Why Is There a Hole in Your Heart?
George thought he was dying. In fact, he wished he would die, since it would be hard to imagine how he could be in more pain. He had already vomited several times and continued to suffer from stomach cramps and severe nausea. He had a migraine headache, complete with visual distortions and impaired vision. When he could see, he had vertigo; the room seemed like a ship at sea, swaying back and forth. He was hyperventilating and had severe chest pains, too. His wife, Betty, had already called an ambulance.
George and Betty were on their honeymoon in San Francisco . They had been married for all of forty-eight hours. He was twenty-seven.
When they arrived at the emergency room, the doctors couldn't identify anything wrong with George. He was extremely dehydrated, but he didn't respond to the intravenous fluids that they gave him. His symptoms were so severe, though, that they decided to admit him and run some tests.
After keeping George for a week, running extensive tests and spending almost $15,000, the doctors concluded that George was suffering from anxiety. He had experienced a severe panic attack.
The discovery of the hole in your heart and the beginning of your healing process don't have to begin with a panic attack. It might just be mild anxiety or nothing more than a dull ache, a feeling that you don't really belong. You may find yourself sinking down into the black hole of depression, where all light is absorbed by despair. Perhaps you find yourself unable to control your anger, exploding with people and feeling out of control. Maybe you find yourself unable to connect to your partner, or even find a partner. Maybe you find yourself betraying your partner. You may notice that you're less able to keep from having another drink, no matter how you might try to deceive yourself. Or perhaps it was consuming that next line of cocaine, the extra box of cookies, or whatever form of pseudo-love you find yourself drawn to as part of your own personal nightmare.
What all of these difficulties have in common is that they are a result of anger being acted out in a dysfunctional way. Each represents the inability to use anger to fix what is really hurting them--their underlying emotional injury.
George, our honeymooner, learned this, too. Upon returning home, George began psychotherapy and found out that his panic attack was a way for his emotional being to get his attention about some serious concerns that he wasn't facing about his new marriage. He had been so out of touch with his own emotions that he had blocked out all of his misgivings about his wedding. So the only way his emotional being could get his attention was to make him utterly miserable. Beating yourself up with intense anxiety is an angry thing to do to one's self. However, George's emotional being seemed to have no other choice.
In therapy, George began to realize that he had gotten into a marriage that was, in many ways, a reenactment of some of the negative dynamics from his childhood. His new wife, Melissa, had a tendency to drink too much and had very loose boundaries. These behaviors were very similar to those of his mother. George had been oblivious to these problems until he finally got into treatment, thanks to his panic attack. His panic was actually an underlying angry reaction to emotional injuries that he had been ignoring, which didn't look angry on the surface. His panic attack forced him to deal with these problems.
This book is being written to help you, like George, understand and deal with the emotional difficulties that are mostly a dysfunctional use of the anger in your life: depression, anxiety, relationship problems, explosive anger, passive-aggressive anger, and addictive behaviors. My hope is that by the time you have finished reading this book, you will understand why you are suffering--and also know that you can use the very same anger that has been fueling your dysfunction to begin to move toward healing.
Injury and Healing
You might not expect a book about anger to talk about healing. But all problems, as well as all anger, begin with injury. Injuries need to be healed. Being injured causes pain, and pain is the original negative feeling.
There are three emotions that result from injury after the initial feeling of pain: sadness, fear, and anger. Sadness is a grieving of the injury. Just as we cry about the loss of a loved one, honoring our memory of them and their importance to us, we also mourn, in a smaller way, an injury to our self-esteem. For example, if we get a bad review at work, we may feel sad about it.
Fear is about not wanting to be hurt again. Just as we may become startled by a loud noise, our body generates energy in response to any injury to avoid being hurt again. Fear carries both energy and information to avoid further injury. Using the same example about a bad review at work, we may respond by becoming afraid that we may lose our job.
Anger, in contrast, is the natural healing energy that the body generates in order to attend to the injury. It would be reasonable to feel angry about receiving a bad review at work, whether it was justified or not. But how can you use that energy to fix the problem? If the anger is expressed directly--by blowing up at your boss, for example--you could lose your job. But that same anger may be used positively. For example, you could become more dedicated to working harder to get a better review in the next quarter.
