Supporting the Symptoms
This is Part 2 of a multipart blog entry, check back in a few days for the continuation.
In Part I of this article we looked at the case of the unfortunate set of twin women who, after successful deep brain electrical stimulation treatment, became close to symptom-free, and then committed suicide. To understand what may have happened, I began discussing an individual I saw in treatment recently, and how I purposely halted the move towards symptom alleviation for her. Now let’s explain what this is all about.
To start, we need to review the very reason of why “symptoms” form in the first place. One main avenue through which symptoms develop (symptoms like various forms of anxiety, or problems with mood, eating disorders, relationship problems, etc.) is when a person’s lifelong way of navigating through life breaks down as it encounters situations in life which overwhelm or challenge that way. In other words, symptoms usually don’t come out of nowhere. Rather, symptoms typically emerge “from the cracks,” as it were: a person’s ordinary routines, behavior patterns, things he or she typically says or does, some of which might be potentially problematic start to “metastasize” and become truly problematic. For example, another patient whom we’ll call Rob, always hated airplanes and shaped a life which hardly ever required flight, started avoiding all forms of travel. This change oftentimes happens as a result of a change in life circumstances (perhaps our fearful traveler, Rob, had just become a father).
But how do people get these “ways” of navigating life in the first place, and why would they “break down” under adverse circumstances?
When we grow up, in addition to whatever temperamental tendencies we are born with, we also form our personalities over a lengthy period of development based on repeated interactions with the important people around us, beginning with our families. When things go well, a person gradually incorporates and integrates within their personality concepts of trust, autonomy and agency, self-esteem and self-worth, friendship, dedication, commitment and perseverance, ability to delay gratification and tolerate frustration, to play, to work, to dream, and to love. When things go wrong, to oversimplify it, some or all of those wonderful concepts will either not develop well or will be replaced with things like mistrust, selfishness, fearfulness, low self-esteem, helplessness, low acceptance of frustration or difference, etc. We’ll have some potential “sore spots” in our personality. However, as we all need to grow up from our school-age years, all throughout later education and beginning to work, we need to find ways of dealing with the sore spots we may have developed in our personalities, and plow ahead regardless. So begins the process of how we shape our lives to help us avoid confrontations between the “sore” spots of our personalities and realties of life. (Again, we might presume that our reluctant traveler, Rob, started out with issues regarding trust and control, which happen to be exacerbated when putting one’s life in the hands of a fallible human controlling a 200-ton chunk of metal hurtling through the air at the speed of sound).
To be clear, however, this whole process unfolds unconsciously. We do not actually sit at our kitchen tables with fresh brewed coffee and map out creative ways of choosing partners and careers to carefully avoid these core personality quirks that dog us from childhood.
Now, when life changes happen (even positive ones), when life throws us for a loop and we are forced to contend with things like one’s pending graduation from school, the death of a loved one, the loss of a job, or a significant change in the makeup of the town one lives in, or in becoming a parent, then the sore spots in our personality might get called into question. The new widow might need to confront her issues regarding loneliness and love, or the overconfident corporate exec who gets laid off might need to confront his underlying lack of self-worth in order to persevere and find ways to support his family, or our new father and terrified traveler, Rob, might need to confront his struggles with freedom, dependency and control. In these cases, we could expect “symptoms” to develop. What are symptoms? Symptoms are time-specific, socially sanctioned and culturally approved of ways of expressing psychological distress, conflict and pain. As we said above, these would include various kinds of anxiety (generalized, specific phobias, panic attacks, obsessiveness); problems with mood (bouts of depression which may or may not involve swings into overactivity); problems with anger and rage; addiction problems and relationship problems, etc. In children, we find problems with acting out, disobedience, lowered grades, attentional and impulse problems, school avoidance, or depression as well.
But all symptoms have the same thing in common no matter how long they’ve lasted: symptoms are the best way a person has (unconsciously) found to straddle the fence between actually living through life and having their selves implode inward or shatter outwards. The pregnant woman might develop crippling anxieties about childbirth and begin to think about terminating the pregnancy, the self-assured exec might succumb to the darkest depression and not apply to any new jobs. Maybe the insecure college senior might start obsessing about a potential insect infestation in her dorm room, start failing courses and postpone graduation. And Rob, well, now poor Rob won’t leave his bed, and is unable to help care for his newborn. Needless to say, it’s the job of the therapist to slowly and carefully tease out both the underlying personality conflict as well as the precipitating factor in a patient’s life, But, and here’s the catch: slowly! Why? Because, as we’ve established by now, the symptoms are all that stands between a person’s sanity and insanity. They are the compromise between a catastrophic confrontation with one’s own unresolved and truly frightening issues, and the world as it unfortunately is. It is the only thing keeping the person from truly going crazy. You see, symptoms are functional. As much as the medical establishment paints symptoms as problems to be fixed, and as disruptive as symptoms may become in a person’s life, symptoms are actually coping mechanisms; they are actually the very things that enable the person to wake up the next day.
Stay tuned for Part III where I return to the twins and my recent therapy case and bring this all together.