Urology Pearls: Is ‘just because’ the right answer?

Shahar Madjar, MD

Why do we think and feel the way we do?

In his book ‘Becoming Myself,’ Dr. Irvin D. Yalom asks himself why he, at the age of 85, is still seeing patients. Yalom is an emeritus professor of psychiatry at Stanford University and the author of several fascinating books including Love’s Executioner which is one of my favorite reads. In Love’s Executioner, Yalom demonstrates, through the tales of several of his patients, how emphatic psychotherapy can free a person from their deep emotional suffering. Yalom draws from his vast knowledge of philosophy and from his reading of great literature, as he tries to help his patients face the four ultimate existential concerns of life: the fear of death, the search for freedom and the anxiety freedom elicits, the often unsuccessful struggle to escape isolation, and the constant search for meaning.

Why does Yalom, at age 85, keeps seeing patients? It isn’t for economic reasons instead, Yalom writes, “I have enough money to live comfortably.” Instead, he says, “I love my work too much to let it go before I have to. I feel privileged at being invited into the intimate lives of so many people, and after so many decades, I think I may be getting good at it.”

Several pages after that, Yalom writes about Howard, a successful hedge-fund manager in his mid-eighties who couldn’t stop working long hours glued to the computer screen. Yalom asks Howard, as if he were catching his own image in the mirror, as if he were asking himself: “I wonder if you feel that work keeps you alive, that without work you’d drift into the final stages of life–senility and death.” Then Yalom keeps writing, “retirement should be … a time of contented reflection …” but “there are unruly feelings from my very early life that continue to create turbulence and threaten to surface if I slow down.”

As I am reading all of this, I think: here, Yalom the writer finds, or rather loses himself on a psychotherapist’s sofa of his own making. In his search for answers, he brings to the surface the same existential concerns he tries to resolve for his patients: Isolation (he feels privileged to be invited into the lives of others), meaning (he feels he is getting good at helping others), freedom (choosing between retirement and working seems to elicit at least some anxiety in him), and the fear of death. But which is the true reason for his choice to continue working? Why is he even thinking about this question? I feel that Yalom–an accomplished clinician, philosopher, writer–is still searching for an answer.

Lacking definite answers in Yalom’s ‘Becoming Myself,’ I turn to another of my favorite writers who also happens to be an avid marathon runner, the Japanese author Haruki Murakami. In his book ‘What I Talk About When I Talk About Running,’ he ponders about a simple question: why–despite “exhaustion [that] had seeped into each and every organ,” and in the face of his declining, aging body–does he keep running marathons? Like Yalom, Murakami tries to bring about rational explanations such as the wish to keep his body in the best shape possible, but in the end, he concedes: ” … that’s just my nature, the way I am. Like scorpions sting, cicadas cling to trees, salmon swim upstream to where they were born, and wild ducks mate for life.”

As I think a bit more about why we think and feel the way we do, I can’t get one particular Israeli song out of my head. Micha Shitrit wrote the lyrics, and Arik Einstein, whom I adore, performs the song with a great deal of charisma and humor. The song “Because of You,” goes something like that: Like a magician pulling a rabbit out of a hat/ Like a waiter who sets the table/ … / Like a man jumping off a building/ Like an astronaut lost in space/ I love you, I love you, I love you.”

This is powerful! Here is my reading of the song: Why am I in love with you? I can explain it the way I can explain how a magician pulls a rabbit out of a hat, or why we all sometimes feel as if we are lost in time and space. Which is to say, I just don’t know how, or why. But that’s okay. Because I love you!

Do you see what I am trying to say here? There is nothing wrong with asking questions. After all, asking the right questions is the best way to reach meaningful answers. But sometimes, the roads you take by asking lead to destinations farther then any answer you can reach. And when you are asking yourself ‘Why?’, the answer “just because” is often good enough.

Editor’s note: Dr. Shahar Madjar is a urologist at Aspirus and the author of “Is Life Too Long? Essays about Life, Death and Other Trivial Matters.” Contact him at smadjar@yahoo.com.


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