The Mummy at the Dining Room Table:

Eminent Therapists Reveal Their Most

Unusual Cases and What They Teach Us
about Human Behavior
By Jeffrey A. Kottler; Jon Carlson
Introduction
You will not recognize anyone you know in this book (great efforts have been made to disguise
their identities), but you may certainly see aspects of yourself reflected in their incredible stories.
The people profiled in these cases were faced with difficult and unusual challenges, not so
different from those you may have confronted in your own life. What is different are the ways
these individuals attempted to cope with their demons, the perseverance they displayed, and their
good fortune to end up under the care of an extraordinary therapist.
Although the stories in this book are indeed quite amazing and unusual, this is not a book that
glorifies the most bizarre aspects of human behavior. It is instead a collection of tales about
psychotherapy relationships that were as transformative for the therapists as they were for their
clients. These are stories of compassion and caring, tales that demonstrate the kind of
commitment practitioners make to their craft. This is not a book that intentionally makes heroes
and heroines of therapists (although there are plenty of quite amazing and creative strategies by
some of the greatest practitioners alive). Rather it is a book that celebrates the courage of
individuals who, in the face of overwhelming and debilitating problems, manage to overcome
these challenges through hard work and continual trust in their professional helpers.
WHY THESE CASES?
In the field of human behavior, we have seen more than our fair share of unusual and challenging
cases. Many of these have not only shaped the development of psychotherapy but also captured
public interest. Sigmund Freud's case of Anna O. was seminal in the evolution of psychoanalysis.
Here was a young woman presenting symptoms of blurred vision, difficulty swallowing, and a
paralyzed right arm, but with no physical causes for these problems. Freud and his colleague
Josef Breuer found themselves not only challenged to treat the first case of hysteria but also
enamored by the peculiarities of Anna's condition. (Breuer became a little too enamored with
Anna, but that's another story.)
In more recent times, the story of Sybil, the first documented case of multiple personality
disorder, was a runaway best-seller. Clinicians were not the only ones who were interested in
reading about this woman with sixteen distinct personalities and how her therapist managed to
deal with the challenge. The same is certainly true of other books that have followed in the
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tradition of presenting strange cases for popular consumption. The Man Who Mistook His Wife
for a Hat spawned a whole industry of stories about people who have weird neurological,
psychological, or behavioral disorders.
We wondered why strange behavior holds such fascination not only for the public at large but
also for members of our profession. There are reasons why we remember particular cases, even
after twenty or thirty years, but forget others. There is also some meaning in the choice we make
to discuss one case out of the thousands we have seen in our lives. Why do we consider one
patient more unusual or distinctive than all the others?
In some cases, the therapists picked the patient who represented the first of somethingthe first
success or failure, the first representative of a diagnostic entity (a borderline or schizophrenic
disorder, for example). More often, the cases selected were those that were high in "novelty,"
meaning that they were just so different from anything or anyone else the therapist had seen
before or since. Nevertheless, which case each of us chose says as much about who we are as it
does about the people we describe.
WHY THESE THERAPISTS?
Consider that therapists, as a group, are among the most articulate and verbally expressive people
around. As a profession, we are well trained and highly experienced in all the nuances of
communication, problem conceptualization, and interpersonal relationships. We are good talkers
and experts at explaining complex ideas in understandable terms. What we do for a living,
essentially, is persuade people to do things they don't want to do, and convince people to
surrender sacred (but self-destructive) beliefs they have held all their lives.
Now consider further that among this population of professionals who are the most skilled
talkers around, there is a subgroupthe top
fraction of 1 percentwho are still even more articulate. These are people who have developed
theories followed by all the rest. They are the ones who write the books and manuals that guide
other clinicians. These are the therapists you see on talk shows, read about in articles, or hear
interviewed on the radio. These are the best and brightest members of a profession that already
represents some of the most intelligent, perceptive, sensitive, and interpersonally effective
people. These are the people whose voices you will hear in this book.
Our collection of stories come from thirty of the most prominent and well-regarded therapists.
They live in different parts of the world. They are trained in different disciplines of psychology,
psychiatry, counseling, family therapy, and social work. They represent radically different
approaches to therapy: psychoanalytic, cognitive-behavioral, constructivist, feminist, humanistic,
systemic, and all the rest. It could probably be said that many of the therapists in this book don't
so much follow a particular theoretical orientation as much as they have invented one. Between
them, they have written most of the major books in the field that guide all other therapists.

