We were surprised by many of the findings. For instance, many clinicians think that “delayed grief” is common and a precursor of future problems. But hardly any of our subjects experienced intense grief after an initial period without much grief. Another idea, one still common among psychiatrists, was that recovery required getting in touch with grief and that avoiding “grief work” caused problems later. We didn’t find that, either. We also thought that sudden losses caused more grief. Also not true.126
One of the most profound findings contradicted my psychiatric training. I had learned that severe or prolonged grief was usually caused by an ambivalent relationship with the deceased. That was based on Sigmund Freud’s idea that unconscious anger toward the lost loved one would be turned against the self and show up as depression. I spent many hours trying to help bereaved depressed patients get in touch with such unconscious anger. It was shocking to discover that our data provided no support whatsoever for the idea. People with ambivalent relationships before the loss tended to have less grief than other people. As Homer Simpson would say, “D’oh!” The best predictor of depression after a loss was also no surprise at all: having depression before the loss.
What about my target group, those who reported little grief? There were plenty of them, but they tended to be just about the same as other people in terms of their other relationships, their health, and their ability to cope with life. My hypothesis that such people would show dire problems was wrong. However, when I delved more deeply into their individual records, I rediscovered something that I had learned many times before: people are enormously subjective. A few people who reported no grief symptoms when interviewed six months after the loss said in the interview eighteen months after the loss that they had experienced intense grief right after the loss. For others, it was reversed. At eighteen months after the loss, they recalled no grief previously, but the data at six months revealed substantial symptoms. People are subjective beings.
Grief is so tragic and so awful that you have to wonder why it exists. There are two main possibilities: it could be a useless side effect of mechanisms that make deep relationships possible, or it could be a special form of sadness that offers benefits like those sadness provides after other losses.
Few researchers have taken on this question. The British psychologist John Archer wrote a lovely book arguing that grief is the price of love.127 He argued that grief itself is useless but pain after loss is necessary for close bonds to be meaningful. In his view, grief is an unfortunate side effect of natural selection being unable to create the benefits of loving relationships without also giving rise to incredible pain.
This doesn’t seem plausible to me. A grieving person’s suffering, disability, and lack of energy can be so desperate that you would assume selection would find some way to allow relationships to be warm, deep, and secure without so much suffering at their loss. Months and years of poor sleep, poor appetite, hopelessness, and lack of motivation take a huge toll. Seven percent of people develop complicated grief that impairs their functioning for years.128,129,130 If it is just a side effect that natural selection could not fix, it is a particularly stupid, awful one. If a drug were found that would eliminate grief, should we use it? An answer requires finding out if and how grief is useful. And that requires understanding why sadness exists.
Sadness in general seems to come too late to do any good. The loss has already happened. But loss is a situation that has recurred over and over in every life since the beginning of time. Sadness was shaped to cope with the situation of loss.131 But how can it help?
Pretend for a moment that you are in the horrifying situation of watching one of your children being pulled out to sea in a riptide. Would you just go on eating your lunch? No way. The first thing you would do is to scream to get help rescuing your child. You would simultaneously get all other children out of the water as you dive in and try to rescue the missing child, even knowing the danger and that it is probably too late. If you were sensible enough not to swim out or fortunate enough to get back to shore safely, grief would promote endless rumination about what you could have done to prevent the loss. This would help prevent a repetition with other children. Your sobbing would signal your need for help and warn others about the danger.
When a child dies of cancer or pneumonia, speculating about what you might have done to prevent it is mostly useless. However, the tendency to blame is built in, so people do it anyway, blaming themselves, doctors, anyone who was involved. Those motives can create marvelous initiatives, Mothers Against Drunk Driving being a spectacular example. Every community has organizations dedicated to preventing the kind of sickness or accident that carried off a loved member of the community.
In our ancestral environment, loved ones must often have simply not returned to camp. Searching for them would have been essential. A loss creates mental preoccupation and a search image tuned to detect relevant cues. In the weeks after a loss, bereaved individuals often think that they see or hear the lost loved one. Tiny random sounds or sights are misinterpreted as the person’s voice or form. Visual and auditory hallucinations arise. Such experiences are sometimes interpreted as wish fulfillment, but a more plausible explanation is that they are products of a search image that makes it easier to find the missing person. False alarms in such a system would be normal, useful, and experienced as ghosts.
Anniversary reactions are also common and fascinating. Many people occasionally experience sadness that seems unaccountable, until they realize it is the anniversary of a loss. I doubt that anniversary reactions are adaptive in general; however, in ancestral environments many opportunities and dangers recur with seasonal regularity. So smelling overly ripe apples in an orchard may bring back vivid memories of a fall long ago.
CHAPTER 10
KNOW THYSELF—NOT!
If . . . deceit is fundamental to animal communication, then there must be strong selection to spot deception and this ought, in turn, to select for a degree of self-deception.
—Robert Trivers, foreword to The Selfish Gene, 1976
Too much sanity may be madness. And maddest of all, to see life as it is, and not as it should be!
