed.

You’re experiencing ‘Transference’ with me, Andrew. This occurs as the relationship between therapist and patient becomes more familiar… more intimate and Intimacy is what this is all about. Your subconscious, your inner child, is having deep feelings associated with me as a significant person from your past that you desired closeness with, and I, for a while at least, fulfill that cherished position until you can separate and become comfortable having these feelings with others in your life. Rusk realizes that this is a lot of information for Andrew to absorb.

The expression on Andrew’s face softens, though confession has not relieved his fear of exposure. The love of Transference is different. It is a love unlike urgent sexual feelings for men or women.

I think about you and wonder what you do when you’re not here and whether you’re with your wife or lover, Andrew says cautiously.

Tick…

Andrew, your Transference is a projection, but it is beside the point. The fact is that your fantasy signals the beginning of a desire for true intimacy. Tock…

"But what if they become sexual feelings," Andrew blurts out urgently. Tick…

Perhaps these feelings are the only way you have known to approach intimacy. You have sexualized others, put them on a kind of pedestal to receive the gratification that you believe will make you feel something, like the high you get from a drug, and being high exaggerates your perception of yourself as a kind of super man. Sometimes you are great, then other times you feel as though you are ‘less than’. These feelings are a cover and they are black or white; all good or all bad. Tock…

Andrew is at a loss for words.

For now, just stay with the process, Rusk says, trying to reassure Andrew. We can continue this another time.

Andrew holds the doctor’s words in the highest regard and has done so since his last session. I wanted to talk about Jenny, Andrew says quietly.

Rusk considers this. "You know, it is very difficult to handle your feelings for Jenny when the little boy inside of you is demanding attention and love. First take care and listen to his needs. Be kind to him; to yourself. If you love yourself, it will make the journey with Jenny a little less frightening. We can get deeper into this next time," he says as if making a mental note to himself. He wonders if what he says is some kind of deposit to reassure himself of his patient’s return. Am I expecting that Andrew will not come back? Rusk considers, suddenly feeling insecure. Tick… Tock… Realizing that they have reached the top of the hour and must wrap things up, Rusk asks, How about this same time next Wednesday?

Andrew turns away from him as if to shield his eyes from the sun which has become too brilliant. The motion strikes Rusk as curious. What is it, Andrew? Rusk gently offers. Andrew turns towards him revealing tear streaked cheeks.

Suddenly Rusk feels an acute ache of sadness from a place within himself that he rarely visits. It is an immediacy which he, as an ethical clinician, must control and has controlled in the past with ease. It is only a natural response to empathy, but why is today different from other days? He cannot resist uttering, watch it, under his breath as one does quite harmlessly to give emphasis to a thought.

Andrew does not hear this and still he resists the consolation of his inner voice. Rusk gets out of his wingback chair and, very deliberately, sits by Andrew’s side, placing his hand on Andrew’s shoulder. Andrew lays his head in Rusk’s lap, sighing as he does so. Rusk gently caresses Andrew’s hair, tentatively at first. He lets the silkiness of the strands slip through his fingers and toys momentarily with the nape of Andrew’s neck. All the while, voices are screaming, No! as though all the years of psychoanalytic training and ethical curriculum have now flown straight out the window. Suddenly the clocks stop wearing on him. Andrew reaches for Rusk’s arm and comes up with his wrist instead.

Abruptly, as if coming out of a trance, Rusk pulls away and gives him a box of Kleenex. Here, wipe your eyes; Rusk says almost coldly, we have to end for today.

He quickly writes out the time and day of their next appointment on a card and hands it to Andrew. They walk silently to the door while Andrew quietly snivels. Rusk tries to maintain a shred of dignity as his patient looks into his luminous eyes. There is no further exchange between them as Rusk watches him exit into the plain beige hallway.

He returns to Andrew’s chair a bit elated but after realizing this he grows concerned about what has just happened. What have I done? He thinks to himself, full of reproach. I touched him inappropriately! He takes out a pad and makes some notes, trying to distract himself from the transgression.

Patient, Andrew Carter is in crisis. He presents Ego Dystonic feelings about his sexual feelings for men. He has moderate anxiety. He would benefit from a course of anti-depressant meds. I will start him on a course of Imipramine and Trazdone for sleep. At this time he is transferring paternal feelings toward me which I have explained as a process of the psychotherapy. Additionally, he must be monitored. He may have an impulse disorder which is probably the result of concern for his daughter.

3

B e fore leaving, Gerald decides to visit a few patients in North Point’s Psychiatric wing to take his mind off Andrew. He reviews the moment of sitting next to Andrew, of Andrew’s head in his lap and of caressing his hair. I was unethical , one part of his brain says, and as a rapid reprimand another part of his brain chimes in, No! You were just being comforting . Yet the wrestling match takes off as if it was a jet down a runway.

He exits the elevator at Three North and enters into the world of the institutionalized where everyday people with their own lives have lost their dignity. In the glass enclosed office, he removes some charts from their alphabetized containers and browses through notations made by the night staff before going to visit them.

Good morning, Dr. Rusk, says Wanda Hendricks the psych assist nurse.

Is there anything to report on my patients? Rusk asks while still scanning a chart.

Tilting her head back in thought, no, it’s been quiet for the most part, but your patient, Ashley Kimball…

Yes, what about her? he asks, his concern growing.

Well, she’s been drawing more than usual.

"Well she is a graphic artist… That’s how she’s expressing herself," Rusk says almost dismissively.

"Yes, I know. But it’s what she’s drawing that I’m concerned about. I asked her if she would let me keep a few of her latest to show you, Wanda says while pulling open another drawer of folders. Look at this one," she says, tossing it on the desk.

It is an accomplished rendering of a pregnant woman with her stomach cut away revealing a fetus inside with its umbilical cord hanging out, blood dripping. A raw T-bone steak hangs at the end of the cord. While staring at the drawing intently, Rusk gingerly touches the cord with his fingertips, running it down to the hanging piece of meat.

"Separation anxiety, Wanda. She’s raw. This makes sense after our last session. Please keep an eye on her; it’s important that she feels like she’s a part of