Welcome to From Insults To Respect. Today’s post offers an approach for respectfully helping someone experiencing hopelessness during a first-hour counseling session. I commend it to you for I have found it remarkably helpful over my many years providing counseling services.
Helping people experiencing hopelessness can be rather challenging because many of them have no interest in doing anything about it. As the renowned psychologist and philosopher William James explains in a letter to his famous novelist brother, Henry James:
Henry is left of William
To suggest personal will and effort to one “all sicklied o’er” with the sense of weakness, of helpless failure, and of fear, is to suggest the most horrible of things to him. What he craves is to be consoled in his very impotence, to feel the Powers of the Universe recognize and secure him, all passive and failing as he is.
That said, if you find you are engaging with someone experiencing something like this, is there nothing else to be done other than offering your condolences? For your consideration, here’s what I refer to as a Jamesian approach because it is based on some of the writings of William James.
Beyond Just Offering Condolences
Who are capable of trying the approach I have found so helpful?
Most people have the ability to try this Jamesian approach. However, there are some who will not be able to do so because they have very little patience in the presence of anyone feeling hopeless. Such persons might cry out, “Enough with this helplessness crap. Snap out of it and get the hell on with your life for crying out loud!”
Now, admittedly these unsympathetic people sometimes find, upon confronting someone with their demand, it actually seems to have been helpful. The person who had been feeling helpless becomes enlivened with the demand and can then find themselves improving their functioning and end up thanking the demanding person.
However, some of these demanding people find their approach in the situation with which they were dealing didn’t work and conclude there is nothing else that can be done. These people, totally disgusted with the continuing helpless attitude, very likely will not be able to utilize the Jamesian approach I wish for you to consider.
That said, it just so happens that some people who begin with the lack of sympathy approach end up seeing it has been far from helpful. They may yet be left harboring some desire to be helpful in some way. If they didn’t end up completely severing any subsequent relationship with the person feeling helpless as a result of their demanding approach, they might, through a turn of mind, come to say, “Well, I guess I have the ability to try a more supportive approach.” Such persons might still be able to utilize the Jamesian approach.
As for everyone else who thinks they can spend an hour being present with the person feeling helpless and express empathy, while being a good listener in other ways can give the approach I soon will describe a try. I’ve never seen any harm from such attempts.
Three types of situations in which the Jamesian approach can be utilized
The first two types of situations one can utilize this approach involves a professional counselor or psychotherapist. The client arrives for an appointment. The professional then begins the session by asking the client, “What concerns would you like us to address?” The despondent person might reply,
“There really is nothing to address. I only came for this appointment because my sister kept urging me to speak to a professional about my situation and I finally gave in. To me this whole appointment is a waste of time. My situation is hopeless.”
Or, the person might respond,
“I’ve been feeling stressed out and hopeless and I heard I might qualify for disability benefits. I can sure use the extra money.”
As you will soon see, neither of these two situations provide any obstacles for utilizing the approach.
The third type of situation the Jamesian approach can be helpful involves nonprofessionals that know someone they care about who has reached that helpless state of mind and are willing to see if they can set up a time to spend an hour with the discouraged individual.
The Jamesian Approach
Phase 1 (first half hour)
You begin by asking the person you hope to help, in a soft, caring manner, “How have you been doing?” Over the course of the next half hour, your job is to listen with all the empathy you can muster, to whatever your counselee wants to share with you.
If your conselee becomes angry with him or herself, your job is not to convince the person that becoming angry at one’s self is wrong or foolish. Rather, you make sure the person knows you heard what is being said, by making the following type of reply. “I see you are angry about… (summarize what the person said about why he or she is angry)” and then in a soft, caring voice say, “I understand you have been through some very rough experiences.” It is essential during this half hour that you do nothing that can appear to be correcting or constraining the expression of the counselee.
Listening in a sympathetic manner during the first half hour is time well spent. During this time you will be modeling for the counselee an alternative to how he or she might want to respond to the situations that currently has been leading to angrily insulting oneself. People learn a great deal by observing others. Your job in this first half hour is to be a superb model of reacting to very human mistakes by remaining supportive to the notion that we all goof-up from time to time.
