My first reading of Rachel Aviv’s piece on Oliver Sacks, “Mind Over Matter,” in the December 15^th 2025 issue of The New Yorker, left me despondent and a bit peeved (https://www.newyorker.com/magazine/2025/12/15/oliver-sacks-put-himself-into-his-case-studies-what-was-the-cost). It seemed like an exposé, maybe even a take-down of sorts, designed to lower our opinion of the famous neurologist. In my second reading, I was able to glimpse Aviv’s effort to be fair-minded and present a balanced picture. How did I miss that the first time around? Was my first reading a misreading? Or was there some inchoate, affect-laden content part of my experience that might be elaborated? Is there even such a thing as a fair-minded exposé? And how might that differ from a critical reading?

Rachel Aviv was granted access to records and notebooks by the Oliver Sacks Foundation, many of which had never been viewed before. This allowed her to observe and compare his private thoughts to his published works, where she detects evidence that Sacks projected himself into some of famous case studies (like Leonard L from Awakenings), and how he worried, and felt guilty, about having taken liberties by putting words in his patients’ mouth, fostering narrative coherence at the expense of truthfulness. There are no universally accepted standards for writing about patients, but writing about yourself as if you were writing about a patient seems to cross a line. It matters, though, how aware you are of doing so (and it also matters why--for example, protecting the patient’s confidentiality).

Aviv argues that in the case of Leonard L, Sacks misrepresented him as, bookish and introspective, like Sacks himself, whereas according to testimony by friends and himself, he was an ordinary, social kid. Indeed, Aviv’s commentary turns on Leonard’s retrospective self-understanding in which he proudly describes two rapes (one of a cousin) when he was younger, which she interprets as Sacks submerging the sexualized material due to his own discomfort. I can think of alternative explanations: that Sacks might not have been convinced that the alleged rapes occurred and were fantasies created under the influence of L-Dopa or that the rapes would have added an element of psychopathy that pulled the story in an awkward and unseemly direction.

I am not claiming that Aviv is wrong to be concerned that Sacks read himself into his patients, although I do regard it as heartening that he worried about this in his journals and knew himself well enough not to be in denial about it Clinicians need to use themselves as instruments of understanding, and it can be confusing to disentangle self from other. Good clinicians replay interactions and often recognize their failures and mistakes. Aviv notes that, over time, Sacks’ case histories became more sober, presumably less likely to postulate others as himself. Moreover, Kate Edgar, his no-nonsense editor, testified that she was unaware of any funny business with the case histories.

For Aviv, Sacks’ sexual repression as a gay man for most of his life is a relevant and major factor in considering his legacy. It is certainly striking that he did not have sex for 35 years during the time that his writing career took shape. Aviv notes that Lawrence Wechsler, a friend of Sacks wanted to write a biography about him, and decided to organize it around Sacks’ homosexuality, which led Sacks to pull out of cooperating with the project.[i] Aviv reads Sacks as uncomfortable with being gay, at one point noting that Awakenings came out the same year as Stonewall occurred. But Sacks is explicit about his indifference to current affairs in his second memoir, On the Move (2015), “whether political, social or sexual” (hereafter abbreviated as OM, p 237). However unresponsive Sacks was to social changes regarding homosexuality, he was deeply affected by his experience of the past: that “it was not easy, or safe, to be an open or practicing homosexual in the London of the 1950s” (OM, p.38).

Sacks also experienced a major trauma in his mother’s reaction to his being gay, which was to tell him she wished he had not been born. Aviv tells this story in a truncated form: what actually happened is that Sacks revealed his identity to his father and asks him not to tell his mother, which his father did —resulting in a double betrayal (OM, pp.10-11). A significant part of Aviv’s story then concerns the psychoanalysis Sacks had with Leonard Shengold, which last nearly a half-century. Aviv questions whether the analysis helped Sacks to find peace with being gay, and she seems to be skeptical about whether such an interminable analysis could possibly be beneficial.

My response to knowing that Sacks had such a long analysis is not to presume its success or failure. During the last 7 year of his life, Sacks fell in love and partnered with a fellow writer, Billy Owens, which Aviv reports on neutrally, whereas it has always impressed and delighted me to learn about.[ii] I am inclined to believe, as Sacks did, that his analysis helped him to cultivate and sustain his creativity. I would also guess, given the relatively undeveloped state of clinical neurology then, that Sacks used the sessions to discuss his patients and benefit from Shengold’s clinical training and wisdom. When I was writing my book, Minding Emotions, in which there is a chapter on Sacks, I contacted Shengold and had a friendly exchange with him after Sacks’ death, inquiring whether he would talk to me about their work together. He declined, he said, because he intended to write about it himself. It was obvious that he was proud of their work together. and he told me the same story which Aviv reports: that they agree to call each other by their first names, just before Sacks’ death.[iii]

There is something is missing in Aviv’s account of Sacks. At one point, she notes that he was writing in a discipline where “reproducibility” iis expected, which reveals a gap between the obligation that she presumes for the case studies that he does not. He was far more curious about phenomena that was radically unique and unexpected. Sacks was a critic of growing specialization in neurology, and in medicine in general, where objective measures were adopted to the exclusion of listening to patients. He also voiced a specific concern about neurology’s indifference to its own history.

In Sacks’ first memoir, Uncle Tungsten (2001), he reflects on being enamored with the 19^th century poet/chemist, Humphrey Davy, “one of my particular heroes” (hereafter abbreviated as UT, p. 85) whose description of consuming nitrous oxide, was possibly the first psychedelic experience in western literature (UT, p. 118). Sacks delights in enumerating Davy’s other discoveries and repeating some of them in his own lab (UT, p, 122). Sacks points out that Davy loved to conduct experiments in public, stressing that this was prior to the divide between literary and scientific culture.

