“But I do all those things and nothing works. I don’t think anything will ever work.” As the words left her lips she began to cry, but only with her eyes. The tears ran but the rest of her appeared resolute.
She was desperate and defeated at the same time.
I have been working with this patient for about a year and like so many of my patients in the past this particular one seems stuck at the edge or the gap of disbelief. That is she was on one side of a chasm and on the other side was the person she wanted to be, the healed person, but in between was an insurmountable space, a gap which she believed she could not cross.
This patient, like the others, has been struggling with their unmanageable circumstance for so long, had tried perhaps dozens of techniques often including psychiatric medications, and failed to achieve any meaningful results so many times that they no longer believe change is possible. Not for them anyway, but in looking around these patients almost always see other people who are living the suffering free lives they so desperately long for.
Let me be clear; when a psychologist states someone believes something that can mean a few different things. For example it can mean, and I think this is the definition most people would come to in a knee jerk type reaction, they agree with the evidence at hand. This is a thinking function form of belief and is a perfectly acceptable definition, although as the world appears to have moved away from checking one’s sources of information and into the outright denying scientific evidence is valid, it can be a bit problematic.
In this case what I mean is a feeling function form of belief. By that I mean this patient didn’t so much agree with prevailing evidence (though she certainly professed to) but was afraid that nothing was ever going to change for her.
So rather than coming to the logical conclusion based on the exploration of evidence, this patient was allowing her emotional reaction to her history of perceived failure to dissuade her from not only participating in the exercises and trying the suggestions I gave her in session but even considering them as being potentially beneficial.
In other words she had already decided she had failed before even trying and then using this perceived future failure (which I must emphasize had not happened) as a weapon to beat herself up and as a megaphone to amplify every disparaging belief she had about her self.
I recognized this in her and prepared my response to her statements. I am the type of psychologist who relies heavily on the experts of the past to help my patients in session and to get my message across I will use anything I think may be useful in facilitating understanding. I have been known to quote books, movies, cartoons, song lyrics (I have even sang songs a few times in session)…in short I will use any tool I am inspired to while working with a patient. I don’t prepare thee things in advance I allow my unconscious to guide me, much as I am encouraging my patients to allow their unconscious to guide them.
I tell all my patients two things about my technique of psychotherapy: I tell a lot of stories, and sometimes I’m just as surprised as everyone else as to what comes out of my mouth.
There is an ancient Japanese Samurai proverb I have often used in situations like this, that goes something like, “Never speak negatively about yourself, because the inner warrior hears and is lessoned by it.” In this case I did not think that lessons in Bushido were the best mode of conveyance. I needed something more.
I was not disappointed.
What arose from my depths was quote by one of the truly gifted psychological thinkers. This philosopher in particular had a method of communicating deep wisdom in such an easy to understand way I really think of him as a master of the art of psychotherapy. I guess one can get pretty good at something if they practiced for 900 years.
“Have you ever seen The Empire Strikes Back?” I asked her as her tears began to slow. “You know the second of the original Star Wars movies?”
She nodded her head in the affirmative and squeaked out a quiet, “Yes.”
“You remember that scene where Yoda is trying to get Luke to use the force to get his X-Wing fighter out of the swamp?”
“Yeah!” she said loudly and with enough energy to startle me, “that’s what I mean. Yoda does all this teaching and Luke tries to do what he says but he can’t. That’s just like me. I have tried what you said and I failed. I always fail.”
I wait a moment to see if she will go on but she has returned to silently staring at me with eyes which refuse to stop crying and a face which refuses to commit to the act.
“Yes Luke tries and fails. He even goes back to Yoda out of breath and do you remember what he said?”
She nods yes again but this time remains silent. I always hope my patient will anticipate my point at times like this, especially when they, like me, know the example referenced so well. That doesn’t always happen and in this case does not appear to be.
“He said ‘it’s impossible,’ didn’t he?” I don’t wait for a response this time before going on.
“And then what did Yoda do? He put out his hand and used the force to not only pull the spaceship out of the swamp but fly it over to a safe spot before putting it down.”
I pause for a moment to see if my patient will come to my conclusion on her own. She doesn’t so I finish my story.
“Then Luke comes running up to Yoda and says, ‘I can’t believe it,’ and Yoda says,” again dramatic pause my patient does not fill in, “this is why you fail.”
Many of my patients, and perhaps many of you, have heard of the mind/body connection. It really is all the rage these days, but like many other psychological concepts that enter into the lexicon of commonality, it is poorly understood.
As I have discussed in previous posts; you have two parts of you—a conscious part and an unconscious part. While these two parts can act together in harmony they are often at odds with each other. At the risk of repeating my early mentioned post, this is mostly because the conscious part does not want to accept the unconscious part even exists let alone that it can control behavior.
The truth of the human experience is that behavior and decision making are mostly, and at times completely, the result of unconscious motivations. That is what you do and how you react to your world is largely and occasionally completely unconscious. The conscious part of us really only exists to categorize and rationalize the things going on in our world and our actions within that world.
These two entities interact with the world and each other through the body. That is the physical manifestation of their existence is referred to as the body. The unconscious and the conscious are influenced by the body (if your thyroid is out of wack you will be either anxious or depressed depending on whether it is over or under active) and your unconscious and conscious can have influence over the body.
