Looking for that magic pill

“Isn’t there a pill that I can take to make these feelings go away?” It’s a plaint I frequently hear. The client, faced with powerful feelings, feels overwhelmed and is looking for a means—any means—of altering the feelings, making them go away. And I understand that impulse: who enjoys the experience of acute anxiety, or depression, or grief, or rage? The urge to change uncomfortable feelings is, I think, a very human one. However, I also think that strong feelings, when carefully managed, offer opportunities for insight, for creative solutions, for growth. I think that medications are not, in and of themselves, the sole means for dealing with powerful feelings. Rather, they may be part of a strategy—but usually only a part.

The search for a magic pill for managing difficult feelings has become more pronounced in the age of Prozac—one that appears to have become more urgent in recent years. While feelings of all kinds can be powerful and even seem overwhelming--especially uncomfortable feelings like anxiety, sadness, anger, and depression--they are less and less tolerated; we want to make them go away as soon as possible. Quite frankly, there are times when medications are necessary and effective. Medications provide relief when carefully prescribed and monitored. But there are other times when medications are mis-used. Sometimes the line between elevating mood and eradicating feelings is difficult to discern.

These days, though, there seems to be an increasing movement to medicate away any feeling of discomfort. Pharmaceuticals would seem to offer unlimited panaceas to all our ills, allowing us to live in worlds where there are easy solutions to life’s challenges.

It’s not that easy.

Most of us have developed beliefs about our feelings. That we label feelings as “good” or “bad” reflects some of our beliefs, as does the assessment that some feelings are more “appropriate” or “acceptable” than others. The impulse to make feelings “go away” also reflects beliefs about our relationships to our feelings (that they are alien to us and must be erased). Reaching for alcohol or a pill to alter our feelings reflects our dis-ease with some of our feelings as well as beliefs about our ability to cope with strong feelings. (And the impulse to self-medicate is an especially strong one in a culture where the chemical means to alter mood is so readily available. It’s also a tricky impulse: self-medication is a common path to addiction.)

Feelings just are. They are neither “good” nor “bad”. They rise and fall throughout the course of a day, an hour, even a minute. We don’t have much control over their existence, but we do have control over our responses to them. The trouble is, too many people respond to their feelings by trying to eradicate them instead of working through them, letting them teach us about ourselves, letting them lead us to insights and even change.

Mental health involves the ability to manage feelings. Sometimes managing feelings may require medical help. There are psychiatric conditions that are effectively managed with medications. Certain depressions, anxieties, and thought disorders respond very well to medical intervention. However, even these are usually treated most effectively with both medication and psychotherapy.

Let me be clear: there is a time and place for medications. Psychotropic medications have value and can be an enormously effective means for helping alleviate anxieties, depressions and other mental ills. Medications can be useful for helping people develop cognitive clarity, thereby supporting problem-solving efforts. However, medications by themselves do not usually lead to optimal mental health. For that, some combination of medication and psychotherapy is most effective.

In any event, I think that the question to ask yourself when reaching for a chemical solution to a difficult feeling is this: what is my intent? To erase a feeling? To develop greater clarity in my thinking? To support my growth? Talking about this with a professional might be a first step toward discerning an answer and working through to a solution.

Watching words

A lot has been written in the past week about language and its power. The violence in Tucson and its aftermath sparked a much overdue national discussion about language in our public discourse. As a therapist, I am very aware of the power of words. The power of language is something that ancient people knew and respected. Every major wisdom tradition and its literature speaks to the power of language: in the Judeo-Christian tradition, God speaks the world into existence. In indigenous Australian traditions, totemic beings sang the world into existence. And from the Buddha:

The thought manifests as the word; The word manifests as the deed; The deed develops into habit; And the habit into character.

So, watch the thought and its ways with care And let it spring from love Born out of concern for all Beings. As the shadow follows the body, As we think, so shall we become. --From The Dhammapada

Words give shape to our sense of reality. They can uplift, affirm, and celebrate; and they can demean, wound, and destroy. This is not news.

But, as the Buddha insightfully noted, language subtly shapes our inner worlds; it likewise shapes our responses to the external world just as it shapes our character. The language with which we communicate reflects the internal language we use to think about ourselves and our experiences. Indeed, most of us think with language. We carry on continual internal conversations with ourselves, constructing stories in our heads about ourselves and our experiences—stories that give our experiences additional dimensions, textures, and meanings. We then encounter and respond to the world through the lens of those thoughts, words and meanings, not realizing that our encounters with others are now distorted by what our thoughts and language have constructed. Language can filter our perceptions of events which impacts our subsequent actions which are, in turn, responded to by others who have constructed their own stories about what they've experienced. All those thoughts and words create misunderstandings and confusion, usually reinforcing those internal stories we have developed. Without being fully aware of it, we have developed a habit of being in the world. Indeed, “as we think, so shall we become.”

One of the central goals of psychotherapy is to become more aware of one’s thoughts and feelings. Talking—and listening carefully to one’s words—is the primary means for developing awareness. Therapists pay close attention to language because it reveals conscious and unconscious habits of being. Indeed, we pay attention so that we can develop understanding and find a common ground from which to work on changing those habits of being that cause suffering. Attending to our thoughts and words is hard work, and altering our habitual ways of being in the world is even more difficult.

Over the past 25 years, mindfulness—being compassionately watchful of “the thought and its way with care”—has become an increasingly valued habit of being in psychotherapy, especially for therapists. Moreover, it is a habit that many therapists try to help their clients develop. Mindfulness is something that we can all practice and integrate into our daily lives.

It seems to me that real change in our public discourse can only begin with each of us as individuals living with mindful awareness in community: each of us becoming more compassionately mindful; each of us practicing becoming aware of his or her thoughts becoming words, becoming deeds, becoming habits of character.

So, watch the thought and its ways with care And let it spring from love, Born out of concern for all Beings.