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"Gentle Into that Good Night"
By Charles B. Strozier
This final chapter in my biography of Heinz Kohut describes one of the most dramatic and moving events in his life. It was October 4, 1981, four days before his death from a decade-long battle with cancer. Kohut, in pain and with difficulty, pulled himself together to give an impressive talk on empathy at the fourth self psychology conference in Berkeley, California. He was exceedingly pale and thin but spoke for half an hour, extemporaneously as usual, drawing on themes from a lifetime of work but adding some important twists. It was at Berkeley that Kohut was most decisive in making his point that empathy with a patient, and empathy alone, heals. He adds, of course, that empathy cannot stand alone and that psychoanalysis consists of a unique blend of empathy and interpretation, even though interpretation itself might be understood as a higher form of empathy. At the end of the talk Kohut noted that he surely would not attend another self psychology conference and said goodbye to the audience of 500, all by then in tears, knowing it was the end of a life and of an era. That was a Sunday. Kohut returned to Chicago later that day, spent Monday at home but knew he had to go into the hospital on Tuesday. That was October 6. For the next two days he spent as much time as he could with his wife and called his son and friends, even wrote some letters as though he was clearing his desk. Late Wednesday he went into a coma and died peacefully early the following Thursday morning, October 8.
- Charles Strozier, PhD
Gentle Into that Good Night
Do not go gentle into that good night,
Old age should burn and rave at close of day;
Rage, rage against the dying of the light.
The Berkeley campus lecture hall was filled to capacity that Sunday morning in early October 1981. Some 400 people were seated, another 100 wandering in the aisles or outside on the plaza. It was a typically beautiful California day. The sun was warm, the grass still mostly green, the trees lush.
Excitement tinged with dread filled the air. It was the final day of the fourth annual conference on self psychology. There had been a pre-conference on Thursday for the uninitiated, then a full round of lectures and workshops on aspects of self psychology for participants on Friday and Saturday. And yet, unaccountably, Heinz Kohut himself had not yet appeared at the conference. At the three previous self meetings - in Chicago, Boston, and New York - Kohut had been everywhere. He had greeted old friends and new acquaintances personally. He had attended plenary sessions in his trademark faded grey V-necked sweater, sitting in the front row, and had joined actively in the questioning and discussion. Whenever possible, he had attended workshops, where he was animated and lively, always at the center of the dialogue. In the evenings special banquets with celebratory speeches, as in Chicago in 1978 and Boston the following year, had featured him and his work. And at the very end of the self conferences, Kohut had commented on the conference as a whole, its themes and issues, and identified questions for the future.
This weekend Kohut was a very sick man, holed up in a hotel room. His decade-long struggle with lymphoma had reached a crisis. His re-treaded heart was increasingly fragile. Nagging inner ear problems continued to torment him. For months he had hardly been eating, and his once-robust frame now barely tipped the scales at 100 pounds. He was so skinny his bones protruded. He could only sit in a straight chair with a pillow underneath him.
But almost no one knew the extent of his decline. No colleague from Chicago had seen Kohut since July, when he left for his vacation in Carmel. He was then weak but active, writing his last book, even seeing a few patients. Calls over the summer from friends yielded little concrete information. He had a way of brushing off personal inquiries and talking at length about himself without revealing anything of significance. The ruse was carried through at the conference by Elizabeth Kohut, who attended many sessions herself and tried to look untroubled. When asked about Kohut's health, she indicated only that he was weak and resting at the hotel but definitely planned to speak to the conference participants on Sunday morning. Friends anxiously consulted each other and tried to pry more information out of her. But no amount of whispered huddling at the margins of a busy conference brought forth any more concrete information about Kohut's physical state.
Kohut had, however, invited Jacques Palaci to visit him Saturday at the hotel. Palaci had made it a point to travel from Paris for the meetings since they first began in 1978. Kohut always tried to do something special with Palaci, and they had established a tradition of visiting for a day or so after each conference. It is not surprising Kohut chose Palaci to visit him that Saturday. Palaci was Kohut's link. to the past, to his youth, to Vienna. Nothing would be compromised by revealing to Palaci how sick he really was.
