In my last entry, Why “get in touch” – 3, I tried to explain in more concrete terms how one goes about psychotherapy, how one gets “in touch”, and what some of the common road blocks are to the process. The day after I finished it, I had a session with a patient that illustrates some of the material beautifully. He gave me permission to share it here. (Names and details changed to protect confidentiality.)
John (40 years old) came to treatment complaining of episodes of agitated depression during which he would feel suicidal, despairing, enraged; other times he reports anxiety symptoms (obsessing, chronic self-doubt and insecurity), or not feeling much of anything beyond a rather silly but intrusive preoccupation with dating women. Despite his considerable success in this area he is often preoccupied with feeling unattractive to the opposite sex and he seems to really believe that his occasionally failing to land a date is the source of his agony.
Obviously such intense feelings and preoccupations are really about something else. John is not a man who struggles to find female companionship and even love – he’s been married twice, both times choosing to end the relationships, and over the years has in fact experienced less rejection than most men. His claim, if true, that in his teens and early 20s he was less successful with women than some of his peers does not come close to accounting for such intense despair two decades later, especially after so much romantic success in the interim.
So what is really hurting John? What is the true source of his distress? (He has no drug or alcohol abuse problems, and he is physically healthy.)
In contrast with his intense overreactions to minor slights in the present – for example being rejected by a woman at a party to whom he acknowledges he was not even that attracted! – John recounts his childhood with a startling blandness. Today he told me of a recent conversation with his mother in which she told him a story from when he was 2 days old and brought home from the hospital. According to his mother, he was crying in his bed for an hour or more before his father would allow his mother to check on him. His mother reported that his father’s attitude was that life is hard and a child must learn to tolerate discomfort – something John recalls hearing from his father in later years as well, so he believes his mother’s account. John remembers at about age 10 his father took him to a double feature of very intense horror movies; there were scenes shocking to adult audiences at the time (early 1980s, only a few years after we were all grossed out by “Alien”, long before we were used to such vivid gore as can now be seen regularly on television shows like “House”). Finally, John remembers his mother and paternal grandmother being very cowed by his father. He remembers – and his mother recently confirmed this to him – that neither woman would sing to the child unless John’s father wasn’t around because he would object so strenuously, demanding that “no one will coddle my kid”.
You can probably begin to see the puzzle beginning to take shape here. John can’t find any reaction in himself to these stories, either in the past when they happened or when he thinks about them now. Meanwhile, he overreacts so dramatically to what are by comparison very trivial blows to his ego in the present. Historians tell us that those who aren’t aware of history are doomed to repeat it. Same is true on the personal level: What we don’t feel/remember we’re doomed to act out.
As I describe in the main website John is “lost” in that he is unaware of what happens inside him and what happened to him; that is why he has symptoms. When he can remember his experiences, both from the far past and more recently, his symptoms diminish. This is what happens in any successful psychotherapy. Symptoms fade, functioning improves, happiness increases as a person remembers, gets “in touch”
For example, a few months ago John came in during an episode of the agitation, despair, and suicidal thoughts he had described when we started. By the end of the session, we had identified – simply by going over the events of the previous few days – when the bad mood started and what the trigger was. As with Simon and Jim in the previous entry, John’s overactive mind interfered with him simply noticing what happens to him. But when he did see it, the result was unmistakable.
By the end of the session he understood that being rejected by a woman at a party, combined with some other minor insults that day, sent him into his state of feeling like the most despicable creature on the planet, and made him furious that “everyone else gets to be happy”. Having articulated this, he could see how silly it was, he understood how it spiraled into the suicidal thinking that troubled him for the next few days, and – most importantly – he felt better. The improved mood sustained over the next weeks, and he was functioning somewhat better as well.
Encouraging as such a change is, it is only temporary. Although a bit more resilient each time we can have such a session, John remains susceptible to intense despair and will continue to be so until he makes a similar connection to the more distant and powerful causes of his bad feelings – the stories he has begun to tell me about his childhood, stories in which profound despair are an understandable reaction, stories in which anyone would respond with such agony.
And here is where the blocks to remembering feelings/experiences – to getting “in touch” – appear. After John told me about hearing of his third day of life I asked him for his reaction to the story. I asked whether any feelings or thoughts came to mind either as he heard it or in recounting to me. His answer was “no, because many people have bad childhoods; some must be worse than mine…”. As with Simon and Jim in the previous entry, John is not open to his own reactions in part because he has decided in advance what those reactions should be.
His answer is a classic case of “rationalization”. It is important to understand that rationalization feels to the rationalizer like productive thought. That is, you think you’re doing the work of psychotherapy but in fact you are doing the opposite. You are using what feels like thinking to actively avoid noticing or feeling anything that’s going on inside you or even between you and other people. We can see how this process continued with John as our dialogue proceeded.
In response to his generalization about other people’s childhoods, I asked if he would say to a friend who told him she had cancer and was feeling frightened and despairing that “other people have cancer and worse, so why are you so upset”. He answered “of course not”, then smiled and acknowledged that he was using that same preposterous rationale to deny any reaction to the stories he was telling me about his own life.
But this motivation to avoid getting “in touch” – that is, to resist – is powerful. So John’s next words were “but of course this story is probably not relevant to the treatment”. Again, he tried to skitter off the topic. You may notice that this is exactly what Jessica did (her story starts a few paragraphs into the posting). John tried to slither out of the discussion despite being well aware: 1) he can’t possibly know what is or is not important to the treatment any more than a medical patient may know why a history of neck injury might be relevant to pain or tingling in the hands; that’s what he’s hired me to know; 2) it’s pretty far-fetched to imagine that such striking information about how he was raised father would be irrelevant to helping him understand intense bad feelings in the present that have no apparent source in anything happening in the present.
John’s next words begin to answer the question of why we tend to be so avoidant of getting in touch. He asked me how to go about noticing his reaction to things like his mother’s stories about his childhood or his own memories of those years. I said think of going to a movie like “Jaws”, years ago when we saw those things for the first time on huge movie screens and were not yet used to such realistic gore and suspense. If you sit back from the experience, analyzing the film technique, you might learn something but you won’t feel that thrilling fear such a movie evokes. By contrast – and he remembers doing this – when you simply buy the popcorn, sit down eagerly, and open up to whatever comes at you, it’s scary! He suddenly said “I don’t want to be scared. I see that now. I feel a lot of fear and never want to feel it.”
This is why we avoid getting in touch, avoid the memories and feelings that cure us: Because it’s scary and because it hurts. Take a look back at Fred’s story in this previous entry (scroll down the entry to find the paragraph about Fred). His is a very painful experience to recall, full of deep humiliation, fear, helplessness. Who wants to remember that?
John’s statement also shows how such avoiding makes us “lost”. His habit of rationalizing away from any awareness of what his memories feel like leaves him out of touch with what happens to him day by day. Thus, he’s surprised to realize that even today “I feel a lot of fear”.
This is more common than you might think. Lots of people walk around unaware of what they’re feeling although everyone around can see it. The most obvious example of this is the teenager – usually a male – who insists “I ain’t scared!” The louder they say it, the more fear we can see. But if the shouter shouts it loudly and persistently enough, even he starts believing the denial. And years later, like Simon and John, like Ron and “Bully”, he’s unaware of what goes on inside him but he’s subject to bewildering bouts of despair, preoccupied with something that he’s entirely competent in, and hampered by panic and anxiety symptoms.