FIG1 When Gordon Livingston,
M.D., put down some thoughts about what he had learned during his 33 years
practicing psychotherapy, he had no expectations of appearing on "Good
Morning America" or the "Diane Rehm Show" on National Public
Gordon Livingston, M.D.: "We keep telling ourselves and each other
what we wish and intend. We need to just do it."
But the resulting book, Too Soon Old, Too Late Smart: Thirty True
Things You Need to Know Now (Marlow & Company, 2004), struck a chord
with readers and commentators.
The book sold out at local bookstores after a laudatory review in the
Washington Post. Charlie Rose touted it on his television show. The
TV and radio appearances followed, and the small volume is in its fourth
Livingston, a life member of APA, told Psychiatric News,"
Honestly, I'm a little surprised at the reaction the book has
generated. Apparently people I don't know personally are buying it."
The book takes the form of a conventional "self-help" treatise,
but Livingston's messages are much tougher than those of more famous
Roxanne Roberts, in the November 30, 2004, Washington Post, wrote,"
He is more Job than Dr. Phil, painfully aware of life's limitations,
trying to spare you a little hurt. He thinks in paragraphs, not sound
The comparison with Job is apt.
In 1991 Livingston's 22-year-old son Andrew committed suicide after a long
struggle with bipolar disorder. Lucas, his youngest son, was diagnosed with
leukemia six months later. That child died at age 6 after an unsuccessful
bone-marrow transplant from his father.
How does one deal with such losses? Not with the aim of reaching closure
about the experience, said Livingston.
In fact, he wrote, "Like all who mourn, I learned an abiding hatred
for the word `closure' with its comforting implications that grief is a
time-limited process from which we all recover."
Instead, Livingston wrote of the possibility of honoring the memory of his
children by expressing the love he feels for them to those who still need
He and Elizabeth Edwards, wife of former Democratic vice-presidential
candidate John Edwards, became acquainted on an Internet site for bereaved
Edwards, whose son died in an automobile accident, said in the foreword to
Too Soon Old: Too Late Smart that she keeps a folder on her desk
marked "Gordon" containing a collection of his e-mails and posts
for occasions when she needs a "voice that is at once stern and
reassuring, hopeful but unwilling to proffer any guarantees."
"At the same time that he warns us how little we control, he reminds
us that we are never stripped of all our choices," Edwards wrote.
The 30 "true things" that Livingston offers to his readers
appear simple, but they are hardly simplistic. They all nudge readers toward a
greater acceptance of responsibility for their actions and lives.
These are among his lessons: The statute of limitations has expired on most
of our childhood traumas... .Any relationship is under the control of the
person who cares the least... .Feelings follow behavior... .Only bad things
happen quickly... .There is nothing more pointless, or common, than doing the
same things and expecting different results.
"If there is an overall theme to the book," he said to a caller
to the "Diane Rehm Show," "it is that we are what we
"We're too wordy. We keep telling ourselves and each other what we
wish or intend. We need to do just do it."
He warns his readers, "In judging other people, we need to pay
attention not to what they promise, but how they behave. This simple rule
could prevent much of the pain and misunderstanding that infect human
Livingston, who is a graduate of the U.S. Military Academy at West Point,
became a psychiatrist after serving in Vietnam as an Army doctor.
In 1969, after he had come to see the futility of the war, the newly
promoted major handed out copies of a satiric prayer about the conflict that
nearly got him court-martialed. Instead, Livingston was sent home as "an
embarrassment to the command."
He went back to John Hopkins University, where he had attended medical
school, and was befriended by Jerome Frank, M.D., a professor of psychiatry
who wrote extensively about psychotherapy and international disarmament.
Frank arranged for Livingston to begin his residency in psychiatry at
Livingston maintained a psychotherapy and psychopharmacy practice in
Maryland for more than 30 years as director of the psychiatry department of a
large, multispecialty group.
Not surprisingly, he has tough words about what has happened to his
"This is the profession of Freud, Jung, Harry Stack Sullivan, and
Irvin Yalom," he said. "Managed care and insurance company
reimbursement schedules have turned many of us into pill pushers."
He laments the diminishing role of the psychiatrist as a "source of
wisdom and guidance for people seeking help with the eternal questions of how
to live meaningful lives."
His book's unexpected popularity might result, he thinks, from the fact
that it deals with basic issues—such as trust, love, and loss—that
are central to the "human desire to find meaning and
He said he fears that those topics have become the "province of
nonmedical practitioners who engage in the messy, uncertain, and prolonged
process of psychotherapy."
Livingston recognizes that medication can be a "wonderful aid"
in the treatment of emotional disorders. He added, however, that prescribing
medication "should not be the entirety of our professional
contribution," and he worries that diagnostic labels can have the effect
of relieving the patient of responsibility for making changes.
And change, Livingston wrote in his book, is the goal of all therapeutic