“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.]

I love this cartoon. The joke works because we want to pay for inner strength; it should feel difficult, like a triumph – something deeply reached for.

But I don’t read it as an outright critique. As much as this cartoon questions the legitimacy of drugs, it also pokes fun at modernity. The joke works, too, because reaching for the medicine cabinet is so utterly unromantic. Where once there were shaman, vision quests or holy insight, now there’s Rite Aid, $10 and a ’scrip for Paxil.

Nonetheless, is it so far-fetched to find strength in the act of helping oneself? How much humility does it take to crack open that white bottle cap for the first time? It’s easy to conceive of “pill-popping” as a shortcut, an easy way out – until we’re the ones faced with the choice. We may have a hard time admitting it, but inner strength isn’t always there. Sometimes, we need to reach out.

And that’s an act of courage in itself.

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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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[A wonderful follow-up to this post. Props to Cathy Horyn, who really hits all the bases in writing responsibly about a suicide.]

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

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I think practically, sexual abuse victims need to hear loud and clear that what happened to you is what happens to most people. It was wrong and not your fault, and you should report the crime, and the perpetrator should be punished. I don’t think that sex abuse victims in most cases need years of therapy to get over the betrayal. What they need first and foremost is the straightforward truth: You are not alone, you have nothing to be ashamed of, it’s his fault, and this is a crime.

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[I sympathize with Susan Clancy's skepticism of universal narratives. But her claim that trauma from sexual abuse "almost never happens" is difficult to swallow. Yes, maybe young victims don't experience trauma right away. What should we expect? Of course kids don't understand sexual abuse. Of course it confuses them more than anything else. No child has the capacity to process complicated emotions immediately, if at all. But kids grow up. And when they come to understand, what then? Wouldn't we expect their confusion to turn to rage? At least some of the time? -Ed.]