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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What Body Dysmorphic Disorder and Gender Identity Disorder Have in Common

Toby SheldonEarlier this week while on an elliptical trainer at the gym, I watched a portion of The Doctors airing on the TV monitor above me, all about a 33-year-old man, Toby Sheldon, who has spent more than $100K for plastic surgery to make him more closely resemble Justin Bieber. A desire to look like Justin Bieber seems to me like prima facie evidence of mental illness; sarcasm aside, I find his behavior deeply disturbing. People who voluntarily and repeatedly go under the knife to change their appearance have always struck me as painfully confused, trying to fix something wrong within them by changing their exterior. Toby admits to being “obsessed” with having a youthful appearance (and many people want plastic surgery for the same reason), but given his relative youth when he underwent his first surgeries, it seems likely that age is a stand-in for something else. My guess is that he felt badly about himself, “ugly” on some profound level, and he “explained” that feeling with reference to hair loss and the age-related droop of his flesh.

In numerous other interviews, Toby has insisted that it’s not so much about looking like Justin Bieber as having the same youthful features. This seems like a distinction without a difference: if you want only to appear more youthful, why not strive to reclaim a younger version of your own features? Toby has also said that when Justin Bieber first burst on the scene to enormous acclaim, he, Toby, felt extremely envious of Bieber’s success. This statement seems closer to the mark. Toby seems delighted to tell reporters that he is occasionally mistaken for the star. If only he could become Bieber’s identical twin, then maybe he wouldn’t feel so ugly inside. In the other interviews I’ve watched, Toby is always talking about how happy with his appearance he now feels. The TV segment regularly cuts to shots of Toby consulting his own image in the mirror, endlessly examining his features and arranging his hair. This preoccupation with his looks doesn’t convey a sense of well-being, at least not to me. It seems obsessive: Am I really okay? Do I still look young? Maybe I was wrong — I’d better check again.

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