Category Archives: Psychopathology

What is the Difference between Sadness and Depression?

It may come as a surprise to some, but sadness and depression are not the same.

It would be easy to mistake the two if we simply listen to how people generally talk about their feelings when they are having a bad day or feeling down for some reason.

Most people tend to use the terms sad and depressed interchangeably, not knowing what the difference really is.

This confusion, however, does a disservice to us since it inadvertently gives sadness a negative reputation, while also minimizing and confusing the issues that are really at stake when someone is truly depressed.

I therefore want to clarify this confusion once and for all and make it clear why depression is not always about being sad.

What is sadness?

We all feel sad sometimes. Sadness is part of the normal human spectrum of emotions, just like anger, happiness, fear, and so on. In fact, the ability to feel sad is a sign of healthy human functioning. Sadness is how we cope with loss and reinvest our energy in something new that takes the place of what we have lost.

We feel sad when we lose a relationship, but also when we lose a job opportunity, or when we reminisce about good moments in childhood which are no longer part of our lives.

Sadness in this sense is the indication that we have lived fully, that we have dared to love, that we have dreamed of things, and that we have enjoyed life. And loss, of course as we all know, is an inevitable part of life since life is ultimately a change process.

What is Depression?

So now that we know what sadness is about, let’s discuss how it is different from being depressed.

Depression, is different from sadness in many important ways.

Unlike sadness, it is not an emotion. Rather, it is a response to not dealing well with one’s emotions.

Studies have shown that depression often relates to a person’s difficulty with accepting, tolerating, or expressing certain emotions.

It short-circuits emotions because something about these emotions seems overwhelming, threatening, or uncomfortable. The result then is a sense of being stuck in certain emotions or a general flattening of emotional experience that leads to lack of vitality and lack of excitement.

Hence a frequent cause of depression is the inability to tolerate loss and the experience of sadness.

Rather than allowing the natural process of grieving to occur, a person who finds it difficult to let themselves be sad, may instead numb themselves to feeling, collapse into helplessness, or let it affect their basic sense of worth.

In these cases sadness is no longer experienced and expressed as part of the natural process of life, but is instead short-circuited and turned into a depressed state.

Depression is in this sense not an emotion, but an anti-emotion. It is a result of life turning against life, or forces from within working against the natural process of living fully.

But isn’t Depression about Feeling Sad?

Research performed by emotion-focused psychologists Leslie Greenberg and Jeanne Watson, has actually found a greater connection between depression and anger, than depression and sadness.

Only in 39% of the cases studied did depression involve themes related to loss or sadness, whereas it involved anger in 66%.

By anger, I of course mean, unexpressed or repressed anger which keeps a person in a powerless or subordinate position, or expressed anger that masks underlying feelings of low self-esteem or unfulfilled needs.

Emotion-Focused Therapy for Depression
Les Greenberg and Jeanne Watson have written an excellent book on the emotions involved in depression.

Book cover for Les Greenberg's book: EFT for DepressionIt has been noted in particular that when men become depressed they are more likely to express outward anger than to feel inwardly sad. This is because men in general feel less comfortable and have been less encouraged by our society to fully embrace sadness as an acceptable emotion.

The relation between depression and emotion is therefore much more complex than we normally think of when we simply conflate feeling sad with being depressed.

What is the Cure for Depression?

Since depression often short-circuits the natural experience and expression of emotion, the cure for depression often consists of helping people experience, express, and cope with their banished or threatening emotions.

This process often involves the following components:

  • Freeing up blocked or inhibited anger or sadness so it can be dealt with and understood
  • Helping a person work through fear, shame, or guilt about acknowledging, embracing and expressing their natural emotional responses
  • Helping a person not feel overwhelmed by their emotions
  • Helping a person discover the cause of the emotional responses that have been blocked or deemed threatening, in particular the underlying unmet need for love, safety, approval, or mastery

Allowing oneself to be sad as a means of coming to terms with some loss or unfulfilled wish is oftentimes part of this process, but the process also often involves resolving other stuck points as they may relate to anger, fear, shame, or guilt.

The ability to feel sad fully without stopping the process prematurely due to discomfort or fear is therefore often part of the antidote to depression and not part of the problem of depression itself.

As you can now see sadness and depression are very different entities and should not be confused. Although depression may involve sadness, it often distorts or blocks sadness from its true purpose. Depression is therefore often just a way station on a journey toward fully recuperating one’s emotions, including the ability to experience and express sadness as a natural part of life.

image of psychodynamic therapist, Dr. Rune Moelbak
About Me:
I am Rune Moelbak, Ph.D., a psychologist in Houston Texas. I specialize in helping people get unstuck from their depression by using a variety of the most effective psychological methods. You can learn more about therapy for depression by visiting my website.

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Learn 15 of the most effective psychological techniques to beating the blues. Continue reading What is the Difference between Sadness and Depression?

Generalized Anxiety Disorder: How to Stop Worrying and Start Living

Generalized Anxiety Disorder (GAD) is a label often given to people who worry excessively about many different things. They worry both to the point of making themselves significantly distressed and to the point where others start to get exasperated because they really don’t find the anxious person’s worries to be justified or realistic.

Why Do People Worry?

The first step in understanding the tendency to worry is to acknowledge that worrying is generally intended to be a helpful mechanism that reminds us of things to watch out for. Its purpose is to keep us from getting in trouble.

Worrying in itself is therefore not a problem. It is what makes me move my car from an area with unclear signage to avoid getting a parking ticket, and what makes me arrive 30 minutes early for a job interview just in case there would be an unexpected accident that would slow me down on my way. These kinds of anticipations of bad things happening generally serve me well. They help me plan for eventualities that could harm me and make me feel more in control of my life circumstances.

When Do We Worry Too Much?

In the life of someone with generalized anxiety disorder, however, worrying no longer serves it’s intended function to help us adapt well to genuine risks and challenges in our environment.

Here the worries have a number of characteristics that make them more burdensome than helpful. This is because the nature of the worries frequently includes a number of different exaggerations that distort the true risks involved.

