Advice and Consent

Should You Leave?: A Psychiatrist Explores Intimacy and Autonomy--and the Nature of Advice BY Peter D. Kramer. Penguin Books. Paperback, 336 pages. $17.

Any time I have ever been in therapy, it has seemed simple to say whatever is on my mind. But one question that always lingers, which I have never had the nerve to ask, is What do you really think of me? It’s not only that I would be ashamed to ask. It’s also that I know the therapist would never say.

Like the religious person who wonders what God makes of their actions, the habitually analyzed can only guess what their therapist truly believes about them. Couples, too, wonder about the opinion of their counselor: Are we much worse than other couples? Do we perhaps have a certain charm?

Of course, in the twenty-first century, therapy has moved further and further away from the blank-faced ideal of Freudian analysis, so that now many strands of psychological help have become baldly direct. Still, the therapist does not reveal her secret opinion of her patients or say directly what she thinks they should do.

Maurice Rouzée, Lovers, 1942, tempera on paper, 49 × 64".
Maurice Rouzée, Lovers, 1942, tempera on paper, 49 × 64". Courtesy Wallector Contemporary/Artspace

The psychiatrist Peter D. Kramer, author of the 1993 best seller Listening to Prozac, went on to write Should You Leave? (1997), a testing of the taboo against advising patients rather than leading them to their own inner wisdom. The book takes the form of a very literary and experimental sort of self-help manual, in which Kramer divulges the secret thoughts he has had about his patients (not his actual patients, but fictional composites), who more often than not sought his help because they didn’t know whether to leave a relationship. Turns out, their psychiatrist did have an opinion! And he had opinions about the psychiatric practice of not revealing opinions! This book, formally delicious and strange and fluid and meandering, became his way of saying all the things that were supposed to remain unsaid.

He presents his case studies like little short stories. A certain kind of man with a certain psychological disposition wants out of a certain typical relationship for expected sorts of reasons. Kramer explains what he sees when someone like that sits before him; how such conversations tend to go; why he thinks this person wants out versus why they say they do; what he believes they would get out of leaving versus what they expect they would get. He talks about if they stayed, how they might stay in a way that would lead to psychological growth for both partners. He also says what he thinks the person should do. It’s impossible not to relate to almost all the scenarios and psychological profiles he outlines—like finding that one has every psychiatric disorder when reading through the DSM-5. The reader also relates to the therapist, especially his desire to disclose his secret opinions about the people he encounters to those people—something, actually, none of us are supposed to do.

The book is filled with secret insights and observations about patients that could never be spoken in the therapist’s office. For example, discussing a married man with children who wants to leave his wife for a younger, seemingly more exciting partner, Kramer writes, “We know that older men need younger women not because the men still have it but because they don’t; it takes something special to get them started.”

Reading along, you get the thrilling sense that there might be someone in the world who knows what you should do—that there are right and wrong answers to the question of stay or go in various circumstances—it’s just that they never tell you. Kramer advises the indecisive man who wants to leave his quiet girlfriend to stay, suggesting he use Kierkegaard’s “rotation method” of “not wandering but rather tending to one field and rotating the crop, which is oneself.” He tells the bold woman who wishes to remain with her philandering and lying boyfriend to leave, but after she indicates that she wants to stay, he allows, “You can risk continuing the relationship if you make that risk an occasion for your own maturation, for your attaining something you can bring with you if the relationship fails, as it likely will.”

This “you” is interesting: Kramer has the reader stand in place of his patient. Each successive case study is presented as a guess about who “you” (the reader) are; he muses about why “you” might have picked up this book and about what problem you likely came to present.

The case studies are interwoven with Kramer confessing his own anxieties about advice. He observes that the very nature of advice is to cement the values of society—values that, in many cases, are simply no longer helpful. Kramer is aware that therapy has a political dimension, too: He looks at his intuitions through the lenses of various important thinkers, such as feminist psychiatrist and activist Jean Baker Miller, who observed that the private work of caring for another is always underrated in a capitalist world.

A subnarrative that runs through the book explores a dialogue between Kramer and “Lou,” a senior psychiatrist and friend to whom he is trying to justify his whole strange project. Lou represents the side of Kramer that is skeptical of Should You Leave? and of advice in general; it is revealing to see Kramer being subtly led (advised?) by his mentor, even as he considers whether it’s ethical to give advice at all.

Should You Leave? reads like it was a relief to write—a playful, joyful, transgressive, and exciting project. And why wouldn’t it be? After years of knowing so much about “you,” the psychiatrist finally speaks his mind, released from the prescription to never tell you what.

Sheila Heti is the author of eight books, including the novels Motherhood (2018) and How Should a Person Be? (2012; both Henry Holt).