This is a brief email discussion I had with a really interesting retired psychotherapist, who we will just call “H.J.”. It’s a follow-up to a couple of chats we had over coffee, and I felt some of the points raised would resonate with readers of this website.
Emanuele: I remember you said something that I found interesting about one thing that you found across many of your patients, and that was a lack of balance in their lives. Can you expand on that point?
When I saw people for psychotherapy during my working life as a psychiatrist/psychotherapist, I came to be guided by three poles or what I think of as psychic realities.
They are first of all integration, that is integration of split off parts of our experience and emotion which have been exiled to a place out of our awareness. One could call that place of unawareness the unconscious. The second reality is what I came to regard as a strong element in our psyche which was striving for wholeness and integration of all elements of our personality, of ourselves. Jung called this part of the psyche the Self. It could even be regarded in a more biological way which includes the whole organism as something which is driven by the sum total of our genetic make up, the genome if you will, plus the effects of our culture and upbringing by caregivers and other teachers on this Self or its truncation or inhibition or overstimulation. Finally there is another Jungian concept which guided me, the concept of balance.
It is through this concept of balance that I found the most effective way of working with the people who came to me for psychotherapy when they were having sometimes very severe problems with living. It was through careful listening and positive regard of those symptoms and problems which people presented in therapy sessions, I found I was able to identify imbalances and how the symptoms might be used as teachers and might be used to identify areas of the personality cut off and undeveloped which the person seeing me needed to aid them in their healing and the steps they might need to take in modifying their lives and outlook to achieve some balance and peace and satisfaction and growth.
One example of many I can think of will suffice.
I once saw a young attorney who had graduated near the top in his class and had been offered a prestigious position at one of the leading law firms. This job was seemingly the crowning achievement which he had long worked for. In spite of this “success” he developed a strong impulse to jump from the window of the high rise he worked in. This suicidal ideation and impulse was part of what could be called depression. Slowly he had become aware that he felt “flat”, often without emotion, joyless, and also had poor appetite as well as sleepless nights. Always there was a feeling of ” is this all there is”, is this success. and an intense guilt for having what he had and what many others of his group wanted and which was not making him happy.
Through the sessions it became abundantly clear to me and finally to him that he was living a life prescribed by others, in this case a beloved father and grandfather who strongly wanted him to have a career in law. His real interest though was strongly in other directions, although it was not easy for this to become apparent, and only gradually did he accept that this was the case. It meant reclaiming a huge part of his will which had been subordinated to strong authority figures, including those powerful lawyers who were the partners in the firm where he worked. It meant patiently bringing to life the joys he had felt as an adolescent when he had been consumed with an interest in literature, study of history, and film. It also meant a careful study of his dreams to find what they were showing, what they might be teaching him.
There is a saying that “all work and no play,makes Jack a dull boy and Jill, a dull girl”. One might also say that this too much work could make them sick. So, it was too much work which had set off the complex string of emotions and discontent, and above all too much work of the wrong kind, plus the anxiety and dread of displeasing, the isolation of important parts of self and the imbalance which was his life, and the depression both as a sign that something was wrong plus a self protective mechanism to prevent his action which would displease and would also lead to confrontation with important others.
Gradually he recognized and gave space for his real inclinations and began to accept fewer work hours, to include in his life more pleasurable activities which he wanted, more time spent in relationship with others outside the legal world, and finally a real change of career to that of judge. Some of his political interests had led to work in one of the political parties with the suggestion of his new acquaintances to run for the position of a superior court judge position.
Now, the reader might ask, would anti-depressants help, and if so, was psychotherapy necessary. The answer would be maybe yes to the first question and I think yes to the second.
I personally think that in a young man like this it might be a mistake to smooth the situation out with anti depressants as in my view he needed the stimulus of the symptoms to push him to more self-realization. Others might disagree and use medication and psychotherapy. In any case I think a real examination of one’s life is in order whether in psychotherapy or not. In this man since he was in psychotherapy it was through this method that he achieved self-realization, a change in his life, and diminution of symptoms.
It would be a mistake to think that psychotherapy can always be useful without medication. I feel strongly that much imbalance in the nervous system is genetically induced in some people and with our current knowledge does require the use of medications to prevent suicide, chronic disability, and to allay the symptoms of psychosis or severe mental disorders.
Emanuele: When you’ve seen your patients, or anyone else for that matter, change, is there a common catalyst for a successful change?
The question then “is there a common catalyst for change?”
I did psychotherapy for a long time, and in the case of the people who saw me for therapy, the common catalyst for change was a feeling of discomfort, a feeling of dis-ease if you will, sometimes pronounced anxiety, sometimes depression.
So, I suppose the feeling or unease or suffering would also be a common catalyst for change in persons not in psychotherapy as well.
The subject of change is a really big one. The ancient Chinese classic called the I Ching, or the Book of Changes, around two and a half millenniums ago recognized its key role in life. Initially the book was used to divine the future and to furnish some wisdom about how to recognize it and what to do about it. Some people still use it for that, but in my experience even then they do, they still profit more from the self examination which the divinations facilitate and use that divination as a catalyst for change.
One of the first philosophers in the Greek world, Heraclitus, supposedly wrote that “you cannot step in the same river twice”, that is to say that change is with us all the time and we can’t do much about it except to adapt and to live life taking those changes in stride and if, necessary, changing ourselves..
In thinking about the question in more depth I would say that openness to the world around us and to our experiences in that world is an extremely important condition for change. With that openness to experience we can be made more aware of possibilities in life through relationships with others and hearing their stories, from literature that we read, films that we see, and just an awareness of what is going on inside of us which might be prompting a different direction.
Almost everyone knows someone who is very self-centered, egocentric. Their thinking constantly revolves around themselves and their experience. Almost any mention of any subject or any other person’s experience will be applied to something which happened to them. Everything is then put into this self referential trap.
I write trap because that is exactly what happens to any new subject or argument, that is in these people it goes inside them where it is trapped and dies while those persons will chatter away about some personal experience. The thinking of these persons is a closed loop, it begins and ends with their experience. They are closed to the world and to the many feasts and opportunities that it and life offer.
So, suffering, an acceptance that life is all about change and that one must go with the flow of it, and openness to ourselves, to others, and to life experience and what it teaches, what it suggests are some of the catalysts for change.
Maybe the reader can suggest other elements which promote change from his/her viewpoint.