Should You Leave? by Peter D. Kramer

From the Publisher

In his phenomenal bestseller Listening to Prozac, Peter Kramer explored the makeup of the modern self. Now, in his superbly written new book, he focuses his intelligent, compassionate eye on the complexities of partnerships and why intimacy is so difficult for us. With the art of a novelist and the skill of a brilliant psychiatrist, Kramer addresses advice seekers struggling with such complex questions as: How do we choose our partners? How well do we know them? How do mood states affect our assessment of them and theirs of us? What does "working on a relationship" truly entail? When should we try to improve a relationship, and when should we leave? Equally at home with Shakespeare, Emerson, and Kierkegaard as it is with Freud and Jung, Should You Leave? is a literary tour de force from a uniquely insightful observer and a profoundly resonant and helpful approach to resolving dilemmas of the heart.

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• Reading Group Guide

Reading Group Guide

INTRODUCTION

"When a psychiatrist writes a bestseller, he is then urged to write a book of advice. But I think our culture's awash in advice. The problem is we don't know whether it applies to us or whether we're an exception."
-- Peter D. Kramer, from an interview with the Detroit News

In Should You Leave? Dr. Peter Kramer explains why therapists often refuse to give patients answers to questions. In contrast to the self-help books that crowd the shelves, Should You Leave? questions the very existence of objective advice -- for giver and receiver. What masquerades as advice, he argues, is often little more than a general transmission of values. Real advice can begin only with a thorough understanding of the individual advice seeker, who may or may not share the same values or belief system as the adviser.

In what he describes as "a hybrid of fiction, non-fiction, and self-help," he spotlights a wide range of fictional patients -- all close to breaking up with their partners -- from a kaleidoscopic series of viewpoints, speaking simply to "you," the composite patient. Whether any of these individuals should leave is no easy question.

First, the variables of personality and the dynamics of relationships and circumstances invite an endless array of interpretations, scenarios, and solutions (just as in the best of fiction, which Kramer calls "the most serious attempt to understand the human condition").

Second, the entire concept of relationships is rooted in an interplay between values of self and other. To this debate, filtered through his fictional mentor, "Lou," Dr. Kramer introduces major perspectives from philosophy and clinical psychiatric thought. They range from Freud's theories of the early family to Murray Bowen's championship of individualism in context; and from Leston Havens's pathology of possessor and possessed to Martin Buber's view of personhood as indivisible from relationship. Each patient in Should You Leave? can be viewed through the lens of one or more of these theories.

Iris, a self-made and flamboyant editor, is confronted with a cruel betrayal by Randall, whom she feels to be her ideal partner. To stay would be, according to Ivan Boszormenyi-Nagy's "relational ethics," investing in a love with no payback. Murray Bowen would want Iris to assert her autonomy. Jean Baker Miller, with her stress on "relational awareness," might see the strength of Iris's attachment as a greater personal and social good. Whereas Kramer wonders if she might translate her autonomy skills in business into a relationship with Randall that could foster similar growth in him.

Rose, a feisty but nurturing Irishwoman, and Abie, a Jew of Mediterranean heritage, have fed into their ethnic stereotypes of each other. To Melanie Klein or Henry Dicks, the pioneer of couple therapy, their "mutual projective identification" is cause for a breakup. But Kramer speculates on a cluster of factors: on the real balance of power in the relationship; on whether Rose could leave if the courts denied her child custody; on whether she will settle for staying because Abie, though violent, is the best deal she's yet found in a man.

From these psychiatric masters, and writers from Shakespeare and Ralph Waldo Emerson to James Joyce and John Updike -- even from a cultural about-face by Ann Landers -- Should You Leave? draws lessons on the importance of everyday detail and "selective inattention," emotional maturity in the context of conflicting ideals, and how to distinguish a truly independent self from its manifestation in a relationship. Kramer moves us beyond a simplistic "Mars and Venus" image of men and women toward a more subtle review of the intricacies of communication in general. How do mood states -- including, so often, depression -- affect our assessment of each other? What does "working on a relationship" entail? When should we work to improve a relationship, and when should we walk away?

Ultimately, this book places the personal balancing act of autonomy, connection, and community in a larger context. It also challenges conventional ideas of intimacy: Has our culture miscast marriage as an entitlement to happiness? Are gender differences an intrinsic roadblock toward intimacy? How far will personal growth go toward saving and transforming a relationship? Can our society, in fact, survive with autonomy as its ideal -- or are we overripe for a return to connectedness and contractual responsibility?

