Susan Rako M.D.

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The Three Options We Have in Life

Wisdom of Dr. Elvin Semrad

Posted Feb 19, 2016

We who sit in the trenches with our patient, attuned to his/her struggle to find a way to live in the world as it is in the self that he/she is, commonly wish to have something to offer as a source of support for the challenge.  At such a time, I am grateful to have had the opportunity to learn from Dr. Elvin Semrad, the most influential teacher of the art of psychotherapy of his and subsequent generations.

Semrad said, "We have three choices in life: to kill ourselves, go crazy, or learn to live with what we have in life."

Simple.  True.

Obviously this is not something I would be moved to say to someone who is actively suicidal.  Thankfully, the degree of such despair is not commonplace.

But for my patients facing challenges in their lives that seem to them complex and unique, to hear from me:  "My wisest teacher, Dr. Elvin Semrad, used to say:  "We have three choices in life ..."

What a gift he gave to me and to my patients.  I can pass on his wisdom one step removed from its being an utterance of my own.  The words are insulated from a direct connection to me.  As well, they carry a sense of universality.  There is comfort in knowing that one's struggle is part of the universal struggle of humanity.  One is not alone.  When I quote Dr. Semrad ... "We have three choices in life ... ," my patient becomes notably attentive.   " ...to kill ourselves, go crazy, or learn to live with what we have in life." 

Saying these words, listing these options, simplifies the focus and helps us to get down to basics.  We can pick up the detailed work with renewed attention.  What does the patient have to accept in life and is continuing to resist?  What feelings does this task generate?  Anger?  Sadness? 

About his words, Semrad used to say: "Take what you find useful, use it and pass it on. As for the rest, throw it away."   

I am glad to pass this on.

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