“One doesn’t do existential therapy as a freestanding separate theory; rather it informs your approach to such issues as death, which many therapists tend to shy away from”—Irvin Yalom

through wide, east-facing windows, the light of an uncharacteristically hot, clear summer afternoon in San Francisco floods a spacious studio apartment on Russian Hill, above the city’s North Beach area. The vista embraces the circa-1950 Transamerica skyscraper, the spans of the Bay Bridge and, tucked below the commanding Coit Tower on nearby telegraph Hill, the spires of the Washington Square Cathedral.

“That’s where Joe DiMaggio and Marilyn Monroe got married,” notes Irvin Yalom in soft measured tones. It’s a reassuringly quotidian comment from this eminent psychiatrist and author, who in a series of textbooks and popular writings has probed the dark recesses of the human psyche and its loftiest philosophical concerns.

Dressed casually, his trim beard a patchwork of light and dark, and his gaze direct rather than piercing, Yalom presents a less imposing figure than his publicity photos suggest. He is eager to talk about the new turn his writing career has taken with this months publication of When Nietzsche Wept (Fiction Forecasts, June 8th) his first work of fiction ever published by Basic Books.

Set in Vienna in 1882, the novel traces a dramatic—and entirely fictional—series of meetings between the depressed and physically ill young Freidrich Nietzsche and Josef Breuer, a middle-aged, highly respected Viennese physician. Breuer, friend and mentor of medical intern Sigmund Freud, is caught up in his own despair, unable to find meaning in his life or to shake his obsession with a young former patient who is—and ever will be known as Anna O.

The tale’s elegant conceit turns on Breuer’s attempt to engage Nietzsche in a course of the emergent “talking cure” without the proud and the very private young philosopher’s knowledge. Breuer persuades Nietzsche to enter a sanitarium for treatment of his migraine headaches; in exchange, in daily meetings the philosopher agrees to apply to the despairing physician’s symptoms to his own developing philosophy, to determine whether it can bring meaning to a flesh and blood’s existence.

“I started with the desire to write about Nietzsche,” Yalom explains. “I wanted to tap his works, which haven’t been harvested for the area of therapy. I decided to catch him in the time of his greatest despair, after the breakup with Lou Salome (an aristocratic Russian woman who would become an eminent psychoanalyst) in 1882, but I couldn’t find someone who might have been his therapist. I was just about to have to settle on a fictional character, a Swiss ex-Jesuit, when Breuer dawned on me. I should have known from the beginning. For years I’ve taught a Freud appreciation course for the residents at Stanford Medical School, because of course they don’t read Freud. I loved his first book, Studies in Hysteria, which is half Breuer’s book. The case of Anna O., described in it, occurred in 1882, so the timing was perfect. I had my time, I had my man, Nietzsche, and then, finally, I had my therapist.”

The novel’s subjects and themes are reasonable outgrowths of its author’s career as therapist, teacher and writer. After his psychiatric residence at John Hopkins and a subsequent stint in the Army, Yalom, who grew up in Washington D.C., took a position at Stanford: “the only job I’ve really had.” He lives with his wife of 36 years, Marilyn Yalom, a scholar in women’s studies and French literature, in Palo Alto, Calif. Their four grown children also live in the Bay Area.

“I’m now a full time professor of psychiatry at Stanford, but I spend most of my time seeing patients and writing,” Yalom says. “I’ve always loved to write and I’m a voracious reader of fiction, but my early published work was mostly empirically based. I did research and wrote a lot of monographs—all part of the academic requirements for tenure and such.”

In the psychiatric field, Yalom is probably best known for his book The Theory and Practice of Group Psychotherapy; his longtime publisher, Basic, published the first of three editions in 1970. “It has sold probably half a million copies in hardcover,” Yalom notes, “and has been translated into many languages. One reason for its success is that it’s sprinkled throughout with short case vignettes. I’ve had tremendous feedback from people who’ve enjoyed it because it reads like a storybook.”

A decade passed before the release of his next book: Existential Psychotherapy, a hefty and rewarding exploration of the thoughts of existential philosophers and writers as applied to the practice of psychotherapy. Explaining the book’s genesis, Yalom says, “I spent a year in England while writing the group therapy book, and even then was looking for an existential approach. I went to see R. D. Laing, thinking I might get into therapy with him for the year. Instead I ended up with his analyst, Charles Rycroft.”

“Rollo May’s book Existence, which came out while I was in my residency, had a great influence on me. Johns Hopkins then took a kind of middle position between the psychoanalytic bastion on one hand and a practical approach, guided by Adolf Meyer, on the other. I felt there was another direction one could go, but I never had any colleagueship until I met Rollo.”

“One doesn’t do existential therapy as a freestanding separate theory; rather it informs your approach to such issues as death, which many therapists tend to shy away from,” he adds.

The success of his next book, Love’s Executioner, confirms that view. Published in 1989, the book brings together 10 eloquent and moving accounts from his practice; it sold some 60,000 copies in cloth, and is now a Harper Perennial paperback. Existential Psychotherapy “drew together a lot of my major interests,” Yalom explains. “In Love’s Executioner, I put the stories on the main stage and then built in the theoretical material.”

