I frequently ask patients, “What are you saving yourself for?” People spend a lot of time conserving energy, usually while they wait for some event outside themselves to trigger their taking action. At times it appears that they are waiting for a reappearance of the Messiah. I always thought that those who feel the rapture is near are fortunate. Not just because they will be saved while the rest of us endure the tribulation, but because they have a good justification to be in a waiting mode, where their main responsibility is praise and worship as they prepare to be transported directly to heaven.
Those of us who lack the comfort of this belief have to come up with other excuses for our inaction. For some people this presents little challenge. Passivity is the enemy of progress in therapy. The conventional medical model in which the doctor gives instructions and medications to patients does not, by itself, work when someone is trying to change his or her life. The process of figuring out what is wrong with our conceptions of how the world works (as opposed to how we would like it to work) and correcting them is, like most educational exercises, time-consuming. It is also frequently uncomfortable as we begin to slowly confront the events and influences that have made us who we are and realize the power of the inertia and habit that stands between us and the people we want to be.
After I published a book of ideas about the human condition awhile ago, numbers of people, some of whom lived quite far away, called to set up appointments to consult with me. Having found insight and entertainment from my book, they came with high expectations for the help that I might provide. One of them said, “I’ve seen a lot of therapists; you’re my last chance at mental health.” Flattered, I imagined that I would give these patients a new and transformative experience. In fact, what happened is that most of them were disappointed and discontinued therapy after a few sessions. I had not met their expectations as someone who would save them. Now I warn patients who come to me after reading my books, “I’m better in writing than in person.” People don’t want to believe it, but it’s the truth.
I remember John Updike saying that as a young man he was usually disillusioned by meeting writers whose work he admired. They turned out to be drunks, self-important windbags, or otherwise different from the enlightening artists he had expected. And later, when he was a writer to be met, he saw the same disappointment in the eyes of those people who now eagerly encountered him. He didn’t feel witty or profound enough in person to meet the exaggerated hopes of the admirers of his work.
Those who look outside themselves for direction that will transform their lives are likely to be similarly dissatisfied. The challenge for all of us is to mobilize our own considerable capacity for change, to refine our judgments about what we want and how to get it, and not to imagine that the instructions or conclusions of someone else will rescue us.
In general we can only bring ourselves to the task of change when remaining as we are has become sufficiently painful that we cannot stand it any longer. It begins to dawn on us that life is not a rehearsal. Our time, while uncertain, is finite. People at every age are dying every day, most with a lot of unfinished business.
We all carry around inside ourselves some idea of what we would like our lives to be. The images of success with which we are bombarded are, in general, both superficial and unattainable. The values of steadfastness and determination do not receive the admiration they deserve. In fact, a consumer society is likely to celebrate the quick solution, the drug that will provide relief, the replacement of the old with the new, the triumph of form over substance. These messages, surrounding us like the air we breathe, produce a lot of confusion about what will make us happy.
Another question I’m fond of asking is, “You seem hesitant about doing things differently; do you consider yourself fragile?” Since the prospect of change is nearly always anxiety-provoking, it’s not surprising that people resist it. We are told constantly that an important objective in life is to “chill out;” we hear “don’t sweat the small stuff,” and “go with the flow.” So it’s not surprising that people come to regard all anxiety as abnormal and something to be avoided at all costs. There is, in fact, a huge pharmaceutical industry devoted to fostering the belief that no one should have to tolerate anxiety for longer than it takes swallow a pill. In some ways this seductive idea has become the basis for the “medicalization” of human suffering.
A patient who appeared in my office recently was a veteran of several psychiatrists and a consumer of considerable medication. He listed his problems as follows: “anxiety, depression, attention deficit disorder, insomnia, sleep apnea, and narcolepsy.” He was, of course, taking antidepressants and anti-anxiety agents. In addition, he was on methamphetamine for ADD and hypnotic medicine to help him sleep. He had had surgery on his soft palate to help with snoring and was hooked up to a positive pressure machine every night to insure that he didn’t stop breathing in his sleep. He wasn’t much interested in psychotherapy. He had been fully medicalized.
Somewhere in the midst of all this pill-pushing, favored not just by the drug manufacturers but also by the managed-care companies who control reimbursement for mental health care, we have lost something in our ability to take responsibility for our lives and deal with the inevitable mood changes that are a part of living.
This is not to deny that medication is frequently invaluable to help people cope with mental illness: schizophrenia, bipolar disorder, major depression. Medicines can also help temporarily with problems in living: situational anxiety, grief, post-traumatic stress. But when the only thing psychiatrists do for people is medicate them for their intrapsychic discomforts, we have sacrificed something essential in our professional identities. We also convey the message to patients that the passive acceptance of such “treatment” is the preferred method of dealing with emotional problems.
I prefer to challenge people to relinquish passivity, stop waiting for answers outside themselves, mobilize their courage and determination, and try to discover what changes will bring them closer to others and to the people they want to be.