These exaggerations fall into a number of different categories, which it will be helpful to understand so we know what we are dealing with…

Here they are one by one…:

Frequent Worries of Highly Anxious People:

“I take too much responsibility for others instead of setting healthy boundaries:” 

This kind of worry places excessive blame on myself if something were to happen to someone else. For example: “If my friend feels alone or depressed, it is probably because I am not doing nearly enough to hang out with them” or “if my boss gets annoyed or frustrated with me, it is probably because I am too lazy or unintelligent, or because I am a bad employee”. Not only does this kind of worry tend to turn to self-blame and excessive guilt, it also makes me feel that I constantly have to prove myself to others in order to be a good friend, good employee, good spouse and so on. It is therefore not unusual for people with generalized anxiety to overextend themselves, to take too much onto their plates, and to leave very little room for themselves and their own needs.

“I look to others for answers rather than trusting my own intuition:”

People with generalized anxiety often have a fundamental mistrust of their own decision-making. They fear that they would be unable to cope, or would be responsible for other people’s suffering, if they were to make a wrong decision. For this reason, people with generalized anxiety will often seek expert advice rather than consult with their own intuition, or they will defer to others about which restaurant to go to instead of feeling within what they are really in the mood for. This other-oriented living is just another way that the person with generalized anxiety silences their own voice and lives in hiding from their own needs, rights, wishes, and feelings.

“I externalize my anxiety rather than looking for the cause within:”

People with generalized anxiety live in constant anticipation of bad things happening around them that they think they would have prevented if only they were proactive enough or paid enough attention. Their constant attention to dangers in the environment conceals the fact that the real danger in generalized anxiety is often a danger from within. Clinical wisdom tells us that the fears that underlie my worries in GAD are really fears related to the eruption of emotions such as sadness, anger, or insecurity that I feel within myself and that I don’t think I can cope with. People with generalized anxiety often have an unconscious fear of disintegration, helplessness, and emotional overwhelm, which makes them live in fear of their own emotions and makes them want focus their attention outward instead of inward. Instead of dealing with their fears of their own emotions, they instead worry about physical symptoms in their body which they mistake for possible illnesses, or about other people for whom they feel responsible, or about eventualities in the future they can plan for or try to control.

“I blame myself rather than feel angry at others:”

People with generalized anxiety often have a hard time standing up for themselves, saying “no” to others, or feeling justified for having their feelings. Anger, which is the emotion that alerts us to boundary violations, injustice, and unfair treatment often evokes anxiety or feelings of guilt in people with generalized anxiety. As a result, the anger often gets converted into excessive people-pleasing and excessive self-blame. If someone gets mad at me, I internalize their anger and use it to beat myself up for my wrong-doings, or if someone offers a negative opinion about something I did, I take it to mean that I have inner defects or short-comings that I need to make up for. The lack of comfort with anger makes me invalidate my own perspective or right to self-define, and leaves me vulnerable and exposed to criticism from others.

How to Overcome Debilitating Anxiety:

The first step in overcoming generalized anxiety and excessive worry is to make the different kinds of excessive, unfair, or unrealistic patterns of self-protection which I have described above problematic to the anxious worrier. The person with generalized anxiety has to be helped to disentangle themselves from the part of them that worries or scares them. They have to realize that worrying and feeling anxious is something they do to themselves rather than who they are.

This differentiation of themselves from their worries is best facilitated by a therapist who can help them name both the ways in which they worry themselves and what it feels like to be on the receiving end of these worries. The outcome of this kind of differentiation is that they can begin to understand the needs and fears of the “worrier”, as well as the feelings of helplessness, inadequacy, and plight of the part of them that can never get a break from the “worrier”.

Helping the Worrier Turn Attention Inward:

Instead of the therapist simply joining with the more dominant worrier voice and helping this part of the person find the reassurance that it constantly wants but can never find, the therapist instead helps both parts of the person address the underlying emotional needs that never get tended to as long as the worrier simply pursues its agenda of finding reassurance outside of the anxious self.

The solution to the worrier’s problems is not to be found in getting reassurance or advice from the therapist, or finding ways to be better, stronger, smarter, more accomplished, more likable, or more in control. These are the pseudo-solutions the worrier tries to pursue to avoid addressing the source of their own vulnerability, and are ultimately very hurtful and damaging to the part of them that has to live underneath the weight of these responsibilities.

The Real Cause of Generalized Anxiety:

Once the person with generalized anxiety stops looking for solutions in never-ending self-improvement or never ending pursuit of more control, he or she is finally able to address the real issues at the heart of their worries. They can now gradually come to face the earlier life experiences that have made them feel too frail, too vulnerable, too unsupported, or too overwhelmed.

To do so, the person with generalized anxiety needs to be helped to turn their attention inward toward the pain they have avoided confronting, so they can become more comfortable with their own emotions and more grounded within themselves.

One reason that this has not been possible so far is that the person with generalized anxiety has learned to dismiss those feelings inside of them that were to uncomfortable or distressing to others around them .

The worrier came to be dismissive of their own feelings and needs because others were not there for them the way they should have been or because others could not handle or tolerate their emotions.

It is this original or ongoing rupture in compassionate understanding from others that often needs to be addressed in therapy so the person with generalized anxiety no longer needs to shut themselves down or turn their gaze outward.

The solution to generalized anxiety is therefore not to increase the effort to control situations and become ever more perfect. It is to become ever more comfortable with acknowledging your own vulnerabilities and learning to find ways to soothe and comfort the part of you that did not feel safe, supported, or reassured when growing up.


emotion-focused therapy for generalized anxietyFor more information about the underlying causes of generalized anxiety disorder, I highly recommend the book:  Emotion-Focused Therapy for Generalized Anxiety by Jeanne Watson and Leslie Greenberg

 


Dr. Rune MoelbakAbout me: I am Rune Moelbak, Ph.D., a psychologist in Houston Texas who offers a deeper approach to working with generalized anxiety. To learn more about anxiety visit my therapy website.

 

The Illness is the Cure: The Forgotten Wisdom of Our Psychological Symptoms

I always liked the saying “The illness is the cure”. Why? Because in the area of mental health, it alerts us to something profoundly insightful about the nature of the psychological and emotional problems most people struggle with.

Whether we feel depressed, have panic attacks, or generally feel weak, bad, or inadequate, these kinds of problematic states and ways of suffering are rarely ever simply problems to be removed or eradicated. They are NOT the illness, but like a fever or a cough, a symptom that alerts us to something about our life or our approach to life that is off-kilter, wrong, or in need of change.

