“And yet it seems to me that the process itself, in its very commitment to interiority — its attempt to ferret out prime causes and pivotal events from the psychic rubble of the past and the unwieldy conflicts of the present — can be intriguing enough to stand in as its own reward.”

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[This is a doozy of an article: long-winded, self-involved, not entirely pleasant to read. The obligatory horror stories of pathologically insensitive therapists make me cringe; I believe them but feel they're sensationalized and unbalanced. With the utmost sympathy, Daphne Merkin does seem like a person destined for therapy. I don't mean this as an insult – I wouldn't be featuring this article if I did. (I wouldn't be here if I did!) Merkin's struggles are real, and she's honest about them. As a result, she doesn't offer up the most likable self-portrait. I don't know if that's her objective, but in any case she bravely illustrates a core tenant of therapy: we evade the truth of ourselves at extremely high cost. If you read this article, read it with an open mind. Daphne Merkin may not be "your kind of person," but the sympathy that she feels for herself in the face of obviously frustrating emotions is, I'm sure, a consequence of her life in therapy – a consequence and a great accomplishment. -Ed.]

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[I have a friend in medical school – a psychiatrist in training – who tells me that AA gets tremendous credit for being the most effective addiction recovery program in existence. This surprised me, because a) I didn't know that AA's success rate is the gold standard, and b) I thought that many of AA's strategies were at odds with certain classic, psycho-therapuetic mores. The latter appears to be true, although this article suggests a welcome shift in attitude. If AA offers the best chance for recovery, than psychotherapy should follow its lead. Therapists, say the authors, should break out of their comfort zones when the failure of addiction looms; the successful treatment of alcoholism may require more communion with patients than is commonly advised.

This makes a lot of sense to me. In my own treatment (not for addiction, admittedly), my therapist never shared her own stories. I knew next to nothing about her life, and I assumed it would stay that way. But in one instance, she shattered this well-established practice – it was shocking to both of us – by sharing an incredibly intimate story about a death in her family. I could see this made her nervous. Clearly she was going out on a limb, defying her own notion of "best practices." Yet her intuition paid off. Her story changed my life, not because it made me feel any closer to her, but because it made me feel closer to others (certain others at first, and then more generally). I went from feeling confused and frustrated to feeling sympathetic and forgiving.

She told me her story, she said later, in an attempt to give me facts that she never thought I'd get, i.e. I wanted explanations from people who couldn't give them to me. The revelation of her family's secret became a stand-in for the experience I'd been missing, both literally – she told me something I never thought I'd hear – and figuratively – her story gave shape to the actions of people in my own life. She drew a parallel, but she also broke a boundary. Both helped my treatment; I can't say which helped more. This is the art of psychotherapy: the acknowledgment that, despite an appropriately clinical approach, any rules-based system is bound to fall short in the face of us. -Ed.]

This pending law in Nebraska correlates abortion with mental weakness; it suggests that women who are pressured to have an abortion should be handled with kid gloves. First of all, women face all kinds of pressure from all sides at this juncture: lovers, friends, family, and even circumstances themselves. Making a choice under pressure doesn’t mean that it’s a bad choice. Most important choices in life are made this way. Second of all, if we’re honest about these pressures, then we can see this law for what it is: an attempt to use the stigma of mental illness against women considering abortion.

As you probably know from reading this blog, I’m all about de-stigmatizing mental illness. This stigma leads to suicide all the time – every day. It killed my sister, who took her own life before she was willing to take an anti-depressant (even after she filled a prescription). So the thought of using this stigma, reinforcing it, for political victory makes my blood boil. Whatever your position on abortion, we must do better than this law.

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The movie Greenberg stars Ben Stiller as an introverted, volatile, self-obsessed jerk. Its ad campaign promotes Greenberg as a kind of “lovable loser,” a 40 year-old ne’er-do-well with the affected charm of a teenage cynic – i.e., someone we can relate to. Yet it’s not a fair portrait, exactly. Greenberg is far less likable than you’d expect.