Elizabeth Kohut's look when she greeted Palaci at the door was his first indication of just how serious things were with his old friend. But nothing could have prepared him for what he saw when he came to Kohut's bedside. Palaci instantly recognized the imminence of death in the pallor of Kohut's skin, the edema that caused his belly to swell, the major loss of weight that left him an empty shell, and the odors of the sickroom. The mere fact that Kohut stayed in bed when Palaci walked in suggested to him the seriousness of the situation. Kohut hated to appear helpless or sick.
Motioning Palaci to his side, Kohut greeted him warmly. He did not deny to this friend how sick he really was. He brought him up to date quickly on his various ailments and the status of his lymphoma. He also shared how awful the night before had been. He was taking three times the prescribed doses of all his drugs but nothing could touch his pain. "Living like that is not worth it," he said. "I'm not afraid of dying, and it's coming soon. But I do have concerns for who will continue my work." And with that Kohut gossiped about the three men - Arnold Goldberg, Paul Ornstein, and Michael Franz Basch - who he felt could conceivably emerge as leaders of self psychology after his death. Conversation then turned to personal issues. Palaci told his friend he was separated from his wife, about which Kohut was deeply empathic. He had known Diana, who was an artist, for years and had always loved to talk with her about her work. In fact, it had always surprised Palaci the way Kohut could so totally immerse himself in the interests of someone who neither knew nor cared about psychoanalysis. But now it was time to console his friend. Kohut reminded Palaci that creative people are not as stable as others, and his separation was probably the price of marrying an artist. It put the issue in perspective for Palaci and both made him feel understood and gave him some hope for the future.
Kohut then confided in Palaci how difficult he knew it was going to be to give his talk the next day. Still, he was determined. Palaci asked whether Kohut was really up to making such a presentation. Indeed he was, asserted Kohut. All these people had gathered to honor him, to examine his ideas, and to see him. He could not disappoint them. Besides, he had a plan. He would remain in bed until the last minute, then get hooked up with a vial of adrenaline dripping directly into a vein near his heart. He had arranged for an ambulance to transport him to the lecture hall just before he was supposed to speak. Palaci could only shake his head in amazement. He knew when set on such a course Kohut was not to be dissuaded.
Palaci left Kohut to rest, though a few hours later he called to make sure he was okay. In that phone conversation Palaci mentioned that while sitting on the bed talking he had dropped his comb out of his pocket. "I'm so glad," Kohut said, "Now I can think of you every time I comb my hair."
The night went badly. Bernard Brandchaft happened to be staying in a room just down the hall from Kohut. After a busy day at the conference, Brandchaft and his wife had returned to their room to watch a TV presentation of Jacques Brel Is Alive and Well and Living in Paris. Brandchaft loves music and was very moved by the production, as he always is when he hears it. In the midst of it, however, around 10:30, he heard some noise in the hallway. Brandchaft opened his door a crack and to his astonishment there was Kohut, in his pajamas and bathrobe, shuffling about. He was obviously distressed. Brandchaft walked out and asked him what was wrong and could he help. Kohut waved him off, not unfriendly but decisive. Brandchaft felt Kohut was embarrassed to be seen in that condition and that he wanted to preserve a favorable image of himself in his friend's mind, even in this extreme situation. Brandchaft returned to his room, but he was frightened. Peeking through his door, he watched Kohut to be sure he had not fallen or somehow hurt himself. After a while and in obvious pain, Kohut returned to his room. Brandchaft closed his door and immediately called Arnold Goldberg, who he knew would be the most likely person to be in close touch with the situation. Goldberg said there was no way to help and that, in any event, Elizabeth was with Heinz and would take care of him.
Somehow, Kohut made it through the night. The next morning, after dressing slowly and painfully, he set off for the conference hall. On the way, he stopped with his wife for a brief lunch at McDonald's, which he boasted of later to his son. He loved such symbols of America, his adopted country. At half past ten, just as the four other panelists wound up their comments, the ambulance arrived at the plaza outside the Berkeley campus lecture hall. A curious crowd instantly gathered near the ambulance. The driver removed a wheelchair, and Kohut got out of the front seat to sit in it. He had a grim, set look on his face that baffled many who knew him. He seemed to look through them. He was completely focused. A silent parting of those gathered near the ambulance made room for Kohut to pass, with his wife at his side, and approach the entrance to the lecture hall. At the doorway Kohut deliberately rose from the wheelchair and began the long walk to the podium.
