01 Mar

Relationship Anxiety

When asked why life is stressful, we often talk about the demands of work, the responsibilities of being a parent, paying our bills and so on.

Yet, as I discuss here, every time we interact with another person it introduces an element of uncertainty into our lives, and under certain conditions, can generate remarkable levels of stress. This article examines the fundamental basis for this stress response and how it  connects to conflict, anxiety, and depression.

At a general level, there are many similarities between people in how they experience their self, others, and the world. Without such commonalities we could not communicate, share ideas, work together towards goals, and so on.

But I don’t think we properly appreciate the remarkable quality or quantity of  the differences which exist between each and every one of us, in how we are experiencing this thing we call reality.

Neither do we properly appreciate how those differences impact on our relationships with others. Let me expand on this further.

From moment to moment, my experiences  of the “me in here”, the “you over there”, and the “world out there”, comprises my reality. That experience provides the basis for what I believe, and how I live my life. I must be able to trust this.

Trusting that my perceptions are accurate is as important for me as it is for you.  Yet surprisingly, none of us experiences or interprets “reality” the same way – ever.

Even at the same moment in time, and same physical location, someone standing next to you, looking at the same event will be having differing experiences from yours.

Indeed it is quite possible the two of you could be having experiences so dramatically different you would never even know you were in the same room.

Nonetheless, both of you will be experiencing your own personal reality; a reality which is true for each of you, but not the same for either.

Thus when two people start talking to each other, they are always expressing their personal version of reality to each other.

Every interaction I have with someone introduces me to a version of reality different from mine; sometimes similar, sometimes diametrically opposed – never the same.  Both of us will assume that our view of reality is true.

So what happens when one person’s perceptions and experiences of reality, their truth, comes up against another person’s perceptions and experiences, and those truths do not match?

Every time this happens, we experience some measure of anxiety; a response which is often so small it is unnoticed.  Sometimes however, this anxiety response triggers a large alarm.

The answer to the question as to when is the alarm small and when is it large is, “It depends”.

If we happen to be engaging in “small” talk, differences in our experiences may seem inconsequential such that the alarm bell will be essentially silent.

But if two people present each other with differing experiences of reality that have high personal importance where there is a need to be right about one’s perceptions,  the alarm bell will be loud, and each person will begin to experience strong emotional reactions. It is here that the possibility for conflict begins.

This can become painfully obvious when disagreements occur with those we are supposed to feel safe with, or to whom we are “close. Depending on a complex array of personal, relational, and situational dynamics, such disagreements may lead to aggressive argument or even conflict, or they may eventually be peacefully negotiated. Whether we like it or not, conflicted disagreements threaten the fundamental assumption of trust we work so hard to establish in our close relationships, which was one of the primary reasons for having that relationship in the first place.

What is fueling this conflict  is not simply the subjective differences in opinion.  Rather, the conflict is being energized by a challenge to each person’s perception of reality, which links directly to our fundamental need to know what is happening around us and to be able to trust those perceptions.

Interestingly, for some people, their fundamental sense of security concerning their own perceptions is strong and robust.  When their perceptions of reality are challenged by others their reactions are well controlled and relatively calm.

For others however,  their fundamental sense of security is weak and fragile.  Their reactions when their perceptions are challenged can be quite volatile and even aggressive.

Why some people are secure while others are insecure is complicated.  Why some issues in particular press “hot buttons” for some people and not for others is also complex and neither issue can be properly covered here.

What I do want to emphasise is that If threats to our beliefs about what is right, true, and fair are constantly occurring, then even the strongest amongst us will begin to more experience mounting anxiety.  And if this continues over an extended period of time we will begin to experience chronic stress with all of the associated symptoms.

If we have no solution to this chronic threat we will begin to burn out.  Eventually we will begin to experience depression.

Please read my next post, Relationship Anxiety (Conclusion), for my closing remarks.

22 Dec

Anxiety and Depression: A Fundamental Difference in Treatment

“Yes, there are two paths you can go by
But in the long run
There’s still time to change
The road you’re on
And it makes me wonder. ”  (Led Zeppelin – Stairway To Heaven)

Helping someone who is psychologically unhealthy become normal, is not the same as helping them become healthy. In this article I want to highlight this distinction and, in so doing, demonstrate the differences in the underlying assumptions, therapeutic efforts and expected outcomes between these two approaches.

While much of our suffering in this world arises from physical  pain, the overwhelming majority comes from emotional/psychological pain.  These experiences have numerous labels such as unhappiness, sadness, fear, anxiousness, loneliness, confusion, and so on.

