Over a 35-year period, I have witnessed a number of changes in the counseling and psychotherapy world. The majority of these have been positive. During this time, seeking out help has become
more acceptable. Now, more than ever, people are looking for tools to help them cope, understand and grow. Despite the added awareness, questions and concerns abound pertaining to the present pace of life. On top of all of the disorders and conditions lies our greatest issue. That issue being meaning itself. In short, at the bottom of many therapeutic concerns is an existential crisis.

The American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-5) lists conditions worthy of counseling interventions. Blue Cross and other insurers are willing to cough up lots of money to help ameliorate the impact of many of these. Look all you may, but you won’t find any condition labeled “existential crisis.” The reasons are plenty. Some claim the term is too vague. Others might assert that it is a B.S. diagnosis. Another reason could be that it is often confused with disorders like depression and anxiety that are more definable. Whether vague, B.S., or not easily defined, it is a condition most of us have experienced at one moment or another.

A number of years back, a few of my counseling buddies and I were discussing treatment modalities and our jobs in general. When my turn came to discuss the nature of my work, I claimed to be a clinical philosopher. After raised eyebrows, a guffaw or two and a “Seriously?” I elucidated further. My job was to set aside clutter, connect folks to the community and, most of all, help people identify a sense of purpose. None of this is third-party reimbursable.

Over the years I have come to respect a number of clinicians in the mental health field. The vast majority of these professionals have helped their clients move towards more fulfilling lives. Unfortunately, numerous outside factors, especially insurance coverage, have had a significant impact on mental health services. Insurance drives the length of stay in residential programs. Insurance also gets to determine which medications are OK’d for use. All too often, programs have been created based on reimbursement over the needs of the patient/client.

Another factor that has come to play a key role in psychotherapy is the increasing use of prescription medications. Because of this, many have come to believe that treatment is primarily based on medication. For certain, medical advances have helped to lessen the suffering caused by some mental illness. However, the over-prescribing and misuse of powerful, as well as addictive medications, has opened up a Pandora’s Box of issues. There are instances where having someone to speak with is just the right medicine. Sometimes it is important to reflect, work things out and feel supported. Much of this is not rocket science –  counselors with training and experience have helped patients for years. Guiding people through a process of pain, understanding and eventually better mental health takes time and patience, along with courage.

We all have our personal Iliads and Odysseys to tell. Life is full of ups and downs. Some will experience greater degrees of each – but many of us have stories filled with meaning. Despite the great breakthroughs regarding medications, the need for human contact and understanding is paramount. Pills might be able to clear a path – but the help other people can provide makes the journey a bit easier.

Not everyone experiencing an existential crisis needs counseling. There are those who figure it out themselves. Others find help through family, friends, clergy and civic involvement. There is no magical cure – just a willingness to explore and be open for change.

There is a great deal we can learn from our time on earth. Come to think of it, there is much to learn from others as well. Nobody wants to experience those occasional down periods. We often feel it would be easier to wish the blues away. However, these very moments can be the ones that provide significant insight. It isn’t always pretty and having another human being to guide you along the road helps. A clinical philosopher could prove invaluable at this juncture.

Folks like Friedrich Nietzsche, Franz Kafka and Søren Kierkegaard hinted at the existential crisis phenomenon years ago. Later, Rollo May and Alvin Toffler would add their own views. Such considerations had to do with finding meaning in a modern world (one where science and technology have stepped to the forefront). Each of these theorists were asking us to find new meaning for a changing landscape.

Every era has its own challenges. While overlap comes in the form(s) of economics, war, religion, and exploration, the present era has unique existential dynamics. Alienation and insecurity appear to be at the forefront – at least in America. For all of our contrivances, we are lonelier than ever. For all of the things we possess – are we any happier or wealthier? It does not take much training to understand that things and possessions, while nice, cannot insure contentment. They also cannot insure understanding. These come from a place where price tags are not found.

A little more than two years ago I wrote a piece about going down to North Carolina which included a poem to my newborn grandson, which I think encapsulates much of what I’ve written here (Editor’s note – an earlier version of the poem was incomplete):

A Journey

Some of it’s silly,

much of it’s not.

A lot of it’s brains,

a portion is heart.

Wanting to be alone and also a part –

confusing yes – confusing not.

Living a paradox, yet seeking the truth,

searching for heaven, but often uncouth.

Life is such an ironic mixture,

often so transient – and still wanting fixture.

Knowing that losses will lead to wins,

“The Journey is better than the inn.”

And those wrinkles on a time worn face

are often the lines that lead to grace.

So dear friend, heed me not,

for where one stops, others may start.

Search your soul and always strive

to meet again for a long summers drive.

In the end life is one big journey. Finding ways to make our lives more meaningful means searching, asking for help, taking risks, getting up again, laughing, crying, forgiving and more. Who knows, you might bump into a clinical philosopher along the way.

Bob Houghtaling is the director of the East Greenwich Drug Program. He also served on the Exeter-West Greenwich School Committee, taught at Providence College Graduate School of Education and was a consultant at the Rhode Island Training School.