There is a problem with the mental health crisis…crisis.
We don't talk about it much. For all the "we need to talk about mental health" we do, there are two crucial issues that we avoid.
The first is ambivalence. People with psychiatric illness face ambivalence. People without psychiatric illness face ambivalence also. Ambivalence is a state where you're not quite sure which way you want to go. This unsureness? It can get extremely severe for people with depression, OCD, anxiety, and other conditions.
We have a special name for a really bad in ambivalence. The complete inability to decide what you're gonna do? It's called pathological indecision. It's indecision so bad you literally can't make a decision. The problem is in the ability to make a decision. Those decisions don't have to be big--it can be any decision. Will I have water with ice or without? Even that could be the equivalent of having to decide which of your children to push into volcano.
The second issue? It’s also ambivalence. I was uncertain about offering only one crucial issue!
Ambivalence can also be more subtle. We've all heard the casual dismissal: "It seems like this person just don't want to get better?!" That may be true, but misses an important part of the experience for people who are suffering. Many attempts to get better don't succeeded. If you're suffering, having your hopes dashed? That sucks. It could be the difference between getting through a difficult day, and worrying that you won't. Many of the people I work with, as a psychiatrist, they avoid trying. Not because they don't "want to get better"--rather, they are wary. There exist risks in the attempt. Making our situation better comes with the risk that it might not. Nobody wants to have their hopes dashed!
Decades ago, Dr. Seligman, a prominent psychologist, put forward the psychological theory of learned helplessness. He took dogs, and shock them repeatedly, and essentially they learned to take it. They learned helplessness was the best response to a situation in which they didn't have control. I'm not talking about the scientific theory. The concept, that constantly fighting is not necessarily the response from most? It holds true.
If we knew exactly what was going to happen, ambivalence would not be common. When you order a glass of water at a restaurant, it's usually brought to you. People don't have pervasive difficulties dying of thirst because the predictability of water? It is high. The same as true for the predictability of treatments for our mental health conditions being wildly effective. In the experience people are suffering, nothing has helped. Why would the next thing help? There is a built-in logical fallacy, of course. Just like those ads from investment advisors, prior results are not a guarantee of future performance. Prior failure does not necessarily predict future failure. Ambivalence is a way of getting predictability back in our life. If we don't try, if we hedge our bets, then we don't get disappointed. That can make a lot of sense, in the moment.
Hopelessness is predictable. And predictability?It provides its own kind of soothing.
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Very well written and shared Dr. Muir. Thank you