Sunday, July 19, 2015

How Therapy Produces Anxiety

The mind/body problem is not news. It’s not even new. I wrote about it extensively in my book, The Last Psychoanalyst, so I will not rehash my own views here.

The notions of mind over matter, of mind directing and commanding our actions, of mind expressing itself in words or in symptoms … these are endemic to psychoanalysis and to the culture of psychotherapy. Effectively, we owe them to Descartes, but, in modern times we owe them to Freud.

Once we become persuaded that the mind is in control of everything we imagine that if we therapy our minds everything will be well. Thus, Freudian psychoanalysis avoids any and all advice about changing behavior, in favor of isolating the mind and trying to access its unconscious component.

Tanya Luhrmann summarizes the views of one George Makari, views which, as I mentioned, are anything but original. Of course, however often these views have been critiqued, they continue to prevail in many precincts of the therapy culture.

In Luhrmann’s words:

From this, Mr. Makari writes, was developed the psychological mind and psychoanalysis and an expectation that personal thoughts and feelings are the central drivers of human action — not roles, not values, not personal sensation, not God. In the United States, the enormous psychotherapeutic and self-help industry teaches us that we must pay scrupulous attention to inner experience. To succeed and be happy, we are taught, we need to know what we feel.

Luhrmann adds:

It is based on a particular model of the mind that we take for granted, but that is in fact as culturally idiosyncratic as the way we dress. I’m not suggesting that the basic science of emotion depicted in the movie is wrong. Emotions do seem to be crucial in organizing human thinking. I’m suggesting that there is something deeply cultural about the way this mind is imagined, and that it has consequences for the way we experience thoughts and feelings.

Of course, the model of the mind is a philosopher’s fiction. It has been seriously critiqued by the most distinguished of British philosophers, from David Hume to Ludwig Wittgenstein. It is currently being critiqued by cognitive therapists, whose work does not, for the most part depend on the mind over matter and mind over behavior paradigm.

And yet, once you have learned how to think in a mind-centered way, it is devilishly difficult to think otherwise.

Yesterday, for example a friend posted this passage from Wittgenstein on Facebook:

The way to solve the problem you see in life is to live in a way that will make what is problematic disappear. The fact that life is problematic shows that the shape of your life does not fit into life's mould. So you must change the way you live and, once your life does fit into the mould, what is problematic will disappear.

It’s not about changing the way you think or feel. It’s not about exploring your mind to discover the infantile traumas that caused you to behave the way you behave. Wittgenstein is recommending that you change the way you live your life, that you modify your conduct… perhaps by developing and practicing good habits.

It beats retreating into your mind. When you retreat into your mind you are acting as though you are powerless to change the way you live your life.

For a clinical example, take another look at my recent post, Up From Off Of the Couch.

Luhrmann explains that the mind over behavior fiction consigns people to needless anxiety:

Yet what is inherited is the potential for anxiety, not anxiety itself. Life events obviously play a role. Another, less obvious factor may be the way we think about the mind: as an interior place that demands careful, constant attention.

What happens to your life while you are hard at work getting lost in your mind? Effectively, you cannot devote your mental energy to dealing with real people or real dilemmas in the real world. Thus, you will become more anxious. The world will be stranger and stranger and you will have a greater sense of being buffeted by events outside of your control.


Anonymous said...

The body-mind does not merely recognize patterns. It generates patterns based on past experience.

The role of central pattern generators (CPGs) is easily recognized for athletic feats:

What is less commonly recognized is that speech, emotions, and social interaction also depend on muscle memory involving something similar to muscle-organizing CPGs. Yes, toilet training, and other forms of socializing children, involves automatic process of activating CPG patterns!

The sociology of establishing and changing CPG patterns (behavior) would not appear to be so simple since it is similar to the effort to learn a foreign language after one has established the CPGs associated with the mother tongue. Yes, toilet training involves CPGs too otherwise one is free to go anywhere one wants anytime one wants without fear of offending others for doing so.