If your counselee finishes earlier than a half hour, begin to ask the following questions. “Please talk to me about when you first began to feel so helpless?” and “I’m interested to hear how you have been functioning since you have been going through this very tough experience. If the functioning question is answered in a sentence or two, you are to invite some additional sharing of the counselee by asking, “Have you been able to go to work?” If yes, ask, “How has that been going?” If there is still time left during the first half hour, also ask the counselee if he or she has been able to do home chores, such as cleaning and making meals. If this hasn’t filled up the first half hour of your one hour session, continue with these additional questions: “How have you been sleeping?” “Have you been staying connected with some people you care about?” With these series of questions, you should have no difficulty passing this half hour of listening in a caring manner.
Phase 2 (second half hour)
Now, in seeking to introduce phase 2, sometimes the counselee is not quite finished sharing what she or he has been going through. If this is an intense part of the distressed person’s experience, I recommend not interrupting. Instead, at the close of the hour you will have to set up another hour session. However, I have found most times you will be able to gently say,
“I’d like to pause here for just a few minutes, if that is ok with you. I would like to tell you a story that many people who are going through a similar experience as you, find helpful. In referring to these experiences as similar to you, I recognize each person’s experience is unique. That said, with us being fellow humans, we can often see certain similarities that might help us make some useful connections with our own unique situation. So, would it be ok if we pause here just for a few minutes so I can tell you this story?”
It is very rare, from my experience, that the counselee will refuse this request, but if they do so, don’t press the case of the value of hearing the story. Just respond by saying, “Maybe I can share the story with you on another occasion.”
If your counselee agrees to hearing the story, it is ok to read it. Here’s the story.
During William James’s life he became the greatest American psychologist and philosopher of his time, and remains even today enormously well regarded for his wisdom. But as a young man of 25, while studying for his Harvard medical degree, he suddenly dropped out. As he explained the reason, “it was as if something hitherto solid within my breast gave way entirely, and I became a mass of quivering fear. . . . I awoke morning after morning with a horrible dread in the pit of my stomach.”
After about 6 years of these dreaded experiences, he suddenly began to feel much improved. Here’s how Will’s father explains it in his letter to his other son, Henry, in March of 1873:
He came in here the other afternoon when I was sitting alone, and after walking the floor in an animated way for a moment, exclaimed “Dear me! What a difference there is between me now and me last spring this time: then so hypochondriacal” (he used that word, though perhaps in substantive form) “and now feeling my mind so cleared up and restored to sanity. It is the difference between life and death.” He had a great effusion. I was afraid of interfering with it, or possibly checking it, but I ventured to ask what especially in his opinion had promoted the change.
He said several things: the reading of Renouvier (specially his vindication of the freedom of the will) and Wordsworth, whom he has been feeding on now for a good while; but especially his having given up the notion that all mental disorder is required to have a physical basis. This had become perfectly untrue to him. He saw that the mind did act irrespectively of material coercion, and could be dealt with therefore at first-hand, and this was health to his bones.
We see in the above that at this time James had viewed his distressful experience that led to his departure from medical school as a “mental disorder” that he had to accept as due to something wrong with his body and therefore he could do nothing but accept that he had this condition. Then, his conceptualization began to develop from a physiological pathology model to one that gives at least some freedom to the will.
William’s Father with his brother Henry on the righ
He came to this understanding from his own counselor in the form of reading the works of the philosopher, Charles Renouvier, especially in the sections that provides a vindication of the freedom of the will. At the same time, he was also reading the poems of William Wordsworth. What did these poems have to do with one who had been so suffering for many years?
Charles Renouvier
Wordsworth’s poems are often about his deep love with being in nature, as we get some sense of from considering some of the lines from “I Wandered Lonely As a Cloud:”
I wandered lonely as a cloud
That floats on high o’er vales and hills,
When all at once I saw a crowd,
A host, of golden daffodils;
Beside the lake, beneath the trees,
Fluttering and dancing in the breeze.
This exuberance with being in nature, for Wordsworth, spilled over into his life even when he was not in nature as we see in the following lines:
A poet could not but be gay,
In such a jocund company:
I gazed—and gazed—but little thought
What wealth the show to me had brought:
For oft, when on my couch I lie
In vacant or in pensive mood,
They flash upon that inward eye
Which is the bliss of solitude;
And then my heart with pleasure fills,
And dances with the daffodils.
For William James, he not only read Wordsworth, his reading led him, through an act of will, to go out in nature. The particular scenes he came upon of woods beside a body of water lifted his spirits. It also got him walking, which is well documented to improve health. It also improved his interpersonal relations, for he discovered some people who shared this love of nature, and they often would join him on his nature walks. Sometimes he and his companions would walk in silence, just enjoying the pleasant sounds of birds and the rippling of water. Other times they would enjoy discussing common interests.
