by Jennifer A. Katze, M.D.
(Excerpted from an article in “Explorations” Magazine)
[November 1995; Vol. 22 No. 5]
Quiet desperation is what Thoreau called it, and he advised us to go to the woods and live with Nature, soothed by simplicity. Now Walden Pond is surrounded by noisy, competitive, hard-driving Boston suburbia, and joggers go there in pursuit of an endorphin fix, still seeking well-being. We who can afford it take expensive vacations in search of relief and perspective; we who are less fortunate shoot heroin or snort coke. We long to escape misery, and the bittersweet irony of the well-fed and politically unoppressed is that misery can still be our constant companion. Created misery, not environmentally imposed: quiet desperation, neurotic misery, from within and unamenable to geographic cure. It is one of the most elusive plagues of twentieth century developed countries, and one of the least honorable ones. For how can we compare such suffering to starvation, political torture, disease, war, homelessness? And what do we do about it?
Our libraries are packed with literature on that subject, from the subtle reflections of Camus to the cruder recipes of self-help gurus. In spite of all that, the fact is that we do suffer from within, condone it or not, and such suffering can vanquish all the joy that our privileged lives should hold. We are the products of the psychic forces from our past as much as the chemistry of our genes, and the past can no more be redone than our genes swapped for better ones.
The quest for salvation from our malaise has become increasingly pharmacological. We are the Prozac generation. The premise of this approach is both soothing and damning: it’s our genes that have betrayed us. And true, for those who are depressed, manic, obsessive-compulsive, or psychotic, the new drugs are often a blessing. But for others who know that our suffering is much more complicated than that, that we are the beleaguered bearers of an identity, a self, that is warped and wounded by our experience, our history, Prozac and its cousins may offer a sort of analgesia, but no real change, no longed-for transformation. Judging from drug sale statistics, such chemical comfort has become the remedy of choice for the nineties, but is still not enough of a solution to save many of us from our neurotic misery.
So we desperately seek real change, and still we find mostly other sources of placation, palliation, more comfort. Thus we are also the generation of the New Age, with crystals, herbs, massages, mudbaths, and meditation; an age of frantic scrambling up corporate ladders, to earn more and more to spend on less and less helpful hedonistic acquisitions; or of the skyrocketing appeal of the Religious Right, where being Born Again should be, must be, better. We seek the aid of Past-life-regression weekend retreats, Alcoholics Anonymous, health spas, Scientology, diet workshops, Oprah Winfrey, and sport-athoning; or the refuge of Cyberspace, where lifetimes can be spent cruising on an electronic world of curiosities to fill our voids and spare us the pain of personal experience. Everywhere we look today we are surrounded by evidence that we feverishly pursue relief from inner, created suffering, the sort that robs us of peace. We are lost on a planet that is overpopulated with homo sapiens (whose only dangerous living competitor, we are assured, is the virus) looking for a way to live with dignity, meaning, and satisfaction. Unsullied Mother Nature--wilderness--our historical comforter (and source of fear) has been squeezed into distant preserves far from the center of most of our lives.
Psychotherapy? Yes, another twentieth century offering. Remember when psychotherapy was highly respected and much more affordable, included as it was in our health insurance policies because mental health was a societal priority too? Only a decade or two ago we firmly believed that such a commitment of time and money offered a path we could follow to explore and understand our deepest feelings in a way that liberate us to be more, freer, content. It was before Prozac, and we possessed a fundamental conviction that the self and one’s personal will are the agents of true change. No delegation of responsibility, no pursuit of external fixes, no chemical magic, and nothing easy about it. Now we turn far more often to drugs: how they might help is easier to understand, the results are more predictable and expeditious, and they demand so much less of us. By contrast, the relative mystery of the psychotherapeutic process makes it so much easier to dismiss, and its outcome will never be readily predictable.
