by Frank Tallis
Anita’s sobbing subsided and she became very still. The adult surfaced and she said, ‘I didn’t mean to hurt Greg. I really didn’t. I just went into a blind rage.’
Why do people engage in self-defeating behaviour patterns?
Freud employed the term ‘repetition-compulsion’ to describe an innate tendency to reproduce early traumas in the context of current relationships. The outcome that Anita most wanted to avoid was abandonment, the condition of her childhood, yet she persisted in behaving in ways that made Greg’s departure an increasingly likely outcome. Although much of her behaviour was motivated unconsciously, she must have had some awareness of what might happen. The division between the unconscious and conscious is not absolute; there are twilight regions, penumbral fringes and blurred boundaries. Moreover, she was perfectly aware of her history. She had had relationships with other men before Greg, she had experienced jealousy, made accusations, and subsequently, these relationships had also come to a premature end. Why did she carry on repeating the same mistakes? Why was she so inflexible?
Consideration of the origins of repetition-compulsion eventually led Freud to infer the existence of the death instinct, a drive that lends support to all forms of self-defeating behaviour and ultimately self-destruction. He justified the notion with recourse to a law of nature: organisms evolve from inanimate matter and must inevitably return to the inanimate state. This common destiny finds correspondences in our thoughts and predispositions. When we engage in self-defeating behaviours, we are allowing the death instinct to carry us a little closer to oblivion.
Repetition-compulsion is probably more economically explained as a kind of bad habit. We learn certain patterns of behaviour very early and they become our default setting. These behaviours arise from schemas that are so entrenched, so central to our sense of self, that any departures from their script make us feel wholly disorientated. We experience what the radical psychiatrist R. D. Laing called ontological insecurity; we no longer perceive the world as a place of unquestionable, self-validating certainties. We feel like we’re losing ourselves.
Self-defeating behaviours persist—even when they cause us pain—because the alternatives are associated, at least initially, with greater distress. Dysfunctional schemas are like an old pair of shoes. They aren’t really fit for purpose, but they’re what we’re used to and they don’t pinch.
When a relationship breaks down, couples can still benefit from attending joint therapy sessions, particularly if children are involved. There are usually loose ends to tie up, bills to be paid, outstanding issues to be resolved before all parties—including the children—can move on. Civil communication is still necessary if couples are to separate without causing too much collateral damage. I spoke to Anita about this possibility. She wasn’t interested and nor was Greg.
I suggested to Anita that she might consider making a longer-term commitment to psychotherapy. She said she’d think about it, but I wasn’t convinced.
‘Perhaps you’re feeling let down right now.’
‘You tried…’
‘It would be understandable.’
‘I’m disappointed. But I don’t feel let down.’
We worked on her depression and talked a great deal about trust.
‘If I’d known for certain,’ she said, ‘that Greg was trustworthy—then I wouldn’t have had to ask him so many questions.’
‘But how can you ever be certain? There are no guarantees. When we love we have to take risks.’
‘I can’t take risks.’
‘Other people do.’
‘I’m not other people.’
She studied her pointed heel and tested its point with her finger.
Anita wanted love, but to love is to be jealous, and to be jealous in the way that Anita was precluded love. After she broke up with Greg, Anita came to see me for six more sessions and then cancelled the following three. The final page of her notes: three dates followed by the letters D, N and A.
I never saw her again. Or at least, I never saw her again in person.
The Diagnostic and Statistical Manual of Mental Disorders (DSM) of the American Psychiatric Association is a comprehensive guide to diagnosis and classification. It is currently in its fifth edition (DSM-V). This diagnostic bible has attracted a great deal of criticism over the years, the most serious of which are that it is non-empirical and that the content is overly influenced by drug companies. Many psychologists and psychotherapists believe that the entire enterprise of psychiatric diagnosis is misconceived, simplistic, misleading, reductive and prejudicial. People—they say—should not be ‘labelled’.