Should you leave? In the end, concludes Dr. Kramer, the only valid advice will be found in a garment woven from threads explored in this book -- tailored exclusively to each one of us.

ABOUT PETER D. KRAMER

Peter D. Kramer received his M.D. from Harvard. A clinical professor of psychiatry at Brown University, he has a private practice in Providence, Rhode Island. He is the author of Moments of Engagement: Intimate Psychotherapy in a Technological Age and the landmark bestseller Listening to Prozac. His writings have appeared in The New York Times, The Washington Post, and other national publications.

A TALK WITH PETER D. KRAMER, M.D.

Q: In Should You Leave?, you not only take a therapeutic "fictive attitude" to cases, but build them around entirely fictional protagonists. And you say the classic psychoanalytic theorists "are no more useful than Tolstoy, Dickens, Balzac, Thomas Hardy, George Eliot." What are some specific examples from those, or other writers?

A: Should You Leave? is, among other things, a tribute to the mid-century psychotherapists whose work is implicit in my own. They are men and women whose ideas, often in overly simple form, serve as the basis for much popular self-help -- I mean Helmuth Kaiser, Henry Dicks, Murray Bowen, and other thinkers to whose writings I refer when imagining responses to someone who might come to me for counsel. These theorists are largely forgotten; my hope is to bring them back into our consciousness, so that we can consider their contribution in fuller form. But I do not want readers to face their work uncritically. These thinkers are brilliant but capable of foolishness or error. In the end, a therapy is a perspective on the human condition, often an autobiographical perspective, though the function of therapy, for patient and theoretician alike, is to transcend autobiography, to escape an overly limited viewpoint.

Seen in this way, psychotherapy is like fiction -- an attempt to make sense of the social surround and the individual story in that surround. I doubt that therapists can make the claim to be wiser than novelists.

Certainly the self-help books that arise from therapy seem less wise. Consider this thought experiment. In the midst of a complex life, you face a dilemma. You have before you two piles of books, one of self-help and one of literary novels. In which stack is your story in all its painful detail more likely to be represented? The self-help books may have more direct advice, they may offer relief of that sort. But they are likely to frustrate you because they lack the subtlety and ambiguity of life as you experience it.

I am not thinking only of dusty classics. I happened just now to read an early Edna O'Brien novel, Girl with Green Eyes. The protagonist is a young woman, a self-educated and sexually naive working girl, who is eager for a liaison with a wealthy, cosmopolitan, older married man. The affair can only be disastrous -- no book of advice would encourage it, and as readers we are continually made anxious over the girl's well-being. The affair does end, and the young woman suffers. But she has the resilience to make the experience the basis for her entry into adult intellectual life. Social experiences are like that. They are not lived by just anyone, but by individuals with particular strengths. And they do not have one outcome -- success or failure -- but multiple ramifications.

The function of the novel, in additon to amusement, is to remind us of ambiguity, ambivalence, variety of viewpoint. Facing the notion that I might write a self-help book, I decided that my way of making it correspond to a serious understanding of relationships would be to draw on techniques of contemporary fiction, in the belief that the fiction of our time represents the reality of our time as well as it can be represented in written narrative. I hope that these techniques draw the reader into imagined dilemmas and allow readers to pick up tools (such as the perspectives of Kaiser, Dicks, Bowen, and others) in a sufficiently complex context.

I also like the idea of stuffing this advice book with fictions, because I think we come to know others through the "fictive attitude," in the sense of doubting what others say to us and instead creating stories that may predict future behavior. Images of others are creative acts. Relationships are creative acts. Q: What special value did a second-person narrative have for you, here, and what works by other authors drew you to this literary device? A: I like second-person fiction -- for example the short stories of Lorrie Moore in her collection Self-Help -- because it is at once personal and strange. When a protagonist is "you" ("All you want is a simple piece of advice"), the reader is being addressed intimately. At the same time, the reader knows that he or she is not Iris, enmeshed with Randall, so that the narrative retains a constant element of oddness. The final effect, I hope, is one of inviting the reader to try each vignette on for size while causing the reader to maintain a critical distance -- perhaps oscillating between merger and autonomy just as people do in relationships.

