Sunday, March 27, 2011

Need to know

I've been thinking a lot lately about the seeming need of human beings to understand things.  If something is wrong psychologically or emotionally people always want to know why.  They are reluctant to take a given action unless they understand the reasons for it.  They are frequently unwilling to make a decision unless and until they can determine why one option is more favorable than another. 

Sometimes human curiosity is a good thing.  Throughout history it has led to the development of amazing technology, driven the discovery of treatments and cures for all sorts of physical and mental ills, and has helped to expand the ways in which we interact with our environments and with each other.  There is no question that the human drive to understand has been a useful quality that has likely given us an edge over other species and propelled us to the top of the food chain.

What stands out to me is not the quest for understanding that leads to something useful and adaptive.  Rather, what strikes me as odd is that we apply our desire for discovery to endeavors that are completely useless.  We look for reasons in situations where finding them would have no practical implications.  If there is no chance that knowing why a particular problem exists in its current form will help us to better deal with or solve the problem in question then honestly, what is the point?!?

And yet this need to know has such an impact on our behavior.  For example, time and time again people come to me wanting to know why they are depressed, anxious, emotionally unstable, etc.  I can understand the desire to know -- it is, after all, human nature.  So I am willing to spend a little bit of time on identifying possible contributing factors.  Most people are satisfied with the explanation that there are a number of factors that might have played a role in creating their current situation.  They are typically content to identify a few of the most likely culprits before moving on.  But there are some people for whom this is not enough.  They return again and again to the question, "Why am I like this?"  They spend excessive amounts of time and energy thinking about and analyzing their past experiences.  The reality is that there is no specific, identifiable reason.  Even if such a reason existed, what good would come from discovering it?  It would tell us nothing about how to resolve the problems the person is facing.  Knowing how you got there will not show you how to get out.

That's just one example of how frustrating the human quest for reasons can be.  I could come up with a million others, but I'll refrain.  The point is, there comes a time when the need to know why becomes part of the problem.  Frequently people want to know why a particular thing is before they are willing to accept it.  Non-acceptance inevitably leads to suffering.  When you refuse to accept what is you begin to fight against it.  You get caught up in wanting things to be different than they are.  Not only does this create a lot of negative emotions it also prevents you from figuring out how best to cope with reality.  If you can't accept it then how can you cope with it?

The solution?  I suppose it is being willing to let go.  Accept that things are as they are and that it really doesn't matter why.  You will have to do this again and again; the urge to ask why will continue to come back up.  Whenever it does, you will again have to remind yourself that chasing that urge is a fruitless endeavor.  You will have to make a conscious choice to simply allow things to be as they are.

Sunday, March 20, 2011

The need to express yourself

You always hear that you shouldn't keep your emotions "bottled up," that it's "bad for your health."  What you don't hear a lot about is what to do instead.  What do you do if you can't express your feelings in a given situation because it's not the right time or place?  What if you're so angry that expressing that anger might unleash a violent storm with negative consequences for yourself or the people around you?  What if leeting another person know how you feel would do more harm than good?

I am fully convinced that "bottling up" emotions is not healthy.  I believe that emotions usually -- but not always -- need to be expressed in order to keep them from hanging around only to reveal themselves at inappropriate times or in inappropriate ways.  If, however, it is not possible to express an emotion for whatever reason, at the very least it should be acknowledged.   Ignoring or suppressing emotions won't make them go away.  They will inevitably return, although they may manifest themselves in different ways (perhaps as an unexpected angry or violent outburst or maybe as physical pain such as headaches, ulcers, or stomach problems).  Acknowledging a feeling brings it into your conscious awareness.  Once it's there you can make a decision about what (if anything) to do with it.  If an emotion is not acknowledged it remains unconscious.  It is still there but you no longer have control over what it does.  (I think that one of the reasons people reach a point where they have no control over their emotions - or where their emotions are in control of them - is because they've suppressed, repressed, or otherwise kept their emotions from consciousness for so long that they've accumulated, grown, and joined forces until they've become a powerful and destructive force).