Like the red lamps on the dashboard of a car, they alert us to the problem, but are not themselves the problem.

The Fallacy of Treating the Symptom as the Cause:

There is a real fallacy here that many people fall into if they do not realize this nature of their psychological distress.

If they simply think of their anxiety or their depression as the problem, then they might try to medicate the symptom to the exclusion of finding out why the symptom is really there.

In some sense this approach would be tantamount to attempting to solve a car issue by smashing the red light on the dashboard.

However, when you realize that the psyche uses the symptom of depression or anxiety to alert us to the fact that it is ill or that something in our life needs to change, our symptom becomes more of a friend than a foe. It now serves as a calling to resolve an issue which we may have been avoiding or which has stumped us in some way.

As in the saying “the illness is the cure” it serves merely as the first step toward the cure, and as such it is in fact the first step toward a transformation and reorganization that needs to occur for balance and health to be restored.

Way too often, we short-circuit this natural healing process because we get frightened by the calling and can’t see the road ahead. We mistake the symptom for the cause, and the burgeoning cure for the illness itself.

Discovering the Truth of Our Symptoms:

There is a depth of understanding that has gotten lost in our current search for quick fixes and immediate happiness, but was always there in the minds of the founders of the craft we now call psychotherapy.

A psychiatrist like Carl Jung, for example, beautifully wrote about heeding our symptoms as a calling:

“Depression”, he said, “is like a woman in black. If she turns up, don’t shoo her away. Invite her in, offer her a seat, treat her like a guest and listen to what she wants to say.”

Carl Jung
Carl Jung

Even poets have alerted us to the fact that our distress is merely a signpost toward making necessary changes. As Rainer Marie Rilke writes:

“Why do you want to shut out of your life any uneasiness, any misery, any depression, since after all you don’t know what work these conditions are doing inside you? … If there is anything unhealthy in your reactions, just bear in mind that sickness is the means by which an organism frees itself from what is alien; so one must simply help it to be sick, to have its whole sickness and to break out with it, since that is the way it gets better.”

Rainer Maria Rilke
Rainer Maria Rilke

Sigmund Freud, too, reminded us of the danger of not listening to our symptoms, for as he rightly warns us:

“Unexpressed emotions will never die. They are buried alive and will come forth later in uglier ways”

Sigmund Freud
Sigmund Freud

The Calling of Symptoms is to “Know Thyself”:

So much gets lost when we don’t heed the advice to listen to our symptoms and pursue them as the first step toward a cure.

Depression, anxiety, badness, and upset, cures itself once its truth is understood and its emotional conflicts disentangled.

The calling of mental illness is to “know thyself”.

The calling is not for a dimming of your awareness through medication, quick fixes, or a rush to premature action, but for an expansion of your consciousness, so you can reap the benefits of your psyche’s own wisdom, and find out more about what is meaningful and central to you at your core.

Illness is not a destination, but a way-station, and those who dare to unlock its message will be amply rewarded and transformed in the process.

image of psychodynamic therapist, Dr. Rune MoelbakAbout me: I am Rune Moelbak, Ph.D. psychologist in Houston, TX. I help people work through their symptoms of anxiety and depression to achieve a transformation to a better, lighter, and more centered self. Visit my website for more information. 

What Is Your Depression Telling You?

In my many years of experience as a psychologist and a psychotherapist, I have seen exceptionally few clients for whom depression was simply a disorder of the brain.

In the vast majority of cases, once a person begins to examine their feelings and their life more closely, they discover that their depression has a meaning and a message.

Depression, in other words, is not just a medical illness, but is what happens when a person is stuck in some aspect of their life without knowing exactly why.

Depression Hides its Own Cause:

Depression often conceals its own reason for being there. It is not unusual for a person to be depressed without being able to pinpoint some definite event that explains why they are depressed.

This absence of a cause often makes it feel like depression has no meaning and is simply the sign of a brain in disarray.

Perhaps this is why the vast majority of people end up treating their depression with anti-depressants, encouraged, no doubt, by commercials on TV.

However, if you go down this route you will largely miss the point of your depression, and will not  grow in the way your depression is challenging you to grow.

Your Depression has a Message:

why am I depressed?The reason why you are depressed is often not apparent. This itself is one of the hallmarks of depression. Depression tells us: you are stuck in some way, unable to deal with some emotion, haunted by the aftereffects of some experience, or dragged down by the reoccurrence of some pattern of behavior.

If you simply knew which emotion, experience, or behavior made you stuck, then perhaps you would not need to become depressed. Then you would have a pathway out: you would know what to do, or what to change.

The fact that you are depressed, however, tells you: it is not that easy.

Perhaps you have a need to be more assertive in life in order to not be walked all over, but this in turn triggers a fear that other people will reject you or that you will be abandoned by others.

Or perhaps, you have a vague hunch that you are not happy in your marriage, but this realization would have such disastrous consequences for life as you know it, and so instead you suppress it with the consequence that you are now depressed.

In both of these examples, depression simply communicates that you have hit some stumbling block to the authentic acceptance and expression of yourself.

It tells you: you need help to find a different path out of your current dilemma, and that your current solution of ignoring or suppressing isn’t working.

How to Get Unstuck from Your Depression:

What we discover when we take the challenge posed to us by our depression, is that we are almost always depressed for good reasons, even if it does not look like it from where we stand.

The trick of getting out of your depression is to get help to expand your awareness of what it is that is keeping you stuck. Once the full picture of what is keeping you depressed is brought to light, you will no longer feel stuck, and therefore no longer be depressed.

This was the case for both the person who could not be assertive, and the woman who could not allow herself to embrace her discontent with her marriage…

The Man Who Could not Be Assertive:

depressed manIf the person who is unable to be assertive begins to examine some of the fears that keep him stuck in unfulfilling relationships, he may begin to gain access to more of his frustrations with other people, which he now no longer needs to block from his awareness.

As he allows himself to more fully embrace his anger, he may realize that he is tired of always trying to please people, and may begin to express more dissatisfaction when people let him down. As his anger becomes accessible again, he may also be able to feel entitled to his sadness that people have not really been there for him, and to challenge his negative view of himself as someone who is not deserving of respect. As he gets to the root of where his negative belief of himself comes from, and begins to access more compassion for himself, he may be able to shift his view of himself and feel more entitled to have his needs met.