Later in his life, William James added another element to his understanding of the disturbing experiences he had as a young man. It was prompted by a quarrel.
Healthy-minded individuals often believe that those who worry are “morbid-minded” and “diseased.” In their defense, some of those referred to as morbid-minded have argued that “the world’s meaning most comes home to us when we lay them most to heart.”
After describing the argument between the so-called “healthy-minded” and the “morbid-minded,” James then states:
In our attitude, not yet abandoned, of impartial onlookers, what are we to say of this quarrel? It seems to me that we are bound to say that morbid-mindedness ranges over the wider scale of experience, and that its survey is the one that overlaps. The method of averting one’s attention from evil, and living in the light of good is splendid as long as it will work. It will work with many persons; it will work far more generally than most of us are ready to suppose; and within the sphere of its successful operation there is nothing to be said against it as a religious solution. But it breaks down importantly as soon as melancholy comes; and even though one be quite free from melancholy one’s self, there is no doubt that healthy-mindedness is inadequate as a philosophical doctrine, because the evil facts which it refuses positively to account for are a genuine portion of reality; and may after all be the best key to life’s significance, and possibly the only openers of our eyes to the deepest levels of truth.
To James, people confront events daily that create feelings of helplessness, pain, sadness, horror, and dread. James argued that the feelings that go along with these kinds of events can lead toward truth. Thus, he counteracts any tendency to assume that those referred to as morbid-minded are automatically inferior to those referred to as “mentally healthy.”
So, this is a story of one man’s experience of feeling helpless to do anything helpful by an act of his will, and thus spent years in a deeply disturbed state. Through being counseled by reading the writings of Renouvier (specially his vindication of the freedom of the will), along with discovering the health promoting effects of spending time in nature and with some people who shared his developing love of nature, he found this was health to his bones. As the years went by, he came to understand that there can be some benefits that come from the experiences many so called healthy-minded people view as morbid-mindedness or, more frequently in today’s culture, “mental illness.”
Here this ten-minute story ends. At its conclusion, gently ask if your counselee would like to share any thoughts or feelings that came about upon hearing about William James’s experiences and ideas about what people today often refer to as having a mental illness. Then, in the few minutes left of the hour, begin again to listen in the caring manner I described above.
Well, I hope this post has provided an approach for beginning a counseling experience with someone suffering from a sense of hopelessness. Until next time, may all of your concerns be addressed with wisdom, love, and kindness.
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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE.
Welcome to From Insults to Respect. Today, let’s see if we can tie together some of the loose threads of mylast post, which chronicled Joni Mitchell’s experience of depression. There we found that she explicitly rejected the idea that her experience indicated that she was mentally ill. Instead, she came to believe that, “Most of my best work came out of it. If you get rid of the demons and the disturbing things, then the angels fly off, too. There is the possibility, in the mire, of an epiphany.”
We also discussed that in contrast to Joni’s position is the medical model, which views people who experience depression as having an illness that requires, as the first line of treatment, taking pills that are called “antidepressants.” Many who hold this view have absolutely no respect for people who hold the view expressed by Joni.
Upon publishing my post about Joni, one person that has impressed me over a period of time as being highly intelligent expressed a concern that attitudes like Joni’s will lead people to view depression as perfectly normal. The consequences of so doing, he feared, will lead to all of the efforts to increase access to mental health services getting flushed down the toilet. If depression is normal, why wouldn’t the majority of people decide to ignore this group of sufferers and their needs?
Well, in my opinion, this is a legitimate concern, and before this post draws to a conclusion I intend to address it. But first, let’s take a look at another example of someone who, like Joni Mitchell, came to believe that the experience of depression can be of enormous value.
Leo Tolstoy’s Experience
In his painfully personal book, My Confession, the great Russian writer Leo Tolstoy tells us about his two-year period of despair. At about the age of 50, his life had become “flat, more than flat: dead.”
“I felt that something had broken within me on which my life had always rested, that I had nothing left to hold on to, and that morally my life had stopped. An invincible force impelled me to get rid of my existence, in one way or another…. Behold me then … hiding the rope in order not to hang myself from the rafters of the room where every night I went to sleep alone; behold me no longer going shooting, lest I should yield to the too easy temptation of putting an end to myself with my gun.”
All of this took place at a time when Tolstoy’s outer circumstances seemed excellent.
