Why Healing Requires Confronting What We Most Want to Avoid

When I first began my career as a clinical social worker, I worked with individuals who had been chronically homeless and actively psychotic for years—sometimes five, ten, even fifteen years of living on the margins, their inner worlds overtaken by voices and visions that separated them from consensus reality. Many of these individuals had become fixtures in their communities, known by name to local police officers and emergency room staff, cycling through shelters and psych wards with a kind of grim regularity. The conventional wisdom, and the goal toward which our team worked, was to stabilize these individuals on long-acting antipsychotic injections and connect them with supportive housing. And we succeeded, often. People who had been lost to the streets for over a decade would find themselves, sometimes within weeks, living in apartments with their own keys, their delusions quieting to a manageable hum.

You might think this was an unambiguous victory. In many ways, it was. But what I did not anticipate—what my training had not prepared me for—was the profound grief that followed. These individuals were waking up into a world they had not participated in for years. Parents had died. Children had grown and moved away. Siblings had stopped looking. The streets and shelters had become their community, and now that community was gone, replaced by four walls and a silence that could be deafening. The delusions, for all their terror, had also provided a kind of structure, a narrative that explained why things were the way they were. Without them, there was only the bare fact of how much had been lost, and how much could never be recovered.

I remember one man in particular who, after stabilizing on medication, sat in my office and wept for the better part of an hour. He was not crying because the voices had returned or because he was unhappy with his apartment. He was crying because he had finally realized that his mother had been dead for seven years and he had not attended her funeral. He had been too lost in his own internal world to register her passing. The medication had not given him his life back—it had given him the capacity to see, with terrible clarity, everything that was gone.

This same pattern emerges with striking regularity in addiction recovery, though the timeline is different. In Alcoholics Anonymous and other recovery communities, there is a phenomenon that clinicians sometimes call “the wall” or the “second-year crisis.” In the early months of sobriety, there is often a kind of euphoria, a relief at having escaped the immediate chaos of active addiction. But somewhere around the one- or two-year mark, something shifts. The fog lifts completely, and people begin to see—really see—the wreckage of their using years. Marriages that ended. Children who grew up without them. Careers that never launched or collapsed mid-flight. Health consequences that cannot be reversed. The addiction had been a problem, certainly, but it had also been a kind of anesthetic, a way of not having to feel the full weight of what was accumulating in the background. Sobriety removes the anesthetic. What remains is the surgery without sedation.

What I am describing is not a clinical curiosity or a cautionary tale about the side effects of treatment. It is, I believe, a fundamental truth about the nature of psychological healing—one that finds its most profound expression in the existential philosophical tradition and that carries implications for anyone engaged in the difficult work of becoming more whole.

The Kierkegaardian Paradox

In 1843, Søren Kierkegaard published Fear and Trembling under the pseudonym Johannes de Silentio—John of Silence—a name that already hints at the impossibility of fully articulating what he was attempting to describe. The text is an extended meditation on the biblical story of Abraham and Isaac, the moment when God commands Abraham to sacrifice his only son on Mount Moriah. Kierkegaard was not interested in the story as a piece of ancient religious history. He was interested in what it revealed about the structure of faith, and by extension, about the structure of any authentic human transformation.

What fascinated Kierkegaard was the psychological and spiritual movement Abraham had to make. This was not a simple act of obedience. Abraham had to genuinely give up Isaac—not merely go through the motions while secretly hoping for a last-minute reprieve, but actually release his attachment to the thing he loved most in the world. Kierkegaard calls this the movement of “infinite resignation.” It is the moment when one surrenders completely, when one accepts that the thing one desires is truly gone and will not return. And here is the paradox that Kierkegaard found so astonishing: it is only after making this movement of complete surrender that Abraham receives Isaac back. The gift returns, but only after it has been genuinely released. Had Abraham held on, had he made the journey to Moriah while secretly clinging to hope, the transformation would not have occurred. The authentic reception of the gift required the authentic renunciation of it.

Kierkegaard distinguished between the “knight of infinite resignation” and the “knight of faith.” The knight of infinite resignation makes the first movement—the surrender, the acceptance of loss—and remains there, stoic and noble in their renunciation. But the knight of faith makes a second movement that Kierkegaard himself admitted he could not fully comprehend. After surrendering completely, the knight of faith somehow receives the finite back again, lives in the world again, but now transformed. The world looks the same but is entirely different because of what has been traversed.

This is the structure I see again and again in clinical work, though most people understandably resist it with everything they have. The alcoholic must genuinely accept that their drinking days are over—not with the secret hope of eventually returning to controlled use, but with a complete surrender—before they can receive back the life that sobriety makes possible. The grieving person must accept that the loved one is truly gone, not coming back, before they can integrate that loss and find new meaning. The lonely person must accept that they have, in some fundamental sense, always been alone—that no external relationship will fill the existential void—before they can genuinely connect with others in a way that is not desperate or grasping.

