Patient is a divorced woman who presents with depression. Expresses regret over what she believes to be “bad choices” and a life poorly lived. Reports that if her life doesn’t improve in one year, she plans to “end it.”
“I have something to show you,” Rita says.
In the hallway between the waiting room and my office, she hands me her cell phone. Rita has never handed me her phone before, much less begun speaking to me before we’re settled in my office with the door closed, so I’m surprised by the gesture. She indicates that I should take a look.
On her screen is a profile from the dating app called Bumble. Rita recently started using Bumble because, unlike more hookup-oriented apps like Tinder (“Revolting!” she said), Bumble allows only women to contact men. Coincidentally, my friend Jen had just seen an article about it and forwarded it to me with the message For whenever you’re ready to date again. I’d texted back, Whenever isn’t here yet.
I glance from the phone to Rita.
“Well?” she says expectantly as we enter my office.
“Well what?” I ask, handing her back the phone. I’m not sure what she’s getting at.
“Well what?” she replies incredulously. “He’s eighty-two! I’m no spring chicken, but please! I know what eighty looks like naked, and that gave me nightmares for a week. I’m sorry, but seventy-five is as far as I’ll go. And don’t try to talk me out of it!”
Rita, I should mention, is sixty-nine.
A few weeks ago, after months of encouragement, Rita had decided to try a dating app. After all, in her daily life, she wasn’t encountering any single older men, much less those who met her requirements: intelligent, kind, financially stable (“I don’t want anyone looking for a nurse and a purse”), and physically fit (“Somebody who can still get an erection in a timely manner”). Hair was optional, but teeth, she insisted, were not.
Before the eighty-year-old, there had been a same-age gentleman who was not so gentle. They had gone out to dinner, and the night before what was supposed to be their second date, Rita had texted him the recipe and photo of a dish he said he wanted to try. Mmmm, he texted back. Sounds delicious. Rita was about to respond, but then another Mmmm popped up, followed by You’re killing me here . . . , followed by If you don’t stop, I won’t be able to stand up, followed a minute later by Sorry, I was texting my daughter about my bad back.
“Bad back, my eye, the pervert!” Rita exclaimed. “He was doing who knows what with who knows who, and he certainly wasn’t talking about my salmon dish!” There was no second date, and no dates at all until she met the eighty-year-old.
Rita had come to me at the beginning of spring. At our very first session, she was so depressed that when she gave me an account of her situation, it seemed as if she were reading an obituary. The final line had been written, and her life, she believed, was a tragedy. Thrice-divorced and the mother of four troubled adults (due to her own bad mothering, she explained), grandchildless and living alone, retired from a job she disliked, Rita saw no reason to get up in the morning.
Her list of mistakes was long: choosing the wrong husbands, failing to put her children’s needs above her own (including not protecting them from their alcoholic father), not using her skills in a professionally fulfilling way, not making an effort when she was younger to form a community. She had numbed herself with denial for as long as that worked. Recently, it had lost its efficacy. Even painting—the one activity she enjoyed and excelled at—barely held her interest.
Now her seventieth birthday was coming up and she had struck a deal with herself to make her life better by then or stop living it.
“I think I’m beyond help,” she concluded. “But I want to give it one last try, just to be certain.”
No pressure, I thought. While suicidal thoughts—known as suicidal ideation—are commonplace with depression, most people respond to treatment and never act on those hopeless impulses. In fact, it’s as patients begin to get better that the risk for suicide increases. During this short window, they’re no longer so depressed that eating or dressing seem like monumental efforts but they’re still in enough pain to want to end it all—a dangerous mix of residual distress and newfound energy. But once the depression lifts and suicidal thoughts subside, a new window opens. That’s when the person can make changes that improve life significantly over the long term.