Personally, I have no ideological objection to diagnosis. A diagnosis is nothing more than a summary term for symptoms that tend to cluster together. Some diagnoses are less convincing than others, and there is always a danger of medicalising normal behaviour, but on the whole, I find diagnoses useful, and classification a means of imposing order on what would otherwise be a bewildering and confusing universe of symptoms. I prefer DSM to its competitor, the ICD system of the World Health Organization, simply because I find it easier to read and more digestible. There is, however, enormous overlap between the two.
As mentioned earlier, Anita easily met DSM-V criteria for a diagnosis of Delusional Disorder: Jealous Type. This condition is classified under the section heading: Schizophrenia and Other Psychotic Disorders—a group of very serious mental illnesses. But how can one ever be sure that suspicions are delusional? Without constant monitoring, twenty-four hours a day, it is impossible to be certain.
Some 20 to 40 per cent of married heterosexual men admit to having had at least one extra-marital affair—as do 20 to 25 per cent of heterosexual married women. Approximately 70 per cent of dating couples cheat on each other. Over half of the single population engage in ‘mate poaching’—attempting to break up an existing committed relationship. From the perspective of evolutionary psychology, the human reproductive strategy is mixed, a judicious combination of pair bonding and opportunistic sex.
The diagnosis of Delusional Disorder: Jealous Type is actually very speculative. It depends entirely on a decision about the unknowable. Was Greg telling the truth? Had he always been faithful? I thought he was an honest, decent man. But I could be wrong. He might have been a skilled manipulator with obscure motivations. And if he was lying, where does that leave the diagnosis? It is a worrying thought. I reassure myself by going over the facts, by considering what I do know, rather than ruminating about what I don’t know and can never know. Anita had deep-rooted problems and a history of pathological jealousy. She had no substantial evidence to support her unhappy conclusions. As such, she could be described as delusional. At the back of my mind, however, there is a persistent, niggling doubt.
Some ten years after I watched Anita leave my consulting room for the last time, I was lying on a bed in a hotel room in New York, pointing a remote controller at a wall screen and channel hopping in a distracted fashion. I glimpsed a face that looked familiar. It was definitely Anita. She hadn’t changed much at all. Her eyes were unmistakable. She was standing in the middle of a large, opulent room talking about colours and fabrics, and I realised I was watching a trailer for an interior design show. I jumped off the bed and tried to see if Anita was wearing a wedding ring, but the image dissolved and I found myself studying a map of the east coast of the USA and listening to a weather forecast.
Chapter 4
The Man Who Had Everything
Addicted to love
In therapy, some patients engage in what might be likened to an emotional striptease. Layer by layer, resistances are removed, until the final concealments fall away and the truth, however painful, unpalatable or shocking, is revealed. That moment, the moment before the final revelation, is hyper-intense.
Almost thirty years ago I was seeing an entrepreneur—a lean, elderly gentleman with a Van Dyke beard and a fondness for colourful waistcoats—for stress management. He told me about a project that h
e was about to invest in but I didn’t really understand what he was talking about. A few years later I was able to decode what he’d been saying. It was a project that effectively changed the world. He came to see me four times.
The first three sessions were routine—an assessment, a formulation and some preliminary educational work.
He was an affable man with working-class origins and like many people who have ascended the social hierarchy to positions of influence and power he was fond of telling stories that highlighted the magnitude of his achievements. I had to keep reminding him that we had a job to do. He had a heart condition and his cardiologist considered stress management an important component of his long-term care. He would smile and make bountiful gestures: What’s the hurry? We have all the time in the world.
A false smile engages the muscles around the mouth but not the muscles around the eyes. The delta of lines that fanned out across the entrepreneur’s temples didn’t move. In fact, they never moved.
