Archive for the ‘Psyche’ Category
Some form of trauma in early life is a very common human experience. The imprint of such experiences can powerfully influence the subsequent trajectory of a lifetime. Much of my work as a psychiatrist involves helping people to heal such wounds. Doing so enables an individual to escape from the gravitational field of the traumatic event. I will use an incident from my own life as a basis for discussing wounding and healing.
I was a blue baby. I was born with the umbilical cord tightly wrapped around my neck. I required resuscitation with supplemental oxygen, immediately upon delivery. I recovered completely, without any apparent deficits.
This event, as it was narrated for me repeatedly by my mother, had three principal effects on me:
1. I believed that I had been meant to die.
2. I believed that I needed to be rescued.
3. My capacity for communication was inhibited (perhaps due to the image of the constriction around my throat).
My healing, correspondingly, has had three major components:
1. Embracing life.
2. Developing self reliance.
3. Finding my voice, through speaking and writing.
I offer my experience to you for your own reflection:
What events have constricted your life? In what ways? What steps can you take to liberate yourself from this constricting influence?
In the I Ching, an ancient Chinese book of wisdom, it is written:
“A man is oppressed by bonds that can easily be broken. The distress is drawing to an end. But he is still irresolute; he is still influenced by the previous condition and fears that he may have cause for regret if he makes a move. But as soon as he grasps the situation, changes this mental attitude, and makes a firm decision, he masters the oppression.”
The I Ching, Wilhelm/Baynes edition, pp. 184-185.
From this passage, we can distill four steps to healing from trauma:
1. Grasping the situation
This step involves both identifying the key traumatic events in your life, and clarifying their effects on you. I found psychotherapy to be of immense value to me towards this end.
2. Changing your mental attitude
I had to change my mental attitude from one of a dependent victim to a belief in my own innate capacity to thrive. What mental attitudes to you need to change?
3. Making a firm decision
I made a firm decision to say “yes” to life, at every opportunity. What decisions do you need to make?
4. Taking positive action
I have taken a vow to do my best to relieve suffering and to inspire others to achieve their highest potential. I am taking all actions within my reach that are in alignment with this aspiration.
Aligning yourself and your every action with your highest purpose is the most potent force for healing.
Do you experience major mood swings? In this blog posting, you will gain new perspectives on your condition. As well, you will learn about treatment approaches and coping strategies.
I will share some thoughts with you regarding bipolar disorder from four vantage points: biological, psychological, social and spiritual.
Heredity plays a major role in the transmission of bipolar disorder. Although there is much speculation, the biological basis for this condition is not known. Extensive genetic research is being pursued, in an attempt to identify the mechanisms that render an individual vulnerable to this disorder.
Lithium remains the first line medication for classic bipolar disorder, also known as Bipolar I. This condition is characterized by full blown manic episodes, with or without alternating major depressive episodes. Other forms of bipolar disorder, including Bipolar II (major depressive episodes, alternating with period of hypomania), and rapid cycling bipolar disorder are best treated with an anticonvulsant mood stabilizer, such as Lamictal (lamotrigine). Hypomania is a less severe form of mania.
Bipolar depression usually requires the addition of an antidepressant medication. Extreme mood states can trigger psychotic symptoms, a break with reality. In this case, an antipsychotic medication, e.g. Abilify (aripiprazole), may be necessary.
From a psychological point of view, bipolar disorder may be viewed as a decreased capacity to regulate emotional states. Affective self regulation is impaired in people with certain personality structures. Narcissism is characterized by unstable oscillations between grandiosity and insecurity. Borderline personalities experience and manifest rapidly shifting, intense affective states.
These personality traits may often be traced back to early childhood experience. Phyllis Greenacre, a child psychoanalyst, wrote that “the infant is seen in the beam of the maternal pathology.” Some mothers are prone to have a split perception of their children. Such mothers (often themselves borderline personalities) will alternately idealize and devalue their children. These children, in turn, will tend to internalize a correspondingly split view of themselves. With the idealization, euphoria and grandiosity may ensue. Devaluation of the self will likely manifest as depression.
