Happiness in this World

Reflections of a Buddhist physician

Crazy Makers

For some people, the world will never be right.

"The Buddha's compassion is perfectly equal and impartial. The Buddha views all beings as his own children and strives to elevate them to attain his same enlightened state of life. It's not there are no differences among people. Rather, it's that the Buddha, while fully recognizing people's differences, does not discriminate among them."

—Daisaku Ikeda

As a physician who sees almost every type of person who walks the planet Earth walk through his office at one time or another—from African Americans to Chinese to Germans to Italians; from people who never made it out of grade school to Nobel Prize winners; from the ultra-religious to the most stringent atheists; from schizophrenics to the suicidally depressed to the astoundingly resilient—I can attest to the fact that not only are there "differences among people," but that sometimes those differences are so vast that it seems impossible to imagine we're all living on the same planet Earth. Sometimes I feel there are almost as many "planet Earths" as there are people, their orbits separated by the immense gulfs in understanding and values that separates our thinking. And though everyone is deserving of our compassion, not everyone deserves the whole of our personal time and energy.

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Some people are their own worst enemies, their attempts to handle their daily troubles so misguided that they end up causing more misery than they alleviate. Such people often settle on strategies to help them manage their negativity that others find intolerable: unwarranted aggressiveness and attempts to manipulate to manage insecurity; malicious gossip and even deliberate sabotage to manage jealousy; grandiosity and even narcissism to manage poor self-esteem; splitting (where everything is experienced and judged in painful extremes, all good or all bad) to manage intense emotional lability; bizarrely inconsistent approach/avoidance behavior (the classic borderline personality mantra, "I hate you, don't leave me") to manage self-hatred.

Often such dysfunction appears in response to injury inflicted early in life at the hands of others, and should be greatly pitied. Yet no matter how much compassion we may feel for such damaged people, it doesn't mitigate, no matter how much we might wish it did, the difficulty of interacting with them. And often there comes a point at which we realize we lack the ability to enjoy our interactions with them at all.

I have a number of such people in my medical practice. And though, in all honesty, they're often as difficult for me to handle as they are for everyone else, I remain as committed to them as I am to my other patients. Whenever I find myself musing about transferring them to another physician's practice, I stop myself with one pointed question: "If not me, then who?" And yet medicine (and psychiatry) is sometimes as powerless to help such people navigate life more cleanly and pleasantly as are the few self-appointed heroes who often populate their personal lives and continuously try to connect them to the world in a healthier way. Not to say that such people can't find help—just that it's extremely difficult.  I tell myself that my refusal to abandon such troubled people is the best treatment—sometimes the only treatment—I have to offer them. So I continue to offer it, no matter how challenging my interactions with them may be.

And challenging they are. A Buddha may care equally about all people as his children but in his heart of hearts still enjoy the company of some more than others. And being a Buddha doesn't mean lying to yourself about whatever feelings you may have—even the less-than-admirable ones. A Buddha is still human, no matter how enlightened, and humans will always prefer some things—and some people—to others.

Which is all to say that sometimes it's all right—even appropriate—to detach with love. Caring about the welfare of others doesn't by itself commit us to a lifetime of living in close proximity to them. Some people are simply too difficult for us to endure gracefully—and leaving them in some concrete fashion may sometimes be necessary for us to preserve ourselves. We may feel tremendous guilt and that we're being unfair. But we may also feel great relief to discover just how much of our stress was due to the presence in our lives of someone too toxic for us to bear.

To pretend that such circumstances—and such people—don't exist is to take political correctness to a ridiculous, detrimental extreme. People simply are endowed with differing degrees of mental health. This makes the mentally ill—or the severely emotionally injured—no less worthy of the respect than anyone else, but does sometimes necessitate that we respect them from a distance.

Though in my professional life I've never once abandoned such a person, in my personal life—where relationships must be mutually satisfying to survive—I have. Never with anything in my heart but concern, both for their welfare and mine, but also once having recognized my own mental health was at risk, never with much hesitation either. This may strike some as overly harsh, but I—all of us—have lives worth protecting and enjoying as well.

Some relationships, of course, resist abandonment, most notably relationships among family members, the breaking off of which usually carries far more significance and causes far more pain. And though the bar for choosing to break off such relationships must be higher, such a bar still exists. This remains always a personal decision, but one that remains all right to make—and must, in fact, sometimes be made.

This is a difficult topic, for it risks legitimizing the notion that the more dysfunctional among us deserve the pain they create for themselves. In no way do I mean to suggest this. Instead, my intent was to legitimize the notion that our compassion must sometimes be pointed preferentially at ourselves.

 

If you enjoyed this post, please feel free to visit Dr. Lickerman's home page, Happiness in this World.

Alex Lickerman, M.D., is a general internist and former Director of Primary Care at the University of Chicago and has been a practicing Buddhist since 1989.

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