When he arrived for his fourth session, his manner was more subdued. His answers to my questions were elliptical and eventually he reached for a tissue. The sagging pouches beneath his eyes had collected a few tears. I asked him what was wrong and he continued to give me vague, unsatisfactory answers until the session was almost over. He glanced up at the wall clock and then studied me with such concentrated attention that his brow became compressed and striated. We had less than five minutes. ‘Stress management, eh?’ He said the words with a hint of detraction. ‘Some forms of stress can’t be managed.’ His pale grey eyes, slightly cloudy in appearance, didn’t blink. I could hear the rush of blood in my ears. The moment was suspenseful, like the charged latency that precedes a thunder clap. ‘A long time ago,’ he continued, ‘I was on a boat in the middle of the Arctic Ocean—skirting the pack ice—and I ordered a man to be thrown overboard.’
‘Who was he?’ I asked.
The entrepreneur replied with solemn determination: ‘He was a very, very bad man.’
‘And you left him there?’
‘Yes. As I said, he was a very bad man. Do you understand? Very bad.’
Was my patient being serious? Or was this some kind of test? Perhaps I was being duped?
‘We’re going to have to talk about this…’
The entrepreneur tugged at his cuffs and showed me the time on his wristwatch. The hour was up. ‘I have another appointment.’ He stood, adjusted the hang of his trousers, put on his long coat and shook my hand. ‘Yes,’ he said. ‘We’ll talk about it.’ After he’d left my consulting room I looked out of the window. A black Mercedes was parked outside the entrance on triple yellow lines; a uniformed chauffeur got out, opened one of the rear doors, and I watched as the entrepreneur vanished into the shadowy interior. He didn’t come back.
Psychotherapists sometimes refer to ‘admission tickets’—relatively trivial problems that patients use as a pretext for entering therapy. When the patient feels comfortable and emotionally safe, the actual or substantive problem is revealed. It isn’t uncommon to discover that the real problem has some moral dimension which is the cause of a troubled conscience. There are marked parallels between psychotherapy and the Catholic confessional. Secrets weigh heavily on the soul and the process of unburdening can be a great relief. For some people, psychotherapy is all about confessing.
Ali was a man in his late thirties. His grandfather—who had arrived in the UK as a penniless immigrant—and his father (who had died when Ali was young) were responsible for creating a large and profitable manufacturing business. Ali was a family man, a good man, respected by the leading members of his community. I found him friendly enough, but he had about him a certain air of detachment. It was something I was familiar with—this manner, this attitude—which made me feel that my patient was seated behind a thick sheet of glass. Ali was slightly removed and emotionally flat. I didn’t feel that we were connecting properly.
For treatment to be effective there needs to be some kind of connection between therapist and patient. It can be a simple bonding, as might develop in any situation where two people work together to achieve the same ends. Or it might be a more complex connection, as in psychoanalysis, which gives special significance to the transfer of emotions and ideas associated with an earlier relationship onto the analyst.
Ali’s distance, his remoteness, was a quality that I had come to associate with the super-rich and celebrities. Perhaps the former are somehow benumbed by continuous exposure to exceptional experiences and the latter are discomfited by having to answer questions as themselves. Many celebrities are completely unable to step out of role and continue to behave like comedians, actors or rock stars, even in the consulting room. This makes trying to help them almost impossible. It’s like attempting to treat a cardboard cut-out rather than a real person.
Ali dressed very casually: ripped jeans and trainers, a creased linen shirt—a cheap, hippy ornament hanging from his wrist. He wasn’t a man who could be accused of flaunting his wealth. I noticed that when there were pauses in our conversation he very quickly looked bored.