The impetus for Sacks’ work can be understood as a protest against the deepening of this divide between “two cultures” in the 20^th century, outlined by Snow.[iv] Sacks refuses this divide, declaring that: “I think in narrative and historical terms” (OM, p. 102), and affirming his intellectual identity: “I am a storyteller, for better or worse. I suspect that a feeling for stories, for narrative, is a universal human disposition, going with our powers of language, consciousness of self, and autobiographical memory” (OM, p.384). While autobiographical memory provides no assurance of accuracy, the long and slow work of clinical work aims to converge toward truth, insofar as that is possible.

Davy was a fascinating figure: a close friend of Coleridge, the first scientist to be knighted since Issac Newton, ahead of his time in experimenting with photography and cinema, and creator of the Davy safety lamp, which had a personal connection for Sacks, as it was later modified by his maternal grandfather. But what Sacks most admired about Davy was his personality: “not modest, like Scheele, not systematic, like Lavoisier, but filled with the exuberance and enthusiasm of a boy, with a wonderful adventurousness and sometimes dangerous impulsiveness—he was always at the point of going too far—and it was this which captured my imagination above all” (UT, p. 131). In observing these characteristics of Davy, Sacks is clearly identifying with them.

Indeed, one of the only repeated passages in both of Sacks’ memoirs, UT and OM, is a comment made by a teacher about him, which made a lasting impression: “Sacks will go far if he does not go too far” (UT, p. 140; OM, p. 7). Like his hero, Humphrey Davy, Sacks was willing to risk going too far. This bothers Aviv, and she is reluctant even to credit his self-awareness. The issue goes beyond personality style; it bears on diagnosis, as Sacks notes how neurology dwells on deficits over excesses. In an Op Ed that Sacks wrote in the New York Times, on June 5, 2015, just two months prior to his death, he was in a playful mood, amused by his propensity to mishear phrases like “Christmas Eve” as “Kiss my Feet.” Engaged and ludic until the end.

My reaction to Aviv’s piece cannot resolve its ambiguity. Aviv holds Sacks accountable for insinuating himself into his reading of his patient Leonard; yet later she mentions that Leonard was overwhelmed with grief (shedding “enough tears to fill a bucket,” according to his mother) upon learning Sacks would not be returning to work after breaking his leg. This seems like confirmation that Leonard did not feel misunderstood by Sacks in the room.

So maybe some caution is needed in equating the writer and the clinician. Aviv links the two and is turned off by Sacks’ exuberance. Her reading falls short because she neglects to heed how Sacks wished to be understood. This is why I sense the presence of underlying affects, which distinguish Aviv’s reading from one that tried to wrestle with the project that Sacks adopted for himself, to write with the freedom of having no boundaries between science and literature.

[i] Wechsler did publish his book: And How Are You, Dr. Sacks: A Biographical Memoir of Oliver Sacks (Picador, 2020).

[ii] In Sacks own words: “Deep, almost geological changes had to occur; in my case, the habits of a lifetime’s solitude, and a sort of implicit selfishness and self-absorption, had to change. New needs, new fears, enter one’s life—the need for another, the fear of abandonment. There have to be deep, mutual adaptations” (OM, p. 381).

[iii] E. Jurist (2018). Minding Emotions, (Guilford), p. 116.

[iv] C.P. Snow (1959). The Two Cultures and the Scientific Revolution (Cambridge).

Mental health professionals should familiarize themselves with a new, phenomenon, just crystalizing, of patients writing about their experiences in therapy. We have an obligation to weigh and even to integrate patients’ experience along with our own hopes, expectations and knowledge. This is especially true, given that there is some reason to worry that we tend to overestimate our success.[i] Yet, we do not need to go as far as presuming an adversarial relation between patients and therapists. On the contrary, documentation of therapeutic success is plentiful and represents a powerful source of information about happens in therapy.

In a previous newsletter, I have written about Stephanie Foo’s memoir, What My Bones Know, which focuses on her diagnosis of complex trauma, as well as her journey of exploring an array of different therapies, until she finds Jacob Ham, a relational psychoanalyst (https://elliot4cc.substack.com/p/mentalizing-health-intellectual-integrity?utm_source=publication-search). They agree to an experimental project of audio recording sessions, with the intention of each listening to and commenting on what was said. Ham occasionally apologizes, and Foo comes to feel that having distance from their actual sessions enables her to hear him better. In my last newsletter, I discussed Joan Peters’ memoir, Untangled, a reflection on the two analyses she had, in her 20s and 60s, the first of which was successful but did not include an effort to understand the relationship, and the second of which went deeper and emphasized the relationship (https://elliot4cc.substack.com/p/mentalizing-health-two-new-excellent) There is an experimental quality to this memoir, as it features an Afterward by the second analyst.

In this month’s newsletter, I plan to discuss a recent memoir by Baek Sehee in two books, I Want to Die But I Want to Eat Tteokbokki (2022), and I Want to Die But I Still Want to Eat Tteokbokki (2025). As the titles indicate, Sehee is a person who clearly seems to be heading in opposite directions—toward her own demise and toward fulfilling, life-affirming appetitive desires (tteokbokki are Sehee’s favorite food: spicy rice cakes that can be prepared in a variety of ways and serve as a Korean comfort food). The memoir consists of passages of self-reflection, followed by a recounting of sessions with her (unnamed and ungendered) psychiatrist.[ii]

The first memoir begins with an intriguing question: “Why are we so bad at being honest about our feelings” (p. IX). This question takes on a determinate meaning, as Sehee explores her wish for attention from others and her preoccupation with her appearance. She understands her her diagnosis as dysthymia, but her psychiatrist also notes her social anxiety and suggests the diagnosis of histrionic personality disorder. Both patient and psychiatrist concur that underlying her struggles is low self-esteem, which Sehee ties to her childhood, where her family was poor, and she was dominated by an older sister and bullied at school. Later in the memoir, she alludes to her father physically abusing her mother (p. 178).

