Vignette: A Man Dying of AIDS
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By Arthur Rosengarten, Ph.D.
Before AIDS was so termed, an early victim of this incurable virus came into my therapy office to prepare for his death. Diagnosed with “Kaposi Sarcoma,” his mysterious lesions continued to spread throughout his body, he had lost 40 pounds, was weak and chronically fatigued. The experimental chemotherapies undertaken at Stanford Hospital in Palo Alto, California had done nothing to improve his condition. David, age 55, a Ph.D., a retired school principal and life-long educator, to his credit had accepted that he was dying of some mysterious illness and now desired to psychologically ready himself (and his lover) to this tragic fate.
After four or five couple’s sessions over previous weeks we had worked through much of his relational loose ends, the couple often weeping together in my office, but remaining remarkably dignified under the stress. I was struck by their ability to hold together. David now wanted to center himself emotionally and spiritually for his immanent death. His doctors had given him perhaps only a few weeks more to live. I suggested we might use Tarot; he was unfamiliar with the cards but receptive to the idea.
Though Tarot readers without psychological training usually favor divination or what might be termed “empowered blind selection” for card access, in this case I sensed a more open-ended, process-oriented approach would be more therapeutic. Under the circumstances, predictive divination seemed meaningless as David’s fate sadly was all but sealed (short of some medical miracle), and there was little interest in this sort of “future-viewing.” David, I should note, was himself quite agnostic regarding his beliefs about death itself and was not particularly interested in religious or metaphysical bromides. On the other hand, reflective divination, based on symbol amplification and analysis, seemed somewhat futile if it meant merely a deeper scrutiny of his present circumstance.
There was really little left to reflect upon. He was in incredible pain, his days were literally numbered, and he felt reasonably complete with the significant relationships in his current life. He had appropriately contacted his few remaining family members in New York, informed them of his sad situation, and felt sufficient closure in that regard. He could no longer work, and he was bed-ridden and nauseous for most of his days over the past months.
What David needed was to find himself in his last hours. He wanted to put the meaning of his life into some discernible order, most of which resided now in his tangential memories of the past. His present thoughts, beliefs, insights, and the inner places that touched him were for the most part overwhelmed by the stressors of his condition. However, even under the most severe and ghastly conditions, as Frankl wrote of the nazi concentration camps in Man’s Search For Meaning, it is basic human nature to seek a sense of coherency and meaning to one’s circumstance. Tarot is a natural facilitator of this need.
I suggested that my AIDS patient select a deck from several available in my office, one that most appealed to his emotions, that spoke to his heart. He chose the Aquarian Deck as the colors and imagery had a soothing quality which he liked. Then I placed the full set of 78 cards on the table, in no apparent order, and face up so that each card was in clear view. The process was quite simple, and remarkably meaningful to him. I asked that he slowly scan through all the images and pull out every card that touched him in some way without being stingy with his feelings. It was not important that he know a card’s designated meaning, only that it spoke to him, tickled his imagination, or touched his emotions. He relished the task, and slowly sifted through the images, picking out perhaps three quarters of the deck, one by one. I believe anyone given the same task under normal conditions would likewise respond positively to the intrinsic evocative properties and possibilities laden in Tarot images.
I then laid out all the selected cards, and asked David to arrange them in some meaningful groupings that made sense to him. Whatever felt right to him and connected to his own sense of organization and meaning. After a few minutes spent rummaging through the cards, this task too was rather quickly comprehended and actualized. He designated three groupings of cards: those he liked, those he didn’t like, and those he found mysterious and intriguing. I then asked him to choose which of the three he preferred to explore first. He chose “the cards I don’t like.” Besides fostering coherency and personal meaning, the process was designed to empower a sense of personal choice, something there was precious little of in the wake of a deteriorating terminal illness.
The other two groups were removed and I placed only the aversive cards on the table, again face up and in no particular order. David was encouraged to further order these in any way that made emotional sense, there was no “right way”. After only a few minutes he had made three more sub-divisions that he called “childhood and adolescence, adulthood, and my present life.” Within these three sub-categories I asked whether certain cards belonged together, felt interconnected, or else seemed more singular or isolated, and again asked that he make further arrangements to reflect these distinctions.
Of the eighteen cards David did not like, seven belonged to childhood and adolescence, six to adulthood, and five to the present. His criterion for selection was that in some manner each card triggered feelings of guilt, regret, or despair. From a structural Tarot standpoint they revealed no apparent rhyme or reason, though each grouping made remarkable emotional sense to David. “This group here is related to my mother,” he said, “this group to my sexuality,” and so on. The task was designed to allow David, rather quickly as time was of the essence, to sort through and organize the themes of his life. The cards were like symbolic magnets drawing together the bits and pieces of David’s overwhelmed psyche. The process was for the most part non-verbal and required no analysis or interpretation. Only David could make those determinations.
Through tears and laughter we spent the remainder of the session free associating and recollecting from the stimulus of the cards. I encouraged David to release what he could of the cards he didn’t like, and make peace, if possible, with the rest. Under the circumstances, simply identifying and emotionally connecting to these symbols was perhaps the needed work itself. Time was very short. At the session’s close I handed David the stack of cards from his second sub-group–’what I like’–to take home and explore for homework. We would do a similar process with this grouping on the next day.
On the following morning David returned notably more calm and relaxed. He had spent much of the previous evening with his partner exploring the cards that he liked. He said the experience had been “very therapeutic” and life confirming. He had cried, laughed, and recounted many wonderful parts of his life. I asked what was learned? He said he had loved books, his work with children, and teaching primarily. Certain cards had triggered such memories much as projective techniques are used to stimulate unconscious contents in psychological testing for diagnosis and assessment. The exercise helped to stimulate positive images and emotions connected to his former healthy and productive self, now all but subsumed in the chaos and distress of current circumstances. Tarot cards, through their imagistic power, often aid in suspending and preserving visual representations of past experience regardless of current or transient emotional states.
At the close of the session I then handed David his third stack of cards, those that he found “mysterious and intriguing.” I invited him to explore these over the weekend, as with the other groupings, and return again early the following week. The next time I saw David in my office would be the last time. The illness was taking its turn for the worse and he died a week afterwards. Our session that day however was powerful for the two of us. I was touched by the receptivity of a person so near the end. What David had found most intriguing was the entire Major Arcana itself. Each trump card brought a different fascination and sense of hope, he said. Their universality had rekindled memories of his early studies of philosophy as a young man, most of which he had forgotten. He was now grateful to reconnect to larger principles beyond his own suffering. And he was reminded of the illusory and dreamlike nature of ordinary reality itself, his “reactive mind” as he called it, not to mention his illness. The experience had had a tremendous calming effect. He was now ready I believe, or at least willing, to approach the larger mystery of his dying.
–Dr. Arthur Rosengarten is a practicing psychologist in Encinitas, California and author of Tarot And Psychology: Spectrums of Possibility (Paragon House, 2000)