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.

Liam has recently made some good progress in recognizing just how angry he feels, but we have also come to understand his tears as a form pressure release. In his family of origin, the expression of strong feeling was discouraged and he never learned how to bear with and understand his own emotions; he is easily overwhelmed and often cries as a means of relief from the emotional pressure, “sobbing it out,” so to speak, without fully understand what he is feeling. Other members of his family have severely repressed their feelings so they come across as flat and unemotional; they feel too little while Liam often feels too much.

Tears aren’t necessarily a form of evacuation. They may express grief or sadness as an integral part of those emotions. And consider the terms tears of rage and tears of joy. Almost any strong emotion can stimulate the lachrymal glands. Tears seem to be an organic part of intense experience, especially when it involves an element of surprise, when we’re psychologically unprepared for the onset of strong feeling. For me, I sometimes feel intense emotion building up from below and forcing itself out through my eyes. It isn’t always an unpleasant experience and sometimes it feels good to cry. I suspect most people feel this way.

For many of us, shedding tears also brings a kind of relief, and this isn’t necessarily a defense mechanism — at least, not an unhealthy one. Only when it becomes chronic or a means to avoid conscious experience does it become a problem. Liam usually cries to get rid of feeling rather than to express it, mostly because he feels under such intense psychic pressure. The image above shows an angry character with steam coming out of his ears: like a pressure cooker, he is so full of anger that he needs to “let off steam” to discharge part of the psychic burden, or else he will explode. In such cases, a person seeks for a way to evacuate and rid himself of at least a part of his rage. For Liam, tears provide such relief.

Another client cuts herself in order to evacuate emotional pain. Suzanne’s blood-letting is akin to Liam’s shedding of tears, although it involves a much more serious health risk, of course. Suzanne has described the relief she feels as she watches drops of blood fall into bath water, as if the gradual dispersal of that vivid red also “disappears” her feelings. (Those of you who have read my Cinderella will recognize this dynamic in her cutting.) Self-injury is a complex psychological process involving more than mere relief, however. Like Liam, Suzanne also finds it difficult to consciously acknowledge anger. Cutting not only affords her relief from unbearable emotion through blood-letting but also allows her to express her (unconscious) rage in an act of violence against her own body.

Some of my clients who struggle with borderline issues have screamed at me during session or over the phone, so overcome with pain and rage they couldn’t bear it; they “unloaded” on me to find relief. This kind of emotional assault feels more like an evacuation than a communication. They wanted to put their distress into me rather than experience it inside of themselves. In a less dramatic way, you may have experienced this dynamic with friends who dump all their problems on you and never ask a single question, a phenomenon I described in an earlier post as the toilet function of friendship. At the end of the day, the evacuation of pain (rather than bearing with, understanding and communicating it) seems to be very common.

By Joseph Burgo

Joe is the author and the owner of, one of the leading online mental health resources on the internet. Be sure to connect with him on Google+ and Linkedin.


  1. I relate to this post very much. I was not allowed to express negative emotions — or rather: not exactly “not allowed,” but it was better to stay as unnoticeable as possible, so that’s just what evolved.

    And my version of this is definitely the crying. For me, it’s not like a show-stopping boo-hoo-hoo type thing, but more like “my eyes are leaking against my will,” and it happens in association with any sort of very strong emotion but especially anger, even mild anger.

    I have tried many times to “will it away” with no luck. I feel no more control over eye-leaking than I have over whether I reflexively move my hand from a hot stove. So on the one hand, I seem to have no control — but on the other hand it’s a distraction and gets in the way of me handling situations the way I’d like to.

    Hm, for me the worst times are when I’m appropriately angry about something and I decide to talk to the other person about it. And I have trouble with these situations (obviously) so I think hard about what I want to say and how. I feel I go in all reasonable and prepared to get my point across. And then my eyes start leaking and it is a huge distraction away from the issue at hand and undercuts whatever I’m doing. Other people seem to have a strong natural response to tears, and all of a sudden the focus is on the fact that I’m “crying” instead of what I want to say.

    I hate it! Don’t know what to do about it though.

    1. It is SO hard to feel and think at the same time! I mean this quite sincerely, that it is the hardest thing in the world to have a feeling but not let the feeling have you; to feel deeply without it “distracting” you, as you put it, from what you intend to say.

  2. I am reflecting on your story of Liam and his family. My own FOO strongly discouraged the expression of feelings. And I am prone to tears, and identified with Liam as I read it.

