Sunday, October 30, 2011

A Personal Life Story

We all have a life story.   A life story is my personal account of all the important events and experiences that have contributed to my becoming who I am today. Because my life story explains how I became who I am it plays a significant role in shaping the way I define (and perceive) myself.

Throughout life, we accumulate an endless number of experiences, the majority of which we later have no memory or recollection.  Our brains cannot possibly store a detailed account of every waking minute of every day we are alive.  Thus, it must filter and prioritize in order to decide which experiences to preserve and which to discard.  For this reason my personal life story - my self narrative - consists of events to which I ascribe a particular meaning (and that I deem important).  The meaning I ascribe to a given event consists of the conclusions I have come to about why the event occurred and how it affected me.  Meaning is therefore highly subjective.  If someone else were asked to select the most significant events from my life, that person might create a narrative that differs significantly from the one I've adopted.

When a patient first comes to me for therapy he tells a story.  His story explains, "What's wrong?" and sometimes "How things came to be this way."  Often, his story continues to unfold over the course of several sessions until I ultimately get a pretty clear picture of how this person defines himself.  For example, one patient recently summarized the theme of his life story as follows: "Everyone I have ever cared about has either died or betrayed me.  Everything I have ever worked to achieve has been taken from me by some other person."  This short summary speaks volumes.  It tells me that this particular patient perceives himself as powerless over his environment; he thinks of himself as a victim of external circumstances and of the malevolent intentions of others.  This worldview causes him to have no hope that he will be anything other than a victim for the rest of his life.  Because "everyone" he has cared about either abandoned or betrayed him he does not trust anyone.  This prevents him from even attempting to establish meaningful relationships with others.

We allude to the themes we've taken from our personal narratives when we say things like, "I've always fought for what I wanted.  I'm not going to give up now" or "I've always been emotionally sensitive, even when I was a child," or "I've blown every opportunity life has ever given me.  I'm a complete failure."

A life story is always a work in progress.  We can always choose to add a previously forgotten anecdote that reveals our inner strength.  We can always choose to highlight our successes and accomplishments.  We can always convey our setbacks in terms of what we learned from them.  There are many ways to tell a tale - even the same tale.  When we compose our personal narratives we get to decide which events are important enough to include.  We get to connect the dots and draw our own conclusions.  In this way, we are empowered to determine how we want to define ourselves, which in turn shapes our hopes and expectations for the future.

Sunday, October 23, 2011

Why some people always insist on being right

All of us have probably known or at least encountered someone who is simply unable to accept responsibility when he makes a mistake or to admit when he is wrong.  We have probably all, at some point, known the frustration of dealing with someone who is "always right" and "never wrong."  We may have experienced the futility of trying to reason with someone like this; even when presented with irrefutable evidence to the contrary, the person continues to insist that he is right.  In situations where it is apparent that a mistake has been made (or an offense has been committed), he will blame someone else; it is NEVER his fault.  If backed into a corner, a "never wrong-er" will, for example, insist that his behavior was a justified response to being abused or treated unfairly.  (i.e., Yes, he was wrong, but it wasn't really his fault).  A person like this will not even accept responsibility for his own emotions; he will, for example, insist, "Well he shouldn't have made me angry."

Nobody likes to admit to being wrong.  However, most of us recognize that it sometimes need to be done and we do it, even if we don't want to.  So what makes the people who cannot or will not admit to being wrong different from the rest of us?  Is there away to get them to acknowledge when they are wrong and to admit when they've made a mistake?

I started thinking about this because of my own frustration dealing with someone who insist on always being right.  For me, the worst thing about having a conflict with this person is that since he is "always right" then I always have to be wrong.  I quickly started to resent being blamed for every problem that arises.  Like most people, it's very hard for me to admit when I've done something wrong.  Sometimes it takes a little while for me to recognize that I've made a mistake.  Whenever someone I care about points a finger at me to tell me I'm wrong, however, I always take some time to think about it and to reconsider my actions.  If, after consideration (and sometimes even consultation with someone I trust), I see that I've done something wrong then I admit it.  I apologize and try to identify what I need to do to avoid making the same mistake again.  Ideally, the other person involved in the conflict will also examine his behaviors and will accept responsibility for whatever part he played in the situation.  It is discouraging when this doesn't happen. 

So I wanted to know why it is so difficult for some people to admit they are wrong.  After doing some research, it became clear that different people have different reasons for doing this.  I am going to list a few of these reasons.  However, this list is by no means exhaustive.

