Thursday, May 13, 2010

'Withdraw'

'Withdraw'

This term turns out to be a powerful way to summarize a huge number of ways in which we deal with emotional pain.  It is probably, on average, the first step we take when hurt. It can be recognized in our early recognition of “fight or flight.” We do not like pain and move away from it.

A great cause of pain is the world causing a sense of humiliation in us or any sense of shame.  The idea is to get a sense of how this concept of “withdrawal” along with a few others in later essays, are in fact capable of engulfing huge swaths of our behavior.  I start by thinking in biological terms, again: pleasure- pain. Did you ever nudge an amoebae with a pipette under a microscope? The organism moves away.  It withdraws. A sea anemone closes  it’s tentacles.


So on the most practical level it is a move toward safety, although depending on the circumstances some would call it cowardice others prudence.  Would that such labels were of any use.  The purpose here is to show that such responses as “withdraw” start at such an early age we are well within their clutches before we can do much about them. It can take years to free ourselves and unfortunately we can simply  become simplly more and more entangled in our own web.

Yes there is a specific term for this “problem” when it becomes severe and it is “agoraphobia” but  one point of these essays is to blur the line between those “official” words and the terms I am using such as “withdrawal.” That is “Agoraphobia” is withdrawal but all withdrawal is not agoraphobia in fact the vast majority of withdraw is not agoraphobia yet damages all of us. 

Yet, we like to think of it as a  “them” not “us” problem. They have the problem we do not. We do not see all the ways we “withdraw” from people hurting ourselves and others. A few examples:

In the distant past I remember my first year away at college early in the semester I left the safety of my elite campus and went with a “townie” out to a restaurant a few miles out towards the strip malls with a friend of his. We sat down and were talking and at some point I noticed that his friend had disappeared.  I panicked I said, "Where did he go?" How was I going to get back to school? He said he left.  I was flabbergasted.  My friend was a bit older and very nice guy and looked at me knowingly, like I was  a lost puppy.  Knowing what? Knowing that I had just “not been” around. Knowing that I had not learned about people that abandoned other people.  Not knowing about people who “withdrew.”

So an important point “withdraw” is a double edge sword.  We “withdraw” because we were “attacked” but this sets up a “habit” that we later cannot control, that may later lead us to not attack other but to “abandon” them when they need us. Ah, but wait a very important insight to appreciate is that to “withdraw” can be an attack. What feels worse to be yelled at by a loved one or to simply have them disappear sometimes never to return? I have mentioned before there is research to show that children that have been verbally abused do better than those that have been abandoned.

Then just the other day deep feelings were triggered in me when a patient got a ride to see me and we were having a very difficult time negotiating something. He said “I would have walked two hours to get here.” I saw his “ride” In the waiting room and then I saw him get up and leave and the patient excused himself for a minute. Then after he came back a while later I asked him what happened to his ride he said, “Oh he left.”  A discussion ensued and I asked him what more important thing did his friend have to do? I said and asked,  “he knew he was bringing  you to the doctor right?” (he did not have to wait to see me at all).  So the point is the man (fifty some years old) “withdrew,” bolted for some reason known only to him. True enough I always say when you know the answer it makes perfect sense. He probably “hates” doctors’ offices. But it is one more testament to our level of empathy for one another or at least our capacity to carry it out.

Finally, one place where there is a huge crystal clear problem with “withdrawal” is in Japan where they have a specific name for it. It is called Hikikomori (pulling away, being confined).  It is a phenomenon whereby young men will leave school and come home and live in their room. This possibly affects up to 20 per cent of all adolescent males or 1 per cent of the overall population.  I understand that it is pretty much that it is not that  they live in the house but in their room ( by definition at least 6 months) . This can and does go on for years.  It is often precipitated by an incident of bullying at school.

I mention that humiliation is a primary cause of withdrawal such as above in the case of Hikikomori. I am sure it occurs to anyone that fear would be a great motivation to withdraw and so it is,  And so too are any number of sequences of feelings.

Brian Lynch

http://www.squidoo.com/thinking-feeling-doing (Summary of Principles used in these posts.)
www.brianlynchmd.com
Tomkins, Silvan S.: Affect Imagery Consciousness NY: SPringer Publishing Company, 1963.
Shame and Pride : Affect, Sex, and the Birth of the Self by Donald L. Nathanson Paperback (March 1994)
W.W. Norton & Company; ISBN: 0393311090

"Anger-Rage"

"Anger-Rage"

It was not too long ago that many thought that we all “learned” to be angry. That is supposedly that it was theoretically possible for someone to develop without the capacity to get angry. Apparently there are people out there that still believe this.

