The Mostly-Bad Mother

During a recent session with a client, she was revisiting some memories about her mother, familiar to both of us since the beginning of her treatment.  Although her parents provided the basics — food, clothing, a roof over her head — they were both disastrous on an emotional level.  As the session unfolded, my client repeated many painful details from her childhood, and yet amidst all those memories, I caught little glimpses of the way she had at one time found her mother beautiful.  It made me think about the spots of goodness to be found in the mostly-bad mother, and how hard it is to hang onto them.  It’s an issue I continue to struggle with in relation to my own mostly-bad mother.

I could describe my own parents in very much the same terms as my client’s:  they fed us, clothed us, gave us a very nice home and bought us used cars once we learned to drive.  In financial and material terms, I had a comfortable, upper-middle class upbringing.  Emotionally, it was fairly awful.  I won’t burden you with the details; many people have more horrific stories to tell and entered their teens even more scarred than I was.  Suffice it to say that I suffered from severe bouts of depression and at 18 concluded, on my own, that I badly needed professional help.  Without telling my parents, I went to consult a psychiatrist who was a casual business acquaintance of my father’s.  He intervened on my behalf and spoke to my parents.  Later, after an endless and agonizing argument in which my mother and father insisted that either (a) I was making “it” all up; or (b) I was so mentally ill that nothing would help, they finally agreed to pay for my therapy.

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Defense Mechanisms V: Idealization

Once again we have a concept familiar to most people.  Idealizing a new love interest, hero worship, excessive and unwarranted optimism — these experiences all depend upon the process of idealization.  They also illustrate the point I tried to make in my last post, that these individual defense mechanisms we’re discussing are to a degree artificially distinct categories and don’t occur one-by-one.  Idealizing a loved object involves denial of the parts of reality that undermine perfection.  Extreme optimism involves denial of our doubts or questions about the future.  Both processes involve splitting to some degree, where the perceptions or ideas that might lead to a more nuanced view are projected outside.

The process of idealization may take aim at several different objects:  self, experience or another person.  I’ll discuss each one of those processes separately, but first I’d like to say something about what drives idealization.  In graduate school, one of my professors once told us, “The worse the object, the more the need to idealize it.”  I don’t remember which professor said it, and whether he was quoting from another theorist, but the expression has remained with me for nearly 30 years.  In this sentence, the word “object” is used in its
theoretical sense, to mean another person — as in, “the object of my affections.”  Given the emphasis on the mother-infant relationship in my training, I’m quite sure this professor meant that the experience of having a grossly deficient mother is excrutiating for the infant; the more intolerable that pain, the more likely he or she would be to defend against it either by idealizing the actual mother or escaping from her into a relationship with a perfect one in fantasy.

If you pursued the latter defensive strategy, you might spend the rest of your life looking for a perfect object to love.  As described in an earlier post on love junkies, you might cycle in and out of infatuation, believing you have finally found The One this time, only to succumb again to disillusionment.  I’m sure this phenomenon will be familiar to most of you.  Another way of conceptualizing that process is that the person uses the heady and idealized feeling of being in love as if it were a kind of drug to ward off pain.  Perfect love as the antidote to other unbearable emotions.  (Just don’t call it an “addiction”; if you’ve been reading my site for a while, you know how I feel about the thoughtless way people use the language of addiction to describe everything.)

One of my clients, Kay, for several years dated the same two men in rotation.  She’d spend an idyllic weekend with Rod and decide he must be her soul-mate.  Then a week later, he’d begin to grate on her nerves and she’d “realize” that Danny was the right guy instead.  The honeymoon period with Danny would eventually wear off, of course, and back she’d go to Rod.  And on and on.  Helping her to have a more realistic relationship with a man, and with her own pain, was extremely difficult.  She kept me and our work together at a great distance through her preoccupation with these two men, and the continual dilemma over which one to choose.
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Narcissistic Rage and the Sense of Entitlement

While the manic phase in what is commonly known as ‘bipolar disorder’ usually involves manic flight into grandiose fantasy and impulsive behavior, on occasion it leads to rage, violence, suicide and even murder.  The DSM-IV refers to this as “dysphoric mania” or a mixed state, where manic and depressive symptoms occur simultaneously.  Outbursts of rage also occur in other disorders:  they feature in Intermittent Explosive Disorder, Borderline Personality Disorder, Narcissistic Personality Disorder and various types of narcissistic behavior; anyone dominated by feelings of shame may be prone to occasional outbursts of rage, which are often an intense form of blaming, one of the primary defenses against shame.  While the DSM-IV defines these disorders as unique categories of mental illness, with individual diagnosis codes, they actually exist along a spectrum and have much in common.  Most of the clients I’ve seen who demonstrated features of Borderline Personality Disorder or presented with Bipolar Disorder symptoms also displayed features of narcissistic behavior, often involving outbursts of rage.

