What We Suffer Most From …

A beautiful sunrise
Freud, Semrad, and my grandmother all made a seminal observation about life.

Early in my training in Psychiatry, my most important teacher, the legendary Professor, Dr. Elvin Semrad, made the following observation:

“I’ve always thought that some of the things people suffer most from are the things they tell themselves that are not true.”

Decades earlier, Sigmund Freud said:

“Psychoanalysis is the study of self-deception.”

I have found that much of the work of psychotherapy is the challenge of examining the details of the relentlessly repetitive thoughts that plague our patients and that prove to be untrue. One key to finding these false ideas is recognizing how much of what troubles a person is based on holding to the concept of how something or someone (even himself or herself) “should be” or “should have been.”

Insisting that there is a way things should be, that there is a way a person should be, represents resistance to seeing what’s so and to accepting what’s so in the moment — a denial of existential reality and a futile attempt to avoid the pain of managing whatever or whomever (even ourselves) as it is or as we are. It is also a way of justifying our anger and asserting our right to expect something closer to our wishes.

Actually, we can find no basis to support the idea that there is a way that things should be. I remember my grandmother saying, in Yiddish, in response to any such should statement: “Vu iz dos geshribn?”, which translates to: “Where is it written?”

The gap between what’s so and what we wish were so is both a minefield and a potentially fertile ground. How a person manages the frustration, anger, and (in the best case) sadness that is generated in living with reality is the fundamental business of therapy.

A person telling him/herself that something or someone should be different from what’s so is a lie at the root of perpetual suffering. Accepting what IS so requires facing painful truth, with the opportunity to work through frustration to sadness and grief — which can diminish over time. Letting go of what we wish for but do not have frees up energy to attach to what IS actually available. This is growth and new life.

We cannot get though life with energy and integrity without suffering some pain. Psychotherapy has been nihilistically described as the process of trading neurotic pain for existential pain. The important difference is that neurotic pain is perpetual, does not yield, and generates deadness; existential pain is dynamic, yields, and generates life. And takes courage to bear.

As Semrad said, “No therapy is comfortable, because it involves dealing with pain. But there’s one comfortable thought: that two people sharing pain can bear it easier than one.”


Rako, S, & Mazer, H. (2003). Semrad: The Heart of a Therapist. iUniverse