Altogether, I wanted the book to have a quality I call (using a psychiatric term) "enactment" -- I wanted to have the reader in the course of reading feel, in relation to the narrative, something of what each partner feels in a relationship. At the heart of the book is the theme of transparency and opacity. We know others in an instant, and yet after years of marriage important aspects of our partner may remain hidden. My hope is that the use of the second person enacts that theme.

I liked the second person for other reasons: It reflects the experience of receiving advice, which is often given in the second person. The second person is often the language of self-help books. I wanted to use elements of that genre while at the same time suggesting the virtues of a quite different sort of writing, namely contemporary fiction -- as if to say to the reader, we both know that this is what it is like to face an impasse in a relationship. It is complex in this way.

The second person is not the only technique of modern writing that shapes Should You Leave? Since my mentor, Lou, is a fictional character, the short stories attributed to Lou, in the collection "Pieces of Resistance," do not exist outside the text of Should You Leave? The précis of Connie's story ("You Will Be Fine . . .") is the story; Connie's is a story told in the form of a critique of a story. I want for this method, difficult as it may sound in this description, to be unobtrusive in the book. The narrative should make sense on its own terms even as it dawns on the reader that Lou must surely be fic- tional and that these mid-century short stories must be reevaluated as contemporary stories.

And then there is the matter of Lou's gender. I suppose that initially most readers will assume that Lou is male. But soon I make mention of Freud's female colleague, Lou Andreas-Salomé. And it becomes apparent that our Lou, Lou Adler, has some stereotypically female traits. Lou is flirtatious. Lou is not the primary breadwinner. Lou is the cook in the couple. There may even be the rare reader who, thinking back to my first book, Moments of Engagement, recalls that my most influential mentor-in-residence was a woman. And then there are the references throughout Should You Leave? to gender ambiguity, as in "You Will Be Fine . . ." and in the vignette of Francis and Frances, and in the discussion of Phyllis Rose's book, Parallel Lives. So who knows? Who knows whether Lou, Terry, and Leslie are men or women? And does it matter? In a time dominated by self-help based on an almost obsessive attention to gender role (Mars and Venus, etc.), I thought I might make a quiet contribution by crafting advice for fictional spouses -- Lou and Terry -- whose gender is never specified. Does it matter? Would we see the marriage differently depending on the assignment or mix of genders? Does the issue of leaving always turn on gender?

Q: Is there a type of patient you find particularly intriguing, one that drew you into the issues of both Should You Leave? and Listening to Prozac?

A: I think that this culture is particularly rough on people who are sensitive, loyal, perfectionistic, and unassertive. Such people -- I might say that they have elements of the melancholic temperament -- have (or end up with) minor mood disorders. They tend to be troubled by anxiety, depression, and obsessionality. And often they have troubles in relationships, because they value continuity and complexity so highly, in a nation that all but encourages divorce. By the standards of our society, they stay too long and give too much. My patients are often people of this sort, and I care about them. They want (like Iris, like so many of the characters in Should You Leave?) to be exceptions -- to resist the appeal in a materialist country of the next best chance.

In some regards Should You Leave? and Listening to Prozac are about the same topic, happiness. Both books ask about alternatives to the standard approach to happiness in a culture where assertiveness and autonomy are rewarded, happiness in a culture in which pleasure has been commodified. Both Prozac and divorce have their role, either can be life-saving. But I want to ask also whether there is, or should be, a role for the slow and imperfect fix, a role for relationship as a value.

Q: How significant is interaction between mood disturbance, especially depression, and emotional intimacy?

A: Crucially significant. The middle chapters in Should You Leave? all concern this issue. When does a bad relationship cause depression, and when does depression cause a relationship to fail -- or to appear failed in the eyes of the depressed partner? Epidemiological studies show that mood disorder is likely to be a factor in any troubled relationship. Though depression is rarely a topic in books about troubled couples, on a statistical basis, in failing relationships the odds are that one or both partners are depressed now or were depressed when they entered the relationship. Whether or not the relationship contributes to the mood disorder, I would like to see the affected partner treated before he or she makes a decision about leaving. Again, the issue is one of perspective. Depression entails a constrained perspective.

Q: One technique you suggest, as part of relationship change, is "rotating the self." Could you expand on this?