While all of these responses to injury--sadness, fear, and anger--will be addressed in this book, the main focus will be on anger, the energy that is meant to heal.
The Human Condition
Injury is part of the human condition. We are vulnerable. We all get injured. It starts with being born and ends only, perhaps, in our passing. There is no escaping it.
So, you might ask, "If injury is inevitable, what's the point of trying to heal it?" The answer to that is what made you go into therapy or buy this book, and it's why we choose to have children. It's also why a tulip or daffodil bulb not only pushes up through compacted soil and reaches for the light, but goes beyond that to reveal itself in the glory of its flower.
We grow and move toward healing because of our pain and also because of our love of life. We grow and move toward healing because we know in our hearts that we deserve better than what we have received. Some people may even view this energy to heal, which I believe is generated by the unconscious, as a function of God. My personal belief is that God encompasses all that is, and therefore there is a part of God in all of us. Much of the work of psychotherapy may be seen as an attempt to contact and connect with that part of us.
For many years I resisted the idea that spirituality is important in psychotherapy. Having survived the experience of living in Boulder , Colorado , in the seventies and eighties, I saw many people use the concept of spirituality as a way to avoid dealing with the necessities of being moral human beings. They would use the idea of being on a spiritual path as an excuse to engage in all manner of destructive and angry behaviors. They would dismiss morality as "beneath" their high level of spirituality. In spite of having seen the term spirituality abused many times in my life, there clearly is an aspect of the spiritual in all healing. Again, I want to stress that my definition of spirituality includes a sense of morality. That means that what you do here, in your life, is important.
I want to clarify the term unconscious that I used above. So many words, like spiritual and unconscious , seem to be mystical and hard to pin down or understand. To make my meaning clear, when I use the word unconscious I mean that part of our selves that is present when we go to sleep. It is our body and that part of our minds that regulate our bodily functions that we do not consciously monitor. The unconscious heals our physical wounds, digests our food, and keeps us breathing while we are sleeping. Our unconscious keeps our hearts beating and cleans the poisons from our bodies. It nurtures our whole being, bringing nutrients to every cell in our bodies every day. It even speaks to us about the emotional dynamics of our lives by bringing dreams to our sleep.
But none of this really answers "Why do we have holes in our hearts?"
The obvious answer is that we all get injured in our childhoods. None of us has perfect parents who were able to anticipate our every need, set appropriate boundaries, and protect us from the plentiful injuries available out in the cold, cruel world. And, to add to what we are all up against, we have to realize that all of our parents come to us injured as well.
In fact, to really understand the impact of injury on our own personal human condition, we have to examine our place in the context the history of humanity. If you look at the maturation of humanity as a species, using the development of an individual as a metaphor, it's clear to me that humanity, is in its adolescence, at best. As a species we continue to act in ways that compound the trauma that are naturally a part of living.
If you have ever known anyone who has lost a parent at a young age, then you may understand the impact of that kind of trauma. Tremendous abandonment issues are likely to arise, even though it is obvious that parents usually don't die to get away from their children. Nonetheless, a parent's death is a serious emotional injury to any child.
Now, think about human history, where we have only just begun to scratch our way out of living in the mud. Diseases, which we have only begun to control in the last century, have taken many parents before their time. Currently, in America , the average life span is seventy to eighty years, but not very long ago those in their forties were considered to be ancient.
Think about the impact of famine, plague, and, especially, war on the emotional development of children. Those kinds of events bring the reality of life's difficulties into close focus very quickly. War creates an incredible amount of Post-Traumatic Stress Disorder, not only in the loss of parents, but in the rapes and torture that so frequently accompany the organized brutality of battle.
The tremendous impact of injuries like these on how we view other people and on our ability to trust and connect emotionally is simply overwhelming. But take it a step further: children who survive their various traumas usually become parents. These parents can be dysfunctional as a result of the impact of not just their own injuries, but, in effect, the cumulative impact of all the centuries of wounding. Each injury leaves its emotional scars on the ongoing development of the collective human psyche.
