The power of love in mental health
Oliver Seligman on how his therapist’s approach helped him turn a corner; with Tone Fagerli’s response.
06 February 2024
Most people have no desire to be an inpatient in a mental hospital. Yet in November of 2014, I was so broken down by years of depression, mania, and psychosis that a bed in a quiet ward was all I longed for.
My relationship with bipolar began in 1993 when I was in my final year of school. In the weeks before my A-level exams, a blissfully euphoric mania slithered into my mind before morphing into a paranoia that tried to destroy me. It all came to a head at a police station in the South of England and only ended after two months as an inpatient at the Royal Edinburgh Hospital.
A year later, I was prescribed lithium, a mood stabiliser that I took every day for nearly two decades. Initially, lithium worked well. The chalky-white pills strengthened my fragile brain, expelling the extreme highs and lows from my mind, along with the anxiety which had haunted me throughout my teenage years. I felt strong, my confidence returned, and I was able to re-join life again. However, it wasn’t only elation, depression and paranoia that dried up like a thirsty creek in the midday sun.
In fact, my entire emotional life ground to a halt. Love, melancholy, sadness, jealousy, satisfaction, tenderness, worry, and contentment all but disappeared from my life. I felt numb. I had been an artist and a writer and loved to act. Yet as soon as a high dose of lithium was coursing through my veins, my interest in, and ability to perform, vanished. Headaches and exhausted days in bed became the norm, I was confused by simple tasks (such as trying to find my way home), and I began to hallucinate.
In 2011, as a 35-year-old, I began asking myself, ‘Do I really need lithium?’ Bravely, or foolishly, I lowered my dose until I was off the drug.
Fast forward to December 2014. Coming off lithium had been a nightmare, plagued by psychotic episodes and depressions. In agreement with my psychiatrist, I chose to go back on the drug, but this time on a lower dose. My psychotic and manic symptoms vanished, but a stubborn depression persisted. I was devastated that my plan had failed, that I had wasted so much time, and caused so much damage to my family and my life. Back on lithium, I was ‘stable’ but down. I felt no hope, no optimism, or desire to make anything of my life. All emotional sunlight was obscured by a thick canopy of despair that covered my mind.
It was in this depressed state that a clinical psychologist came into my life like a breath of fresh air.
Tone Fagerli was loving and enthusiastic. A woman with practical, down-to-earth wisdom and an easy smile. Someone to whom I could relate and trust. Before I met Tone, I had been treated by two other clinical psychologists, neither of whom had helped me. They had the same qualifications as Tone, but their personalities were so different. Both had a frosty demeanour, and I never saw either of them smile.
If a psychologist isn’t warm and loving, I don’t rate their chances of helping me to find happiness.
Tone was different. In our first meeting, she put me at ease. Partly with her reassuring words but primarily because of who she was. Tone exuded the qualities of warmth and love, which rekindled in me something I had lost: over a few weeks of psychotherapy, I began to feel a sense of hope. These moments sprouted into self-belief, which then blossomed into confidence. Glimmers of positivity shone through what had been an impenetrable darkness. I had been consumed by bipolar, but Tone helped me take a step back and look at the condition with fresh eyes. I was getting better.
I could do this!
When I was ready, we identified some core beliefs which were holding me back. Since I was a small child, I set standards for myself (and others), which were unrealistically high. My perfectionist tendencies had served me well in exams, but when it came to happiness, they hindered me. As an adult, I put myself under pressure to live an impressive life and achieve things that a healthy person would struggle to achieve.
Tone could see this, but instead of pointing it out, she guided our conversations in directions where I could discover it for myself. It is one thing to be told about my limiting beliefs, but far more powerful to discover them for myself. Our conversations gave me permission to lower my standards and give myself (and others) a break. I could contribute to the world without having to conquer it. For the first time in years, I could relax.
Tone also helped me to recontextualise the resentment I felt after being ill for so long. Over the years, I had been given some questionable advice and was furious with the people who had given it. This resentment could have chewed me up for years, but psychotherapy helped me contextualise what had happened, let go of these negative feelings and move on.
One quality I believe is sometimes overlooked in a good therapist is a sense of humour. In a world where taking ourselves too seriously is all too common and often encouraged, a healthy dose of humour goes a long way. Humour has a way of taking the edge off our problems by recontextualising them.
Whilst some situations call for a sensitive approach, I think it is helpful to recognise that injecting humour into a situation can often improve it. Tone had a great sense of humour, and I often walked out of our meetings with a smile on my face after she made me laugh about myself and my habits. Tone was always kind but knew how to poke me into taking myself less seriously.
I began to see life as an adventure again rather than the battle it had been. In short, Tone’s loving approach worked wonders for my state of mind and for my relationship with bipolar.
Love not only played a powerful role in my psychotherapy but helped me as an inpatient in mental hospitals all over the world. As a scared and confused teenager roaming the corridors at night, patient nurses gently calmed me down and led me back to my bed. Their love penetrated the thick cloud of psychosis that had overcome me.
Hospital visits were also acts of love, which connected me to the life to which I wanted to return. My family and friends showed me I wasn’t forgotten and would get home at some point. When exposed to love, we humans benefit in myriad ways, but I have yet to see the mainstream medical community give love the attention it deserves. It is a footnote at best. I believe the recovery process of many a patient would be assisted if love was consciously harnessed in treatment. Of course, giving love requires time, which requires money. It’s hard to be loving if one is doing the work of two people or filling in forms all day.
