Pink-faced and portly, I, Schachter, hunched behind my computer screen, stared across the desk at the client, a woman in her forties, a Ms. Green.

“And I can’t breathe. My chest is tight. I’m afraid of everything! The phone makes me jump right up to the ceiling. I don’t even answer anymore. All the time they want money.”

I watched the hypnotic movements of her thin mouth, her narrow face, her pulled-back brown hair. I wondered if I was going to nod off again, but I didn’t think I would this time. Of course, I never thought I would nod off. It just happened.

“Why does everyone want money? I can’t help them, because I have no money left.” She left the last word hanging and stared back at me.

I looked around the pathetic public sector office: Fluorescent bulbs on the ceiling, government-issued calendars on the walls. Red marks highlighted the pay periods and vacations, endless weeks leading toward some impossibly far away retirement day. I waited, to see if she would recover by herself, then asked, “How is your sleep? And your appetite?”

“How can I give them money when I don’t have enough for myself?”

I circled my eyes subtly to my daily schedule, flashing at the bottom of my monitor. There were already two other clients checked in and waiting.

“Do you have trouble falling asleep, or staying asleep?”

“The electric company. The landlord. Every month, they want more money.”

“Your bills? They make you anxious?”

“I can’t breathe. I blow into a paper bag. And my hands shake like this.”

She held out slender fingers, nails painted random colors: amethyst, gold, ruby. They did, indeed, shake. That could be her meds. A benign tremor in the first few weeks was nothing to worry about.

“Nothing to worry about.”

“Not for you, because your hands are fine.”

I tried to remember when patients had become clients, when my belly bulged over my belt, when the clinic added a fourth appointment every hour. It seemed like yesterday when I was young and in training. How different the job I signed up for was from the job I’m doing now! The fifty-minute hour? Each patient lying on the couch four times a week? Try four fifteen-minute med visits every hour, eight hours every day.

I conjured thoughts of my training analyst, a white-haired, smiling man who never sat behind a computer, who relaxed instead in a leather recliner and smoked a pipe, who gazed out at an amazing view of Lake Michigan from the luxury of his twenty-third-floor office.

“How is your sleep? And your appetite?”

“I blow into a paper bag.”

Ahem.

I heard, or thought I heard, a deep, throat-clearing sound break the silence. My analyst, Wellington, had loved silence. Sometimes the two of us sat in the sweet cherry pipe-filled silence on the twenty-third floor, on elegant European furniture. Wellington would make that deep, throat-clearing sound, smile and say: “What is the flavor of the silence today?”

“Have the meds helped at all?” I asked Ms. Green.

“Well, I take the pink one on Mondays and Wednesdays and Saturdays. It’s a little pink pill, just so tiny, with water and sometimes milk.”

“But you’re supposed to—”

“Or juice, or even a little honey. You know, from the honey dripper. It drips, drips, drips off the end. It’s very smooth. It’s organic. I get it delivered from Amazon.”

Ahem.

I thought I heard the throat-clearing sound again. I’m too young to be demented and too old to be psychotic, at least for the first break. And my hearing, I’d recently checked, was still normal for my age, not a rousing endorsement, but hanging in there.

“You need to take it every day or—”

“On Mondays, and Wednesdays, and sometimes Tuesdays, if I feel a little utchy, or if it’s raining. Or if I don’t sleep, or if I sleep too well. Sometimes I like to sleep in the morning, with the sun coming in through the window. Do you know what I mean?”

“Yes.”

“How could you know what I mean? You see me only once every three months. My family vacationed in the south of France when I was a young girl. And the sun came in through the window.”

“Right.”

“Mother worked so hard. Daddy would chide her, ‘You’ll wear the tips right off your fingers.’ And he’d whisk us off to vacation. It was glorious. We were so happy.”

“Mm-hmm.”

“But it’s hard to sleep when I’m so nervous. You have to do something about my nerves.”

What is the flavor of the silence today? Old Wellington said, in my head.

Wellington was dead, three years now. I’d read about it in Psychiatric News. Turned out he was analyzed by someone who was analyzed by someone who was analyzed by Freud, which warranted a half-page spread in The Psychiatric News. Lung cancer, who’d have thought? From pipe tobacco that he said he never inhaled.

“But you’re on meds for your nerves already. Aren’t they helping at all?”

“Well, I’m up and I’m down. Doctor, do you think I’m bipolar? Because I’m up and I’m down all the time.”

“But the meds. Are they helping?”

“Let me finish. You always interrupt.”

“There are other clients waiting. We’ve already gone over—”

“Up and down, like a yo-yo, or one of those thingies.”

“A yo-yo?”

“It’s like a yo-yo but it turns.”

“That’s a yo-yo.”

“No. They light up and  …”

“A flashlight?”

“It twirls and swirls and whips.”

