I have been observing for some time the journey of the mentally ill, but the existential nature of this journey is not as real as when it affects the life of a loved one. In a metaphorical way of thinking, mental illness is the repetitive journey down the “rabbit hole” in such a way that the journey is thought necessary and the thought of necessity creates a feeling of impending doom that one constantly seeks to escape (anxiety) or that one accepts as their reality (psychosis). To live in light of this doom is to open the door of life to depression, a persistent gloominess that accompanies the necessity of the rabbit hole. From the perspective of one who watches the journey, my desire is to jump between them and entrance to the hole. I want to stop their journey, to disrupt the repetition that they may understand that the journey is not necessary, but to act in a brash fashion such as this is to join forces with the suspicious darkness of the rabbit’s domain; it is to somehow diminish the pain of their journey and minimize the fear they feel. Such diminutive attitudes have accompanied the walk of the mentally ill throughout the history of humankind forcing upon them a sense of shame that only heightens their feelings of necessity. “Just get over it!” is the cruel retort of those who walk in a different type of darkness, the darkness of ignorance and intolerance. But if one trained in the art of empathy is unable to block the journey with a cognitive-behavioral slight of hand, then what helps those grown weary of heir journey and the angst of instability? Or, for those who watch their loved ones journey down the rabbit hole, how can they help without getting caught up in the hopelessness of necessity?
For any who have worked in the realm of mental health, they know that help is a precious way of embracing the journey of the mentally ill while at the same time being mindful that is the journey of the one filled with anxiety, overpowered by gloom, filled with the suspicion of paranoia or haunted by the dauting shadows of delusion that is being observed. The empathetic observer (the therapist) cannot make the journey their own. The malady of the rabbit hole is the reality of the one who is sick. In this, stubbornness clashes with necessity. To make the journey their own would put the empathetic observer in the position of owning the problem thereby making it all about the observer, an act that allows the observed (the client) to further lose themselves in the darkness of the hole and validates the notion that their journey is inevitable; that it is necessary. Stubbornness then gives way to necessity and the help so earnestly desired is lost to the hole’s darkness. But empathy is a stubborn refusal to submit to the necessity of the journey through a confrontation. This is not a confrontation of “I’m right and you’re wrong.” It is the reflexive confrontation that emerges from the stubborn refusal to accept the problems of the observed. This happens when the observer stubbornly refuses to become the observed thereby creating a environment of countertransference where the observed is confronted by their self.
To give in to the brain’s circuitry in a deterministic fashion is to reduce human experiencing and the phenomenon of mental illness to a type of fatalism immune to the confrontation necessary to mental health.Harold Anderson
In this confrontation, vulnerability is laid bare and the possibility of fear cautions the observed to proceed with trepidation sometimes heightening their shame to a place where the observed turns from themselves and flees to the menacing darkness of the hole. The confrontation of which I speak is a dangerous place where the light of healing pierces the darkness of the hole bringing hope. But the light is dim and the source from which the light emanates is fragile. Its fragility must be guarded with care. It is the therapeutic relationship that guards the fragility of this hopeful light. It is the care of this relationship that creates a therapeutic environment inspiring the observed to confront themselves so that perhaps for the first time they begin to see themselves as they really are. In this confrontation, the “no” of necessity begins to give way to the therapeutic environment so that in their confrontation with themselves, the observed begins to realize the graciousness of their subjectivity. They do not want to be ill. They do not want to suffer from anxiety or depression, they do not want paranoia to dominate their life, they do not want the shadows of delusion to usher them once again down the rabbit hole of their illness. The power of the self is gracious and its ‘yes” to life is brought into confrontation with the “no” of the rabbit hole’s necessity. When this happens the “no” of necessity weakens and the self’s “yes” to life becomes a very real possibility.
This sounds good, but is this not simply idealism? While one may admit that mental illness is not something that one can just “get over,” is not mental illness a condition of the brain’s chemical and electronic configurations patterned on the genetic blueprints received from family and conditioned by experiences of one’s environment? Put differently, is not mental illness an illness of the brain so that little can be done about it since one cannot reconfigure the DNA of the brain and its chemical patterning? It is difficult to argue with those who point to the suborn obduracy of the brain’s function as the source of mental illness, for in so many ways it is the brain that determines the nature of our world and our experience of it. A depletion of serotonin can cause a depressed state; a reduction in our dopamine levels can decrease our sense of pleasure. For those who suffer from bipolar disorder, the function of the brain is most certainly a factor and the shadowy hauntings initiated by delusion finds its cause in the circuity of the brain. To give in to the brain’s circuitry in a deterministic fashion is to reduce human experiencing and the phenomenon of mental illness to a type of fatalism immune to the confrontation necessary to mental health. Part of the healing that comes from the confrontation of the observed with its self is found in acceptance. We not only are confronted by the gracious reality of our subjectivity, but we are also confronted by the reality of our subjective experience as conditioned by our physical status. The graciousness of the self that occurs with confrontation empowers the one suffering from diabetes to accept their condition so that they can take steps to increase the quality and longevity of their life. Likewise, those who suffer from mental illnesses such as bipolar disorder, personality disorder, or schizophrenia learn to accept their condition through an honest encounter with their selves that they may accept the care of their caretakers by taking the medication required and engaging in therapeutically empowering process so that they can refuse the rabbit hole and say “yes’ to life.