We all have such experiences. In and of themselves they are well within the “normal” range of experiences and usually dissipate in a short amount of time.

But when they don’t go away, when we cannot get ourselves out of such states and they begin to adversely affect the quality of our life, or if we have have never been able to enjoy life because of them, it seems perfectly reasonable to try and do something about this.

In an effort to make the pain go away, or at least hide it, some people try using alcohol or drugs, some begin to work longer hours, look towards another relationship, start gambling, or any number of other possibilities. If those solutions ultimately do not work, and don’t destroy us, and we are willing to believe someone else can help us, then we might seek professional assistance.

So where are we likely to go for help, what kind of help will we get, and what will we be helped with?

In our society, the primary options recognized for mental health concerns are medical and psychotherapeutic.  Depending on which of these choices is made, there will be important differences in how your suffering is going to be viewed and treated.

Within the standard medical/disease/pain model of illness, such suffering is typically understood to either cause or be caused by an imbalance in our brain chemistry which adversely affects how we think, feel, and subsequently act. Given this level of understanding, it is not surprising that numerous types of drugs have been developed to address such imbalances.

If you go to your GP, family doctor, or a psychiatrist, for the most part they will suggest one of several medications designed to increase, or decrease, the amount of certain neurotransmitters in your brain depending on how your problem is diagnosed.

From the psychological model of illness, while these experiences may indeed have neurochemical correlates, the primary source of the problem is typically understood as flowing from disturbances in our thoughts and feelings.  Given this level of understanding it is not surprising that individual psychotherapy is mainly oriented towards modifying how we think about ourselves and our life, with the implicit understanding that this modification will also affect how we feel and act.

While there have been literally hundreds of therapeutic approaches developed over the years, the dominant therapy today is Cognitive Behavioral Therapy.  As you might surmise, it is designed primarily, to modify how you think.

While these description and explanations are highly simplified, it is nonetheless the case that both the standard medical and psychological approaches follow a similar line of reasoning that goes something like this: because you are suffering, there is something wrong which requires correction. This correction will be considered successful when you no longer report feeling depressed, anxious, stressed, and so on.  In other words, success is measured by the removal of your symptoms.

Certainly these approaches seem sensible. After all, suffering is difficult and painful, and when we hurt it is natural to want to get rid of this pain.

But given that we are seeking treatment from people designated as having expertise in the field of “mental health”, do these approaches actually help people become mentally and psychologically healthy?

If we view the function of mental health experts as offering services designed to help us think, feel and act “normal”, then providing assistance in removing symptoms defined as abnormal fits that definition.

But if one views mental health as referring to an ongoing process of psychological development and maturation, then they do not: removing symptoms or altering how we think offers no avenues or directions for learning – it encourages no growth.

I do not consider being normal as equivalent to being psychologically healthy.  In my experiences, most people seem primarily interested in trying to be comfortable and secure, even though few actually seem to achieve this.  Scratch just below the surface and most people become anxious and uneasy, being very careful about what they let out, and what they let in.

So much of what we are seems to flow from fear.  Directing our energies to protect our self from harm, whether real or imagined, ultimately leads to an orientation in which we avoid, rather than embrace life.  Shutting down rather than opening up is a natural consequence; no wonder we hurt

In keeping with this observation, I would argue that much of what we call “being normal”  is actually unhealthy; a general condition where the particular ways in which we think, feel, and act, actually impairs our growth, and in so doing creates suffering in our self, and unfortunately, also creates suffering for others.  To the extent that this is true, attempting to return people to normal offers a very limited solution to our suffering

The sad part here is that we do not see how much of our suffering is related to how we live and act in our normal lives.  Mainly, we do not seem to recognize the fear-based ways in which we view our self, others, and our world.  Since we seem to possess such a poor understanding of the role this plays in creating suffering, our responsibilities and capabilities for resolving this are also limited.

Unfortunately, rather than waking up to this condition and finding constructive solutions that could benefit our self and others in our world, we are encouraged to remove or ignore that pain, and almost every other experience we find to be difficult. This, I believe, is a serious conceptual mistake supported by the prevailing medical and psychological framework.  There is little chance we will find lasting solutions through such avenues.

Rather than simply getting rid of this pain, we need to learn from it. Our suffering needs to be re-conceptualized as providing us with a powerful source of motivation for learning about this suffering, and the harmful consequences of our normal ways of doing things.  With these experiences as our teachers,  it  can also provide us with the right motivation for learning how to properly nurture our growth and development.

Otherwise, it seems unfortunate that once we have gone for help, the very motivation which drove us to seek assistance in the first place cannot be put to more productive use than to remind us to take our pill or practice thinking differently.