His depression, which was simply telling him that he was stuck in the dimness of a narrow awareness, would now give way to insight and new possibilities of being himself. As he would then no longer be stuck, he also would no longer be depressed. His depression would have served its purpose, and he would have heeded its message.

The Woman Who Was Unhappy in Her Marriage:

depressed womanIf the person who is unhappy with her marriage begins to more fully allow herself to feel her discontent, and if she examines what the fears are about that hold her back from accepting her discontent, the dilemma in which she is stuck may begin to shift. She may be able to more fully discover what she needs in order to be happy in her marriage and may begin to realize that she has some options to more actively fulfill these needs that do not involve getting a divorce. The fear of realizing that she and her husband may in reality be incompatible, may then lessen, and may cease to serve as a barrier to more fully embracing her needs and wants.

As the unconscious dilemma in which she was stuck begins to become known, and she begins to become more fully aware of the reason for her fears and her unhappiness, she is then able to unlock the message of her depression and use it to become unstuck.

What is Your Depression Telling You?

In the majority of the cases of depression I have seen in my many years as a psychotherapist, there was a message to be unlocked in the person’s depression. Once the person began to fully access and examine the full extent of their feelings and experiences, they were able to see what their depression was telling them, and were able to feel unstuck again.

The reasons for one’s depression, cannot be found by looking at the bottom of a pill bottle, but must be discovered through a process of self-examination that is best facilitated by the process of psychotherapy. Only then will you address the real issue which your depression is telling you to look at, and only then will you be able to set your life on a different path.

If you want to understand your depression better, watch my video in which I explain some frequent causes of depression:

image of psychodynamic therapist, Dr. Rune MoelbakAbout me: I am Rune Moelbak, Ph.D., a psychologist who specializes in helping people unlock the message of their depression. Please visit my website for more information about the treatment of depression. 

The Truth about Pathological Lying

The line between telling the truth and telling a lie has always been the central theme of psychotherapy.

The real self (an acceptance of one’s real feelings and motivations) and the reality principle (a sober assessment of the world as it really is) has always been considered the hallmark of health or good adjustment. 

Various forms of lying, on the other hand, have been the hallmark of what we consider to be pathology or maladjustment.

When we tell a lie, we make reality conform to our ideas rather than adjust our ideas to fit reality. 

In neurosis, for example, the truth gets distorted (minimized or magnified) in the service of maintaining a certain level of psychological safety. We need reality to BE a certain way in order to feel okay with ourselves and comfortable in the world.

In psychosis, on the other hand, our lies become fully-fledged fantasies without any basis in external facts.

Pathological Lying:

Although we all need some modicum of fantasy and untruth in order to make our lives and our view of ourselves more tolerable, for a certain group of people, lying becomes the central mechanism by which they interact with others.

We can call these people pathological or compulsive liars, although in many cases, pathological lying is really more of a symptom than a definition of who I am. 

The compulsivity of pathological liars means that these are not people who choose to lie. Lying here becomes automatic. It is a mechanism for maintaining psychological safety and reducing interpersonal anxiety.

Pathological Lying as Reaction to Trauma:

In my own work with compulsive liars I have generally found that the lying is a reaction to trauma.

One person, for example, was in a physically abusive relationship where he learned that he needed to say or do things more out of a concern for maintaining the other person’s happiness, than out of a need to express his true thoughts and feelings. The truth became associated with danger and became hijacked by the more primordial need for safety. Who I am, in this scenario, becomes who I need to be in order to be liked or accepted by others. Being myself becomes a dangerous proposition, a luxury which I cannot afford. Instead my truth becomes a self-presentation I can adapt to what I think others want from me.

Another person was helped to discover that at the root of her lies was a profound fear of being abandoned if she were to be herself. Vivid examples stood out about not having been picked up after soccer practice, and otherwise being forgotten about or neglected by caregivers in many situations. Now, she had come to think of herself as mostly a burden and as someone who could only count on others to be there for her as long as she provided a benefit to them. Most of this woman’s life thus became a frantic effort to be who others needed her to be so she would not be rejected and plunged into a deep dark hole of feeling worthless and dispensable.

Truth is Only Possible When We Feel Safe:

In both of these examples, the compulsion to lie was driven by a compulsion to stay safe, and a perceived risk involved in being and expressing one’s more genuine self.

Both examples reveal to us that telling the truth is always only possible on the basis of a fundamental sense of safety in one’s relationships with others. The ability to be real with oneself and with others requires validation that one is good enough as is, and certainty that others will be able to tolerate and care for one’s unembellished unadulterated self.

In this sense, pathological lying is really just like any other neurotic defense mechanism. It serves to ward off shame, lack of self worth, and a fear of abandonment and rejection.  

image of psychodynamic therapist, Dr. Rune MoelbakAbout Me: I am Rune Moelbak, Ph.D., a psychologist who helps people get in touch with their personal truths. If you have been hurt or shaken up by the lies of someone you love, or find it difficult to relate to others without lying to them, psychotherapy can help.

Shame: The Hidden Root of Most Psychological Problems

You won’t find “disorders of shame” as a category in the DSM-5 (the official American catalogue over mental health diagnoses), and yet shame is probably the biggest single cause of most of our psychological problems.

Shame is often the secret engine that get us started on a path of disordered eating, makes us feel bad about our bodies, causes us to be depressed or have social anxiety, makes us engage in pathological lying, leads us to feel lonely and empty in our relationships with others, and makes us escape into addictions of all kinds.

Shame: A Personal Story

When I was first starting out in this business and had to learn to market my private psychology practice, I had a very shameful experience.

I had been invited to a radio show to talk about my views of therapy. Thinking that this would be an excellent opportunity to plug my practice, I spoke at length about how listeners could contact me, and sought to market my website and my blog. After the show was over, the radio host did not realize that he was still on air as he turned to his assistant and bad-mouthed me for being so self-promoting. My initial reaction was one of embarrassment. The radio host had seen me and judged me in a way that was not flattering, and had pronounced it to the world. He had attributed qualities to me that I both recognized as somewhat true and felt were undesirable and incongruent with how I would want to be. In spite of this, the experience was probably most shameful for the radio host who had been caught off guard in a role that put his professionalism into question. He too must have felt ashamed that these private thoughts had now been broadcast to the world and to his radio show guest.