Civilization represents humanity's attempt to make life fair. It is an extension of our feelings when we take seriously the responsibility of parenting. We want to provide comfort and protection to our children. We want them to have lives as good as or better than our own lives. To some extent, we would like to prevent or heal suffering. We would like to increase the joy in life for as many of us as possible. I've always seen Santa Claus, in a non-religious way, as the ultimate symbol of civilization. He--along with Mrs. Claus and the various and sundry elves--represents an adult's tremendous love and attempts to make children happy.
In this light, it's clear to me that psychotherapy functions as the cutting edge of civilization. If civilization represents humanity's attempt to make life as fair as possible, given that it is not, then psychotherapy represents a person's attempt to heal from injuries which are, by definition, unfair. The more healed each person can become, the more likely he or she is able to function as a better parent. Thus, incrementally, one person at a time, mental health attempts to help civilization as a whole to mature and grow to a more effective and humane level.
Just like penicillin, the first true antibiotic, psychology is only about a hundred years old. Psychotherapy, which will always be more of a craft than a science, is the attempt to help people heal from their emotional injuries. It has been around for an even shorter period of time than antibiotics. In its current form, it has existed for, at most, fifty years. The art of psychotherapy continues to grow and progress as we learn new and different things from science about the brain, the body, and the functioning of the mind.
Years ago, in my first experience with orthopedic surgery, I saw a poster in the physician's office of a picture of a sapling tree with a broken branch that had been bent over. Its limb was wrapped, and a crutch had been put in place to support it in a more vertical position. The caption was something to the effect of "As the twig is bent, so grows the tree." Just as with any physical intervention or therapy, the central issue will continue to be how to heal the wounds of childhood. We also need to limit the ways that those injuries resonate and cause dysfunction into and through our adult lives.
There are various types of psychotherapy that can help an individual heal the hole in his heart. Long-term and short-term therapy can help address anger-related injuries. There is no clear boundary line between long-term and short-term psychotherapy. They are frequently interwoven. They both work on injury, though short-term therapy tends to work on more immediate problems and long-term therapy tends to focus more on healing childhood injuries. However, since current life struggles relate to the injuries of your childhood, you need to understand the connections between them, regardless of which type of therapy you are doing. This doesn't mean that everyone needs to do years and years of psychotherapy in order to have a good life. Some may need to, and others may want to.
Keep in mind that psychotherapy is costly, emotionally demanding, and time consuming. I always laugh when I hear managed care companies talking about how people who spend a long time in therapy are like Woody Allen, who they consider to be the poster-child for what they call the "worried well." For most people, going to therapy is far more stressful than taking your car into the shop, and I don't know anyone who enjoys doing that every week. Just finding time in a busy and demanding life is a major hassle and the results of therapy are frequently a lot less concrete than having your fuel pump replaced.
I think of short-term therapy as being focused more on solving problems in an immediate, day-to-day manner. If you want to quit smoking or if you're depressed, you usually don't want to sign up for years of therapy. You just want to get to a better place in your life as soon as possible.
The good news is that working on your problems in the here and now, while it usually requires an understanding of the connections to your past, doesn't require a full healing of your injuries. But doing short-term work in therapy does aid healing. You'll find out, as you go along and work on the here-and-now aspects of your problems, if you want or need to do that longer term work and, if so, how much of it you want to do.
Psychotherapy is a growth process, and the transition that takes place within an individual is one that takes time. This is part of what's problematic with much of today's managed care therapies that claim to be "solution-focused" therapy. Solution-oriented therapies in general can be valuable counseling techniques, very focused and helpful. However, they can be simplistic, frequently ignoring the impact of childhood injuries on the treatment process. When someone has issues with authority, as most of us do, there can be all kinds of resistance to the treatment process. When your "solution-focused" therapist tells you what to do, it can elicit resistance as a result of a transference dynamic with authority. If these dynamics are not addressed in the context of a safe and caring relationship, treatment will not succeed, no matter how focused it might be. Building a safe and caring relationship takes time, and that costs managed care companies money. Unfortunately, today, much of managed care is mostly focused on getting people out of therapy to save money for the administration and profits of insurance companies and/or their agents. True personal change, like developing relationships, takes time.