In terms of expressing emotion - while it may not be appropriate to express an emotion at a given time, in a given place, or to a given person, you can at least take a moment to recognize how you are feeling, choose to keep that feeling to yourself for the time being, and return to it later when you are able to express it.

Expression does not always have to be verbal, although verbally identifying an emotion has been shown to make that emotion more manageable (and sometimes less intense).  Art, music, or physical activity are also potential conduits for emotional release.  Still, humans are social creatures by nature; perhaps that is why - at least in terms of the most intense or troubling emotional experiences - we seem to benefit most from finding someone supportive to share them with.  Studies have shown that after a distressing experience people tend to seek out others to share their emotions with.  People with diagnosable depression, however, do not show this tendency.  This suggests that not sharing such emotions with others contributes to, exacerbates, or serves to maintain depressive symptoms.  In addition, avoiding emotions related to a distressing experience or experiences is a factor that has been shown to contribute to both the development and the maintenance of symptoms of PTSD and other anxiety disorders.

I realize that I have repeatedly warned of the perils of emotional avoidance.  Still, I don't think it's possible to over-emphasize this.  If we are to lead a psychologically healthy and emotionally fulfilling life we have to find ways of expressing - and sharing - our feelings.  This will probably be uncomfortable at times but in life what is good for us is not always comfortable.  Maybe we don't want to get immunizations because we don't like needles but we do it because it prevents us from getting life-threatening diseases.  We might not enjoy a colonoscopy but at age 50 we go get one because it could prevent us from getting colon cancer.  And women - we may not enjoy our yearly female exam but we get it done because we want to make sure we stay healthy.  When you look at it this way there is absolutely no reason not to engage in healthy emotional expression.  Yes, it may be uncomfortable to share you feelings at times; however, rarely is it as bad as getting a colonoscopy.  Keep that in mind next time you have the urge to bottle up your emotions.

Sunday, March 13, 2011


Awareness of and acceptance of emotions have been important concepts in psychotherapy since its inception.  Freud proposed that unconscious defense mechanisms served to keep distressing and intolerable emotions out of the patient's awareness.  The goal of therapy (psychoanalysis at that time) was to help bring these feelings into the patient's conscious awareness.

While it can be useful at times to avoid the experience of emotion (whether by conscious or unconscious methods), a large body of evidence suggests that doing so on a regular basis causes, contributes to, and/or maintains a wide range of mental (and physical) health problems.  An increasing number of therapeutic techniques -  from DBT to ACT to exposure based therapies -  feature acceptance of uncomfortable (and comfortable, of course) emotions and experiences as one of their primary interventions.  The irony in this is that acceptance itself and for its own sake is often the goal of these treatments.  In fact, accepting negative emotions with the goal of making them go away is not really acceptance at all  and is counterproductive.  If acceptance of emotions is applied merely as a strategy for getting rid of these emotions then can you really say you are accepting them?  Or is part of you engaged in not-accepting (trying to get rid of them)?  The very act of identifying ridding oneself of negative emotions as a goal is itself not accepting.

The opposite of acceptance is avoidance.  People who cannot or will not accept their internal experiences tend to engage in efforts to avoid them.  Examples of avoidance include denial, distraction, repression, and suppression.  Drinking or using drugs are also examples of avoidance if they are used in order to decrease the experience of negative emotions or to mask these emotions via their mood-altering effects.  People may also avoid situations, places, people, or events that generate distressing emotions.

Avoiding unpleasant internal experiences seems like a common sense goal.  After all, who wants to feel unhappy, anxious, or angry?  However, if these negative emotions emerge with any frequency a person can end up spending all of his or her time and energy trying to avoid them.  Eventually they become so consumed with avoiding that it prevents them from living a meaningful life.

It wasn't until I recognized the role avoidance plays in mental illness that I began to see the relationship between ancient eastern religions (like Buddhism) and modern psychology.  Followers of Buddhism have recognized for centuries that mindful, nonjudgmental attention and acceptance of thoughts and feelings reduces suffering and improves the quality and meaning of life.  Modern psychology has only started to recognize this over the past 150 years or so.  Better late than never, I say.

