Mental

Resolution of Trauma

Ron Johnson emotional maturity, Feelings, grief, love, Mental, mindfulness, Self-Awareness

Not long ago I wrote a blog entitled “the only mental health diagnosis” identifying it as trauma-related, and hence PTSD. This remains my opinion of the plethora of diagnoses that are so popular these days. As I previously noted, people simply want to make sense of ails them, whether their feelings, their behavior, their thinking, or their relationships. In almost all cases the ailment is due to the traumata that they have had in their lives, particularly the emotions associated with the traumata. In this blog I want to suggest how a person can get over the causes of his or her PTSD, ideally without even labeling it as PTSD, much less anything else. We will briefly discuss the following:

  • What is a trauma
  • What is PTSD
  • Finding the trauma
  • Facing the trauma
  • Feeling the trauma
  • Finishing the trauma
  • Forgetting about the trauma
  • Forgiveness regarding the trauma

What is a “trauma”?

A trauma is any unsuspected event that has deleterious effects on the individual. This negative effects could be physical, emotional, cognitive, or relational. In other words traumata are not restricted to the physical assaults, like sexual assaults, that occur to people or the physical wounds that one acquires in the theater of war. The essence of a trauma is not the event or the damage done to the individual, but rather to unexpected nature. In other words, we are traumatized by something harmful to us in some way that we did not expect. The general categories of traumata include:

  • Physical trauma includes sexual abuse, physical abuse, physical damage that occurs in the course of a day, or physical damage that occurs because of war
  • Emotional trauma is perhaps the most significant part of traumata and it is the most subtle. In fact, the large majority of PTSD comes from emotional trauma such as:
    • Not being given the privilege of feeling sad or angry when traumatized. Many children are simply not given the opportunity to feel these emotions.
    • Being given too much privilege of feeling these things. Some kids are given too much freedom of expression, which has the effect of their failing to govern their emotional expressions in adult life
    • Having an overwhelming feeling of fear during a trauma. This can cause an overwhelming feeling of not being safe in the world
  • Cognitive trauma is less frequent but occurs when an individual is not allowed to think, express these thoughts, and experiment with engaging the world with appropriate thought.
  • Relational trauma is usually mixed with cognitive and emotional traumata. Its essence is in the failure of an individual to develop meaningful relationships with other people.
  • Neglect trauma. More prevalent in undeveloped countries, this is the phenomenon of an individual, usually an infant, who is not given enough nurturance or comfort to allow the brain to develop. Romanian orphanages are full of such children due to the former regime’s demand that Romanians have more children.

You can see that all of these traumata fall in the realm of the unexpected. I do not expect an adult to assault me, neglect me, or fail to allow me to think or feel.

What happens with one is traumatized and suffers PTSD? I encourage you to examine the many resources available, like Van der Kolk’s The Body Keeps the Score and the many articles that fall under treatment of PTSD, like EMDR. Very simply put, when traumatized, the brain has a reaction that ideally allows the mind to make sense of what has happened. I could be traumatized by seeing a child drown but not suffer PTSD if I am allowed to feel through, think through, and perhaps act through this situation. Again, very simply put, there is a brain function that occurs with any trauma, which is first emotional, secondly, cognitive, and thirdly behaviors. Of these three operations the usual cause for PTSD is the failure to feel the emotion associated with the trauma. Thus, most PTSD is the brain’s having failed to find, face, feel, and finish the emotions associated with the trauma, and then go further to forgetting and forgiving as deemed necessary.

Finding the trauma in PTSD

This can be an easy task or a difficult one because the trauma could be forgotten or repressed in memory or for some other reason, like having suffered something that seemed right at the time and necessary. Some people artificially “forgive” a parent for abuse or neglect because they love their parents and understand that their parents were not able to avoid physical abuse or neglect given their parents’ own personal history or other circumstances. A woman whom I see in marital therapy was raised in an environment where she was not allowed to have any expression of sadness or anger in addition to her mother being delusional. There are other more complicated cases when a parent is physically or mentally unable to properly care for a child. In wartime soldiers often think something like, “this is necessary to do, and there is not time or place for feeling sad, angry, or afraid because I need to the job at hand.” Circumstances like this impairs the individual from feeling, thinking and doing something in the face of the trauma. In almost all such cases the child does the right thing to keep feelings, thoughts, and behavior to a minimum to avoid being more seriously damaged. I just met with a young woman who knew that her mother was inclined to rage and abuse, so she wisely kept her feelings and thoughts to herself and “managed the situation quite well,” as she said. This wisely keeping thoughts, feelings, and behavior to oneself is the cause of almost all PTSD.