Sehee experiences problems in relationships. For example, in developing a new relationship with a friend, she worries about how different they are. She also worries about being too self-revealing and then finds herself annoyed with the friend’s messages to her. Sehee’s psychiatrist notes the extremes in her reactions as well as the lack of “middle ground” and acceptance of the “nuances of relationships.” Sehee’s reactivity is evident in her response to how the friend feels about a book Sehee had recommended, which was to feel attacked and to retaliate, calling her “arrogant and exhausting” (p. 85), prompting a nastier exchange. Sehee is aware that her black and white thinking makes things worse, and that she needed to work on negotiating self/other relationships. As she explicitly acknowledges, “I really don’t know how to tell the difference—between what I really want and what others want from me” (p. 48). The psychiatrist seems to be onto something in considering a personality disorder.

Surprisingly, Sehee does not reveal whether or how the self/other issue plays out with her partner or the psychiatrist. The partner is portrayed as supportive, but she is not forthcoming about their relationship. It seems as if, over time. she develops a positive relationship with the psychiatrist. Their relationship has a didactic quality—with new thoughts about her diagnosis (adult ADHD, not just histrionic personality disorder) and new medications introduced. The psychiatrist tries to be non-judgmental but does urge her to work on developing “willpower.” We learn nothing about the psychiatrist’s orientation and training.

By the end of the first memoir, Sehee is less depressed, but not cured. Progress has been made in self-knowledge. She voices the thought that her primary motivation in life is love, exclaiming: “I want to be an emotionally bright person, even if it means becoming impoverished in terms of rationality” (p.165). Sehee makes an appeal for the value of altruism, which she juxtaposes to selfishness. She recognizes that the pleasure she took in putting down others was because she failed to know herself. Yet, contradictory emotions persist, and Sehee attempts to avoid numbing her emotions by oscillating between “romanticism and cynicism” (p.192).

A natural expectation would be for the second volume of Sehee’s memoir to continue the journey and narrate a tale of attaining mental health. But Sehee seeks to liberate us from such an illusion: “The more my therapy progressed, and the more my wounds healed and the scars turned faint, the more vulnerable I became to suffering. It was too easy to uncover buried hurts and immerse myself in depressive thoughts again” (p. XIII). To which she adds: “This book will not be a useful guide to those seeking a complete cure for depression” (p. XIV). Indeed, her suffering intensifies; not only does she quit her job but undergoes agonizing experiences of self-harm and suicidality. Yet, Sehee also reaches deeper in the second volume, presenting a startingly candid self-portrait.

A key event that unnerves Sehee occurs when a male journalist interviews her about her first memoir. Although his voice sounded young on the phone, Sehee reports that he turned out to be middle-aged (she notes that 80% of her readership were young women in their 20s or 30s (p. 109)). The interview did not go well, as the journalist was condescending and discourteous. Sehee’s initial reaction was to blame herself for being overly sensitive, but in talking with a friend, she began to be incensed and rageful. Consequently, she took her sleep medication during the day (but not again at night) and struggled restlessly: “Even in my dreams I feel frustrated” (p. 112). Her psychiatrist normalizes and supports her in considering the vicissitudes of her reactions, and they agree that it was a good thing that she had not overreacted at first. The psychiatrist is quite effective in helping her to down regulate about the interaction, which previously would have been more difficult.

I must confess, however, that in other contexts, the psychiatrist’s role was mystifying to me. “They” position themselves as an advocate of “rationality” (p. 44) and “scientific and rational methods” (p.134) and seem skeptical about Seehe’s forays into astrology and vegetarianism, The psychiatrist even discourages her from continuing with her feminist readings. The psychiatrist exhibits a strange preoccupation with her tattoos, introducing them impromptu, and with a curiosity that inscribes generational \differences.

We are not privy to Seehe’s emotions toward her psychiatrist. However, at one point, she asks him if it is common for a psychiatrist to talk with patients and meet for 30-40 minutes, and he acknowledges that it is not. It seems that they are engaged in psychotherapy, but at no point is this agreed on explicitly. They have a hierarchal relationship, which guides their interaction—for example, it is evident that at times she does not understand why changes in medication have occurred. The psychiatrist believes their work has been helpful, and Seehe does not disagree. She does pointedly note that “I really don’t have much to discuss with you anymore” (p. 195). And she emphatically desists from the notion that she is cured, especially refusing that as a satisfactory ending for the book. The word “still” in the title conveys a message about the inescapability of contradictory emotions.

The nameless, genderless, ageless psychiatrist and Sehee do share an emotionally intimate moment, when she is musing about feeling empty, and asks them if they ever feel this way. The psychiatrist responds personally and affirmatively, connecting such a “natural” and “necessary emotion” to why we desire relationships. Sehee concludes the book by recognizing the need to accept loneliness as part of human life, but also by appreciating her doctor and others in her life “who have enabled her to be myself” (p. 203).

What a pleasure it is to read a memoir about therapy that resists an artificial, happy ending but does not discount that progress has been made. The combination of medication and therapy was effective, although I wonder how Sehee experienced this. Her transference and her general level of engagement with her psychiatrist is difficult to assess.

Toward the end of the memoir, Sehee characterizes herself as “an unexceptional person” (p. 203). I would have to differ with this opinion, insofar as being exceptional would seem to rely upon being true to yourself. I am, by any definition, an old man, and found myself swayed by Sehee’s memoir, thinking about her experiences beyond reading about them, and hoping that she would find herself on a path that felt right to her. I believe she managed to do that, and that readers will find inspiration in digesting this saga.