The example illustrates well what shame is really about. It is about being seen by others in a way we do not want to be seen and in a way that make others pass negative judgment on us.

The initial reaction that comes with shame is the urge to hide or run away. We feel as if we would rather cease to exist for a period of time as evidenced by the expression: to “die of shame”. And yet, if all goes well, we learn through these experiences to adjust our behaviors to become more acceptable to others: to be less self-promoting, or be more careful about what we say and when we say it. In short, we learn from our mistakes, and forgive ourselves and forgive others for their faux-passes.

Shame, in this way, is not altogether bad. In fact, without out it, we would not be able to adjust or regulate our behaviors to the socially acceptable norms, and would not be able to coexist with others.

The Benefits of Shame:

Shame makes us inhibit ourselves to preserve and protect social bonds. It is what makes people not just prattle on endlessly about themselves at a party, and it is what makes us “get a hint” when someone politely brushes us off. In this way it makes us able to function in our society without getting shunned or bothering others too much. Some people who have too little shame, may in fact find it very difficult to get along with others and may feel shunned and rejected in their lives, without quite knowing why.

Pathological Shame:

Shame only becomes disordered when it over-functions or over-regulates our behavior. Instead of becoming a learning experience about the particular norms of a situation, it may instead become a permanent mark on our personality or a permanent rejection of some aspect of who we are. Instead of just becoming the occasion of embarrassment, it may turn into a more permanent sense of ourselves as bad, wrong, repugnant, or unlovable.

The wish to hide now gets attached to an aspect of the self, which we can no longer allow others to see because it would be mortifying for that to happen. We may become ashamed of our body, our sexual desire, our need for others, our desire for independence, or any number of other things. When the shame is really deep, we can’t even access these attributes of ourselves without confusing them with our judgment of them. I may for example refer to any consideration for myself and what I need as a sign of “selfishness”, I may think of sex as inherently “bad” or “dirty”, or I may think of a healthy ability to rely on others as “being needy” or “weak”.

The more powerful my experience of shame, the more I have a need to hide those aspects from others, and even from myself. A part of who I am or how I feel must now be disowned, silenced, or hidden at all cost, and I essentially become estranged from a part of myself.

The problem with this desire to push aspects of myself away is that my shame continues to exercise influence even when it is disowned or goes unacknowledged.

Unhealthy Ways of Dealing with Shame:  

Whenever who we want to be begins to diverge from who we inherently are, the result is almost always some form of psychopathology.

Many people with histories of shame develop an obsession with becoming someone other than who they are. Their entire life may now become a flight from self and a desire to merge with an ideal image of themselves. They want to be free from blemishes and embarrassing traits, but can only hope to achieve this by cutting off a part of who they are.

Unfortunately, the solution they are seeking and the problem they are trying to escape, are two sides of the same coin. The more I pursue my aspiration to become other than myself, the more I increase my judgment on who I really am. Shame and the pursuit of overcoming shame are thus often one and the same.

The problem is of course that I cannot run away from my past, nor can I heal the wounds of shame by simple trying to run away from myself. Shame will always follow me as my shadow, unless I attend to it and address its root cause.

No amount of money in the future can ever heal the wounds of childhood of someone who grew up poor and was teased and ostracized by his classmates, and no amount of self-sacrifice can ever heal the shame of someone who adopted the belief that their lack of love for their parents was what led to their parents divorce.

If we want to overcome our shame, the cure does not lie in ridding ourselves of our shameful attributes, but rather in learning to accept who we really are.

The Cure for Shame:

The antidote to shame is love and self-compassion. However, since shame is such an interpersonal experience and is tied to how we view ourselves in relation to others, simply reciting self-affirmations or telling ourselves we love ourselves, will not produce any real results.

Since shame was created through an emotional experience originating in a social encounter, or was internalized from messages we received from others about what is acceptable and what is unacceptable, the cure for shame must be “a corrective emotional experience”. Love for oneself has to come from the experience of being lovable or acceptable to others. One has to be able to open up to others, to show oneself as one is, and to experience that others can still love and accept one in one’s most vulnerable and exposed state.

This corrective experience is in large part what therapy is about. Therapy helps create the safety and trust to reveal ever more of who one truly is from underneath the layers of social pretense. Sometimes this means getting in touch with facets of one’s experience, which are even foreign to oneself, since one has spent most of one’s energy repressing them in order to fit in and become what one thinks others want one to be.

Ironically, the greatest change in oneself and how one feels about oneself, doesn’t come from changing who one is, but rather from truly becoming who one is. Too many people are embroiled in battles of self-improvement that are nothing but concealed manifestations of an underlying shame. The distance between who one truly is and who one feels a need to be in order to fit in, be normal, or be acceptable, is often the culprit of many of the psychological problems that people report with in therapy, and is often what needs to be dealt with if a person is going to experience lasting peace and happiness in their life.

> Also Read: Social Anxiety and Shame

image of psychodynamic therapist, Dr. Rune MoelbakAbout me: I am Rune Moelbak, Ph.D., a psychologist in Houston, Texas who helps people get to the root of their psychological problems, so they can experience real change and not just temporary gains. Click to visit my website.

 

A 1001 Depressions: Which One is Yours?

When we generally think of depression, we think of it as the same phenomenon. People sometimes call it clinical depression, and professionals often call it major depressive disorder. However, depression is not really ONE thing, and there are as many variations of being depressed as there are people who are depressed.

Why is that? Because, in the majority of cases, depression is the individualized expression of a life struggle. It is simply like a fever that tells us there is something we need to look at or something about the way we live our life we need to resolve.

Sure, we cannot exclude the possibility that depression is once in a while the symptom of a brain in disarray, but this type of more biologically based depression is only a small subset of a much more diverse landscape of causes.

