Why Patients Deserve Special Respect


The stigma of mental illness lingers despite the carloads of Xanax-filled vials in the pockets and purses of America. The notion of life as an easily mastered enterprise persists. When the going gets tough, the tough get going — so we are told. Those who cannot, by force of will, get through difficult events unaided are thought to lack the right stuff.

I disagree. There is a quiet heroism in admitting you need help. Opening yourself to a stranger requires courage.  Awareness of your limitations is humbling. If all this were easy, therapists would observe lines leading to our turnstiled offices. Traffic pile-ups would slow the route.

Don’t get the wrong idea. The people who seek treatment are indistinguishable from everyone else. They range from rich, famous, and gorgeous to a more unremarkable lot. They are your neighbor and your friend. They might have been you and they may yet be you.

The best of them are willing to do anything to change their lives. They risk, cry, and expose their naked psyche. They meditate, think, try new behaviors and revisit old ones. They confront themselves in the darkness.

They look in the mirror for reasons beyond hair arrangement and shaving.

You may say you’ve been through worse than they and came out better, all without the crutch of psychotherapy or medication. Can you be certain? There is no calculus to compute your pain and measure your suffering against others. When you invent one call me, for then you can say you did it all alone, by the superior force of your will against the greatest odds.

Those faced with severe anxiety or mood disorders know things too terrible for words: endless sleep disturbance, perpetual unease, and (in the case of depression) minute-by-minute misery fraying the cord binding them to life.

You would not want to feel as they do if you could, and if you could the experience would not be as you imagined. You’d live inside of a monster who lives inside of you, consuming joy until your former self is gnawed away. Living the experience would lead you to repent any prior judgment, but shame might mute your apology. When patients choose to live and fight in spite of their calamity, the rest of us can only bow before them. To heap scorn on those souls who display courage even they themselves doubted adds to their misery. The crowd owes them encouragement instead. We diminish ourselves by withholding it.

Judgement, however, is hard to escape. A young married man who was a therapy-virgin told me he thought unfaithful males are weak in their lack of resistance to temptation. Yet he had never been severely tempted by a woman to whom he was drawn since his wedding; never had to turn from the scent, sensuality, and softness of another with seduction in her eyes. His thoughts on the subject were largely abstract and observational. What value might one give his opinion? No more, I suspect, than the rest of us when we say, “I would have done that” or “He shouldn’t do this” as we witness the battlefield of life from a safe distance, like the chest-beating bravado of old men who send young men and women to war.

The same gentleman, by the way, was a brilliant extemporaneous public speaker, but struggled to make a phone call. We are frail creatures, no? A lack of experience in counseling, like other opportunities one hasn’t had, puts negative judgment on a slippery slope to irrelevance.

Among those who think therapy deserves its stigma are at least a few who choose another way of living, less heroic than they think. There you will note plenty of avoidance, alcohol use, nightly marijuana trances. Some of their marriages are endured rather than enjoyed. You will discover those with few friends and jobs they wish were better. Anger and depression reside among them disguised. In other words, their lives are not so different than those of the pilgrims to the counselor’s office, except …

People who search for a therapeutic remedy face the imperfection not only in themselves, but in life. They tend not to live with the illusion that faith, by itself, will transform this mortal coil and their place in it, even if they await a more distant reward.

Perhaps most admirable of all, the most dedicated clients wish to learn: to do new things, explore the psyche, reexamine their past, and travel to the unnamed, undiscovered country. They are discontented with their present life and the majority wish to move beyond blame — though blame they may — and take responsibility for change.

Winston Churchill said that “Democracy is the worst form of government, except for all the others.” Maybe therapy is like that: the worst remedy for unhappiness, except for doing nothing; a painful attempt to face the truth and reorder your existence, modify relationships, and pour yourself into a vessel on which you’ve written: “This has value. This is worth my best effort.”

If you find a better way, let me know. Until that time, hats off to those who take Socrates to heart: “The unexamined life is not worth living.”

The top photo is called A Life of Theater Photo: Sadness –Final Chapter. It is the work of Gabriel S. Delgado C. and sourced from Wikimedia Commons.