    You say “Other members of his family have severely repressed their feelings so they come across as flat and unemotional; they feel too little while Liam often feels too much.” I feel things strongly, or what seems strongly to me, but I also come across as “flat and unemotional” because I take care never to let those strong feelings show. When they do come out, it tends to be in uncontrolled tears. So I partly identify with Liam, partly with his other “flat” family members. I wonder what they are feeling inside. My brother tends to be much more expressive than I am. He will visibly show anger, in a way that I never would – – raised voice, angry posture – – but he will then deny feeling angry.

    Liams’s experience of “not understanding what he is feeling” is exactly how I am.

  3. I tend to cry — no matter how hard I try not to — when I’m overwhelmed with rage. A friend once suggested that it was a way of keeping myself from saying anything that would do permanent damage. A nice frame, but it sure doesn’t feel like that. Also, I think it’s entirely possible to multi-task: cry and say damaging things at the same time.

    1. No doubt some people can multi-task that way. Your take seems right, that you’re “overwhelmed.” Doesn’t that word mean we have so much feeling that we can’t “contain” it? So it overflows in the form of tears.

  4. I’m a speech pathologist in a successful private practice and admit that setting fees,and sometimes collecting them, has always been uncomfortable. I think when you enter a “helping” profession it is assumed that your goal to help should supersede your drive for financial gain. I have been asked about sliding scales. I too do not deal with insurance. It has taken time but I am bolder now about not feeling so apologetic about money. But yes, it can become an ethical struggle. I’m good at what I do so my caseload is always full so I don’t have a need to “barter” though I realize that I have parents who probably struggle to fit therapy into their tight budgets. But I have decided that what I do is as important as any other service that is not bartered. I don’t asks my healthcare providers, mechanic, accountants, etc to reduce their fees. Like you, I feel my clients have options. They are making a choice when they call me, either by reputation, referral, or search. I imagine it is the same for you. Sometimes I see siblings so I have parents asking me if the second child could be seen at a reduced rate. I have come to value my time. There are only so many hours to see students. If someone takes up a spot at a reduced fee, it affects my monthly income. It sounds ruthless but for me, it feels more like growth. BTW, one family that requested a reduced rate lives in a small mansion and drives two luxury cars. My “digs” are a bit more modest so it’s ludicrous. I had to laugh at your client saying he’s off to Europe. Setting a fee that represents your skill level and experience does not seem unreasonable. I think we have to leave the guilt behind if we are to be successful business people as well as therapists. And as an aside, I have to say I found your site because of my experiences, repeatedly, with poor communicators. Loved the discussion. I thought it was only me. But I have to say thatI love your discussions and I am impressed with the comments. A smart group you have here!

    1. Thanks, Kathy. I think you intended this comment for my post on the sliding scale in psychotherapy, but I’m going to post it hear anyway since I very much appreciate your perspective.

  5. Hi Dr. Burgo,

    Thanks for your timely post. I was actually just in my own therapy session trying to find a way to express some of the mountain of rage that I have repressed since childhood. It feels similar to how you describe your awareness of your anger building up from below. For me, it is in my chest like a squeezed fist. I did “vent” a lot of it to my therapist who listened patiently but the sense that I had was it was just using him as a toilet, as you described. I felt some relief after, but I am very aware that it was just the tip of the iceberg and the feelings will return all too soon.

    I asked him “What do I do with it all?” As I read your post, I had the same question since you describe how people manage their painful emotions in self-injurious ways. How do you advise your clients bear the emotions in productive and safe ways? Especially when they are not in the safety of the therapy setting?

    Thanks very much,

    1. It takes a long time to learn how simply to “bear with” a feeling rather than evacuate it. It’s not a “solution” most people like, either. Who wants simply to endure one’s suffering? But the thing is, all feeling states are temporary and will eventually pass. If we try to stop them beforehand, or prematurely bring them to an end, we interfere with the natural ebb and flow of emotion. I always say that the defenses are worse than the pain they are meant to “cure.”

