CPPNJ - The Center for Psychoanalysis and Psychotherapy of New Jersey

Sunday, October 23, 2011

Contentment: What you can find in a pill

According to a new survey, the use of antidepressants rose 400% in the United States in little more than a decade. (If only I could say the same for my stock portfolio.) The National Center for Health Statistics reports that antidepressants are now the most commonly-prescribed medications among 18-to-44 year olds. Nearly a quarter of women age 40 to 59 take them.

Sadly, less than a third of people taking antidepressants, and less than half of those taking two or more, had seen a mental health professional in the previous year.

It gets more depressing -- every pun intended. According to the study, most people on antidepressants suffer from relatively minor depression (sometimes called dysthymia), and some may not be clinically depressed. And yet as many as two thirds of Americans with severe depression receive no treatment at all.

A number of experts believe that we have reduced depression, anxiety and other states of the mind into simple neurochemical disorders, failing to address the broader psychological aspects.

Psychotropic (psychiatric) medications have helped many people; I have strongly recommended them for some of my patients over the years. I do not wish to minimize their importance in any way. But their overuse, particularly without accompanying psychotherapy, is part of a larger problem. As a society, we are mired in a get-well-quick mentality that treats complex emotions like a Betty Crocker cake mix -- a right-out-of-the-box approach that's quick and easy, but minimizes the pleasure and importance of finding out what's really cooking, so to speak, to cause a person's suffering.

Something is wrong when we have gone from self-examination to Prozac Nation -- a situation which has only worsened since the famous book of that title was published in 1994.

When people pop pills without also engaging in psychotherapy, they are not addressing the deep-seated problems that are caused their depression, anxiety, self-doubt and compulsions. The act of avoiding what makes them anxious about themselves likely is at the heart of their problem to begin with. Without making the effort to address how they got stuck, they are likely to only perpetuate their shame and feelings of inadequacy regardless of the effectiveness of the medication. "I am not strong enough to tackle my problems," is the message they give themselves. "I have to find an easy way out."

The benefits of psychotherapy are numerous, particularly a psychodynamic approach which looks to understand the underlying causes of maladaptive patterns and find ways to permanently alter them. The person's sense of self and ability to navigate their lives improve immeasurably. There is great joy in being able to understand and master issues which have kept us stuck. As change unfolds in the psychotherapy sessions and in the person's every day life, most people find their relationships -- with themselves and others -- and their sense of accomplishment and confidence improve in dramatic ways.

The process involves work -- more than just popping a pill. But if you really want to get to the crux of your problems, looking inside to find a sense of purpose may be more profound than anything you keep in your medicine cabinet.

-- Eric Sherman, LCSW

Tuesday, October 4, 2011

Understanding self sabotage

Still repeating the same self-defeating patterns?

Dating the same kind of controlling jerk you vowed to avoid three controlling jerks ago?

Putting off assignments until the last minute, then making sloppy mistakes in a rush to meet deadline?

Sleeping late, not going to the gym, overeating... and then hating yourself for it?

On the surface, it makes no sense. Why would anyone keep shooting themselves in the foot when clearly they can see their toes smoking?

But when you consider the unconscious -- the thoughts, feelings and motivations that "secretly" guide your actions -- even the most irrational behaviors come in to focus. Consciously, you want to complete the assignment, find a healthy romance, and stop angering friends by running late. But deep inside, conflicting desires are at odds with your conscious intentions.

Sure you want to prove yourself, but what if you unambivalently attack an assignment and then fail? What if you pursue a romantic partner who can truly nurture you -- and he walks away? It feels worse to be rejected by Prince Charming than to stick with the jerk you know isn't right for you.

I have worked with numerous people who, on the verge of important accomplishments -- or perhaps right after something good has happened -- become anxious and yank the rug out from under themselves. It may seem counterintuitive, but it sure beats getting your hopes up and having somebody else dash them -- especially if that's been a frequent experience in life. By extinguishing your own hopes, your unconscious is trying to protect you from the rejection that has already happened in the past, and that it is sure will happen again if it lets its guard down. The pain you know is familiar, and by causing it yourself, you at least feel in control. You know how things will turn out since, without realizing it, you have engineered them that way.

People often say they procrastinate because there are lazy. I like to reframe it so that they can see what they really are is frightened. They put off a daunting task because they are afraid they will not be good enough to accomplish it. Or what if they do, and still feel empty inside? Not trying is a way to keep alive the hope that things will still work out in the future.

Also, by unconsciously repeating the past -- by dating an aloof, rejecting man like father -- you hope to master the pain and come up with a new ending. If you can win over Mr. Wrong, you can finally please daddy (in abstentia) and feel worthy, powerful and recognized.

The problem is that it rarely works. Instead of mastering and changing the past, we repeat it almost verbatim. What may be required is a working through facilitated by psychodynamic psychotherapy. In treatment, you confront your unconscious belief systems and finds new ways to address them. This happens in vivo with the psychoanalyst, another parent figure likely to stir up familiar rejection anxieties, but who is also able to find new ways to respond to them. Rather than reject, he affirms. Rather than become angry, he remains curious.

So stop procrastinating and start looking inside. You may be surprised by what you find.

-- Eric Sherman, LCSW