Whenever suicide comes up—either because the patient or the therapist broaches the topic (bringing it up does not, as some worry, “plant” the idea in a person’s head), the therapist has to assess the situation. Does the patient have a concrete plan? Is there a means to carry out the plan (a gun in the house, a spouse out of town)? Have there been previous attempts? Are there particular risk factors (lack of social support or being male; men commit suicide three times more often than women)? Often people talk about suicide not because they want to be dead but because they want to end their pain. If they can just find a way to do that, they very much want to be alive. We make the best assessment we can, and as long as there’s no imminent danger, we monitor the situation closely and work with the depression. If the person is set on suicide, though, there are a series of steps to take right away.
Rita was telling me that she would kill herself, but she was very clear that she would wait out the year and not do anything before her seventieth birthday. She wanted change, not death—as it was, she was already dead inside. For now, suicide wasn’t my concern.
What was concerning to me, though, was Rita’s age.
I’m ashamed to admit this, but at first I worried that I might secretly agree with Rita’s grim perspective. Maybe she really was beyond help—or at least beyond the kind of help she wanted. A therapist is supposed to be a container for the hope that a depressed person can’t yet hold, and I wasn’t seeing much hope here. Typically I see possibility because the people who are depressed have something to keep them going—it might be a job that gets them out of bed (even if they don’t love that particular job), a network of friends (just one or two people they can talk to), or contact with some family members (problematic but present). Having children in the house or a beloved pet or religious faith can also protect against suicide.
But most notably, the depressed people I saw were younger. More malleable. Their lives might seem bleak now, but they had time to turn things around and create something new.
Rita, however, seemed like a cautionary tale: a senior citizen, utterly alone, lacking in purpose and full of regret. By her account, she had never truly been loved by anybody. The only child of older and distant parents, she had messed up her own children so badly that none of them spoke to her, and she had no friends or relatives or social life. Her father had been dead for decades, and her mother had died at ninety after suffering for years with Alzheimer’s.
She looked me in the eye and presented me with a challenge. Realistically, she asked, what could change at this late date?
About a year earlier, I’d gotten a call from a well-respected psychiatrist in his late seventies. He asked if I would see his patient, a woman in her thirties who was considering freezing her eggs while she continued to look for a partner. He thought that this woman might benefit from consultation with me because, he said, he didn’t know enough about the dating and baby-making landscape for today’s thirty-somethings. Now I knew how he felt. I wasn’t sure that I fully understood the aging landscape for today’s senior citizens.
I’d learned in my training about the unique challenges faced by older adults, and yet this age group gets short shrift when it comes to mental-health services. For some, therapy is a foreign concept, like TiVo, and besides, their generation grew up largely believing that they could “get through it” (whatever “it” was) on their own. Others, living on retirement savings and seeking help at low-cost clinics, don’t feel comfortable seeing the twenty-something therapy interns who predominantly staff them. Before long, these patients drop out. Still other older people assume that what they’re feeling is a normal part of aging and don’t realize that treatment might help. The result is that many therapists see relatively few seniors in their practices.
At the same time, old age is a proportionately larger percentage of the average person’s life than it used to be. Unlike the sixty-year-olds of a few generations ago, the sixty-year-olds of today are often at the top of their games in terms of skill, knowledge, and experience, but they’re still pushed out professionally for younger employees. The average life expectancy in the United States now hovers around eighty, and it’s becoming common to live into one’s nineties, so what happens to these sixty-year-olds’ identities during the decades they still have left? With aging comes the potential to accrue many losses: health, family, friends, work, and purpose.
But Rita, I realized, wasn’t experiencing loss primarily as a result of aging. Instead, as she aged, she was becoming aware of the losses she had been living with her entire life. Here she was, wanting a second chance, a chance she was giving herself only a year to realize. As she saw it, she had lost so much that she had nothing left to lose.
That part I agreed with too—mostly. She could still lose her health and beauty. Tall and slim, with large green eyes and high cheekbones, her thick naturally red hair flecked with just a few strands of gray, Rita was genetically blessed with the complexion of a forty-year-old. (Terrified of living as long as her mother had and running out of retirement funds, she refused to pay for what she called “modern beauty expenses,” her euphemism for Botox.) She also attended an exercise class at the Y every morning, “just to have a reason to get out of bed.” Her physician, who had sent her to me, said that she was “one of the healthiest people her age I’ve seen.”
