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.

16 Jun

For Crying Out Loud

Several years ago I was seeing a young woman in my practice who was struggling with depression following the recent death of her mother. In spite of how sad and distressed she looked, she seemed to be struggling to let herself cry.

When I commented that she seemed to be having difficulties accepting her feelings, she responded that this was not actually the problem for her.  Rather, she was concerned that if she truly expressed what she was feeling, other people in the building would hear her and wonder if something was wrong, if perhaps she was being attacked.

She didn’t want to just cry softly.  She wanted to yell and scream and protest that her mother died too young and her loss was too painful to bare.  She wasn’t able to do this in the privacy of her apartment building, and she was also worried about doing it here. She was afraid that if she released this in my office someone might alert security or call the police and she didn’t want that to happen.

I sat in my chair for a while watching her closely and thinking about what she had said.  I could understand she was holding a lot inside and if she let it out it would probably burst like a damn and flood the room.  I was pretty sure I could listen to all of this, but I could imagine that people out side might indeed wonder what was going on and be worried.

I began to think where this woman could go and yell as loudly and as long as she wanted without worrying how others would respond. The more I thought about this the more I realized her concerns were quite valid.

It seems to be remarkably hard in our society to simply and freely express what is in our minds and in our hearts.  Even with loved ones in the privacy of our own homes there always seems to be a limit to what we can say.

Sometimes we just need to let things out.  Sometimes we just need to know that someone cares enough for us to listen to what we have to say, however we say it and whatever it sounds like. Not because we want them to fix it; we just don’t want to hold onto it any longer.

It is not just having a place to express oneself  that is important, but also learning how to do it in such a way that we can truly listen to ourselves. When we cannot experience we cannot learn. As we learn to trust rather than fear ourselves, we experience the freedom to explore further, and so we learn and grow.

When we are afraid to let others hear us it adds one more level of complexity to the already difficult struggle of finding out who we truly are.  The fear that we cannot let ourselves out anywhere to anyone is a disturbing and distressing reality.

If there is any fundamental action I try to encourage in the people I see in my practice, it is for them to find a way to express what could not be expressed before. Most people have not allowed themselves to do this since they were a child.  As adults, most people cannot do it now even if they are given the chance. And they don’t even realize it.

Without this growth there will always be pain and suffering in your life.  Although, even with growth, there will be pain.  But the pointless of it all will end. And when we activate our own compassion and acceptance for that suffering, we will  discover some of the most important lessons life has to offer.

19 Jan

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

The only reality we have is this living moment. The only possibility we ever have to make a different choice, to alter a course of action, or to change our mind, resides in “this” moment. Yes, we can plan on doing something tomorrow, but both that decision to wait and the action itself when it occurs will be choices made in present tense, “now” moments.

Oddly, it seems to me for most people the significance of “this” moment, pales in comparison to how important we consider our past and future to be, and our absorption in the “world out there”.  This certainly seems to be true given how much time we spend in reviewing yesterday, planning for tomorrow, and looking at screens in front of us. Indeed for most people, the very notion of “being aware of this” moment seems to have almost no meaning, and subsequently  almost no value.  This is a shame.

In order to grasp the profound implications of this, it is important to first understand an interesting quality of the human mind.

Let me begin by noting that most people are only nominally tuned into the thoughts they are having at any given point in time, their current emotional and body level feeling states, running memories, decision making processes, and most of the impulses which drive the actions in which they are engaged.  As such, they are not conscious of  most of the essential  experiences one could describe as being “me”. 

The fact of the matter is that almost everything we do is done with very little awareness. A very large percentage of our day is spent on automatic pilot, and only in very particular circumstances do we actually “wake up”  and pay attention to what we’re doing.

And yet, for the most part, none of this is a problem.

Our essentially non-conscious self system functions like this because we have already practiced and learned how to behave and respond to our life during our many years of growing up.  As one example, having learned to talk a long time ago I don’t have to start relearning every day. The same goes for driving my car, shopping, interacting with others, and on and on.

But what happens if I have to do something different than what I’ve learned to do? What if my ways of being in the world aren’t working for me and I have to utilize more adaptive and productive behaviours? Somehow I have to be able to override the purely habitual and automatic quality of those learned responses which are not working for me, and modify or adapt them to become proper and effective responses.