[i] See this CBT study, where there is a disparity between the perceptions of therapists and patients about therapy: Schermuly-Haupt, Marie-Luise, Michael Linden, and A. John Rush. 2018. “Unwanted Events and Side Effects in Cognitive Behavior Therapy.” Cognitive Therapy and Research 42 (3): 219–29. https://doi-org.ccny-proxy1.libr.ccny.cuny.edu/10.1007/s10608-018-9904-y. Also see, this article that stresses a “self-serving bias,” wherein therapists fail to recognize their incompetence: Johnson, W. Brad, Jeffrey E. Barnett, Nancy S. Elman, Linda Forrest, and Nadine J. Kaslow. 2012. “The Competent Community: Toward a Vital Reformulation of Professional Ethics.” American Psychologist 67 (7): 557–69. https://doi-org.ccny-proxy1.libr.ccny.cuny.edu/10.1037/a0027206.

[ii] The psychiatrist is referred to as “they,” but I did not have the impression that that indicated non-binary status. It is curious, in fact, that we hear so little about the identity of the psychiatrist. Is this out of respect for them? Is there a cultural meaning here that is not universal?

Memoirs are proliferating at such a pace that it’s hard to keep up with them. Some memoirists I am writing about and have enjoyed reading are producing new books faster than I can digest their previous works—like Alison Bechdel, Melissa Febos, and Maggie Nelson. This month I want to write about two extraordinary but very different memoirs by lesser-known authors that center on experiences in therapy: Past Tense by Sacha Mardou and Untangling by Joan Peters. I need a temporary break from politics and mental health (maybe you too), even as the current regime careens recklessly and the resistance (hopefully) gains momentum in the aftermath of the No Kings rallies.

One of the most impressive things about Sacha Mardou’s graphic arts memoir is that it allows her to depict therapy sessions, representing her therapists’ contributions as well as their interactions. Mardou is a reluctant patient: “I’m British. We don’t do therapy” (p. 42). In the initial session, she does not reveal her major family secret: that her parents split up and exchanged partners with another family, then her father committed incest with the daughter (Gail) of the other family and was subsequently sent to prison. The drama intensified when Gail came to live with Mardou and her family. Gail molested Mardou, and as a tempestuous adolescent threw Mardou down the stairs, after which she (Gail) was removed from the home. Mardou suffered neglect in many other ways—being expected to take care of herself from an early age, being exposed to her mother’s zealotry (as a Jehovah Witness), and dealing with frequent moves.

Mardou slowly warms to Chris, her therapist, who mostly practices talk therapy but introduces her to Internal Family Systems (IFS) therapy. Despite what transpired with her father, Mardou wants to work on her relationship with her mother in therapy (as she had been estranged from her father for a long time and had written off having a relationship with him,). At first, Mardou complains about her mother—for example, how she expressed an insensitive wish to have met her current husband earlier, which would have meant that Mardou was never born. She is also disaffected by her mother’s intense religiosity.

Chris encourages her to be more empathic to her mother, and over the course of therapy, this happens. Mardou learns that her mother was raped by a man who had married into her family, and that she had not been nurtured by her own mother, who suffered trauma in World War II, losing both her husband and brother. Mardou comes to see how trauma and religion coincide in her mother’s life.

With Chris’ help, Mardou finds the words to approach her mother in new ways, and there are touching moments of rapprochement between them. Naïve criticisms of therapy often maintain that therapy makes people blame their parents, externalizing their problems; but here we see the opposite: that Mardou’s therapy journey results in her becoming more empathic and having a better relationship with her mother.

Mardou develops a positive response to Chris. In narrating how she was molested by Gail, Mardou is consoled by his voice which is “so kind and calm” (117). He urges her to appreciate that she is a good mother to her daughter and to have compassion for herself, as she has for her daughter who happens to be around the same age as when the sexual abuse occurred. As she departs his office, Mardou and Chris hug, which is depicted without comment.

When Chris first introduces Mardou to IFS, she is turned off by it, then becomes curious, and even passionate about it. IFS is a trauma-based approach that is closely related to van der Kolk’s understanding of trauma. It captures Mardou’s sense of not been seen in her childhood.

As a treatment, IFS emphasizes the notion of parts, which are a little confusing to understand, as they seem to be defensive roles adopted due to a lack of nurturing. Three parts are elaborated: manager parts that “protect our image and keep us safe,” firefighter parts that “try to quash painful feelings via compulsions,” and exiled parts that “hold traumatic experiences” (p. 138) Allegedly, recognizing these parts, helps us to free them from interfering with our functioning, restoring “self-energy,” another key term in IFS. My account of IFS is taken directly from Mardou who becomes an advocate: “I really want to do IFS and not so much talk therapy” (p. 152).

Following the wish to do IFS, Mardou opts to see a therapist who is a woman and who is also familiar with IFS. Interestingly, she begins to see Sally, her new therapist as a secret, not discussing the switch with Chris until after the decision is made. Mardou seems to develop a productive relationship with Sally, as they explore aspects of her past history, some of which I have alluded to already. It is surprising, therefore, that Mardou makes the decision to return to work with Chris, feeling that he understood her intuitively more than Sally. That Mardou sought out IFS but found herself feeling less connected to her therapist seems like as an affirmation of the primacy of the therapeutic alliance. Mardou does not explore the return to Chris besides telling us that she wanted more than Sally could give her. Is she a reflection on IFS? It does not seem so from Mardou’s point of view, but it left a question in my mind. Also confusing, given her trauma history, is that Mardou informs Chris that she is seeking counseling not therapy (p,272).

Indeed, with Chris, Mardou uncovers painful memories of witnessing her father brutally abuse her mother (p. 308), and the shame she holds as a result. She also comes to the realization that she loved her father, despite her alienation from him. Working with Chris is healing and provides closure. He is happy to grant permission for her to include him in writing the book we are reading. Their work together concludes as she resigns from her job as a librarian, which means she can no longer pay for therapy. Her journey is therapy has paid off, and she concludes that therapy has changed her life.

