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The people who make us laugh are more important than you think.
You don’t have to be a psychiatrist to recognize raw courage. Most of us know courage instinctively and viscerally when we see it: the unidentified Chinese man standing in front of a column of tanks leaving Tiananmen Square1; firefighters charging down the stairs of the World Trade Center on 9/11; and now the President and people of Ukraine as they stand against a brutal and ruthless aggressor. Few Americans could have listened to Ukrainian President Volodymyr Zelenskyy’s recent speech to the US Congress without feeling moved by this “profile of courage.”2
As psychiatrists, we adhere to several human values: professional duty and responsibility, of course, but also values inherent in the psychotherapeutic process. We value rational and respectful dialogue; attentive listening; and empathetic and compassionate care. But it seems to me that courage as a key value in psychotherapy is rarely discussed. Yet, without courage on the part of patient and therapist, the entire psychotherapeutic journey would be thwarted from the earliest stages. As Manuel Manotas, PsyD, rightly observed3:
“Engaging in the therapy process is a courageous undertaking that is not for the faint of heart. Successful therapy requires you to see what you don’t want to see in yourself. We all have parts that we don’t want to see, parts that scare us and that we have carefully hidden inside of us. Good therapy is supposed to help us discover these parts. Even in the security of a strong therapeutic relationship, this is no walk in the park.
Psychiatrist Bruce A. Kehr, MD, made a similar point4:
“At its core, the psychotherapeutic relationship requires shared courage on the part of patient and therapist. At the start of psychotherapy, and occasionally throughout, the experience can seem quite frightening to the patient. Accepting some hitherto avoided realities is emotionally difficult and can feel daunting and overwhelming. Sometimes extremely painful feelings, embarrassing or shameful fantasies, and disturbing memories will arise during therapy, all requiring courage to confront, explore, understand, and resolve them.
Yes, I know: the kind of courage required to face bombs and bullets is not quite the same as that required to face painful repressed memories or post-traumatic flashbacks. In some ways, these internal threats can be even more terrifying than the external dangers of war. But both types of courage require intense focus, fierce determination, and relentless persistence – and, of course, hope. An old-fashioned word, rarely used these days, captures some of these qualities: long-suffering.5
Comedians and Courage
As Ukraine’s president, Zelenskyy was sometimes patronized or maligned for his previous acting career.6 The rabbis of the Talmud (Ta’anit 22a) understood a deeper truth about comedians. Here is the story :
A rabbi was walking in a Persian market when the prophet Elijah himself appeared to him. The rabbi asked Elijah, “Is there anyone in this market who deserves a place in the world to come?”
At first Elijah said, “No.” But shortly after, 2 men passed by, and Elijah told the rabbi that the 2 men would be granted a place. Burning with curiosity, the sage approached the 2 men and asked them what they were doing.
“We are buffoons,” they told him. “We lift the spirits of those who are depressed.”7
Yes, and often the patient and the therapist, like the comedian,8 find it difficult to persevere in the face of darkness, discouragement and disappointment. Supporting each other in the midst of this internal struggle takes real courage.
Dr Pies is Emeritus Professor of Psychiatry and Lecturer in Bioethics and Humanities, SUNY Upstate Medical University; Clinical Professor of Psychiatry, Tufts University School of Medicine; and Editor Emeritus of Psychiatric timeMT (2007-2010).
1. Almond K, Widener J. The story behind the iconic “Tank Man” photo. CNN. Accessed March 24, 2022. https://www.cnn.com/interactive/2019/05/world/tiananmen-square-tank-man-cnnphotos/
2. Key moments from Zelensky’s speech to Congress. Washington Post YouTube page. March 16, 2022. Accessed March 24, 2022. https://www.youtube.com/watch?v=aU_Qte__Gj0
3. Manotas MA. Courage, Vulnerability and Strength: How Therapy Empowers Us. -0924154
4. Kehr BA. Brave unstoppable you: face yourself to find happiness. Potomac Psychiatry. January 15, 2021. Accessed March 24, 2022. https://www.potomacpsychiatry.com/blog/psychotherapy-and-courage
5. Forbearance. Dictionary.com. Accessed March 24, 2022. https://www.dictionary.com/browse/longanimity
6. Volodymyr Zelensky. Wikipedia. Accessed March 24, 2022. https://en.wikipedia.org/wiki/Volodymyr_Zelenskyy
7. God bless comedians. Looking for Simha. February 23, 2015. Accessed March 24, 2022. https://www.seekingsimcha.com/?s=comedians
8. Christensen J. The Sad Clown: The Deep Emotions Behind Stand-Up Comedy. CNN. December 4, 2018. Accessed March 24, 2022. https://www.cnn.com/2017/03/01/health/sad-clown-standup-comedy-mental-health/index.html