A: I am referring to a phrase of Kierkegaard's -- the "rotation method" -- that has been picked up by psychiatry. Therapists may accuse patients, and I think "accuse" is the word, of rotating partners, or using the "geographic cure," that is, of leaving, instead of staying and confronting problems. I try to make sense of what Kierkegaard recommended, treating oneself as a field in which the crop is rotated, that is, experimenting with staying put and changing the self. What constitutes change (in terms of a person's capacities in relationships) and how might you attempt to change? That question, the meaning of change, is another theme of the book.

Q: Almost all the couples in Should You Leave? are childless. When it comes to leaving, you remark that "I tend to worry that divorce and remarriage will provide a child with four undeveloped parents instead of two." How would your evaluation of these cases, or others, be modified by the existence of children?

A: The presence of children in the family usually creates a presumption in favor of trying to make the marriage work -- often so strong a presumption as to overshadow the sorts of issues that otherwise dominate between partners: matching, projection, fairness, and the like. Those same tensions do play themselves out in couples with children -- I hope parents contemplating divorce will find Should You Leave? useful -- but paying attention to them becomes harder.

Most of the cases in Should You Leave? are "close calls," at least I meant for them to be, and taking children into account would tend to tip the scale strongly in one direction or another. I doubt I would be content to see Sandy leave Mark (in the chapter "Unequivocal Eye") if a marriage with children were at issue. In the cases of psychological abuse ("Simple Gifts"), I would be quick and direct in urging separation if I believed children were being harmed within the marriage.

In my vignettes, I imagined childless couples or couples with grown children -- and couples where other factors, such as finances, do not affect the decision to stay or go -- because I wanted to get to the heart of relationship as relationship. I hope that this intensity of focus finally makes the book a social commentary -- a commentary on this culture's values, what we sustain. Can we care about such oddities as commitment, intimacy, complexity, time together? Can we grant reality to the space between people? Can we think of a relationship as an entity, with its own interests, as separate from the interests of each participant? Do we honor connection, or only autonomy?

DISCUSSION QUESTIONS

1. "When I read a self-help precept," says Dr. Kramer, "invariably I think that the opposite advice might be equally apt, for someone." Has his concept of targeted advice, and multiple perspectives, made this book of value to you?
2. How have you found Should You Leave? different from typical self-help books on relationship problems? What insights have you gained from its unique approach?
3. Does its ambiguous use of second-person narrative clarify its message? How does that technique reflect the intimacy and tensions of relationships?
4. In illustrating some of his points, Dr. Kramer refers to Anna Karenina, King Lear, and the Bible. Do you agree that a response to fiction can be more useful than a list of precepts? What works of fiction have produced that sort of response in you?
5. Do you feel a clash between autonomy and connection? Are women really more connected than men? Was the psychiatrist Murray Bowen, as recounted in Should You Leave?, right to manipulate his family to achieve both?
6. Is connection just an avoidance of selfhood, as some say, or is America blinded by its ongoing romance with autonomy? How should we, in this day and age, rate the Emersonian ideal of auton-omy and the self-reliant individual? Or the "me first" revolution of the past decades? How has feminism balanced the tension between independence and attachment? How do you, or others you know, manage it -- or are the two mutually exclusive?
7. Is it possible to talk about things that are good for a relationship as opposed to what is good and bad for the people involved in it? Is a relationship an entity?
8. Dr. Kramer quotes the feminist Katha Pollitt's remark that "men are from Illinois and women are from Indiana," and adds: "They are different, but not in especially confusing ways...they are adapted to cope with one another." Do you agree? How much does gender matter; and what does the story of Connie in Should You Leave? tell us about it? Does "Lou" gain power and meaning from being genderless?
9. Which "patients" in the book do you identify with most? Why?
10. Dr. Kramer writes about the complexities, and different styles, of relationships between therapist and clients. What has been your experience of these?
11. In the story of Melanie, Dr. Kramer questions Martin Buber's position that "objective entitlement," or justice, exists within a relationship. What do you think?
12. Are you well-matched with your spouse? If not, why not? What is "matching"? What is growing together? Is either of you depressed; and how could this have a negative, or even a positive, effect on events?
13. Does Dr. Kramer's description of "re-entering the marriage" at a higher level of consciousness and detachment open the door to a spiritual evolution?