Stepping into Life

    - Ren Zhengga

What are the benefits of psychotherapy? What is our goal as therapists? I’ve been asking myself these questions for many years. My experience with clinical psychological services in the post-earthquake disaster zone has compelled me to continually reflect upon these questions and reformulate answers to them. By doing so, I have gained a deeper and closer understanding of psychotherapy.

Many patients that I’ve seen have been suffered severe personal injuries, or have had to bear the death of their children in the earthquake. These individuals have grouped together and given themselves names: "the fathers of children who passed away," "the mothers of children who passed away," "amputees."

Although I have no way of truly understanding the struggles, helplessness, and pain unfolding in their hearts, I have tried to feel their inner pain from their harsh cries, pained eyes, and suppressed cries.

For three years, I have accompanied them from helplessness to hopelessness, and then from hopelessness to hope, while experiencing each and every moment in their lives. I keep asking myself: where should I stand? I continually switch between embracing my position as a medical professional and looking upon it with suspicion; I continually try to open myself up. Again, I ask myself: where should I stand? I walk into both their lives and mine.

In three years, the disaster area has been built from temporary shelters to tents, from tents to huts, and finally from huts to permanent residences. When I revisit the three years that have passed, I suddenly remember all the changes we’ve encountered, but it seems like nothing has changed – or only our hearts have changed.

From the time I first arrived at the temporary shelter point, whenever I worked with the survivors I encountered in the disaster zone, I would continually ask myself: What is the objective of my job? What can I actually accomplish? What do they need? What is most real to them?

Recently, the area I served has seen storms and mudslides. The survivors’ newly built houses carried their hopes, and when the land slid and rain fell this time around, their lives were pushed towards a window. I asked myself: can I bear this?

Do I need to help them change their understanding of the disaster or help them see the lasting influence of the wounds they suffered when they were young? Or should I establish a friendly relationship with them? And what would be the meaning of that relationship?

The first time I saw him was in a house in the disaster zone. His daughter had passed away during the quake, and a co-worker told me that his case was a difficult one. He suffered from complex grief, depression, PTSD, adaptive difficulties, and somatisation (bodily pain and discomfort with no obvious physical cause)…

This is enough background for the case, but, at the same time, it is nowhere near enough. When a psychiatrist wrote this particular patient a prescription, he would worry about the side effects and waver between taking or not taking it, depending on his mood. I saw him a year after the quake. He couldn’t work and couldn’t rest. Because of this, his wife had to deal with her own pain and take him to see a whole slew of doctors. He would repeatedly describe the pains on his body: stomach aches, hemorrhoids, lack of appetite, headaches and insomnia…

He gave me a diary of his symptoms that included entries such as: "When I wake up, I don’t know why I have to go on living," "I feel very sorry for my wife," and "Sometimes I feel like I’m really not being a man…"

Over his two years of suffering, we met once a week. We actually didn’t talk about too many things. Every time we tried, he returned to talking about his helplessness and hopelessness, his own weakness and frailty – in spite of which he walked from a distant mountain with his wife to see me every week and we would walk and talk for an hour.

He’d occasionally ask me: "Dr. Ren, can I find a job with my condition?" I’d reply: "Give it a shot." He asked me this for half a year, but he was afraid to try. When he felt helplessly terrified, I would stand by his side. When he wanted to escape his symptoms, I would accept his feelings of escape but offer him support and encouragement.

Winnicott and Bion have said that psychological healing requires both support and acceptance. Many times, I had to comfort that wearied and beaten man, and act as a vessel to contain his joy, anger, and sadness. In this environment, he could search for the solutions he needed in comfort, because he knew that I would be there every week to support him.

As time pushed his condition to slowly improve, he finally found a job in a mine. At first, he worried that he’d have no way to finish his tasks and was concerned that his illness would return out of nowhere. In therapy, I often conveyed to him that I’d return every week, that I’d never leave. As long as he was willing, he could find me every week. I think he found a certain sort of courage. He knows that every week he has somebody to turn to, someone who would wait for him here and not only in his hopes or fantasies.

Now, he sometimes still worries about his condition, and his depression occasionally returns. In all honesty, his relationship with his wife hasn’t fully recovered, and he’s often stressed, often can’t sleep, and often has nightmares… but these are no longer such pressing concerns to this couple. They still carry their symptoms from the disaster, but they have started live again. They have started to care for each other and to care about others again; they have restarted construction on the house that they had shelved for so long due to illness. What therapists can do, I think, is to work together with the patient towards the patient’s new life and goals.

A middle-aged female amputee I knew was absorbed with the loss of her leg for a full year. She used a false leg, but having the false leg wouldn’t let her live her normal life. She never left her room unless it was an emergency. I saw her a year later. She began to explain her pain, anger, and helplessness to me. Every week, I’d go to see her with a co-worker and listen to her inner struggles. A shelter was renovated nicely, but she hadn’t actually seen it. Every time, she’d tell me how hard it was to live without her leg, how she thought everybody would laugh at her, how she feared falling down…

Every week we’d see her, and every week she’d stand by her door and wait for us. We went from not trusting each other to the solid trust we now share. Once, she wept heavily in front of me and described her tragic fate to me between tears. From birth to marriage to now, she often jumped through time, and in that moment I realized that we exist in time. After our sessions, she decided to try moving on from living a life in pain. She began trying to walk back into her life and often repeated what I said in therapy to awaken herself. She still can’t walk very far, but she’s trying her best. I see her dragging her heavy legs, walking into her new life.

Psychotherapy doesn’t provide a single method for dealing with problems, and it doesn’t seek to change everything about the patient. Rather, it seeks to establish new possibilities. By working with a therapist, the patient creates new experiences and new forms of interpersonal relationships, as well as new connections, new hopes, and new possibilities for the patient’s future. As a therapist, one needs to open a new door towards new possibilities for the patient.

For three years, many volunteers have continually been working in the disaster zone. Frankly speaking, we haven’t had any special training. In the area where we serve, we go once a week and only spend a few short hours there. If things suddenly come up one week and we can’t go, they’ll ask why we didn’t come and remind us that they expected come every week at that specified time.

They remind us because they know that when they need us in dark times, and we’ll be there for them. We know that we’ve entered their lives, and through them, we can find ourselves. People can’t easily escape the confines of time. Our lives are composed of time. Because of the pain of the past and the pain yet to come, we forget the essence of our lives. During our days spent working with them, they teach us how to enter our own lives and really live …

(The simplified Chinese version was originally published in 《社區心理康復專刊》, 12 October 2010, Issue No.7, reproduced with permission)