—Miguel de Cervantes Saavedra, Don Quixote
The Animal Behavior Society is an organization of scientists who investigate why animals do what they do. They study how natural selection shapes brains that give rise to behavior that maximizes fitness. This seemed like crucial knowledge for a psychiatrist, so I went to the society’s annual meeting. I expected to come away with new ideas, but I was completely unprepared for what happened: in the middle of the annual banquet I realized that I would have to spend years trying to understand psychodynamics in evolutionary terms.
The first morning of the meeting included a symposium on whether animals have consciousness. Another symposium was about why individual animals that experience early harsh environments become risk takers that start reproducing sooner. If life is likely to be short, doing whatever it takes to reproduce early will be worthwhile. This simple notion immediately triggered thoughts about patients who were abused as children and grew up to be reckless adults. Studies of what is called “fast versus slow life history theory” have developed into a major line of research in evolutionary studies of behavior.1,2,3
At lunch the scientists at my table thought it was great that a psychiatrist had a serious interest in animal behavior, but they made plenty of jokes about Prozac. Then one said something that surprised me: “If you are a psychiatrist, then you must know that the purpose of the unconscious is to stay unaware of our motives so we can better deceive people.” I said that I knew about the idea from conversations with the biologists Dick Alexander and Bob Trivers, who first came up with it, but that it was by no means widely accepted. Several at the table disagreed, citing the ubiquity of deception in the animal world: camouflaged butterflies, birds that pretend to be injured to lure predators away from the nest, cannibalistic
fireflies that lure male victims by imitating the female’s flash.4,5 They explained that all communication systems get exploited, creating ever escalating arms races between strategies for more subtle deception and more powerful ways to detect deception, that create ever more complex signals. Their fascinating comments were certainly relevant to human relationships.
At the banquet the next day, I sat with a different group. The conversation turned to how understanding the evolutionary origins of cooperation could help people get along better. After a few minutes of discussion one person said, “But we all are basically selfish, aren’t we? It is just that the unconscious hides our motives from us and others.” The same idea again! Something in my mind flipped. If animal behavior researchers were confident that natural selection shaped our capacity for keeping things unconscious to allow us to better deceive others, I had to investigate. If the idea was true, it had the potential for grounding psychodynamics in biology. If it was false, it was a clever meme that could harm relationships.
University of Michigan biologist Richard Alexander wrote, in a 1975 article, “Selection has probably worked against the understanding of such selfish motivations becoming a part of human consciousness, or perhaps even being easily acceptable.”6 The idea got more attention in the foreword Robert Trivers wrote in 1976 for The Selfish Gene. He said, “There must be strong selection to spot deception and this ought, in turn, to select for a degree of self-deception, rendering some facts and motives unconscious so as not to betray—by the subtle signs of self-knowledge—the deception being practicised.”7
Trivers went on to write several papers and a book arguing that self-deception evolved to make it easier to deceive others.8
Trivers and Alexander didn’t know much about psychoanalysis, however. It is based on the observation that our behavior is influenced by unconscious ideas, emotions, and motives, and that powerful ego defenses keep some things out of our consciousness. Psychoanalysis is a strategy for getting around these defenses, thus revealing things previously hidden by repression and thereby reducing self-deception. As the psychoanalyst Heinz Hartmann put it, “Indeed, a great part of psychoanalysis can be described as a theory of self-deception.”9
The evidence for repression that inspired Freud came from otherwise unaccountable symptoms. My own work provided plenty of examples. The neurologists asked me to evaluate a middle-aged woman whose right arm had been paralyzed for three months. With a sudden onset, no precipitant, and no viable neurological explanation, they thought the cause was psychological. When I met the patient, she held her right arm limp in her lap. On neurological examination, she was able to shrug her right shoulder slightly but otherwise could not move her arm or fingers. Reflexes were normal. Sensation to touch and pinprick was intact. Arm musculature was reduced only a little. There were no twitches or contractures.
When I asked if she had been under any stress, she said, “No, not really, except for my arm is paralyzed, so I can’t do anything.” She mostly took care of her house and her two children, who had recently started high school. When asked about her husband, she said, “It’s the usual, he’s a man, you know.” She refused to provide details but suggested indirectly that her husband was a philanderer who had little sympathy for her arm problem. She then immediately said, “But I am here just to get help with this paralyzed arm, not to talk about my husband.” As we were concluding the mostly unproductive interview, I asked her, “So if your arm could be miraculously cured, what would you do with it?” She became visibly emotional, and, to my incredulous eyes, she raised her right fist to her shoulder and then brought it down sharply as she said, “I guess I’d just put a knife through his back!” I said, “You raised your arm!” She said, “I did not, it’s paralyzed.”
Doctors at the medical clinic where I worked often asked me to see patients who were having hard-to-explain spells. They invited me to see a teacher who had fainted several times at work, resulting in three ambulance trips to the emergency room. She was a single, otherwise healthy middle-aged woman who denied having depression and anxiety. After half an hour, I still had no clue as to what was wrong, so I asked her the exact moment and place of her first fainting episode.
