The thing with “wanting” therapy to work, and why that’s not a choice

Eine von mir übersetzte deutsche Version kann man als Gastbeitrag hier lesen.


I just came across a list of things mentally ill people hear all the time that’s meant to be helpful by others, but usually reaches the opposite. One point was that you have to “want” it to work. Saying that has an incredibly arrogant and presuming subtext, it gives anyone who says it an uneducated image (and in almost all cases, that will be the truth) and will annoy and frustrate any mentally ill person that hears it. It does have some truth in it though, in its base principle — it’s how it’s being said and what’s being implied that’s awful and not helpful, so I’ll try to differentiate and elaborate here on what is actually true in that statement besides the common implications and subtext.


Making appointments for therapy, following therapy advice, taking meds etc. will not have the same, full effect if the brain in terms of emotions is not convinced to want to change your current mental state and situation. Now, that does sound like an eloquent way of saying exactly what the people usually say (and likely almost all of them mean) — it is not.

The difference is that I’m not talking about or implying the rational decision you have control over. You prove that you rationally want your mental state to improve by making appointments, going to therapy, talking honestly about how you feel — or at least wanting/trying to in cases where your depression is so strong that it prevents you from doing these things. The rational wish is still there in that case, but depression can be awfully strong like a boulder pulling you underwater while you desperately want to breathe.

When it comes to own emotions, noone has direct control — and only ever indirect influence. One can just do everything that’s necessary and try to do anything to convince your own emotions to agree. You continue doing anything that you rationally know makes sense and/or is necessary until it happens. Until then, everything you do requires self-discipline contrary (to some degree) to your emotions as they will always try to maintain the current situation, even if that’s ridiculous rationally (emotions just don’t give a fuck about that).

The reason that emotions that work towards your rational goal help you reach it is the placebo effect that is scientifically proven (articles: easy to read; scientifically written) to be a (minor) factor in any healing process, physical as mental. Purely by any human’s emotional conviction (not rational belief, important distinction!) that something will or will not work — or is necessary or not — the process is influenced positively or negatively to some degree.

It has, depending on your underlying problem, more or less influence (although always in minor scale, compared to actual therapy and medication) on the healing process — and will, of course, never work all by itself — but the little influence it has can make a difference given certain circumstances of your condition.

A way to try to influence this is to get emotional support in any way, like caring for yourself in whichever way that works for you — there are great lists for self-caring methods on the internet that are so exhaustive you’ll likely find something that works, which you can’t always know without trying. It’s also always helpful to be open and honest with your emotions towards understanding people so they can comfort you. Things mentioned in probably every pamphlet about how to improve one’s mental health in everyday life can also help; they (and especially uneducated/arrogant people quoting them) may sound presuming, condescending, unprofessional etc. but the basis of their reasoning is, again, the placebo effect that is undeniably a (minor, again) factor.

Now, it’s important to keep in mind that not being able to do these things in a way that helps you (right away) is not your fault and you’re not to blame for it not working at any time. Again, noone is at fault for their own emotions and this is purely an emotional thing. Emotions have influence on pretty much every decision to some degree and can, ever so subtly, influence you negatively to prevent you from what’s necessary to change your mental state due to situation/state-preserving reasons I talked about above.

Depression is very good at doing this subtly, finding amazing rational-sounding arguments against anything potentially helpful and lying to your face without you ever really being able to notice. You do what you can, you have to try to forgive yourself for your own mistakes influenced by emotions best you can while carrying consequences towards others you may have hurt in the process. It happens, not all will understand (or forgive), but that’s their problem, not yours. Again, you can only influence your rational decisions directly, not your emotions. If people don’t understand that, that’s on them. It does not free you from responsibility — but from guilt. And at least for your own self-worth, that’s a huge difference.

This is a scientific article about the power of the brain of convincing yourself of what’s real and rational or not: The article is written about the example of severe delusions and hallucinations, but the base principle is applicable to any mental situation and condition — especially with depression, considering how strongly it’s able to influence one’s perception of reality and rationality.

If you need an example of your own life: Compare your actions and what you say during a breakdown with those of what you do and say outside of one. Remember how “right” or appropriate the things you did and said sounded like in your brain — or rather felt, but your depression doesn’t want you to be aware of that — during that breakdown. Depression and mental conditions have influence on your decisions even outside of breakdowns though, they’re just less strong. How much you’re aware of the ratio between actual rationality and depression’s fake rationality is very similar though.

That does not mean that you can’t ever intervene or at least influence it. Being aware of this process, which is why I’m so detailed and elaborate here, is vital for doing that. Research further for yourself, and apply your findings to your own experiences, condition, and situation.

Good luck on your fight. Survive despite the depression, not with it. It’s not a part of you, and you fight against it. It does not even deserve your little finger; it’d just rip your whole arm off.

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