Ares Olympus said...

re: What happens to your life while you are hard at work getting lost in your mind? Effectively, you cannot devote your mental energy to dealing with real people or real dilemmas in the real world. Thus, you will become more anxious. The world will be stranger and stranger and you will have a greater sense of being buffeted by events outside of your control.

Putting "real" 3 times in one sentence would seem to be trying to say there's something unreal that we can give our attention to. Do people really "think too much"?

I can consider something like structured dance, where you're trying to conform to some external standard of a dance, what everyone else is doing, or following prescribed rules. Following rules would seem to take a lot of mental effort and concentration, at least in the beginning. And when you become aware of the difference between intention and result, when you see you're concentrating so hard on getting the footwork down that you're totally off beat, that can generate a lot of anxiety, or at least one that builds up in the back of your mind and makes you want to stop. So that experience is attempting to use "mind over matter", but it is a heroic effort, and if it always remained so, we'd give up, but it does get easier, almost unexpectedly when you try next time.

So where the mind seems to go wrong is not because we're too focused on mind, but that we're too unaware of subtle changes going on, and assume what's hard today will be hard tomorrow and feel anxiety when we extrapolate our frustration in the moment into eternal frustration that will never be relieved. So that's why encouragement is important.

Similarly I imagine therapy can seem frustrating because it seems like nothing is happening, and if you're repeating the same story over and over, perhaps nothing is happening, but I imagine if the therapist can pull the same story into a slightly different perspective, then it can be reevaluated from another point of view, perhaps one that isn't as painful or as dangerous to think about.

I've liked the idea of "defense mechanisms" since I first heard the term, and so we might accept the mind (or ego) creates defenses against things that are distressing or shameful or unacceptable in some way. So I imagine therapy might help a patient see when and how they are using a defense mechanism to avoid a true issue, like Scott Peck talked about "legitimate suffering" versus "neurotic suffering",

So we can assume neurotic suffering has no personal responsibility and action that can be done, because its an avoidance of a true problem, and thinking more about it won't help. But if therapy can identify a truer source of suffering, then action can be proposed to face it.

Perhaps thinking about "legitimate suffering" produces more anxiety because there's actually something there that needs attention? Just like I could handle 30 minutes of dance practice before my mind rebelled, perhaps 30 minutes of talking can make a difference that is subtle and hard to see, except over time.

On the other hand if everything "real" is outside of one's self, then all suffering would appear to be someone else's responsibility, and you can become comfortably asleep to your own participation to creating it.

Anyway, so we can see "mind" is a problem, and you can avoid that problem and say "If god had meant me to fly, I'd have wings" and abandon your greatest gift, all because it seemed "too hard".

Ignatius Acton Chesterton OCD said...

"Once we become persuaded that the mind is in control of everything we imagine that if we therapy our minds everything will be well. "

This sham of mass catharsis, based on reason alone, has been in vogue since the French Revolution. It doesn't end well. This is how we get thought control, with summary executions for those who resist.

Ignatius Acton Chesterton OCD said...

We're all suffering a bit of anxiety as we await our national therapy session on diversity policy...

This is going to be a geographic forced institutionalization. We're all going to be cleansed of our sins through forced confession and then housing penance financed by... the taxpayer.

There is no end to the madness. It's accelerating. This is how Big Data becomes a big problem. We are all being looked at as statistics. There's no humanity in any of this. This is the latest attempt at the forced perfectibility of man. Haven't we seen enough bad endings for these sorts of things? Telling people who to live with, or the "correct" categorized recipe for a community?

Makes me wonder if the Federal Office of Personnel Management data breach wasn't intentional. No one seems to care very much. Does LifeLock protect you from this nonsense?

Yes, this is anxiety-inducing. Especially when it will all be done by executive fiat. So much for representative democracy. I suppose Obama doesn't think we're fit for those sorts of quaint ideas.