Find the trauma or trauma in one’s life can be taxing. First, you don’t want to do it. Naturally, you don’t want to dredge up “dirty laundry” and “focus on what was wrong,” admirable behavior but also emotionally costly and ultimately costly. A man a recently saw for a neuropsychological evaluation said such things about his childhood, which was evidence of his good character development, but also evidence of why he suffered from Chronic Fatigue Syndrome, which is well established as caused by PTSD. So, finding the trauma can be traumatic in itself as you try to see where you were first traumatized. Furthermore, if you suffer PTSD, you have had one or more experiences of being re-traumatized over your lifetime. This means that you had the original trauma, say being left alone for an extended period of time, but you have been “left alone” for necessary reasons many times in your life since then, and perhaps many of these felt traumatic. Read Van der Kolk’s book on how the brain gets re-traumatized.

Finding the trauma or traumata can be challenging. First, of course, you don’t want to do it because it will bring up painful memories. Secondly, you can’t do this alone. You need a competent therapist to assist you in the process. Let’s go on to the process

Facing the trauma

Facing the trauma takes a bit of time. This could be seconds or days but not months or years. Facing something that you have perhaps lived with for years is a challenge because it has become part of you operating fabric while not really a part of the fabric of your soul. Facing the trauma is naming it for what it was: traumatic. You might be able to label it more specifically as abuse, neglect, or indulgence but that may not actually be necessary. Yes, indulgence can be traumatic because you weren’t given the opportunity to see limits of life and feel sad by not having what you want. It is enough that you find the origin of your PTSD the best that you can. In fact, you may not be able to find time, place, or person involved in the original trauma, but you can find how you felt.

When you face the trauma, you will face the three things that we have discussed: feeling, thoughts, and action. In other words, you will see how you felt emotionally, what you thought cognitively, and what you did as a result of being traumatized. You need to recognize all three of these elements of trauma in order to resolve the trauma because you ultimately need to feel through the trauma, think through the trauma, and possibly take some action in your current life. You may, for instance, fallen into a dangerous relationship with someone that you need to end because the individual re-traumatizes you; you may be in a job that is not good for you because it re-traumatizes you; or you may need to move out of you home state or back to your home state. In all of these actions, you thinking must be clear, not affected by emotion. But to be able to make a good rational decision as to what to do, you have to do the hardest part: feeling the emotion that is always associated with traumas.

Feeling the trauma and finishing it

This is the hard part, but the essential. It is hard to find the trauma and face the trauma but it is truly challenging to feel the trauma. What it mean to “feel the trauma”? It means to feel what you were unable to feel when you were originally traumatized. Furthermore the feelings, primarily the emotions, that trouble you in your current life were the feelings that you had when you were traumatized. The emotions were three, and possibly all four of the basic four emotions that we have as human beings: sorrow, anger, fear, and joy. The most lasting emotion that you have is fear, which then migrates into some form of anxiety. The frequent emotion that occurs with PTSD people is anger, often taken out on other people and oneself. The most important emotion you felt was sadness. Generally, you retain the fear most of all, the anger, secondly, the sadness thirdly. You might even have some residual joy in the experience odd at that might sound. Sexual abuse victims sometimes have to admit to themselves that they had some sexual pleasure when being violated, and army veterans have to admit to having some pleasure in killing people. More often, however, the predominant emotion is fear, which constitutes the bulk of the phenomenon of PTSD: people retain the fear associated with having been helpless in the traumatic situation. Feeling this fear is the hardest part because your brain most certainly does not want you to feel fear of any kind and will work against you feeling this emotion. If you feel fear and stay with it, you will then gravitate to the next stage of emotion, which is the heart of trauma resolution: feeling sad.