He had been married to his wife, Yasmin, for almost twenty years and they had four children. It hadn’t been an arranged marriage, as such, but their respective families had been business associates and both sides were keen for the couple to meet. The subsequent courtship was encouraged—perhaps even incentivised. Over time, Ali’s uncles—who had been running his father’s business—retired, and Ali became managing director. All of Ali’s children attended private schools, and he and his family lived in a spacious house situated in a very desirable suburb. Ali had everything: inherited wealth, two sports cars and a devoted, beautiful wife. Then, one day, something happened which caused an unprecedented domestic upheaval. Purely by chance—she hadn’t harboured any suspicions—Yasmin discovered that Ali had visited a prostitute. She had picked up Ali’s phone with the intention of looking up a number in his contacts list, and was horrified when she came across a series of lewd text messages. This wasn’t Ali’s usual phone—it was his other phone.
Ali was slumped low in his arm chair, almost supine—his legs fully extended. ‘She was very upset. She wanted a divorce.’
‘What made her change her mind?’
‘I explained how stressed I was. It’s not easy running a big business. And I’ve been doing it for a long time now. I explained that I’d been depressed for a while and that I wasn’t thinking straight. She said: “If you’re not well then you should get help and if you don’t get help we’re finished.” So I said: “Sure—of course—anything.”’
‘What’s making you depressed?’
He pursed his lips and didn’t answer for several seconds. After such extended consideration I was expecting more than a single word. ‘Stress…’
‘How are you stressed?’
‘There’s a lot to do, you know? Responsibilities, admin; a few years back things were difficult for a while and I had to lay off a lot of people who were dealing with my paperwork. I had to start doing the book-keeping myself.’
‘Couldn’t you start employing people again?’
‘Sure. It’s something I should have done years ago. But I just never got round to it. There was always something else to do, something that needed urgent attention.’
‘When you get stressed, how do you feel?’
‘How do I feel?’ I nodded. ‘Well… not so good.’
‘Do you get any symptoms?’
‘Yes, I suppose so. Headaches.’ He drew a line across his forehead with his finger. ‘I get bad headaches.’
He wasn’t very forthcoming. I asked him about his depression.
‘When you get depressed, what kinds of thoughts do you have?’
‘I think about the business—where it’s going…’
‘Anything else?’
‘My marriage. I’m not proud of what I’ve done.’
His answers were consistently brief and uninformative. It was as though his lassitude made speech effortf
ul. His fleshy eyelids drooped and he blinked—slowly—like a contented cat. He looked as if he was about to drift off to sleep.
Once, a patient of mine fell asleep while I was in the middle of a sentence. I knew that if I woke him up he would be embarrassed, so I waited until he roused and the instant he opened his eyes I finished my sentence. He was completely unaware that he’d been asleep for fifteen minutes.
I began to suspect that Ali had come to see me only because of his wife’s threat. His illicit rendezvous had been exposed and he was now pretending to be unwell in order to prevent his wife from issuing divorce proceedings. I put this to him, phrased more diplomatically, and I was surprised by his reaction.
‘No,’ he said, raising himself up. He seemed genuinely disconcerted by my suggestion. ‘I think Yasmin’s right. I think I have got problems.’
‘Do you think you could try to speak more openly about what’s going through your mind?’
‘Okay.’ He rocked his head from side to side as if trying to free a trapped nerve. ‘Okay. I’m not used to all this.’ He referenced the generality of the consulting room with a lazy roll of his hand. ‘I’ve never been a great talker.’
Our conversation remained insubstantial. Ali yawned, fiddled with the charm on his bracelet and occasionally repeated himself: ‘It’s hard, running a business—a big responsibility. I’m not sure Yasmin appreciates that. She’s never had to do it. I’m not saying that justifies what I did, no way—but still…’
‘Are you resentful of her sometimes?’
‘Resentful. Me? No, she’s a great wife. Always has been; and a great mum.’
Perhaps I’d judged him too harshly. Perhaps he did have a significant problem but was simply too anxious to talk about it. Why was I thinking this? Ali didn’t look particularly anxious and the tone of his speech hadn’t changed. I just had a feeling—a hunch. I have already highlighted the perils of emotional reasoning. Wasn’t I making the very same error that I warned my patients against?
