Tell us about yourself.
I was born on Kibbutz Beit Alpha [in the Jezreel Valley], to older parents. I studied psychology at Tel Aviv University and did my advanced degrees in the United States. I am a clinical psychologist, consultant, lecturer, instructor and therapist. I always knew that I wanted to deal with people and not with machines.
Over the years I realized that my interest lies in people's wellbeing. What I am most proud of in my career is that I was freed up from teaching psychopathology in favor of leading a research seminar that dealt for the first time with wellbeing, which is truly most precious to me. It's no accident that I am the founder of something called Single-Session Therapy, or SST, which is actually a type of psychotic optimism.
You're referring to a therapeutic method that you developed, which, as its name suggests, advocates a one-time, intensive intervention and not long-term therapy.
At the start of my career I worked at a public hospital in California. The demand was high and there was a long waiting list. I was asked to help with patient intake [pre-therapy evaluation and registration]. I discovered that I was doing intake after intake, listening, talking – but afterward the patients didn't come back.
We should point out that these were not easy cases, but people who applied to or were referred to the public framework of mental health care in the United States. These are not first-world problems.
Most had never been in therapy. Broken families, stories of abuse, addictions, suicidal tendencies. Many black and red flags came up during intake. At first I was quite offended that they weren't returning, and then I decided to examine this in depth – maybe it's a phenomenon? I spoke with my superiors and discovered that it was happening with them, too. It took me something like half a year to muster the courage to contact the people who didn't return and simply ask them: Why didn't you come back? The replies were astounding. People explained to me that they had received from that single session everything they needed.
That is radical thinking, almost heretical in terms of the milieu of clinical psychology, contrary to the training you underwent.
True. My legendary teacher made it clear to me that there is no such thing as fewer than five meetings a week.
There is no pretense of solving everything in a solitary session, only to improve.
We're not trying to pry, but to play where the ball is. To understand what strengths and abilities can be found; to gaze with uncompromising optimism beyond all the bad stuff. Even in 99 percent cases of major depression, there is 1 percent of vitality. That is where we will conduct the dialogue. The question is actually under which lamp we are searching during a session of this kind. When you are willing to listen to distress and discover the power and strength of this actual moment, and the patient's desire to come out of the encounter differently, even just a little – the magic happens.
I can say, personally, that one pretty random piece of advice that I received at the age of 25 influenced my life deeply.
Listen, I did multiple follow-ups of my patients. Hundreds and hundreds. In the end, somehow what remains is one sentence. Sometimes I didn't even remember having said it, maybe it was actually spoken by them, but still, that is what they took with them.
What, for example? Do you remember any of those sentences?
For example, there's a saying, along the lines of: "A person who puts you down is projecting their own flaws upon you. Show compassion for their flaws and ignore their attempt to put you down." That's something not every reader can relate to, right? But it represents a certain moment of connection during the session, in which the timing and the attentiveness and the precision transform it into something that is recalled, something that accompanies you on the continuing journey of life, that's like a key that frees you from being stuck and releases distress.
Those sentences also accompany me; they are a meaningful part of my soundtrack. The only question – determined in advance – and which I would ask a quarter of an hour before the end of the session is: "We have 15 minutes left. What is your takeaway from this encounter today?"
That's a sort of omnipotent stance for the therapist, no? You have 50 or 70 minutes to try to change this person's life. Can you do in that time something that a different therapist didn't succeed to do after years-long treatment?
There's actually a good deal of modesty here, because I'm not out to solve everything. I am limited in time, and under that limitation I try to do my best and be of benefit. The ability to foment change resides in the patient – not in me. All I will do in that session is to look for the most constructive channel for my patient. There is optimism regarding the possibility of bringing about a dramatic improvement, knowing that we have only this one hour. Some will succeed, some won't. It's their right.
I hope we'll manage to get back to the subject of SST, beyond this superficial glance. You asked that we focus on something else: on the complex circumstances surrounding our conversation today.
Yes. I very much want to talk about that, and I also want to ask you not to publish this interview until after it's all over. In another three weeks I am going to Switzerland. I have chosen to undergo euthanasia, or whatever people want to call it. Switzerland is the only place in the world where every citizen, from every country in the world, can undergo this process legally.
From my point of view, this a process that is identical to what I underwent with all the dogs I raised and loved all my life: I brought them to the veterinarian, I cried, and in five minutes it was over. And with all the pain, there was serenity in it.
I looked at the numbers of Dignitas [the Swiss nonprofit that provides physician-assisted suicide]. They are tiny – between 100 and 300 people a year.
It amazes me that it is still so rare in the Western world. After all, we know that most elderly people live for 10 to 15 years without any dignity, and yet we take pride in extending their lifespan.