She said it had been after lunch, just as she was leaving the teachers’ lounge. I asked her what happened next. There was a significant pause, and her voice changed slightly as she said, “I guess they called the ambulance and helped me in.” When I asked if she could remember who helped her, she got an odd look on her face, and then said, “I think it was Bob.” I asked about the other fainting episodes, and she emphasized that it was just a coincidence, but Bob had caught her each time. I asked her to tell me more about Bob. She said that he was popular, attractive, and helpful, “just a very nice man.”
She returned for another session later that week and said our conversation had made her realize that she should tell me that she had had a crush on Bob for a year. She stressed that she was sure it had nothing to do with her fainting episodes, even as she described him carrying her in his arms to the ambulance three times. She insisted strongly that she had no interest in having a man in her life.
A man was referred to our anxiety clinic because he had experienced several months of tension, nervousness, and sleeplessness. There was a moderate family history of similar anxiety, but he’d never had symptoms until recently. I asked about stressors and life changes. He said that nothing was different, that everything was going fine at work, and that he was looking forward to his wife having a second baby in a few months. I asked if the pregnancy was causing stress. He said no. He then quickly went on to describe his deep commitment to his church and the importance of his religious beliefs and church projects. When asked about the projects, he described an antipornography group he had started. He and a few other church members met with local storeowners to try to convince them not to carry pornographic magazines. He had started the group about a month after his anxiety had started.
I asked if anything else had happened around that time, and he said, “No. There have been some changes in the neighborhood, but nothing bad.” I asked him to say more, and he described a woman moving in next door after a divorce. He had helped her move boxes into the house. After a pause he said, “I’m not really sure what kind of woman she is.” “How so?” I asked. “Well,” he said, “she invited me in for a drink, but I don’t drink. Then she suggested that I should come back later in the evening. That just didn’t seem right.” As you may have suspected, the date of her move coincided with the onset of his anxiety.
Repression Is Real
Many people think that repression mainly keeps traumatic memories from consciousness. That was Freud’s original idea, but it is contentious and not that relevant to a modern perspective.10 Freud shifted his view as he observed what kinds of things are repressed. Overwhelmingly, they are socially unacceptable wishes, memories, desires, emotions, and impulses. Being in love with another teacher who is married. Wanting to murder your husband. Getting turned on by an invitation from the attractive divorcée next door.
Although the reality of repression is well supported, many deny it. Some even repress it. When I began my career, psychoanalytic ideas were dominant. The chair of nearly every major psychiatry department was a psychoanalyst. They have all been replaced by neuroscientists. Purged is more accurate. Psychoanalysis is ridiculed, and those who practice it are held in contempt by many academic psychiatrists. It’s a bit dangerous even to acknowledge, as I am doing here, that some psychoanalytic ideas are valuable.
It is easy enough to find psychoanalytic ideas ripe for ridicule. The credulous tendencies of some psychoanalysts were brought home to me by an article in a psychoanalytic journal, intended as a friendly spoof, about the symbolic meaning of ingrown toenails. Alas, many took it seriously, making the author’s point more strongly than he had intended.
It is unfair, however, to use such examples to dismiss all of psychodynamics. Preposterous extrem
es are easy to find in every field. Some learning theorists try to explain and treat every psychiatric disorder, even psychosis. Some neuroscientists make grand claims that all mental problems are caused by something broken in the brain. Some family therapists think most disorders are caused by family dynamics. Some evolutionary psychologists propose wild sexy ideas that get lots of attention. And some evolutionary psychiatrists make preposterous claims about the adaptive significance of mental disorders. Every perspective gets pushed to extremes that dirty the water. But there is a baby in every bathtub. The baby, for psychoanalysis, is the fact of repression.
Repression poses a first-rate evolutionary mystery. “Know thyself” always seemed to me to be a practically useful maxim as well as a virtue. Like most people, I assumed that objective perceptions of inner and outer reality would maximize fitness. But at that banquet, I realized my naiveté. Could objectivity harm fitness? How could I assess the hypothesis?
The things repression keeps from consciousness are not mundane events, such as our gallbladders contracting while we eat; they are powerful feelings and desires. Lust, hatred, and envy lurk in the depths. Our minds employ several strategies—psychoanalysts call them ego defense mechanisms—to keep such things out of conscious awareness, no matter how hard we try to get in touch with them.
While I was a college student working in a summer program at a mental hospital, I had a conversation with a psychologist and two other students while driving late one night. We were talking about people who are hard to get along with. I took the opportunity to complain about a nurse who didn’t like me. They asked me for details, and I explained that the nurse was a bully who had strong opinions about everything and was unsympathetic to young people. They asked me for specific examples, but I had trouble coming up with any. After I complained about her for another ten minutes, the psychologist said quietly, “I think you’re probably projecting.” I had no idea what she was talking about. She went on to say, “There isn’t much evidence that she is criticizing you, but you clearly dislike her intensely, so you may be denying that and instead thinking that she dislikes you.” “That’s ridiculous,” I said. Then one of the other students said, “Or else you are turned on by her.” It wasn’t until I was well into my training as a psychiatrist that I realized that they were probably right, at least with the first hypothesis, and that we all have false beliefs about other people and ourselves.
Good Reasons for Bad Feelings Page 22