There are indeed a 1001 different depressions…

A 1001 Varieties of Depression:

Insecure Attachment:

One of the more common forms of depression is rooted in what we now have come to know as insecure attachments in childhood. Growing up with uncertainty about the availability and dependability of key people in one’s life robs a person of a secure core of knowing they will always exist and will always matter to others around them. As a result, this kind of person is perpetually fighting a sense of frightening loneliness, which they are always trying to distract themselves from. The frightening loneliness is the same kind of fear a child has who gets lost in the grocery store and isn’t sure if she will ever find her parents again. It rears its head when important relationships are severed or when the person feels abandoned. At such times this person may become severely depressed and lose any kind of hope for the future. They get lost in their sense of not mattering to anyone and find it hard to carry on  when they feel their life has lost its meaning.

Loss of Self:

Revolutionary Road Revolutionary Road is an excellent illustration of how a person can get caught in an empty life and get lost to oneself in the process[/caption]

Another kind of depression happens as a result of the emptiness that follows from a loss of clearly defined self. People with this kind of depression have become so accustomed to adapt to their circumstances, that they have lost touch with what they really need or want. For far too long, their agenda has been to keep others happy or avoid upsetting anyone, and now they feel empty and hollow because they have completely lost touch with their needs, wants, and passions. Their life starts to feel like it is just a performance. Many people lose themselves this way in their marriages or at work, where it feels like they are just filling a role, and not really living their life. You can find a good illustration of this kind of depression in the movie: Revolutionary Road.

Avoidant lifestyle:

Then there is the avoidant kind of depression, brought about by living a fear-drive life. This kind of person cuts off too many areas of their life to avoid failure or anxiety. Maybe they avoid risking altogether, and therefore also do not get the rewards of those who conquer their fears and face their challenges. This leads to a dull life robbed of excitement and thrills that come with being fully alive. This kind of person may shy away from the risk of rejection and therefore never experience romantic intimacy with another person. Or, they may avoid truly pursuing their career dreams because they are afraid of failing. The end result is an impoverished life and chronic sense of dysthymia.

Shame about Self:

Then of course we have the people who are too ashamed of themselves to fully let themselves be known and seen by another person. These people have mistaken unkind acts by others as a sign that they deserved mistreatment and are blemished, broken, damaged, or bad. Histories of sexual or physical abuse can often lead this kind of damaged view of oneself and the price of this view is depression. Such people end up not really relating to others fully. They may be afraid that others will reject them if they truly know them, or may ward off love from others, which they discredit or believe to be disingenuous. They cannot be nurtured by love because they cannot love themselves, and the result, of course, is a chronic sense of dissatisfaction with life and with oneself.

Internal Conflict:

Our Inner Conflicts Karen Horney’s book “Our Inner Conflicts” is an excellent resource for people wanting to know more about potential conflicts that can lead to depression[/caption]

Another common variety of depression is the one caused by an internal conflict that leads a person to become stuck in an unresolvable dilemma. A person may for example feel guilty or fearful of choosing a career not condoned by their parents, but may also feel lack of motivation and lack of passion if they pursue the path laid out for them. Oftentimes these conflicts that lead to action paralysis or a sense being damned if I do and damned if I don’t, are entirely unconscious. A person may simply show up to their therapist and complain of feeling depressed without knowing why. Depression can in other words take the place of fully dealing with an uncomfortable dilemma that may involve making others unhappy, or may threaten a person’s established sense of self.

996 Other Depressions:

Add to this catalogue, hundreds of other varieties of depression and you will get the point that depression is not ONE illness, nor is it reducible to a simple catchall diagnosis that must be dealt with the exact same way. In fact, for different people, different life events can trigger a depression. If your life is built around security needs, the ending of a relationship may be the trigger. If you gain your self-esteem from being the life of the party, losing favor with certain friends may be the trigger. If your life is about achievement, getting fired might do the trick. It is therefore important to not get lost in the diagnosis, but to see what the diagnosis reveals about the person beneath the diagnosis.

Heeding the Message of Depression:

Depression is not simply a problem to be treated with anti-depressants. It is a starting point for self-examination. It tells us we are “stuck” in some area of life, cut-off from our true feelings and needs, or unable move on from traumatic experiences of our past. It tells us we must get our life back, and reclaim it from whatever forces are keeping us back.

In the short term we may be able to medicate the problem away, but rest assured, the depression will return until its message has been received. No one in the history of mankind has ever been able to run away from themselves.

image of psychodynamic therapist, Dr. Rune MoelbakAbout me: I am Rune Moelbak, Ph.D., a psychologist in Houston Texas, specializing in the psychodynamic treatment of depression. To learn more about my approach to depression, please visit my website, where you can access additional resources.

Growing Strong in Your Weak Places

“The world breaks everyone and afterward many are strong at the broken places” (Ernest Hemingway)

Ernest Hemingway spoke of a universal psychological truth, when in A Farewell to Arms, he suggested that you grow stronger in your broken places, much like a wound that heals itself by growing a protective scab.

Those who suffer through difficult experiences and invalidating environments have to find within themselves a strength that others don’t necessarily have to. They grow stronger in their weak places.

Strengths through Suffering:

If my family was abusive, my psychological survival would demand of me that I stretch myself beyond the normal requirements for human development.

I might have to develop special abilities to numb my feelings, get into my head, or depend on myself, in order to survive such an upbringing. As a result, these facets of my human capacities will become more developed in me than they will in others, and might give me special advantages, in spite of their drawbacks.

If I become skilled at numbing, suppressing, or silencing my feelings, I might be particularly skilled at working in professions that are too emotionally intense for others. I might handle the job of a paramedic, that would make others queasy, with an even keel, or I might keep calm in a crisis situation when others lose their ability to think or to act.

The Need to Rise Above our Vulnerabilities

The world is filled with people, who due to their trials and tribulations in life, have developed unique facets of themselves that have propelled them into successful endeavors: Comedians who learned that laughter was the best medicine to cheer up their depressed mothers, business men who vowed to never lack money in order to overcome the suffering endured by their parents, and world travelers who came to embrace freedom and independence to deal with the anxieties of getting too close to others.

Alfred Adler, one of the early psychoanalysts, developed the idea that human beings have an inherent need to rise above their weaknesses and excel at something.

Oftentimes our particular hardships become the driving force that propels us to succeed, or that supplies us with a mission for our life and a reason to get out of bed in the morning.