In recent years, after falling ill, I have taught the subject of the clinical psychology of older adults, particularly of Holocaust survivors. My students meet them – people over 90 who lived a marvelous life of heroism and are now living an unworthy life, a life that humiliates them. My students need to raise their spirits and tell them: keep going, be strong, life is worthwhile. And I observe from the side and say: No. I don't really feel that. This is a superfluous life.
You chose to end your own life, even though your disease is currently in remission.
In full remission. I made this choice in the knowledge that the only wish of my patients, my friends and very definitely of my most beloved wife and children, will be that I go on living.
Oct. 7 nightmares
When did you understand that you don't want to go on living?
After October 7, I accompanied, from close-up and afar, people who'd experienced the most horrible nightmares possible. Listen, I started my path as a psychologist at a Telem [nationwide network offering psychological care] center in the western Negev – Kfar Azza, Nir Oz, Be'eri – those places were part of my life. And I keep going back there: All the incomprehensible atrocities that happened there are just keep playing out in front of me, 24/7. And I'm already dealing with the third round of cancer, and I say to myself: Enough, I don't want this.
Gradually, I came to a realization – that it's important for me to have a good ending. I started to raise the subject out loud and to talk about it with my wife Anat and say that I deserve a good ending.
What is a good ending?
In Hebrew it's called "death of the righteous." You go to sleep and don't wake up.
And in a broader sense? What is a good end?
The end of a person who lived a full, meaningful life, filled with happiness and love. Whose children have grown up and have life partners. Happily for me, I have already had all that, so I started to seek a good end for myself, while everyone who's dear to me is saying, "No way" and "It's out of the question."
That's understandable. That is the self-evident and expected human response in the face of your choice.
I think it has to do with the limitations of empathy. I think that anyone who is healthy is simply not capable of understanding this suffering, and it might be that it's impossible to understand it at all. So it's easy for my beloved family to tell me to go on, because they don't understand the suffering.
But you were sure.
Yes. I wasn't sure about the timing, but it became increasingly clear to me that this is what needs to happen. Every day my burden grew heavier, and I was deprived of more and more capabilities. And in the meantime, life goes on; there are joyful and moving life events in the family. I think I didn't assess correctly what my death, as a husband and a father, was going to exact from me.
I am a devoted father and husband, loving and present – and it was very difficult. Five times I postponed my trip to Switzerland, for supposedly good reasons – weddings and pregnancy. I was preoccupied with the thought that, heaven forbid, I would die in a way that I don't want and am not ready for. That was something I knew all along: that I don't want to die in an ER or on the operating table. I want to die with dignity.
So that is the good end you wish for: to die with dignity.
That is the right of every person. I lived a full life, fitting, happy. I did my part for the world, I passed the age of 76, and I am entitled to choose this.
It's clear to me that you're right so it's superfluous for us to dwell on the principle. I would rather we spoke about your personal choice, especially as a psychologist who is deeply acquainted with our complex approach to death. You are choosing to end your life. That's a choice that subverts – mentally and physically – basic instincts. Actually, I'd like to try to understand, with you, what differentiates people who made that decision from people who are not interested in or are not capable of making it.
I truly think that anyone who has not physically experienced this suffering, over the course of many years, cannot genuinely understand.
For sure – and yet many people experience great suffering and know there is no cure for their disease, yet they do not make such a decision.
I respect every choice. As a psychologist, I can say that we are not built to think about the long term. I assume that, like people who understand that they have to quit smoking and say "I want to quit, but not today," people whose quality of life is degraded are also afraid of death, so they simply postpone it. I think that if I were to tell a person in that condition – "Listen, there's no possibility of putting it off by a day but only by 10 years, so decide now: Do you want to die tomorrow or in another 10 years?" – many would say: I want it to be tomorrow.
But even so. It's a complicated matter. To go to Switzerland. To wait there for three days. To undergo the process at a predetermined time. There's a kind of de-familiarization, maybe an alienating of death.
A crude de-familiarization, maybe even a blunt one. I set my first date four and a half years ago. I asked the Dignitas representative for a one-way ticket to Switzerland, and he asked whether I wouldn't prefer a round-trip ticket. That sounded odd to me, and then he said that it often happens that people get the confirmation and then ask for delays of one kind or another.
It's actually a combination of two things that are very difficult for people: long-term thinking and commitment to a specific time. There is the human drive to extend things: No matter what the age or the level of suffering is, "life must go on." It's a powerful drive, and I respect anyone who has the resilience and the stamina [to go on].
So in your view, to go on living like this is an act of resilience? If you had to break down the urge or the desire to stay alive, how much of it is personal, and how much social or related to your environment?
I think I've downplayed the power of the social element. I am by belief a contexualist, but I didn't assess correctly to what extent my surroundings would challenge me when making this choice.