Whatever the path, the route to wellness is a long and arduous task that is often filled with disappointments caused by the shame that comes from vulnerability or the weakness of physiological function. The journey down the rabbit hole as well as the journey to mental wellness is an emotional journey where the negative emotions of the rabbit hole often scream more loudly than the whispering emotions that accompany the light of hope. It is this imbalance—the imbalance of mental illness—that the therapeutic relationship helps the observed to manage. Being mindful of one’s environment and one’s sense of self, the observed must learn the blessings of a well-disciplined mind. Mental health is the ability to balance one’s emotional life so that negative emotions do not overwhelm the positive. Such management, such discipline is the goal of the therapeutic relationship and the key that unlocks the gracious power of the self. It is this discipline that is the work of therapy.
The process of therapy is difficult enough when the observed is one we do not know. It is nearly impossible when the observed is one whom we love. The reason lies in the balance of emotions that is the heart of therapy. When a loved one suffers, we want to save them. We will do anything to try and alleviate their suffering and in that we lose perspective. And even if we do an admirable job of maintaining the role of the observer, the emotional exhaustion of watching a loved one suffer drains us and empties our self of its gracious power. The toll can be devastating to the health of the observer while overcoming the stubbornness of empathy with the sympathy and compassion of our love. In this, the confrontation necessary to the observed does not take place and necessity prevails. The rabbit hole threatens victory widening its entrance to admit two instead of one.
Often loneliness, desperation and even panic nag at even the trained observer when a loved one enters the rabbit hole of mental illness. How do you observe a mother, father, sibling, or child when the rabbit hole beckons, and their lives are filled with its seeming necessity? When a loved one enters the rabbit hole the trained observer’s training becomes a feeble guard and the desire to rescue, to protect the loved one looms large. The trained observer’s compassion comes into conflict with their professional identity, which accounts for their exhaustion. Not only are they caught up in a fight with the rabbit hole and its seeming necessity, but they are at war with themselves fighting a battle with the depths of their love and the “objectivity” of their professional stance. Indeed, the battle between these two extremes become a spectrum upon which emotions bounce from one end to the other. When this happens, the trained observer is confronted with their own necessity—survival. If not them, then who?
If the loved one lives in a place where there are numerous support personnel, they are fortunate and they can draw upon their support to soften the trained observer’s feelings of desperation, and provide breaks that can ease their frustration. In these situations, it is important that the trained observer avail themselves of help and develop a space in which other trained observers can help. Psychiatric care can improve the chemical imbalance of the observed’s brain and trained mental health providers can ease the tortured structures of their mind. When such are available, the trained observer can loosen their control and find rest in the competent care of others. But what happens when this care is not readily available as is the case in remote areas where trained observers especially in mental health are not available? Then the trained observer must locate support structures for their own well-being (family and friends) and avail themselves and their loved one to the limited health and mental health resources available. The trained observer, in these instances, must care for themselves for only by doing so will they be able to manage the spectrum upon which their life will inevitably fluctuate.
Watching those who live out the necessity of going down the rabbit hole of mental illness is a process that is indeed complex and demands careful attention on the part of the trained observer. Empathetic observation strives to bring the necessity of the rabbit hole into conflict with the essential goodness that lies within the observed thereby freeing their drive to wellness. When, however, the observed is one we love, the existential realities of necessity that drive the observed into the hole of mental illness threatens the very well-being of the loving observer. The dialectical tension so necessary to the freedom of health threatens to fade into sympathy and the darkness of the hole begins to penetrate the lives of the loving observer and the observed. In such instances, the loving observer must find refuge in support structures that alleviate them of their need to intervene to save their loved one and relieve them of their suffering. This is difficult to do for the path to mental wellness is complex and sometimes long. Looking deep into the recesses of self, the loving observer must relinquish the reigns of care by caring for themselves and only then drawing upon available resources to help mediate their love. The rabbit hole of mental illness may be difficult for many to avoid, but by finding the goodness that lies at the heart of the self, both the loving observer and the observed who is loved can find relief.