What change looks like

As a clinician in the mental health field, I’m in the business of change. And so often I see patients who are navigating this terrain. They face significant distress sitting at its interface. But there are several aspects to change that I’m wrestling with. 

A lot of mental distress comes from being stuck. Stuck between or within phases of life, in negative relationships, bad habits, careers that produce stress and burnout.  Stuck in life circumstances that cause fragmentation and fear. Situations that challenge our ethics and morals. Resolution of that ‘stuckness’ is often the core issue, more so than symptom management, severity and all the nuance of the DSM disorder paradigm. These are often downstream of the stuck sensation itself. 

One paradox at the heart of change is that it can both be simple and difficult, occurring instantaneously and yet take decades. It can be both easy and hard. It can be visible and hidden, often only showing up in hindsight. When in the midst of change it is not readily experienced as such, instead feelings of uncertainty and unfamiliarity can appear, along with a myriad of other emotions. 

There is also a loss of sorts, perhaps unrecognised in the moment. Where the old self is let go, and cast aside, whether conscious or not. There must be a realisation of alternate realities that will never occur. They must die along with the old identity and old paradigm.  These must be wrestled with, fought through and reconciled.  Following this, space must also be created to inhabit the new changed state. 

I often nudge patients towards change, whether through reflection, medications, lifestyle changes, or by bringing them into contact with the decisions they have to make.  The act of making a decision is key. Leaping out of stuckness requires decisive action, which emphasises agency. Agency is the individual's ability to be the author of their own life and is a key ingredient in change. There is nearly always more agency and capability available than the patient first realises.Change itself is not always good or bad. I’m reminded of persistent self-sabotage, worsening problematic behaviours and the cascades of problems that occur in people’s lives from negative change. However, change is not simply taking the ‘red pill’ or ‘NZT-48’ as The Matrix or Limitless suggest. Change is often felt internally long before the external world sees it. Real change should produce and confront real emotions for it to be valuable and durable.