28 Oct

Depression and Anxiety: All Roads Lead to Rome, Don’t They?

Over the course of twenty plus years I have worked with thousands of individuals, a good number who either report as being depressed, or anxious. The really odd thing is, that other than having somewhat similar symptoms, these people were so remarkably different from each other I wonder if we (those who label and treat others) might often be guilty of a fundamental perceptual error.  Let me explain. Read More

31 Mar

Being Here: Depression, Stress, Anxiety and All (Part III)

In previous articles on Mindfulness,  I have suggested that most people  have only a limited awareness of their own experiences.  Rather than utilizing our capacity to be aware of and learn from those experiences we are effectively blind to most of them, and don’t even know we are doing this.  This article examines one of the implications of how this limited approach to our own experiences effects our lives.

My “world” as I know it and respond to it comes from my experiences of  that world.   Similarly, who “I  am for you”  is the sum total of  the many complex and varied experiences you are having of me when we are together and how you act towards (or against me) flows inexorably out of those experiences.    While those momentary experiences and actions arise as a result of a vast number of  historical, social, biological  and intrapersonal factors, I am concerned here with the degree to which we are more or less conscious of  those experiences.

If I am not conscious of who you are for me, then what do I really know about you?  What can I say about you? If I am not conscious of my experiences of you in the moment of our being together and of my reactions to being in your presence, then what  sense can I make of those reactions and how could I possibly explain them to you if you asked.

From a larger perspective, if I am out of touch with how I am experiencing you and how I am experiencing my world,  then who am I?  And if my life is not working for me, or I want to improve it, how can I even begin to start making informed and wise choices about this.

Generally, when our world or relationships are not progressing smoothly we try to “think” our way through this.  We sit down with our self and try to rationally assess what is going on, how we have behaved or reacted to a situation, what others have done to us and so on.  While this effort is better than simply blaming someone or something else, or not even worrying about what has happened, it is unlikely to be of  much help in actually addressing the situation.

Trying to recollect and think about such complex and complicated processes after they have happened is a notoriously problematic way of making sense of events . If you have not been paying close and careful attention to your experiences as they were occurring, you will have to reconstruct them from memory.  Trying to recall what happened some time ago and then converting that limited and selective information into a certain form of rational-logic we call thinking has to result in a distorted if not inappropriate assessment of the situation.

There is a very high probability that the choices and actions flowing from this process will lead to further complications and/or conflict and then it becomes even more difficult if not impossible to resolve. Such is the situation most of us face on a daily basis.

If  I am confused about who I am, who you are and what I am doing, and you are equally confused then what kind of relationship can we have?   How can I possibly relax with myself  in a world that fundamentally doesn’t make sense.  No wonder people feel anxious and can eventually get depressed about their life and their relationships.

Surely there has to be a better way.

I think there is a better way, a more useful and productive path to follow and hope that the articles on Mindfulness will begin to present that way.  I encourage feedback and responses to what I am writing and  look forward to some dialogue on this issue.

09 Nov

Lies and Uncertainties

Trust versus mistrust. Perhaps this capacity is the greatest factor in determining whether someone can truly enjoy their life and love, or whether they spend it in survival mode and fear.  Almost assuredly if we are to be happy we have to be able to trust another, and trust our self.  This article considers this distinction in more detail.

One of the frequent complaints I hear from patients in my practice concerns their difficulty in trusting people.  When this issue arises my first question to myself is directed at the possibility that there is something I am saying or doing which may be triggering this issue at this time.

Following my own inquiry, I then ask the patient to explore this issue in more detail and eventually inquire with them directly about my own actions.  If there is something amiss between us then we have an opportunity to work this out until hopefully, it is resolved.

Typically however, the complaint being expressed by that person is in reference to the “masks”  people wear or the “games people play”.   I think it is generally true, that in order to function in our complicated world, that people do this.  For some it is simply part of being human in a complex world, while others really are two-faced and manipulative.

Generally my own experience of such behaviours is not one of alarm or disgust but rather an acceptance that this is what we do.  For many others however, the varying roles adopted by others seems almost overwhelming, generating such discomfort in the person that they cope by either withdrawing or becoming confrontive and challenging with the other who is seen as being false.

What I typically wonder about is whether these sensitive individuals have developed those fear responses because they have learned form their experiences early in life that people they should have been able to trust were not actually trustworthy? Did they find, perhaps in their family of origin, that parents said one thing but did another? Was it because the child was made the scapegoat for the parents frustrations with each other, or might there even have been emotional, psychological or sexual abuse involved in the name of love?  Even if the parents were fairly straightforward and reliable, what about teachers, family relatives, clergy, or others in authority positions that may have betrayed trust?

