Sunday, February 24, 2013

Is it possible not to have feelings?

A lot of my patients describe themselves as "emotionally detached."  Some of them tell me they've always been this way.  Others nostagically recall a time when things were different and find it disturbing that they can no longer experience emotion. 

A healthy emotional life is essential to overall well being.  Apart from enrigching our lives, emotions are important sources of information.  Emotions enable us to respond quickly to situations we don't yet understand.  They help us to evaluate new situations and unfamiliar environments.  They allow us to quickly identify what is important in a given situation and what is not; they direct our attention towards certain stimuli and away from others.  In short, emotions help us function. 

Unfortunately, they also have the potential to create significant problems.  No one (or almost no one) is born emotionally detached.  To feel is part of the natural human condition.  There are, however, circumstances and events that can occur during childhood that interfere with healthy emotional development.  There are also events that occur later in life that are so distressing that they completely disrupt pre-existing emotional processes, even for those with very healthy emotional functioning. 

Whenever I encounter a patient who has disconnected himself from his feelings I make adequate emotional functioning a primary goal of our work together.  I only occasionally get any resistance.  Most people realize that something is missing from their lives and are eager to do what they must to rememdy the situation. "You have emotions," I always assure them.  "You just don't notice them anymore."

I sincerely believe this.  I do not think it is possible for a human being to be completely devoid of emotional experience.  I do, however, believe that a person can be so detached from his emitions (for whatever eason) as to be completely unaware they exist.  If he wants to reconnect with his feelings, I explain, the first thing he must do is tune in.  But how does he do this?  What steps does he take? 

In my experience, the best strategies come from something call emotion-focused therapy.  (It's also known as process-experiential therapy).  Emotion focused therapy identifies what it calls "adaptive strategies for accessing emotion."  These strategies represent healthy ways to experience and respond to emotion:

1. Pay attention to emotion-related body sensations.  I often ask patients to set aside anywhere from one to five minutes twice a day to mentally scan their body from head to toe.  I give them a little chart and ask them to write down any physical sensations they notice in any part of their body, no matter how small.  I also given them a list of sensations that are commonly associated with specific emotions (for example, tightening of the chest for anxiety or a knot in the pit of the stomach for depression).  The goal is just to get them to start paying attention.  Emotions happen in our bodies.  We call them feelings because we physuically feel them.  All we have to do is pay attention.

2. Recall past emotion episodes.  There are a lot of different ways to do this.  I might ask someone to tell me about a memory of a time they felt happy or excited.  I might ask them to write a story describing a time they felt sad.  In any event, I try to get them to recall exactly what they felt in that moment, essentially re-creating the past emotional experience. 

3. Expose yourself to vivid emotional cues.  This could mean watching old movies of a loved one who is now deceased.  It could be describing something in such detail that a person can practically see it in his mind. 

4. Enact emotions by expressing them physically: Most emotions are accompanied by the urge to act.  Fear produces the urge to remove ourselves from danger.  Anger creates the urge to forcefully remove the object of our anger.  Anxiety is an action inhibitor and so generates the urge not to act.  Desire creates the urge to approach, possess, or consume the object of our desire.  Emotions also tend to be associated with certain facial expressions.  For people who are accustomed to suppressing their emotions, enacting them physically through symbolic action or exaggerated facial expressions can help them become more comfortable with them.

Sunday, February 17, 2013


I just wanted to update anyone who is interested...I won my appeal.  My insurance company has agreed to pay for my medication for a period of one year.  I guess after that I have to appeal again, or something.

Anyway, I've had a rough week.  I haven't been feeling well so I haven't really been able to put together a coherent blog post.  I'll be back on track next week though...

Sunday, February 10, 2013

Middle child syndrome?

My sister and her husband have two daughters.  My nieces are 7 (almost 8) and 5.  They are expecting a new addition to their family - a third baby girl - to arrive in June of this year.  My seven year old niece is excited and can't wait to meet her new sister.  My five year old niece is slightly less enthusiastic...In a few short months, she'll no longer be the baby in the family; she'll be the middle child. 

My parents also have three daughters and I happen to empathize a bit with my five year old niece; I was just shy of five years old when my younger sister was born.  In one of our family albums there's a picture of the three of us (my older sister, my younger sister, and me) on the day my little sister was born.  My older sister is holding her and smiling.  I'm sitting next to them, scowling.  I remember that day.  My parents told me I wasn't old enough to hold the baby.  I was pissed.  It's a longstanding joke in my family that this incident set the tone for the rest of my childhood. 

Maybe you've heard of something called the middle child syndrome.  Well, if such a thing truly exists then I had it, no question.  I can remember feeling like I had no place in our family.  My mother confirms that I told her as much, repeatedly. 