Kohut had sent out advance word that he would definitely make it for a few brief comments at the end of the morning session. The panelists on stage and most of the conference participants in the hall thus knew that the stir at the back of the room signaled his arrival. Arnold Goldberg, the last speaker at the long table covered with a white cloth, instantly ended his comments. All eyes turned to the door. Some stood at their seats to get a better view. Kohut walked alone and firmly down the long aisle, up the three steps to the proscenium, and took his place stage right at the far end of the table.
For most people in the hall, his appearance, while suggestive of the seriousness of his medical condition, did not really give it away. He was pale, to be sure, even ashen, and it was clear he had lost weight, for his neck looked scrawny and his high cheek bones were sharply accentuated. But everything else disguised his state, and the anxiety about his absence that had hung in the air during the conference now completely dissipated with him actually in the room, seated at the long table on the stage. He was alive, and without too much denial one could be convinced he even looked well. Had he not walked down the long aisle and up to the stage on his own? And when he started talking he was clearly the familiar Kohut of everyone's memory and imagination: the high-pitched voice that ranged from a comforting sing-song to a sharp whine or cackle; the soft and appealing lilt of his Viennese accent, which had entered into the transferences of a thousand patients in three decades of psychoanalytic practice; the hand gestures to emphasize certain points; the self-deprecating jokes; the warmth and human energy that he radiated; and, surely, the charisma, whatever it is, that filled the room and suddenly changed the entire atmosphere of the conference. Everyone felt the air changing.
The topic of Kohut's lecture was empathy. He apologized for taking up the subject again, both in the lecture and in his recently completed draft of How Does Analysis Cure?. In both contexts he was returning to the subject, despite the fact that he had decided a couple of years ago that he was "sick of that topic." He had written himself out about it. Yet people kept criticizing him "over and over again" with the same arguments and profound misunderstandings. It wore him out. "I was wasting my time, my emotions, my energy," he said. He felt he should get on with some new ideas. But "idiot that I am," he said with a slight smile, he eventually came to feel that "when people keep asking you the same damn question, something must be wrong!"
Kohut's lecture ranged over many old and new aspects of his topic, reminding himself and his listeners how central empathy had been to his life's work on narcissism and what he was now calling self psychology. Empathy is the way of knowing in psychoanalysis, he argued. It is also the precondition for cure in psychotherapy; indeed, even without anything else happening in the treatment, an authentically empathic therapist can effect significant healing in the patient. Empathy alone is not the goal. Psychoanalytic psychotherapy consists of empathy and explanation, and it is that unique combination that distinguishes the enterprise and insures lasting change in the self. At the same time, there is no question Kohut privileges empathy. He even suggests that what is generally called "interpretation" in psychoanalysis could be considered a "higher form of empathy." Kohut's final lecture, in other words, reframed the problem of cure in psychoanalysis, going beyond even the discussion in his last book, How Does Analysis Cure?.
After half an hour, however, and clearly tired, Kohut announced he wanted to close. His head was beginning to tilt slightly forward, as though its weight was difficult to support. He looked, if that was possible, even paler than he had at the beginning of the lecture. His hand gestures had become subdued, and the scrunching of his nose and adjustment of his glasses less pronounced. The eyes seemed sadder. Everything spoke of a profound exhaustion.
But in fact he had trouble stopping. He knew it was his last lecture. And so, first, he reiterated that empathy must not be abused for vaguely supportive measures and that it must be appreciated on its various levels of development. He uttered that pronouncement even though he knew immediately it had the tone of a hard-and-fast rule. Hardly wanting to go out on a fussy note, he added quickly, by way of qualification, "Certainly, I'm not stodgy," the more you know the freer you can be to experiment and find your own truth and avoid "some ritual that one sticks to anxiously:" We don't really know yet how to treat people with serious self disturbances, he went on. But with time and care and patience we will discover the best approaches and the most effective ways to blend empathy and explanation.
