To the best of my knowledge, every acute inpatient ward offers some inpatient group therapy experience. Indeed, the evidence supporting the efficacy of group therapy, and the prevailing sentiment of the mental health profession, are sufficiently strong that it would be difficult to defend the adequacy of the inpatient unit that attempted to operate without a small group program.
If people in their 20s had more death awareness, would that in fact temper their ambition or drive? My hunch is yes. It would certainly do something for those who are most ruthless, who tend to make others most miserable. Some sort of greater awareness of their own finiteness and what their time on earth really is, and what they really want to do with their lives, could help improve them.
Specialness as a primary mode of death transcendence takes a number of other maladaptive forms. The drive for power is not uncommonly motivated by this dynamic. One's own fear and sense of limitation is avoided by enlarging oneself and one's sphere of control. There is some evidence, for example, that those who enter the death-related professions (soldiers, doctors, priests, and morticians) may in part be motivated by a need to obtain control over death anxiety.
You know, I think everybody I've seen has come from some other therapy, and almost invariably it's very much the same thing: the therapist is too disinterested, a little too aloof, a little too inactive. They're not really interested in the person, he doesn't relate to the person. All these things I've written so much about. That's why I've made such a practice really, over and over to hammer home the point of self-revelation and being more of yourself and showing yourself. Every book I write I want to get that in there.
There was a time in our lives when we were so close that nothing seemed to obstruct our friendship and brotherhood, and only a small footbridge separated us. Just as you were about to step on it, I asked you "Do you want to cross the footbridge to me?" - Immediately you did not want to anymore; and when I asked you again you remained silent. Since then mountains and torrential rivers and whatever separates and alienates have been cast between us, and even if we wanted to get together, we couldn't. But when you now think of that little footbridge, words fail you and you sob and marvel.
One reason patients are reluctant to work in a therapy group is they fear that things will go too far, that the powerful therapist or the collective group might coerce them to lose control--to say or think or feel things that will be catastrophic. The therapist can make the group feel safer by allowing each patient to set his or her limits and by emphasizing the patient's control over every interaction.
In a study we did of bereavement, we found that rather impressive numbers of widows and widowers had not simply gone back to their pre-loss functioning, but grown. This was due to a kind of increased existential awareness that resulted from this confrontation with the death of another. And I think it brought them in touch with their own death, so they began to experience a kind of preciousness to life that comes with an experience of its transiency.
If I'm among men who don't agree at all with my nature, I will hardly be able to accommodate myself to them without greatly changing myself. A free man who lives among the ignorant strives as far as he can to avoid their favors. A free man acts honestly, not deceptively. Only free man are genuinely useful to one another and can form true friendships. And it's absolutely permissible, by the highest right of Nature, for everyone to employ clear reason to determine how to live in a way that will allow him to flourish.
It's not easy to live every moment wholly aware of death. It's like trying to stare the sun in the face: you can stand only so much of it. Because we cannot live frozen in fear, we generate methods to soften death's terror. We project ourselves into the future through our children; we grow rich, famous, ever larger; we develop compulsive protective rituals; or we embrace an impregnable belief in an ultimate rescuer.
What? 'Borderline patients play games'? That what you said? Ernest, you'll never be a real therapist if you think like that. That's exactly what I meant earlier when I talked about the dangers of diagnosis. There are borderlines and there are borderlines. Labels do violence to people. You can't treat the label; you have to treat the person behind the label. (17)
One thing I feel clear about is that it's important not to let your life live you. Otherwise, you end up at forty feeling you haven't really lived. What have I learned? Perhaps to live now, so that at fifty I won't look back upon my forties with regret.
Some day soon, perhaps in forty years, there will be no one alive who has ever known me. That's when I will be truly dead - when I exist in no one's memory. I thought a lot about how someone very old is the last living individual to have known some person or cluster of people. When that person dies, the whole cluster dies,too, vanishes from the living memory. I wonder who that person will be for me. Whose death will make me truly dead?
I always wanted to be a writer. Maybe, had I been brought up in another generation, I might have just gone into writing rather than medicine - which is not to say that I didn't also have a great attraction towards the idea of being a healer. Fortunately, I've been able to combine the two in ways I could never possibly have imagined.
I wrote my first textbook in 1970. It was called 'The Theory and Practice of Group Psychotherapy,' and over the years, many students told me that they enjoyed reading it because there were so many stories in there; often just a paragraph or a page of something that happened in a group session.
I think all kinds of meanings in life transcend your self. They're linked to other generations of people around us, to our children and our family. We're passing on something of ourselves to others. I feel that's what makes our life full of meaning.
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