1118 Am J Psychiatry 163:6, June 2006

BOOK FORUM
ajp.psychiatryonline.org
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 psychiatric
residency, Irvin Yalom, M.D., came to speak at a departmental
grand rounds. I still remember a pithy comment from his pre-
sentation: Psychotherapists tend to neglect the topic of
death. This comment had the ring of truththe subject of
death 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 psychotherapy
efforts with cancer patients, he found it impossible to avoid
the specter of the Grim Reaper. In his classic text, Existential
Psychotherapy (1), he underscored the life-affirming value of
looking 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). In
his most recent work of fiction, The Schopenhauer Cure, the
problem of living with the certainty of death is once again at
center stage.
As the novel begins, psychiatrist and group therapist Julius
Hertzfeld, a typical Yalom protagonist, is struggling with ac-
cepting the death sentence that accompanies his diagnosis of
metastatic melanoma. With a year to live, he must decide how
to spend his time in a way that makes him feel that he has not
wasted his last moments on earth. He chooses to contact
Philip Slate, a man he treated for sex addiction 23 years ago,
with the ostensible aim of seeing how he is doing. His former
patient explains to him that he was not helped by 3 years of
individual psychotherapy with Dr. Hertzfeld, but he an-
nounces that he cured himself by studying the writings of
Arthur Schopenhauer. He is now, in fact, a philosophical
counselor 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 about
Schopenhauer at the same time that Philip masters the con-
cept of human relatedness. In this arrangement, the author
explores another of his favorite themes: mutuality and reci-
procity in the psychotherapeutic relationship. How much of
ones self should one use as a psychotherapist? When does
self-disclosure advance the process? When does disclosing
too much personal detail burden the patient by disturbing the
asymmetry of the psychotherapeutic contract?
Dr. Yalom ingeniously juxtaposes a chapter on Schopen-
hauers life between each chapter that advances the plot. The
reader 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 misanthrope
who makes Samuel Beckett look like a Pollyanna. His solution
to 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. He
noted 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 of
death, 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 from
these 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 the
weight of the ideas that he presents. At times, the develop-
ments within the plot seem more driven by the needs of his
themes than by the psychological dimensions of the charac-
ters. Nevertheless, psychiatrists and psychotherapists will
find much to ponder in this new Yalom contribution, and I
heartily 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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