JUN 1999


Therapists Talk 
Shrink Rap 


    Michael E. Holtby, LCSW, BCD



This article has been published in Colorado's award winning AIDS newsletter, Resolute!
It cannot be re-printed for publication in any other form without the permission of the author.

"I can't quit you babe,

but I've got to put you down for a while."

Blues song by Otis Rush

Wayne (1) was the most recent of my clients to die. People in the epidemic are still dying. Unfortunately, not everyone is undetectable. In Wayne's case after the death of his long-time partner he had lost his will to live, and he existed the last few years in a haze of marijuana smoke. He tried to stop, he tried to find another reason to go on, but nothing seemed worth it -- not the new condo, the new truck, or the new boyfriend.

The first person I met with HIV was Michael Callen. The year was 1983 at a conference to acquaint health professionals with the "gay plague". The following year I had my first HIV client. He was a man who actually turned out not to have AIDS, although he very much wanted to. He had some other life-threatening illness, but it was before the antibody test. That was in the days when the prognosis was 18 months and we called it HTLV-III. He wanted AIDS because it made him part of something, an emerging community and he could be an activist. He was a nurse, very intelligent, but also a gay man who had never been able to come out, and always felt on the outside looking in. His social skills weren't well developed, and he scared away most other men. The first time he was hospitalized the staff also thought he had AIDS and left his meal trays outside his room.

My next client didn't have AIDS himself, but his partner did. When the antibody test became available it turned out that he too was positive. I felt an overwhelming sense of helplessness. I don't remember the year Ram Das came and spoke to the Colorado AIDS Project, but he had a great impact on me through this talk and others. I was able to accept his admonition that just being present with someone was doing something important. I couldn't stop people from getting sick. I couldn't stop people from dying, but I could be there. In retrospect I remembered Ram Das' words many times. When Dan was within days of dying I sat holding his hand while he looked at me through hollow sockets. He could not longer speak, but his eyes said enough.

For the last three years, including 1999, only one of my clients has died each year. I keep waiting for the year it is zero. But I remember vividly the year it was a fourteen. Sixty-nine of my clients have died over the years. There undoubtedly are others I lost track of, that are no longer living. In addition to clients, AIDS has taken my best gay friend, Charlie, who used to vacation with us and stay over night on Christmas Eve. AIDS also took my attorney, Paul Hunter, and later his partner, Hank Toy. AIDS also took Phil Price, the editor of Out Front, whom I had known and worked with since first coming to Denver in 1977. And AIDS claimed the editor of Resolute, Jeff Davis, a dear man who wore pearls and was resolutely cheerful through painful chemotherapy and other indignities.

Clients I was personally involved with didn't start dying until 1987. That same year Peter DiLeo and I did two groups with the idea of launching them, and then letting them continue without us. We did ten sessions with each, and then they were on their own. Neither group lasted long, seemingly blown apart when members began to die. The survivors couldn't deal with their feelings about the absent members, and stopped meeting. It was at that point that I decided to start a group which I intended to facilitate continuously. I first started a weekly group ten years ago, and two years later had enough interested people to start a second group. During the years when a lot of people were dying both groups were full, with waiting lists of prospective members. The second group ran continuously up until this year with some of the original members. As members got sick they would come in wheel chairs, and near the end we would meet at their homes or around their hospital beds.

I remember attending the first AIDS, Medicine and Miracles Conference in Boulder, when beepers went off all through the audience, reminding their owners to take their AZT. Over the years I spoke at more funerals than I can now recall. I gave the eulogy for two of my clients, being the person who knew them best. In Jim's case he asked me to write his eulogy six months before he died, and then discuss it with him as a way to reflect on his life. In Tom's case I had seen him evolve from a suicidal, overweight man who was scared of living; to a man whose memorial service filled the church with over a hundred people who loved his sense of humor and humanity. AIDS had transformed him before it took his life.

I find myself thinking most about those who died when I reflect back over the past two decades. One of the first to die was a young man who ended his life again living with his parents. It was something he dreaded because of his mother's abuse: when he was a young boy she broke him of sucking his thumb by cutting it with a razor blade. I think about the time that Steve brought Tony's ashes to group, set them on the coffee table and told us how he had really died - he was close to the end, but it was a hastened death. I think about the time that Dave called me to say Chris wanted to kill himself that weekend, and the group met at his house and got him to wait until we could order an "exit bag". He died a natural death in Hospice of Metro Denver. Almost his last words were: "Has the bag come yet?" I think about Bill, who hung onto life with a ferocious tenacity right up to the end despite his face being covered by KS lesions -- which had once said was his worst fear. Or I think of Bob who lost his sight to CMV and lived several more months smoking cigarettes and listening to television.

I have trekked a trail of tragedy over the past fifteen years. I remember the man whose wife didn't know the whole story of his sexuality until their first born child tested positive. I also remember the selfless care of so many partners, who selflessly labored under the burden of months with an invalid partner. I remember the man whose wife wouldn't even kiss him for fear of getting his HIV. But that same man is now with a wonderful woman who accepts him and his compromised health. I have one client who has never been able to stay sober, abusing alcohol, and shooting methamphetamine. Every time he is sober for very long he goes into a grief reaction over the two lovers he has lost to AIDS. The feelings overwhelm him and he has a relapse. On the other hand, there is the man who believes HIV saved his life, giving up his IV-drug use and becoming an AIDS activist.

And now my longest-running HIV group has taken a sabbatical, possibly to resume in the future -- possibly not. They are all long-term survivors who have been positive for many years. They felt it was time to move on to other things. AIDS had been so much a part of their life for so many years. It wasn't that they were going back into a closet of denial. It was more that we could only go over the same topics so many times. Been there, done that.

I am writing this piece as a way to say goodbye, not to another person who has died; but to writing this column. The time has come for me to move on to other things, just as my HIV group members have done. I still have PWA's on my caseload, but unlike the early nineties, they aren't a large proportion. HIV referrals have been down for over a year. Psychotherapy is apparently not a high priority among PWA's at this point in the epidemic. They have gotten past the crisis of being newly tested, for many their viral loads are undetectable, and they are focusing on drug compliance rather than the existential meaning of life. And the epidemic has shifted: those with AIDS now are poorer and more reliant on public agencies. A private practice therapist out of the managed health care system, is an exclusive boutique in the world of K-Mart.

I wrote my first Shrink Rap column in August of 1994. Since that time thirty-three columns in total have been produced. One was rejected by mutual agreement with the editor, two lead to versions that were published in professional journals, and those same two others were reprinted as chapters in a just released book.(2) My writing has lead to presenting at numerous AIDS conferences, around the country and in England (something I've concluded I don't do particularly well). It has also lead to my meeting some of the most interesting people I have ever encountered in my life. My work with HIV is not over, but as for Shrink Rap I sing Otis Rush's lament, "I've got to put you down for a while."

1. I have changed the names and other identifying factors of the clients sited here to protect their confidentiality.

2. Shernoff, Michael (editor), AIDS & Mental Health Practice: Clinical & Policy Issues. NY: Hayworth Press, 1999.



Last messed with November 15, 2001

Copyright(c) 2001 Michael E. Holtby, LCSW. All rights reserved.