“Inside Out” and the Legacy of a Legend

A beautiful sunriseI wrote this piece in July, 2015 before the idea of a blog had crystallized for me. It was the first experience that pressed for written expression in the decade since the publication of my memoir (That’s How the Light Gets In: Memoir of a Psychiatrist – Random House).  While reference to the film is a few months dated, the meaning of the piece is timeless.

I sat at the movies on a soft summer Sunday evening in Chatham on Cape Cod. As the Pixar production of Inside Out revealed its message, I was unexpectedly overtaken by a rogue wave of sadness.

Much of the animated film takes place in the developing mind/ personality of a little girl named Riley. She has been a joyful child, loving her parents, her friends, her place on the hockey team, her happy life. At the start of the film, because of Father’s job stuff, Riley’s family has had to move far away from their happy home.

We meet four colorful characters who represent Riley’s feelings — Anger, Disgust, Fear, and Joy (most of all, Joy) — shown all to have their places in Riley’s life. A fifth character, Sadness — a squat little blue being who tinges everything that she touches, including precious globes of core memory — is allocated no acceptable function or place. Joy, the tireless and determined leader, keeps vigilant watch over Sadness, who simply can’t keep herself from touching the memory globes. In spite of Joy’s fantastic efforts to keep Riley happy (the phenomenal body of the film), Sadness finds her place. And, finally, it turns out to be Sadness who saves the day. The resolution of the film is satisfying and moving, but it touched something more for me. I wept through the credits. I nearly whispered my thoughts aloud:

Oh, Semrad. Here, the heart of this film, a creative illustration of the tenet you taught: Sadness is the vitamin of growth.  Nearly forty  years gone and I miss you still.

Susan Rako
Dr. Elvin Semrad was Director of the Psychiatric Residency Program   at Massachusetts Mental Health Center, a teaching program of Harvard Medical School. “Mass Mental” was physically crummy, but in other ways remarkably well endowed — an unparalleled psychiatric training program where the most promising medical school graduates of top medical schools were supervised by an enthusiastic and brilliant staff of psychiatrists, the best and brightest of Boston. The elite two-year psychiatric training program graduated twenty-five mostly inspired psychiatrists each year, many of whom went on eventually to become chiefs of staff or directors of departments of psychiatry in hospitals and medical schools through the United States and abroad. Others have carried on primarily in clinical practice and teaching, and some in research. All of us were strongly impacted by Semrad, and many have passed on what he taught, often quoting him to our patients and students.
Sadness is the vitamin of growth.   How does this work?  Wanting something to be when it is not, or wanting something to be other than it is – is a standard of the human condition.  We hold on to our wishes, with energy invested in the wanting.  When we manage to let go of wanting, the healthy initial natural consequence is sadness.  Letting go, experiencing grief and sadness, frees up the energy formerly invested in the wanting — frees it to attach to something in one’s world that is available.  This is growth.
Dr. Semrad believed that the most significant learning came from the seat of your pants; that the patient is the only text book we require. He felt that the best treatment was one person helping another to look at the facts and feelings of his life. Investigate, investigate, investigate. He emphasized that the most important task of a neophyte psychotherapist was to learn to sit with the patient, to listen and to hear, and to help the patient to bear the pain that he or she could not bear alone.
The years of Semrad’s teaching directorship at Mass Mental (mid- late1950’s until he died of a heart attack in his office in 1976 at the age of 67), saw the beginnings of the psychopharmacology revolution. He was not a fan. When the emphasis goes to drugs, restrictions, and controls, then love goes out the window and the patients lose out. For Semrad, “treatment” meant psychotherapy.

In 1968, ahead of his time, Semrad lamented: We’re in an era where treatment isn’t popular. We’re in a manipulation era.  I’ve never seen a group that is more hopeful or willing to believe in magic than the (neuro)endocrine people. They think that if they can just find the right juice, life will be an endless pleasure.

Semrad also said, “Anything is all right at the right time, in the right place, and with the right person.” We who carry on his legacy have had the opportunity to learn a lot about the right time, the right place, the right patients for psychotropic medication. And we who learned the work of psychotherapy from Semrad and from the patients we serve know that there is no magic juice to make whole a person coping with life by avoiding painful feelings. Sitting at the movies on that Sunday evening, along with the wave of grieving for my mentor, I felt buoyant joy that Inside Out had been made. A Disney film popularizing the essential role of sadness in psychic integrity.  Wow.

~ Susan Rako