Although Mardou’s memoir represents her therapists’ views, Peters takes things one step further in including an Afterward by her analyst, Kristi. This is highly significant: memoirs that discuss therapy often leave us wondering whether their therapists would corroborate what transpired. Peters had two analyses, when she was a young adult (at 28 years old) and one when she was an older adult (at 67 years old). As Peters is aware, her tale is partly about how psychoanalysis evolved between those times.

Peters’ first analysis is with Lane, a Freudian, whom she never got to know well. Peters felt comfortable with Lane because of their shared ethnicity as New York Jews. The reason Peters sought out therapy was because she had “nightmares and black despair.” Therapy helps, but Peters informs us that they never discussed their relationship or the analysis itself. She describes their work together rather blandly as “a memoir of an analysis.” It is surprising to hear how little attention was paid to transference; the analyst’s interpretations were paramount.

Peters credits Lane with helping her to identify defining moments of childhood and providing “comfort, understanding and interpretation” (p.58). Lane encourages Peters to recall what she remembers about her father’s premature death from colon cancer, and to come to terms with her difficult relationship with her narcissistic mother. It dawns on Peters that her mother is repelled by her because she associates her with her husband’s death.

During this analysis, Peters is in a relationship with a woman, and when she reveals this to her mother, her mother vows never to see her again— but then calls her after two weeks. Peters was previously married to a man whom she describes as more like a brother and subsequently marries a man who is an unlikely partner (she is bohemian; he is straight); but they remain together and have a lasting relationship. During this analysis, Peters is seeking to find herself professionally—at first, teaching at Middlebury and then more happily at CCNY and at Rutgers. The analysis benefited her by supplying the maternal love that she lacked, but much remained unresolved.

At the time of her second analysis, Peters has moved to California and retired. She has found a love of hiking. She is struggling to write a book. Her adopted daughter lives nearby. She decides to seek out therapy primarily because of issues with her daughter. Her consultations with problem-solving therapists do not go well. So, she decides to look up a local psychoanalyst, and finds Kristi. She chooses her because Kristi has a stated interest in spirituality, which Peters figures might be a good fit with her Zen practice.

Naturally, Peters has the expectation that her analysis with Kristi would resemble her previous treatment. At the end of a productive session, Peters announces that “You did your work and I did mine” (p. 97). Peters cannot entertain the possibility of a we (or what has been identified in the psychoanalytic literature as the third). Peters also faces painful moments with Kristi and is surprised when Kristi apologizes and explains how she had misjudged Peters’ emotions. Kristi introduces Peters to the idea of rupture and repair, a defining feature of therapeutic relationships. Indeed, it begins to occur to Peters that Kristi’s practice is fundamentally about working on and working through their relationship.

Over time, Peters discerns that Kristi’s approach to psychoanalysis suits her. Kristi goes beyond the call of duty in paying home visits during the pandemic. In a touching gesture, after Peters must flee her home because of surrounding fires, Kristi drops by the feed the chickens. Peters tells us that this led to a new level of connection between them. It is hard to know if Kristi had such casual boundaries with all her patients. We learn that Peters was Kristi’s last analytic case. In any event, it seems that what occurred were boundary crossings, not boundary violations.

What is crucial is their relationship and their mutual effort to understand it. Peters realizes that her first analysis had a one- person perspective. Kristi is self-revealing, but also introduces Peters to attachment theory, where infants are dependent and rely upon being nurtured by their caregivers. Peters perceives that Kristi is drawn to her in a way that her mother was not. Peters reports traumatic memories that she had not told Lane, like her nose job, bursting out in tears during the session.

Peters observes that Kristi helped to untangle her feelings (note the title of the memoir). She emphasizes how her emotions were aroused as she recalled memories, surpassing the insights she had with Lane. When Kristi must relocate because of her husband’s health, Peters experiences “analytic grief.” Kristi understands her disappointment, observing that it is a quality of all human relationships. Peters reflects on what she has received from psychoanalysis in comparison to Zen and psilocybin (and also EMDR and somatic therapy): that it is the most transformative but also the most laborious (p.147). Peters values the work she has done with Krist, analogizing herself to an injured bird nursed to health (p. 186).

Kristi’s Afterward to Peters’ memoir makes this book unique. Kristi recounts her first impression of Peters, and her realization that this case would be a more challenging than she first assumed. Kristi appreciates the traumas in Peters’ early life, the death of her father and her mother’s lack of being loving. She emphasizes how arduous it is to contend with transference. Kristi is cautious about what she reveals about Peters but informs us that she was the hardest working patient she had.

Kristi understands psychoanalysis as providing the opportunity “to regress, reexperience and connect with long buried feelings and memories” (p. 190). Despite their ostensive differences in identity—Kristi is a practicing Christian who comes from the Midwest—they work out a collaborative relationship. Kristi explains that she is a relational psychoanalyst who is willing to recognize that she, too, has an unconscious which shows up in the dynamic between them. She has an optimistic take on psychoanalysis: “if we can think it, we can heal it” (p,193). Her generosity to Peters during their work together and in writing the Afterward creates a mutual love, which is inspiring to encounter.

The two memoirs by Mardou and Peters at first glance could not be more different. Mardou is hesitant about talk therapy and warms to IFS; Peters logs years in psychoanalysis. Therapy is culturally alien for Mardou in a way that it is not for Peters. Mardou’s saga has more dramatic trauma than Peters; yet, it ought to be said that comparing traumas is an ugly business. We might note that both experienced the loss of their fathers, but both are fortunate to have supportive husbands (and happy marriages). Both Mardou and Peters depict their therapists in detail, and both become highly motivated patients, passionate enough to write memoirs about how therapy altered their lives.