“I had a good wife who loved me and whom I loved; good children and a large property which was increasing with no pains taken on my part. I was more respected by my kinsfolk and acquaintances than I had ever been; I was loaded with praise by strangers; and without exaggeration I could believe my name already famous.”
Tolstoy goes on to explain how his melancholy stimulated a gnawing questioning that eventually led to one insight after another. His trouble had not been with life in general, not with the common life of common men, but with the life of the upper, intellectual, artistic classes, the life that he had personally always led, the cerebral life, the life of conventionality, artificiality, and personal ambition. He had lived wrongly and had to change.
Then, one day in early spring, while he was alone in the forest listening to its mysterious noises, he was filled with a sense of deeper meaning. “After that,” he wrote, “things cleared up within me and about me better than ever, and the light has never wholly died away.” According to Tolstoy, his suicidal feelings disappeared, and he went on to live a productive life until he passed away at the age of 82 of natural causes.
Some Thoughts on Tolstoy’s Experience
The great psychologist and philosopher William James was someone who viewed the pathologizing of human experience as simple minded and nothing more than superficial medical talk. Rather than resorting to mentally ill jargon, the good professor explained in his monumental book, Varieties of Religious Experience, his view of Tolstoy’s experience:
It was logically called for by the clash between his inner character and his outer activities and aims. Although a literary artist, Tolstoy was one of those primitive oaks of men to whom the superfluities and insincerities,the cupidities, complications, and cruelties of our polite civilizationare profoundly unsatisfying, and for whom the eternal veracities lie withmore natural and animal things. His crisis was the getting of his soulin order, the discovery of its genuine habitat and vocation, the escapefrom falsehoods into what for him were ways of truth. It was a case ofheterogeneous personality tardily and slowly finding its unity and level.
Tolstoy’s anguishing experience appeared at first to come on him as if out of the blue. Later, Tolstoy came to understand it as having been due to living wrongly. Only by questioning deeply and repeatedly the meaning of his despair did he come to this understanding.
Now, with all of this as background information, let’s return to the concern that came up at the beginning of this post–if we don’t accept the medical model, might it provide a perfect justification for not funding mental health services?
In my view, the medical model actually gets in the way of adequately funding services.
Viewing someone in the midst of an anguishing experience as someone with an illness that is no different than any other illness leads many prescribing doctors to most often send the client home with some pills. That is viewed as sufficient. The patient is left with a host of negative side effects, and maybe in time, the patient will begin to feel better and attribute the improvement to the pills. If not, they go back to the doctor who will try adjusting the dose, trying a different pill, or adding other pills.
It is my view that even when people learn to value, even treasure, depression experiences, they don’t say that’s all there is to life. These experiences lead them to more deeply delve into their personal concerns thereby potentially leading them to seek more effective, efficient, economical, and beautiful ways to address their concerns.
Although Tolstoy did manage to successfully work out his most pressing concerns without professional help, keep in mind that he was an extraordinarily gifted person with a great deal of supportive people around him, and he was financially comfortable. Even with all of that, a well trained mental health service provider who avoided pathologizing his experience may have been of enormous help.
In my previous post, we saw that Joni Mitchell was not only experiencing the physical sensations of depression. Fully part of her experiences was to delve deeply into several concerns– “How am I going to get back in the saddle? And what about the audience? Would you still love me if you knew what I was really like?” She sought help from a psychotherapist.
As someone who provided mental health services for many years, let me present an example of what I am trying to get at.
Phil, not his real name, came to my office troubled about how depressed he had been feeling. After some time listening in a caring way to his concerns, I discussed this notion that depression can be viewed as a valued experience. He was pleased to learn this. At the same time, he didn’t in the slightest bit come to the conclusion that with this interpretation of the nature of depression there was no more need to continue to see me. However, I do think that framing depression as often a very valuable experience that many of our most gifted people put to good use was far more hopeful than framing it as due to defective genes.
Over the course of a year I found that the concerns Phil was most troubled about was his drinking, and that he had trouble developing close relationships. Both of these concerns are genuine health risk factors. My job was to help Phil to transform these risk factors to “health protective factors.” By doing so, this could prevent far more serious health issues down the line.
So we explored what was interfering with his developing close friends. It soon became apparent that he was very critical of people he met, and his style of criticizing was very nasty. For example, he would call people he disagreed with stupid in a very nasty way. And it also became apparent that he would criticize himself in the same disturbing manner.
