The people who make us laugh are more important than you might think.
It does not take a psychiatrist to recognize raw courage. Most of us know courage instinctively and viscerally when we see it: the unidentified Chinese man who stood in front of a column of tanks leaving Tiananmen Square1; the firemen charging up the stairs of the World Trade Center on 9/11; and now, the president and people of Ukraine, as they stand up to a brutal and pitiless aggressor. Few Americans could have listened to Ukrainian President Volodymyr Zelenskyy’s recent speech before the US Congress without feeling moved by this “profile in courage.”2
As psychiatrists, we embrace several human values: professional duty and responsibility, surely, but also values inherent in the psychotherapeutic process. We value rational and respectful dialogue; attentive listening; and empathic, 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 both patient and therapist, the entire psychotherapeutic journey would be thwarted in the first few steps. As Manuel Manotas, PsyD, has rightly observed3:
“Engaging in the process of therapy is a courageous endeavor that is not for the faint of heart. Successful therapy demands that you see what you do not want to see within yourself. We all have parts that we don’t want to see—parts that scare us and that we have carefully hidden deep inside. Good therapy is meant to help us uncover those parts. Even in the safety of a strong therapeutic relationship, that is no walk in the park.”
Psychiatrist Bruce A. Kehr, MD, has made a similar point4:
“At its core, the psychotherapeutic relationship requires shared courage on the part of the patient and the therapist. At the beginning of psychotherapy, and from time to time throughout its course, the experience can feel quite scary for the patient. Coming to terms with certain realities heretofore avoided is emotionally challenging and may feel daunting and overwhelming. At times, extremely painful feelings, embarrassing or shameful fantasies, and troubling memories will arise during the course of therapy, all demanding the courage to confront, explore, understand, and resolve them.”
Yes, I know: The kind of courage required to face bombs and bullets is not entirely the same as that required to face painful repressed memories or posttraumatic flashbacks. In some ways, these internal threats may be even more terrifying than the external dangers of war. But both kinds of courage require intense focus, fierce determination, and unflagging perseverance—and, of course, hope. An old-fashioned word, rarely used these days, captures some of these qualities: longanimity.5
Comedians and Courage
As the Ukrainian president, Zelenskyy has sometimes been patronized or disparaged for his previous career as a comedian.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 marketplace when the Prophet Elijah himself appeared to him. The Rabbi asked Elijah, “Is there anyone in this marketplace who merits a place in the World to Come?”
At first, Elijah said, “No.” But a short while later, 2 men walked by, and Elijah told the Rabbi that the 2 men would be granted a spot. Burning with curiosity, the sage approached the 2 men and asked them what they did.
“We are jesters,” they told him. “We cheer up those who are depressed.”7
Yes—and often the patient and therapist, like the stand-up comedian,8 find it hard to persevere in the face of darkness, discouragement, and disappointment. Sustaining oneself in the midst of that internal struggle takes genuine courage.
Dr Pies is professor emeritus of psychiatry and lecturer on bioethics and humanities, SUNY Upstate Medical University; clinical professor of psychiatry, Tufts University School of Medicine; and editor in chief emeritus of Psychiatric TimesTM (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 address 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.GoodTherapy.September 24, 2015. Accessed March 24, 2022. https://www.goodtherapy.org/blog/courage-vulnerability-strength-how-therapy-empowers-us-0924154
4. Kehr BA. Courageous unstoppable you: facing yourself to find happiness. Potomac Psychiatry. January 15, 2021. Accessed March 24, 2022. https://www.potomacpsychiatry.com/blog/psychotherapy-and-courage
5. Longanimity. Dictionary.com. Accessed March 24, 2022. https://www.dictionary.com/browse/longanimity
6. Volodymyr Zelenskyy. Wikipedia. Accessed March 24, 2022. https://en.wikipedia.org/wiki/Volodymyr_Zelenskyy
7. G-d Bless the Comedians. Seeking Simcha. 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