I believe many medical practitioners would benefit from being educated as to how important their love is. Not because they are not already loving enough, but because this knowledge would empower them. This became clear to me after a talk I gave to a group of psychiatrists in Norway. After the talk, a psychiatrist came up to me. With tears in his eyes, he told me he worked with some of the sickest people in the country and had no idea what a difference his love could potentially make.
As soon as his patients were no longer critically ill, they were sent to other units, so he never knew what impact he had had or if they had ever recovered. He only saw them again if they became critically ill again and returned to his ward. He felt despondent and had been contemplating giving up his job.
Yet, hearing about love’s potential role in treatment inspired him to explore love, giving him a renewed sense of purpose. He told me he couldn’t wait to get back to his ward to experiment with this novel idea. All it took to inspire him was to be made aware of the value of the love he already possessed.
Imagine working in a clinic where love is a top priority, and all employees are encouraged to value it. A place where love is acknowledged as an instrumental part of treatment. Many of those who have looked after me over the last 30 years expressed a great deal of love but did so because they were loving people, not because the system supported it.
I believe that if a person acts in loving ways, they create a field of love around them, and this is contagious. If you go to a party where one person is holding a grudge, it can pull the party down. If you go to another party where someone is in love, it can uplift the group. Loving people spread good vibes and optimism, and by giving love away, we magnify it. The more we give away, the more we receive. The field of love uplifts us, makes us feel safe, and comforts us.
So how do we amp up the love?
A loving field can be catalysed by a simple loving act. Even if we don’t feel particularly loving, by acting in loving ways, we can strengthen the field. Even small acts of love can have a great impact. Speaking kindly to others, showing courtesy, and caring without over-caring all create love. Love first, ask questions later.
Thanks to a combination of therapy, correct lithium dosage, and some other habits I have picked up over the years, I live a peaceful and happy life. My side effects are tolerable, and I no longer get lost within two hundred metres of my flat! My emotional life has to some degree, returned. Indeed, I am the only person I know who is enthusiastic about being able to feel angry!
My experiences with bipolar have led me into the realm of mental health. I have a passion for helping people to escape the suffering of mental illness and to find peace. I have written a book called Befriending Bipolar: A Patient’s Perspective, and I am currently studying for a master’s in the Psychology of Mental Health at Edinburgh University.
I hope to have a positive impact in this area of psychology, but now that I am not such a perfectionist, I wish to do it one step at a time. At Edinburgh, I am learning a great deal. However, it strikes me that for even the best psychologists, exam results and qualifications have become our gods. We need to redress the balance and focus on acknowledging or studying the impact of love. Perhaps a psychologist’s ethics, values, and kindness are as important (or more so) than their education or knowledge base.
‘I hope there will be an increased focus on caring and loving environments for patients’
I have read Oliver’s article and I am happy to add some reflections on what he has written and around the therapeutic process.
Firstly, I would like to say that the achievements Oliver has made since I got to know him and his way to recovery and into exploring the field of psychology, mainly reflect back on him. I have read his book Befriending Bipolar and heard him giving talks to health professionals several times about living with bipolar and his own journey towards recovery. He is a great storyteller, very open and honest, and able to talk about serious and painful experiences with warmth and with a sense of humour. I think this makes it easier to get the story across.
Oliver talks about how much being met with warmth and love has meant to him. Even when he was so depressed that he could not express himself, the love and warmth from another human being came across to him anyway and helped him endure some terrifying and really painful times. I think it is very important for us working in the mental health field to hear this from our patients. It supports us in our work with people who are suffering, and it helps us when we are exposed to strong emotions of pain, anxiety, and anger. It also helps us when we are exposed to the rough parts of human life. Knowing that we make a difference by being an empathic and caring fellow human being gives meaning to what we are doing.
I also think that one of the ways we are distancing ourselves from the burdens of working in hospitals and mental health units, where we are not able to give our patients the care and help we know they need, is by stopping ourselves from having feelings of warmth, love and the empathy towards our patients. So, I do hope that there will be an increased focus on caring and loving environments for patients in the mental health field.
As for reflections on the therapeutic process, I see instilling hope as one of the most important things for me to do when I first meet a new patient. Conveying to the patient that we have witnessed numerous people find their way back to a good life, and that we have the means and the knowledge to help them recover is fundamental. Recovering from mental illness and experiences of trauma is hard work, and patients need lots of hope to enable them to do that work.
In that regard, being Oliver’s therapist was not very hard work. He is a man who loves to laugh, likes to learn and explore, enjoys finding ways to express himself, and has a zest for life. I do like to laugh myself. It makes me handle the tolls of my work in a better way. Of course, I try to put humour in there in a kind way and adjust it to the other person. Utilising humour is surely not always appropriate, but when it works, I think it strengthens the working alliance between the patient and the therapist, and it tends to take the toll off the hardships of life. And as Oliver says, humour can help us recontextualise our difficulties.
Meeting my patients with warmth and a caring attitude is something that I try to do. However, how I present myself will vary according to the problem the patient brings into therapy and the patient I experience in front of me. I mostly try to be genuine, as I think it helps reduce anxiety within the patient (‘what you see is what you get’). Transference and countertransference are elements that are present when two people meet and connect over matters of emotional importance.
When working with patients with trauma-related disorders and/or personality disorders, the transference will usually be more openly addressed and be a more important part of the therapy. I reduce my openness and warmth in situations where I do not think it is safe or where I do not think it is helpful for the patient.