The Four Questions

There are three questions that I hear repeatedly in my work as a therapist: Who (or what) am I? Do I have any value? Why doesn't anybody see or hear me? Sometimes there is a fourth question: Why should I live? These are not intellectual questions to be discussed with a glass of wine over dinner; they are deadly serious and come directly from the heart, and they reflect a primordial experience of the world separate from problem solving and reason.

Usually it is not the questions themselves that bring people to my office, at least not directly. Typically a relationship has failed or is failing, a job has been lost, an illness has occurred, or something has happened in the person's life that has dramatically reduced their sense of agency. Instead of resilience and conviction, the person is surprised to find a bottomless pit. Suddenly, the person experiences the terror and helplessness of freefall, and they make the telephone call. It only takes a session or two, however, to find there are two problems: the current situation and what the situation has uncovered.

Where do these questions come from? Why are some people terrorized by the four questions their whole life, while others don't even notice their existence? And why are they so cleverly disguised in many people's lives - only to suddenly emerge as all-encompassing and sometimes life-threatening ruminations? It is currently fashionable to posit a purely biological explanation for behavior that we can't explain (just as, in past decades, it was fashionable to posit a purely familial explanation): the four questions are really cognitive manifestations of a neurotransmitter imbalance (too little synaptic serotonin), or reflective of a broader genetic problem. There is truth to both of these answers but they are incomplete. Biology certainly plays a role, but biology and life experience interact - each one affecting the other.

In fact, the four questions exist for good reason, and they make perfect sense--if you understand the ancient language of subtext. What is subtext: it is omnipresent between-the-lines communication, the hidden messages of all human interaction. But what a strange, wondrous, and slippery language subtext is. Subtext is wordless, yet it is the language of dreams and great literature. It is the language mastered by infants and then slowly replaced by logic and reason. It is a language where the same words can mean a thousand different things depending on context. It is a language that eludes social scientists because it is so difficult to measure. And, ironically, it is the only language I know where a likely outcome of comprehension is loneliness and alienation - because it is compelling, and yet so few people understand it.


Why do the four questions emerge after trauma or loss? Because in the subtext of the parent-child relationship, these questions were never adequately answered. Or if they were answered, the message was: you don't exist for me, you have always been a burden, or you exist for limited reasons having to do with my own psychological needs. Lacking satisfactory answers, the person can spend their whole life erecting props - ways they can validate their very existence. They do this through relationships, career success, self-aggrandizement, obsessive or controlling behavior, drug or alcohol use, or other ways (I will talk about all of these in later articles). Loss or trauma causes the props to fall, and instead of tumbling to a sturdy stone foundation ("I had a bad time or bad luck, but I'm basically O.K."), people slide into a vortex of terror, shame, and worthlessness.

Parents who provide their children inadequate answers to the four questions are not evil. Usually, they are struggling with the same questions themselves: who they are, what value do they have, how can they get people (including their own children) to see and hear them--and sometimes should they live or not. Without definitive, fundamental answers, parents lack the emotional resources to answer the questions for their own children. The intergenerational cycle continues until finally someone gets help.

Psychotherapy provides answers to the four questions. Therapy is not, however, an intellectual process. A therapist gently uncovers the vulnerable self, nurtures and values it, allows it to grow free of shame and guilt, and provides comfort, security, and an attachment. Just as in the parent-child relationship, the subtext of the therapist-client relationship is critical: it must be loving.

About the author: Dr. Grossman is a clinical psychologist and author of the Voicelessness and Emotional Survival web site.

next: Six Questions about Voice and Voicelessness

APA Reference
Staff, H. (2008, October 30). The Four Questions, HealthyPlace. Retrieved on 2024, July 13 from

Last Updated: July 14, 2016

Medically reviewed by Harry Croft, MD

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