In this book, you will have the opportunity to hear the greatest living theorists and practitioners
talk about their strangest cases. In each story, you will not only gain an intimate look at how
individuals have chosen to adapt in unique ways to adversity in their lives but also get an inside
peek at how some of the greatest minds of our generation sort out the complexities of the
situation in such a way as to cure their clients' presenting problems. As never before, you will
learn about how therapists work with their most challenging clients, and you will gain a deeper
understanding of human suffering.
FROM UNUSUAL TO BIZARRE
As we began collecting the stories, we soon realized that there was no universal way to structure
these interviews or the chapters that resulted from them. We started out with an interview
protocolwe even sent a list of prospective questions to the participants ahead of time. We
thought our lead question was fairly straightforward: tell us about the most unusual case you
have ever worked with. We expected to hear stories about bizarre variations in human behavior,
and of course we did. But some therapists elected to interpret the assignment in a different way:
rather than focusing on what it was about their patients that was truly strange, they may have also
looked at the cases in terms
of their most unusual features. In other cases, what was most memorable was not so much
people's bizarre behavior, but rather the unusual circumstances the patients found themselves in
that required them to act in amazingly resourceful ways.
Each of our conversations was unique, guided not just by where we wanted it to go but by the
direction that the master therapist wanted to take. Considering that we were working with rather
strong-willed, articulate folks, it was not easy to keep things along the predictable track we had
in mind originally. This means that each chapter is different from the rest, not only in the variety
of material presented but also in aspects of its style and structure. Some therapists came to the
conversation completely open, loose, and flexible, willing to go wherever it might lead. Others
had actually written out their case ahead of time and wanted to read it to us before we talked
about its implications. Still others insisted we stick with the prearranged agenda that had been
prepared ahead of time.
One thing that struck us right away was the diverse ways that famous therapists conceptualized
this subject. Originally we explained that we were collecting stories about "unusual" cases they
had seen. This word did not resonate with all the people we spoke with. Some went in the
direction of their own perceptions, preferring the word memorable to describe their case; others
liked the more descriptive nature of the word bizarre. Then other therapists quibbled with any of
these choices and instead substituted unforgettable, haunting, interesting, or strange. No matter
which word we selected to introduce what we were after, there was a high likelihood that the
therapist would change it to something else.
Regardless of the particular label attached to the patient, what all the cases have in common is
that they challenged the therapist by presenting clinical problems for which he or she was
unprepared. These are thus stories about not only the development of suffering patients but also
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seminal experiences in the lives of their therapists. In some cases, whole theories evolved as a
direct result of these cases.
SOME CAUTIONARY NOTES
There was great concern about preserving the confidentiality and privacy of the people profiled
in this book. In some cases, the patients are now deceased. In other instances, the therapists
received permission from the individuals to talk about their cases. In all instances,
names and identifying features have been changed, as have some of the characteristics and
settings, in order to disguise patients' identities. As is true for physicians, therapists' first rule of
practice is to do no harm. If these patients thought that that there was a resemblance between
them and the people depicted in the book, we would hope that they would feel proud to know
how important they were in the lives and work of their therapists.
We hope that these stories convey how much compassion and caring these therapists felt for their
clients. If some of the voices of our contributors appear cynical or judgmental, or even appear to
poke fun at the expense of others, we wish to accept full responsibility for taking things too far.
In truth, what made these conversations so revealing and insightful was the informality, the
looseness, the playfulness with which we prompted our colleagues and friends.
For you, the reader, it will seem as if you are listening in to the most intimate, private
conversations between trusted colleagues, but with this privilege comes an understanding of its
context. It is a reality that therapists talk about their most unusual cases just as plumbers,
accountants, and surgeons talk about their own; it is a significant way that professionals in any
field become better at what they dowe learn from every conceivable variation that can occur,
and adjust our methods to fit more flexibly in the future.
All of these stories are utterly and completely trueno matter how unbelievable they may
sound. Although some dialogue has been reconstructed, the essence of the cases, and what they
have to teach, have been preserved.
ACKNOWLEDGMENTS
We are grateful to Alan Rinzler, our third "partner" in this process, whose keen therapeutic
wisdom and editing skills helped shape these stories into such powerful tales of transformation.
Thanks to Jean Naggar, our agent.
We are indebted to Laurie Johnson, who transcribed all the interviews and then handled all the
voluminous correspondence with our participants.

And to the contributors themselvessome of the best therapists and most distinguished
theoreticians in the worldwe are most grateful to them for donating their time to be
interviewed and reviewing the stories afterwards. They were paid nothing for their efforts. They
receive no authorship credit. Their only reward was the enjoyment they have received as a result
of talking to us about an unsettling aspect of their work. They participated in this project because
they believe strongly that others can learn much from their most unusual cases.
Finally, we wish to acknowledge the incredible courage and commitment of the people profiled
in these stories. They sought help, persevered, and often triumphed over great odds to recover
from past traumas. They demonstrate not only the amazing richness and diversity of human
behavior but also the resilience that makes it possible for any of us grow beyond our present
limits.
Jeffrey A. Kottler
Huntington Beach, California
Jon Carlson
Lake Geneva, Wisconsin