In a depth psychologically oriented therapy, the therapist takes on the role of a symbolic parent, whose function is to serve as an accurate mirror of the patient’s personality. Tensions and contradictory aspects of the patient’s psyche can be accurately reflected and articulated, without splitting. This process promotes the integration of the personality, and the stabilization of mood states.
A cognitive behavioral therapeutic approach would help the patient to monitor closely her own thoughts, or self-talk. The patient learns to catch and to correct those thoughts that are either excessively idealizing or devaluing of the self. Since thoughts are triggers for feeling states, thought correction will tend to minimize excessive mood swings.
Unstable, labile mood states make it extremely difficult to function at work, or to maintain relationships.
Getting help with mood stabilization in a social context is vitally important. Try seeking feedback from a significant person in your life regarding your behavior, as well as their perceptions of your mood states. This kind of objective feedback from a trusted friend or family member can greatly help you to become more self aware.
Support groups, and group psychotherapy, can serve a similar function. A good resource for finding such groups in your area is the Depression and Bipolar Alliance (http://dbsalliance.org).
There is a Buddhist image of viewing yourself as the host, and your emotions as your guests. Achieving this perspective will powerfully help you to stay grounded, even in the face of intense oscillating mood states.
Drawing strength from all of these internal and external resources will help you to achieve a level of integration and self awareness that you may never have attained, in the absence of a mood disorder.
Sport energizes the psyche and uplifts the spirit.
Sport and Psyche
One of my favorite runs is at Point Reyes National Seashore. This is a national park, a wilderness peninsula, north of San Francisco. The run ascends a mountain, continues along a ridge, descends to the ocean, proceeds along a coastal trail, climbs a steep bluff to a dramatic lookout point and finally returns to the trail head by way of a path through an evergreen forest. As I run, my psyche is filled with light, with the scent of the ocean, with the sight of hawks circling overhead. My spirit is recharged with the primal energy of nature.
Do you have similar experiences? Are you caught in the rut of your daily routine? Do you feel run down?
Craig Valentine, a well known public speaker, is fond of the saying, “change small, change often.” If you are sedentary, start your activity program gradually. At first, engage in one of your favorite activities for 5-10 minutes per day. As you gain strength and stamina, increase your active time incrementally to one hour per day, six days a week.
As your fitness improves, so will your confidence, energy and self esteem. Increased health and longevity will be added to your blessings.
Sport and Spirit
Sport is a portal to the realm of spirit.
Seven years ago, I ran a half marathon in Death Valley. This is a surreally beautiful, other worldly wonderland in Southern California. The run traversed Titus Canyon, a narrow cleft through steeply rising cliffs. As the hundred runners spread out along the course, we were each alone, surrounded by shimmering light. Suddenly, I caught a glimpse of ancient Native American petroglyphs (rock art), high up on the cliff to my right. These drawings were used in healing rituals by tribal healers, or shamans. Time stood still. The veil separating past from present, matter from spirit, grew very thin.
Have you lost your connection to the realm of spirit? Does your spirit soar? Do you feel at one with creation?
Take your physical activity, your sport, into nature. Quiet your mind. Open yourself fully to sensory impressions. Doing so will stop your inner chatter about past and future.
Your spirit will expand. You will feel supported by the “ground of being.” You will be “at one” with nature, with the Great Spirit.
Being active in nature is a tonic for both psyche and spirit. You will find peace, tranquility, energy and inspiration. You will “shuffle off the mortal coil” of deadening routine and endless rumination. You will be fully present in the moment.
As T.S. Eliot wrote in “Burnt Norton”:
“Sudden in a shaft of sunlight
Even while the dust moves
There rises the hidden laughter
Of children in the foliage
Quick now, here, now,
Ridiculous the waste sad time
Stretching before and after.”
Dissociation refers to the splitting off of painful experience from awareness. Dissociation is the hallmark of trauma. A child experiences abuse or neglect as an unbearable catastrophe. Dissociation is the psychic defense of last resort. Unable to cope or to flee, the child simple “spaces out.” People sometimes refer to this state as “going out of body.”
