Over the weekend, my wife and I visited her parents. During the long drive to their house we had a deep discussion about psychotherapy and mental health. Well, this is not surprising, considering that we are both clinical psychologists.
We delved into the goals of therapy and discussed which treatments are most effective for different individuals and situations.
This conversation reminded me that when people seek mental health support, they often lack awareness of the basic truths surrounding the treatment options they will encounter. It's astonishing how chaotic the situation has become in a world where long-term processes are no longer feasible due to limited time and resources to assist everyone.
Therefore, I would like to share some reflections on therapy in the current era, and, in conclusion, provide insight into three crucial questions that, in my opinion, should be considered when selecting the appropriate mental health support.
1. Which Pill to Swallow? The Blue or the Red?
You probably remember "The Matrix." In the movie, Morpheus, the leader of the rebels, asks the main character, Neo (played by Keanu Reeves), to choose between a red and blue pill. Morpheus goes on to say, "You take the blue pill... the story ends, you wake up in your bed and believe whatever you want to believe. You take the red pill... you stay in Wonderland, and I show you how deep the rabbit hole goes." (1)
In the movie, the blue pill is a sedative that would make Neo believe that his recent experiences were just a dream or hallucination, allowing him to return to The Matrix and live peacefully in its virtual, fraudulent reality. The red pill, on the other hand, would reveal the truth about Neo's existence and enable him to disconnect from The Matrix.
Now, transitioning to the world of therapy, the blue and red pills symbolize a choice between two options. The blue pill represents maintaining the current reality by reducing the subjective discomfort that comes with it. The red pill, on the other hand, leads to the revelation of uncomfortable truths but also enables one to change their reality.
2. The Real Reason for Seeking Mental Health Treatment
So, if you were to seek mental health support, what would be your reason?
Are you primarily interested in avoiding pain and seeking pleasure? Or are you more focused on changing the aspects of your real life that bring you unhappiness?
If we were to consider this from the perspective of rats, the answer would be relatively straightforward. As rats, the pursuit of pleasure would take precedence without much hesitation. A study conducted in 1954 already demonstrated that when rats are able to stimulate regions of pleasure in their brain by pressing a button, they will continue to do so to the point of self-starvation (2).
However, the human brain is much more developed and intricate. Our reactions are also influenced by the meaning we attach to the things and experiences around us, particularly those that relate to our social environment. In predominantly urban settings, crowded with people, there is often a disconnect between the individual and a sense of community that provides the emotional connection we deeply crave. As the musical band The Friends of Natasha wrote, "millions of people are alone."
Consequently, many individuals seek treatment because they struggle to find their rightful place among others. This includes difficulties in forming successful relationships, experiencing loneliness due to a lack of connections, and feeling vulnerable in the realm of employment, where they may not feel valued or do not believe they have a positive impact on others (3,4).
And studies indicate a clear connection between individuals who lack close and supportive relationships and various manifestations of mental illnesses, including depression and ineffective coping with crises (5,6). Therefore, such individuals who seek help are in need of the red pill - to discover and establish their significance and relevance within the social environment.
3. The Most Common Interventions Provide a Blue Pill
In most cases, we only seek mental health treatment after exhausting all other efforts to improve our lives without clear success. Along this journey, a persistent mental anguish arises and eventually becomes our primary concern. At this point, the driving force behind seeking help is the presence of mental pain.
If this seems illogical, consider what individuals typically disclose to their primary care doctors, which eventually leads to a referral to a psychologist. They do not typically share a desire to enhance their relationships or a lack of fulfillment in their work—these aspects of life are challenging for everyone. Instead, they share feelings of hopelessness or an inability to cope with stress. In other words, the focus is on the mental pain that hinders their functioning, rather than the external realities of life that may have contributed to their mental struggles.
The society steers us towards primarily focusing on mental pain since changing our reality is much more challenging. There is no clear protocol for how to change our lives (despite what life coaches may try to sell), and sometimes it could seem to be beyond our control, leaving us with nothing to work on in the therapy room.
Indeed, the most common interventions in mental health, particularly for adults, such as medication and various cognitive-behavioral therapies, can be seen as blue pills. They aim to provide symptomatic relief and prevent mental pain.
These interventions are designed to reduce the experience of suffering, such as depression or anxiety. Their advantage lies in their focus on alleviating mental distress, which can also save lives (consider, for example, a person experiencing depression that may lead to suicide attempts if left untreated). However, the downside is that if these interventions mark the end of the treatment journey, we may have discovered a way to live a life that is ultimately detrimental to our well-being in the long run.
4. Three determining key questions that relate to life itself
The story of mental health care in the modern world is of a human society grappling with individual-level problem-solving, despite the significant number of people experiencing distress.
The emphasis on individual-level solutions is understandable, as it remains crucial to make life easier for individuals in the absence of a social revolution. However, my main concern is that this focus on finding medications and simple interventions to alleviate suffering may hinder us from addressing the root cause of the problem - loneliness and the struggle to find relevance in life.
This tension between the individual and society prompts me to reflect on when it is reasonable to simply swallow the blue pill - when reducing the symptoms of suffering is sufficient.*
If someone we care about (including ourselves) requires mental health treatment, or is currently undergoing it, it is worth posing the following three questions to determine which pill is more suitable:
Does (s)he have deep and intimate relationships with several friends or family members? Relationships that offer support and mutual experiences, fostering a sense of togetherness?
Does (s)he have people who depend on her/him? Is (s)he necessary to them?
Does (s)he have a positive impact on others in the world through her/his work?
If the answer to these three questions is YES, it indicates that the person lives a life that provides a sense of relevance. In such cases, assistance in reducing mental pain might be all that is required to regain equilibrium.
However, if the answer to any of these questions is NO, it is crucial to recognize that treatment should not solely address the symptoms of mental problems. Over time, the person in need of support may not find profound satisfaction with the outcome at the core of their being.
This is because our mental well-being, ultimately, is not solely tied to the presence of mental issues but predominantly connected to the feeling of relevance we experience in this world.
And yes, this is the kind of conversations I get to have with my wife. This is a huge thing to be thankful about :-)
Till next time, be well.
* My opinion does not replace personal advice from a licensed professional and can not be accountable as such. (1) Wachowski, L., & Wachowski, L. (1999). The Matrix. Warner Bros.
(2) Olds J, Milner P. Positive reinforcement produced by electrical stimulation of the septal area and other regions of rat brain. J Comp Physiol Psychol. 1954;47:419–27.
(3) Tennant C. Life events, stress and depression: a review of recent findings. Aust N Z J Psychiatry. 2002;36(2):173-182.
(4) Brown GW, Harris T. Social origins of depression: A study of psychiatric disorder in women: Routledge; 2012.
(5) Bassett E, Moore S. Mental health and social capital: Social capital as a promising initiative to improving the mental health of communities. Current topics in public health: IntechOpen; 2013.
(6) Vanderhorst RK, McLaren S. Social relationships as predictors of depression and suicidal ideation in older adults. Aging & mental health. 2005;9(6):517-525.