To Live or Survive...That is the Question

“I might not have to die. I had been afraid to admit it until that moment, but I wanted to live…I just didn't know how.” 

Eric Arauz An American’s Resurrection 

In the process of working with someone in treatment, it is of paramount importance to be able to resonate with him or her. To meet at a common place where you can attune yourself to the person’s condition. 

To authentically connect. 

This is an area many clinicians will speed through with the assumption that “of course patients will listen to me or work with me. Their lives depend on it.”

And it is here that many clinicians make a fundamental mistake in relationship building by attempting to move a human to buy-in to a medical intervention, a course of treatment, a pharmaceutical regimen, and/or an emotional breakthrough that will change and save the person’s life. 

The trajectory of a life that is being actively ravaged by mental illness, addiction, eating disorders, posttraumatic stress disorder, etc. is often on a steep decline, as that person is heading down a vicious, unknown hole torn into the fabric of known life.  Such a trajectory is a punishing movement that brings people into contact with emotions and experiences that they never knew existed. 

It is traumatic. It is isolating and overwhelming. The momentum of your life stops. 

You move into Survival mode. 

This is a place where your life keeps getting worse, and you keep losing more and more. You relinquish the ability to plan for the future because the “intolerable vulnerability” of your ever-changing and ever-worsening life situation is devastating. Unrelenting. Terrifying. Riveting your attention in the present moment, trying to stop the fall. 

When you are continuously injured, beaten, embarrassed, ashamed, diminished, violated, and demeaned in your existence, you become reluctant to move forward. Your life becomes about the cessation of emotional and physical pain, and you lose the ability to see past the present moment into the future. You end up desperately holding onto the side of the life raft, unwilling to chance the one-foot step across the unknown “sea” to the safety and succor of the rescue boat. 

To begin to reach someone who has this type of history, you must acknowledge the pain of existence, and the pain of change. It’s important to see that we are not being non-compliant to medical direction as much as protecting ourselves from continuing torment. Our only concern is to halt the flood of misery that drowns us from the inside.   

A Live mode is one that is based on deferred rewards for actions taken today. Longitudinal, big-picture, goal-oriented thinking. 

The payoffs for most treatment interventions take time. In general, medications take weeks, if not months, for optimum benefit to occur, and side effects can show up prior to any cessation of acute symptoms. Relationships can take months, years, and decades to put back together. 

As a patient, all the while I am on fire from the skin-in, being viscerally eviscerated by shame, grief, and remorse. Each second is a hell in itself an “endless present” where Hope hurts. 

Acknowledge this hell with those you treat. Don’t try to diminish the pain but instead acknowledge the anguish. 

Teaming instead of Treating. 

Explain the dynamic of Live and Survive thinking and don’t separate the two. Put these modes of thinking on a fluid spectrum of healing that will take someone from one to the other. 

Like Virgil, sit in the raft with me. Congratulate me for holding on for so long. In the immediacy of early treatment, give me inches to walk and stand next to me. I need someone to convince me I will Survive, to allow me to learn what it means to Live. 

To push into the unknowns of a life lived in the continuum of flow and possibility that make it a momentarily manifested miracle of infinite creation. 

All aspects of treatment are important, from neuroscience to pharmacology to affective regulation techniques, but we must not lose sight of the phenomological experience of it all. The human relationship between two people that have just met each other will be the foundation for every other aspect of treatment. And with the large percentage of trauma incurred by those in treatment for behavioral health conditions, developing a trusting and lasting partnership with anyone will take time, patience, and empathy. Something many of us sitting across from you in your office may have never experienced in our lives. 

Albert Einstein said, “There are two ways to live your life…One is as though nothing is a miracle. The other is as though everything is a miracle.” Work with me in my existentially static state of Survival to endure the inner violence of a paradigm-shifting change to my existence. 

Help me to let go and Live, to bloom in resonance with the rest of our passionate universe. To see my own life as something sacred and not just a death sentence to serve until it is finally over.

Eric Arauz, MLER, is an international behavior health consumer advocate, trainer, and inspirational keynote speaker. He is a faculty member at the Rutgers-Robert Wood Johnson Medical School Department of Psychiatry, the Vice-Chairman of the current New Jersey Task Force on Opiate Addiction in citizens 18 to 25 years old, and a person with the lived experience of bipolar I disorder, PTSD, addiction, and suicidality. He is the SAMHSA 2012 "Voice Award" Fellow and the author of An American's Resurrection: My Pilgrimage from Child Abuse and Mental Illness to Salvation. 

The views expressed on this blog are solely those of the blog post author and do not necessarily reflect the views of Psych Congress Network or other Psych Congress Network authors.