When treatment is not worth it!
While listening to a Vox Conversations podcast with host Sean Illing and his guest Paul Bloom, the psychologist whose new book examines the relationship we have with suffering, happiness, and having a meaningful life, I was thinking about clients and family members of clients for whom I work; their sometimes seeming resistance to make the changes they need to make if they are to have what I envision as a richer, more fulfilling life.
I wonder if some of these individuals may have little hope or belief that counseling is going to help. Depending on how their mind is affected by their illness, they may not have any belief that they have any problem.
I also suspect, however that there are those individuals who are fearful of feeling better because their history is such that any improvement in their happiness or positive experience of life is temporary. It has to be profoundly disappointing to have a brief period of feeling better only to be followed by a return to acute symptoms of mental illness or even some other illness with acute physical pain.
Although I did not hear Dr. Bloom use the term quality of life he often refers to the desire of most of us to experience life as meaningful. Meaningful may not equate with pain free or even happy. For example, Dr Bloom talks about the experience of parenting as one which can include great moments of joy and profound love, but which is also, at times, exhausting, painful and frustrating. Mountain climbing in subzero weather, running a marathon and a host of other activities come with a huge and often painful cost. I recently listen to someone describe dog sled racing and was humbled by the description of the often grueling experience. Yet, many will do this trip a number of times and report experiencing a great deal of satisfaction.
For many, however, any sense of joy or even meaningfulness is accompanied by the knowledge or the fear that depression, other symptoms of mental illness or other pain can, in a moment, resurface and return one to a state of mere existence; an existence when time seems to stop. Is there any greater misery than having a taste of joy, satisfaction or meaningfulness only to have it snatched away. One can get used to just about anything but to have a fleeting taste of something less painful or even joyful and then lose it again can be a hopeless, depressing feeling. I wonder if some choose to quit medications or stop other treatment which is reducing symptoms so that they do not have to continually face feeling better and then returning to living with all the symptoms of mental illness or physical pain. Health care workers, family members or others may accuse the person of not wanting to get well. Yet, it may be less painful to live with what one knows rather than getting one’s hopes up only to be dashed again and again.
I also wonder if there is the possibility that the person who is used to having their life controlled or mostly controlled by their illness is fearful that if they show signs of functioning better others will have expectations that overwhelm and frighten them.
What I do know if that most of us, including those with active mental illness, do the best we can with the tools we have. Those tools include or exclude faith in our abilities and in the treatment for one’s particular illness or condition. If one has never been frozen by mental illness such as depression, schizophrenia, PTSD, addiction or some combination of these then one may have no real ability to understand the thought process and behavior of those who live with such illnesses.
It is vitally important that we not increase the struggle and pain of the mentally ill by berating them for “not wanting to get better” or “being too lazy to do the work they need to do”. For any treatment to work there must (1) the ability to have faith that there is something to be gained ,(2) that positive changes are more than temporary and (3) the gain outweighs their perceived loss. We may not understand or relate to their perceived loss but it is their loss.
Written December 14, 2021
Jimmy F Pickett
coachpickett.org
While listening to a Vox Conversations podcast with host Sean Illing and his guest Paul Bloom, the psychologist whose new book examines the relationship we have with suffering, happiness, and having a meaningful life, I was thinking about clients and family members of clients for whom I work; their sometimes seeming resistance to make the changes they need to make if they are to have what I envision as a richer, more fulfilling life.
I wonder if some of these individuals may have little hope or belief that counseling is going to help. Depending on how their mind is affected by their illness, they may not have any belief that they have any problem.
I also suspect, however that there are those individuals who are fearful of feeling better because their history is such that any improvement in their happiness or positive experience of life is temporary. It has to be profoundly disappointing to have a brief period of feeling better only to be followed by a return to acute symptoms of mental illness or even some other illness with acute physical pain.
Although I did not hear Dr. Bloom use the term quality of life he often refers to the desire of most of us to experience life as meaningful. Meaningful may not equate with pain free or even happy. For example, Dr Bloom talks about the experience of parenting as one which can include great moments of joy and profound love, but which is also, at times, exhausting, painful and frustrating. Mountain climbing in subzero weather, running a marathon and a host of other activities come with a huge and often painful cost. I recently listen to someone describe dog sled racing and was humbled by the description of the often grueling experience. Yet, many will do this trip a number of times and report experiencing a great deal of satisfaction.
For many, however, any sense of joy or even meaningfulness is accompanied by the knowledge or the fear that depression, other symptoms of mental illness or other pain can, in a moment, resurface and return one to a state of mere existence; an existence when time seems to stop. Is there any greater misery than having a taste of joy, satisfaction or meaningfulness only to have it snatched away. One can get used to just about anything but to have a fleeting taste of something less painful or even joyful and then lose it again can be a hopeless, depressing feeling. I wonder if some choose to quit medications or stop other treatment which is reducing symptoms so that they do not have to continually face feeling better and then returning to living with all the symptoms of mental illness or physical pain. Health care workers, family members or others may accuse the person of not wanting to get well. Yet, it may be less painful to live with what one knows rather than getting one’s hopes up only to be dashed again and again.
I also wonder if there is the possibility that the person who is used to having their life controlled or mostly controlled by their illness is fearful that if they show signs of functioning better others will have expectations that overwhelm and frighten them.
What I do know if that most of us, including those with active mental illness, do the best we can with the tools we have. Those tools include or exclude faith in our abilities and in the treatment for one’s particular illness or condition. If one has never been frozen by mental illness such as depression, schizophrenia, PTSD, addiction or some combination of these then one may have no real ability to understand the thought process and behavior of those who live with such illnesses.
It is vitally important that we not increase the struggle and pain of the mentally ill by berating them for “not wanting to get better” or “being too lazy to do the work they need to do”. For any treatment to work there must (1) the ability to have faith that there is something to be gained ,(2) that positive changes are more than temporary and (3) the gain outweighs their perceived loss. We may not understand or relate to their perceived loss but it is their loss.
Written December 14, 2021
Jimmy F Pickett
coachpickett.org
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