I explored with Phil options that have been helpful to others. He selected learning to meditate, and to get more exercise in order to work off his anger in a positive, healthy manner. He learned the value of saying more supportive things to people he met, and to himself as well. He came to realize the value of minimizing the negative criticism that he provided, and when he did criticize, to do so in a far more charming manner. In the end, he made a new group of friends, joined AA, and was in a far more healthy state when my services came to an end.
So, as this example illustrates, rather than a mental illness model, in which pills are often viewed as sufficient, we can utilize a mental health concern model to advocate additional support for mental health services. With a mental health concern model, counselors and psychotherapists can be viewed as valued members of the allied health profession because they help to transform health risk factors into health protective factors.
The need for these types of mental health services, therefore, need not be reduced by framing depression as a valued experience. Rather, it allows us to move on from this understanding to advocate that our services fully address real mental health concerns.
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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional and social intelligence. To begin at the very first post you can click HERE.
“Good morning, Barbara,” I say, as my first counseling case walks into my office. I notice she looks a little angry. Upon sitting down, she declares, “I’m terribly frustrated. I’ve been depressed now for over two weeks, and I just can’t shake it!”
It’s easy for me to empathize because I regularly have bouts of what I refer to as melancholy. A deep anguish comes over me, and during this period I often begin to think about how I went through my father’s death when I was twelve, how I’m getting older and can no longer do the many athletic things that thrilled me when I was younger, and on and on. Sometimes these dark melancholy experiences come about because something clearly happened that upset me, and sometimes they seem to come out of the blue.
Beyond Listening in a Caring Manner
After listening in a caring way to Barbara for a few minutes, I ask her if something specifically happened that led her into her current emotional experience. Then I explore with her a question about how often she has these experiences and if she feels she has them more frequently than most people, about as often as most, or less than most. Then, I ask her about how she has been functioning in other areas of her life–sleep, eating, exercise, interpersonal relationships, work/school, household responsibilities.
You see, as people experience depression, or other concerns that often lead to a classification of having a mental disorder, some people go about their lives functioning as they typically were doing before the concern arose, while some find that in some areas they begin to function below the levels that are typical for them, while some find that their functioning increases in one or more areas. For example, some sleep about the same amount, some less, and some more. I have met people who, when they are depressed, start cleaning every inch of their home, while others find it difficult to get out of bed.
Also of interest when exploring a person’s expressed concern is to look at how the person had been functioning before the onset of the presenting concern. If some important relationships had begun to function below average, or if the person had been sleeping less than average to keep up with work demands, these facts can be insightful when seeking ways to address the presenting concern.
Now, once I found out what Barbara was concerned about, what might have precipitated the concern, and how she had been functioning in various areas of her life, I had a pretty good idea as to how to proceed in addressing her concern. I had no need to decide whether or not she had a mental disorder. However, many mental health practitioners are required to declare that the person seeking mental health services has a mental disorder if they want to get paid. Is this mental illness labeling really necessary?
Mental Illness Labeling Versus an Addressing Concern Approach
There are those who embrace this mental illness/disorder labeling. One reason is the pharmaceutical industry’s promotion of this idea to sell people on the idea that they need certain drugs to live a more normal, healthier life.
Beyond that, another major reason for this is that these individuals have a group of people in their lives that blame them for the way that they have been feeling or acting. When a doctor has declared, for example, that John Smith has a mental disorder, he may feel vindicated. “You see, there really is something wrong with me!” he may cry out in his defense.
In actuality, those who are doing the blaming may continue their blaming despite the doctor’s opinion. Moreover, many of us don’t blame people whenever they find some concern has arisen in their lives even if they are going through a non-illness experience. I know I’m not blaming myself when I experience melancholy, and I was not at all blaming Barbara for what she was going through.
Those who are uncomfortable about the use of “mental illness” terminology point out they are stigmatizing because they are used as put downs in our society. Moreover, the media associates the most heinous crimes with those referred to as the mentally ill even though the vast majority of those classified in this manner are not violent.
Among the most articulate individuals to voice objections to the mental disorder labeling was Harvard psychologist and philosopher William James. Over one hundred years ago he wrote a book titled, The Varieties of Religious Experience (1902). At that time many medical doctors argued that people who were religious were all mentally ill. In response, Professor James wrote:
Medical materialism seems indeed a good appellation for the too simple-mindedsystem of thought which we are considering. Medical materialism finishesup Saint Paul by calling his vision on the road to Damascus a discharginglesion of the occipital cortex, he being an epileptic.