“I had expected to write 40 or 50 short pieces,” he adds, “something like Lewis Thomas’s Lives of a Cell, drawing not on biological material but the psychological stuff I’d observed in therapy. These brief vignettes, however got longer and longer. They had an organic basis and seemed to write themselves. As each one reached around 20 or 30 pages, I’d find myself beginning to think of the next one. It was an amazing experience”.

With that book, Yalom recalls, “I knew I was moving into new territory. I thought I might be better off with another publisher, one that had a more general audience, but Basic really wanted the manuscript and offered me more than they had ever offered for any other book. As it turned out, no one else even bid on it.”

Having worked without an agent for nearly two decades, Yalom was represented by Knox Burger for Love’s Executioner. For his first fiction effort, he switched to Owen Laster, who had read the novel-in-progress and responded enthusiastically.

Though all of Yalom’s books follow an arc of theme and topic, the move into fiction represented a huge step for him. “I wanted to write of things outside the office, but I wasn’t sure that I could. I knew I needed help learning how to write a novel. There were times working on this book that I felt so clunky, like such a beginner.”

Looking for someone to evaluate his efforts, Yalom found Alan Rinzler, a former New York editor who is now a therapist, who made valuable suggestions. He also consulted Richard Ellmann, who was on the faculty of Bennington College’s writer’s conference in the summer of 1988, when Yalom spent two weeks there, and conferred with Erwin Glikes, an old friend who was once the president of Basic Books.

The historical research for When Nietzsche Wept was difficult, Yalom says, but compelling. “I found an old Baedecker and pored over maps of 1882 Vienna. My best source was Irving Stone’s widow, Jean, whom I spoke to on the phone. The Stones spent seven years in Vienna for their painstaking book on Freud, Passions of the Mind [1972]. She had a lot of information about Breuer’s home.

“And although I’ve been reading about Nietzsche for years, I’m not trained in philosophy, so did a lot of background reading. I audited courses on Hegel, Nietzsche, phenomenology, Heidegger.

“The medical material came mostly from an 1882 German medical text that was issued in English in 1886. But there were always questions. At one point, I had Breuer examining Lou Salome for a respiratory disorder. I didn’t know whether she would have undressed in front of him, whether a chaperone was required. I never did find out, but the chapter got cut, anyway,” Yalom adds ruefully.

Signing with Basic presented an editing problem; the nonfiction house doesn’t have a fiction editor. In the end, the book was edited mainly by Basic’s Phoebe Hoss, “who has worked on all my books and whom I love.”

For the new book, as for Love’s Executioner, Basic was the only house to show interest. Yalom maintains his faith in the novel, noting that Love’s Executioner received “about 100 reviews, with only one or two negative.” But he does acknowledge a thin skin for criticism, and characteristically produces an illustrative tale.

“One of Alan Rinzler’s suggestions for the novel was that I cut the first seven chapters. Now, I remember reading his notes on the sofa and falling into a deep sleep, something I never do, and dreaming about a badly deteriorated restaurant called the Kitchen Sink. When I woke up I realized I’d been dreaming about the book; Alan’s comments had made me feel as though I’d put everything into the book but the kitchen sink, to its detriment.” He laughs: “My first reaction to editorial comment.”

Yalom will augment Basic’s promotional efforts with some of his own. “I’ll be going to 12 to 15 cities for talks/signings. But I’m also calling the chairmen of nearby medical schools, like Harvard and Tufts in Boston, and offering to do Grand Rounds, which is actually just a lecture to a large audience. Throughout the years I’ve often been invited to do Grand Rounds, but have always declined. Now everyone’s surprised to hear I want to come.”

With his teaching schedule fairly flexible, Yalom must juggle appointments with patients and writing time to accommodate the tour. He is also juggling ideas for his next book, which he expects will be another novel, grounded in his experience as a therapist. “The writing of this novel possessed me,” he explains. “I was in the Seychelles part of that time and one day, while diving—I was about 80 feet under—I realized I was listening to Nietzsche and Breuer converse in my head. They never left me.”

When asked about those ideas for his next book, Yalom reiterates a “deep and abiding interest in the personal relationship between the patient and the therapist: How real is it? What are the parameters?

“In the Nietzsche book I suggest that real healing doesn’t happen until there’s true rapprochement, until the duplicity ends and the two can reveal themselves, one to the other. Most of my notes for the next book revolve around the patient-therapist relationship and the issue of the boundaries between them,” he adds.

An admirer of Kazuo Ishiguro’s novel The Remains of the Day, Yalom is drawn to but daunted by the challenge of writing in the first person, as Ishiguro did. Issues of fictional technique dog him, and he’s avidly reading rhetoric and style books, as well as works by this pantheon of writers, which includes Thomas Mann, Milan Kundera and Paul Auster. He speaks with near reverence of Richard Selzer, John Gardner and Cynthia Ozick, “whose poetic imaginations make me despair of my own.”

Yet his next words hint at depths he has not plumbed. “My offices at Stanford were recently moved, and my secretary found an old envelope that must have slipped behind the furniture. Its contents included a poem I’d written right after my wife’s father died. And in it are the lines that I have Nietzsche composing as he walks through a cemetery in Vienna. I wrote those words when I was about 20 years old, but I had no recollection doing so. Isn’t that incredible? I’d like to be more in touch with that part of myself.”