The complaints of these patients have profound implications for their day to day interactions with others, and in terms of their own self.

Obviously if one does not feel sure about another, about their motivations or intentions, it is impossible to relax. Always the doubts are swirling and questions being raised – “What does he mean by that”?, “What does she want from me”?, and so on.

There is no room for trust, and a limited or distorted ability to experience or give pleasure in being with someone.

As for the person them self, the constant inability to relax means a chronically heightened level of stress and anxiety creating a wearing on their body.  There is an overuse and draining of their energy supplies all being funnelled towards one particular goal of trying to read between the lines and assess if they are safe or not.

From this place of fear and doubt there is little we can learn from others that is positive and helpful.

When our psychic energies are primarily and singularly directed towards to checking the motivations of others there is little energy available to be directed towards our psychological growth and development.

Across time it means the separation between our chronological age and psychological age widens disproportionately – we get older but no wiser.  In effect we become increasingly immature.

As I have presented in other articles, this failure to grow is a primary source of suffering, often reflected in depression, anxiety, and relationship conflict.  It is a very unfortunate price to pay due to the sins of others, and it is a horrible and sad way to waste a life.

30 May

Personality Disorders Versus Neuroses

Over the last 30 years, numerous empirical studies have suggested it is possible to arrange defensive mechanisms into a hierarchy of relative psychopathology beginning in severity with “psychotic defenses”, and ranging through “immature defenses”, “intermediate defenses”, and finally, “mature defenses”.  This article considers the immature and intermediate defenses. Read More

24 Jan

The Development of Personality Disorders

In an effort to explain the different psychological and behavioural profiles between the diagnostic categories of “personality disorders” and “neurotics”, current clinical thinking and practice offers a neuro-social model of psychological developmental.

The heart of this model is that there are fundamental differences in the character structure of individuals associated with these two diagnostic categories which originate from the early stages of neurological and psychological development; a position supported by increasing evidence in genetic-biological studies as well as psychodynamic-psychoanalytic research.

This model suggests that during the early years of childhood, a predictable and invariant sequence of distinct and increasingly complex psychological stages accompanies normal brain development. As each successive stage unfolds, unique psychosexual, cognitive, moral, and affective capacities come into existence; the emerging combination of which produces noticeable developments in the personality of the infant.

If a sufficiently healthy environment is provided for the child, then the fundamental groundwork for a normal healthy adult will be laid. However, should trauma occur during any of these stages, pathological development results which if not corrected early, will manifest in personality disturbances in later life.

Accordingly, when trauma occurs during any of the stages of development, a variety of physiological reactions are triggered within the child.

The greater and more prolonged the trauma, the more these reactions occur.

It is hypothesized that these charged physiological states induce lasting neurochemical alterations in brain chemistry, produce significant modifications in neural connections between and within various brain structures, and also become encoded into the existing memory system of the child.

Not only do children develop different neurochemical and psychological processes in response to trauma, but every subsequent stage of mental and emotional development will be affected by these changes.

Over the years and into adulthood a psychological structure still develops, but it is a structure based on neurological and psychological distortions reaching far back into the infantile stages of development.

Based on this reasoning, the earlier that trauma occurs, the greater are the number of subsequent stages of development which will then be affected, and thus the greater and more serious is its effect.

Thus, an individual diagnosed with a personality disorder is understood to have suffered some form of trauma at an earlier developmental stage than the neurotic because their emotional and cognitive processes are generally more poorly developed, their defense mechanisms more immature, their behavioural responses to stress typically less effective, and their relational capabilities more limited.

What is of most importance to emphasize from a psychological perspective however, is that the degree to which the diagnostic categories of personality disorders and neurotics do reflect real and enduring differences in character structure, then specific treatment approaches are also required.

For example, psychoneurotic versus borderline depression and anxiety are two very different phenomenon, each requiring different treatment modalities. The same is also true for reports of relationship disturbances, self-esteem issues, mid-life crises, and almost every other psychological symptom which people experience.

Any effective and appropriate intervention thus depends upon an accurate diagnosis. This in turn rests upon a skilled understanding of the particular types of needs, motivations, cognitions, defense mechanisms, and pathologies presented by the patient which reflect disturbances originating during specific and identifiable stages of early development.

It is the failure to recognize this fact that has led to many unsuccessful therapy hours which have been frustrating for both the patient and the therapist.

