Acting Out Behaviors

In my last blog post I addressed the "acting in" behaviors of depression and anxiety. Here I would like to focus on "acting out" behaviors that people turn to in an attempt to manage uncomfortable internal emotional states. There are many ways that people may "act out," such as putting substances (alcohol, prescription and recreational drugs, nicotine, or food) in their bodies to "self-medicate," overworking, gambling, working out excessively, obsessively turning to plastic surgery for cosmetic changes, excessive shopping, binge watching tv, spending hours playing video games, or engaging in risky and/or excessive sexual activities. When these types of behaviors are being used to unconsciously (or perhaps consciously) manage one's feelings, it probably means that the individual is choosing to flee from living in the present moment or the "here-and-now" to avoid fully inhabiting and experiencing one's feelings.

Cognitive behavioral therapists would focus on these behaviors directly and work on helping their patients learn ways to change the behaviors. Psychodynamic or psychoanalytic therapists like myself view these behaviors as symptoms or coping mechanisms that the patients employ because they might be the most adaptive ways they have learned to regulate the unacceptable, scary, or threatening feelings that are buried beneath. Rather than focus so directly on these symptoms, we believe that if we can help patients access and express the underlying unresolved feelings and come to understand how they are internally organized in relation to their emotions and unconscious processes, then over time people can learn healthier, more effective ways to manage their internal worlds. As a patient does so, we find that the unhealthy symptoms start to dissipate because there in no longer such a strong need to rely on archaic defense mechanisms that served a purpose at one time but now are more likely to be hindering an individual's progress.

A behavior is always a choice (even when it may not feel like a choice); feelings are not. If we subscribe to the belief that most people are well-intended and would choose the healthiest methods available to them, then we can come to see inexplicably harmful behaviors as adaptive attempts to manage difficult internal states. When people are able to learn alternate ways to manage these internal states, they are apt to choose the healthier options. When people learn that they needn't fear nor judge their feelings and begin to practice ways to tolerate, effectively manage, and perhaps even embrace their emotions, then they are better positioned to fill their tool boxes with the most healthy and effective tools. 

 

Depression and Anxiety as Defense Mechanisms

There is a great deal of confusion between feelings and mood states. Feelings (or emotions) are normal, healthy aspects of being human. Sadness, anger, joy, and fear are all common feelings that every human experiences, often daily. Mood states are not feelings. Depression, anxiety, and Bipolar Disorder (often known as manic depression) are mood states and can be considered mental disorders when severe enough. This isn't necessarily the case, as most people have experienced some type of depression or anxiety in their life time without it being serious enough to constitute a mental illness. We can say that we "feel depressed" or "feel anxious," which adds to the confusion between feelings and mood states.

Mood states may be understood as defense mechanisms that serve to protect us from underlying feelings. For instance, if we experience our anger as unacceptable or threatening, we might "depress" it and end up being "numb," resulting in not being in touch with the underlying anger. People who suffer from depression often describe themselves as being lethargic, fatigued, hopeless, or despairing. We cannot be in touch with our emotions when we are depressed. Reversely, when we are in touch with our feelings, we are not depressed at that moment. Anxiety may also be a way to manage underlying emotions. If our anger becomes too intense, we might react by becoming highly anxious. In this case, the anxiety is in response to a perceived threat induced by our anger. To complicate this further, if our anxiety then becomes too intense, we might then clamp down on it and become depressed. I describe this to my patients as layers upon layers, with the root feeling (which is pure and healthy) being buried deep down. So in this example, anger is the pure, healthy emotion that the individual has come to believe is bad, dangerous, or unacceptable. So Anger -> Anxiety -> Depression. Freud described depression as "anger turned inward." I believe this is what he meant by that explanation. Thus, a person might only experience his depression or anxiety, having suppressed his anger to a point where it cannot be easily accessed. But if a person suppresses one emotion, he suppresses all emotions. So when a person is suffering from depression, he cannot fully inhabit his anger, joy, fear, or sadness.

In psychotherapy I help my patients explore what feelings they might be defending against by employing the defenses of depression or anxiety. By teaching people that their feelings are normal and healthy and not to be feared, they start to shift their relationships to their emotions. Over time, this helps people learn alternate ways to manage their feelings so that they no longer believe they have to push their feelings away at all costs. We may view depression and anxiety disorders as forms of "acting in," i.e. turning inward to try to manage difficult emotions. In my next blog post, I will address "acting out" behaviors that people may employ as alternate ways to attempt to manage internal emotional states. 

Anger is Not a Four-Letter Word!

Anger gets a bad rap. Almost every patient I've ever worked with and almost every person I've ever met has struggled to view their anger as healthy and to manage it effectively. ALL EMOTIONS ARE HEALTHY! They are neither good nor bad, right nor wrong. Emotions are part of the natural fiber of being human. We don't judge ourselves for being thirsty, sleepy, or hungry. Yet we judge ourselves terribly for having feelings, especially unpleasant feelings. Most of us learned at a young age that these feelings are unacceptable, bad, shameful, even dangerous. But none of us were born this way. We don't come out of the womb judging our normal human emotions as something to be avoided. We learn this along the way, usually from a very young age. More often than not, our parents and their parents learned the same things about their emotions, so these inaccurate messages get passed on from generation to generation. If our parents cannot view their own anger as healthy, how can they teach their children that anger is healthy? 

People also get confused between emotions and behaviors. Emotions are simply the feelings themselves. Anger, sadness, happiness, fear - these are just pure feelings. Behaviors are the strategies we use to express our emotions. We have choice over our behaviors; we have no choice over our feelings. Every human feels every emotion, maybe even each day. Emotions are fluid and can change often throughout the day. We can no more control what we feel than we can choose not to breathe. When people view anger as unhealthy, I believe they are confusing behavior with emotion. Many people have learned unhealthy ways to express their anger. Some people become violent, aggressive, and lash out in hurtful ways. Others turn to substances or sex to attempt to manage their anger. Still others turn their anger against themselves and become depressed and beat themselves up horribly. 

In my last post I discussed pathological accommodation. One of the ways people accommodate others is by splitting off their anger because they view it as bad, thereby becoming inauthentic selves. Therapy can help patients learn about their own relationship to their anger and help them unlearn the faulty beliefs they were taught growing up. It can also help them learn to access and express their anger in healthy ways. This all requires that patients first shift their perspective on the emotion of anger so that they can come to view it as legitimate and valid. I am hopeful when I see that more kids today are being taught about feelings from a young age and being taught how to identify and regulate their emotions. Saying to a child, "You are really mad!" is a great way to empathize with the child and help him identify his anger. To follow it up with, "It's ok to be mad, but it's not ok to hit people" teaches the child to differentiate his emotions from his behaviors. We communicate that our anger is valid and we can learn effective ways to manage it. Psychotherapy can help patients learn the same lessons, which will in turn enable them to become more authentic human beings. Nurturing a positive relationship to one's anger is key!