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Lying on the Couch

Therapy had gone well for the first few sessions. We talked about a wide range of topics, but focused on the effect drugs had had on his life. During his band’s tours in Europe in the mid-’70s, he had spent time in prisons in Denmark and Paris for drug dealing. He knew friends who had died of overdoses and, of course, there was what happened in Harlem. Even though our sessions started in the summer, Steve, like most recovering junkies, always wore long sleeves. It wasn’t until nearly two months of therapy that I saw the leaf underneath his long-sleeved shirt.

“I see you’ve got a marijuana plant growing under that fine shirt of yours,” I said.

He rolled up his cuff to show me.

“A stupid idea for a tattoo,” he said.

“Let me guess, you used to shoot into the purple stems to keep track marks hidden,” I said.

“You are either one hell of a guesser,” he said, “or I ain’t the first junkie to grace this office.”

“I’ve seen it before,” I said.

“Was the person alive or dead?”

“Good question,” I said avoiding the answer. “What is it like to carry that reminder of your addiction with you?”

The link between my cousin and my patient was established through the true experience of them both being heroin addicts, both being charismatic, and both having similar tattoos. But telling the truth of the story had to be separated from the facts. Steve, of course, was not his real name, and the details of his life, being a Wall Street broker and studio musician, being a federal prisoner and being ambushed in a drug deal in Harlem, were all features either actually taken from his life, fabricated, or borrowed from the lives of other patients. This technique creates a character via an amalgam, yet allows the point of the story, that both were ultimately self-destructive, to be brought to the reader.

Then there is Enrico.

The connection between Gary and Steve could be brought into focus easily even while blurring the details of Steve’s life. But in the title essay “Confessions of a Former Child,” I describe my childhood concern that eating foods with seeds would get me pregnant. (Yes, although sad and bizarre it is totally true). Later in the piece I describe my work as a psychologist with an intellectually disabled adult, Enrico, who shared similar fears.

After I finished graduate school, to make extra money I signed up to administer psychological testing for the state. This type of testing was needed primarily for adults with what used to be called “mental retardation,” people whose intellectual disability caused them to function at the cognitive level of a child. Because I had training as a developmental psychologist, I thought I could deal with this. I believed I had the skills, the talent, the patience, and the desire. I was limited by only one small fact, a minor detail missing from my repertoire of personal and professional experience: I had never actually met a person with an intellectual disability.

Enrico was a big man, very big. He was six feet four inches tall, and two hundred and forty-one pounds. He spoke broken English and had a measured IQ of fifty-two. His family was from Italy, and he had never had the opportunity to get any special education or training back in his country. Enrico’s father was a wealthy businessman who shunned Enrico and only allowed him to work on their large estate. Enrico was an embarrassment. He was, however, used to doing lots of heavy physical labor. He was strong, but at the age of twenty-eight he knew nothing of the world. A simple, innocent man who knew only how to work hard.

His family moved to the United States for the business opportunities it afforded his father. The entire family—Enrico’s mother and father, two sisters, four brothers, aunt, grandmother, housekeeper, gardener, and family dogs (there were six of them)—moved into a large home in the west end of our county. Within two weeks Enrico was lost and victimized in the new world. He had been arrested three times for exposing himself in public; he was beaten by a gang of youths who mistook him for a rival gang member; and he announced to his family that a woman named “Mary” would become his wife and have sex with him if he gave her a thousand dollars.

Welcome to America.

Notice the number of Enrico’s identifying characteristics: gender, size, weight, ethnicity, IQ, education, family, socioeconomic status, work style, type and number of pets, sexual proclivity, legal record, gang connection, and issues with poor decision making. Some of these things were, indeed, part of the profile of the person I was writing about, and some completely extraneous detail designed to mask Enrico’s identity, and enhance the reader’s sense of character.

But the primary goal of the description is achieved: to introduce the reader to an individual who, because of his disability, will have thoughts that mirror the way children look at the world. This is the essential factual feature for the arc of the story: specific thoughts I had as a child reflected back to me by an intellectually disabled patient about how someone becomes pregnant.

The worried look on my publisher’s face softened and my debut memoir was sold for an advance of six figures. This is true. Just keep in mind that two of those figures were to the right of the decimal.

Lying on the Couch

Daniel Tomasulo, Ph.D.

Honored by Sharecare as one of the top ten online influencers on the issue of depression Dr. Dan Tomasulo, Ph.D., TEP, MFA, MAPP is a core faculty member at the Spirituality Mind Body Institute (SMBI), Teachers College, Columbia University, and holds a Ph.D. in psychology, MFA in writing, and Master of Applied Positive Psychology from the University of Pennsylvania.

He authors the daily column, Ask the Therapist, for, and developed the Dare to be Happy experiential workshops for Kripalu.   His award-winning memoir, American Snake Pit was released in 2018, and his next book, Learned Hopefulness, The Power of Positivity To Overcome Depressionis hailed as: “…the perfect recipe for fulfillment, joy, peace, and expansion of awareness.”  by Deepak Chopra, MD: Author of Metahuman: Unleashing Your Infinite Potential.

Learn more about Dr. Dan at his website.

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APA Reference
Tomasulo, D. (2018). Lying on the Couch. Psych Central. Retrieved on August 6, 2020, from
Scientifically Reviewed
Last updated: 8 Jul 2018 (Originally: 26 Jul 2010)
Last reviewed: By a member of our scientific advisory board on 8 Jul 2018
Published on Psych All rights reserved.