a question of perspective…

“I don’t know why you keep saying that, I know there’s something wrong with me. there has to be.”

I’ve heard her say this before and she isn’t the only one. Many patients have tried to make the same argument with me in the past. though the path changes along the way, the destination is pretty much the same.

Trying to sound reassuring I said, “I know you want to believe that but that doesn’t make it true.”

“I do believe it,” she said again on the verge of tears, “I know it. I normal person doesn’t think thesethings, doesn’t do the same stupid shit over and over again. A normal person doesn’t feel this way. There has to be something wrong with me.” Actually crying now she added, “There has to be,” almost pleading with me to confirm her belief.

truth is, for the most part, there is nothing wrong with this patient, or any of my patients really. oh sure they do some pretty ridiculous things sometimes and none of them would be sitting in my office if some part of their lives had not become unmanageable, but unmanageability doesn’t equate to broken or as so many of my patients insist, wrongness.

I have many issues with the modern medical model when it comes to the conceptualization of mental health. Leaving the utter lack of actual evidence the mind lives in the brain or that neurotransmitters have anything but basic effect on mood aside for now, it is the externalization of symptomology which drives me up a tree.

us psychologists refer to it as one’s locus of control and that is what the medical model messes with. and I really don’t like it.

one of the more challenging aspects of my work is getting people to accept responsibility for not just their lives but how they feel about their lives.

I know the choices I make lead directly to the world I live in (subjective reality and all that) but acknowledgement of those choices also determines how I feel about the world I have created.

we call that an internal locus of control.

An external locus of control would be the belief that something outside of my control, say a god or a government or a medical/biological/physiological issue (like a tumor) is responsible for whatever it is that I am dealing with.

so if I continually date people who cheat on the relationship, if I have an internal locus of control I will eventually begin to wonder why it is that I keep choosing people who cheat to have romantic relationships with.

if on the other hand I follow the medical model and have an external locus of control I may begin to believe that all women or men cheat.  

to be clear there can be and often are biological or physiological causes for psychological issues. Thyroid issues can cause both depressive and manic-like states as well as anxiety, vitamin deficiencies can have an effect on mood, hormone issues can have a real affect on mood as any number of women with unusually dramatic hormonal shifts as part of their usual menstrual cycle or anyone who has gone through fertility treatment could tell you. As my first clinical supervisor told me untold thousands of years ago, the first symptom of breast cancer is often depression.

I can and I do discuss all of the possible physiological issues which could contribute to how they are feeling but that is not really what they mean when they tell me “there must be something wrong with me.”

that statement, that belief that there is something “wrong” mostly stems from two sources; the medical model suggesting through various doctors offices, television shows, and their own fantasy materials all of which tell them the healthy person doesn’t experience any mental health symptomology (a belief which is not just categorically but catastrophically wrong) and two the types of things they were told as children stuck.

I think the first issue is easy enough to understand but maybe not, so if you have questions ask away.

The second issue can be a bit more devious and sometimes harder to wrap one’s head around. It really isn’t that complicated but I suppose that really depends on one’s acceptance of and belief in the presence of the unconscious. (see my other posts regarding the unconscious and how stuff gets in there)

it works like this: my patients (and you) were once little people who had no idea what was happening in or around them as well as had no idea how to react to any of these things. the way children process emotions is through varying levels of acting out, that is to say they get cranky, and their primary form of communication is play (something that technology and social media have severely and negatively impacted).

a scared child, a confused child, an anxious child, heck a tired child will all pretty much act the same–some combination of whiny and crying (it is only after repeated or severe trauma that a child will typically display the frozen fear response). The reason is simply they are experiencing something they don’t know what to do with or don’t feel safe to experience.  a child in this state will be looking to her or his parents to not only validate their experience but to help them to navigate their way through it.

children are experiencing everything for the first time and that includes emotions. so when a child is feeling something new they may feel overwhelmed by it and if they are overwhelmed they react to it the same way they reacted to being hungry as an infant, they cry. The way the adults in that child’s life react to the child’s emotional experience can and do, impact how that person experiences emotion for the rest of their lives.

if my patient was told that they should not be experiencing that emotion, by the old tried and true “stop crying or I’ll give you something to cry about,” or maybe “go to your room until you are ready to behave properly,”then the lesson learned is that if I am overwhelmed by an emotion I may be physically punished or worse be rejected by the people I love and need the most.

that is a devastating lesson for a child and one that sticks with them, sometimes forever, sometimes until they meet with someone like me who introduces them to the repository of everything they have ever experienced, heard, seen, tasted, or felt; the actual source of their emotions and the true guide of their behaviors—the unconscious. 

that childhood lesson also can become translated over time to equate to “there must be something wrong with me that I have or feel emotions.” This lesson can and does cause a lifetime of discomfort or misery and can be the source of addictions of all kinds. Nothing can grow the need to tranquilize emotions like the belief one should only experience the ones which feel good.

so deeply held is the belief that there is something diagnosable wrong with them, either in the brain or mind, that when they come to see me and I tell them there is nothing wrong with them they almost always argue. In a lot of ways the first job of the psychotherapist is to counter a lifetime of misinformation and inappropriate conclusions.

So what can you do if you are residing in the camp of inaccurate belief that is somethingmustbewrongwithme ville?

first thing is go to a medical doctor and get a full physical including blood analysis (or labs), and once your doctor gets your labs back you can discuss what, if anything is found, and what you can do about it. Almost always there will be a recommendation to get more exercise and drink more water. In addition to that I like to tell all my patientsto take a good multivitamin and an extra vitamin D. In today’s world it is not only possible but actually very easy to eat all day long and not get any nutritional value at all, let alone the recommended daily dosages of vitamins and minerals.  seriously your body needs those. So much does your body require these nutrients that if your diet is lacking in any of them, your body will leach them from where ever they are stored inside itself.  Your body will literally digest itself in order to provide the body (mostly the brain) with the nutrients required to operate.  so even if you have a really good diet you are probably missing a thing or two, so take a good multivitamin to hedge your bets a bit.

the extra vitamin D is simply because there is an absolute epidemic of low vitamin D in this world, (which isa bit interesting to me as your body actually manufactures vitamin D when exposed to sunlight)  but also because vitamin D is required to properly absorb many different minerals your bones and teeth are made of, and wouldn’t you know it the research on the issue has shown that low vitamin D can cause anxiety and low minerals can cause what most people think of as depression.

Second when your mood issues drive you to seek out professional help, usually after your primary care doctor tells you there is nothing medically wrong with you and then gives you the same recommendations I just did, and that person tells you there is nothing wrong with you, believe them.

you are a beautiful and flawed human being and you are most likely having a human experience the only way you know how to do so. This is not a sign or physiological frailty but a sign that you are actually doing the best you can and that should be celebrated even if you are not satisfied with the results.

the next thing you need to work on is taking responsibility for the fact you are making decisions and begin examining the methodology you employ in your decision-making process.  

once you understand that you are making decisions and how you are making those decisions you can start to make changes to that whole process. this is psychotherapy in a nutshell really but it is also the process people have referred by names such as adaptability, resilience, wisdom, and others since time immemorial.

you are not broken, you are human and your efforts, not your results, need to be calibrated.