"On Healing" April 2006

Posted on Mon, Apr. 17, 2006
How about therapy for a very sick world?
By Dan Gottlieb

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.
Marcia

Dear Marcia:
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.

Posted on Mon, Apr. 3, 2006
A test for stressed kids:
Let no child be left emotionally behind
By Dan Gottlieb

When Socrates said the unexamined life is not worth living, he wasn't referring to the relentless examinations our children are taking in schools these days. The incessant pressure to perform is one reason why our children are showing signs of stress.

Suicide, although relatively rare, is still a leading cause of death among young people. And children in middle-class and affluent neighborhoods are at increased risk for substance abuse, depression and anxiety disorders, concluded Suniya Luthar in the Journal of Psychological Science.

This study didn't address eating disorders, including obesity. Or the tremendous number of children diagnosed and medicated for ADD and ADHD.

The problems don't stop in affluent and middle-class neighborhoods. Poorer children face threats of violence every day. They enjoy fewer community supports and endure deteriorating schools, facing their own relentless pressures to perform.

Responding to these trends, Columbia University has developed yet another examination for our children called "TeenScreen," which measures children's psychological states.

I applaud this effort to identify children who need help. I would be even happier if every community had sufficient care for all children who need it. But early screening addresses only the problems, not the causes. Even TeenScreen would not satisfy Socrates.

Last year I spoke to some children in a private secondary school. Later, I spoke to a group of middle school children in the economically depressed Kensington section of Philadelphia.

I asked both groups what their lives were like. The private-school kids complained of stress, insufficient sleep, and lack of time to "chill" with friends. They all had different definitions of happiness, including wealth, power and freedom. But not one child defined happiness as involving love, family or the larger community.

When I spoke to the Kensington children, I learned about the extreme adversity they bear daily. One 12-year-old girl said she was always afraid that she would get raped at school as her older sister had. Another was afraid to answer the door because his neighbor got killed that way.

Over the next few weeks, I received many letters from both groups. Many said the same thing: "Thank you for coming. No one has ever asked us about our lives before." These children have been "examined" ad nauseam, but no one had taken the time to hear the musings of their hearts or teach them what true happiness means.

Certainly this doesn't explain the increase in children's psychological problems. But it does say that too many children are living unexamined lives.

Many psychological problems may be caused by living in a community that demands too much or expects too little. So providing psychological services to these children, while essential, is like treating someone for an allergy who is continually exposed to dust and pollen.

Family therapists have long known that when children show symptoms, it reflects problems in the family. So if a child becomes withdrawn or rebellious, they may be doing so because there is unacknowledged conflict in the family.

Too often children wind up in therapy when the family needs treatment.

And so it is with the larger society. As our children show more symptoms of emotional distress, we must do more than examine and treat their symptoms. Before intervening and repairing, before passing judgment or wringing our hands, let's give our children what Socrates suggested. Sit down with each one and ask about their lives. Then listen with curiosity and compassion, feeling sadness for their suffering and joy for their dreams.

There is ample research that children benefit enormously when they "hang out" with adults who simply examine their hearts and dreams. Pretty smart fella, that Socrates.

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