In my practice I have repeatedly seen that many presenting complaints, such as anxiety, depression, and irritability, are due to life dissatisfaction, as opposed to manifestations of major psychiatric disorders. The article "Study Finds Link Between Life Satisfaction, Suicide Risk" in the April 6 issue objectively studies what I have been anecdotally observing over the last several years. There is a need for psychiatrists to focus on the importance of such issues as interest in life, happiness, general ease of living, and feelings of loneliness and how they relate to mental wellness.

Ever since the beginning of my psychiatry residency training, complaints related to such "soft" quality-of-life variables have been minimized. The clinical focus was always on the signs and symptoms of more severe DSM diagnoses. This probably follows from psychiatrists’ current orientation along a distinctly medical model to treat a disorder and attempt to attain baseline, or adequate, functioning. Many of the patients I see in my practice are dissatisfied with their lives, yet they are functional and lack significant psychopathology. Traditional psychotherapies, particularly psychoanalytically focused ones, have been of limited value with these patients.

I have been getting extremely good results by using a model that approaches these individuals not as mentally ill, but as not yet functioning at their highest level. This is a model based on achievement and peak performance technologies. It has been developed from linguistic patterns, the understanding of how belief systems are established and abolished and modeling the effective strategies of others who have proven success in varying life areas (success leaves clues). It also has its roots in Ericksonian indirect hypnotic techniques and Neuro-Linguistic Programming. These patients find this approach exciting because the focus is in unlocking their drives and potential, with the goal of striving for outstanding life success, rather than simply attenuation of psychiatric symptoms.

The article notes that those individuals scoring higher (less satisfied) on the Finnish researchers’ Life Satisfaction Questionnaire were more likely to have been smokers or heavy alcohol users. As an addiction psychiatrist in private practice, I have seen how this peak-performance model is extremely useful for individuals in recovery from substance abuse. Some have been able to initiate sobriety and clean time by this approach. The most frequent complaint from those in early recovery is despair about their life situation now that substances are out of the picture. Alcoholics Anonymous and 12-step-oriented rehabilitation facilities attempt to deal with this despair by an immersion experience in the 12-step belief system. The validity of this belief system must be accepted and incorporated into the individual’s mind as an absolute belief for "true" recovery. If not, the message is that recovery may not be attainable. I treat many people who are unable or unwilling to adopt this belief system, and thus they increasingly despair over the inability to change their perceptions about their life situation. Using exercises and techniques via this empowerment model, I have been able to teach and coach these individuals to install confidence-enhancing belief systems, attenuate limiting belief systems, establish congruence and rapport with themselves and others, and more consistently attain their life goals.

Both this article and my experience demonstrate that none of us should minimize "existential angst" in our patients. We see in the worst case that the end result could be suicide.