Dear Dr. Gottlieb:
I have been hearing a lot about new therapies, but none seems to address the bigger picture, which is the insane world we’re living in.
If a person really sees what’s happening, who wouldn’t be depressed or anxious? A brief list includes military violence and torture, our growing police state to protect against terrorism, and the ongoing rape of the environment. We all have to figure out a way to keep our balance.
The world does appear quite ill. There seems to be more anger, segregation and alienation, and all these foster mental and emotional distress.
But we humans often cope in ways that make them worse. Gated communities, for example, keep springing up to deal with our anxiety about “others.” In California alone, 40 percent of new construction is behind cement walls. And the more we separate from one another, the more isolated we feel.
When we don’t spend time with our neighbors and people of other groups, we risk inventing fables about who they are and how they think. That makes us feel even more insecure. Add in a highly demanding, transient lifestyle, and many people feel disconnected even from themselves. We psychotherapists see the fallout every day. People come with symptoms related to feeling alone and misunderstood. And although psychotherapy cannot heal an ill world, at least it can create a safe environment where people can reconnect with themselves.
Sometimes, it can make things worse.
When we suffer, we become self-focused and our world becomes smaller. And this is where psychotherapy can do harm. By training people to focus on every nuance of their personal experience, long-term therapy can make their focus quite narrow. And they can wind up feeling more alone.
Last year I saw a man who had been in psychotherapy for 18 years. He opened our session by saying, “I feel like a failure. I started psychotherapy because I felt I wasn’t very important, and here I am 18 years later, and I still don’t feel very important.”
I waited a minute to allow this man’s terrible shame to sink in.
Then I moved closer and said: “I have good news, you are not a failure. You really aren’t very important in the broad scheme of things!”
First, he laughed, and then he laughed harder. And then he cried with relief. He said deep down he always thought there was something wrong with him.
Psychotherapy cannot treat an ill world, but it can do more than treat symptoms. I don’t believe alienation can be treated in an office; it must be treated in the larger world.
I learned a valuable lesson several years ago when I was seeing a woman for severe depression. She had tried several medications but all had severe side effects. She was also working a stressful job that made her depression worse.
One day she asked if I would approve her taking a medical leave of absence. I knew the isolation could deepen her depression, but I also perceived that her work environment was toxic. So I agreed to a leave with one proviso: that she donate 20 hours a week to help living beings.
She agreed, and began volunteering at a school and at an animal shelter. In the short run, she reported that she was meeting nice people and felt less lonely. Soon, she began to socialize more.
After several weeks, her depression began to lift and she became more fully engaged in psychotherapy. When she returned to work, she kept volunteering and called it a lifeline.
The world might be ill, but we must do more than kvetch about it. And psychotherapists have a special responsibility. We should be fostering mental health by encouraging our patients to meet their neighbors, get involved in the outside world, and learn who needs help and then helping.
We know that helping others raises endorphins – the body’s natural antidepressant. So maybe the next generation of psychotherapy will help people heal themselves by helping the larger world.