As an adult, it seems odd that I resented being the middle child.  I love my sisters and I'm glad there are three of us.  We each have our role in the family.  We have a close relationship with one another and with our parents.

If you ask me how being a middle child shaped my personality I'm not sure I could explain it.  I know I went out of my way to be as different from my older sister as possible because I wanted to be my own person and not just "Tina's little sister."  I remember wanting to protect my younger sister; I was quick to go after anyone who was bullying her.  Thinking about it now, it seems like I got the best of both worlds by being both an older and a younger sibling.  Yet I know I didn't always feel this way.

There is a large body of research exploring how birth order affects everything from intelligence to education attainment, from personality to perfectionism.  While traditional wisdom accepts that birth order has a strong impact on who a person becomes and what he achieves, the research is inconclusive.  Some studies suggest that birth order has a significant impact on a range of other variables; other studies find no evidence for this at all.

What I really wanted to know when I started looking into this topic was this: Is "middle child syndrome" a real thing?  The short answer is no.  There is no empirical evidence to suggest that as a whole middle children tend to feel lost, neglected, confused, or resentful (or at least not with any more frequency than other children).  So empirically, scientifically, professionally speaking, middle child syndrome does not exist.  The evidence simply doesn't support it.

Yet a quick Google search of the term "middle child syndrome" indicates that while there may be no empirical evidence to support it, society readily accepts it as a valid phenomenon.  It is a cultural myth.

And yet, don't these things tend to contain some kernel of truth?  What do you think?

Sunday, February 3, 2013

Self Forgiveness

Willingness to forgive is a trait that varies in degree from individual to individual.  Some people are so quick to forgive that they become easy to take advantage of.  Others nurse grudges for years over minor infractions.  Most of us fall somewhere between these two extremes: we are willing to forgive most people for most offenses but have identified certain conditions under which forgiveness is simply not possible. 

One thing I've noticed fairly consistently with my patients is that most of them are willing and able to forgive others but have a difficult time forgiving themselves.  Many of my patients who struggle with self forgiveness have been burdened by guilt and self blame for years.  By the time I see them, what started as guilt has become shame and self loathing.  How does this happen?

Think of someone you know (we'll call him Person A) who has a grudge against someone else (we'll call him Person B).  Whenever Person A hears Person B's name so much as mentioned he becomes angry.  He tells everyone he knows not to talk about Person B around him, but he sometimes brings Person B up himself just so he can say something mean about him.  Depending on how bad the grudge gets, Person A might go out of his way to learn things about Person B, especially things that suggest Person B is unhappy or having problems.  "It serves him right," Person A says when he learns of any malady in Person B's life.  Hating Person B can become quite an obsession if things get out of control...And so imagine this turned inward.  Imagine directing all this anger and hatred at oneself. 

Hall and Fincham offer another explanation.  When one person has been hurt by another, his instinct is often to avoid that person so as not to activate negative thoughts and feelings associated with the offense committed against him.  Often, it is possible to avoid the transgressor indefinitely: reconciliation is not necessarry, even if one chooses to forgive the offender.  This is not the case with someone who feels guilty about an offense he has committed against someone else.  It is not possible to escape negative thoughts and feelings about the offense by avoiding contact with the transgressor when one is the transgressor; it is not possible to avoid contact with oneself.  Attempts to avoid contact with oneself eventually lead to self estrangement or self destruction. 

So what needs to happen for a person to forgive himself?  According to Hall and Fincham, before a person can forgive himself he must acknowledge the wrongness of his actions and accept responsibility for what he has done.  Acknowledging wrongdoing and accepting responsibility are likely to generate feelings of guilt or regret.  This is all part of the process.  These emotions must be experienced fully and allowed to run their course, no matter how difficult, in order for self forgiveness to occur. 

This may sound simple, but true self forgiveness is often a long and arduous process.  It is typically quite painful for a person to admit that his actions caused very grave consequences.  The guilt that ensues is a heavy burden that becomes a constant companion from the moment responsibility is accepted until the moment self forgiveness occurs. 

For many people, feelings of guilt precipitate conciliatory behaviors and motivate efforts at restitution.  When apologizing to the victim is not possible, some confess their misdeed to God (or another higher power) and ask for His forgiveness.  Research suggests that people find it easier to forgive themselves when they believe they have been forgiven by their victim or by God.  Thus, receiving forgiveness from others sometimes enables us to forgive ourselves.  (Remember this next time you think about holding a grudge).

Something else that can help with self forgiveness is trying to find something positive to take away from an otherwise bad experience.  This is akin to finding the silver lining in a dark cloud.  Thus, while one acknowledges the negative consequences that resulted from his actions, he is able to take something positive from the experience as well.  Common examples of this include learning a valuable lesson, changing your priorities, or realizing how much a particular relationship means to you.

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