“An eggbeater? The Taj Majal? China?”

Ms. Green turned to the side; her face fell. She took out her phone and sighed. She started typing.

“What are you doing?”

“You’re grumpy today,” she said, typing away.

“I’m not grumpy. Is that a…” I craned my neck to peek at her phone.

“Doctor is very irritable,” she self-dictated.

“Is that a Yelp review?”

“… because he is very grumpy. And his office is cluttered.”

It was, indeed, cluttered. Stacks of papers lined the walls. Drug company paraphernalia, Prozac pens and Zoloft coasters piled up in the corner. The rickety chair that she sat on. And next to her, a six-by-six cardboard box open to the side, flaps hanging, a present from the county, new regulations paperwork that I had filed away. I hadn’t had time to digest the new rules, or to clear the box.

I escaped into the scene in my head: the cherry tobacco–filled office on the twenty-third floor, the flavored silence, the view of the lake. Wellington’s shiny bald head, Italian suit, the shuffling way he greeted me at the door and guided me to the couch. He never spoke until I spoke, and this seemed kind to me rather than rude. It was my time.

I just don’t know what to say today, I thought.

And what is stopping you? That slow, calming voice. The manicured eyebrows that curled up into the forehead, lined with gentle concern.

“Do you think we should change your meds?”

“Well, I’m very anxious,” Ms. Green said.

“So, they’re not helping?”

“You won’t take them away, will you? With all I’m going through right now? They want to take my car. Without my car, how would I get around?”

“On the bus?”

“The bus? With the crowded people and my agoraphobia? You know I can’t be around people at all. Haven’t you heard a word I’ve said? I’m anxious.”

“Yes, but—”

“My money is gone. I waited in line all day at the Social Servants office.”

“Social Services?”

“They gave me this form for you to fill out.” She handed me a stack of papers. Its weight was familiar. I saw several of these forms each week at the clinic. Avoiding private practice, working in the public sector, had its pros and cons.

“Yes, this is a disability form.” I studied her answers. On question number three, Why do you feel you’re disabled? she’d written, I followed my bliss. It got me nowhere.

“When was the last time you worked?” I asked.

“My last job did not make me happy at all. The medicine is the only thing that keeps me afloat, and now you’re going to take that away.”

“But you’re still anxious.”

“Look how I shake.” She jammed her fingernails toward my face.

“But you said it’s working.”

“Yes, except for the anxiety.”

“But that’s what it’s for.”

“My friend Lorraine. She takes Lexapro. And she’s very, very happy.”

To the analyst in my head, I said, I’m in a quiet mood today, is all.

A quiet mood?

I said, “Your meds are supposed to boost the serotonin in your–”

“My serotonin is very low,” she said. “I can feel the serotonin dripping down, drip, drip, drip, right here past my ear.” She pointed to an earring, some past heirloom she had possibly managed to hang on to despite hard times.

“You can’t feel serotonin.”

“A little trickle, it goes whoosh, whoosh, whoosh, and the chemicals in the little bags, zapping from one side to the other.”

“In the synapse. Yes. To balance–”

“My chemical imbalance! Doctor, my friend Lorraine said to ask you to do something about my chemical imbalance. Like the people in the commercial, running at the beach. They’re so happy.”

Do you want to pass the whole session in silence?

I’m fine, I said to the voice in my head.

And how much energy does it take to be so fine all the time?

I turned to Ms. Green. “We have to stop for today,” I said.

“But you’re not done analyzing me,” she pouted.

“I’m not analyzing you. You don’t know what analysis is.”

“No, because you’re not doing it right.”

“I was in analysis for six years.”

“They couldn’t fix you?”

“Four times a week.”

“And you’re still so unhappy.”

“I’m not unhappy,” I shouted.

She typed at her Yelp review. How could I expect her to understand analysis? My analyst was a kind, gentle old man. The time I spent in his office added a richness and depth to my life. Analysis is not advice. It’s a process you’re in. It wasn’t so much what he said.

I never said anything.

It was the relationship. He was like a father to me.

Schachter? I hardly remember him.

His office was a sanctuary. Every detail spoke of quality. Every fabric carefully chosen, Old World soft.

I did go to Europe every summer.

It was a sacred space. A time to explore the mysteries of the mind. The couch could take you anywhere.

It paid the bills. They say if you can find the right café in Paris, and listen carefully enough, you will hear the mother of the world giving birth to each new moment.

“I want to be in analysis,” Ms. Green said.

“Your insurance wouldn’t pay for it,” I told her.

“Why not?”

“It wouldn’t meet medical necessity. Or you’re not sick enough. Or you’re too sick. Or you’re not getting better. Or you’re getting better so you don’t need it anymore.”

“But I’m not getting better.”