In the context of the original traumatic situation, this defense preserves the child’s sanity. Unfortunately, dissociation tends to persist as the primary mode of psychic functioning throughout the lifetime of the individual. Such people have great difficulty in knowing or communicating what they are feeling. These deficits lead to an impoverishment of the person’s emotional life. Such people tend to experience themselves as ephemeral, or insubstantial. They usually have great difficulty in achieving or sustaining intimacy in their relationships.
There has been speculation regarding both biological and psychological causes of dissociation. From a neurologic standpoint, studies have shown a decreased corpus callosum in traumatized people. The corpus callosum connects the two hemispheres of the brain. The right hemisphere processes emotional experience. The left hemisphere includes the language region of the brain, in most people. A constricted connection between the two hemispheres could result in a limited capacity for recognizing and articulating emotional states.
From a psychological point of view, Joyce McDougall, a French psychoanalyst, believes that dissociation is the effect of exposure to overwhelming emotion that threatens to attack an individual’s sense of integrity and identity.
Within a developmental context, a child acquires the capacity for emotional experience, regulation and expression, through the parent’s capacity for attunement to the child’s emotional state. If the adult is incapable of recognizing and distinguishing emotional expressions in the child, it can impair the child’s capacity to experience his own emotional states.
Psychotherapy offers a reparative experience for a person suffering from dissociation. Suffering is actually a misleading term. Many dissociated people are unaware of their own dissociation. Often, such a person seeks psychotherapy due to a spouse’s frustration with them.
Working with a profoundly dissociated person in psychotherapy is challenging. The engine for psyche change is psychic distress. If the distress itself is dissociated, there may be minimal motivation to engage in psychological work. Moreover, it is difficult to establish an emotional connection of any depth with a dissociated person.
Often a starting point involves gradually drawing the person’s attention to her state of dissociation. The therapeutic process is one of symbolically reparenting the child. The therapist, unlike the actual parent, is able to register and to articulate her patient’s emotional states. Through repeated interactions in which the therapist is able to service this function accurately, the patient gradually internalizes the process. As she incrementally acquires the capacity to recognize what she is feeling, the therapy gains traction.
As a person develops increasing awareness of his own emotional states, both present and past experiences come to life. It becomes possible to narrate, to process and to release the previously frozen residue of early trauma. As parts of the self that had been dissociated become available for integration, the personality becomes richer, more complex, more textured and more vibrant.
Dissociation makes people feel like ghosts or robots. Experience has an “as if” quality. Integration of a full range of feelings gives rise to a robust, embodied passion for life.
As Walt Whitman wrote in “Song of Myself”:
“Urge and urge and urge,
Always the procreant urge of the world.”
The goal of marriage is not happiness, but rather individuation, or striving towards wholeness.
This assertion is the central theme of “Marriage: Dead or Alive,” a book written by the Jungian analyst Adolf Guggenbuhl-Craig.
I believe that this redefinition of the purpose of marriage is both helpful and important. The popular myth of marriage as “a bed of roses” is misleading and destructive. This expectation leads many people to become overly self critical and despairing when their marriage goes through the inevitable rocky times.
Marriage is metaphorically a hermetically scaled container. Within it, each spouse will experience over time the full range of his or her emotions: good, bad and ugly. The entire contents of both partners’ unconscious are reciprocally projected onto the other. If one fails to recognize these projections, one comes to experience one’s spouse as demonic. However if both individuals are capable of consciousness regarding their respective projections, then there is a unique opportunity for growth and for healing.
Encounter with the Shadow
Through reclaiming our projections, we complete ourselves. We encounter the shadow side of our own nature. This is always a painful and difficult experience. It requires openness, honesty and an unshakeable commitment to “own our own stuff.” The rewards, however, are great: increased self awareness as well as an enhanced capacity for relatedness.
To quote Guggenbuhl-Craig:
“It never happens that in marriage two completely healthy people get together. Both have their neurotic peculiarities and distortions. But marriage does not have to do with one partner’s curing the other, or even with changing the other significantly; this is not possible. Through the act of getting married, one has taken on the task of mutual confrontation until death … The peculiarities of oneself and of one’s partner must be borne, accepted and integrated into the interplay between the spouses …
“The more one confronts everything, the more interesting and fruitful becomes the path to individuation.”*
Marriage: Dead or Alive, Revised Edition. Spring Publications, 2001
Dr. John Deri’s next Blog Talk Radio Show: Healthy Mind and Body will be on Wednesday, March 3, 2010 from 8-9:00 PM PDT.