If you face the trauma, you will face the fact that you lost something that you loved. Most importantly, you will see that you lost a piece of yourself. You will see that your basic self was assaulted in some way and as a result you no longer felt entirely human. As a result of trauma, many people developed “dissociation,” which means a kind of separating their thoughts and feelings from reality, something that they learned to do when they were in the traumatic situation. Feeling the emotions associated with a trauma is difficult because you probably dissociated in some way at the time of the trauma in order to get through it. Indeed, you did “get through it” but at the cost of your having to repress the feelings of fear, anger, and sadness. Repression of these emotions is the heart of PTSD in your current life but you brain “helped” you get through the trauma by doing that very thing. Naturally, you don’t want to feel these emotions now, and your brain will try to keep you away from them, but the task is to feel all of them in order to be restored to your true self. Facing the anger you felt (but couldn’t express) is the easiest part, even though it is difficult, and fear is much harder to feel, but the most important thing you have to face is the sadness associated with the loss you suffered. If you lost a leg in war but weren’t allowed to feel sad, you need to feel sad now in order to resolve the trauma. If you lost a sense of self, or perhaps self-respect, when you were sexually, physically, or emotionally traumatized, you need to feel the sadness of having lost a part of yourself.

Fear is the most basic emotion we have and it keeps us alive. Sadness is the most important emotion we have and it allows us to love, lose, cope with loss, and love again. You want to love again, but you will be able to do this only when you no longer hide the sadness you have from the original trauma. You can feel sadness and it will end but you most certainly don’t want to feel this sadness. No one does. You need a good therapist to help you through this grieving process. Perhaps you lost an arm, your voice, or something physical like your favorite toy, but the most serious loss you have suffered in the loss of self. Grieve the loss of self and you will find self. You will be free to love again, lose again, and love again all over again. You have finished your grief. When you have finished grieving, you can think clearly and then take action. It is not enough to just feel sad. You need to see how what you might need to do in your current life that takes courageous action based on wise thinking. You can think wisely and act courageously when you are not burdened by old hurts. You’re almost done. You need to forget and maybe to forgive.

Forgetting the trauma and forgiving

I have to be careful in discussing the forgetting process of trauma resolution because it is not a failing to remember the event or events that were traumatic in your life. Rather, it is no longer focusing on them, no longer being dominated by the unfinished business of grief associated with old traumas. People who have “finished” the feelings associated with sexual trauma, for instance, remember the time, place, and person during the trauma but they are not fixated on this event. It is history but it is not current events. What they have done is to have faced the fact of the trauma and faced the feelings associated with the trauma. Now, they don’t have to look back at this horrible time in their lives with fear, anger, or sadness. It is history. When a war veteran can speak of having killed some 13-year old boy who was shooting at him in Afghanistan, and then allow himself to feel the fear, anger, and sadness related to this event, he will not forget the boy nor having killed this boy but he will be free of the emotions associated with this tragic event so he can go on with his current life unburdened by old emotions that belong in the past, not in the present.  He might even go further: he might need to forgive….

But what is he forgiving. He is forgiving the boy for shooting at him, the Taliban who recruited this boy to shoot him, and American President who started the war in Afghanistan, and the captain who ordered him to kill this boy (or be killed by him). He might even need to forgive himself, although forgiving oneself is a bit more complicated and not a part of this discussion.

Find, face, feel, finish, forget and forgive. That is the resolution of traumata and resolving the PTSD that often results from it. Find a good therapist who can help you do these things.

The Only Mental Health Diagnosis

Ron Johnson Children, Development, Feelings, grief, Mental, Self-Awareness

I am amazed how frequently people talk about various mental health diagnoses. It is common to hear people talking about their “anxiety,” “panic disorder,” “ADHD” or other things, so much so that I hear such conversations while waiting in a cashier’s line. Of course, it is even more common in my business. I regularly do “ADHD neuropsychological evaluations” for people, both children and adults, who come to my office seeking some kind of answer to what ails them. Often, adults want to be “tested for ADHD” because they have some kind of trouble with memory or focus in their daily lives. I met with the parents of a teenager recently who has been diagnosed and treated with medication for his alleged ADHD condition for nearly 10 years. I found it interesting that the father noted that he most certainly suffered from ADHD as a child and adolescent but somehow got through childhood without medication. I told them that I was the same as a kid as I remember my maternal grandmother telling my mother that “you’re never going to raise that kid” because I was so active and unpredictable, like running down the block stark naked when I was three with my aunt chasing me all the way.

