Is it better to live a good man in a delusional world or a monster in reality?

This was the question that the protagonist in the movie Shutter Island asked his psychiatrist. It is the same question in one form or another that patients have been asking me for the past 20 years.

We all construct illusions to help us deal with the horrors of our past or present. Illusions are the guardians of sanity. If we were constantly conscious of all the pains and stresses of our lives past and present we would have a mental melt down. Through the eons of evolution our brain has developed many elaborate defenses against the ravages of life from the very complex ones like splitting into different personalities to simpler forms of denial and repression such as forgetting a medical appointment or our mother's birthday or just escaping into computer games, alcohol/drugs or convincing ourself that the lip stick on our husband's shirt collar is just tomato sauce.

So, if illusions are our life saver, why is therapy so infamously trying to punch holes in it?what is all this fuss about Reality? Well, the problem with these gaurdians of sanity is that they are frequently exploited, burnt out and often fall asleep on the job. The fact is that the more you rely on denial and repression the less effective they become. When the pressure of all that has been locked up for years mounts and pounds on the locked doors of consciousness our guardians get overwhelmed and drop the ball. Pandora's box opens: depression, anxiety, phobias, obsessive thoughts not to mention an assortment of physical symptoms exotic enough to stomp the best of our medical profession comes flying out. You see, the tears that the eyes will not shed the body will weep. With the advancements of neuroscience we can now take colorful pictures of the brain when emotions are not handled right and these pictures beat Scorsese's scary scenarios.

Trying to run away from our emotional reality is like trying to outrun a freight train, eventually it is going to catch up with us. A patient told me once that she was so mortified to acknowledge that her husband was just like her father that she had for years blinded herself to her daughter's abuse. Reality finally hit her when her daughter attempted suicide. How is this for a Scorsese movie?

Illusions are often hard to give up and reality unbearable to live with. A therapeutic and supportive environment is often essential to abolishing the walls of illusion. An old saying advises us that if you save someone's life you are now responsible for him. The same goes for illusions: if you take someone's illusions away you better be prepared to give him something equally sustaining in their place. This is what therapy offers people. You see, the question is not whether it is better to live in reality as a monster, but rather whether there are really monsters or just human beings who make mistakes, learn from them and move on with their lives in spite of the horrors of their past and sometimes because of them.