Dealing with People Who Say Therapy is a Crutch


It is so easy to judge. Legions of “friends” and acquaintances evaluate your decision to enter treatment. Some signal thumbs up and applaud your courage. Others gesture thumbs down and render disapproval:

It’s not as bad as he thinks.
He needs to suck it up.
I’ve been through worse.

While many people are understanding, critical voices say you betray weakness by reaching for this “crutch.” Surprisingly, those who have experienced a similar problem are often less empathetic than the rest. If your friend also got over a traumatic accident like yours, research says he is probably less sympathetic than people who were lucky enough not to have had that piece of bad luck. The closer your experience is to one the other person triumphed over, the more likely he is to think your adversity is manageable. A pity, because when you reach out to the buddy you expect to be most soothing, you might discover he comforts you not.

Sometimes we must give up on such “friends.”

Nature fashioned us to survive. Like athletes trained to forget their failures quickly, we are more content if we get past the pain of remembrance. Thus, our own photo-shopped recollection of triumphing over the bad breaks of life can make us less sensitive to fellow-men when those traumas are akin to ones we once endured. Arm-chair chest-thumping is like the braggadocio of a political office-seeker who tells us how easily he would fix a national problem if only he were in office — condemning the effort of those who now grapple with the job. The sideline of life is a place where judgment produces cheap and imaginary victories rarely duplicated once the judge steps out of his robes and into the game himself.

It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes (up) short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who know neither victory nor defeat (Theodore Roosevelt, 1910).

Adding to our misfortune is the tendency to condemn ourselves. History offers examples of people who triumphed in extreme situations. We get the sense such folks are plentiful because they are the objects of story and song — as numerous as the apples on a fruit tree. If we buy-into the ease with which people survive and thrive we compound our already miserable state by observing the contrast with our own plodding struggle.

From the therapist’s chair, survival and persistence are, by themselves, heroic. Perhaps not the heroism of a Shakespearean tragic figure like Coriolanus, but admirable nonetheless.

I treated just such people in my therapy practice. For a time, sometimes for months or years, they were immobilized by the hammer blows of fate. Signs of resilience and the will to fight slowly emerged. Not always, but often.

The art of life is more like the wrestler’s art than the dancer’s … it should stand ready and firm to meet onsets which are sudden and unexpected.” (Marcus Aurelius, VII, 61).

Like the athlete thrown to the floor, in time you must get up.


The moment of resurrection is different for each of us. On the wrestling platform of life no referee demands a speedy rise. Ah, some in the audience will criticize, but they do not writhe in your anguish or see the torn sinews beneath your skin.

The effort to stand again is not over until you say so. Those who judge are unaware (or have forgotten) how they would react in a similar situation. Some resort to a kind of cheap self-flattery to quell anxiety at the possibility of themselves experiencing your adversity. “Oh, I would have been able to handle that” is soothing to say and makes them believe they are resilient and brave, but is lots easier from the grandstand than on the field.

Your misfortune is also a cruel opportunity, but an opportunity nonetheless: to triumph over fate. Sometimes victory is just persevering.

When Shakespeare’s flawed hero Coriolanus was banished from Rome, his mother lamented his departure. He attempted to console her with words she taught him. The perspective he learned from her was that a crisis was a chance to distinguish himself as better — more heroic — than the average person:

Where is your ancient courage? you … used

to say extremity was the trier of spirits;

That common chances common men could bear;

That when the sea was calm all boats alike

Show’d mastership in floating …

In other words, it is easy for us to sail along without concern when the water is smooth.

You who are in pain would give up the suffering if only you could. Now, however, you will find out who you really are. The rest of us are waiting for whatever challenge drops on us for the chance at such knowledge. I am not suggesting we seek it. Yet, once fate arrives, do battle in whatever form you can however weak you feel. Even if taking a breath is, for now, all you can muster.

For those of you in the fight of your lives, I salute you.

The Wikipedia “Fight Back!” logo is the work of Kasuga-commonswiki.