What can we say that psychotherapy actually offers? Certainly the comfort of another person’s concern, one who is truly listening and witnessing. And oh yes, something very, very straightforward and limited: understanding of ourselves. We know what we know, and we know what we don’t know, but the fearsome thing, that which robs us of freedom, is what we don’t know that we don’t know. What needs to change if we are to reduce suffering inside, and it’s invisible unless we can develop insight into ourselves. And insight is only a tool, powerless if unused. Whether we actually achieve change in psychotherapy is another matter, and what would (and do) our managed health care gatekeepers say to that uncertainty? There are so many “variables”, so little to assure “cost-effectiveness”: business terms applied to the state of the mind’s health.
So these days many of us are ambivalent about this treatment, wholly disenchanted at worst and aware of its limitations at best. Yet we know how insight is developed, and how difficult it may be to do so effectively unless the relationship between the therapist and patient is itself grounded in health, often hard-earned trust, and mutual respect. The patient and therapist slowly learn about the patient together, and it can require enormous time, fortitude and compassion to discover that which one doesn’t know one doesn’t know. Psychotherapy is not for the unskilled or faint-of-heart practitioner, nor is it for the impatient, world-blaming and see-no-inner-evil patient. This work is no random, hocus-pocus process, but rather both an art and a science rooted in indispensable ideas and techniques. Therapists must have these skills and the incorruptible quality of the therapeutic relationship itself in order to hope to guide patients in their pursuit of insights into their suffering. But again, insight does not produce change.
How people change through psychotherapy is a very complex and dicey matter, but the good news is that they can and do. Change, when and if it occurs, is hard-won, painful, and partial. But here, with psychotherapy (and strong motivation) at least we have that chance, the chance to transform ourselves so that we are freer to savor our lives and achieve some peace. I am not talking here about the suffering from a genetically-driven mood disorder or schizophrenia, but the suffering that has ensued from our character make-up (but to escalate the complexity, of course our inner conflicts and our character development are enormously influenced by genetics, including the existence of major “genetic” mental illness). This neurotic suffering will not disappear without a change in the conflict, and a change in the conflict amounts to a change in what one is and how one lives, feels, reacts.
It requires a change in what we have come to call personality, and however it may have come to be what it is, it resists becoming anything else. No matter how much we might consciously wish to be different, to resolve the conflicts which have made us who we are, we will run afoul of entrenched forces which will resist. The force of will, the arduous effort, and the duration for which we must maintain such effort, once we have learned what change is needed, is why enduring change is far from assured.
This goes much deeper than Prozac, and Prozac will never replace it, though we are in some danger of forgetting that. It should never become a matter of one versus the other, for in fact their contributions do not compete. There are many ways to find comfort in a difficult world, including anti-depressants, but there are few ways to deliberately and knowingly change ourselves for the better, and the “talking cure” (Freud; but not talking AS the cure) is one. Though patients indisputably and marvelously benefit from today’s new psychiatric medicines with either control of major mental illness or some relief from neurotic anxiety, stagnation and despair, these medicines simply cannot offer what psychotherapy can. In spite of that fact, we are in an era when psychotherapy is rapidly becoming marginalized, trivialized, and even barely taught in some psychiatric training programs. This in only partly because of the widespread magic-bullet use of Prozac-like drugs, but even more so the result of marketplace forces and strictures of the economy which are coincident with (and perhaps indirectly supported by) some subtle but very troubling attenuation of belief in ourselves as individuals with a psychic job to do. We’ve all heard the popularized social speculation about the growing trend to see ourselves, our generation, as victims of all sorts of forces, with the natural corollary that we are proportionately less likely to see ourselves as responsible for who we are and might be. We must remember what is possible for each of us and why psychotherapy must not ever be side-tracked. It is no dinosaur, and we are not powerless to change ourselves. We do not have to settle for palliation, and the vision of ourselves as victims is an indulgence we cannot afford if we are to suffer less as individuals, or, as members of society, are to act to reverse the destructive trends which threaten our very existence.