March 22, 2023

We all harbor secrets. Some are big and bad; some are small and trivial. Researchers have parsed which truths to tell and which not to.
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Posted August 22, 2022 | Reviewed by Hara Estroff Marano
In Civilization and its Discontents, Freud observed that struggle is intrinsic to the human condition. As a psychiatrist, I help people deal with it. That includes helping them to direct that struggle towards finding happiness.
I help people identify the source(s) of their unhappiness and work through ways that help them 1) stop hurting, and 2) begin to experience a much-improved state of mind relative to their initial problem. Notice how contextualized and open-ended that second task is.
Happiness (or, rather, getting there) involves work, tailored to each individual in some particular aspect of their lives. The goal, which many patients achieve at least to some degree, is to experience less conflict or struggle; more personal freedom; greater clarity about themselves and/or others; more contentment; and at the far end of the spectrum, maybe even joy.
Always, we focus on the patient’s learning to take the initiative, to direct his or her mind towards whatever they need to find in order to feel happy. At work, it could be finding a sense of purpose after aimlessly drifting. It could be finding a way to feel valuable after retirement. We examine a patient’s thought processes; their pratfalls; their finding the incentive to continue.
Because the goal is proceeding towards happiness, the question of incentive—i.e., motivation, the will to keep going—turns up no matter what the patient’s ultimate concerns. Patients set about finding mental energy, the personal wherewithal to make a difference in how they proceed through life. Ultimately, I have observed people’s committed struggles to feel better about where they are, who they are, and what they still can accomplish.
I define the domains of happiness around those that continually (unremittingly) involve my patients:
Work and Money. This is about pursuing happiness in professional life. How do we balance the need to work with all the stress indigenous to a work environment? How do we choose an occupation when we love doing one thing but something else pays more? Work and sacrifice seem to run in tandem. It’s as if taking up a profession, or even just holding a job, is a constant balancing act where personal preference, financial reward, and even ethics are constantly jostling for importance in a complex calculus that changes over the course of our lives.
My patients struggle to define their relationship to work at various, crucial inflection points along the way. They adapt and transcend disappointment. They find more in work than merely a source of financial security or a way to structure their lives.
Wellness and Personal Growth. Wellness refers to an individual’s continued growth across and balance among several dimensions of life: the physical, to be sure, but also emotional, social, and professional. It may also include a spiritual dimension, which is not so much a belief in God as a capacity to listen to your heart, live by your principles, and be fully present in whatever you do. In this posture, spirituality means curiosity and openness to experience; you learn about being human, and allow yourself and others to be who you (or they) really are; you see opportunities for growth in the challenges that life presents. Thus, whether “wellness” is or is not physical, it takes work. It takes commitment, and a sensitivity that extends beyond oneself.
Sex and Love. At various times in our lives, we struggle with passions that we may not understand but that still seem to control us. We think, “Well, if I understood this feeling, maybe it wouldn’t be love—and I don’t even want to understand sex.” Nonetheless, such impulses can drive us to distraction, sometimes to the point where we can’t really cope with any aspect of our lives.
So, the question becomes: how do we sustain the intensity of these feelings (which can be immensely pleasurable) while keeping them from wreaking havoc? How do we learn to love generously, and to approach sex so that no one is emotionally damaged? How do we balance intense relationships with everything else in our lives (which sometimes include conflicting relationships)? How do we resolve feelings of guilt? My patients struggle toward answers.
Family and Friends. What does family even mean anymore, when so many of our relationships are intentional, provisional, and based on what we need in the moment? What do we owe to our friends, or they to us? Sometimes, it seems like all these people are just “others” who get on our nerves, stand in our way, and make demands based on unwarranted assumptions. Yet without other people, we’d be isolated and alone.
So, how do we navigate this vast community towards whose members we have such varied affinities? How can we act responsibly? How to establish intimacies that can actually sustain us? Every relationship is different, and they all evolve. What is it that we want from relationships, and how can we learn to give, to be empathetic?
Aging. Nobody likes getting old, but it happens. Aging affects every aspect of our lives. The challenge is how to maintain our self-regard, even as it seems that we’ve become less relevant (not to mention less attractive, less fit, and maybe even less competent). It’s easy to become demoralized.
But it’s possible to find new routes toward feeling useful, satisfied, even fulfilled. As our world shrinks towards the confines of our bodies, we can discover ways to remain connected to the larger world. We can learn to accept where we are in life, but then make the most of it by adapting and giving back.
In my practice, I encounter people where they are—somewhere along a spectrum leading to happiness in one or another aspect of their lives. Their journey (or trek, or climb) may feel asymptotic, in that they don’t always feel sure that they’ll arrive at where they want to be. They may not even be sure about where they want to be. But that’s okay. It’s the nature of happiness that it comes in and out of focus, such that we are constantly readjusting our pursuit. Nonetheless, we feel much better (much happier!) just knowing that we’ve taken positive steps. We’ve begun to get past the habits and inclinations that have made us unhappy. The sense of progress lifts our spirits.
Dr. Friedberg practices as a psychodynamic psychiatrist in Manhattan. He is a Clinical Professor at Mount Sinai Icahn School of Medicine and Editor of the Academy Forum, a leading professional journal. 
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We all harbor secrets. Some are big and bad; some are small and trivial. Researchers have parsed which truths to tell and which not to.


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