The topic will be - Panic Disorder: The Absent Self
Panic disorder is a terrifying, potentially disabling condition. It can be viewed as a specific form of separation anxiety: separation from the self.
In this episode, Dr. Deri will discuss psychological and pharmacological approaches to the treatment of panic disorder. The role of early life trauma as well as the potential co-occurrence of substance abuse will be highlighted.
Dr. Deri will discuss a clinical case, by way of illustrating and elaborating on these themes.
To listen to the show you can:
1. Dial the phone in telephone number at (347) 989-0560
2. Tune in to our online channel at http://www.blogtalkradio.com/Healthy-Mind-Body
Panic disorder is a terrifying, potentially disabling condition. In my experience, it is a specific form of separation anxiety: separation from the self.
Richard was a 39 year old married man living with his wife and their two young children. He was a self employed businessman. He presented with an acute onset of panic attacks. These episodes had been occurring with increasing frequency, during the weeks prior to our first session.
Richard and I worked together in twice a week psychotherapy for a period of four years. His symptoms of panic disorder were relieved by high doses of antidepressant medication, during most of this time.
Richard’s early life experience was powerfully influenced by his distant, critical, cynical father. The father, a successful professional, was rarely at home. Richard’s mother was comparatively more available to him. However, she was primarily focused on her husband. Moreover, she was largely preoccupied with her own painful feelings of isolation. As a result, Richard was on his own emotionally.
Like Sophia in my previous blog posting, Richard turned to alcohol as a young man. He used alcohol as a way of deadening and escaping from his psychic pain. Some years later, he began regularly using cocaine.
When I met Richard, he was drinking 6-9 drinks per day, as well as the occasional bottle of wine. Despite this clearcut pattern of alcohol abuse and dependence, Richard was in complete denial about his alcoholism.
Themes in Therapy
The primary theme in Richard’s therapy was to draw his attention to his repetition compulsion. He abandoned his family and himself much as he had been abandoned. A recurring memory wove like a thread throughout the therapeutic work. Richard had been put out in the back yard whenever he had cried as an infant.
A key dream, to which we often returned, consisted of a brief exchange between Richard and his mother. In the dream, Richard told his mother, “I’m in pain.” To which she replied, “I’m in pain, too.” In other words, Richard was entirely excluded from his parents’ minds.
As a young unemployed adult, Richard literally went hungry. His wealthy parents withheld financial support.
As a mature adult, Richard abandoned his own family, through alcoholism and workaholism. He was absent to himself as well. He would often work for long stretches, without eating or sleeping. He was entirely out of touch with his emotional states. Alcohol and work were his psychic refuges of unconsciousness.
The Therapeutic Work
The initial therapeutic task was building Richard’s capacity for mindfulness regarding his own self states. This work began with developing his attention and appropriate responsiveness to basic bodily sensations, e.g. eating when hungry. This process of growing self awareness then extended to his emotional states. During the early phases of our work, Richard would compulsively play video games, when he was neither drunk nor working. Gradually, he learned to make space for his own psychic experience. He developed an increasing repertoire of healthy activities in synch with his emotional states.
The next major hurdle in therapy was overcoming Richard’s denial of his addictions. To put it briefly, this achievement was won as a result of a two year long intrapsychic and interpersonal tug-of-war. Once Richard joined AA and CA, our therapeutic work truly blossomed. The step work and the psychotherapy were mutually synergistic.
Within the context of the fourth step (“performing a searching and fearless moral inventory”), it became possible to draw Richard’s attention to his abandonment of his family. This was an extraordinarily painful phase of the work.
Another key component in Richard’s healing process involved helping him to recognize and to neutralize his own inner critic. This voice was a direct internalization of his critical father.
Finally, through a combination of the psychotherapy and the twelve step programs, Richard overcame his narcissism. He developed a genuine, growing capacity for concern for others. This transformation in his character was deeply moving for both of us. Our own relationship with each other was immeasurably enriched accordingly.