It is intriguing that it was actually Darwin that began to solidify the innate nature of anger and then was promptly ignored for some seventy years and, as I say, only recently has the notion really taken hold. But then what can be said about anger?

I think many will agree that anger is  problematic and maybe the most problematic of the specific emotions. Many think we should never express it while others think it should always be expressed. Many want us to “learn“ to control it.

Like so many things we seem to know so much less than we seem to presume. Or at least we if the knowledge is there it has not been widely disseminated.

I think it goes something like this:  Anger can be triggered in essentially one of three ways. First, it is a survival mechanism that is triggered directly when the organism is threatened in such a way that  it is in imminent danger. I would say “overwhelmed” but that it not necessarily accurate. That may be the case but it need not be the necessary condition is imminent danger to the point that a certain type of action need be taken.

It is thought that this is not based primarily in our cognition, that is our thinking, but is “hardwired” and will take place on a individual basis based on our life experiences.  The point is it is it is “automatic.” It is our body taking care of us.

A most important insight is that probably the great majority of anger comes secondary to the hurt after shame and humiliation  or the hurt suffered after failing to reach a desired goal, not from being in imminent danger, a most important distinction.

These have been most useful insights in helping people in understanding their relationships and their struggles with “anger” problems. It is my “simple” approach to “anger management.” I have said often elsewhere that “anger management” is wrongheaded in that it focuses on the anger per se. The problem with this is that  most anger is of this second type of being secondary to “hurt” that it is like asking someone to hold a hot potato and “deal with it.” “Deal with your anger.” “Control your anger.”  What is missed is any understanding of the origin of the anger that is that the party was “hurt” because they wanted something and did not get it. So in labor and management problems anger comes from desires being blocked. So to in marriage, in friendship. The primary thing is a desire that is not achieved then ends in hurt and this ends in a type of confusion. Anger ensues.  Simply telling the person or group to deal with the anger sets up a vicious cycle and deflects the issues and gets everyone off track. Those  in power can easily use it to their advantage and hammer away at “anger control” issues and make it the “the” issue. “We will not discuss anything until you get your anger under control.”  For example in a relationship the person getting angry quickly can get caught in a dependant position. The more controlled person can brow beat the other to no end and obscure and legitimate desire the partner started with that produced the anger. The more the desire is ignored the greater the anger because the more the anger is focused on the more it becomes the issue and the more the conversation is co-opted and the angry party becomes more confused and more shamed and humiliated and maybe now guilt ridden because they now start to become convinced that they are wrong about everything and maybe start to doubt the worth of what they wanted in the first place. In the end it will only lead to more anger because, of course they are not wrong.  Ok, the wished for desire might be unreasonable but it has to be respected and negotiated.

And yes none of this has to be “on purpose” by any party involved it is that we simply do not understand anger and we do not listen to each other. We are not listening to what  the other person wants and are not trying to accommodate.

Much of this explains why in interpersonal relationships when anger flares we so rarely remember what the whole thing was about. Why is that, again, it is because there is going on a great confusion. Nothing is “pure.” We have “wanted” something and have not gotten it so we are in a state of at least momentary “shock”, cogitative shock, and confusion if you will. Due to earlier learning we have “learned” that anger is an appropriate response in these situations. “I don’t get what I want so I throw a tantrum.” Or at least show my displeasure but in that state I do not do my thinking neurons much good. I prolong the state of confusion and shock. The ability to store short term memory is hindered and fragmented. The feeling/affect of “surprise” is involved which further hinders my later recall.                                                                   

Then there is a type of anger or any emotion that is in effect fairly purely  “cognitive.”  That anger that follows being “hurt”,  it is important to understand, is not imparting for survival. It is very “cognitive” it is a “learned” response , a defense against a perceived “danger” or remember where we started when we said that at one point most “experts” felt we all “learned” or did not learn to be angry. So, of course, we can all “act” “as if” we are angry, a “third” type of anger?

None of this to say that anger does not get out of control and is not often difficult to control. 

Brian Lynch
Shame and Humiliation

Brian Lynch
Shame and Humiliation
http://www.squidoo.com/thinking-feeling-doing (Summary of Principles used in these posts.)
www.brianlynchmd.com
Tomkins, Silvan S.: Affect Imagery Consciousness NY: SPringer Publishing Company, 1963.
Shame and Pride : Affect, Sex, and the Birth of the Self by Donald L. Nathanson Paperback (March 1994)
W.W. Norton & Company; ISBN: 0393311090
How To Get Where You Want To Go Brian Lynch

Tuesday, May 11, 2010

"Surprise, surprise!”


“"Surprise, surprise!”


