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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On Optimism

OptimismOver the course of my practice, I’ve come to know a few men and women who emerged from families so toxic and dysfunctional that I often wondered how they managed to survive, emotionally speaking, and why they hadn’t long ago surrendered to despair. Given how little goodness they encountered in their post-uterine world, why did they continue to believe in and keep looking for something better? What was the source of the ongoing hope that brought them to my office in the belief that someone could help? I think of these clients from truly awful families as optimists; this piece serves as a bookend to my last post on pessimism but maybe I’m misuing the word optimism. In this case, I mean that my optimistic clients, encountering a world without love, almost entirely bereft of goodness, nonetheless believed in the possibility of good and kept on searching for it. Hopeful might be a better adjective to describe these people.

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On Pessimism

Pessimism I haven’t been posting much lately because I’ve been focused on my book about narcissism, plus I just completed another article for The Atlantic, which you can find here. It’s about bullying as a kind of narcissistic behavior, linking the Richie Incognito story with the suicide of Rebecca Sedgwick and further thoughts on Lance Armstrong. Anyway, I’ve now emerged from my research-and-proposal-writing cocoon; it feels good returning to the “outside” world!

So in my practice, I’ve lately been thinking about pessimism as a character trait. Selena, the client I described in my post about the importance of joy in psychotherapy, tends to be very pessimistic about her future. She believes that she blew her opportunity to launch a career right after college and that nobody will want to hire her now because newly-minted college graduates will be applying for the same positions. Not long after she graduated, Selena was fired from a job that didn’t particularly suit her, and she found the experience painfully humiliating. Most of us would feel the same way, but Selena has had a hard time recovering and moving on. She feels that getting fired has “tainted” her. Pessimism about her future keeps her immobilized.

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Antisocial Personality Disorder: The Sociopath Next Door’ve been reading The Sociopath Next Door by Martha Stout — an excellent and yet frustrating book about antisocial personality disorder. Stout’s engaging style and in-depth clinical experience with victims of sociopathic predators bring the subject to vivid life. The vignettes read more like suspense novels: as the character of the sociopath gradually unfolds, your sense of foreboding grows. You continue reading with a mixture of dread and fascination, wondering what will happen to Stout’s clients, whether they will extricate themselves from the manipulative grip of an unfeeling spouse or parent, whether the unsuspecting people who surround the sociopath will wake up in time. I found the book a gripping read.

It’s a practical book, too: Stout explains with great clarity how to recognize sociopaths, pl