At the start of the movie, we learn that Greenberg’s troubles run deep: he’s just been discharged from a hospital, but “not that kind of hospital,” his sister-in-law warns; “he had a nervous breakdown.” She’s warning Florence Marr, the family’s nanny (played by Greta Gerwig). With the household in Thailand, Florence doesn’t have much to do. But she’s asked to check in on Greenberg, who’s crashing at his brother’s house, just to make sure he doesn’t need anything. Greenberg exhibits the classic symptom of co-dependency in LA: he doesn’t drive.

Florence approaches Greenberg with a forced nonchalance, fluttering around him and avoiding eye contact. She’s quintessentially West Coast. Terrified of confrontation, eager to appear cool, she waits for Greenberg to make a move. And despite his palpable anxiety, he does.

Stiller plays Greenberg brilliantly. (The script, by director Noah Baumbach, gives him plenty to work with.) Greenberg looks so uncomfortable in his own skin that half the time he could be wondering where to put his hands. And his awful, mangy hairstyle suggests a person entirely at odds with the material world. A neurotic character like Greenberg is prone to be overacted, yet Stiller and Baumbach give us something real: a man not defined by his neuroses but genuinely beset by them. In an early sequence, Stiller approaches a swimming pool with a haunted, brazen look. ‘Oh no,’ I thought – ‘is he gonna hurt himself?’ But Greenberg attacks the pool instead, desperate to overcome his inner wuss. In seconds we realize that Greenberg can’t swim. The pool wins.

Rather too quickly, Florence falls for Greenberg. She seems to want an easy life, but what she really wants is to make a complicated life easier. She finds a foil in Greenberg. With her eagerness to smooth everything over, she drifts through the ugly circumstances of their relationship like a college intern. She sighs a lot. (Her brief character setup is a passive one night stand, suggesting that Greenberg is an unfortunate love interest in a long line of many.)

Am I making this sound like a horrible movie? Because it’s not. Florence and Greenberg are not admirable people. I shudder at the thought of being either’s parent. Greenberg, when he’s not grouching about trivial wrongs, can be shockingly nasty. And Florence laps it up like a hungry, lazy dog. So why should anyone go see this movie? It’s a tough question. The film, like the relationship, is not a pleasant experience. But to answer this question – Why watch this? – is to answer something else as well. Why put up with anyone?

I am not at all a masochistic moviegoer. More than most, I loathe directors who take advantage of an audience. But in Greenberg, Baumbach expertly toes the line. He fashions a character that is just shy of insufferable. Any more annoying, and we’d wind up hating the experience. Any more sweet, and Greenberg would become a stock character: the down-on-his-luck dude who finds redemption in love (yawn). In testing my limits as a moviegoer, Baumbach had me thinking about my limits as a friend. How much patience did I have for Greenberg? Would I have had more or less if he were a real person? Would I have considered someone like him at all?

This is the fundamental conundrum of mental illness. Often, if not all the time, mental illness is defined by how much it aggravates us. The more frustrating a condition for us, the more severe we judge it to be. So if we’re committed to helping the mentally anguished, what limits can we rightfully have? If a family member or friend has become intolerable, isn’t that more evidence of need? How do we balance our own lives and those of more turbulence? The answer to “Why put up with anyone?” brings us back to the Golden Rule. We put up with exasperating people because we know how easily we can become exasperating ourselves.

So is Greenberg mentally ill? Absolutely. Some may disagree, likely because Greenberg seems too “normal.” But that’s exactly the point. Psychiatric disorder in cinema tends toward the extreme: One Flew Over the Cuckoos Nest, A Beautiful Mind, The Aviator. Yet Greenberg presents the most vivid, honest portrait of illness I’ve ever seen on the big screen. Here’s a guy desperately trying to cope with the smallest niceties in life – and failing. When his best friend surprises him with a birthday cake in a restaurant, he storms out before yelling, “Sit on my dick!” The outbursts are painful to watch; they’re far from endearing. But you feel for the guy. Greenberg is a reminder of just how tough life can be.

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Read Judi’s Blog, Life As A Hospice Patient

We’ve built an impressive civilization around the primacy of individual agency. Our near-worship of human potential, and its attendants hard work and self-sacrifice, has given us everything from the light bulb to the internet. It is safe to say that in the last two-hundred years Americans have contributed more to the advancement of knowledge than most other people. We are a nation of hard workers hoping to become heroes. We persevere.