What force did you summon up to counter that?
That it's my right. Even my obligation. And I take 100 percent responsibility for it. I didn't choose my parents, I didn't choose my kibbutz, I didn't choose my country. I have the ultimate right of choice here.
So in the "hierarchy" of motivations, choice is in first place? Also the ability to choose while suffering?
Correct. That is the essence of Viktor Frankl, who brought me, intellectually, into the world of psychology. I read Frankl when I was 12, and I thought: Wow, what a privilege; within the Holocaust you can choose the meaning you confer on what's happening. The cruelest reality in the world is forced upon you, and within it you have a choice. In my eyes this is not only an act of self-respect, but also an act of heroism against a debased culture. You can feel the way I feel and still value life. There's not a contradiction.
What about control?
I am currently in a place where I surrender to uncertainty, surrender to absolute lack of control. I accept that. I accept the letting go.
In the act itself there is control. More precisely, a return of control. It seems to me that that's why it's called "assisted dying" and not "euthanasia."
I am the one who has to press the button after they intravenously inject the substance that ends life. I alone press it.
I meant also control in the broader sense. When making this decision to end your life at the time, the place and in the way of your choosing, there is a kind of return of the control that the disease deprived you of.
Of course. What didn't I undergo during these years: radiation, treatments, surgery. I opted for postponements, as I said, and still see my decision as something I am entitled to, and possibly as something I am responsible for when it comes to those I love, and that's what's hardest. I am effectively telling the people I love most in the world: There is no medicine that will allow me to be your husband or father any longer.
Dignitas is also not a cheap thing, right? But another 10 years in this condition – not 10, five; I don't have 10 years – would have cost me much, much more. I understand that many people who will hear that will think I'm not normal. What is this? Someone who could live another five years, and he's going abroad to die? But a person also needs to assess the quality of their life, and for me that is critical. It's related to my independence.
We must bear in mind, again, that your disease is currently in remission.
Yes. I am still lucid. I'm talking to you now. I even see a few patients. But after three rounds of cancer, you understand what remission is. It's just a respite. In my eyes, 10 years before is better than 10 years after.
You are actually saying: An intolerable reality was forced on me, and I am helpless in the face of it. My only way to attain certainty within this uncertainty is to put an end to that reality.
Both of my parents died from cancer, as did my grandparents. I think I arrived at this insight of finality and terminality at a very young age. It is embedded very, very deeply within me. Our life is filled with uncertainty. With ambivalence. With mixed feelings. The only certain event that occurs to all of us is death. Even a person who decides to put an end to their life only wants quiet for themselves. Instead of ganging up on them, looking for motives, and whether they actually succeeded in implementing their plan or judging their choice – give them some quiet.
'I have no fear'
When you think about the procedure, does it frighten you? Are you even afraid of anything at this point?
No. I underwent a serious cardiac event in the ICU. I underwent operations, radiation. I have no fear, because what difference does it even make? In the end a person dies from something. If they have the privilege to choose the path which in my view is the most aesthetic, the most decent and, yes, one of compassion – why wouldn't they choose it? In Israel, the only thing you can request, within the framework of the law, is that you will not forcibly be revived. That's it.
There's the law and there are gray areas that we're all familiar with. There are ways to do it that don't involve traveling to Dignitas.
You're referring to palliative sedation. For me that is less appropriate. I have witnessed situations like that. I saw cases where it went on and on. I don't want that. I can't do that to my children. What – for them to sit there days and nights and wonder if I'm breathing? If I've stopped breathing? And if it takes a week? What sort of way is that to part? To my mind, the way I am choosing is the right way. And nothing is clearer than that, both in terms of irrevocability and the dignity of a person who is still in control of their body and mind, and can do this as is their right and in the way they chose.
You gave a great deal of thought to the practical side of the act, to how it would unfold.
Absolutely. I looked for the most elegant way. As I said, the horrors of October 7 strengthened the understanding – that I have to choose and decide, and that it needs to be done elegantly. Like the Swiss do it. Every day, according to the law. It's a complex procedure and they don't miss a thing. You have to send them plenty of documents. You have to present a psychiatrist's opinion. You mustn't make a mistake; you mustn't write anything that isn't the absolute truth. They check everything and go over everything meticulously; it takes them a long time before they get back to you.
Do you remember the day you got their answer?
Of course.
How does it arrive? Email? Phone?
I didn't want my wife to deal with it for me, so I hired someone to handle all the bureaucracy. I remember he sent me a WhatsApp message: "We have a green light." I said, "Wow!"
You talk about that so enthusiastically. Did you feel joy?
Not only joy, also great relief.
Peace of mind.
Peace of mind, at last. I'm now freeing my wife and my family, and that's it – it's out there. I no longer have to prove anything to anyone. Everyone can understand whatever they want: about me, about themselves; against me, against themselves.