The Loneliness Beneath the Loneliness

This last example deserves particular attention because I see it so frequently in my clinical practice, and because it is so consistently misunderstood. People come to therapy complaining of loneliness, of feeling disconnected, of wanting more meaningful relationships. These complaints are legitimate and deserve to be taken seriously. But very often, what I discover is that the presenting loneliness is actually a defense against a deeper loneliness that the person has never fully acknowledged.

Consider someone who has surrounded themselves with friends, who is active on social media, who attends gatherings and maintains connections with family and colleagues. By all external measures, they are not isolated. And yet they feel lonely—a persistent, gnawing sense that no one really knows them, that they are playing a role, that genuine intimacy remains somehow elusive. When we explore this feeling, what often emerges is a dawning recognition that they have always felt this way. The loneliness is not new; what is new is their awareness of it. They have been managing this feeling for years, perhaps their entire lives, through busyness and social performance and the comforting myth that belonging was just around the corner if they could only try a little harder, be a little more likeable, find the right community.

The therapeutic task is not to immediately connect this person with better friends or more meaningful activities, though those things may come in time. The therapeutic task is first to help them acknowledge the loneliness they have been running from. They must accept that they have always been alone in this particular way, that the void they feel is not going to be filled by any external arrangement of relationships. This sounds like terrible news. In the moment, it feels like terrible news. Patients resist this insight with tremendous force, and understandably so. It seems nihilistic, pessimistic, cruel. Why would a therapist lead someone into such darkness?

But here is what Kierkegaard understood and what clinical experience confirms: it is only by genuinely accepting this foundational loneliness—not fighting it, not distracting from it, not hoping someone will eventually come along and fix it—that the person becomes capable of genuine connection. As long as they approach relationships as a solution to their existential isolation, they will bring a quality of desperation and need that actually interferes with intimacy. They will be scanning for the thing they lack rather than meeting the other person where they are. But once they have truly accepted their aloneness, something remarkable becomes possible. They can enter relationships freely, without the grasping quality that comes from treating others as a means to fill an internal void. They can enjoy connection precisely because they no longer need it to survive. This is the Kierkegaardian movement: release the thing completely, and it returns in a transformed way.

Carl Jung described a similar dynamic in his writings on the shadow. The shadow, in Jung’s conception, is the repository of everything we have rejected about ourselves—the parts we find shameful, unacceptable, or too painful to acknowledge. Jung’s insight was that these rejected aspects do not disappear simply because we refuse to look at them. They continue to operate unconsciously, influencing our behavior and relationships in ways we cannot see. The only path to wholeness, Jung argued, was to turn toward the shadow, to acknowledge and integrate what we have rejected. “One does not become enlightened by imagining figures of light,” he famously wrote, “but by making the darkness conscious.”

This is not a prescription for wallowing in negativity or dwelling on one’s faults. It is a recognition that authentic selfhood requires honesty, and honesty requires looking at what we would prefer to avoid. The depressed person must often acknowledge the rage they have been suppressing. The anxious person must often acknowledge the grief that lies beneath the worry. The person struggling with addiction must often acknowledge the underlying pain that the substance was medicating. In each case, there is a backing up, a retreat to an earlier and more fundamental problem that was being masked by the presenting symptom. And in each case, this backing up feels like going in the wrong direction. We came to therapy to feel better, not worse. We came to solve the problem, not to discover that the real problem is something we have been avoiding our entire lives.

The Horror That Makes Beauty Possible

What I am describing is, in essence, the necessity of disillusionment as a precondition for genuine experience. We must let go of our illusions about the world, about other people, about ourselves, before we can see any of these things clearly. But illusions, by definition, are comfortable. We do not cling to them because we are stupid or weak; we cling to them because they protect us from a reality that feels overwhelming. The illusion that our parents were perfect protects us from the terror of childhood vulnerability. The illusion that hard work always leads to success protects us from the arbitrariness of fate. The illusion that bad things happen to bad people protects us from the randomness of suffering. To surrender these illusions is to step into a world that is more frightening than the one we have constructed, and the psyche resists this step with considerable force.

Irvin Yalom, the existential psychiatrist, identified four “ultimate concerns” that he believed were at the root of all psychological distress: death, freedom, isolation, and meaninglessness. What makes these concerns “ultimate” is that they cannot be solved or eliminated. We will all die; this is not a problem to be fixed but a reality to be faced. We are fundamentally free, which means fundamentally responsible, which means fundamentally without excuse. We are isolated in our own consciousness, unable to fully merge with another no matter how intimate the relationship. And the universe does not come pre-equipped with meaning; whatever meaning our lives have is meaning we have created or adopted. These are not pessimistic conclusions; they are simply accurate descriptions of the human condition. But accuracy, in this case, is terrifying, and so we construct elaborate defenses to avoid the confrontation.

