Monday, March 30, 2015

Manipulating our own emotions

The two disorders most commonly treated in the field of mental health are anxiety and depression.  Depression is always a disorder;  there is no degree of depression that is healthy or beneficial in any way.  Anxiety is different in that respect.  High levels of anxiety, especially in the absence of any real threat, is clearly dysfunctional.  Very low levels of anxiety, however, are not healthy either.

For instance, walking down a dark alley at 2 am jingling your keys and whistling blithely is probably not in the service of survival.  We need some anxiety to make us wary and watchful. In the absence of any anxiety at all, it would be easy to forget to make sure your doors are locked at night, or that you have changed the batteries in your smoke-detector.  A small amount of anxiety can "motivate" you, or at the least trigger your attention to potentially difficult situations.

We use anxiety to push ourselves (in the absence of cognitive motivation) to take precautions against over-spending on unnecessary items or not paying our income taxes.  We make ourselves mildly uncomfortable to get ourselves out of our comfort zone and take action when it is useful.  We do this by imagining potential problems in the near future, which triggers an anxious reaction.  For instance, we tell ourselves that if we spend too much, we won't be able to make the car payment and that the dealer will repossess it.  That thought arouses our anxiety, and we then make a plan to do something about it, and as a result our anxiety decreases. Or we might tell ourselves that having too much to drink at the office party might result in behaving badly enough to affect our employment, so we decide to limit ourselves to one drink.

Recently a patient told me that when she hasn't had any fun or excitement for a while, she begins to get restless, and thinks about "going  shopping", which is always fun for her.  Her income is extremely limited, and she is aware that if she spends much money she could have a serious problem in meeting her bills and rent.  So she tells herself something like the following:  "It doesn't matter if I spend too much, I can always work it out somehow.  It will be fine! Stop worrying!  Nothing bad will happen!".   As a result her anxiety drops.  Since she has always used her anxiety to control herself (instead of cognitive decision-making) there is now nothing to stop her, and she spends recklessly.  

Most of us use our anxiety to limit and control our behavior, so when we drive our anxiety down through denial and rationalization, we lose our limits and our willingness to control our behavior.  The more we rely on emotion and "motivation" to control ourselves, the more unsafe and unwise our behavior can become when our anxiety is too low.  Of course there are other ways to lower anxiety below the useful point:  we can drink too much or use drugs.  Even under these latter conditions (drugs and/or drink) we have used self-talk to deny the negative possibilities resulting from drinking or using drugs, so our anxiety-provoked defenses become non-operative.

An alternative is to make cognitively-based decisions.  These are decisions reached through rational and non-emotional thought.  They require data-based information and accurate appraisals of possible outcomes.  When we need to make a decision, we can set our emotions aside and consider the real issues and potential outcomes, not just what we want to imagine. We can take  a longer view of possible outcomes and consider them as well.

I remember telling my children when they were in the early years of adolescence that the time to make a decision about sexual behavior was at home in the afternoon and sitting in the living room, not in the back seat of a car after kissing and fondling for an hour or when under the influence of alcohol.  Emotion-based decisions are always remarkably short-sighted. That's fine when you're choosing a movie to watch or a flavor of icecream.


Sunday, March 29, 2015

Group Prejudice

I believe that much "racial" prejudice is not racial at all.  It seems much more likely to me that there is developing an increasing conflict between socio-economic classes, specifically the middle- and working class people and the "gangsta/rebel" groups.  I say groups because they are belong to all "ethnic" groups in all kinds of neighborhoods.

The gangsta-rebel groups function like all groups.  They emphasize differences between those within their groups and everyone else.  These differences are deliberately exaggerated and are intended to antagonize those in other groups.  Their language, dress and behavior are deliberately well outside the bounds of what the middle-class groups would find acceptable.  Even their music flaunts vulgar language and concepts which are alienating to those outside their groups.  Consider "rap" music, droopy pants, caps worn at a specific angle, public language in songs and on stage, and public behavior:  all designed to antagonize and alienate, thus emphasizing their refusal to belong.  They feel that they refuse to belong rather than that they are denied admission.

In general all groups tend to emphasize their differences from other groups.  The "gang" mentality existed long before gangsta garb and behavior was so public.  If you can't belong to a desirable group, you can refuse to belong, and in that way take more control of your life.  "I don't want to belong to your group" is better than "I'm mad because I can't get it".

There are larger and larger segments of our population that are excluded from middle-class socioeconomic culture because of the economy and the difficulties the impoverished have in obtaining a decent education and well-paying jobs  Yet they like all of us need to belong.  The less they have, the more they "need" each other.  The more different and antagonistic they are, the more the middle-class have reasons to exclude them. The more they are excluded, the more difficult it is for them to get the education and jobs they need.

The system becomes self-sustaining.  I need to be different because I can't belong;  I can't belong because I am different.  The middle-classes exclude them because they are rebellious and "different. And so the alienation and antagonism grows.

The police are seen as the enforcers and hirelings of the middle classes.  They are more the "enemy" than the protectors.  The lower classes become more excluded and powerless, and the groups within them become more important and stronger.

The saddest part is that we attribute this group rivalry to ethnic issues rather than seeing the rebellious and resentful issues that group rivalry itself causes.  The gangsta groups tend to be associated with the ethnic groups to which a majority of them belong.  We mistake consequence for cause. We lose sight of individuals for the suit they are wearing, which is at least in part what they wish.