The ideology of individualism is a useful one, a beneficial one. But it’s not entirely true or always helpful. “Behind every good man is a good woman.” “It takes a village to raise a child.” These are aphorisms that pay lip service to the shortcomings of our individualist bent. And if this myth of personal agency – that if you look deep within yourself you can conquer anything – is not entirely true, then where exactly does this conviction clash with reality? Where does this belief system fail us the most? In the realm of mental illness.

A few days ago the New York Times ran a brilliant piece about how we’re exporting our “symptom repertoire” to the world, about how disparate cultures have begun to adopt our uniquely American expressions of mental anguish.

NOWHERE ARE THE limitations of Western ideas and treatments more evident than in the case of schizophrenia. Researchers have long sought to understand what may be the most perplexing finding in the cross-cultural study of mental illness: people with schizophrenia in developing countries appear to fare better over time than those living in industrialized nations…

Trying to unravel this mystery, the anthropologist Juli McGruder from the University of Puget Sound spent years in Zanzibar studying families of schizophrenics. Though the population is predominantly Muslim, Swahili spirit-possession beliefs are still prevalent in the archipelago and commonly evoked to explain the actions of anyone violating social norms — from a sister lashing out at her brother to someone beset by psychotic delusions.

McGruder found that far from being stigmatizing, these beliefs served certain useful functions. The beliefs prescribed a variety of socially accepted interventions and ministrations that kept the ill person bound to the family and kinship group. “Muslim and Swahili spirits are not exorcised in the Christian sense of casting out demons,” McGruder determined. “Rather they are coaxed with food and goods, feted with song and dance. They are placated, settled, reduced in malfeasance.” McGruder saw this approach in many small acts of kindness. She watched family members use saffron paste to write phrases from the Koran on the rims of drinking bowls so the ill person could literally imbibe the holy words. The spirit-possession beliefs had other unexpected benefits. Critically, the story allowed the person with schizophrenia a cleaner bill of health when the illness went into remission. An ill individual enjoying a time of relative mental health could, at least temporarily, retake his or her responsibilities in the kinship group. Since the illness was seen as the work of outside forces, it was understood as an affliction for the sufferer but not as an identity.

For McGruder, the point was not that these practices or beliefs were effective in curing schizophrenia. Rather, she said she believed that they indirectly helped control the course of the illness. Besides keeping the sick individual in the social group, the religious beliefs in Zanzibar also allowed for a type of calmness and acquiescence in the face of the illness that she had rarely witnessed in the West.

Mental illness is more of a crisis in America because we’re expected to take care of ourselves so completely. When we can’t – when our feelings overwhelm us to the point of breakdown – we have failed as individuals. And seeing illness as a personal failure doesn’t just suck; it’s a burden that can be fatal.

My sister was a casualty. An incredibly bright and hard-working businesswoman, she prided herself on managing a very busy schedule. She wanted a lot from life, but more than anything else she wanted to be “a success:” she wanted to buy her own car, live in her own house, run her own company, and raise a family, too. Independence with a capital “I.” (She loathed expectations of femininity. When we were kids I told her that I’d never heard a girl fart. From then on, she made a point of doing so in my presence – loudly.) By any measure, she gained the life she craved. But when illness struck, she was horrified, not so much by her feelings, but by her inability to master them, her inability to take care of herself. She wanted desperately to be independent. And quite suddenly, she couldn’t be.

More from the Times article:

The course of a metastasizing cancer is unlikely to be changed by how we talk about it. With schizophrenia, however, symptoms are inevitably entangled in a person’s complex interactions with those around him or her. In fact, researchers have long documented how certain emotional reactions from family members correlate with higher relapse rates for people who have a diagnosis of schizophrenia. Collectively referred to as “high expressed emotion,” these reactions include criticism, hostility and emotional overinvolvement (like overprotectiveness or constant intrusiveness in the patient’s life). In one study, 67 percent of white American families with a schizophrenic family member were rated as “high EE.” (Among British families, 48 percent were high EE; among Mexican families the figure was 41 percent and for Indian families 23 percent.)