Surprise, a really ignored emotion or feeling or more accurately an obscured emotion due to its nature, and what is that?  It is that, as we know, surprise is not a pure emotion but one that is followed immediately by some other emotion such as joy or terror. For many of us we are particularly conditioned for one or the other and most unfortunate for those people who have been conditioned to always or near always associate it with fear or terror. I will often hear peoples say “Oh I hate surprises.” This is probably due to having a history of what amounts to childhood abuse: a sibling or parent who would scare the hell out of them, as opposed to your father surprising you with a gift when he came home from work for no particular reason.


One sense of painful surprise that has stuck with me since I have begun my study of basic emotion is the all too oft occurrence of the mother, or today, the stay a home parent who will say, “ just wait until X comes home then you will see.” Well X does not come home until late when the kids are asleep and X prances into the bed room and gets the kids out of bed for their punishment. The kids suffer great “surprise” and terror. And at this point have no idea what is going on.


For one thing, one attribute of surprise is that it “clears the circuits.” It wipes out everything that goes before it. Here the kids are in a deep sleep and are awakened, their memory banks are cleared and their adrenalin starts pumping and they now can try and escape the intruder that came into the camp. There is no reason at all for them to be remembering that they were jumping on the sofa 10 hours previously and did not head the pleas to stop.


So surprise has much to do with trauma. But first let me say that I want you then to appreciate  that pure surprise, I believe, is never pleasant. That is the initial jolt is a painful shock, it is only made worse or ameliorated by interest and or joy that might flow so the odds are weighted against coming out with a lifetime average of good experiences with surprises.  


But back to trauma; so logically when bad things happen surprise is likely to be involved and whether we are a “good” guy or a “bad” guy the emotion is almost impossible to control. Again, when it happens and especially when we are a “good” guy, when we are blindsided our memory banks are wiped clean, at least for the moment. This means that memory can and tends to be fragmented. Not repressed but fragmented and associated with fear-terror and shame.  When we are small do we have power? Not likely, we therefore feel helpless. If we are subjugated to this trauma repeatedly we might turn to anything at hand to sooth ourselves sleep, food alcohol, incest, cutting. Each of these will bring on new experiences of surprise and new experiences of secondary feelings and some relief of interest and joy but of course interest and joy that will come at a very high price later on of shame and guilt.


Much of sleep problems are due to childhood traumas such as just described. A famous case is that of Michael Jackson. Michaels was not shy about talking about his father terrifying him and his bothers at least once one night in a dormitory arrangement when he came in an open window dressed in a frightening costume. Michael seemed to be tracing his sleep problems to that incident. His father, of course was, “teaching them a lesson.” A lesson that ended in his son’s death some fifty years later and a murder charge for Dr. Murray.



How do we fix things? As always not easily done and too much to do justice here but it is but certainly not by ignoring things. It is essentially by reconstructing and bringing into consciousness the sequence of events, i.e. learning and then deconstructing what has been reconstructed so that we can have control over those feelings, affects that are controlling us.


So surprise at its core is a painful experience and its evolutionary role is essential to our survival. It is meant to clear the circuits so that we might forget entirely what was going on just prior to the event that is now taking place so that we can put our full attention to it.  We our out gathering mushrooms in the jungle and a Bengali tiger catches our eye. No matter how good the treasure trove of mushrooms we want to clear our mind of dinner and focus on the tiger.


As culture has become more sophisticated, unfortunately, so has the various ways feelings can become complicated. Surprise is primary for survival that then leads to joy.



I want to thank Jim Duffy, psychologist and Melvin Hill, therapist for much of my understanding of the above.



http://www.squidoo.com/thinking-feeling-doing (Summary of Principles used in these posts.)
www.brianlynchmd.com

Tomkins, Silvan S.: Affect Imagery Consciousness NY: SPringer Publishing Company, 1963.
Shame and Pride : Affect, Sex, and the Birth of the Self by Donald L. Nathanson Paperback (March 1994)

"Therapy"

"Therapy"

"I just dropped in to see what condition my condition was in." 
Kenny Rogers

I am, again, a person that talks to people with the hope that through a good conversation we will come to some conclusions about their lives that will help them move forward. Through serendipity, it often happens,  I learn something and I move forward! That is we both learn.

So what have I learned recently? It is this, that therapy itself can be used for many purposes. Or let us say not “used” or ok “used” but unconsciously used for various purposes not all of them “good.”

People supposedly come to therapy to solve problems. But it is   obvious that maybe the stated purpose and the subconscious one may be very different.  It may be the proverbial one step forward and two or three back as I have mentioned before. Once that first step has been taken then fear and shame take over and progress is inhibited.  It is well known that patients often will have a period of worsening symptoms before real improvement is seen.