The therapeutic journey, as Yalom understood it, involves a gradual stripping away of these defenses, a movement toward greater authenticity that necessarily passes through existential anxiety. This anxiety is not a symptom to be eliminated; it is the appropriate response to the human condition honestly perceived. The goal of therapy is not to remove the anxiety but to help the person develop the capacity to tolerate it, to face reality without crumbling, to live with the truth rather than against it.

Here is the double bind that makes this work so difficult: we cannot know goodness until we have acknowledged how much badness there is. We cannot appreciate truth until we have accepted how many lies we have been living with. We cannot experience genuine beauty until we have stopped pretending that everything is beautiful. The person who insists on seeing only the positive, who refuses to acknowledge suffering and loss and the genuine horror of existence, is not actually optimistic—they are defended. Their positivity is a performance that prevents real contact with life in its fullness.

Viktor Frankl, who survived the Nazi concentration camps and went on to develop logotherapy, understood this perhaps better than anyone. Frankl did not emerge from Auschwitz with the message that positive thinking can overcome any obstacle. He emerged with the message that meaning can be found even in the midst of unavoidable suffering, but only if one faces that suffering honestly. The forced labor, the starvation, the constant proximity of death—these were not experiences to be reframed as opportunities for growth. They were genuine horrors that had to be endured. What Frankl discovered was that even in the midst of such horror, the human being retains the capacity to choose their attitude, to find meaning, to maintain some shred of dignity. But this capacity emerged from the honest confrontation with horror, not from denial of it.

The Icky Truth

There is something about authentic honesty that feels almost forbidden in our culture. We are permitted to complain, of course, and we are permitted to identify as victims, and we are permitted various forms of sanctioned negativity. But there is a different kind of honesty—a clear-eyed acknowledgment of how things actually are, without the drama of complaint or the comfort of victimhood—that feels transgressive in a way that is hard to articulate. When you sit with a patient and help them see, without judgment or agenda, the actual nature of their situation—how alone they have been, how much they have lost, how responsible they are for their own life—it can feel, in the room, like something illicit is occurring. We are not supposed to see this clearly. We are not supposed to say these things out loud.

Part of this, I believe, is cultural. American culture in particular prizes optimism, forward motion, solution-focused thinking. The message, implicit in countless advertisements and self-help books and motivational speakers, is that problems exist to be overcome, that negative feelings are obstacles to be cleared, that the good life is a matter of getting your mindset right and pushing through. This cultural framework has no place for the kind of backward movement I am describing, the acknowledgment that things are worse than we wanted to believe, the sitting with horror rather than immediately transcending it. To suggest that healing might require dwelling in darkness, even temporarily, sounds irresponsible at best and sadistic at worst.

But there is also something deeper at work, something more personal and universal. The truths we must face in authentic psychological work are not abstract philosophical propositions. They are truths about our own lives, our own choices, our own complicity in our own suffering. This is not a pleasant thing to see. The alcoholic must see not only that they have lost years to addiction but that they chose to drink, again and again, that no one forced them. The lonely person must see not only that they lack connection but that they have been avoiding connection, sabotaging it, running from the very intimacy they claim to want. The person stuck in a bad relationship must see not only that their partner is problematic but that they have been choosing to stay, that some part of them is invested in the dysfunction. These are icky truths. They feel not allowed. And yet they are the truths that, when finally accepted, create the possibility for genuine change.

What I am describing is not a counsel of despair. It is, in fact, the opposite—it is the only reliable path to hope that I have found in twenty years of clinical work. The hope that is built on illusion is fragile hope; it lasts only as long as the illusion can be maintained, and life has a way of shattering illusions eventually. The hope that is built on honest acknowledgment of reality is resilient hope; it has already absorbed the worst news and found that life continues, that meaning is possible, that connection remains available even when we are not desperate for it.

Kierkegaard described faith as “a task for a whole lifetime.” I think healing works the same way. It is not a single insight or breakthrough but an ongoing practice of honesty, a willingness to keep turning toward what we would rather avoid. Every time we make the movement of surrender, every time we release our grip on how we think things should be and accept how they actually are, we create space for something unexpected to enter. We do not know in advance what that something will be. We cannot control it or manufacture it. All we can do is create the conditions for its emergence by clearing away the obstacles we have erected, the defenses that once protected us but now only limit us.

The patients who taught me this most clearly were those early ones, the chronically homeless and psychotic individuals who woke up into grief. They had no choice about their awakening; the medication did it for them. But those of us who have more control over our psychological development face the same fundamental task. We must be willing to wake up, to see clearly, to grieve what has been lost, and to accept a world that is more frightening and more beautiful than the one we imagined. The fear that Kierkegaard wrote about is real; the trembling is appropriate. But so is the faith that waits on the other side of surrender—not faith in any particular outcome, but faith that the journey through darkness is worthwhile, that honesty serves us even when it hurts, and that the real gift of life can only be received by hands that have first learned to let go.