This traditional Japanese chawan, crafted by hand and transformed by extreme heat, sits quietly on a shelf in my dining room. Its surface carries the evidence of its making: the torn lip, scarred surface, variable texture, flashes of color.
As I examine this vessel, on its shelf and in my hands, I am struck by all that it inherently contains. Like each of us, it bears the work, scars, and beauty of life and love. Women often become extraordinarily skilled at containing things: the needs of children, partners, colleagues, aging parents, friendships, households—and, often, their own emotions. Competence becomes a way of coping. Anticipating needs, staying organized, maintaining control, and worrying about what might go wrong can be enormously effective strategies. A problem arises when control, perfectionism, and worry begin to eat away at the freedom, beauty, and satisfaction we seek in life.
It’s easy to focus on how much the vessel can hold rather than on the inherent beauty of the vessel itself. We can become so accustomed to carrying more—to being capable, productive, and resilient—that we barely notice the effort it requires until we begin to overflow. I understand this; I have seen it in my office. We may have talked extensively in therapy about where our patterns came from and recognized how they helped us survive and succeed. And yet we may still find ourselves exhausted, tense, sleepless, unfocused, and irritable. We wonder: What happened to my capacity? Why does a life I used to be able to manage suddenly feel like too much?
When a woman tells me she has always been anxious, but now can’t sleep, can’t manage ordinary life demands, and no longer feels freedom or joy, I don’t assume she needs to work harder to cope. Instead, I try to understand what has changed, why her vessel is at capacity, and what is now asking more of her than she can sustainably hold. For many, even while doing meaningful work in psychotherapy, symptoms and suffering can grow and overwhelm our capacity to heal.
As a psychiatrist, I try to step back and look at the whole picture. What is happening with mood, anxiety, attention, sleep, energy, and physiology? What has changed? Are there medical or hormonal factors? Could a medication be contributing? Is depression or anxiety part of the picture? Has a longstanding coping strategy become unsustainable under new demands? And how does all this fit with the work already happening in therapy?
Psychiatric care and psychotherapy answer different questions, though they often work best together. Therapy can help us understand the patterns, relationships, conflicts, and experiences that shape our emotional lives. Psychiatry adds another lens: What is happening with mood, attention, sleep, energy, physiology, and capacity? Has something changed? Is there a psychiatric condition contributing to the suffering? Would medication help? Could medication be making something worse? My job, when I can do it well, is to work toward a clearer understanding of what is happening—work that begins well before the prescription.
The imperfect vessel isn’t beautiful despite its imperfections; its individuality and character are what make it beautiful. Psychiatric care is not about creating perfect vessels, eliminating difficult emotions, or changing your personality. It begins with inquiry: What are you carrying? What has changed? Has your capacity been exceeded—or has something else changed that deserves attention?
Sometimes the work is to understand. Sometimes it is to change something. Sometimes it is to add another kind of support to the work already underway. The goal isn’t perfection; it is helping you have enough capacity to live with freedom, joy, and room for what matters.