Girl (6-8) praying, profile, close-up
It snuffs out Saint Teresa as an hysteric, Saint Francis of Assisi as an hereditary degenerate.George Fox’s discontent with the shams of his age, and his pining for spiritualveracity, it treats as a symptom of a disordered colon. Carlyle’s organ-tonesof misery it accounts for by a gastro-duodenal catarrh. All such mentalovertensions, it says, are, when you come to the bottom of the matter,mere affairs of diathesis (auto-intoxications most probably), due to theperverted action of various glands which physiology will yet discover.(p. 29)
James goes on from here to point out that it is true, of course, that psychology has found that there are definite psycho-physical connections that “hold good” (p. 30). Psychology, therefore:
assumes as a convenient hypothesis that the dependence of mental stateson bodily conditions must be thoroughgoing and complete. If we adopt theassumption, then of course what medical materialism insists on must betrue in a general way, if not every detail…. But now, I ask you, howcan such an existential account of facts of mental history decide in oneway or another on their spiritual significance? According to the generalpostulate of psychology just referred to, there is not a single one ofour states of mind, high or low, healthy or morbid, that has not some organic process as its condition. Scientific theories are organically conditionedjust as much as religious emotions are; and if we only knew the facts intimatelyenough, we should doubtless see “the liver” determining the dicta of thesturdy atheist as decisively as it does those of the Methodist under convictionanxious about his soul. When it alters one way the blood that percolatesit, we get the Methodist, when in another way, we get the atheist formof mind. So of all our raptures and our drynesses, our longings and pantings,our questions and beliefs. They are equally organically founded, be theyreligious or of non-religious content. (p. 30)
James points out that in the natural sciences and the arts it never occurs to anyone to refute opinions, beliefs and experiences by putting down their author’s neurological constitution. Value is determined by “judgments based on our own immediate feelings primarily; and secondarily on what we can ascertain of their experiential relations to our moral needs and to the rest of what we hold as true” (p. 33).
James was additionally concerned that medical materialism greatly overgeneralizes its knowledge of the connections between physiological variables and mind states. In James’s day, the pathology writers would take the few psychophysical correlations that they obtained under highly specialized conditions and then vaguely generalize their findings to discredit, to their satisfaction, all of the states of mind that they disliked.
The Modern Day View
Now, modern day psychiatrists sometimes respond,
“Well, certainly in James’s day we indeed knew almost nothing about such matters, but today our knowledge has vastly increased! Thus, James’s position is no longervalid because we can now make sound statements about the connections betweenphysiological states and mind states.”
To this, I respond that in point of fact there is currently a renewed respect for the extraordinary complexity
that exists during the integration process between mind, physiology, behavior, and environmental variables. Whereas it is true that there have been large gains in our knowledge, these gains are best likened to moving from a few drops of knowledge to a glass almost full; yet, to really understand the integration process, we would need oceans and oceans of knowledge. Trillions and trillions of interactions are involved.
It is for these reasons that the mental illness/disorder terminology is misleading. As Dr. Thomas Insel, the former director of the National Institute of Mental Health, recently said about the psychiatric labeling process known as the DSM.
The weakness [of the DSM] is its lack of validity. Unlike our definitions of ischemic heart disease, lymphoma, or AIDS, the DSM diagnoses are based on a consensus about clusters of clinical symptoms, not any objective laboratory measure. In the rest of medicine, this would be equivalent to creating diagnostic systems based on the nature of chest pain or the quality of fever. Indeed, symptom-based diagnosis, once common in other areas of medicine, has been largely replaced in the past half-century as we have understood that symptoms alone rarely indicate the best choice of treatment.
To hear and view other leading scientists further make this point, I highly recommend the following free video:
When individuals express a concern, exploring how they are functioning in the main areas of their life can be enormously helpful. Someone who reports a concern about experiencing depression, whom, by some gentle questioning, we find out has been functioning below average in the areas of sleep, interpersonal relationships, and exercise may benefit enormously if we work together on getting these areas of functioning in a more optimal range. This is true for those who report other types of concerns such as experiencing anxiety, hearing voices, below average range of attention, obsessive thoughts, and on and on. With a model that includes addressing concerns and exploring ways to improve functioning, labeling someone as having a mental disorder becomes unnecessary and may actually interfere with the aims of a counseling/psychotheraputic relationship.
