I’d like to begin with some words about a remarkable woman who first touched my life over 50 years ago. In 1966, during my training to become an Army medic, the Major that led our training unit was a combat veteran WAC (Women’s Army Corps) nurse. One morning about a month into our training, she called us to attention and gave us our orders for the day:
“Today you troops will be on a hospital ward caring for men who all have been severely injured, and many are in great pain. Some of them will show no sign of the pain they are in. But some of them will shake, cry out and whimper uncontrollably.
Hear me now. As you change their bandages and touch them and turn them in their beds, I don’t ever want to see one of you treat them differently because of how they experience pain. I don’t ever want to see you make the men who openly show their pain feel ashamed. The men who endure pain silently are no braver or better men than those who don’t.
They all must have your equal respect, and you must do your duty in caring for each of them. Remember this: we all have different tolerances for pain. No one should have to suffer alone.”
She had served in World War II and the Korean War. I remember her very kind but soul-piercing eyes. She intimately knew the horrors of war and she stood for mercy. She taught us that a large part of our jobs as medics, in addition to the physical work of putting on tourniquets and applying bandages, was to communicate a heartfelt caring that itself was a necessary healing balm for the wounded to receive.
By practicing that way of being openly caring, I saw firsthand that when physically wounded or injured people are faithfully shown that they are valued and respected and that they will not be abandoned to suffer in isolation, an emotional shift happens inside them. They often report a shift from feeling despair and fear to feeling relief and a palpable hope that they will get better soon. I learned that feeling hope is a key element in physical and emotional healing, and that we as caregivers can help hope come alive in others when they are most vulnerable and in need of our compassionate assistance.
It was several years later, and after I’d had a harrowing passage through a painful year of suffering in a protracted extreme state, that I decided to go into psychology and become a therapist. But during my own emotional crisis, the Major’s intensely direct words about deserving compassion and her credo that no one should have to be left alone in their suffering stayed with me and comforted me.
In “Initiatory Madness,” my first blog here on MIA, I share how crucial it was that I felt the emotion of hope stir within me as I responded to the merciful presence of compassion from caregivers. That unceasing compassion gave me hope that I could survive and be relieved of the terror I was in. The people who loved me didn’t abandon me. This helped me weather the persecutory voices and nightmarish fear.
For the last 40 years, the Army nurse’s message has also informed how I try to be as a caregiver when I’m with people in extreme states and in every form of emotional pain. I still spend time several days a week being with people in this way. I’ve written here on MIA about the value of being with people with an open heart while they are in extreme states. I have seen how receiving compassionate caring can ease pain and fear and help people begin to feel the most welcome emotion of hope.
To experience hope beginning to surface is greatly needed when painful emotions such as intense anguish, rage, self-hatred, feelings of abandonment or of terror may swamp us to the point that our emotions become unbearable. Feeling the emotion of hope lets us believe that the pain we are in will recede a bit — before we can’t stand it anymore, before we become at risk for taking desperate measures just to get some relief. I came close to suicide before I felt the hope that my emotional pain could actually become less overwhelming.
When we feel trapped in emotional pain, we may only see two choices open to us and both of them may look terrible. When that kind of bind happens, hope can get lost.
How can we keep the sometimes fragile emotion of hope alive? How can we find hope when it seems to be lost?
One way is to start to doubt that the trap or bind we are in is permanent — to believe instead that there may in fact be a third way forward that will break open the impossible-seeming bind between two excruciating choices. The emotion of hope helps us form the doubt that we will stay permanently trapped in pain. But so often we need someone to prime that pump of hope for us.
The real life binds that can keep us from feeling hope may form into self-talk or be openly expressed in words such as:
“Should I live on the terrifying streets or return to the psychiatric hospital where people who are supposed to help me might ignore me, or hurt and abuse me instead?”
“Should I take the street drug that keeps me trapped in addiction, or suffer the intense emotions that make me cry out uncontrollably in an agony that only the drug temporarily numbs?”
“Should I stay in this relationship where I’m abused or leave it and be isolated and all alone again?”
“Should I end my life to escape this pain or should I keep suffering without an end in sight?”
The path of hope can lead us free from such grinding forces that bind us, but if we’re left alone in our suffering we may come to doubt that such a path exists at all.
It’s very tragic that a hope-inspired way out of the binds of intense emotional pain is too often invisible or nonexistent if we’re mired down in psychiatry’s disease model of care. Under that model, our emotions of pain are almost always temporarily silenced with emotion-numbing drugs. Our intense emotional expressions aren’t received with empathy and compassion — instead they are subtly frowned upon if not openly feared and shunned. Such a reception to our painful emotional truth can make us feel invisible. Such a pathologizing response can make us suffer alone because no one has reached out to us with the non-clinical, human-hearted caring that we need.
For decades, a great many people in emotional pain have reported to me the huge failure of empathy and compassion that took place when psychiatry’s fatalistic message and disease-model approach combined to make them feel outcast, judged, bad, wrong, deviant and ashamed for experiencing and expressing emotional pain. In my blog “Does the Psychiatric Diagnosis Process Qualify as a Degradation Ceremony?” I share how the “othering” that happens when we are labeled can actually act as a hope-destroying medical curse. The implicit devaluing inherent in the psychiatric disease model works to demoralize us via its fatalistic diagnoses, predictions, prognoses and treatment plans for our alleged lifelong “mental illness.”
But if, instead, a respectful and comforting hand is offered to us in our pain-filled hour of need, then we are given much of what can kindle the emotion of hope in us.
In my experience, the human need to not be left alone when we are suffering is very great. During such times our very basic human needs for being valued, seen, heard and cared about arise as we are at our most vulnerable and are dependent on the goodwill of others. Hopelessness and a self-devaluation set in if we’re detachedly analyzed, labeled, silenced, shunned and isolated.
But when we are reached out to with a gentle, upturned hand of kindness, hope is kindled.
We do need each other when we are at our most vulnerable. No one should have to suffer alone.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.