“Or you’ve run out of sessions. Or your primary care provider didn’t preauthorize—”

“You haven’t helped me at all.”

“I don’t know if I’m helping anyone at all.”

Go on.

I tuned Ms. Green out of my head for the moment and spoke to Wellington in my head.

I don’t know if I’m helping anyone at all.

I see.

I spend half my time on the phone with insurance companies. And it’s some Bachelor’s level non-clinician who’s telling me I didn’t dot my t’s right and there are no sessions left. The contracted rates go down every year. My malpractice premiums go up.

And?

And everyone just wants meds. I’m not against them. God, I’ve been on them for twenty years. I don’t think I could do this work without them.

Oh?

These people are not clinically depressed. They’re suffering. I know they’re suffering. But it’s not clinical depression. It’s more complicated than that. And every fifteen minutes another beastly set of problems that has to be fixed. My waiting room is bursting with …

With what?

One after another.

What’s in your waiting room?

They want this. They want that. Disability. A note for a support animal. Excuses for school. More time on tests. Adderall. They all want Adderall now. Am I supposed to give them all Adderall?

“What about Adderall?” Ms. Green said. “For my ADHD. Because my friend Lorraine …”

What’s in your waiting room?

A beast! A beast is in my waiting room.

And what does this beast want?

It … it doesn’t know what it wants. It’s in pain. It has dreams it can’t reach. It has regrets it can’t get past. It has needs it doesn’t even know the words for. It’s stumbling in the dark.

The dark?

It’s blind and stumbling and groping and it needs to be fed, and I don’t know how to feed it.

It’s hungry. It’s pre-verbal. It’s blind.

It’s angry. It’s lashing out. I want to get out of the whole business. But at my age, what would I do? I’m stuck in a box.

A box?

Ms. Green waved a hand in front of my face. “My friend Lorraine,” she said. “She saw on TED talks where they put magnets up your nose and it spins your brain in a circle, and—”

“I don’t care about your friend Lorraine!”

“She’s a very nice person.”

“I’m sorry,” I told her.

“You never even met her and you say such mean things about her.”

“Don’t put this on Yelp.”

Tell me more about this box.

There’s nothing to say about it. Any way I try to go I’m stopped.

“Lorraine is my friend. She had her serotonin dripping down past her ears and Adderall didn’t work so they put her on Lexapro and she was happy.”

“Your meds,” I said. “We really need to talk about your meds. There are people waiting, and we’re out of time.”

“And before Lexapro, she was a real bitch.”

He doesn’t want to talk about the box.

It’s a cardboard box.

Thank you.

This dirty little public sector clinic office. Fluorescent lights. Posters reminding about policies and schlocky sayings: “The ten things you can do to improve your day.” The rickety chair that Ms. Green sat on, and next to her, the six-by-six cardboard box open to the side, flaps hanging, empty.

Get in it.

What?

Get in the box.

No. I have clients to see.

Stop being such a baby and get in the damn box.

I got up off my chair and climbed into the box. Sitting there, on the floor, in the box, I looked helplessly at Ms. Green, who got up and walked toward me.

Feel the walls.

They’re just walls.

Feel them.

I’m not going to feel the walls.

Are they supple? Firm? Do they give? Or are they fixed in place?

I looked at Ms. Green, thought of all the Ms. Greens waiting for me. Everyone wants something from me that I can’t give them.

You feel squeezed. Is it a constant squeezing, or does it let up?

In the morning it’s tolerable. As the day goes on, it gets worse.

It’s a rhythmic squeezing. A series of contractions.

Ms. Green kicked the side of the box. BAM.

“What about my serotonin?”

They’re frustrated. They’re angry. They’re hurt. And I’m the only one who can do anything about it.

The walls are alive. Feelings move back and forth across the walls as they squeeze rhythmically.

But I can’t do anything about it.

They’re elastic. You push against the box. The box pushes against you. You and the box are a living, breathing organism.

I want to help someone. I want to make a tangible difference in someone’s life. But I don’t know how to make anything better.

You feel as if you can’t move. You’re wedged in.

Ms. Green kicked at the box again. BAM. BAM.

“You can have your Lexapro,” I told her. “But I won’t sign your disability form.”

“Why not?” She kicked rhythmically at the side of the box, a growing heartbeat. BAM. BAM. LUB DUB.

“Because you’re not disabled.”

“How will I live?”

“You’ll have to work, like I do.”

“I couldn’t stand it.”

“I can’t stand it either.”

The old voice in my head: You can’t stand, in this box of yours? Is it small, or is there just no standing allowed?

I can’t see a way out.

Like the beast in your waiting room, you’re blind. You want something, yet you have no words to describe it. The box squeezes you with rhythmic contractions until you think you can’t take it anymore.

But what is the box?

Yes, what is it, indeed?