In other posts, I’ve talked about the function of hatred and anger as a kind of psychic glue in the face of disintegration anxiety; I’ve tried to make room for the idea that rage, as destructive as its external effects may be, sometimes serves a positive psychic function when the alternative is the terror of a kind of psychic death.  Likewise, rage may function as a defense against shame that feels unbearable.  These two are connected:  shame, as I discussed in my early post on basic or toxic shame, is the emotional expression of our sense that we are damaged; that sense of damage can mean that the self is felt to be in pieces, in danger of collapse.  Hatred, anger and rage serve a defensive and cohesive function for these conditions, especially when there has been a narcissistic injury to one’s sense of self that stirs up unbearable shame.

Narcissistic rage may also express a frustrated sense of entitlement, by which I mean the feeling that one has a right to be given something which others believe should be obtained through effort, and unrealistic expectations of favorable treatment or automatic compliance with one’s expectations.  While this is a characteristic feature of Narcissistic Personality Disorder, I’ve seen it in every borderline client I’ve treated, and in many clients with Bipolar Disorder symptoms, as well.  A sense of entitlement reflects an inflated view of one’s own importance and rights, which features intermittently  in many psychological states of mind.  No doubt you’ve known people who express this sense of entitlement, whether or not they fit into any of the diagnostic categories with which we’ve all become familiar.

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The Rise of Bipolar Disorder Symptoms and Treatment

If you’ve been around as long as I have, you may remember a time when the diagnostic label “Bipolar Disorder” was relatively unknown.  Although that term has been around since the 1950s, it came into common usage only in 1980 when the APA released its third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-III); before then, mental health professionals discussed and wrote about Melancholia or Manic-Depressive Illness. It was considered quite rare.   As you may know, that revision to the prior version of the DSM sought to eliminate its psychoanalytic/psychodynamic bias and replace it with a supposedly more “scientific” approach, thereby embedding psychiatry within the medical model of treatment.

According to the 1969 book, Manic Depressive Illness by George Winokur of Washington University, Bipolar Disorder used to be fairly rare.  In 1955, only one person in every 13,000 was hospitalized for it.  Today, by contrast, according to the National Institute of Mental Health, Bipolar Disorder symptoms affect an astounding one in every forty adults in our country!!!  It’s also worth noting that, before psychiatric medications were introduced, the long-term outcome for those patients was fairly good.  Only 50% of the people hospitalized for a first attack of mania ever suffered a second one.  Studies have found that, in the pre-drug period, 75-80% of hospitalized patients recovered within a year and only half of them had even one more attack within the next 20 years.  Today, Bipolar Disorder is a chronic illness, with patients spending years and years on psychiatric medications.  In other words, Bipolar Disorder was comparatively rare before 1980 and the prognosis for hospitalized patients was fairly good; today it’s 325 times more common than it used to be and has become a lifelong illness.

How are we to account for this change, from a rare and acute illness to one that is pervasive and chronic?

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“Psychiatric Meds Are Like Insulin for Diabetes” (Big Lie #3)

In Part One of my discussion of Robert Whitaker’s Anatomy of an Epidemic, we learned that there is no  scientific basis for the theory that mental illness results from an imbalance in brain chemistry; Part Two showed how, in the main, patients who were never given psychiatric meds have far better outcomes than people exposed early on to such drugs.  In this third and final part, I’ll discuss what these medications actually do to your brain chemistry and why they lead to a worse prognosis in the long run.

In order to understand these processes, we need a bit of basic neurology.  I’ll try to keep it simple.  As you probably know, the brain is made up of billions of neurons; each one of these neurons is connected to many other neurons.  Messages travel along the neurons, to and from the brain, moving from one neuron to another across a tiny gap called a neural synapse or the synaptic cleft.  One neuron releases a chemical messenger  called a neurotransmitter into the synapse; the molecule then travels across that tiny gap and bonds to the next neuron on the other side, thereby delivering its message.  The message subsequently continues along this second neuron until the next synapse, and so on.  Here’s a diagram of a typical neural synapse; you can ignore most of the labels:

Synapse

So the message travels down the yellow neuron, releasing neurotransmitters into the synaptic cleft.  On the other side, the green neuron has receptors (the red ovals) where the neurotransmitter bonds, thereby sending  a message which then travels down the green neuron to the next synapse, and so on.  After the message has been sent, the neurotransmitter is released from the receptor back into the synapse where one of two things occurs:  either another chemical agent, an enzyme, goes to work on the neurotransmitter and dissolves it, or the (yellow) neuron re-absorbs it for later use.

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