But here’s the rub; I cannot change something if I am not aware of what I am doing. If I have any hope of being able to change or over-ride my cognitive and emotional responses and reaction patterns,  I have to be  aware of them in the moment of their activation.

But if I am am right in my previous assertion that most people spend too much time not being present to “this” moment, then herein lies the problem.

If my previous life lessons were inadequate in some way, it will be the automatic behaviours that flow from those lessons that will lead to my  constant bumping and scraping up against this life, and inevitably creating varying levels of distress for myself, and for others. Given that my choices and actions didn’t work the first time, it’s unlikely they will succeed the second.

When my normal ways of solving my life problems don’t work despite repeated attempts, it creates a very interesting scenario, almost always accompanied by some anxiety. Eventually, if enough efforts fail and my situation worsens I can even get depressed.

The series of articles on Mindfulness look at this position I am expressing in more detail. I invite you to read them and see if they help  answer any doubts or or questions you have about what I am saying. and  my approach with such issues.

19 Feb

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

In my previous article (Being Here: Depression, Anxiety Stress and All (Part I))  I was arguing that we cannot truly make choices and therefore changes in our life, if we are not aware of, or conscious to, our own experiences. Since most people seem to think they are already quite aware, then either I am making a weak argument, or we are talking about very different things. This article focuses on my definition of this notion of being aware of our experiences, and also looks at some of the implications which flow from it.

To begin,  let me ask a simple question; “Do you know what rain feels like on your face”?

I am betting you would probably say, “Of course I know what rain on my face feels like”.  So let me push the question a little further; “When was the last time you chose to stand in the rain and let it fall on your face, so you could intentionally experience it”?  Now I would  guess that you may never have done that, or if you have, you haven’t done it very often.

I would guess, if you are like most people, what you were talking about when you said you “know” about the experience of rain on your face, was  perhaps your  experience of what happened when you unexpectedly got caught in the rain, and then reacted in some way so as not to have rain in your face.

My point is that there are many experiences which we say we “know”, or which we say we are familiar with, which should more appropriately be called, “experiences we tried not to have”.

Take sadness for example. Who doesn’t know what it feels like to be sad? But have you ever taken the time to really feel sad; intentionally, purposefully? Really sit with it and listen to it, hear how it speaks, where it lives in your body, what kind of memories come up and whatever else is connected to it?

I am trying to clarify that the quality of “sadness” one experiences when “Trying not to feel”,  and the experiences of sadness which arises should one choose to “feel” it,  are not the same experiences. “Trying not to feel” sad is an active attempt to suppress and alter that experience.  “Feeling” sad opens up a whole range of experiences that simply do not and cannot exist otherwise.  

My next guess is that reading about this, the idea of letting yourself feel your sadness, anger, your frustration, or any “negative” reaction, actually seems strange,  if not questionable to you. After all, these experiences hurt, they are painful. And if there is anything our evolutionarily programmed survival system does well, it is too move us away from pain, usually before we even have to think about it.

But  most likely, when you think of the painful experiences what you are thinking of  are those “Trying not to feel” experiences, which I am suggesting actually have different qualities to them than when we allow ourself to be aware of our experiences.   Expressed another way, moving away from, or trying not to have,  an experience has more painful and complicated effects than when we move towards it. 

I would think most people do this suppression/avoiding thing most of the time. There is nothing odd in doing this. But I believe there are many unfortunate consequence which arise from doing so.

It is my opinion that “trying not feel” over an extended period of time, especially when our experiences are powerful and highly charged, leads to depression, anxiety,  and stress, just to name a few.  Further, as I have discussed in other articles,  “trying not to feel”,  also characterized as avoiding our experiences, can also lead to other complications such as gambling, drinking and other addictions.

Finding our way back once we have gone down one of those roads is remarkably difficult.  So I really only see one of two options.  Either we begin to learn how to actually have our experiences, to begin the practice of Mindfulness,  or we cross our fingers that we are going to find something else that is going to work that we haven’t been able to accomplish for our self.

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