Even though people have recognized for centuries that avoidance leads to suffering there is little awareness of this in western society in general.  We cling fast to the idea that normal = happy and that anything else is wrong and should be corrected.

For me, learning to accept internal experiences has made a radical difference in how I live my life as well as in my work with my patients.  I try to pass on what I've learned to others in the hopes that they too will pass it on.  The more people who choose to be willing to accept their thoughts and feelings the less suffering there will be in this world.

Sunday, March 6, 2011


"I've never told anybody..."
"I don't want anyone to know..."
"Nobody would understand..."
"If anyone found out..."

I can't tell you how often people tell me things like this.  They have some burden they've been carrying with them for years and it's finally become too much to bear alone.  The nature of the "secret" varies from person to person, as do the reasons they haven't told anyone.  The response when they finally share what they've been hiding for so long, however, is almost universal - relief.  They feel relieved at having someone with whom to share their burden.  They feel relieved at having revealed their deepest-held secret and not being rejected.  They feel relieved that the look of horror and disgust they expect to see on my face when I hear what they have to say never appears. 

I am no fan of secrets.  There are all sorts of negative connotations associated with keeping things hidden.  When we do something wrong as a child we try to hide it from our parents.  When an angry mother stands before her child and asks in an accusatory tone, "Who broke the lamp?" the child shrugs his shoulders and declares, "I don't know.  It wasn't me."  Nobody has to teach us to do this - it's instinctual.  We know we've done something wrong, we feels ashamed, and we want to hide it.

It doesn't change much as we get older.  Criminals frequently try to cover up (hide) their crimes.  They plead "not guilty" even when they're guilty as hell.  Cheating spouses try to hide their infidelities.  Thieves often try to conceal or sell their stolen goods in order to "get rid of the evidence."  We hide things because we are ashamed, because we are afraid of the consequences of getting caught, or both.

So when a rape victim tells no one she's been raped, when a sexually abused child grows up and hides his past from his new wife, or when a soldier refuses to talk about the fact that he killed people in battle they do it for these same reasons - shame and fear of consequences.  The difference between these and the earlier examples is that these people haven't done anything wrong.

Why fear consequences if you've done nothing wrong?  First of all, these people believe they have done something wrong.  They blame themselves, even though their blame is misplaced.  Secondly, the consequences they fear aren't prison or punishment.  Their fears are of judgment and rejection.  They fear that others will condemn them the way that they've condemned themselves.  They fear that if people know "the truth" about them they will no longer want anything to do with them. 

Shame and guilt are heavy loads to carry.  It is difficult to be happy when you feel the need to constantly punish yourself for some imagined wrongdoing.  Over time, you lose all perspective on the original incident or incidents.  All you remember is what you did wrong and what you could have done differently to prevent it (even if there really isn't anything you could have done differently to prevent it). 

Carrying secrets like these creates so much suffering.  Just the act of telling someone can be very healing.  It is, of course, important to find the right person to tell.  Some people are not able to be supportive or accepting because of their own emotional issues.  Some people are uncomfortable hearing about things over which they have no control.  This kind of person will probably not be receptive to hearing another's long-held secrets.

The other day I had a patient who had been depressed for many years.  He was engaged to a woman he loved very deeply.  He was afraid if he told her about his struggle with depression she would leave him.  Finally, he got up the courage to tell her.  In recalling the incident he said that he was shocked at his now-wife's reaction.  Not only did she not leave him, his sharing brought them closer together.  She was flattered that he loved and trusted her enough to share something so personal.  She offered her support and acceptance and continues to do so.

I suppose my message is this: don't keep secrets.  People hardly ever react the way that you expect them to when you share and the sharing itself often brings people closer together.  People rarely judge us as harshly as we judge ourselves.  Maybe it's time you heard from someone else that it's not your fault.

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