CHAPTER ONE
The Man Who Wanted
His Nose Cut Off
Jeffrey A. Kottler
The examining room was empty except for two chairs and a desk. There was a sink off in the
corner, a vestige of the days when this part of the hospital housed medical cases rather than an
outpatient psychiatric clinic. I was an eager doctoral student, preparing to begin the first day of
my internship.
I was more than a little nervous about greeting my first patient. Although I had been working as a
counselor for a few years, my clients had been mostly young children and college students. Now
I was about to begin working with folks who had considerably more severe problems.
I could hear my patient being escorted into the examining room before I could see him. He made
some sort of jangling sound as he walked, almost as though he were in chains. It turned out that I
wasn't far wrong: his neck and wrists were encircled by strands of beads and chains, dozens of
them.
I took a deep breath and prepared to hear the story of my very first patient. This was the
beginning of my new career, and I was
The man only nodded, his beaded hair jangling.
"What sort of smell?" I probed. By now I was imitating him, sniffing the air in deep breaths. All I
could sense was the antiseptic hospital odor and my own sweat from trying way too hard to do a
good job with my first patient.
"You cain't smell the cowdoc?"
"The cowdock?" I was wracking my brain trying to figure out what a cowdock was, not realizing
that he was haunted by the smell of a cow and addressing me as "Doc." This was so much of a
problem for him that he couldn't concentrate on anything else.
As I tried to gather basic information, I learned that Manny lived on a family farm quite a
distance from town. It wasn't often that he came into the city, but lately he was so distracted that
he couldn't get much work done.
"And so," I stalled, trying to figure out what he wanted from me, "you smell cows on the farm?"
"Course I smell 'em on the farm. That's way they is."
"I see," I said, not seeing at all. "The cows are on the farm."

It's a good thing my supervisor wasn't watching, because this was really embarrassing. I'd been
talking to my patient for fifteen minutes, and all I'd learned so far was that he smelled cows on
the farm where he lived. Considering they had a small herd of cattle at their place, so far this
discovery was not particularly useful.
"The cows is everywhere," Manny elaborated. "They's smell is everywhere."
"And can you smell the cow right now?"
Manny looked at me with disappointment, as if to let me know that I'd let him down. He had
been hoping I could smell them too.
Now I was in a bit of a bind. His presenting complaint was that he was experiencing a disturbing,
chronic imaginary bovine scent. This sounded like a job for an ear, nose, and throat specialist or,
at the very least, a neurologist. But for some reason he had been sent down to our unit, probably
because any physical cause had already been ruled out.
I took a deep breath, as much to calm myself as to once again rule out that there were no cow
smells in the examining room.
"What can I do to help you?" I asked Manny in my most empathic, invitational voice. This was
one thing I could do very well.
Manny looked at me as though I were an idiot and then shook his head because I was so slow
witted. "Well, Doc," he said carefully, making sure that I could understand him, "I want you to
cut off my nose."
"You want me to cut off your nose?" I felt foolish not because of the content of what we were
talking about but because I was so clueless about what else to say or do to help this poor,
suffering man.
Manny just looked at me placidly and nodded his head. I was transfixed by the swinging beads
on the end of his long braids. We just sat that way for some time, each taking the measure of the
other. I had no idea what was going on inside his mind, but I was going through the list of
options I could think of for where to go next. Should I schedule him for surgery to have his nose
removed? Should I order another neurological workup? Maybe a psych evaluation? Then I
remembered that I was the psychological evaluator. I was the one who was supposed to be
assessing this man's mental status and planning some sort of treatment that would alleviate his
distressing symptoms. There were a lot of things that I was willing to do to help people,
especially with my very first patient, but I drew the line at cutting off noses. Besides, I wasn't
allowed to do that sort of thing even if they did issue me a lab coat with the title doctor on it.
Clearly there was some psychological reason for this man's persistent scent disorder. If there was
no medical origin for the condition, then it had to be because of some underlying emotional
problem or past trauma. That much I could figure out on my own. But how was I supposed to get
to the bottom of this situation in the few sessions that I was allowed to see my patients?
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Although these events took place over twenty-five years ago, before the advent of "brief
therapy," we were only permitted to do assessments and then administer some sort of
psychological "Band-Aid" before sending people back into the world. Cutting off a patient's nose
was just the sort of direct, decisive treatment that would appeal to the hospital's efficiency review
committee. But as attractive as this option may have seemed at the time, I had chosen my
profession because I enjoyed playing detective and getting at the root of matters. Whereas the
likes of Freud had months, if not years, to resolve things, I was challenged to do so in just a few
sessions. At least these intake sessions were booked as double-sessions, ninety minutes, so I had
time to explore the situation a little deeper.
THE SECRET
"Could you tell me something about what you do?" This was a very good, open-ended question.
Because I had no idea what else to do next with Manny, I decided it was time to get to know his
phenomenolog-