Back in the days before the pharmaceutical industry took over mental health treatment and the DSM (Diagnostics and Statistics Manual) there was a wonderful diagnosis Conversion Disorder. Conversion was the term Freud came up with to explain how a neurosis (psychological issue) could, if not fully addressed and processed, could become a physical issue, and disorder is what we would say a person who is struggling with issues of conversion is going through (dis-order = not in harmony).
Yes, the concept of the mind/body connection was originally conceptualized by Freud in his work as a psychiatrist.
Freud discovered that many of his patients suffered from unexplainable physical maladies such as paralysis and even blindness. One case in particular was of a young woman who had a paralyzed right arm. She could not move or feel anything in that arm, yet the condition had spontaneously occurred in a limb with no history of paralysis and there was no incident (illness or accident) which could have caused the condition.
I believe it was in a state of hypnosis or perhaps a drug induced euphoric state that Freud discovered the paralyzed limb could still be felt and controlled but the patient would not allow herself to do so. So completely was her dissociation from the limb that she consciously believed it to be dead and rotting and expected the limb to fall off in the near future.
Over the course of treatment what Freud discovered was this patient was being abused by her father and as a result of this abuse she became angry at him and even had fantasized about killing him. The emotions she felt and the fantasies she had become so compelling that she believed she would actually kill her father. Rather than act on these thoughts, because they were so intolerable to her, or one could say as an act of defense against those thoughts, she psychologically cut the arm off from her physical awareness. In essence she decided the only safe thing to do was to remove her arm from her body and the most expedient way to do that was to do so psychically.
Perhaps some context will help here. At the time Freud was working with his patients, the late 1800’s, women were even more subjugated than today. A daughter for example, was expected to work in the family home, essentially as a domestic servant, until she married and then she was to move in with her husband, often in his family home, working as a domestic servant there until she and her husband could establish their own house separate from the husband’s family or her husband’s family died and the house became his.
This was the case for city folk or more likely upper middle class folk. At that time country folk and tradespeople pretty much all lived in one house and worked together on the farm or in the family business.
It was an accepted part of society then, as it is now in many cases, that should something happen to the mother (childbirth is still the most life threatening thing a woman can do, even today) the eldest daughter would not only raise her younger siblings but also take care of her father. This was not supposed to include sexually but in Freud’s experience with patients he found that a great many of his female patients had actually been sexually abused by not just their fathers but in some cases their other male relatives as well.
In this case in particular the patient had been abused by her father from a very young age. Over time she developed a hatred for her father that for hurting her this way, however this powerful emotion was intolerable to her. The reason for this emotion being intolerable stems from the child-parent relationship.
One of Freud’s many controversial postulates was that to the child the parents are god-figures. Think about it this way, from the child’s perspective (especially young children) the parents are bigger and stronger, they make all the rules and enforce them at their will, they grant blessings and issue punishments—to a child the parent (and especially in Freud’s time the father) is as close to being a god as he or she is capable of understanding.
And hated for god or even just being angry with god is not tolerable for the worshiper any more than being mad or hating the parent is tolerable for the child. Think of it this way, when was the last time you saw a person interviewed after some natural disaster that expressed anger toward their god for sending the earthquake, tornado, or flood? Most people interviewed are thanking their god for saving their lives but not angry for putting their lives in danger in the first place. This is the way a child processes the anger, or other negative affective materials toward their parents.
What a child does with this and other intolerable feelings is turn them inward and use them against themselves. So instead of saying something like, ‘dad is wrong for hurting me this way’ or ‘I did not deserve that,’ or better yet ‘fuck dad he’s an asshole,’ the child will think ‘I deserved it.’ Even when there is severe abuse the child is likely to blame themselves for behaving in such a way that the abuse was necessary. In many cases the child will maintain this belief system well into adulthood causing them to seek someone like me.
In this particular case the abuse continued long enough for Freud’s patient to begin fantasizing about revenge and one day while serving her father dinner, she looked down at the knife in her hand and thought ‘I should stab my father with this knife and kill him.’ This was perhaps a reasonable thought for a woman with her history to have but for her it was so intolerable that she had to remove the arm from her body else she was convinced she would actually carry out the fantasy.
Conversion as Freud coined it and conversion disorder as it used to be known is the psyche’s (or unconscious’s) way of making unconscious materials conscious. That is bringing something unknown into the sphere of the known. In this case the conversion was from anger or hatred to paralysis. All I attempt to get the patient to realize she was angry with her father.
Going back to my patient, she believed whole heartedly that nothing she could do would ever help her to either understand what was going on with her or feel any better. With a psychic apparatus which is powerful enough to cause paralysis or blindness, what do you think will happen to a person, not just my patient but anyone, who continually tells themselves ‘I cannot change?’
That’s right, they won’t change. Also, as in this case, a person can become quite combative when someone, a therapist or anyone else, tells them they can change. Why would they want to even try, let alone suffer some fool encouraging them to do so, when they already know they will just fail again, because they always fail?
The worst malady a person can have, in my estimation is knowing.
This patient, as the others, begins to act in session more and more like a petulant child because the part of them that is hurting is the same part of them that is causing all their problems. These people act child-like because the part of them that is wounded is a child.
Technically it is known as the Wounded Child and healing this construct is a touchy subject I will get into in a future post……