ADHD is certainly one of the more common “diagnoses” that people like to have. I use the phraseology “like to have” because it is my belief that ADHD and other diagnoses give people a sense of what is going on with their lives when things aren’t working out well for them. A diagnosis, namely a mental health diagnosis, helps people make sense of what is wrong in their lives. It is as if a person can have some kind of diagnosis, then they have some hope of recovery from the mental health “disorder” or “disease” that they have. Rarely, is that the case. Rather, people get this diagnosis and are not really better for it. Importantly, it is not only the mental health diagnoses that keep people busy figuring out what is wrong in their lives. There is even a larger number of physical anomalies that people suffer that lead to a similarly large number of physical/medical diagnoses. I see a couple whom I have seen off and on for 20 years as they have struggled with a variety of challenges in their marriage, interestingly, not the typical arguments and dissention that usually brings couples to see me. In this case, the original “presenting problem” (which I prefer to call the “presenting situation”) was the man’s impotence, but over the years we have dealt with a number of other (seemingly) external matters including finances and vocational adjustment. It is interesting to me that when I see this couple, the first thing the woman talks about is the great variety of physical/medical problems that she has, talk that could last for 30 minutes of our 2-hour time together if I allowed her to tell me all that ails her. This occurs while her husband sits patiently by until he can then tell me of his physical ailments. True, these people are in their 70’s where such things do occur more frequently, but it is continually interesting to me that they can talk about what ails them physically more fluently then they can talk about how they feel or what they think, this despite the fact that they are both well educated. When we finally get around to talking about how they feel or what they think, they then talk about the various mental health diagnoses that they both have.

The dependency on physical and mental health diagnoses has increased so much over the recent years that it is not uncommon for people to allege to have several diagnoses. I recall a woman I saw for an evaluation who initially said that she suffered from “bipolar disorder, ADHD, PTSD, anxiety, panic disorder, borderline personality disorder, and depression in addition to a similarly long list of physical disorders. I was amazed at her willingness to have all this wrong with her.

The popular mental health diagnoses

Consider how often you have heard about someone’s “bipolar disorder” over the recent years. Note that you never heard the term 10 years ago, much less 20 or 30 years ago. As you probably know, bipolar disorder was previously manic-depressive disorder. Despite the fact that you probably hear about someone having bipolar disorder, this is a very rare disorder that, like so many other diagnoses, is way over diagnosed. In fact, true bipolar disorder is a psychotic disorder where someone has a kind of delusion, often “manicky,” like s/he is going to be the next benign dictator of the world, or will most certainly suicide tomorrow. Bipolar disorder is not the ups and downs that all people have. It is not the grandiosity that we sometimes see with people or the hopelessness that we see with others, much less the changing of mood from one day to another.

The other “popular” diagnoses are as follows along with the symptoms of these disorders:

  • ADHD: impulsivity, distractibility, hyperactivity
  • Panic disorder: accelerated heart rate, feeling of dread, fear of a heart attack
  • Depression: disturbances of three elements in life: low, high, or inconsistent:
    • Appetite (too much, not enough, not hungry)
    • Sleep (too much, not enough, erratic)
    • Energy (too much, not enough, erratic)
  • Anxiety: fear of the unknown future; usually together with increased heart rate
  • PTSD: symptoms of depression and anxiety related to past traumatic events
  • Borderline personality disorder: feeling of a “deep hole” in oneself
  • Addictive disorders (chemical or behavioral): compensations for traumata

There are many other mental health diagnoses that are less frequently self-diagnosed, like schizophrenia and personality disorders, but the foregoing are the most commonly rendered, often by the individual and frequently by a therapist or physician. It is notable that one of my psychology journals reported that fully 40% of Americans were on some kind of psychotropic medication; possibly more now. Medications are antidepressants, anxiolytics (sedatives; anti-anxiety agents), stimulants (usually for ADHD), and anticonvulsives (given to treat bipolar disorder). So, does have the country suffer from one or more mental health disorders? I don’t think so.

What do people suffer from, and what can be done about it?

  • First, there is only one real mental health diagnosis.
  • Secondly, there is only one cause.
  • Thirdly, there is only one effective treatment.
  • Fourthly, there is only one real “cure” because there is nothing “wrong.”

The one real mental health diagnoses: PTSD

PTSD stands for post-traumatic stress disorder. This is the correct diagnosis for 95% of mental distress, as I call them rather than “mental health issues” or “mental disorders.” In fact, I think it would be better “diagnose” this condition as PTD: post-traumatic distress, which would be more accurate. Better yet, when I deal with people who are really seeking psychotherapy for improving their self-understanding and their lives, I simply call it “distress” rather than PTSD, much less depression, anxiety, and the like. It is the distress that people find so disruptive in their lives, and it is the distress that I work diligently to help them to end.

