Elvin Semrad

"Very shortly, you will be going onto your assigned wards. Within those wards, you will see over fifty of the sickest, craziest, most bizarre people you will ever encounter. They will be hallucinating, gesticulating, and delusional in the most grotesque ways. Every cell in your body will rebel and want to block out the experience. But here is the thing you must remember. Every one of those symptoms, as strange as they may seem to you, makes perfect sense to those people. Every single one, has been evolved and carefully crafted, to try to deal with some impossible family situation. Every symptom represents an attempt by that person to adapt to the hand that fate has dealt him. You are to regard each one as an artistic, creative endeavor to survive. Your job, and your only job, is to appreciate, and admire that effort!"

"We have three choices in life: to kill ourselves, go crazy, or learn to live with what we have in life."

"Never idealize anybody: They all stink."

"Sorrow is the vitamin of growth."

"When you feel loved, you don't have to be crazy."

"You have to respect his [the patient's] adulthood. To do this you have to treat him with respect and approach him on his highest level of function. Don't take away from him what he has, or you'll foster regression."

"Therapy is therapy-- talking to the patient about what matters to him, no matter at what pace he can take it... As long as you take the position of talking to a person about what matters to him, then he can feel secure. Someone cares enough and is concerned enough about him to work with him and listen."

"My main interest is to kibbitz and learn."

"[Regarding what to say to a patient:] We all have the same question and problem, and I follow a very simple rule: if it's comfortable for me to say it, then it is the right thing, the right time, and the right way to say it."

"At his approach, it is told, the beside-themselves would find themselves, and the nonsense-talkers would begin to make sense. You've never heard of him ...because he wrote no books, gave his name to no large theory. His words live in an oral tradition. His teachings cannot be taught: They can only be embodied."

"[Semrad was] a rumpled, roly-poly Father Christmas. It was like talking to your grandfather-- who is finally listening to you, for a change."

"Patients who appeared very psychotic became in their contacts with him understandable human beings."

"With paranoid patients, he emphasized the need of a patient to find someone who could share the responsibility for the unacceptable feelings, including acknowledging the "kernel of truth" in the patient's delusions."

"When a resident [physician in training] once asked him what helped build his capacity to help people bear intense feelings of loneliness and loss, he replied, "A life of sorrow, and the opportunity that some people gave me to overcome and deal with it.""

"[When asked:] "Dr. Semrad, does the patient have manic-depressive illness or schizophrenia?" Semrad answered, " I would call the patient Mr. Smith.""

"He sat side by side with patients so that he could look at the world from their view, turning only his head towards them."

"A central prerequisite of Semrad's method was offering enough support so that the patient could relinquish avoidance defenses and thereby share the pain."

"By talking with patients about "what really matters to them," based on their experience, he tried to help them see that they were avoiding before going to what they were avoiding."

"Our great teacher, Elvin Semrad, actively discouraged us from reading psychiatry textbooks during our first year....Semrad did not want our perceptions of reality to become obscured by the pseudocertainties of psychiatric diagnoses."

"[Account of a psychiatrist trainee undergoing routine psychoanalysis by Semrad:] Semrad motioned to me to sit in a straight-backed wooden chair....He entered copious notes as I spoke. From time to time he'd look up at me from his writing....To my left and behind me was his analyst's couch, upholstered in tight pink plastic imitation leather....Semrad asked me to tell him about myself, and I began relating my life story-- who I was, or thought I was, and where I was from. When he'd look up from his writing, he had an expression of profound understanding and respect. I got deeper and deeper into my story. Occasionally, Semrad would interrupt with a question to clarify what I was trying to articulate, but otherwise I continued pretty much on my own, except for his occasional glances up in silence. At one point, I had been talking about my father and our relationship, which in many ways had been painful and strained....Semrad looked up and with a profound look simply said, "Your father has been very important to you." I started to sob....I began my analysis with Semrad the next day and went four days a week. There was not a session that was not profoundly moving, and my life in many ways changed dramatically."