  6. I can certainly relate to this post. I numbed my feelings and emotional pain for years with substance abuse. Since becoming sober, I have become a sobber (a relatively new and unsettling behavior for me) and a cutter (something I have done in the past though, not very frequently). Cutting to me doesn’t feel nearly as unsettling and humiliating as crying does. Many more people seem to understand the pressure/pain relief that comes through intense crying. But I have found that the vast majority of people do not understand cutting, nor do they really want to. In my opinion, the relief that comes from cutting and watching yourself bleed (bleeding out the pain) is faster and better than that which comes from sobbing. Having said that, I realize that sobbing is a much healthier form of pressure and pain relief and am working towards doing that more (if necessary) and cutting less (eventually not at all is my hope).

    1. That has been my experience, too — or rather, the experience of the people I have worked with who cut. I recently learned that Oxytocin is released during cutting. That might explain why it is so much more effective than crying in the reduction of pain.

  7. Hi Dr. Joseph
    Very Interesting, will reread again to absorb it all. Wondering, how do you encourage someone to feel their pain instead of evacuating from it?

    Also, the link—- I described in this early post, isnt working.


    1. I think I fixed that link.

      As for how to help someone feel their pain, it usually happens slowly over time, by therapist and client bearing the pain together. I assume that most people with this difficulty had parents who were unable to tolerate strong feelings, so they never learned how.

  8. Very recently I experienced an episode of uncontrollable tears. It was due to an incident involving a person from my past who showed up at my front door UNEXPECTED and UNINVITED. This occurred the weekend of Mother’s Day. It was the last thing that I would have ever have thought. They searched me out on the internet. Never in a million years did I ever think that I would see or hear from this person again. I never searched them out. I felt so intensely violated and it set off a succession of massive triggers. I felt so flooded by painful memories and emotions.

    I didn’t show any emotion as I was in shock, but afterwards I came inside and I just broke down and started crying uncontrollably. It triggered a flood of painful memories and emotions. When I finally went to bed I continued to feel flooded and couldn’t sleep even with a sleep aid and I suffered with nightmares.

    During the brief exchange that we had they expressed that they remembered me as being sensitive and FRAGILE. People always used that as a way to diminish me as if I’m thin-skinned or that there is something wrong with me.

    I felt violated and it was worse because it felt like someone had invaded my private sanctuary. To make matters worse, invaded by a person who I associate with a painful past. I have been stalked previously by an ex-boyfriend, but this was a different situation.

    When we metaphorically close a door on a destructive relationship, and the other person kicks down that door, the pain comes flooding in again. I am still very much coping with the after shock. I felt quite disturbed by the method they chose of attempting to get in contact. It simply was unnerving and I’m still working through it. They also followed up with a letter.

    I feel that crying helped me to release the duress caused by the incident.

  9. I do ths. I gave a skin condition and I scratch myself, ostensibly because IRS itchy but I have come to realise it serves mainly a cathartic purpose to direct my self aggression and rage issues in a very literal way. I’ve been having therapy and am starting to integrate these feelings of rage but it’s proving incredibly confronting and almost degrading. I wish I could just choose to give up hating myself but I can’t. This knowledge itself compounds my shame.

  10. I have been following your blog on and off for a while now and find the insights you share fascinating.

    I like that you talk about the different functions of tears.

    The process from pain, to acknowledgement of pain, to feeling it fully, to crying, and then ultimately – quite miraculously it seems to me – shifting inside, from stasis back into flow is such a healing dynamic. It allows us to broaden our ability to access all that is human within.

    Here in the UK, crying remains a social taboo, allowed to air its face in public in certain circumstances alone and with limited expression.

    The prophetic tradition in the three abrahamic faiths encouraged the shedding of tears when going about one’s daily life. As you so wisely write, it is not always about evacuation. Sometimes it is expressing something within which needs to move through us to take us to the next level of awareness.

    I would like crying to be championed in schools, modelled by parents for children and for those who fear it to be still with it for a moment. To let the feelings come and wane, so that all the energy we direct towards avoiding pain -in so many harmful ways – can be released into the world in the form of love, the stuff we are truly made of.

    1. Yes, I think that would be great. It’s too bad that sadness still isn’t well tolerated, and there’s so much emphasis on feeling other more acceptable emotions.

      BTW, I was doing some continuing education for my license and found that in the new DSM5, grief or bereavement is now considered pathological if it does on for longer than TWO WEEKS!!! It says something about our culture that we think you need to move on so quickly after a devastating loss.

      1. OK (sigh) … well… thank you VERY MUCH for this. Thank you very much indeed.
        I was appalled and dumbfounded upon reading these criteria for the first time when the dsm5 came out. No wonder people loathe to consult therapists, I thought.
        I cannot emphasize enough how reassuring this is coming from an actual psychologist.