That thought brought to mind a clinical example. Many years ago Kohut had been involved in a long analysis treating a severely disturbed woman. After abruptly leaving another analysis, she lay down on the couch her first day and said it felt as if she was in a coffin and that the top was about to close with a click. Here Kohut mimicked the sound by opening his mouth widely and twice loudly clicking with his tongue. He had always been good at such imitations. He was a natural actor, which early on he had learned to turn to professional advantage. As a resident in neurology at the University of Chicago School of Medicine in the 1940s, for example, he was famous for being able to act out perfectly the odd neurological tics that are described ill the textbooks and must be memorized for boards. That double click was one of his great moments of performance. Watching it made you feel the coffin closing.
Over the years of treatment with the woman, Kohut noted that she was so deeply depressed there were many times he thought he would lose her to suicide. Once he was even spontaneously moved to ask if she would like to hold onto his fingers while she talked. "Maybe that would help you," he said to her. It was a "doubtful maneuver," he added, and he was not recommending it in general. But he was desperate. So he pulled his chair closer and reached out and gave her two of his fingers to hold. The patient clasped Kohut's fingers tightly. It made him think of the "toothless gums of a very young child clamping down on an empty nipple." That was his thought, indeed his interpretation. He did not say it. That would come later. But he thought it. It was fully formulated in his mind.
Then Kohut really did end. "I'm quite sure this will be the last self psychology meeting that I will attend," he said gravely, as many in the audience of five hundred began to cry, aware now more than ever that he was announcing his own end. "I wanted to do my utmost to be able to go through with my promise [to attend]. So, let's all hope for a good future for the ideas embodied in self psychology." And he said good-bye.
The applause was tumultuous now, the tears abundant. Kohut raised his hands: "Enough, enough. I know your feelings. I want to take a rest now."
For several minutes Kohut acknowledged the standing ovation. His exhaustion, however, was palpable, and soon he signaled to Arnold Goldberg, sitting to his right, that it was time to leave. They walked together to the stairs at the right of the stage. Kohut moved slowly and carefully. He made it down the stairs, but once he got close to the audience, with the hall electric with all the emotion of the event, a crowd surged forward. People wanted to talk with him, be near him, touch him. Kohut, frail and completely exhausted, got scared. In desperation he turned to Goldberg: "Keep them off me. Please keep them off me." Goldberg therefore positioned himself in front of Kohut and literally pushed people away from him, like a blocker in football, as they walked down the aisle to the exit of the auditorium.
Outside in the beautiful sunny day, Elizabeth Kohut waited with a car to take her husband back to the hotel. People huddled on the esplanade as they watched Kohut climb gingerly into the back seat and drive off He spent that night resting and trying to recover enough from the conference to take the flight back to Chicago. He called his son and said in German, "I was broken but somehow I got through this." He also called friends who he feared might have been hurt by his failure to acknowledge their presence in the audience as he walked to the stage. Ernest Wolf, for example, found such a message on his machine in Chicago when he returned later that evening. Kohut also asked the Goldbergs, who were staying in the same hotel, to change their tickets so that they could fly back with him. This proved to be complicated and in the end Arnold was able to fly on Kohut's plane but Constance had to take another flight. At the airport the next morning he was met with a wheelchair and taken directly to the plane. During the flight he realized that his patient, Jerome Beigler, was not far off and sent a message by an attendant for him to come visit. Beigler found Kohut sitting with his belt undone and his trousers open due to his hugely swollen abdomen. He was jaundiced and generally edematous, puffy from the accumulation of fluid that his weakened heart could not properly circulate throughout his body.
In Chicago Kohut was taken off the plane in another wheelchair for transport to a car. As they reached the limousine, he signaled to Elizabeth to give the man pushing him a big tip. To the end he was a man of etiquette, formality, and generosity. Kohut at first returned to his apartment, where he spent Monday night. He had two half-read books at his bedside: Victor Hugo's Les Miserables (in French) and Moses Haddad's History of Roman and Greek Literature. For his son it was one of the "most painful" things in his life to retrieve those books after his father's death. By Tuesday morning it was clear Kohut needed to be hospitalized. And so early on October 6 he entered Billings. Kohut was initially admitted for lymphoma but fainted during the intake proceedings and was moved immediately to a "step-down" room in the cardiac unit where he could be closely monitored.