Although I do not prescribe medications, I frequently refer clients for medication as a part of their treatment. Medications can be very helpful in treatment, and, at times are even necessary. This is true regardless of whether we're discussing mood disorders, anxiety problems or explosive anger.
I have been amazed at how frequently clients resist recommendations to try medication. It has, on occasion, taken years for a client to accept my recommendation for a medication consultation. There are many reasons clients have for resisting a recommendation like this. It makes them feel that they are "sick." Fears of side effects keep them from trying. Sometimes clients want to avoid feeling dependent on medication.
All of the reasons and fears that clients can have about medications can be reasonable, yet the fact remains that many, many times the right medication can make a tremendous difference in speeding up the healing process and reducing the level of injury that clients experience in their lives. In the more serious levels of difficulty, they can be absolutely necessary for the client to be able to function. In these cases, clients need a psychiatrist, a medical doctor who specializes in mental health treatments.
If you have a treatment provider who is recommending that you consider medication, I would recommend that you take that advice seriously. It is quite reasonable to get a second opinion, but not reasonable to ignore the suggestion.
What Is Anger?
I have only written briefly about anger. Anger is the centerpiece of this book, and, as you may already realize, I like to be clear about the terms that I use. In this section, I will define anger in a way that is different from what most people understand that word to mean.
We all have trouble with anger. Anger, perhaps with the possible exception of sexual feelings, is probably the most troublesome emotion. It relates to the primitive aspects of our makeup. For most of us, anger is scary. Generally, people with anger hurt others, and none of us likes to be hurt.
However, we are all hurt by events in life. Did you ever notice that hurt and anger go together? The hurt comes first, followed by the anger. Men, in general, get in touch with their anger first, while women, in general, access their hurt feelings first. This is a result of both nature and nurture. The nature part relates to our genetic makeup. Some of us are more cognitively oriented, while others tend to be more emotionally oriented. In terms of the nurture issue, there is an androgyny split that takes place in us as we become socialized to one gender group when we grow up. Quite often, however, the standard sexual roles can be reversed, with men noticing their hurt feelings and women noticing their anger. With any particular injury, though, a single individual can respond with either anger or hurt. They may even show fear or sadness first.
My definition of anger is, as I said, significantly different than what most people think of when they hear the word. Most people associate anger with loud, scary, and bitter explosions. But I define anger as the natural, healing energy that the body generates in response to an injury . This energy is actually meant to address or tend to the injury. For example, instead of blowing up at your boss after receiving a bad review, you can use the anger that surfaces to make your supervisor more aware of the good work you are doing. Or, you might want to dedicate some of that angry energy to doing a better job on your next project.
Actually, angry feelings and their expression occur along a spectrum. The stereotypical angry outburst falls on the red, hot end of the spectrum. In the middle, there is normal, assertive behavior, where people ask for what they want. There is also the blue, cold end of the spectrum, which is passive-aggressive anger.
Passive-aggressive anger is one of the most destructive interpersonal styles of behavior. The other, of course, is the aggressive behavior and violence, which are on the hot end of the spectrum. Both are very powerful interpersonal behavior s . Passive-aggressive anger is based on the underlying premise of "You can't make me!" And that's true--we cannot make people do something. We can imprison them, and we can take their lives, but these actions do not necessarily elicit the behaviors that we want from people.
In intimate relationships, passive-aggressive behavior can lead people to make agreements they won't keep. This then draws anger from their partner, based on the partner's injury of being disappointed. A classic example is when someone agrees to a meet at a certain time and then shows up late, making the other person wait. While passive-aggression often gets a bad rap, especially in relationships, you can see its power in that it is the basis of non-violent protest, such as that espoused by Gandhi and Martin Luther King Jr.
Anger, like fear, contains energy, which make both emotions more action-oriented than sadness. Understanding that anger is an energy generated in response to an injury takes some of the negative feelings away from the experience of being angry. Realizing that it isn't bad or destructive to have these kinds of emotions provides the opportunity to be thoughtful and proactive about how to use this energy to fix what is hurting you. The energy of anger is meant to empower you to solve the problems and heal the injuries in your life.
What Is Power?
Power is the use of energy to act on the world so that it meets your needs. This energy frequently comes from anger, when we are responding to an injury. This is a simple concept, but one that is frequently lost on many of us in our attempts to cope with the world.
