The faulty concept of sick and well

The definition of life: “Slowly dying of an incurable disease.”

Amazingly, psychiatry, being a branch of medicine, still uses as it’s guidelines the concept of “sick” and “well.” “Sick” meaning having uncomfortable, disturbing, even painful symptoms which interfere with one’s functioning or “happiness.” “Well” meaning not having any signs (what the doctors can observe or find) or symptoms (what the patient complains of) which interfere with one’s functioning or “happiness.”  Therefore, by inference, if you are not sick and in some form of pain, you must be well and happy. People tend to feel guilty, stupid, selfish, spoiled, or that there really is something wrong with them if they feel well, but not happy. They tend to keep that information to themselves. They tend to push it from their conscious thinking and go about their business, thinking, “There is not much I can do about it anyway”.

I certainly would be the last one to deny the pleasure one experiences when in pain, any form, is diminished or/and removed. Sometimes to balance the pain that permeates our perception, one might be well advised to “count one’s blessings.” It may give a perception that will tend to reduce one’s pain, especially if the pain is severe, intense, overwhelming, or worst of all chronic or permanent. But nature can be kind. The longer pain, which is not actively increasing, lasts, the less it tends to hurt. We learn to adjust, to adopt, to the chronicity of being crippled for life, of getting old and finding fewer and fewer things giving us real pleasure, of slowly dying of an incurable disease.

Before we get too sad, I want to share a joke with you: The definition of life: “Slowly dying of an incurable disease.”

We may never be physically totally well. We may never be wealthy, famous, or powerful. We may never have found the love of our life, but amazingly, we can still be happy. I do not mean just neutral or the absence of pain, but a positive feeling of well-being.


The doctors should not be blamed for their concept of sick and well. It is not their fault. It is their problem too. Everyone just assumes that if they know about physical well-being, they know about emotional well-being. Happiness is a feeling, an emotion, not a physical entity. Physical illness may take away our happiness, but physical well-being does not automatically give it to us. Doctors go to school to learn about diseases not “dis-eases.” They learned how to change sick into well. They took no courses on how you change well into happy.

Written by Daniel Casriel, MD

Daniel Harold Casriel, M.D., born in New York City on March 1, 1924, was an American psychiatrist, psychoanalyst and writer. He was a past president of the American Society of Psychoanalytic Physicians. He founded the Daytop treatment centers. Casriel died on June 7, 1983 at the age of 59 from a form of Amyotrophic Lateral Sclerosis (ALS). After graduation from the University of Cincinnati College of Medicine at age twenty-five, Casriel began his residency at the Kingsbridge Veterans' Administration Hospital. Less than a year into his residency, he was drafted and sent to Okinawa where he served as an Army psychiatrist. Beyond shaping the field of addictions treatment and psychotherapy, Casriel profoundly influenced the launch of relationship education. His intensive couples workshops for Lori Heyman Gordon's Family Relations Institute in Northern Virginia provided the framework for what emerged into the range of PAIRS' relationship education seminars and trainings that have touched millions of lives. Casriel popularized the theory that the "emotion of love" comes from the anticipation of pleasure. Based on Casriel's theory, "bonding," which he defined as "the unique combination of emotional openness and physical closeness with another human being," is central to sustaining healthy, intimate relationships. Casriel taught that symptoms of bonding deprivation include: "illness, fatigue, depression, rigidity, constriction, isolation, and the range of anti-social behaviors such as drug and alcohol abuse, gambling and sex addictions." Casriel considered bonding a biologically-based need similar to the need for food, water, air, and shelter, yet unique as the only biological need people cannot meet for themselves.

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