The next twenty-four hours were a blur of preparations for death. Kohut's condition steadily worsened and he was often in pain. Yet he struggled to reach closure on a number of fronts. He wrote notes to both Ernest Wolf and Paul Ornstein, again apologizing for his remoteness in Berkeley but more importantly making a final connection. He had a phone conversation with Arnold Goldberg. He reviewed and signed the contract for a collection of essays and interviews (Self Psychology and the Humanities) and had it put in the mail. He worked out with his wife and son the details of having his manuscript, How Does Analysis Cure?, edited and published. He reiterated his insistence that his clinical records be destroyed but that his other papers be made available within five or ten years. He even made sure a photograph would be sent to a colleague. He might as well have been at his desk.
By the afternoon of Wednesday, October 7, Kohut felt comforted that he had done everything he could concerning the details of his death. Remarkably, as people sometimes do before death, he rallied and began to feel better in the early evening. He played a game of Scrabble with his wife. He talked of the past and his life with her and both noted that their thirty-third anniversary was in two days. It was a touching moment of intimacy.
It was not to last. Around 9:00 p.m. Kohut took a turn for the worse and knew it was almost over. An eager and very nervous intern happened to be on call and was summoned to deal with his needs. She bustled in and said something about all the pretty flowers. He cut her off and said, "Let's get down to business?" She adjusted the machines and did what she could to make him comfortable. Other doctors attended. Within a few hours he began to drift in and out of consciousness and soon became comatose.
Kohut died at 3:00 a.m. in the morning on Thursday, October 8,1981.
He was cremated and buried four days later in the Meyer family plot in the Forest Home Cemetery in Milwaukee. His grave is marked by a simple plaque in the ground in lot 7, block 8, section 6, with the words "Heinz Kohut, M.D." On the day the family gathered in the cemetery, October 12, the University of Chicago lowered its flags to half-mast to mark the passing of its distinguished faculty member.
The memorial service later that month went according to the script Kohut had worked out in detail with his son. The service was held at 3:00 p.m. on Saturday, October 31,1981, in the First Unitarian Church on Woodlawn Avenue at 57th Street, where Kohut had long been a member and had even spoken from the pulpit over the years. Rev. John F. Hayward, the minister of the church and Kohut's longtime friend, presided. Robert W Wadsworth was the guest organist, though he was so upset it was almost embarrassing how badly he played. On the inside back cover of the program was an appeal for the Kohut Memorial Fund requesting donations, first, to insure posthumous publication of his works "in the manner he had stipulated before his death" and, second, to meet the needs of young scholars in the humanities to train at the Institute. The service began with the Prelude and Fugue in E minor by J. S. Bach. Then there were readings from Genesis 1:26-28 and 31 and from the Talmud; and of "Pied Beauty" by Gerard Manley Hopkins, Gitanjali 92 by Rabindranath Tagore, and "O World" by Mark Van Doren. Michael Franz Basch and Charles Kligerman spoke in memory of Kohut. The ushers were Sheldon Meyers, David Terman, Robert J. Leider, and Kenneth M. Newman. The Interlude was a recording of Bach's chorale prelude "Wer nur den lieben Gott lasst walten" as performed by Helmut Walcha, followed by praise and prayer by Mr. Hayward. The service ended with everyone singing "A Mighty Fortress Is Our God" by Martin Luther, the words and music to which were included in the program. Kohut had been insistent with his son that the service end with this moving and classic Christian hymn.
An open reception followed at the Kohut apartment. People milled about eating and drinking, conversing casually as one does at such events. Some of Kohut's Jewish colleagues expressed surprise to Thomas, tinged with irritation, that the service had concluded with the Luther hymn. In fact, they were upset there had been a church service at all. These were the same people who had asked Thomas after his father's death if the family would be sitting shiva. At the time, Thomas had no idea what it meant to sit shiva, and is convinced to this day his father also would not have known. Most people, especially those from out of town, conveyed their condolences to the family. There was a general sense of being richer for having had one's life touched by Heinz Kohut. One person, however, was inconsolable. Robert Wadsworth asked Arnold Goldberg, "Now what do I do with the rest of my life?"