It struck me that the box might represent a womb, and I the baby, waiting to be born. The walls pressing in on me, rhythmically squeezing, pushing me out into some new kind of world. But what should I do?

But what should I do?

What do you want to do?

Am I being born? Do I need to push through it? Or stay put?

We’ll have to pick up there next time.

“Michael Moore,” Ms. Green said, “says there was this pill that made you so fat, and the FDA didn’t want anybody to know. So they hushed it up, and they told all the doctors not to say anything.”

“I said you could have your Lexapro.”

“It’s not going to make me fat, is it?”

“It might.”

“Well, it better not make me fat.”

“Then stop the meds. Get off them altogether.”

“But the withdrawal. Michael Moore says the withdrawal will drive you out of your skin.”

“Then why don’t you get Michael Moore to prescribe your meds for you?”

Don’t mind him. He was always so unhappy.

“Where did you come from?” Ms. Green stared at Wellington, seeing him, I supposed, for the first time.

“You can’t see him,” I shouted. “He’s just a thought experiment.”

“But he’s quite lovely, with his broad shoulders and his suit.”

I screamed at Wellington: “You come up with these fancy interpretations. You’re being born. You’re squeezed by life. They sound great. They make you feel like you’re getting somewhere. But you never really get anywhere, do you?”

It’s your therapy, not mine.

“That’s what you say when you can’t think of anything to say.”

All my other patients got better.

“You get in this box and see how you do.”

I wouldn’t get in there if you paid me.

“I did pay you. Four times a week. You sat there and said nothing. You drove a Maserati. You took all of August off to traipse around Europe. What do I get? Pens that say ‘Prozac’ on them. Four clients an hour and I can barely pay my overhead.”

He was always negative and irritable. Horribly fixated at a pre-oedipal stage. I’m not surprised his life turned out this way.

“I read on the internet that irritability is a sign of bipolar,” Ms. Green said.

“You get in here, too,” I said to her. “Try living in this box.”

I reached for her leg, her bony ankle in hose and high-heels. She jumped to avoid my hand. Wellington, that ghost, caught her and the two of them started waltzing around the small fluorescent office.

“Oh!” she gasped.

Careful. You’ll knock the tips right off your fingers.

“But you’re so strong.”

Your hands are soft, like you haven’t worked a day in your life.

“She’s trying to get disability,” I told him.

Disability. That’s fascinating. She’s a marvelous dancer.

“She won’t get it if I don’t sign her form.”

Have you ever been to the south of France?

“Of course,” she told him.

You know the way the light shines in the window in the morning?

“Yes. It’s lovely.”

That’s the light of understanding. When we make the unconscious conscious, then we have a cure.

“You’re a much better analyst than that other guy.”

“It’s the light of laziness,” I howled. “You can’t live your life on vacation.”

Did you ever want to sleep with your father?

“Of course,” she said. “How did you know?”

Mature men have a lot to offer.

“What about dead men?” I’d had about enough of these two. “What can they offer?”

“I feel so happy,” Ms. Green said. “This analysis really works. I’ll have to tell my friend Lorraine.”

It’s been a very fruitful session. I think we made a good start on some important issues.

I watched those ghostly old feet shuffle out the door.

“Where did he go?” Ms. Green asked.

“For me, the analyst always disappeared after the session.”

“But this won’t do at all.”

“The relationship is the cure, he told me, and it takes time.”

She bent down and got into the box with me. “I don’t have time,” she said. “My money is gone.”

“He told me I would integrate him little by little, until I felt strong.”

“Integrate him back!”

“I never could.”

“Oh, he danced like a prince. He made me feel full.”

“Me, too.”

“It’s so quiet without him.”

“I know.”

“Is it supposed to be this quiet?”

“Yes. I think so. Exactly this quiet.”

“Well, it’s way too quiet.” She shuffled on her bottom, struggled to hold her knees in a comfortable position. The box was cramped and dark.

“I know.”

“But what do we do now?” she asked.

“We wait.”

“For what?”

“For the session to be over.”

“How long will that take?”

“I have no idea.”

“But then we’ll be happy?”

“It’s possible.”

“But it’s terrifying, isn’t it?”

“It can be.” Like each new moment being born, over and over again. If the world is a woman in labor, each of us bears a small amount of her pain.

“But how should I live? What should I do?” she asked.

“I was just thinking the same thing.”

“Oh!”

“Do you want a Prozac pen?”

“Like the man in the commercial, doctor. I just want to run in the sand with the waves.”

I felt the walls of the box, firm, smooth, old as time itself.

Did someone schedule a return delivery? The door opened.

“Who is that?” I asked.

It’s Amazon. Did you have something you need to return?

Was it Wellington’s feet that entered again, with the blue vest of an Amazon delivery man? He taped up the box and everything went dark.