For those who desire, for whatever reason, to be labeled as having a mental disorder, I am not proposing that we interfere with this. But for those who desire to have their concerns addressed by well trained mental health professionals without being referred to as having a mental illness or disorder, I do propose that we do provide a reasonable option for them to access mental health services. In my view, mental health professionals, once we hear our clients’ concerns and how they are functioning in the various areas of their lives, we have the basics to formulate, in full cooperation with our clients, a plan for addressing these concerns. I hope you give this some thought.
For those of you who would like to learn more about how an addressing concern approach would work and be consistent with science if adopted by mental health providers, you can access my peer reviewed article for free by clicking HERE.
Until next week, may you find some kindness out there in this fascinating world of ours.
My Best,
Jeff
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Some people will enjoy reading this blog by beginning with the first post and then moving forward to the next more recent one; then to the next one; and so on. This permits readers to catch up on some ideas that were presented earlier and to move through all of the ideas in a systematic fashion to develop their emotional intelligence. To begin at the very first post you can click HERE.
Welcome to From Insults To Respect. Today’s post offers an approach for respectfully helping someone experiencing hopelessness during a first-hour counseling session. I commend it to you for I have found it remarkably helpful over my many years providing counseling services.
However, there are some who will not be able to do so because they have very little patience in the presence of anyone feeling hopeless. Such persons might cry out, “Enough with this helplessness crap. Snap out of it and get the hell on with your life for crying out loud!”
That said, it just so happens that some people who begin with the lack of sympathy approach end up seeing it has been far from helpful. They may yet be left harboring some desire to be helpful in some way. If they didn’t end up completely severing any subsequent relationship with the person feeling helpless as a result of their demanding approach, they might, through a turn of mind, come to say, “Well, I guess I have the ability to try a more supportive approach.” Such persons might still be able to utilize the Jamesian approach.
The first two types of situations one can utilize this approach involves a professional counselor or psychotherapist. The client arrives for an appointment. The professional then begins the session by asking the client, “What concerns would you like us to address?” The despondent person might reply,“I’ve been feeling stressed out and hopeless and I heard I might qualify for disability benefits. I can sure use the extra money.”
You begin by asking the person you hope to help, in a soft, caring manner, “How have you been doing?” Over the course of the next half hour, your job is to listen with all the empathy you can muster, to whatever your counselee wants to share with you.
Listening in a sympathetic manner during the first half hour is time well spent. During this time you will be modeling for the counselee an alternative to how he or she might want to respond to the situations that currently has been leading to angrily insulting oneself. People learn a great deal by observing others. Your job in this first half hour is to be a superb model of reacting to very human mistakes by remaining supportive to the notion that we all goof-up from time to time.
“I’d like to pause here for just a few minutes, if that is ok with you. I would like to tell you a story that many people who are going through a similar experience as you, find helpful. In referring to these experiences as similar to you, I recognize each person’s experience is unique. That said, with us being fellow humans, we can often see certain similarities that might help us make some useful connections with our own unique situation. So, would it be ok if we pause here just for a few minutes so I can tell you this story?”
But as a young man of 25, while studying for his Harvard medical degree, he suddenly dropped out. As he explained the reason, “it was as if something hitherto solid within my breast gave way entirely, and I became a mass of quivering fear. . . . I awoke morning after morning with a horrible dread in the pit of my stomach.”
He came in here the other afternoon when I was sitting alone, and after walking the floor in an animated way for a moment, exclaimed “Dear me! What a difference there is between me now and me last spring this time: then so hypochondriacal” (he used that word, though perhaps in substantive form) “and now feeling my mind so cleared up and restored to sanity. It is the difference between life and death.” He had a great effusion. I was afraid of interfering with it, or possibly checking it, but I ventured to ask what especially in his opinion had promoted the change.
He said several things: the reading of Renouvier (specially his vindication of the freedom of the will) and Wordsworth, whom he has been feeding on now for a good while; but especially his having given up the notion that all mental disorder is required to have a physical basis. This had become perfectly untrue to him. He saw that the mind did act irrespectively of material coercion, and could be dealt with therefore at first-hand, and this was health to his bones.
We see in the above that at this time James had viewed his distressful experience that led to his departure from medical school as a “mental disorder” that he had to accept as due to something wrong with his body and therefore he could do nothing but accept that he had this condition. Then, his conceptualization began to develop from a physiological pathology model to one that gives at least some freedom to the will.
I wandered lonely as a cloud
That floats on high o’er vales and hills,When all at once I saw a crowd,A host, of golden daffodils;Beside the lake, beneath the trees,Fluttering and dancing in the breeze.
