When Relationship is the job: a Sisyphean task

"Did I even stand a chance?" I think to myself.  If I were to talk to my younger self, with what I know now, would I have said anything?  Probably not.  What is there to say to a younger, less experienced, idealistic version of myself? 

Perhaps I would say, "you will embark on a journey to heal and comfort those in psychological distress. 

• You will be given some tremendous tools like medications, but they will disappoint you in the end.
• You will repeatedly try to find short cuts, only to discover bitterly that there are none lest you compromise your values.
• You will become an "expert" (as expert as they come anyway), in this great human thing known as relating, and of forming relationships.  You will understand the pull and push that we exert on one another as you will experience thousands of relationships in your professional life time.  You will use the relationship ideally to change the patient for the better, but many times it will feel parasitic and will come at your own expense.
• You will experience the forces of forming relationships that made humans the most dominant species on the planet, and you will be awestruck.  But you will see how these forces are used for ill, or not accounted and accommodated for, or ignored completely.  You will see how humans devalue what makes us human and this will drive you mad."

Who are we, each of us, without relationships?  What I am reminded of time and again in the psychiatrist's chair is that without relationships we are nothing.  We are infinitely reduced from who we are when in connection with others.  And yet do we, as humans, truly understand and appreciate this?  As more in-person connections are pushed online, as more lonely people seek out artificially intelligent companions, as governments fail to catch up in regulating technology to protect what makes us human, I can not help but think we do not.

Relationships hurt.  They disappoint and are messy.  It is funny how we convince ourselves that just because a relationship is virtual or robotic, that they will be any different.  We are healthiest when we learn about relationships amongst our own kind, but make no mistake, we are relating all the time: to inanimate objects, to hobbies, and most importantly to ourselves.  The more I talk to people who are unhappy and lonely, yearning to be feel better, it most commonly comes down to unfulfilling relationship and false expectations or beliefs about relationship.  On my own journey to wholeness, alongside my patients, I recognize no one person or thing will complete you. 

I do not think it is controversial anymore to say that we repeat our past relationships; That this pattern begins in our infancy and we continue to search for and recreate these relationships throughout our lives.  This is how important relating is to us humans.  Our earliest relations are imbedded in us lifelong, only to be changed if the person has insight into their destructiveness and seek to challenge them in some way.  This is the task of the attachment-style therapist, to step into the role of a client's early parental figures to see what went on; to see what version of the world was modeled for the child.

What does it take to do this?  To understand this fully and to work with the client towards a healthier way of being and relating?  It takes time, pursuing a depth of understanding, and patience.  Values that are increasingly being eroded by modern-day society.  It also takes a therapist willing to be accountable to the client, to say we are doing this together and if it isn't working, I will stick around to work it out.  Accountability, another value that is absent from the most powerful and rich people that run our organizations and countries.  Accountability, a part of the psychiatrist-patient relationship that was never discussed or taught in my training except in the context of saving my own skin from being sued.

It also takes the therapist to experience the unhealthy relating first-hand.  The feeling of being invalidated, disrespected, punished, tossed aside.  It all plays out as the client forms yet another relationship but this time, with the therapist.  This process of relating between therapist and client is instrumental in understanding and helping clients work through their lived experiences.  And because we, therapists, are creatures of relating also, to say we are unaffected, unscathed by this dynamic would be a lie.  It exerts a toll, and can not be avoided.  For how can a therapist be trusted to know the unique circumstances, the ingredients of a person's upbringing, what was nourishment and what was poison, if we never had a taste ourselves?

So this is what it is to be a therapist and psychiatrist today.  We try to bring order into the world, one patient at a time as the world spins into a more disorganized and chaotic way of being and relating.  We try to bring safety into people's lives when the sirens are blaring and there is panic on the other side of the door.  We try to stand for ideals like honesty, compassion, trust, respect, responsibility and to hold ourselves to standards that promote health, creativity and generosity, despite these attributes being absent in some of the most influential, visible, and powerful leaders of our world.  Our relationships with clients are the last bastion of privacy and confidentiality.  Our wisdom losing relevance to the masses and are distasteful to healthcare budgets.  As a psychiatrist who believes her life purpose is to improve individual and perhaps societal mental health, it is to be counter-culture and to work tirelessly against all forces looking to drive us out of our mind, and against one another.

*****

"Unlike cynicism, hopefulness is hard earned, makes demands upon us and can often feel like the most indefensible and lonely place on earth.  Hopefulness is not a neutral position, it is adversarial.  It is the warrior emotion that can lay waste to cynicism. It [Hope] says the world and its inhabitants have value and are worth defending.  It says the world is worth believing in.  In time, we come to find, that it is so." - Nick Cave, Australian musician and writer