I think that most people who always insist on being right do so unconsciously. Denial of wrongdoing is a defense mechanism that kicks in automatically whenever they are accused of doing something wrong.  When you confront them with evidence that they've made a mistake they become defensive (hence the words defense mechanism).  Exactly what is it that they are defending?  They are defending their egos from overwhelming emotional tension and anxiety.  A discussion on the theory of ego defense mechanisms is beyond the scope of this little blog post.  Suffice it to say that people get defensive when asked to admit they are wrong because admitting they are wrong would deal a serious blow to their self-worth and sense of identity.  The person could be a perfectionist who equates making a mistake with being a failure.  The person might have underlying fears of being stupid or worthless; these fears are triggered when hey are accused of being wrong.  Whatever the reason, these people unconsciously view being wrong as a threat to themselves and their identities.

It is sometimes possible to reason with a person like this.  The general rule is to proceed gently and to adopt a non-accusatory tone.  You want to address the problem without attacking the person.  If the person feels like he's being attacked he is going to become defensive and you will get nowhere.  If possible, try to give some positive feedback or point out strengths before bringing up the problem.  If the person's mis-behavior seems to be a reaction to difficult external circumstances then acknowledge these circumstances.  Let him know you understand how difficult the situation is and try to brainstorm better ways to handle it.  If there is a clear way to make amends or end the conflict then let the person know this and offer to help him with whatever needs to be done.  Make sure you choose the right time and place to have the conversation.  Let the person know you want to talk and ask him if it's a good time.  If not, find out when he's available and agree to talk with him then.

What are other reasons people won't admit they are wrong?  Well, some who refuse to fess up when they've done something wrong are motivated by the desire to avoid facing negative consequences.  Maybe the mistake was an honest one or maybe it was an intentional act of wrongdoing; either way, getting caught means suffering undesirable consequences.  How to deal with this really depends on the circumstances.  Some criminals, for example, maintain their innocence even after being convicted of a crime.  Chances are, the less you are able to prove beyond doubt that the person committed an act of wrongdoing/made a mistake/etc. the less likely he is to admit that he did it.  After all, why tell the truth if there's still a chance of getting away with it?  If you have irrefutable evidence then ask yourself this: Do you really need for the person to admit guilt?  The evidence provides sufficient grounds for implementing consequences, even if the person refuses to admit he did anything wrong.

Then there are the manipulators.  These people define right and wrong a bit differently than the rest of us.  For a manipulator, something is right when it benefits him.  Something is wrong when it causes discomfort for him.  In other words, as long as an action benefits him there is nothing wrong with it. It is quite possible that the manipulator intentionally engaged in the act that you consider to be wrong in order to gain something for himself.  You cannot convince the manipulator that his actions were wrong because he simply doesn't see it that way.  If it benefits him then it's not wrong, remember?  The manipulator also has a vested interest in persuading you to accept his alternate version of reality.  His primary motivation is to get whatever he wants; it helps is he can recruit others to assist with this goal (or at least prevent them from interfering).  Manipulators are often quite charming.  A manipulator's endearing nature tends to put people at ease, which makes them more easily persuaded (i.e., manipulated).  You will never get a manipulator to admit he is wrong; do not was time trying.

As I said, this list is far from exhaustive.  If anyone has any other ideas about why people can't or won't admit when they are wrong please feel free to share.

Sunday, October 16, 2011

Alexithymia

The word alexithymia originates from the combination of three ancient Greek terms:

a: lack of
lexis: word
thymos: emotions

and literally translates to having no words for emotions.  It is a clinical term that describes the phenomenon of being unable to express one's emotions verbally.  Someone who is alexithymic typically has difficulty recognizing his or her emotions on a conscious level; because he does not recognize his emotions, he is unable to communicate how he feels to others.  When asked how he feels about something, a person with alexithymia will often describe what he thinks or perhaps how he might respond behaviorally to the situation in question.  Alexithymics often complain of chronic pain, gastrointenstinal problems (e.g., reflux, ulcers, indigestion, etc.), or frequent headaches for which no medical cause can be identified.  When a person cannot recognize or express his emotions it becomes impossible to discharge (or process) these feelings in any meaningful way.  Experts on the subject speculate that alexithymics' somatic complaints stem from unacknowledged and unprocessed emotions that have accumulated over time. 

Dr. Reny Muller (http://homepages.spa.umn.edu/~larry/CLASS/NOTHING/READINGS/NoStorytoTell.pdf) suggests that the inability on the part of an alexithymic to express or process the emotions he experiences physiologically (i.e., the body sensations that always accompany any emotional experience) prevents him from developing a stable identity.  "Who we know ourselves to be depends heavily on the story we tell ourselves about who we are," he explains.  No words = No story = No identity. 

