The Evacuation of Pain

steaming-mad4Nearly four years ago, not long after I first launched this site, I wrote about a client who coped with unbearable feelings via her eating disorder: when she could no longer endure a painful emotional state, she would binge and then purge in an attempt to evacuate it. I discussed this as a form of projection, an unconscious defense mechanism used when psychic pain cannot be tolerated and understood — that is, when it is simply “too much” and the person feels overwhelmed. This process begins during the earliest moments of life, when the infant “screams out” unendurable pain and fear. As I described in this early post, it is the mother’s job to absorb, understand, and respond appropriately to the meaning to the projection.

The evacuation of emotional pain takes many forms. One of my current clients often cries when he feels overwhelmed. When I first started working with Liam, I viewed his tears as sentimental, a form of self-deception where he would weep and feel sorry for himself rather than acknowledge his own anger. During arguments with his wife, for example, he would break down sobbing as their conflict intensified. She usually felt annoyed rather than sympathetic in the face of his tears, especially if he abruptly ended the argument and went to bed, leaving her to carry all the anger.
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The Self-Serving Lie

truth-lies-buttons-show-true-or-liar-100211556 Many years ago when I was just starting out as a therapist, I briefly worked for a large group practice. At the end of my tenure, the managing partner in this group, a respected psychoanalyst, refused to pay what he owed me. When I pointed out to him that he was contractually bound to pay me – according to his own employment contract – he replied, “If we had known that contract wouldn’t work out to our advantage, we never would have signed it.” He actually seemed to believe that this was sufficient reason to stiff me. I finally had to threaten a lawsuit before he coughed up.

This psychoanalyst was not a bad man. He was married with children, he was good to his patients, served on the board of his institute and taught classes for free. But he had a moral blind spot. He told himself that it was okay for him to withhold payment because he had profited less than expected from our relationship. He didn’t see anything wrong with that, and even seemed to feel sorry for himself that he hadn’t benefitted as much from my employment as he had hoped.

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The Shame in Mental Illness

DSM5My recent posts got me to thinking about the term mental illness and how stigma-laden it remains to this day. As a society, we’ve come a long way from the bad old days when most people were too ashamed to admit going to a psychiatrist, when families kept those members with obvious psychological problems hidden from view. Back then, a moralistic aura surrounded mental illness, as if having one implied that you (as well as your family) were morally defective and therefore to blame for your emotional difficulties. This view of mental illness still prevails on the religious right — as in the claim that homosexuality is a “lifestyle choice,” for example, and that gays are obviously making the “wrong” one.

In society at large, the easing of stigma has a lot to do with the marketing of psychiatric medication to address “chemical imbalances” over the last few decades. Nowadays, you don’t suffer from mental illness, you have a mood disorder, a result of faulty brain chemistry rather than a moral defect and of course, not your fault. While I strongly object to the widespread overuse of anti-depressants, I do believe that removing the shameful stigma surrounding depression and manic-depressive illness has been a good thing. It’s difficult enough to struggle through depression without feeling you’re a bad person to boot for being “abnormal.”

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Respecting Your Personal Limitations

StressFirst of all, I’d like to thank those of you who visit the site often enough to have noted my absence this past month and written to me with concern. It has been a trying time, in part because of unexpected challenges that have come along but also because I haven’t taken care of myself as well as I should.

In Don Nathanson’s excellent book Shame and Pride, he describes himself as “the driven sort of personality that must ignore or disavow exhaustion in order to conclude what we declare to be the ‘more important’ business of the day.” I recognize myself in this description. As I was working on Cinderella, I felt driven to complete and release it before relocating to Colorado for the summer, imposing an entirely artificial deadline upon myself. At the same time, I was finishing up a proposal for my book on shame, in the hope that I could interest a good agent in taking me on. I also wanted to finish that project before Colorado, although there was no particular reason why I needed to wrap it up in May rather than July. Like Nathanson, I continually made “the decision to trade the comfort of sleep for the work of writing.” By the end of May, I had completed and released Cinderella, finalized my book proposal and driven myself into a state of exhaustion.

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