But in every other way, Rita seemed dead, lifeless. Even her movements were listless, like the way she sauntered to the sofa in slow motion, a sign of depression known as psychomotor retardation. (This slowing down of coordinated efforts between the brain and the body might also explain why I kept missing the tissue box in Wendell’s office.)
Often at the beginning of therapy, I’ll ask patients to recount the past twenty-four hours in as much detail as possible. In this way I get a good sense of the current situation—their level of connectedness and sense of belonging, how their lives are peopled, what their responsibilities and stressors are, how peaceful or volatile their relationships might be, and how they choose to spend their time. It turns out that most of us aren’t aware of how we actually spend our time or what we really do all day until we break it down hour by hour and say it out loud.
Here’s how Rita’s days went: Get up early (“Menopause ruined my sleep”), drive to the Y. Come home, eat breakfast while watching Good Morning America. Paint or nap. Eat lunch while reading the paper. Paint or nap. Heat up frozen dinner (“It’s too much trouble cooking for one”), sit on her building’s stoop (“I like to look at the babies and puppies that people walk at dusk”), watch “junk” on TV, fall asleep.
Rita seemed to have almost no contact with other human beings. Many days, she talked to nobody. But what struck me most about her life wasn’t just how solitary it was, but how nearly everything she said or did conjured for me an image of death. As Andrew Solomon wrote in The Noonday Demon: “The opposite of depression isn’t happiness, but vitality.”
Vitality. Yes, Rita had had lifelong depression and a complicated history, but I wasn’t sure that her past should be our initial focus. Even if she hadn’t given herself a one-year deadline, there was another deadline that neither of us could change: mortality. As with Julie, I wondered what the goal should be in treating her. Did she just need somebody to talk to, to ease the pain and loneliness, or was she willing to understand her role in creating it? It was also the question I was struggling with in Wendell’s office: What should be accepted and what should be changed in my own life? But I was more than two decades younger than Rita. Was it too late for her to redeem herself—is it ever too late for that? And what degree of emotional discomfort would she be willing to endure to find out? I thought about how regret can go one of two ways: it can either shackle you to the past or serve as an engine for change.
Rita said that she wanted her life to improve by her seventieth birthday. Instead of dredging up the past seven decades, I thought, maybe we should start with trying to inject her life with a little vitality—now.
“Companionship?” Rita says today after I tell her that I won’t try to talk her out of finding companionship with men under seventy-five. “Oh, honey, please don’t be so naive—I want more than companionship. I’m not dead yet. Even I know how to order something on the internet from the privacy of my apartment.”
It takes me a minute to connect the dots: She buys vibrators? Good for her!
“Do you know,” Rita adds, “how long it’s been since I’ve been touched?”
Rita goes on to describe how disheartening she finds the dating scene—and in this regard, at least, she’s not alone. It’s the most common refrain I hear from single women of all ages: Dating sucks.
Marriage, though, hasn’t been much better for her. She’d met the man who would be husband number one when she was twenty years old, eager to escape her dreary home. She commuted to college each day and went from “dying of boredom and silence” to “a world of interesting ideas and people.” But she also had to hold down a job, and while she sat in a real estate agent’s office typing up mind-numbing correspondence after class, she missed out on the social life she craved.
Enter Richard, a charming, sophisticated upperclassman in her English seminar with whom she had deep conversations and who swept her off her feet and into the life she wanted—until their first child was born a couple of years later. That’s when Richard started working longer hours and drinking; soon, Rita was just as bored and lonely as she had been in her childhood home. After four kids, countless fights, and too many drunken episodes during which Richard struck both her and their children, Rita wanted out.
But how? What could she do? She had dropped out of college; how would she support herself and the kids? With Richard, the kids had clothes and food and good schools and friends. What could she, by herself, offer them? In many ways, Rita felt like a child herself, helpless. Soon Richard wasn’t the only one who drank.