In the waning moments, many recalled the poignancy of Kligerman's words at the service: "Heinz was ready for death. He always had a firm conviction that each person had almost an inborn agenda, a destiny to fulfill, that compared to eternity it mattered little how long one lived, provided one lived up to one's potentialities in pursuing his ideal."
1. I am able to evoke the concrete details of the conference because I was there. [Return to text]
2. Most of what follows is from JP I, with some additional comments about Kohut's friendship with Palaci's wife, Diana, from JP 2. It is worth noting that Palaci was more emotional about his old friend in my 1985 interview than either of my subsequent two interviews, partly, no doubt, because it was closer in time to Kohut's death in 1981 but also, perhaps, because I happened to interview him on the fourth anniversary of Kohut's death. [Return to text]
3. BB. (Bernard Brandchaft) [Return to text]
4. TAK. (Thomas Kohut) [Return to text]
5. For the most part the text of Kohut's extemporaneous lecture that I use here is the transcribed and edited version, later titled "On Empathy," published in Search 4: 525-535. Ornstein notes he in turn relied in part on an earlier transcript provided by Robert J. Leider. I have, however, watched the videotape of the lecture more times than I can count and made many further corrections to the published transcripts, as well as noting Kohut's appearance, gestures, tics, mannerisms, and in general the physical surround of the room. [Return to text]
6. CK (Charles Kligerman) [Return to text]
7. Arnold Goldberg, personal communication, June 24,1997. [Return to text]
8. See Ina Wolf, "Chronology." For most respondents the sequence of events from Sunday through Thursday had gotten blurred; their reports to me were confused and contradictory - which is why Ina Wolf's contemporary diary record, noting so many details, is so important. [Return to text]
9. TAK. [Return to text]
10. Ina Wolf, "Chronology." [Return to text]
11. JB. (Jerome Biegler) Beigler also wrote me separately of this incident, November 18, 1997. [Return to text]
12. Arnold Goldberg, personal communication, January 12, 1999. [Return to text]
13. TAK. [Return to text]
14. Interview with Carla Rosenthal, October 14, 1998. [Return to text]
15. EW2 (Ernest Wolf); PO. (Paul Ornstein) [Return to text]
16. I had received the copy of our joint contract from Norton for what became Humanities just before the Berkeley conference and gave it to Mrs. Kohut during the meetings. It arrived, signed, in the mail for me (I was then living in Springfield, Illinois) on Friday, the day after he died. [Return to text]
17. Thomas A. Kohut, personal communication, 1982. [Return to text]
18. Not long before Kohut died, Robert Stolorow visited Kohut in Carmel. Kohut welcomed him into his study and showed him the view and the manuscript of Cure. Kohut then said he wanted to take a photograph of the two of them together. He set up the camera on a tripod and intended to use the automatic device to take a picture of both of them. It was all ready to go when Kohut discovered something was wrong with the film in the camera. Rather than give up on the project, he insisted that Stolorow go to the local drugstore to get more film. Stolorow did, returned half an hour later, they loaded the camera, and the picture was taken. Within days there was the Berkeley conference, Kohut's return to Chicago, and his death on Thursday, October 8. Early the next week, Stolorow received his print of the photo at his university office. Interview with Robert Stolorow, October 21,1995. [Return to text]
19. AG 4; Charles Kligerman, "Eulogy." [Return to text]
20. GM (Gretchen Meyer). [Return to text]
21. EW 3 (Ernest Wolf); interview with Carla Rosenthal, October 14, 1998. [Return to text]
22. Ina Wolf, "Chronology." [Return to text]
23. The details of the service are mostly from the program prepared for the service. I was also there myself. [Return to text]
24. Constance Goldberg, personal communication, April 4, 1996. [Return to text]
25. "I bet he didn't know what that was, either," Thomas said to me (TAK). [Return to text]
26. AG I and personal communication, May 10, 1991. [Return to text]
27. Charles Kligerman "Eulogy." [Return to text]
(For a more complete key to these notes, please refer to Dr. Strozier's book, Heinz Kohut: The Making of a Psychoanalyst, published by Farrar, Straus, and Giroux, 2001.)
Charles B. Strozier's book, Heinz Kohut: The Making of a Psychoanalyst was published by Farrar, Straus & Giroux in 2001. The paperback, with a new introduction, will be published by Other Press in the spring of 2004.