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Remembering why, how, and what for

November 1, 2010
by Dennis G. Grantham, Senior Editor
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As the U.S. and other western nations rebuild from the worst economic circumstances since the Great Depression, millions of people have had to face the threat of fearful losses: loss of job, loss of income, loss of home, and loss of security.

Even more threatening, many have had to face the loss of self, the comfortable sense of knowing where and how they “fit in.” In a world where, lately at least, many bad things have happened to many good people, more and more have felt the pain of their “self” being judged as somehow “less” in the eyes of others.

While philosopher Friedrich Nietzsche assured us that “that which does not kill us makes us stronger,” one needs more than a little life experience to see beyond near-term suffering to the possibility of better things. Recent high school and college suicides remind us that the pain of judgment and exclusion can be immediate and severe, especially for those who struggle with being different.

Yet, young and old who see their way through the hurts, losses, and pains of life often find new sources of strength, understanding, acceptance, and purpose. They become examples to all of us.

Nietzsche, who struggled with mental illness in his own life, captured the power of newfound purpose when he observed that “he who has a strong enough why can conquer almost any how.” Though Nietzsche, an agnostic, believed that human will was the source of this power, his words leave plenty of room for those who believe a divine power is involved.

Whatever the source of this purpose, it's abundantly clear that we will need a lot of strong whys to conquer today's hows:

  • How to teach our fellow citizens that continued investment in behavioral health services is an integral, cost-saving component of better public health.

  • How to gather the comprehensive, wide-scale data needed to make superior quality, individualized treatment decisions possible for all.

  • How to integrate behavioral healthcare into the fabric of primary care and general medicine, making accountable care and medical homes possible.

  • How to build the understanding needed to stop judging, and start supporting those made to feel that their gifts or problems don't fit and aren't worth caring about in our schools, workplaces, and communities. HHS Secretary Kathleen Sibelius' online video statement to bullied LGBT youth that “it gets better” (found at is one example among many of the kind of statement that can be so important to those looking for the “whys” in their own lives.

Fortunately, as Secretary Sibelius and so many of you show every day, our field is pretty good about remembering the whys that keep us, and those we serve, conquering the latest hows.
As we pass Thanksgiving and enter the holiday season, I feel thankful for the many groups, organizations, and businesses who do so much to help inform you and the public, build legislative support, celebrate successes, salute excellence, protect the vulnerable, and recognize the people and programs who advance the recovery and reintegration of individuals in our communities.

Dennis G. Grantham, Senior Editor Behavioral Healthcare 2010 November-December;30(10):6