Each May, during Mental Health Awareness Month, the health care industry releases its usual statements about access to care, workforce stress, and the enduring shadows of stigma. I usually read them between back-to-back appointments, staring at a screen full of diagnostic codes. The systemic issues are always important, yet, amidst the charts, the 20-minute med checks, and the rhetoric, there remains a more profound question I have to ask myself every time I close the office door: How am I going to approach the suffering of the person sitting across from me?
To answer that, I sometimes look back to the sweeping plains of Kansas, to a man who forever altered the landscape of American psychiatry. Karl Menninger was a true titan of the twentieth century. He and his family built the Menninger Clinic in Topeka, turning a quiet midwestern capital into a beacon of hope for the troubled mind. From the pages of his monumental works, The Human Mind, Man Against Himself, and The Vital Balance, there emerges a clear, unyielding professional creed that I try to attempt to carry into my own practice: understanding must always precede judgment.
It is a deceptively simple idea. But in the daily, unforgiving crucible of medical practice, it is an excruciatingly hard standard, and one that I struggle to achieve. Menninger firmly rejected the rigid boundaries that separated the “sick” from the “well.” He argued that mental illness was not a distant, alien country, but existed on a continuum with ordinary human behavior. I see this continuum every week. It is incredibly easy to look at the darkest of human impulses such as suicide, aggression, the urge toward self-destruction, and instinctively retreat into the safety of clinical labels. I have often caught myself doing it. Menninger worried deeply that these labels could become a kind of blindness, a convenient categorization that keeps the doctor from seeing the actual, messy, lived experience of the human being sitting before them.
When I actually pause to look past the pathology, I don’t just see “borderline” or “antisocial” behavior; I see someone desperately trying to manage intolerable internal conflict. Menninger did not seek to excuse this behavior, nor did he believe personal accountability should vanish. We have to make judgments. I make clinical decisions every day that carry heavy, life-altering consequences. So do you. But Menninger understood that to assign blame without first attempting to comprehend the agony behind it is a failure of our duty. The true question is whether I have the courage to get curious before I cast that judgment.
Long before the phrase “therapeutic alliance” became standard medical textbook jargon, Menninger knew that healing was, at its core, a relationship. Technique is essential, of course, but the true work of medicine happens in the quiet, sacred space between two people. Today, we practice in a health care environment increasingly driven by the relentless ticking of the clock and the cold calculus of metrics. We move fast out of sheer necessity. But the great danger of speed is that it impedes curiosity. When I only have a few minutes to adjust a medication, the art of relational presence can feel like a luxury from a bygone era. And when my curious understanding is lost, judgment sometimes unfortunately fills the void to get me through the appointment.
What, then, is mental health? Menninger did not see it merely as the absence of symptoms. He saw it as the vibrant, resilient capacity to live, to work, to love, to weather the inevitable storms of frustration, and to take one’s meaningful place in society. It is an acknowledgment that we are all, beautifully and deeply, imperfect.
Mental health is not a fixed destination, nor a perfect state of mind we can permanently secure. It is a daily, courageous practice to engage with life exactly as it is. Karl Menninger was, at his heart, an optimist. He believed that beneath our defenses and our diagnoses, we all share a fundamental desire to truly know one another. As a physician, it is a choice I must make again and again: to forget the metrics for a moment, to choose connection over withdrawal, and from that understanding, find the healing that sustains us all.
Timothy Lesaca is a psychiatrist in private practice at New Directions Mental Health in Pittsburgh, Pennsylvania, with more than forty years of experience treating children, adolescents, and adults across outpatient, inpatient, and community mental health settings. He has published in peer-reviewed and professional venues including the Patient Experience Journal, Psychiatric Times, the Allegheny County Medical Society Bulletin, and other clinical journals, with work addressing topics such as open-access scheduling, Landau-Kleffner syndrome, physician suicide, and the dynamics of contemporary medical practice. His recent writing examines issues of identity, ethical complexity, and patient–clinician relationships in modern health care. Additional information about his clinical practice and professional work is available on his website, timothylesacamd.com. His professional profile also appears on his ResearchGate profile, where further publications and details may be found.
