At that appointment, I half-lied about the voices. I heard voices, but they were all versions of my own voice or echoes of voices from my past. Those voices were not, I decided, the ones she was asking about. And I lied when I did not tell her about wanting to burn myself and the cook. I lied when I did not tell her about the door that had opened: The only solution is a permanent solution. My psychiatrist did not ask if there was a seismometer in my midbrain that warned of fissures that would widen into deep chasms and, eventually, into an all-consuming abyss. If she had asked about that, I might have answered honestly. It’s difficult to say.

Rather than clearly seeing what was wrong, and laying the responsibility on her parents, she had remained vague, telegraphing her pain to those around her while simultaneously taking the burden upon herself. “You had to shut yourself off,” I tell her. “To protect yourself, but also to protect your parents. You loved your father,” I reminded her. “His behavior didn’t make sense. You took it on yourself instead.

Jean had no doubts about who she was. Not only was she wrong to have written the forbidden prescriptions, she couldn’t even focus on her medical records. Nothing was working out the way she hoped. The fan in her life was definitely broken. Were I to focus

only on what was broken, I would be pulled into her suffering instead of pointing the way out. I wanted more uncertainty for Jean, more of that Zen doubt. Whatever conclusion she aggressively threw at me, I parried it back at her until we reached a truce. Surrender was Jean’s rhinoceros. It went against everything she thought.

As is evident in my write-ups, I do not model this sensibility by resting calmly in a meditative state while my patients free-associate. I engage actively. But I am very quiet inside when I am working; all of my concentration, all of my attention, goes to the person I am with. And I want to know everything, from the television shows they are watching to the food they are eating to their most dreadful thoughts and reflections. I believe in the power of awareness to heal. I want my patients to see how and when and where their egos, or superegos, are getting the

best of them, because I know that if and when they can see this clearly, something in them will release. And their best chance of seeing it comes when my mind is quiet. Somehow, my inner silence resonates in them and feeds their awareness. Each person is like a koan I cannot solve with my rational mind.

Lori Gottlieb worked as a TV scriptwriter, entered and then left med school, gave birth to a child, and got a job as a journalist, but she was dissatisfied. She wanted to make a

difference in people’s lives, not just write about them. She thought of becoming a

psychiatrist. But that’s mostly prescribing medication, she worried. One day, her former med school dean told her, “You should go to graduate school and get a degree in clinical psychology.” If you do that, the dean continued, you’ll be able to get to know your patients better. The work will be deeper and leave lasting benefits...

At a certain point in life, we have to find the career that we will devote ourselves to, the way we will make a difference in the world—whether it’s a job or parenting or something else entirely. While confronting this task, Erikson argues, a person must achieve career consolidation or experience drift...

Sébastien Bras is the owner of Le Suquet, a restaurant in Laguiole, France, that earned

three Michelin stars, the world’s highest culinary distinction, for eighteen consecutive years. Then one year he asked the Michelin folks to stopcoming to his restaurant and never come back again. He’d realized that his desire to please the Michelin system had imposed

tremendous pressure, crushing his creativity.