The Unsung Value of Denial and Distraction: Where Therapists can Go Wrong

Posted on May 23, 2015. Filed under: anxiety, depression, psychotherapy | Tags: , , , , , , , , , , |

Big Eyes

One of my mentors was a psychiatrist of immense intellect and a laser’s capacity to cut to a psychiatric diagnosis. His brilliance as a diagnostician, however, did not extend to gently bringing his well-defended patients down the therapeutic path. He was a surgeon of the mind. Surgeons leave scars.

You might think of psychotherapy’s beginning as a kind of dance, with the patient in motion like Salome, wearing seven veils. The veils and shifting movement are for protection, not seduction. The client suffers “too much” and the covering — any covering — guards against invasion. If you, as doctor, rip the gauzy garments away, you do an injury. Without a shield, the client is exposed, terrified, and likely to flee treatment.

Too much too soon. A good mental health professional doesn’t drain a protective moat until the patient develops the courage to take on the scary world outside the castle (or inside his head). The counselor must avoid retraumatizing the patient, in effect flooding him with emotions he is unprepared for. The irony of hurting when you mean to help could not be more poignant or more terrible.

Young therapists can miss this. So do managed care companies when they want you to push treatment as fast as possible (to cut its cost) or medicate the insured party for the same reason. My mentor was guilty of ignoring the same therapeutic speed bump.

The challenge of focusing on life’s dark side was understood by the mathematician and big thinker, Blaise Pascal, who died just short of age 40 in 1662. He recognized the need to divert oneself from contemplation of the human condition. Students of clinical psychology might benefit from his words. For example:

Being unable to cure death, wretchedness, and ignorance, men have decided, in order to be happy, not to think about such things.

Or this:

I have often said that the sole cause of man’s unhappiness is that he does not know how to stay quietly in his room.

In short, the world can overwhelm such small creatures as we are. Those in most need of distraction are often the least inclined to make use of this necessary method in the pursuit of equanimity.

Pascal again:

However sad a man may be, if you can persuade him to take up some diversion he will be happy while it lasts, and however happy a man may be, if he lacks diversion and has no absorbing passion or entertainment to keep boredom away, he will soon be depressed and unhappy. Without diversion there is no joy; with diversion there is no sadness.

I’d say Pascal goes too far, but his point is a worthy one. I can name many people who seem relatively happy (at least for the moment) because they don’t think about the shadow following them down the street. A memorable patient of mine found escape in diversion and denial: she ate enough carbohydrates to push her well into obesity and diabetes. Yet, while eating, she felt good. Indeed, during stressful moments, she believed she deserved a treat as compensation for her upset.

The therapist’s job is to find a balance between allowing people to use their long-standing psychological defenses while gradually helping them recognize the longer term damage they are doing to themselves by not facing problems. With the large lady in question, it was quite a tightrope walk.

I find myself on both sides of the balance beam. Socrates was right when he said, “The unexamined life is not worth living.” So, however, was Pascal, by implying the deleterious effects of too much “examination,” rumination, and painful memory. The truth is hard to swallow, as the kid in the top photo is about to find out.

I guess if I had to create my own mantra, I’d look to alter the inscription on the Temple of Apollo, which read:

“Know Thyself”

My less pithy version would be: “Know thyself, but not all in one bite. Remember: your eyes (for truth) are bigger than your stomach.”


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