The Desire to Be Super-Human

A colleague of mine recently finished his dissertation on what he calls the “Superwoman Schema”. This is a mindset originally found in a subset of African-American women. These women develop a belief that they must be strong at all times, never show their vulnerable emotions, never allow themselves to depend on others to have their needs met, and always set their own needs aside to take care of others.

This Superwoman schema, helps such women develop the thick skin that allows them to keep afloat in tough environments, and not let their personal feelings get in the way of what they need to do.

Although disavowing one’s own needs and setting one’s feelings aside comes at a price, it is undoubtedly also what has propelled some women like these to achieve great success.

If you have watched the Real Housewives of Atlanta, you will know what I mean. These ladies do not easily let their vulnerabilities show. Having a thick skin has helped many of them rise above tough upbringings, feelings of abandonment and histories of abuse.

Attending to the Underlying Wound:

Of course, the strengths that are born out of weaknesses, also tend to have their downsides. The more one tends to pursue life goals out of an underlying wound, the more these goals tend to take on a compulsive quality: I MUST be strong at all times, I can NEVER allow myself to depend on others, I NEED to ALWAYS be smarter than the next person, I can NEVER make enough money. These dictates soon become tyrannical and perpetuate a judgment of oneself as never quite good enough.

Being human for such people is a dangerous reminder of the past they are trying to leave behind. They therefore spend their lives aspiring to rid themselves of their human frailties. Of course such endeavors are ultimately futile since one can never become what one is not.

Instead of dealing with their pain, and grieving the nurturing they didn’t receive, such people instead disavow their feelings, hoping that they can out-run them. With each accomplishment, however, they only alienate themselves further from who they truly are, and remove themselves one step more from the self-acceptance they ultimately long for.

As long as we cannot accept all of our human experience, including the full gamut of human emotions, from assertive anger, to the pain of disappointment, from the sadness of loss, to our need for closeness, we will always fall short of realizing our most precious project: to become who we are, not more than who we are.

Dr. Rune Moelbak

 

About Me: I am Rune Moelbak, Ph.D., clinical psychologist in Houston, Texas. I help people attend to their emotional wounds so they don’t have to spend their entire life running away from their pasts.

What Causes Psychological Disorders?

Although there are some psychological disorders that have a clear biological or genetic component, many if not most are responses to life’s adversities and quite treatable through therapy.

What is a Psychological Disorder?

A psychological disorder is often not really an illness such as one would define diabetes or multiple sclerosis. Instead it is simply a name given to a collection of distressing symptoms that frequently go together and thus would appear to refer to the same underlying phenomenon.

Major Depressive Disorder, for example, is the name we give to the symptom of persistent low mood or lack of excitement that is accompanied by a minimum of 5 other symptoms such as: hopelessness, low self-esteem, changes in sleep and appetite, low energy, low motivation, decreased concentration, and possibly suicidal thoughts.

Unlike an illness, however, most psychological disorders have no singular defining cause and therefore do not refer to an underlying disease process. What we call psychological disorders are therefore simply descriptions of surface-level similarities in how psychological problems can manifest themselves.

To truly understand why a person is depressed, or what causes the depression, we must move beyond the symptoms to the origin of the symptoms. When we do this we often find that your depression and my depression are not really the same. They are not defined by the same underlying cause, but are simply like the fever or the cough that can hide over widely divergent underlying issues.

The Causes of Psychological Disorders:

When we look at the internal functioning of most people, we often find that psychological symptoms such as depression and anxiety are the result of ways of protecting ourselves from painful or unpleasant emotions.

Somewhere, at some point, we developed negative emotional responses to our primary emotions and longings: Those healthy and natural feelings that a child expresses spontaneously without guilt or shame.

For example, we may have developed guilt about our sexual desire, shame about needing other people, anxiety about expressing our anger, or unbearable pain associated with the experience of loss or rejection.

These secondary aversive reactions to our primary emotions taint these natural emotions and needs, and lead us to shut them out, inhibit them, or engage in all kinds of self-protective behaviors intended to keep us safe from our own unpleasant experiences.

  • To protect ourselves from guilt about sexual feelings, we may for example develop a life strategy of never really dating.
  • To avoid feeling shame about our longing for closeness, we may live a life of always helping others and not being able to receive help from others.
  • To not feel anxious about our anger, we may become a people pleaser, ignore our own needs, and not be able to assert ourselves.
  • To not feel overwhelmed with pain associated with losses, we may bury ourselves in work and live a life of always being on the go and always distracting ourselves.

In each case we may become depressed or anxious as a result of cutting ourselves off from a natural source of vitality and living a life that is at odds with itself or impoverished in some way.

Depression and anxiety are here not referring to a cause. Instead they are the symptoms that have resulted from conflicted experiences and our failed strategies of dealing with these experiences.

Psychological Disorders as Defenses:

Other psychological disorders can be explained in a similar way…

Intrusive obsessions about one’s own destructive impulses (OCD), can in some cases be a way to protect oneself from dealing with guilt about the rightful expression of assertive needs, which one fears would destroy others or be too much to handle.

Social anxiety and the avoidance of social interaction can in some cases find an explanation in the attempt to avoid feeling the shame of rejection, which has been magnified to mean the destruction of one’s self-worth.

In this way, most of what we call psychological disorders can be unraveled and explained as symptoms of underlying conflicts that are specific to each person’s life experiences.

Resolving Psychological Disorders:

A psychological disorder usually makes perfect sense once we understand the full picture of the person’s psychological reality.

The goal of therapy is therefore to locate within a person’s life, the experiences or moments that have led to secondary reactions of guilt, shame, pain, or anxiety to normal, human, healthy emotions, needs, or expectations.

People must unlearn the fear, shame, or guilt that has become associated with being fully themselves. They must be able to fully get in touch with yearnings and feelings that have been considered too dangerous and have therefore been shut out. By thus regaining access to hidden parts of themselves, they can stop being at war with themselves and can become free to respond in more life-affirming ways to life’s many challenges.

Simply slapping a label on someone and classifying someone as having a particular disorder, tells us nothing about the journey each person has to go through in order to undo their disordered ways of dealing with life’s dilemmas.

Dr. Rune MoelbakAbout me: I am Rune Moelbak, Ph.D., a psychologist in Houston Texas. I help people get to the root of their problems so they can experience real change rather than temporary gains.