This exuberance with being in nature, for Wordsworth, spilled over into his life even when he was not in nature as we see in the following lines:
A poet could not but be gay,In such a jocund company:I gazed—and gazed—but little thoughtWhat wealth the show to me had brought:For oft, when on my couch I lie
For William James, he not only read Wordsworth, his reading led him, through an act of will, to go out in nature. The particular scenes he came upon of woods beside a body of water lifted his spirits. It also got him walking, which is well documented to improve health. It also improved his interpersonal relations, for he discovered some people who shared this love of nature, and they often would join him on his nature walks. Sometimes he and his companions would walk in silence, just enjoying the pleasant sounds of birds and the rippling of water. Other times they would enjoy discussing common interests.
Later in his life, William James added another element to his understanding of the disturbing experiences he had as a young man. It was prompted by a quarrel.
Healthy-minded individuals often believe that those who worry are “morbid-minded” and “diseased.” In their defense, some of those referred to as morbid-minded have argued that “the world’s meaning most comes home to us when we lay them most to heart.”But it breaks down importantly as soon as melancholy comes; and even though one be quite free from melancholy one’s self, there is no doubt that healthy-mindedness is inadequate as a philosophical doctrine, because the evil facts which it refuses positively to account for are a genuine portion of reality; and may after all be the best key to life’s significance, and possibly the only openers of our eyes to the deepest levels of truth.
To James, people confront events daily that create feelings of helplessness, pain, sadness, horror, and dread. James argued that the feelings that go along with these kinds of events can lead toward truth. Thus, he counteracts any tendency to assume that those referred to as morbid-minded are automatically inferior to those referred to as “mentally healthy.”
Through being counseled by reading the writings of Renouvier (specially his vindication of the freedom of the will), along with discovering the health promoting effects of spending time in nature and with some people who shared his developing love of nature, he found this was health to his bones. As the years went by, he came to understand that there can be some benefits that come from the experiences many so called healthy-minded people view as morbid-mindedness or, more frequently in today’s culture, “mental illness.”
Here this ten-minute story ends. At its conclusion, gently ask if your counselee would like to share any thoughts or feelings that came about upon hearing about William James’s experiences and ideas about what people today often refer to as having a mental illness. Then, in the few minutes left of the hour, begin again to listen in the caring manner I described above.
Today, let’s see if we can tie together some of the loose threads of my
We also discussed that in contrast to Joni’s position is the medical model, which views people who experience depression as having an illness that requires, as the first line of treatment, taking pills that are called “antidepressants.” Many who hold this view have absolutely no respect for people who hold the view expressed by Joni.
Tolstoy goes on to explain how his melancholy stimulated a gnawing questioning that eventually led to one insight after another. His trouble had not been with life in general, not with the common life of common men, but with the life of the upper, intellectual, artistic classes, the life that he had personally always led, the cerebral life, the life of conventionality, artificiality, and personal ambition. He had lived wrongly and had to change.
Then, one day in early spring, while he was alone in the forest listening to its mysterious noises, he was filled with a sense of deeper meaning. “After that,” he wrote, “things cleared up within me and about me better than ever, and the light has never wholly died away.” According to Tolstoy, his suicidal feelings disappeared, and he went on to live a productive life until he passed away at the age of 82 of natural causes.
The great psychologist and philosopher William James was someone who viewed the pathologizing of human experience as simple minded and nothing more than superficial medical talk. Rather than resorting to mentally ill jargon, the good professor explained in his monumental book, Varieties of Religious Experience, his view of Tolstoy’s experience:
Tolstoy’s anguishing experience appeared at first to come on him as if out of the blue. Later, Tolstoy came to understand it as having been due to living wrongly. Only by questioning deeply and repeatedly the meaning of his despair did he come to this understanding.
In my previous post, we saw that Joni Mitchell was not only experiencing the physical sensations of depression. Fully part of her experiences was to delve deeply into several concerns– “How am I going to get back in the saddle? And what about the audience? Would you still love me if you knew what I was really like?” She sought help from a psychotherapist.
He selected learning to meditate, and to get more exercise in order to work off his anger in a positive, healthy manner. He learned the value of saying more supportive things to people he met, and to himself as well. He came to realize the value of minimizing the negative criticism that he provided, and when he did criticize, to do so in a far more charming manner. In the end, he made a new group of friends, joined AA, and was in a far more healthy state when my services came to an end.
