Three is a deep “hole” inside many people. This “deep hole” causes people great distress and often causes other people distress. So, what does it mean to talk about someone’s “deep hole”? It means that this person feels a certain “emptiness” inside that cannot seem to be filled. This deep hole phenomenon has resulted in many diagnoses, many treatments, and many misunderstandings. Instead of talking about these diagnoses, which simply look to label this deep bole with some kind of label, I prefer to first look at what the symptoms of this deep hole are, note how this deep hole affects how people operate in life, how it affects their social and intimate relationships, and what can be done about it. What I am really interested is how people can feel the deep hole inside of them and how they can find a resolution to the deep hole. Equally important is how their friends and families can see this deep hole and find ways to successfully relate to people with deep holes in their psyches. First, allow me to briefly identify the psychiatric terms that are used to describe this phenomenon

The diagnoses used for the deep hole

Borderline personality disorder (BPD). This diagnosis is usually used for such people. Interestingly, BPD was originally called “pseudo-neurotic schizophrenia” because people with BPD can feel and speak quite healthily, quite anxiously, or quite depressed, but there are times when they seem to feel and speak with a nearly delusional thought or feeling.

Depressed, anxious, PTSD, or just “stressed. People with the deep hole I am talking about can be anxious or depressed for sure and often think they suffer from PTSD or feel unduly stressed.

Bipolar. Unfortunately, this disorder is now quite commonly diagnosed and more commonly felt to be what one suffers due to his or her deep hole. Bipolar disorder is in the category of a “thought disorder,” which includes schizophrenia and an involutional depression.

Relational conflict. Understandably, people with this deep hole experience a good deal of distress in their relationships, both toward and from their partners and friends.

Now, let’s proceed to what I consider to be more important matters.

The symptoms of the deep hole

Felt emotional distress. The person does not feel emotionally stable

Lack of clear sense of self:  Granted, “self” is an undefined term. Usually people can’t clearly answer the question of what they want in life and what they can do in life.

Seeking undue amount of approval or attention: This can vary from demanding attention and focusing on what other people are doing to times of complete retreat.

Primary symptom of fear: Perhaps the most central of all symptoms. This includes generalized anxiety, OCD-like symptoms, panic attacks, and unrealistic fears all of which are beyond the range of normal fears such as loud noises.

An “external” “locus of control”: This is related to many other symptoms, such as seeking approval. The idea is that the person sees him/herself as unduly controlled by external events, persons, bad luck, and can include undue awareness of physical symptoms of distress.

Variety of physical symptoms: Very often this includes “everything hurts” as in fibromyalgia, but more commonly an intense awareness of small physical sensations that tend to dominate the individual’s awareness.

Lack of sustained relationships: The individual seems unable to sustain intimate relationships as well as personal, friend-like relationships. Often, the individual seeks more from a relationship that the other person can provide.

General dissatisfaction with work: Many such people say something like, “I don’t know what I want to do when I grow up.” Often, such people are professional but “fell into” their profession rather than choosing a vocation. They tend to find little value in their work.

Narcissism.  I hate to use such a derogatory term, but I use it without judgment and criticism. Narcissism in adults is the results of natural childhood narcissism resolved in childhood. In other words, if someone has not found a way to feel his/her core self and has not felt safe in the world, such a person continues to retain a childlike understanding that s/he should have everything that s/he wants.

The causes of the deep hole

There is much discussion in the psychological community, some believing that there is a genetic component, which is not my perspective. My belief is that there are two primary origins of this phenomenon: neglect and indulgence. Sometimes both. The worst possible combination is neglect followed by indulgence followed by shame. This is a situation where the individual is neglected for some reason, and then the child puts up such a fuss that s/he is indulged to keep him/her quiet, and then because s/he is still so outrageous, s/he is shamed with rhetorical questions like, “What is wrong with you?”

Thus, the individual does not go through the necessary stages of early childhood:

• First year of life needs of safety, nurturance, and comfort. Quells fear in life.
• Second year of life needs: exploration and experimentation. Establishes the rudiments of love in life and ultimately joy
• Years 2-6: limitation. Allows for anger but prevents the undue expression of anger. Learns that s/he can’t have all that s/he wants in life
• Year 6+: develops a depth understanding of loss in life, and hence develops a good sense of sadness because everything that is love is eventually lost.

Most people with the “deep hole” have a mixture of having failed to establish the basic emotions: fear, joy, anger, and ultimately sadness.

These early years of deprivation and lack of development are rewarded by other circumstances in life that reward undue fear that dominates one’s life, undue expression of anger that damages relationships, or both.

Examples of statements made

Consider the following statements that I have heard from people who display the deep hole phenomenon:

• It if go to the hospital, it will be all about her. This statement was made by a man who had been married 40 years to his wife who was in the hospital for serious back surgery having suffered painful sciatica.
• I deserve to be taken care of. This statement was made by a 30-year old woman who I tested as having a 125 IQ but felt that she was unable to work because of her “PTSD, depression, and anxiety” despite the fact that she displayed none of these symptoms.
• F*** them; I want to continue talking. This statement was made by an individual with whom I had already had more than 60 minutes of therapy, in reference to the other people who were waiting to see me. (Note that the “therapeutic hour” is 50 minutes giving me time to reflect and take notes)
• I want everything you have. This statement was made to the whole range of “friends” that this individual had in life. A clear reflection of his “deep hole” that he wanted to fill.
• Even if you gave me more time in this session, I would always want more. This was made by an intelligent, capable woman whom I saw many years ago. It is interesting that she was aware of wanting but not really aware of how she wanted me to fill her deep hole.
• I need someone to tell me what to do. This statement was made by an intelligent 15-year old who didn’t know how to do much that would constitute responsible, engaging, and meaningful work, play, or conversation.

The repair of the deep hole.

Nothing short of depth psychotherapy. There is no other means of repairing the damage to the individual that occurred early in life. Depth therapy includes understanding of what happened, feeling the sadness of the losses, primarily of feeling sad for not getting what the child wanted, and then the important element of making adjustment in life to get what they get in life followed by making a meaningful contribution to life.

It does appear that some people with a deep hole find a way to adjust satisfactorily to life on their own, or perhaps with a bit of therapy. This phenomenon might be due to the individual’s understanding that life is full of riches and opportunities but not full of what everything that s/he wants

Sadly, most people with a deep hole in their hearts and minds simply find ways to cope with accommodations, usually some form of addiction, chemical or behavioral.

Dealing with people with the deep hole.

• Respect the individual. People with a deep hole need just as much respect, love, and care as everyone else.
• Be aware of the danger. People with deep holes do not know that they are dangerous but they truly are because there seems to be no end to what they want. Their emotional hunger can drive you go give more than you want to give. If you do that, you will resent the individual and be shaming.
• Limit, limit, limit. When we see people with deep holes, we almost immediately start limiting them in some way, e.g. not going over 60 minutes, not seeing them when they want to be seen (all the time), avoiding giving them answers to the questions they ask because their questions are always a form of, “Why can’t I have everything that I want?”
• Avoid being angry. You can do this by limiting and not giving in…kindly.
• Trust your feelings. Many time, you will simply not want to be with this person, which will hurt him/her, but is necessary for your own sanity and peace of mind as well as serving the limiting function.
• All of this is especially hard if the person is a family member. I recommend that people allow themselves the freedom to “love him but not like him,” a distinction that is very hard for some people to make.