I should make a comment about the so-called biological or inherited tendency people have towards various mental health disorders. There is no clear science in this matter but there is a good deal of theorizing in the matter. We do find that certain families have proclivities towards something, perhaps anxiety or depression. But the science is not yet clear as to whether this finding has to do with the environment (usually the biological family) or the heritability factor. We do know that if identical twins are separated at birth, and then they have some sort of mental illness, there is a 50% chance that they will have the same illness. Interesting. But what about the other 50% that don’t share the diagnosis? We come to the mixture of nature and nurture in this situation, with the suggestion that we may, indeed, have an inclination towards some kind of mental distress that surfaces because of the family environment. In my own family there is a plethora of people who have suffered from some kind of anxiety. I have found it necessary to attend to the phenomenon in my own life as well. But was I “taught” anxiety or is there a propensity in my genes towards anxiety? The answer is probably both are true. The larger question, however, is what shall a person do when s/he has some kind of mental distress, a question we shall tackle shortly. Certainly, in my own life, I suffered traumata in childhood, which may have caused or quickened anxiety in me. Read on.

The one real cause of mental distress: trauma

What is “trauma”? Trauma is an unexpected event that causes some kind of damage, be it physical, mental, or relational. We might even suggest that are other kinds of traumata (I use the German plural of the word, but “traumas” is just as good), like financial trauma, property trauma (some kind of loss), or even vicarious trauma. I think I was vicariously traumatized by watching a war-based movie last night that adversely affected my sleep. But PTSD is not just trauma. It is the emotional element in the trauma that causes the distress.

PTSD (or my “PTD”) is a condition in which an individual has not resolved the emotion attached to the trauma. The most obvious kinds of PTSD are sexual trauma and war trauma. I was thinking about the poor soldiers facing a myriad of traumata in the movie from which they might later suffer PTSD. A veteran of war or a victim of sexual abuse suffers PTSD because at the time of the trauma the individual is not able to feel the emotions associated with the trauma. The emotions associated with war are anger, fear, and sadness, but if you’re in a foxhole and need to shoot the bad guy, you don’t have time to feel these emotions. Likewise, if you’re being molested, you aren’t in the position to feel the emotions of fear, which is predominant, much less anger at your perpetrator, much less the pleasure that might actually be associated with the abuse. So, such people suffer from not having felt the feelings that naturally occur in these circumstances. But traumata are not just related to sexual abuse and war trauma.

Developmental traumata are situations where a child fails to receive one or more of the basic ingredients of childhood, which can be summarized as the following:

  • Security and safety
  • Sustenance (food)
  • Physical affection
  • Emotional affection
  • Freedom
  • Limitation
  • Encouragement
  • Challenge

In all of these circumstances, there are three possibilities for traumata:

  • Too much
  • Too little
  • Inconsistent

Allow me to explain. Many children live in circumstances that are, indeed, dangerous, hence lacking in security and safety. But there are children who have too much security. Ideally, a child needs 100% security through much of her first year of life, but if she receives infantile security after that year, she will then feel unduly afraid of the world, perhaps for the rest of her life. Or, she might receive inconsistent security, which means safe and unsafe, which is actually even worse than no safety at all. Research psychologists call this “intermittent reward” (or punishment). Likewise, all the other aforementioned causes of possible trauma could be the “not enough, too much, or inconsistent” categories. Some children have too much limitation and are not allowed to explore the world with trials and errors, while other children have so much freedom that they fail to understand the value of laws and natural limitations. All of these circumstances contribute to PTSD to some degree or other.

Some children suffer from more than one of the lack of one of ingredients of an ideal childhood. For instance, some children are not loved right (lack physical affection), so they put up a real fuss in life. Then, to quiet them down, they are indulged with something. Then, they become even more demanding, and are then shamed. This combination of neglect, indulgence, and shame causes the condition known as borderline personality disorder. The other so-called mental disorders might be seen as having been caused by various traumata:

  • Anxiety: almost certainly caused by some kind of neglect during early life
  • Depression: most likely caused by losses in early life
  • Bipolar disorder: both neglect and losses
  • Schizophrenia: inconsistent love and limitation and some kind of chaos in general
  • Personality disorders (narcissism): lack of encouragement, challenge, and limitation
  • ADHD: too much limitation or too much freedom
  • Additions: a coping mechanism that replaces what was lost in childhood

So what can be done to successfully treat these conditions?