I understand you. I keep thinking about the time that's known in advance. After all, even a sick person on their deathbed knows that they have days or maybe hours left. It's not the same thing here. You know that on a specific date, at 12 noon, you will no longer be among the living.
Right.
Is it easier or harder for you to bear that? Let's say we were to go outside now and ask people on the street: "Would you be willing to know the exact date and time of your death?" I believe most would answer in the negative. Few would be capable of coping with that knowledge.
For me, knowing this gives me peace. A sense of security. It gives me vitality. I feel more alive than ever right now.
That's obvious.
Now, the smallest thing I do is thrilling. Going down to the beach for a minute. Going to an exhibition with my wife.
There's something about having a finite amount of time that changes the way we see things, on every level.
At every stage of life. In therapy, too. In the way we deal with any problem.
Even in the therapeutic approach you developed. Maybe your own perspective is also shaped by this understanding
It's Buddhist understanding and Zen understanding, both about the scale of the suffering and about seizing the moment and also about saying: Shalom, as I like to say, shalom in the three senses – hello, goodbye and peace. Now, knowing which abilities and functions have already deteriorated or may still deteriorate gives me a sense of peace. That's it. I have no more "I can't stand up any longer," or "I can't close a door anymore."
It's amazing that I feel whole, secure and at peace now, even if I deteriorate before the date. There's a sense of calm in knowing the path ahead and the date. In having a choice. I feel profound sadness about what will happen to my children and my wife, the loss they will experience. I cry about that. But I've lived a meaningful life, and I'm allowed to. With this illness, you can see it, okay? You can see how it has taken all my chips off the table
You're referring to your external appearance?
Yes. I see how frightened kids are when they see me. Also adults. People look at me. What is this creature? My speech is slower. I don't smile.
You're saying, in effect, that the reality of your illness frightens you more than death?
Death is a gift. That's what Amos Oz, whom I love, once said: that it's the most wonderful thing in life. It rounds things off, it's final, it happens to everyone, and afterward none of the things that frightened us all our life truly counts. It's hard for me to describe how much this empowers one's mind. Because that's it, the body has already had it. Enough.
You said at one point: "I made the decision, but I didn't know anything about the timing." When did you understand that this was the time?
Yesterday my beloved wife asked me that same exact question, so I have an answer. Listen, I lived with the fact that my face and neck were becoming irreversibly ravaged. I lived with them. When the disease was in remission, I started to examine the possibilities of restoring at least part of their functions. I went to the best and finest of surgeons and experts. Some said it could be done. Some said that I wouldn't even be able to speak after the next operation.
In the end I decided to get a third opinion, and I went to a surgeon who's said to be the best in the country for head-neck disorders. He works only privately, takes something like 5,000 shekels [about $1,650] just for a consultation. I spent an hour with him and tried to understand: Is it possible to straighten my nose a little, so it won't be so crooked? And he's sitting there and explaining that it won't succeed, that what happened to my face will not make any change possible.
After the appointment I went to pay and he said: "No, thanks. We won't take a cent from you." What? I'm in a condition where people don't even want to take money from me? Okay. I got it. There's no salvation. There will be no improvement. This is what there is. With this I want to live? And after that there were a few more incidents and conversations that brought things into focus. I read a few marvelous books, but that was the moment.
You have a hard time with your appearance.
Very. Very, very.
Do you think that if it were possible to remove that variable from the equation, you would feel or think or behave differently?
There is a wonderful and cruel line written by Saul Bellow. He writes that old age is like living in an abattoir. That's how I feel. This whole region seems like an abattoir to me. I lecture and administer therapy, and people sit opposite me and see this thing – and you know, it's not about me, but this sight is intolerable. And several times a day it's necessary to clean this whole insane system, the hole I have in my face. It's horrific. I am not one who looked in the mirror a lot or tried to be some sort of hunk, but it's tough. I see the look the patients give me. It's hard, it's relentless.
Your appearance also doesn't allow you privacy. I assume that you need to refer to it every time you meet someone.
I'm asked about it all the time. It's obvious that I have a disease. That I can't keep it a secret. And that moment is especially difficult because of my profound belief in the fact that it doesn't matter what sort of countertransference there is with the patient – the therapy is not all about me. But suddenly it is all about me. And you see that, and I can't hide it or keep it to myself, and I have to go around like this and be seen and do therapy.
I understand you. All in all, I feel that I understood much of what you said in this conversation, but not intellectually. I understood in my body. In my soul.
I tell you, and I am not exaggerating: I'm celebrating life more than ever. In the three weeks I have left I only want to see people whom I loved for a lifetime. To give big hugs, to cry together and to part. Wow, what a great three weeks to live.