Do I Have a Personality Disorder?

We all have personalities, but what does it mean to have a personality “disorder”?

What is a Personality?

A personality is a certain habitual way I deal with the world around me. When you think to yourself “boy, that person sure has a personality!”, what comes to mind is probably certain predictable characteristics that stand out about them and that don’t just blend in with the surroundings.

Our personality is a collection of enduring traits about ourselves that make us stand out as well as make us predictable. Hence, I might tend to be “the life of the party” or the “loner”, the eternal optimist or the perpetual worrier, the workaholic or the worka-phobic, the antagonist or the person who always tries to please.

Whatever the case, my personality uniquely equips me to deal with certain situations, while it puts me at a disadvantage for dealing with certain others. My greatest strength in one context – becomes my greatest weakness in another…

My personality serves as a kind of immune system that protects my own mental health from the challenges and demands of life. It consists of a collection of go-to coping mechanisms and thinking styles through which I confront the world.

My personality is my specific way of dealing with the demands of life, such as creating a satisfying social life, succeeding in my chosen career, collaborating with others, developing close relationships, and dealing with interpersonal conflicts.

When things go well in life, that is, when my traits or tendencies match with my environment, then I can likely live a symptom-free life. However, when there is not a good match, tensions will begin to rise within me, and I am likely to become depressed, anxious, angry, or otherwise unhappy.

John has a Personality Disorder:

John loves to be “the life of the party” and uses this trait to his great advantage. He becomes an actor so he can feel the thrill of being on stage, and has a very active social life that satisfies his need for attention. His personality helps him succeed in areas of his life that are important to him.

Yet John might begin to get in trouble if he ALWAYS has to be the life of the party, if he NEVER can be alone with himself, or if he ALWAYS relates to others as an entertainer, actor or performer.

He may for example meet a romantic partner he likes, but due to his chronic and excessive need for attention, may make every conversation about himself.

With his excessive focus on his own needs, John may not be able to be empathic with his partner’s needs and may not be able to maintain the mutuality required to create an intimate relationship.

When his partner begins to feel dissatisfied with John’s excessive attention-hoarding and demand that something changes, John may not be able to give in to the demand, since doing so would make him feel depressed, unloved, or empty.

He therefore instead turns the blame back on his partner whom he accuses of just not being that interesting and therefore being responsible for his own misery.

When his partner withdraws his interest in the relationship and in John, John does not have the flexibility in his personality to allow himself to notice this, so he instead “tells himself a story” and tries to convince himself and his friends that everything is fine.

When his relationship finally falls apart, John might at first become self-righteously indignant. He may seek out friends who can confirm his belief that his partner is to blame. He may also launch himself into a string of affairs to confirm to himself how lovable he is and therefore prove that “it is his partner’s loss” — not his

However, if these strategies fail, John may eventually have no way to maintain his fragile self-esteem and may finally have to engage in some painful soul-searching. At this point he is likely to become depressed, may begin to drink, or may not be able to maintain work obligations or friendships.

What is a Personality Disorder?

John would likely be diagnosed with a personality disorder.

His character traits are rigid. If people around him do not adapt to his preferred ways of dealing with situations, John cannot change his approach and adapt to the new situation.

As a result, John is bound to have many conflicts with people around him, and frequently be at odds with the demands placed on him by different tasks or role expectations.

In John’s situation, differences between personality style and environment are solved by devaluing the environment or changing the environment, which works as long as other people are ready to accommodate him.

In other personality types, such as in people with strong dependency needs or excessive fearfulness, differences may be solved by acquiescing, letting go of healthy assertiveness, or abandoning oneself.

In either case, the environment threatens the integrity of the person’s self-esteem and makes it impossible for them to learn from the situation and master a greater repertoire of skills. The person tends to always respond the same way regardless of circumstance and is thus locked into a cycle of repeating the same failed outcomes.

John, for example, may fall in love again, but his next relationship will likely have the same ending, since the need for admiration is the only way John knows to raise himself out of an ever-looming depression.

This then leads to another hallmark of people with personality disorders: They tend to run into the same problems time and again. Depending on their personality style they may show patterns of getting fired due to having trouble taking orders from a boss, falling out with friends due to inability to deal with conflicts, getting divorced on multiple occasions due to the same complaints by their spouses, and so on and so forth…

Personality Disorders are Dimensional:

We all have certain rigid and unbendable traits that can get us in trouble in life and can make it difficult to deal with the demands of particular situations. With each personality comes certain advantages and disadvantages. This is to be expected. Most of us reduce tension and discomfort by creating a life that maximizes our advantages and reduces the need to be someone we are not. This does not mean that we have a personality disorder.

Our personality only becomes a severe liability when we feel chronically deficient in the many aspects needed to live a fulfilling life. We may for example not be able to tolerate intimacy regardless of circumstances, or may not be able to EVER relax or be spontaneous, or may not be able to enter into ANY relationship without sexualizing it. It is in these cases that assigning the label of a personality disorder may be appropriate.

Having a personality disorder is therefore not simply about having a personality trait or habit that gets us in trouble. This trait must be so rigid, so exclusionary of other ways of doing things and perceiving the world, that it severely limits our ability to function effectively in life. Hence there is a difference between being perfectionistic, and not being able to complete a work assignment because one is never satisfied with the result.

Many traits only become dysfunctional when taken to a certain level of intensity or severity. In the first case, perfectionism might help me win awards for my attention to detail, while in the latter, my perfectionism might end up getting me fired.

Therapy for Personality Disorders:

If your personality prevents you from getting along with others, functioning well at work, or getting enjoyment out of life, the treatment of choice is not simply to force yourself to act differently. The rigidity of particular personality traits is often the result of bruises to self-esteem, or early developmental traumas. Particular ways of dealing with tension, psychic pain, and threats to self-esteem developed as a kind of protective armor needed to deal with threats to one’s psychological safety.

Psychodynamic therapy is particularly effective in helping people access these early experiences and traumas so they can be begin to grow from life, rather than remain stuck in the need to protect themselves from it…

About Me: I am Rune Moelbak, Ph.D., a psychodynamic therapist in Houston, TX, who helps people get to the root of their problems. Visit my website to schedule an appointment.