It wasn’t until a particularly terrifying incident that Rita screwed up the courage to leave, but by then her children were well into their teens and the family was a shambles.
She married husband number two five years later. Edward was Richard’s opposite: a kind and caring widower who’d recently lost his wife. After her divorce at age thirty-nine, Rita had returned to tedious secretarial work (her only marketable skill, despite her keen intelligence and artistic talent). Edward was a client of the insurance agent Rita worked for. They married six months after they met, but Edward was still grieving his wife’s death, and Rita felt envious of his love for her. They argued constantly. The marriage lasted two years and then Edward called it quits. Husband number three left his wife for Rita, and five years later, he left Rita for someone else.
Each time, Rita was shocked to find herself alone, but her history didn’t surprise me. We marry our unfinished business.
For the next decade, Rita steered clear of dating. Not that she met men anyway, holed up in her apartment or aerobicizing at the Y. Then came the recent reality of an eighty-year-old’s body—so withered and saggy compared to the body of her last husband, who had been only fifty-five at the time of their divorce. Rita had met Mr. Saggy, as she called him, through the dating app, and “because I wanted to be touched,” she said, “I thought I could give it a try.” He had looked young for his age, she explained (“more like seventy”) and handsome—in clothing, that is.
After they had sex, she told me, he had wanted to cuddle but she’d escaped to the bathroom, where she discovered “an entire pharmacy of medications,” including Viagra. Finding the whole scene “revolting” (Rita found many things revolting), she waited until her date was fast asleep (“His snores sounded as revolting as his orgasm”), and took a taxi home.
“Never again,” she says now.
I try to imagine sleeping with an eighty-year-old and wonder if most elderly people are put off by their partners’ bodies. Is it jarring only to those who haven’t been with an older body before? Do people who have been together fifty years not notice because they acclimate to the gradual changes over time?
I remember reading a news story in which a couple, married for more than sixty years, was asked for tips on happy marriages. After the usual advice about communication and compromise, the husband added that oral sex was still in their repertoire. Naturally, this story spread like wildfire online, and most of the commenters were disgusted. Given the public’s visceral reactions to aging bodies, it’s no wonder old people don’t get touched much.
But it’s a deep human need. It’s well documented that touch is important for well-being throughout our lifetimes. Touch can lower blood pressure and stress levels, boost moods and immune systems. Babies can die from lack of touch, and so can adults (adults who are touched regularly live longer). There’s even a term for this condition: skin hunger.
Rita tells me that she splurges on pedicures not because it matters if her toenails are painted (“Who’s going to see them?”), but because the only human touch she gets is from a woman named Connie. Connie has been doing her toes for years and doesn’t speak a lick of English. But her foot massages, Rita says, “are heaven.”
When she got divorced for the third time, Rita didn’t know how to live without being touched even for a week. She’d get antsy, she says. Then it was a month. Then years turned to a decade. She doesn’t like to spend the money on a pedicure nobody will see, but what choice does she have? The pedicures are a necessity because she’ll go crazy with no human contact at all.
“It’s like going to a prostitute, paying to be touched,” Rita says.
Like John does with me, I think—I’m his emotional hooker.
“The point,” Rita is saying about the eighty-year-old, “is that I thought it would feel good to be touched by a man again, but I think I’ll just stick with my pedicures.”
I tell her that the choices aren’t necessarily limited to either Connie or an eighty-year-old, but Rita shoots me a look and I know what she’s thinking.
“I don’t know who you’ll meet,” I concede. “But maybe you’ll be touched—both physically and emotionally—by somebody you care about and who cares about you. Maybe you’ll be touched in an entirely new way, one that’s more satisfying than your other relationships have been.”
I’m expecting a click of the tongue, which I’ve come to recognize as Rita’s version of an eye roll, but she goes quiet, her green eyes filling with tears.