The one real treatment for mental distress: grief

As you may know, Deb and I wrote a book on sadness entitled The Positive Power of Sadness, subtitled How Good Grief Prevents and Cures Anger, Sadness, and Depression. In this book we discuss how the mental disorders of anxiety and depression are prevented by honest sadness in addition to the phenomenon of undue anger. Let me summarize:

  • You love something
  • You are assaulted
  • You lose this something
  • You feel hurt
  • You feel afraid of losing more
  • You get angry to protect yourself from future loss
  • You compensate with some kind of addiction (chemical or behavioral)
  • You then develop “symptoms” like anxiety or depression

Our suggestion in the Good Grief book (as we all it) is to stop the process at the hurt level and then back up from there. If I feel hurt, I will simply and profoundly feel sad. Just sad. Not angry, not afraid. Not compensating. Just sad. The beauty of sadness is that it ends. It really ends. There is nothing that we cannot finish feeling sad about if I allow myself the privilege of feeling sad. Way too much so-called therapy focuses on fixing sadness or making up for it instead of just feeling sad and allowing sadness to run its course.

This having been said, it is important to note that feeling sad is painful. Hence we avoid sadness by feeling fear or anger or having some kind of compensation. But the problem is that people are generally not good at simply feeling sad. They would much rather feel angry at what happened to them, which always leads to depression, or feel afraid of what they might lose in the future. Both are delusional: we can’t change the past and we can’t change the future. We can reflect on the past and finish the feelings of sadness, or we can consider possible losses in the future and feel anticipatory sadness. But we can’t change the past or future. So, the “treatment” for all trauma is to feel the sadness that comes with all loss, e.g.:

  • Loss of freedom as a child
  • Loss of limitation as a child
  • Inconsistent freedom and limitation
  • Loss of security
  • Loss of physical or emotional love

All of these losses can be felt and finished, but this is no easy task. Simple, but not easy.

The one real “cure” for PTSD

We have already suggested that the treatment for PTSD, or for any other mental distress is grief. Honest grief. But how is this done? Grief is simple, but it is hard, as I just said. It is simple because it is natural. It is natural to cry when I lose something, and it is just as natural to feel the sadness associated with crying. But it is not easy. It is not easy because of several matters, not the least of which is the cultural resistance to sadness and crying, particularly in America. Yet, there are ways to deal with the resistance we all have to grief:

  • Find a competent therapist. There aren’t many, sad to say.
  • Find a true friend…one who does not try to fix you and says very little but stays with you
  • Find a time when you can be alone…and grieve the loss(es) you have suffered in life
  • Write these losses down. You will see some “large” losses are no longer grievous, while smaller ones are still unfinished.
  • When you are angry or afraid “back up” your feelings until you find the hurt that always precedes anger and fear. Then back it up further, and you will find the love that you have for something

If you do this process of finding the core “problem” in PTSD, or any of its derivatives, you see that they are all about love, principally the love of yourself, which has been lost along the way. Love of self is natural, and it is not the same as liking oneself, liking what you said or did. But this is another subject.

I’m Glad that I’m Sick

Ron Johnson Mental, Positive psychology, Self-Awareness

Who in the world would say such a thing? Who in the world would want to be sick? Surprisingly, many people would. It’s not that they actually want to be sick. Rather, they want to have a reason for why they feel so bad. Having a reason why your stomach hurts answers the questions, “What’s wrong with me?” So when your stomach hurts (or your leg, or your chest, or your back), you want to know what is wrong. That seems reasonable, but the reason part of reasonable gets lost when it encounters our present healthcare system that focuses on what is wrong rather than focusing on what is right. I frequently have people tell me that they have some sort of back problem, usually described as a “herniated disc” or a “slipped disc” or some kind of twist in their spine. Unfortunately, they don’t feel any better physically, but somehow knowing what is wrong helps them understand why they hurt so much. Remarkably, it is very possible for two people to have the very same spinal abnormalities with one of these people having intense pain and the other one having no pain whatsoever. Why is that? The answer to that question is yet very illusive.