Monday, March 23, 2015

Trust and infidelity

Many times couples come to see a therapist after one of them has had an extra-marital affair.  The question asked (usually by the wronged partner) is "how can we rebuild our relationship" which usually resolves into a different question:  "How can I rebuild my trust in my partner again?"  Of course, the answer is that you can't. The wronged partner will always have the knowledge that their  partner broke their word and obviously is capable of breaking it again.

The reason they struggle so hard with this question is that it is the wrong question.  As asked, it  is unanswerable.  There is no way to undo what someone has done.  No amount of apology or explanation or resolves to "do better" can change the past.  An important contract between the two people has been broken.  It cannot be repaired, but a new contract can be forged.  "Forgiveness" is not the issue, because you can't stop knowing what you now know.  However, grieving is painful, and resentment and anger are "easier", so sometimes the question is:  Is the wronged partner willing to let their anger go, grieve the lost "trusting relationship" and build a new one?  That's not a simple or easy question.  What's important is to recognize that there is nothing the unfaithful partner can do about it.  Trusting is ALWAYS up to the truster.

It is important in ANY contract to know what are the conditions in which the contract is broken, and what are the consequences?  When this issue is addressed AFTER  the contract is broken, the genuine issues as to consequences are heavily overladen with emotion:  anger, grief, fright and sadness.  It is much more healthy to make such decisions about the contract at the start of the serious part of the relationship.  One should ask (and be asked) what are the "deal-breakers?"  Finding out what the consequences of a broken contract after the contract is broken is very difficult.  Boundaries are best defined before they are broken.

But be that as it may, answering the "right question" is difficult in a different way.  The right question (or questions) for the wronged partner are something like:  Do I want to continue this relationship, even though it has been damaged?  If so, under what conditions do I want to do this?  And what will be the boundaries?  For the unfaithful partner the question is more on the order of:  What kind of contract can I keep?

It must be recognized that trust is a gift given to the other person, not something that must be earned by them.  The trust you give to someone is your gift to them.  Once broken, there is nothing they can do to repair it or get it  back.  Trust is up to the truster, not the trustee.  The truster must make their own decision, knowing their partner, whether the relationship is worth trying to salvage.  The old relationship is forever changed.

Trust, once broken, is no longer salvageable by promises or even good behavior.  One can, however, be clear about the conditions under which the relationship will be continued, if it is to be continued.  The power in the relationship is now in the hands of the person who was wronged.  The old relationship is dead and must be grieved.  A new contract must be written, and a new relationship built with eyes wide open.

Of course this is possible, though difficult.  The key to the success of such a project is at least partially dependent on whether the parties know clearly what the conditions of termination are.  The partners both have to recognize that they are helpless to protect themselves against the possibility of dishonesty, and there is no assurance that it will not happen again.  They are starting again, but this time knowing a little more about each other, and hopefully knowing what and where the boundaries are.

Friday, March 06, 2015

Bearing Witness

As I look backward over a long life-time, I can see what seem to me  important changes that have lowered the quality of life.  I want to discuss one of these with you with the hope that you might have the ideas that could lead to change or perhaps just to help me understand this issue better.

One of the changes that I  notice, probably because I'm a  psychotherapist, is that with the increased splintering of family structures and the increasing distance in relationships, we are each more alone than in the past.  Many people in my age bracket (antique) grew up in families where at least one parent did not work but remained in the  home.  Children had more supervision and attention and also had more opportunities to learn.  In addition, they had someone to whom they could turn when they were troubled.  Now they turn to each other, with frequently disastrous results, especially if they learn to medicate their pain with drugs.

I think that we seem to be losing the sense of having someone in our lives who understands us and our problems, who is kind and sympathetic but who does not direct or chastise.  I think of my grandmother, for example.  She did not offer to solve my problems, but she knew many of the things that troubled me and understood them.  It seemed to me important that this occurred, and even now, so many years later, it still seems important.  What she did is what I call "bearing witness".

I recall while away from home going through an especially troubling conflict which left me anxious and grieving.  I was sitting in the lobby of a hotel, trying to gather my thoughts.  A good friend who was staying in the same hotel was passing by, stopped and looked at me closely, and said "You look troubled."  I agreed that this was the case.  He sat down and said "I don't know what troubles you, but I think I will just sit here for awhile with you."  And he did so.  I experienced this as both very kind and also helpful in ways that are hard to quantify or explain. Yet the experience remains vividly with me over 40 years later.

The experience is similar to "sitting with" someone who is grieving.  They don't need problem-solving skills or "reassuring" comments.  What they (and we) need is someone who is willing to bear witness to our pain and to treat it with respect and tolerance.  I believe this is a very important thing that humans can do for one another.

It is this "bearing witness" that I believe we are losing.  More and  more often I find myself as a therapist simply bearing witness to the pain of another.  The issues are not "therapeutic".  They are simply the need for someone in pain to have that pain recognized and respected.  Since they are unable to find a grandmother or good friend, they hire me to be their witness.  The most important thing I can do for them is to be quiet and wait with them, not to attempt to comfort or problem-solve in a vain attempt to minimize our own discomfort with their pain.  Distancing ourselves from those in such pain is not helpful.

What a shame that we are reduced to hiring friendship or a quasi-uncle to provide for such a simple and basic need!  We shouldn't have to hire a psychotherapist just for simple human contact.  Nor should we think all our sorrows should be managed by changing our attitude or taking a pill.  Unhappiness is not an illness or a neurosis. It's just part of the human condition.