“Let me tell you a story,” she says, fishing out a crumpled, used-looking tissue from the depths of her purse, even though a fresh box sits right beside her on the end table. “There’s a family in the apartment across from mine,” she begins. “Moved in about a year ago. New to town, saving up for a house. Two small children. The husband works from home and plays with the kids in the courtyard, hoisting them onto his shoulders and giving them piggyback rides and tossing a ball with them. All the things I never had.”
She reaches into her purse for more tissues, can’t find any, and dabs her eyes with the one she’s just blown her nose into. I always wonder why she doesn’t take a clean tissue from the box a few inches from her.
“Anyway,” she says, “every day around five p.m., the mother comes home from work. And every day the same thing happens.”
Rita chokes up here, stops. More nose-blowing and eye dabbing. Take the damn tissues! I want to scream. This pained woman, whom nobody talks to or touches, won’t even let herself have a clean tissue. Rita squeezes what’s left of the snot ball in her hand, wipes her eyes, and takes a breath.
“Every day,” she continues, “the mother unlocks the front door, opens it up, and calls out, ‘Hello, family!’ That’s how she greets them: ‘Hello, family!’”
Her voice falters and she takes a minute to compose herself. The children, Rita explains, come running, squealing with joy, and her husband gives her a big, excited kiss. Rita tells me that she watches all this through the peephole that she secretly had enlarged for spying purposes. (“Don’t judge,” she says.)
“And do you know what I do?” she asks. “I know it’s horribly ungenerous, but I seethe with anger.” She’s sobbing now. “There’s never been a ‘Hello, family!’ for me.”
I try to imagine the kind of family Rita might fashion for herself at this point in her life—perhaps with a partner or a rapprochement with her adult children. But I wonder about other possibilities too—what she might do with her passion for art or how she might form some new friendships. I think about the abandonment she experienced as a child and the trauma her own children experienced. How all of them must feel so ripped off and full of resentment that none of them can see what’s actually there and what kind of lives they might still be able to create. And how for a while, I haven’t been able to see it for Rita either.
I walk over to the tissue box, hand it to Rita, then sit down next to her on the couch.
“Thank you,” she says. “Where did those come from?”
“They’ve been there all along,” I say. But instead of taking a fresh tissue, she continues to wipe her face with the snot ball.
In the car on the way home, I call Jen. I know she’s probably also in the car driving home.
When she picks up, I say, “Please tell me that I won’t still be dating in retirement.”
She laughs. “I don’t know. I might be dating in retirement. People used to hang it up once their spouses died. Now they date.” I hear the blare of horns before she continues. “And there are so many divorced people out there too.”
“Are you trying to tell me you’re having marital problems?”
“Yes.”
“He’s farting again?”
“Yes.”
It’s their ongoing joke. Jen has warned her husband that she’s moving into the next room at night if he keeps eating dairy, but he loves dairy and she loves him, so she never moves.
I pull into the driveway and tell Jen I have to go. I park the car and unlock the front door to our house, where my son is being cared for by his babysitter, Cesar. Technically, Cesar works for us, but really, he’s like an older brother to my son and a second son to me. We’re close with his parents and sibling and his multitude of cousins, and I’ve watched him grow up through the years into the college student he is now, taking care of my son as he grows too.
I open the door and yell, “Hello, family!”
Zach shouts from his room, “Hey, Mom!” Cesar takes off an earbud and calls out from the kitchen, where he’s preparing dinner, “Hey!”
Nobody runs up excitedly to greet me, nobody squeals with delight, but I don’t feel deprived the way Rita does—just the opposite. I go to my bedroom to change into sweatpants, and when I come back out, we all start talking at once, sharing our days, teasing one another, vying for airtime, putting plates on the table and pouring the drinks. The boys bicker over setting the table and race to get the bigger portions. Hello, family.
I once told Wendell that I’m a terrible decision maker, that often what I think I want doesn’t turn out the way I’d imagined. But there were two notable exceptions, and both proved to be the best decisions of my life. In each case, I was nearly forty.
One was my decision to have a baby.
The other was my decision to become a therapist.