  11. Hi! I have to say, I just love your blog, I find it very helpful and also learning many new things. I’m also in therapy, have been there almost a year, so everything you write is very interesting.
    About your post: i find it very hard to evacuate my pain. I think there is so much pain in me, that I have blocked it somehow to protect myself. When I feel very very sad, I can’t cry. I hardly ever cry. When I visit my therapist I smile, but feeling very low. It’s very annoying and confusing. I can’t cry even when I want to. And also I’m afraid I start laughing inappropriately when someone is saying something very painful to me (like someone close to me died or something). Could you please help me with that issue? What’s wrong with me? It’s not normal reaction.

    1. My guess is that you’re frightened of being overwhelmed by your pain, that once you start crying, you might never stop. It’s understandable if not completely “rational.”

  12. The past several years I’ve been surprised by a much more frequent than before upsurge of tears when I encounter visual or spoken beautiful or horrifying experience, like WWII stuff or touching human relationship moments. It’s so much more than the decades before, it’s sure gotten my attention. I don’t have any particular associations or interpretation, just a pleasure at being alive and responsive to the poiniance of everyday life. bd

    1. I find as I grow older, I experience the same thing.I wonder if we’re growing more sentimental, or if our usual ways of warding off emotion weaken with age. It seems to work that was with defense mechanisms — they grow less effective over time.

  13. I find your blog sight interesting. I find myself rescuing, saving patients cause I myself was never saved by anyone. Is this healthy for me.

    1. Not necessarily. It can be healing to help other people, just as it can be healing to be a better parent than we experienced. As long as “rescuing” isn’t too self-abnegating and you respect your limits.

  14. I’m not sure I understand. You seem to say that tears are a deflection from feeling and staying with an emotion and also that it is an expression of emotion. Not sure then if it’s a healthy expression of feelings or a defense or if it depends on the situation.

    1. It’s one of those things you know when you experience it. I’ve been with people who were crying with deep emotion and others who were just “crying it out” to get rid of it. Hard to describe because it’s not simple.

  15. I found your website a few months back and the things you talk about are really resonating with me at the moment. I really think I need to sit with a therapist because there seems to be something going on in me and I’m not quite sure how to look at it and disect it on my own. I have been in a stuck space for quite some time. A place of little feeling and emotion, quite numb it seems. I have just had my second child and I feel terrified and overwhelmed that my unresolved issues are affecting their own emotions. What do you recommend for someone in this position that cannot afford a therapist for more than once a month? And do you know any therapists in the UK that you could recommend. Thanks so much x

      1. Just want to hop in here and say that the National health does not cover therapy. If you really push for it you get 6 sessions of CBT. I’ve had that – it really isn’t great.The therapist often isn’t very experienced or trained to any significant level and you can’t get any longer than 6 weeks. Unless you’re sectioned. My therapist was a mental health nurse and did NHS counselling for a while and he said it was incredibly frustrating because you didn’t have long enough with the client and you had to turn many people away (by telling them they were fine and didn’t need help) because you knew they’d need years of in depth work that the NHS couldn’t provide. I went private and pay nearly £100 per session. On paper I can’t afford it but we forgoe holidays and other luxuries because your mental health is important. What better way to spend your money? Over the past two years I’ve spent thousands but the change in me is absolutely priceless. And it is having a knock on impact on my whole family. I’d recommend good therapy to everyone!

        1. Because few therapists are willing to deal with the intrusive bureaucracy of the insurance companies here in the States, most people are in the same position that you describe. And I agree with you about the value of going out of pocket for therapy. What price does one place on the quality of one’s emotional life?

  16. I am reflecting on the part where you discussed eating disorder behaviors as a form of projection. As a registered dietitian specializing in emotional eating and eating disorders, I always knew food wasn’t the main issue, but your post made me think about it from a different perspective. It has been quite heartbreaking to see chronic ED patients go through years of regurgitated CBT and there is no progress. I have been debating whether I should go back to school for MFT to get a deeper understanding of how the family systems play a role in self-development and combine it with my knowledge of nutrition to help bridge the gap for these patients. I have subscribed to your website to learn more about your approach. Thanks for offering such great information and case studies to your readers.

    1. Thanks for joining in. I’ve worked with a number of ED clients, and while it’s always complex and individual, the evacuation of unbearable emotional experience always seems to play a part.

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