How far would Trump be willing to go in following RFK Jr.’s lead in pursuing the MAHA agenda for American healthcare? We no longer need to wait for some answers to this question. At their press conference together on September 22, Trump endorsed and even embellished RFK Jr’s belief that autism can be caused by acetaminophen, the active ingredient in Tylenol, which is unsupported by current evidence, and then adding fuel to the fire by patronizingly warning pregnant women from taking the drug (see Arwa Mahdawi’s enlightening piece on this as consistent with Trump’s patriarchal attitude to women: https://www.theguardian.com/commentisfree/2025/sep/27/trump-tylenol-sexism-tough-it-out). Trump also touted the cancer drug, leucovorin, as a cure for autism, vastly overstating what we know about its potential benefit.

On the one hand, there is nothing very surprising about this, as Trump has long been preoccupied with autism (he sponsored a fundraiser in 2007 at Mar-a-Lago for the advocacy group Autism Speaks), has voiced his own bizarre ideas about vaccines, and, no doubt, is happy to join RFK Jr in disparaging scientific knowledge and expertise. On the other hand, it is doubtful that Trump fully endorses RFK’s anti-corporate stance or that he would be inclined to share the glory of MAHA. Never mind just the Nobel Peace Prize—why not the Nobel Prize in Medicine too? Although Trump invited RFK Jr to “go wild” with healthcare before the election, it remains far from clear how sustainable their bromance will be. This is not meant, however, to underestimate the combustibility that their partnership portends.

Any mental health professional who has encountered patients with autism knows how widely divergent their presentations can be. Trump opts to focus on more profound cases, conveying his sense of the awfulness of autism, echoing favorite themes of RFK. As a counterpoint, I happened upon an interview with Simon Baron-Cohen, a well-known expert on autism who is a clinical psychologist, Professor of Developmental Psychopathology, and Director of the Autism Research Centre at Cambridge University, on Anand Giridharadas’ podcast, The Ink:

The.Ink

An actual autism expert speaks

President Trump and Health Secretary Robert F. Kennedy, Jr., are once again talking about autism, playing up unproven connections and spreading fear without basis…

Listen now

4 months ago · 174 likes · 32 comments · The Ink

Baron-Cohen begins by emphasizing both how greatly the category of autism varies as well as how much our understanding has changed over time. There have been several, recent pieces, prompted by Trump’s news conference, on the import of our evolving understanding of autism through the last few decades: for example, a moving personal and historical reflection by the cultural anthropologist Roy Richard Grinker whose daughter is autistic, although he did not know that when she was young, given the state of diagnosis at that time (https://www.nytimes.com/2025/09/24/opinion/autism-rates-science-diagnosis-parent.html?unlocked_article_code=1.oU8.HHrO.Nh7Os-H_Swpe&smid=nytcore-ios-share&referringSource=articleShare), and a more philosophical, ]but also personal piece by Matthew Yglesias in his Slow Boring newsletter, where he poses vital questions about where research should be heading, given what we have learned from the past, like whether and how shifts in diagnostic criteria can be translated into clinical work.

Slow Boring

The dangerous war on Tylenol

I spoke with someone earlier this week who is optimistic that the Trump administration is going to reform the clinical trial process in ways that should make it cheaper …

Read more

4 months ago · 318 likes · 393 comments · Matthew Yglesias

Baron-Cohen implicitly moves in a corrective direction in seeking to make the public aware of high functioning autistic people, like Elon Musk and Bill Gates, and the conversation turns to include discussion of the representation of autism in the field of high tech—for example, in Eindhoven, a city and center of technology in Holland, where the rate of autism is twice as high as in the overall Dutch population. My point, though, is not simply to contrast Trump and RFK to Baron-Cohen in terms of the kinds of autistic people who grab their attention.

There is an important difference in the respect that Baron-Cohen expresses for the strengths of neurodiverse people. Baron-Cohen’s research distinguishes the cognitive styles of neurodiverse people who like and are good at systemizing and neurotypical people who warm to and excel at empathy. His actual theory is more complex and enumerates various ratios of how empaths and systemizers can be combined. In this interview, Baron-Cohen strives to capture the social investment that neurotypicals value, compared to systemizers who are people attracted to follow “if-and-then patterns or rules” and to understand how things work. The interpretation of people with autism as lacking in empathy is not universally accepted (it is disputed by Rhiannon Lucy Cosslett: https://www.theguardian.com/commentisfree/2025/sep/28/autistic-people-donald-trump-autism-us-president-rfk-jr).

I have questions about the category of empaths, as this seems to characterize an emotional style as much as a cognitive style.[i] And I don’t really want to go down this rabbit hole, but if Trump is clearly not a systemizer, do we need to infer that he is an empath? It must be the case that one can lack empathy, and yet not be a systemizer. In fact, Baron-Cohen has written about making sense of human cruelty as an extreme lack of empathy.[ii] As a further aside, Baron-Cohen stays away from what have been his more controversial views about sex differences in autism (It is unclear whether this is the choice of the interviewer or the interviewee).

The argument at the heart of Baron-Cohen’s view is that neuro-typicals should strive to refrain from bias, overvaluing their style, and thereby overlooking how much systemizers have contributed to society. This is a humane, non-pathologizing stance. Indeed, there has been an outpouring of concerned responses, with different emphases, from prominent organizations like the World Health Organization (https://www.who.int/news/item/24-09-2025-who-statement-on-autism-related-issues[), th[e American College of Obstetricians and Gynecologists ([h[ttps://www.acog.org/news/news-releases/2025/09/acog-affirms-safety-benefits-ace[taminophen-pregnancy), the American Psychiatric Association (htt[ps://www.psychiatry.org/news-room/news-releases/apa-statement-on-white-house-announcement-on-autis), and the American Psychological Association

[https://updates.apaservices.org/autism

The statement from the World Health Organization addresses itself to women, encouraging them to listen to their doctors over the government’s recommendations. It also pointedly notes that vaccines have saved 154 million lives over the last 50 years.[iii] The Statement from the College of Obstetricians and Gynecologists, by the President of the organization, Dr. Steven J. Fleishman criticizes the government’s recommendations as failing to understand research standards, and he makes an excellent ethical and clinical point in worrying about the heightened risk that results from withholding acetaminophen from pregnant women. The statement from the American Psychiatric Association does not specifically address women’s health; but it does dispute the claims about acetaminophen and leucovorin, and stresses the importance of evidence-based research. This statement invokes the spectrum of neurodiversity, ]affirming the importance of diagnosis.

