Despair

“Despair is the only cure for illusion. Without despair, we cannot transfer our allegiance to reality…it’s a kind of mourning period for our fantasies. Some people do not survive this despair, but no major change within a person can occur without it.” —Philip Slater, Earthwalk

In March, in response to an email I’d written about feeling overwhelmed, a figure whom I see as a mentor wrote back, “Despair is not a useful option.” I am sad to say that until now I had not responded to this email.

The past year has held ample cause for despair. The movies "Collapse", "Inside Job", and "The End of Poverty(?)" offer glimpses of the problem. In Washington State last fall voters failed to pass an initiative that would have taxed only the wealthiest 1% and very specifically used that money for public healthcare and education. In Washington D.C. this week a group of freshmen lawmakers, for the sake of upholding tax cuts for the nation’s wealthiest individuals and corporations, is failing to compromise on legislation that will allow the U.S. government to pay its bills. And every day in my clinic I see the human consequences of this failure. The 51-year-old man who has to choose between paying for his medicines and his rent, having already cut back on food. The 63-year-old woman who was evicted from her home and is living in a motel with her daughter and grand-daughter. The 47-year-old patient who begs me to be hospitalized. He cannot buy the medicines that stave off the voices telling him to kill himself.

In my head I am trying to balance these two approaches to despair—despair as a non-option, and despair as the only cure for illusion. The one says, “If you give in to your despair, then who will do the work? Who will fight on behalf of your patients?” The other says, “By continuing to work at the level you are working, what are you actually changing? A life here, a life there, but the system is collapsing around you.”

Which brings me closer to the heart of the matter, which is to say: “On what level am I most useful?” And this causes a lump to form in my throat. Because I know the answer to that question. I know it, and I have been unwilling to face it. I have been unwilling to allow myself the despair that will actually allow me to change.

The truth is: I need you. The answer to that question, the question of how I can work for change on a deeper level than individual patient care, is that I need to reach out to others. Patch Adams says: “We need each other, more deeply than we ever dare to admit, even to ourselves.”

The question then becomes, what am I willing to give up in order to ask for that help? Asking for help, working with others—in a meaningful way—takes time and energy. Where has my time and energy been going? It would be easy to say, “Well, duh! You’ve been taking care of patients...you haven’t had time to stay in touch with friends and family.” And that is part of the story. The easy part. The harder part, the part that takes me into despair, is that I have clung tenaciously to an idea, a fairly simple idea, an idea that has kept me from making positive change in my life.

The idea is this: “I am the hero of the story.”

That is it. It is simple, and pernicious. I am the hero of the story. It is the idea that has kept me from reaching out to friends and family (“I’m tough, I can get through this on your own, I always have!”), from fully engaging patients as partners in their own health (“You’re not ready for the whole truth—that our world is collapsing—so let’s keep this at a superficial level”), from admitting to myself when I’m NOT the positive and healthy person that I strive to be. And in this denial, in this denial of despair, I’ve ironically allowed myself to be the victim. To say, “It’s the overwhelming daily work that’s keeping me from doing the things I want to be doing.” In trying to maintain my hero status, my self-image as the can-do cowboy, I’ve put on hold the essential work of self-reflection and dialogue with others.

And this is not trivial work, not a luxury to be afforded only when things are going well. In fact it is probably most important at the very moment when it seems that there isn’t time to do it. It is not that despair is not a useful option. It is that despair needs to be discussed in bars and shouted from the rooftops.

At the same time I must caution myself against the ebullient joy I feel welling up as I write that last sentence. I have a tendency to flip too easily between self-despair and self-resolution, to think I’m back in the saddle again when I haven’t actually addressed the underlying issue that threw me off. And in this case, as identified above, I need to get rid of the horse and saddle all together, and start the more demanding—and ultimately, ojalla, rewarding—work of coalition.