If indeed this is the case, the case that they take a step backward, then what would be the characterization of that step backward?

Well, I think both the patient and therapist have to be very vigilant for a time.  For what? For one a  physical or emotional form of  “withdrawal”:

Is this person coming to me to “escape” the outer world and establish a fantasy world that is in effect one of dissociation? A world in which I ( the patient) don’t really learn much about life and how to carry what I learn into the world?

Or do I use the session as another kind of “withdrawal” which is a bit more subtle and that is like a drug?  I simply lose myself in the process. I become “addicted” to the process of therapy. The therapist for example becomes my only person I talk too. Then I can actually “withdraw” by not coming to the sessions. Or be “withdrawn” in the sessions.

Finally I can spend the time in the session in various ways of “attacking” myself or the therapist.

All of this  is to say that therapy is a microcosm of life, as it should be but it is one where the stakes are supposed to be a bit out of the ordinary. It is everyone’s job to come back to the straight and narrow, to the problem at hand a bit quicker then we do in normal life, that is “to solve the problem.” But “quicker” in therapy even with something as useful as these explanations can and often is nothing akin to “quick.”

Brian Lynch








I want to thank Jim Duffy, psychologist and Melvin Hill, therapist for much of my understanding of the above.

ttp://www.squidoo.com/thinking-feeling-doing (Summary of Principles used in these posts.)
www.brianlynchmd.com
Tomkins, Silvan S.: Affect Imagery Consciousness NY: SPringer Publishing Company, 1963.
Shame and Pride : Affect, Sex, and the Birth of the Self by Donald L. Nathanson Paperback (March 1994)

W.W. Norton & Company; ISBN: 0393311090

" Email II"

" Email II"

There is a television show called “Lie To Me.” It is quite remarkable and I have written about it elsewhere. It uses the work of Paul Ekman who is its resident expert and who was mentored in part by Silvan Tomkins my theoretical mentor.  The idea of the show is that a Ekman like character runs a consulting firm that helps solve crime and other cases by figuring out if people are lying based on facial expressions amongst other psychological and physical attributes.

So, again, the idea is that in part if you are skilled enough you can tell a great deal if a person is lying by the way they express emotion in the face and by the position of the body and its parts, “tells.”

This is  true in other areas of life. Take email for example. In the show they also look for and use other clues, as I have said, other psychological attributes such as tone of voice and body posture. Are they aggressive or evasive? Do they demonstrate guilt in their response? 

These fall in what we call the “Compass of Shame.” If you are not familiar yet with it is what Donald Nathanson devised to pigeon hole our four habitual responses to the sting of “hurt” and “confusion.” We can 1) Withdraw from the scene. 2) we can attack or blame ourselves for the situation. 3) We can “avoid” the situation by for example using drugs. 4) We can “attack others” or blame others for the problem.

So it occurs to me that we are getting adept at interpreting all kinds of behavior. So  the “Compass of Shame” makes even more clear the tools  Dr. Ekman uses and if we where to apply them to email we might all 1) be a lot more aware of what is going on and 2) be a lot more honest in our dealings in email as one’s action in such a direct and personal act are open to direct analysis.

That is to the attack of self and other is pretty oblivious.

What is rampant in email is avoidance. We need connection and yet cannot find away to converse so we send every manner of creation by others without ever revealing ourselves; jokes, pictures, videos and we will continue to create derivatives.  And  the easiest avoidance is simply not to answer the question asked, pretend it never happened. How many pages have I written seemingly to the ‘Gods.’ 

What is more frustrating than something sent that can be interpreted in various ways by  someone that has not revealed themselves to you for a very long time and yet they give no hint of their feelings about the piece or comment written by someone else?

Finally, there is simple “withdraw.” No response whatsoever.  From the beginning of my studies of these issues it has seemed to me email was the excellent contemporary example to teach the shame response. I invest my “interest” in this project, large or small and send it out into the world. I “want” and “desire” a response.  I either receive one or I don’t. In the case of the former, albeit it might not consciously register we are going to feel at least a twinge of joy and in the later shame.

Of course why someone does not respond is another matter. How many times have I thought it was some strange animosity towards someone only to find out to my shame that some misfortune had delayed the other party. Nevertheless this is by far not always the rule.

Brian Lynch

ttp://www.squidoo.com/thinking-feeling-doing (Summary of Principles used in these posts.)
www.brianlynchmd.com
Tomkins, Silvan S.: Affect Imagery Consciousness NY: SPringer Publishing Company, 1963.
Shame and Pride : Affect, Sex, and the Birth of the Self by Donald L. Nathanson Paperback (March 1994)

W.W. Norton & Company; ISBN: 0393311090