The statement from the American Psychological Association is bold— indicated by its title, Addressing Recent Misinformation about Autism (The APA also published a hard-hitting article ((https://www.apa.org/monitor/2025/09/advocate-autism-wave-misinformation), which bears the title, Correcting Misinformation about Autism, expressing concerns about stigma, surveillance, and the undermining of standard care. It is expanded from an article originally published in May). Cleverly, perhaps, the APA statement dwells on the views of RFK, not mentioning Trump. It disputes the claims about acetaminophen and leucovorin, and it pays particular attention to ways that RFK Jr. has fostered stereotypes about autistic people. The statement also lays out a well-articulated set of commitments: to champion neurodiversity, promote comprehensive science-based research agenda, prioritize accessible, effective services and supports, uphold rigorous standards for research and communication, actively counter misinformation and stigma, and foster collaboration with the autism community. Recognizing the issue of communication strikes me as especially critical, now that the administration is seeking greater control of the airwaves. Recognizing the importance of the autism community is a compelling aspirational step for a professional organization to adopt.

Many of my newsletters have a take home message, but not this one: we have barely scratched the surface around the issues pertaining to autism. It seems clear, however, that the stance of the current administration is indefensible, not to mention embarrassing, imprudent, and likely to cause harm. In closing, I would like to honor the way people with autism (and their families (see https://www.washingtonpost.com/parenting/2025/09/27/autism-community-reacts-trump/) have taken the lead, protesting and fighting back against stigma, and challenging what the term “autistic” means and whether it is a disorder. It is inspiring for people—regardless of their status or identity—to be able to self-defining and to contribute to the ongoing pursuit of knowledge. People who are autistic have pushed us to entertain old but unsettled questions about the boundaries between the normal and the pathological. Progress will not be made without heeding their voices.

[i] Baron-Cohen distinguishes between affective and cognitive empathy, where the former is the ability to have appropriate emotions in response to others, and the latter is the ability to understand the thoughts of other’s (putting yourself in the shoes of others). I am not sure why affective empathy would have to be appropriate; cognitive empathy seems similar to mentalizing.

[ii] S. Baron-Cohen (2012). Zero Degrees of Empathy. Penguin.

[iii] Trump has announced that the US will not support WHO, and RFK Jr echoed criticism of WHO at the UN because of its support for abortion and “radical gender ideology” (https://www.nytimes.com/2025/09/25/health/rfk-jr-un-chronic-disease.html).

On the political stage, it is evident that we must be prepared to wage battle against authoritarianism; otherwise, we risk being dominated and exploited further. This can take us down paths that potentially threaten and/or compromise our values—fighting fire with fire, is the partisan redistricting effort in California as a retaliation for what was done first in Texas the right path? I am not sure, but Governor Gavin Newsom’s emulations of our fearless leader certainly are attention-getting and amusing. In politics, the option of remaining above the fray is never so realistic. But what about maintaining intellectual integrity? How shall we manage not to harm ourselves during this maddening period?

Here's an example, where the issue of intellectual integrity came up for me: as mentioned in previous newsletters, I am completing a book about memoirs that discuss therapy. It turns out that almost all the memoirs that I have been excited to write about are psychoanalytic. In one sense, this might sound surprising, given that psychoanalysis has become less popular these days, and has led me to a heightened appreciation of the importance of giving ourselves over to what actual patients say about their actual experience; in another sense, I was unsurprised in that narrative understanding of early life development and its relation to the present is a shared value between memoir and psychoanalysis. Both memoir and psychoanalysis are about the lives of a whole persons.

The psychoanalytic memoirs document how psychoanalysis has evolved throughout its history. The two memoirs of Lucy Freeman (1951, 1989) are fascinating in documenting how psychoanalysis was conducted in the 1940s onward: the analyst maintains neutrality, is not above homophobia, and wishes that the patient had been disciplined physically.[i] There is no parent blaming, however, and, in fact, Freeman becomes more empathic toward her parents’ failures. Most importantly, Freeman understands her life to be transformed for the better by psychoanalysis.

Other memoirs that regard psychoanalysis as transformative are Ellen Saks (2007) and Alison Bechdel (2012).[ii] Bechdel offers the most detailed account of her work with two therapists, and it includes her own intellectual engagement with the idealized parental figures of Donald Winnicott and Virginia Woolf. For Bechdel, falling in love with psychoanalysis motivates her to work through her relationship to her mother and to carry out the project of writing a graphic art memoir.

There are two quite recent memoirs by Stephanie Foo (2022) and Joan Peters (2024) that are crucial to mention.[iii] Foo has 10 previous therapists of one kind or other before finding a relational analyst with whom she connects. It is not a conventional analysis, as they audio record the sessions, and both review and discuss them. It is extraordinary to hear Foo’s impression that she is better able to hear what her analyst says with the added measure of distance.