There really is no widespread agreement on how best to treat alexithymia.  Essentially, treatment requires teaching someone how to feel.  My personal approach is to start with body sensations.  I give patients a list of body sensations that are commonly associated with various emotions.  I ask them to spend time each day simply noticing and writing down any sensations they experience in their bodies.  Over time, I help them start to identify and name the emotion that describes a given set of body sensations. 

If you think you or someone you know might be alexithymic, you can go online and complete a short screening questionnaire: http://www.alexithymia.us/test-alex.html

Sunday, October 9, 2011

Identity Loss

One thing I've noticed over and over when working with people who have experienced some sort of trauma is how depressed they often feel.  When we start talking about the factors that contribute to the depression people often describe feeling lost and unsure of what to do to move forward.  It became increasingly clear to me that whatever trauma they've experienced has fundamentally changed who they are as as people.

Most people realize they aren't the same as they were before the trauma occurred; actually, that's often why they come in to see me in the first place.  Maybe they've recognized it themselves or maybe their loved ones have said to them, "You're a completely different person now."

What most of my patients want is to be how they were before whatever happened took place.  Unfortunately, that's simply not possible.  "You can't un-do what's been done," I explain.  Events that bring a person face to face with death make them acutely aware of their mortality.  This in itself is a very frightening and yet very profound experience.  A close encounter with death or a severe illness or injury forces a person to reconsider his perception of himself as a competent individual who is able to handle threats and is capable of keeping himself safe.  He suddenly realizes that there are many threats from which he is unable to protect himself; this makes him feel very vulnerable and defenseless.

My patients are fundamentally changed as a result of their experiences; they cannot go back to being who they were before.  This is a difficult thing to accept; acceptance take place over time, not all at once.  A person must make a conscious decision to let go of who they were without first knowing who they are going to become instead.  They have to grieve the loss of their former selves.  "I really liked who I was before," one patient lamented early in his grief process.

After that there is a period of limbo.  Creating a new sense of identity takes a lot of hard work.  A person may have to re-examine deep seated beliefs about himself, other people, and the world.  He may need to find new activities that bring him joy and pleasure.  He may have to end some relationships with people with whom he is no longer able to relate.  He may have to seek out new relationships with different kinds of people.  All of this takes time.  Meanwhile, the person feels like he is no one, going nowhere.  He is lost.

For anyone reading this who has been through a trauma, did the experience change you as a person?  Did you go through a period of grieving the loss of who you were before?  How did you come out on the other side of it?

Sunday, October 2, 2011

Becoming yourself

We are constantly in the process of creating ourselves.  A person's identity is not a fixed entity, although we often treat it that way.  Identity is dynamic and frequently changes over time.  (I, for one, am definitely not the same person today that I was, say, in high school).  An ever-evolving identity means that we are never "stuck" being some way we'd prefer not to be.  If there is some way that we want to be - confident, assertive, social friendly - we can become that way.

This is where the technique of "acting as if" comes in.  A person can act "as if" he already possesses the quality he wants to embody.  The more often he does this, the more comfortable he becomes exhibiting the desired quality.  People will respond to him as if he already possesses the characteristic in question.  Eventually, the person will find that he no longer has to "pretend;" he will discover that at some point he actually became the way he wanted to be.

People are, at times, resistant to approaching change in this manner.  They argue that it would be "fake" or "phony" to behave in a way that is inconsistent with their emotions.  I encourage those who make this argument to take a look at what is driving these emotions.  Are they based on unreasonable beliefs that were developed early in life and never re-examined?  Take, for example, a person who wants to be confident.  She does not feel confident and so believes it would be "fake" of her to pretend to be confident.  But why does she lack confidence in the first place?  Is it rooted in unreasonable beliefs such as, "I have to be perfect for people to like me" or "My feelings don't matter?"  Does it make any sense to allow our behavior to be dictated by emotions that are based on unreasonable beliefs?  Wouldn't that, in fact, cause us to behave in unreasonable ways?

The fact is, the way we define ourselves is constantly changing, so long as we don't cling to any one particular set of ideas about who we are.  Our feelings and beliefs will at times determine our behavior, and rightly so.  This should, however, be a conscious choice, not blind obedience.  If we decide our beliefs about a particular thing are unreasonable and that our emotions about it are unhelpful, we can choose to set them aside.  In this way, we avoid placing limits on who we can become.

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