I felt compelled to write this blog because of an experience I had a few days ago. A man came to see me in my office who has been suffering from what he described as “OCD” (obsessive compulsive disorder), and has been in intensive hospital-based treatment for this alleged disorder for months. Furthermore, he has probably suffered from OCD-like symptoms and other symptoms for years. He told me that he had been making some headway with this very challenging difficulty under this intensive treatment. More recently, however, he said that his wife and he had come across the diagnosis of Asperger’s Disorder (AD), read about it extensively, and began to think that he may really be suffering from AD, either primarily or in addition to his OCD. He asked me if I could test him for AD to determine whether this diagnosis would be an answer for what was “wrong” with him. In fact, Jack (I’ll call him Jack) was quite hopeful that I would diagnose him with AD, thinking that such a diagnosis would lead to some kind of effective treatment. In a sense, he wanted to have Asperger’s Disorder, odd as that sounds. But it isn’t really odd because he just wants an answer to his distress. Can’t blame him for that. Unfortunately, finding a diagnosis like AD does not give him an answer. He might find symptoms consistent with AD, but that doesn’t mean that he has this disorder. Furthermore, many people who have AD-like symptoms are not suffering from Asperger’s just the same as how people can have the very same physical condition with one person suffering immensely while another person with the exact same condition does not suffer. Why is that?

The reason one person with a very specific physical difficulty has great pain compared to another person with the same difficulty with no pain is…we don’t know. In fact there is certainly more that we don’t know than we actually do know. We don’t know, for instance, how cancer starts. We know where it starts, like in the liver or the colon. We know what seems to be some of the reason it started in the first place. We know, for instance, cigarette smoking tends to lead to lung cancer. But what about those people who smoke for 75 years and never have cancer? We don’t know why they seem to be immune to it. We know a lot of things about physical illnesses in the way they progress, like liver cancer tends to progress fast, while lung cancer progresses at a slower pace. But we don’t know why cancer starts in the first place. And we don’t know why cancer starts because we don’t really know why a cell grows and multiplies into two cells. If we really understood why cells tend to multiply, we would know why cancer cells grow too fast and create too many cells. We know a lot about the physical body and how it functions, but we still don’t know everything. In fact, we really don’t know much about how the body functions. Thank God we know enough to correct some of the diseases that infect humankind. Yet, even though we don’t know much about the cause, the course, and the cure for many of these diseases, people still rely on their doctors to tell them what is wrong, why it is wrong, how long it will be wrong, and what can be done about it. Most of us have heard our good doctors say something like, “I am not sure” as an answer to these questions. Physical problems are just too complex to give exact answers to these questions.

We know even less about psychological difficulties, and as a result, there are even fewer answers to the why, how, and when questions although we have a few answers about the what questions. We know for instance what depression is. For instance, we know that depression has certain symptoms, namely disturbances of sleep, appetite/eating, and energy. When people are depressed they usually have sleep problems in the form of insomnia or hypersomnia (sleeping too much). Even more importantly, depressed people have low energy or motivation that we call anhedonia. We also know what anxiety is, but perhaps a bit less. We know, for instance, that people who suffer anxiety worry about the future in a variety of ways, that they can’t overcome this worry with rational thinking, and that they suffer some kind of physical symptom of anxiety, usually chest pains or shortness of breath. There is some neurological evidence that suggests that the brain operates differently with depressed and anxious people as compared to people who don’t suffer these maladies.

We know a bit about the symptoms of depression and anxiety, but we don’t really know why people get depressed or seriously anxious, how they suffer these problems, or when they start to suffer. There is a good deal of theorizing about the causes of depression and anxiety leading physicians and others to talk about a “chemical imbalance” in the brain that can theoretically be corrected with one or more medications. Unfortunately, these so-called chemical imbalances are not well understood in themselves, not universally agreed upon, and only rarely corrected with medication. Certainly, there are brain changes when someone suffers from anxiety or depression, but this is not the magic bullet people want it to be. Informed physicians will say that antidepressant medication helps about half the people who suffer from depression, but we also know that a placebo will help nearly a third of that same group. The difficulty with the medical-cure theory of depression and anxiety is that it certainly does not cure these ailments. Medications help treat the symptoms of such difficulties, but not the problem. Most people know friends and family members who have gone from one medication to another, and sometimes from one on top of another, all with minimal assistance, and certainly with no cure. And on this matter of cure there is fierce debate.