Peters’ memoir describes her two analyses, both of which are positive, but the second one is absorbing to a greater degree. Peters experiences transference on a deeper level, sometimes in a scarier, regressive way. Her second analyst is relational and readily acknowledges the role of her own countertransference. Moreover, this analyst writes a truly beautiful afterward about the work they did together. Peters’ memoir captures how psychoanalysis has changed over time. Both memoirs highlight the patient’s attachment to the analyst but also how the analyst has come to define his/her role as part of the experience, aiding the patient to become immersed in a richer way. Psychoanalysis shines in these memoirs. although in my book, I do take account of other cases, where the experience was equivocal or even negative.

For a long time, I had trouble locating memoirs from other orientations, especially CBT. There are many self-help books from a CBT perspective, but these are a different kind of animal from memoir. To be honest, I also recognized in myself a disinclination to undertake more of a search for CBT memoirs. However, I decided that I needed to look harder which seemed like the better choice, deriving in part a from my background in philosophy. The obligation to recognize and take account of the views of others fairly and accurately is taken more seriously in philosophy than in psychology. I have also been motivated by wanting to write a book based on arguments, not ideology.

I found three noteworthy memoirs that feature or at least include CBT. The first one is by Daniel Smith, which focuses on his long history of anxiety, but also grapples with sexual trauma, his father’s premature death at from cancer, and his preoccupied relationship with his mother.[iv] His mother is a therapist, so it is only natural that Smith is sent to therapy; he eventually accumulates 6 therapists, before meeting Brian, a new therapist. Talk therapy, breathing exercises, and medication help Smith, but not so much. Smith understands this in terms of the cerebral anxiety to which he is prone.

With Brian, things were different, as Smith learned to pay attention to “the subconscious chatter” in his mind. Smith likes how prescriptive Brian is, specifically recommending “a trick” (that is, an exposure technique) that proved useful during anxious moments: “Bring it on! Lemme see what you got” (p. 210). Smith comes to realize that Brian is a cognitive therapist; he bonds with him, and their relationship is key to its success. Smith also notes his appreciation of Aaron Beck’s distinction between fear as the appraisal of danger and anxiety is the unpleasant feeling evoked when fear is stimulated (p. 125). Although Smith acknowledges a wish to be cured of his anxiety, he ultimately realizes that this is not possible. He has a wonderful sense of humor, a sustaining quality that allows him to endure his chronic anxiety.

The second book is by Linda Gask, a psychiatrist, who juxtaposes the saga of her own history of depression with her work with a variety of patients.[v] It is a lovely, courageous and honest book. I found it especially moving that she reflects on cases that did not fare well, including a suicide. Gask makes good use of talk therapy, as she becomes more aware of her father’s physical and emotional abuse while growing up, which was made more painful by his death which occurred at a time when she felt alienated from him. Gask understands that the past can play out in devious and harmful ways. Yet, she also appreciates that therapy needs to provide relief, venturing the suggestion that different therapies can be valuable at different points in time. She decides to give CBT a try and is pleased to find that her therapist is respectful about the work she did in her psychodynamic therapy, even if, she informs us, that in their work together, he is uninterested in her past history. Gask’s experience in CBT seems a bit tepid, but it is portrayed as beneficial to her.

The third memoir is by Mat Gutman is an intense read about a successful TV journalist who is game to try any and all forms of therapies, hoping to overcome his panic attacks.[vi] Gutman experienced an early loss, whose father died in his 40s in a plane crash. Smith turns to CBT to help with his panic attacks and acknowledges that while it might be the gold standard treatment, he did not feel committed to it. Ultimately, he turns to other kinds of therapy—ayahuasca, and then to psylocibin and ketamine. Desperate to be fixed, Gutman propels himself to keep trying new treatments. It’s hard to tell where he lands by the end of the memoir. He is clear about expressing that talk therapy was not enough for him, a refrain that one hears more often these days. A conclusion from Gutman’s memoir is that it can be hard to find the right therapist.

So, what did I learn from my effort to read CBT memoirs? The impact of CBT is positive, but it does not produce the kind of transformation as represented in the psychoanalytic memoirs I have mentioned. CBT formulates and adopts pragmatic goals and staying within such defined aims. Gask’s insight that different treatments are appropriate at different times seems apt. It is not surprising that Smith and Gutman look to CBT to gain tools to deal with anxiety. It is interesting, and not something I realized until writing, that in all three memoirs, the father dies prematurely (especially with Smith and Gutman). History matters, even if that is not an emphasis in the therapy.

Taking account of CBT memoirs has shifted my perception as the benefit of the work is apparent. By now, it should be obvious that the animosity from the therapy wars in the last quarter of the 20^th century were unproductive and arguably hurt psychotherapy as an institution. I am not weighing in here as Mr. Moderation, as I believe that CBT was crafted, less through the noble love of science, than by the wish to thrive by collaborating with the immense power of the insurance industry. Yes, there is a wealth of empirical support for CBT. Such research is necessary, but the kind of research that is now most needed provides more thinking and better argumentation. Underlying that is intellectual integrity. Without intellectual integrity, we will continue to drift and find ourselves on the defensive.

Back to politics: even if we are committed to intellectual integrity, how is that going to help us deal with bullies, crooks and authoritarians? Not an easy problem. There is nothing wrong with fighting to win. When our survival is at stake, there may not be time to fuss over one’s values. But when there is liberty to choose how to act, remaining true to one’s values can be a saving grace. It can save us from moral self-injury, from the discordant, internal sense of having abandoned what one holds dear. The wind blows across self-states, even when we are not able to stand in the spaces.

[i] L. Freeman’s (1951) Fight Against Fear and The Beloved Prison (1989).

[ii] E. Saks’ (2007) The Center Cannot Hold, and A. Bechdel’s (2012) Are You My Mother?

[iii] S. Foo’s (2022) What My Bones Know and J. Peters’ (2024) Untangling.

[iv] D. Smith’s (2012) Monkey Mind.

[v] L. Gask’s (2015) The Other Side of Silence.

[vi] M. Gutman’s (2023). No Time to Panic.