Does this high level of “expressed emotion” in the United States mean that we lack sympathy or the desire to care for our mentally ill? Quite the opposite. Relatives who were “high EE” were simply expressing a particularly American view of the self. They tended to believe that individuals are the captains of their own destiny and should be able to overcome their problems by force of personal will [my emphasis]. Their critical comments to the mentally ill person didn’t mean that these family members were cruel or uncaring; they were simply applying the same assumptions about human nature that they applied to themselves. They were reflecting an “approach to the world that is active, resourceful and that emphasizes personal accountability,” Prof. Jill M. Hooley of Harvard University concluded. “Far from high criticism reflecting something negative about the family members of patients with schizophrenia, high criticism (and hence high EE) was associated with a characteristic that is widely regarded as positive.”

Widely regarded as positive, that is, in the United States. Many traditional cultures regard the self in different terms — as inseparable from your role in your kinship group, intertwined with the story of your ancestry and permeable to the spirit world. What McGruder found in Zanzibar was that families often drew strength from this more connected and less isolating idea of human nature. Their ability to maintain a low level of expressed emotion relied on these beliefs. And that level of expressed emotion in turn may be key to improving the fortunes of the schizophrenia sufferer.

My sister killed herself in 1999, just before the new millennium. She would have turned 37 last week, on January 10th. I can think of no one more independent and more responsible than she. She constantly goaded me into pushing myself to do more. “No one else is going to do it for you,” she used to say.

This is the dark side of American Individualism: those in need of help are loathe to seek it. This concept of Expressed Emotion, or EE, doesn’t just apply to the community; it applies to the subject as well. If friends and family are highly critical – if they are unsupportive of a person in breakdown – it’s likely the person has internalized that kind of thinking. My sister was probably the most “EE” of anyone in the family. In other words, nobody was harder on her than herself. Not surprisingly, this had a lot to do with how determined she was to persevere.

She could have used a little humility. Can’t we all.

And sometimes when I’m feeling kind of overwhelmed by ‘the battlefield,’ I will just sort of stay away from the artificial situations and get back to my closer friends who really get what’s going on in my psyche.”

[Amen. I'm going to make better sleep hygiene my new year's resolution. -Ed.]

I pride myself in keeping an open mind about mental illness, but I have to admit that it’s tough to watch this video without feeling a pang of conservative rage. Where are we going with all of this? Are we so desperate and starry-eyed that we’re willing to experiment on our own children?? Don’t they deserve a more cautious approach?!??!?!

I’m not quick to judge any of the parents. My heart goes out to them. I’ve never had a kid, let alone one with mental illness. But I do know something of the helplessness that surrounds families in the midst of these crises. It’s a God-awful experience – and a dangerous one, too. Feelings of abject helplessness lead to extreme vulnerability. And that’s exactly what you see in this video: vulnerable families being pressured into troubling treatment, all at the behest of powerful institutions with their own interests to weigh. I’m not skeptical of doctors or “experts” (that’s a strain of American fundamentalism I could live without), but at the same time we have to recognize our respective roles. A child’s care is the sole responsibility of his or her parents. The educational system and the health care industry, despite what they advertise, were not designed to care for any particular child. Those institutions have competing priorities (the profit initiative, organizational flow, etc.), including millions of other kids. What is good for a school or a doctor’s office might be at odds with what is good for a child. When it comes to medicating our youth, we should be especially vigilant about these conflicts of interest, and wise to how good people’s judgment can go bad.

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[Note the segment tiles above the video display; to watch the whole program, click on each segment.]

In some ways, the site is a contradiction. Its mission seems particularly suited to the ethos of a blooming web culture – bringing together strangers to share secrets in an arbitrarily structured way that feels freeing and gives rise to a wealth of expression. From another angle, the whole thing seems oddly old-fashioned – decorating tiny canvasses using scissors and glue, submitting them for publication via snail-mail, and hoping your entry gets lovingly scanned by Frank Warren himself. It’s folk art for the internet age. And I love it.

[This is great. Comedian Howie Mandel opens up about his Obsessive-compulsive Disorder on Ellen. -Ed.]