Most of us don't have to think about responding to a mosquito. The natural response is to swat it and flick the squashed creature off of your body. Most people wouldn't think that swatting the mosquito is a use of power. This simple example, of experiencing an injury and using the resulting anger in an appropriate use of power, demonstrates the way that we deserve to function when we experience emotional or physical injury.
When something is hurting us we have a natural tendency to respond in a manner that takes care of and protects us. This same, simple process is distorted in most problems involving mental health. Instead of simply using anger to fix what is hurting us, we end up behaving in ways that cause us further harm. To think of it in terms of the mosquito example, it would be like slapping yourself--not the mosquito. It's amazing how often we do just that. In my experience, people seeking help in psychotherapy have problems that are related to this central concept. By this I mean to include problems with depression, anxiety, addiction, and emotional intimacy.
This distorted response to injury begins with faulty learning in childhood. We learn ways of responding and coping for our very survival. We begin life as completely dependent beings and we learn our lessons about emotions, intimacy, and power from our parents: adults who typically are injured and have created a dysfunctional family environment. Many of us don't begin to realize our own, internalized dysfunction until we leave home. I call this learning process the loss of innocence . We may lose our innocence when we run into some major difficulty, such as depression, anxiety problems, divorce, addiction, or problems with the law.
Leaving home and the protection of our family of origin is a major developmental step, one that can be quite intimidating. Even if it is dysfunctional, the family is known, and, therefore, is safer than the unknown. To prepare for this transition, I believe we put on our emotional and body armor and assume the mantle of innocence , which I view as the basic assumption we make about our intrinsic "OK-ness," or acceptability to others. When we're wearing our mantle of innocence, we assume that all will be "fine" and that we are "fine" as we take that leap of faith and enter the cold, cruel world outside the family of origin.
Losing our innocence, while quite painful emotionally, is the beginning of the movement to maturity. We reach a level of maturity when we can deal with the injuries in our childhood in a way that keeps them from continuing to interfere with our current lives. In order to reach such a place of healing, however, we have to learn to deal effectively with our anger. This can be challenging because of the misunderstandings and negative lessons we learn about angry emotions from both dysfunctional family environments and society in general.
What Is Intimacy?
Emotional intimacy is one of the most difficult things to accomplish because it requires being able to accept all of the feelings of another person, even if you don't like those feelings. It requires us to accept our partner's feelings even when they don't make sense to us. It also requires that our partners accept our feelings unconditionally, too. But when we have learned inappropriate ways of dealing with our feelings, as almost all of us have, it can lead to a lot of conflict and lack of intimacy.
Oftentimes we struggle with intimacy because we've learned dysfunctional things about anger. We often experience a double bind in dealing with our angry feelings. This explains, metaphorically, why we end up slapping ourselves in the face instead of swatting the mosquito. The double bind of interpersonal anger starts when you're angry about something. You see your choices as either expressing that anger and being rejected for doing so, or not expressing it, and therefore not getting your needs met. Part of the difficulty involved with this process is the way in which people express--or don't express--their angry feelings.
Anger has a spectrum to it. Most people are used to defining anger as only the hot or violent end of the spectrum. The other extreme is the cold and distant or withdrawn response. Most people don't see or consider the rainbow of gradations in the center of the spectrum, which includes lots of normal, assertive behaviors.
The interpersonal challenge, especially in our most intimate relationships, is to realize that your anger, and that of those around you, can be a gift. It is a gift because you could choose to leave or not share your pain and anger, which eventually causes more emotional distance. It's not a gift if you're stuck with depression, or overreacting with explosive anger, or withdrawing from those around you. However, if you can accept your own anger and learn how to express it effectively while accepting the difficult feelings of those around you, you're making the power of those intense feelings start to work for you.
Gradually, with conscious attention, work, and courage, these new emotional behaviors will begin to dispel the feelings of helplessness generated by that double bind. To break the double bind of anger means learning that your choices of angry behaviors are not limited to either stuffing your anger or exploding. You will find that the difficult feelings can be expressed outward, to others, with the results that you desire. As your skill increases, you will find more success with those you love, and find others who are interested in and capable of accepting your emotions.
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