24 Jan

Resisting Change in Psychotherpay

“A world that can be explained even with bad
reasons is a familiar world”. (Camus)

People seek the guidance of a therapist when there is disruption and distress in their lives and their usual self-limiting, risk-avoiding way of operating are not paying off. Such patients arrive full of fear, pain, and turmoil expressing strong and genuine wishes to deal with their situation. As surprising at it may seem however, most of these people are not truly serious about actually doing something to change. Rather, their primary motivation is to get the pain to stop.

Read More

10 Jan

A Therapist’s View Of Human Suffering

“We are the hollow men
We are the stuffed men
Leaning together
Headpiece filled with straw. Alas!Shape without form, shade without colour
Paralyzed force, gesture without motion;…”
(“The Hollow Men”, T.S. Elliot)

Across the years of offering psychotherapy  with thousands of patients, I have been continuously struck by one remarkable and puzzling phenomenon. Almost without exception, psychotherapy patients seem to have tremendous difficulty in presenting the subjective experiences associated with their reported problems.

For example, they might say they are sad, but they smile; they say they are angry but they cry. At first glance, this may seem to suggest an intentional hiding or distorting of what they actually feel, a willful attempt to disguise or hold back.

In fact, this is not the case.

Let me try to clarify.

At the start, most patients are eager and willing to “talk” about their problems: their careers, their spouses, or whatever else they feel is causing distress in their lives. With a little encouragement most are also willing to “describe” their feelings surrounding these events; “I feel depressed”, “I feel angry”.

But these same people are very cautious and even reluctant to allow these experiences to actually manifest in our sessions (i.e. they say they are angry but they appear very calm). And sometimes, when feelings actually do surface they are often not congruent with what the patient described (i.e. they say they are angry and smile at me.)

But why should this happen? Why should a person who may have been suffering for many years have such difficulty in actually allowing that suffering to be present during our sessions? And why, when certain emotions do show through, do so many patients seem embarrassed or anxious, as though something slipped out that wasn’t supposed to.

This apparent difficulty and reluctance in presenting more than a superficial amount of one’s subjective experience to another is not an uncommon phenomenon, and is certainly not restricted to the interaction between therapist and patient. Rather, it seems to me quite clearly a “normal” quality of social life, an accepted and expected part of our day to day interactions.

Ask someone, anyone, how they truly and deeply feel about themselves, or their partner, their parents, or you, and see what happens. Not far beyond the simple explanations, the pat answers and the clichés, there seems to be an amazingly sensitive and protected area of subjective reality; a restricted access zone seldom offered to anyone.

The significance of this issue is not simply that we are careful about letting anyone get too close to us. Rather, it is that we are remarkably uncomfortable about even letting ourselves get too close to us. As strange as this may sound, clinical and personal observation confirms that we are basically and fundamentally uncomfortable with , if not afraid of ourselves; with precisely those experiences that centrally define what it means to be ourself.

In truth we don’t know what we really feel because we won’t allow ourselves to feel it. We don’t show this to another because we can’t.

Depending on your relationship to your own subjective reality this observation may seem puzzling, perhaps even inconsequential. But it is not. Consider this following observation by Rollo May, a psychoanalyst in New York City, who defines the chief problem of people in the 20th century as “emptiness”. As he describes it,

not only do many people not know what they want, they often do not have any clear idea of what they feel. When they talk about their lack of autonomy or lament their inability to make decisions, it soon becomes apparent that their underlying problem is that they have no definite idea of their own desires or wants. Thus they feel swayed this way and that, with painful feelings of powerlessness, because they feel vacuous, empty”.

Indeed, the significance of this phenomenon has been recognized, discussed, and debated for hundreds of years by every major thinker of the human condition from Kierkegaard, to Rank, Jung, Freud, and Maslow, as each has attempted to explain this curious and remarkable fact.

The real world significance of this issue is far reaching. Regardless of whether we are talking about personality disorders, depression, anxiety, physical illness, domestic violence, or social unrest, there is always some connection back again to this central aspect of the human condition. Call it alienation, existential anxiety, repression, disassociation, emptiness, or any other term that points in this direction. The failure to recognize and deal with the fact that we are all strangers to ourselves, and by extension,  with others, has lead to immense human suffering. This is a remarkably complex subject requiring considerable clarification. In subsequent issues I will present some of these ideas in more detail.

14 Dec

The Remarkable Thing About Anxiety

It has been clear to psychologists for some time that anxiety lies at the heart of most patients’ difficulties. In many cases, people come for therapy because they are afraid of aspects of their world or their own experiences that only mildly affect others or even seem harmless to them. One example that fits into this category are the various phobias people report and these cover an immense range of feared events such as flying, elevators, animals and so on. In such instances our work together consists of finding ways to overcome such fears so as to live life more freely and enjoyably. Read More