Richard became clean and sober. His panic attacks resolved, off all medication.
His marriage dissolved. His business went bankrupt. His life, as he had known it, came crashing down around him.
Yet, paradoxically, Richard was happier and more grounded than he had ever been in his life. He had a greatly enhanced capacity for intimacy.
Once again, we encounter the archetype of death and rebirth: the phoenix rising from the ashes.
When I called Richard to request his permission to tell his story, he readily assented. “I tell my story all the time in the [12 step] meetings,” he said. “And, guess what? I’ve just celebrated my fifth year of sobriety.”
When I ponder the question of the meaning of life, I no longer have to search for an answer.
Dr. John Deri’s next Blog Talk Radio Show: Healthy Mind and Body will be on Wednesday, January 27, 2010 from 8-8:30 PM PDT.
The topic of the episode will be: How Does Psychotherapy Heal, Part II – Psychotherapy and Dependent Origination
The Buddhist theory of dependent origination will be discussed as a perspective on transference and countertransference in psychotherapy. These psychological phenomena will be explored as a medium for the healing of early childhood trauma in psychotherapy.
During the Blog Talk Radio Show: Healthy Mind and Body, Dr. John Deri will present a clinical case as an example of the work.
To listen to the show you can:
Dial the phone in telephone number at (347) 989-0560
Tune in to our online channel at http://www.blogtalkradio.com/Healthy-Mind-Body
Psychotherapy and Dependent Origination
The Buddhist theory of dependent origination states that all phenomena are contingent on antecedent conditions. The tree is contingent on the seed, the valley on the glacier and so forth.
This perspective is an extremely valuable lens through which to view the emotions experienced in psychotherapy. A patient responds to a remark of mine with a mixture of pain and anger. She has interpreted her therapist’s comment as a callous attempt to exclude her from his inner world.
The therapist knows from previous work with this patient that she had been severely abused by her father throughout her childhood. Her mother had been completely ineffectual at protecting her daughter from her husband’s rage. Neither parent had the slightest capacity or inclination to allow their daughter into their minds. Children will always try to see the parent as “good,” even at the cost of believing themselves to be “bad”. So, this little girl gradually developed a view of herself as deficient and unworthy.
In her psychotherapy, much work has been devoted to a reconstruction of her memories of this early life trauma. The terrifying effects of the physical abuse had been greatly compounded by her rage and panic due to her “solitary confinement”. She had lived her entire childhood utterly alone, despite the physical proximity of her parents.
Freud’s conception of therapeutics had a somewhat cognitive bent. Remembering the original trauma would afford the patient insight into his own woundedness. This insight would constitute the vital element that would enable the patient to heal.
Freud’s younger contemporaries, Sandor Ferenczi and Otto Rank, held a very different viewpoint. They believed that only a repetition of the original trauma within the psychotherapy relationship would have the power to heal the patient. They felt that only through repetition would the patient’s original memories be reactivated with sufficient force and feeling to break through the barrier of dissociation.
The aliveness of the feelings associated with early life trauma, reexperienced within the transference, allows these feelings to be revised and reworked within the context of a caring therapy relationship.
This healing is never a one time process. In the case of my patient, we repeatedly respond to each other in ways that leave her feeling hurt and excluded. Each time this occurs, we struggle together to delineate her process from my process. Each time, we view and review the relationship between the present and the past. As we do so, she has come to recognize that she does have access to my mind, and to my feelings. My positive regard for her is genuine and deep.
With each repetition, she emerges stronger and healthier. The perseverative reenactment of her original wounding, through the shadow play of the transference and the countertransference, engages a gradual but inexorable healing process. The critical difference between the past and the present is the outcome of the traumatic clash. In the here and now of the psychotherapy relationship, each repetition of the crisis resolves with enhanced mutual trust and deeper closeness between us.
In her parenting and in her work, this lady has become a beacon of hope and an agent of healing for others. Within her psychotherapy relationship, two wounded healers have been brought together for the purpose of mutual healing.
I would like to express my deep gratitude to my patient for graciously permitting me to make use of our work in the context of this essay. It is her intention to help to relieve the suffering of others through the sharing of her story.