The Courage to Decide to Get Well from Psychiatric Disorders

It is amazing what an inner decision can achieve in overcoming a mental problem or a relationship problem.

The standard in psychiatric medicine today is that the patient complains about whatever problem and the doctor then prescribes whatever pill – and good luck with the side effects, although they can be really tough and irreparable.   On follow-up visits, the psychiatrist does a kind of supportive psychotherapy in that he listens to the patients’ reports about how they are feeling and then either continues or changes the prescription for pills.  That’s it.

You would think or hope that the standard in visits to psychotherapists – generally clinical psychologists and social workers – in today’s world would convey a much more hopeful engagement with causes and meanings of the psychiatric or relationship problem.  Although standard types of psychotherapy today indeed are more hopeful than the pills, regrettably they often involve a routinized prescription of one or another defined program of a treatment technique – e.g., cognitive-behavior therapy, narrative therapy, psychodynamic therapy, or others — but the technique is generally is not actually chosen by the therapist.  Rather it is the technique which the therapist uses in most cases and it is the school of thought to which the therapist is affiliated and loyal. This is what the given therapist does in virtually all cases they treat, so lots of luck to the patient that the technique is a good fit for their specific problem and personality style. 

A second problem with this standard is that in many cases the goal of the treatment is to eliminate or reduce symptoms but not to look in a broader way at the meaning of life for the patient, their styles of living, and how they themselves are or are not causing much harm to their own well-being or to the well-being of others. The latter in particular is skipped over frequently.

A much more desirable approach to therapy is to have multiple goals of –

  • Relieving or reducing immediate grave symptoms of distress
  • ‘Cleaning out’ as much of the residues of original hurts, insults, rejections and deprivation especially in childhood
  • Mapping truthfully the current life situation, including relationships to other people in one’s life, both from the point of view of whether these others are a source of harm to our patient, but also from the point of view of whether it is our patient who is causing the others significant harm
  • Analyzing courageously the truths of one’s major meanings and purposes in life
  • Working out a plan and goals for correcting one’s greatest faults and lacks and replacing them with good energy, more competent functioning, and creativity

The Wonderful Decision to Get Well

Now back to the choice of a patient — and it can be a couple or a larger family group too — to get well.  Such a wonderful decision can be made by people at any given point in any treatment.  The decision can even be made by people without any mental health professional intervention whatsoever – longer perhaps as a result of a transformative life experience, religious inspiration, the deep influence of a loved one or close friend, participation in whatever experiential group that touches one’s soul, or the plain creative inspiration that always is awaiting us potentially inside of our better selves.

Nonetheless, such inspired recoveries and cures are not going to be that frequent on their own, and they are actually being suppressed by many a standard treatment that is designed to push down and get rid of symptoms but not to engage the fuller story of a person’s way of living.

On the other hand, the therapy that heads towards an actual plan and goals for improving one’s whole lifestyle as a human or the essence of a given relationship that has gotten into a mess, in effect also invites the emergence of a deeper will to live well and healthily.

Years ago, a famous psychiatrist-psychoanalyst of his era, Roy Grinker Sr., who was then editor no less than of the key American Medical Association journal in psychiatry, Archives of General Psychiatry, was struggling with the disappointingly poor results of beloved psychoanalysis.  Grinker came up with the powerful insight that the key subject of the will to get better was typically being ignored in psychoanalysis where the therapist and patient would continue their ‘space travels’ around the perplexing and fascinating productions in the patient’s mind, but not grapple with the decisive choice by the patient whether to get well or to stay in the muck they were in (and in many cases had unconsciously chosen to begin with).

I’ve seen these moments of positive decisions to get well even in very highly disturbed people, and without their saying so in so many words. These moments are gripping and never to be forgotten – one has the privilege of being present when a person is choosing life! 

  • She was actively psychotic, but in and out of the junk of her mad hatter speech we had managed to begin raising questions about her basic ways of organizing her life.  One day she came to her session looking particularly sad and she told of a dream where she died. Sounds ominous, and could be, but my intuitive feeling in this instance was that she was not at all predicting or wanting to die, but rather that she had decided unconsciously that she was going to put down and kill the false self or the destructive part of herself that was holding her mentally ill.  Sure enough, within a few weeks all signs of psychosis had lifted.
  • She was a young and well-educated woman in treatment for deep depression.  In addition to her lifelessness and uncontrollable sadness, she also carried herself absolutely unattractively:  her hair was poorly combed, her choices of clothing were unaesthetic and bizarre, and her body language barely conveyed any reminder of her being a living young woman in the prime of her life.  As the therapy explored the meaning of her life, there came a day when I found myself suddenly and unexpectedly genuinely aware of being attracted and even excited by this young woman for all that she still looked like hell.  Again, as in the previous vignette, I sensed that unconsciously I was picking up an emerging decision by this woman to come alive.  Sure enough, in the coming weeks there emerged an increasingly lovely, attractive and engaging woman with whom it was more and more fun to be with.
  • The couple had been living grimly for some time.  The atmosphere was one of perpetual complaints by the wife and a long suffering avoidant silence by the husband.  The children reflected the sadness of the house, with one thirteen year old boy in particular having become the ‘secret love’ of the mother who, for example, would look in on him when he was taking a bath. 

The therapy introduced the couple to the concept of speaking and sharing with one another one’s feelings and experiences.  A formal framework was created for an exercise every day where each spouse would take a turn in telling what they had experienced that day and how they felt about it, and the listener would then convey back reflections of what they had heard. 

It was a tough battle. Week after week the couple reported that they had skipped or that one or both had sabotaged the exercise by creating a bad atmosphere.  Nevertheless we  persevered.  Finally, they arrived one day smiling in a sweet way I had never before seen and reported that they had decided for the first time to go ahead with becoming genuine communicators with one another.  Only good things followed – for them and for their children (including mother staying out of the one child’s bathroom).

So, this little article is an invitation to a decision to get over major problems.  Happy journey.

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