The oddity of this matter of the what, when, why, and how of so-called mental health difficulties leads people to find the magic bullet even though there is no magic in this vastly diverse field of psychology. I have previously written about the magic associated with mental health treatment: magical diagnosis, magical treatment, and magical cure. There is no such thing. There is no magic in what effective therapists do in their offices, and sadly there are not too many effective therapists in the first place. There are many therapists who are very good people, and very often well trained and intelligent as well as truly compassionate. But we often find that therapists these days are more familiar with identifying what is supposedly wrong with people than they are in finding out what is right with these people. There is even a burgeoning subcategory of psychology called “positive psychology” that purports to examine the right things about people. We have studied much of this positive psychology literature and find it valuable, if quite incomplete. And very few therapists of any stripe and degree are even familiar with any sort of positive psychology. Helping people overcome the difficulties in their lives, requires a depth understanding of psychology, certainly the mental health difficulties like depression and anxiety, but more importantly, the strengths and abilities that people have. It is these strengths and abilities that get us into trouble, much more than the so-called diagnoses.

After hearing from Jack who “wanted” to have Asperger’s Disorder, I told him (with his wife present, by the way), that I thought there may be a different way of looking at what was wrong without thinking that there was something wrong with him. This, by the way, is a statement I say to patients on a daily basis and sometimes on an hourly basis:
“There is nothing wrong with you. Furthermore, there is nothing wrong with the people you work with or the people you live with. And there is nothing wrong with the world. There is something wrong with the interface between you and people, work, and the world. For some reason, you don’t seem to fit. So you have concluded, unfortunately that there must be something wrong with you, work, people, or the world. There is nothing wrong with anyone.”

There are, however, grave difficulties between people just as there are between countries, denominations, and political parties. There are even greater difficulties between tribes of countries that are more tribal than America. It is hard for Americans to grasp the profound differences between Sunni Muslims and Shitte Muslims that has been violent for centuries and has led to the creation of ISIS and other fundamentalist groups in the world. ISIS and its cousins have taken the stand that their philosophy or theology is right…for everyone. So we have these terrible atrocities that ISIS commits in the name of Allah because they know that they are right and everyone else is wrong. Believing that nothing wrong with someone is very different from thinking that there is nothing wrong with what that person does or says.

It is easier to believe that I am right in what I believe than it is to consider that there is nothing wrong with me. Importantly, no one is always right all the time. But you can believe that there is nothing wrong with you as a person while also seeing that you say and do things that are wrong. It is easier to believe that there is something wrong with me or something wrong with the world than it is to admit that I might be wrong with what I said or did. But this is not a distinction that most people make, and it is a distinction that is the hallmark of personal maturity. The more one firmly believes that he or she is not a wrong person or a bad person, the more one can admit to errors of words or actions. Believing that you are a good person at heart, truly believing that, gives you the opportunity to see mistakes you make, misspoken words you uttered, and misunderstandings you created. And then apologize. But you are not apologizing for being a bad person. You are apologizing for failing to communicate, for hurting someone unintentionally, or for neglecting to gather all the facts before you shot your mouth off.

How does all this philosophizing help Jack who came to my office “wanting” to have Asperger’s Disorder? I needed to be quite careful with Jack because he had found some important hope that he could conquer the difficulties in his life by finding an exact diagnosis like Asperger’s. I explained what I do and how I do it, namely finding people’s strengths first and then finding the limitations and excesses of these strengths that cause problems. Within a couple of hours, we were able to come to an understanding of a different way for Jack to look at himself, one that looked at these strengths and limitations that led to his life’s problems. This is a beginning, a new beginning, a way that looks for hope in the positive and healthy rather than the negative and unhealthy. Now comes the hard work of helping Jack sees both his strengths and limitations and find ways to enhance these strengths and acknowledge his limitations in order to make a life for himself. But this is hard for Jack as it is for everyone. If I seek to replace the magic bullet of some kind of mental health diagnosis and replace it with a strengths-based “diagnosis,” I then have to help the person face the limitations of these strengths in order face the even harder task of seeing the opportunities of making the world a better place. For the moment at least Jack is excited about finding and enhancing these strengths than in finding a way to cure him of some magical disorder with some kind of magical treatment.

Further Reading
 My previous blog, The Magic of Psychotherapy
 Our current book, The Positive Power of Sadness (Brock and Johnson), Praeger Press.
 Articles and books written on Positive Psychology (Seligmann and others)