Make Yourself One of the People You Care For...

"Don't compromise yourself. You're all you've got.”  - Janis Joplin
 
Mary's story is not unique. Mary does not know how to say "no" to the other people in her life. Her husband and grown-up children have become accustomed to her meeting their small or big demands. Her extended family takes her for granted when they unilaterally assign her with tasks and responsibilities for family situations and events. Her friends know that she will drop everything and come to their aid and rescue in their latest crisis at all times of day and night. Her co-workers and supervisors praise her for taking on any additional roles and tasks that need to be done, without expecting credit or compensation for the inevitable sacrifice of her weekends or planned holidays. In therapy, Mary complains about the excessive demands placed on her by all the people in her life and their lack of understanding and caring for her boundaries and personal time.

Mary's story is not unique. Almost everyone knows someone like Mary in their life. In my own experience as a therapist, I have seen this issue arise in individuals from just about every culture, race, ethnicity, gender, age, socioeconomic status, among others. Mary could very well have been Maria, Miriam, Meena, Mark, Mario, Dr. Ming, Madison and so on. The fundamental issue is a very human issue. It speaks to the challenge of having a balanced approach towards oneself and those around us.

A big picture issue in this dynamic is the obvious dissonance between being a very helpful and resourceful person for others, while having a passive and helpless experience when it comes to oneself. It is like playing a board game with the only rule being that the one person you cannot help is yourself. As we search deeper for the reasons for this anomaly, we most likely encounter the tendency to view the self-other issue as all-black or all-white. If we seek the choice as only helping others versus only helping ourselves, then as "good" people, we are inclined to take the first choice. Thus, we play out the pattern of being a "good" person, who always helps others, because the perceived alternative is to be a selfish or "bad" person.

The good news is that we can learn, through therapy or in other ways, to move to a more balanced approach towards the self-other dynamic. Once we learn that helping the personal self is not always bad, we can allow help to reach us when we need it. One technique I have found helpful with many patients is helping them imagine a line of people that they are supposed to help, with each person getting a turn and then going back in the line. I ask them to imagine themselves getting a turn as well, making themselves one of the people that they are supposed to take care of. Not always first, but not always last either, getting their turn just like everyone else. This helps people to open a channel towards self-resourcefulness and allowing them to bring the considerable skills in the business of being helpful to the parts of them that could do with that help. This helps shift treatment as well as the direction of life towards more positive and self-affirming paths. Charity does indeed begin at home. 

My Own Worst Enemy

"Education is a progressive discovery of our own ignorance." -  Will Durant

The story is a familiar one.

A scorpion asks a frog to carry it across a river. The frog is afraid that the scorpion will sting it. The scorpion promises not to do so and gives a valid reason to the frog that if it stings, they will both drown. This makes sense and the frog agrees to carry the scorpion. In the middle of the river, the scorpion stings the frog. The surprised and dying frog asks the scorpion, "why did you sting me knowing that you will die too?" The scorpion said, "I couldn't help it, it is in my nature..."

This story reverberates with almost all of us. Who hasn't given valid reasons and made resolutions, only to abandon them soon after? This story especially stings, pardon the pun, in the context of mental health and for the patients who are struggling with it. A common refrain from patients is that "I am my own worst enemy."

Patients often state that even though they know what is best for them, they find themselves unable to change their maladaptive behaviors. These behaviors emerge as unhealthy habits, destructive patterns in relationships and substance abuse, to name a few. Many times, it is easy to see the problem but difficult to understand why it keeps appearing or how to resist yet another repetition of the pattern. The issue that arises from this dilemma is whether this is an innate and fixed part of the person or can this be changed to a more constructive outcome.

Entire books can, and have, been written on this topic. However, let us attempt to highlight a few key issues that surround this subject. The starting point of the inquiry is that a person is aware of a disconnect between his stated values and his actual behaviors, and is wondering why. Let us leave the topic of not even being aware of disconnects for another discussion. Also, there are various methodologies, especially cognitive-behavioral therapies, that do not focus on why there is a disconnect and instead directly attempt to help with reducing or eliminating this disconnect, and this can be a perfectly acceptable outcome in many cases. However, it may be preferable, or even necessary, to understand the root causes of the behaviors, as opposed to their immediate triggers.

Looking at the bewildered frog, and even the bewildered scorpion, we encounter the limits of conscious experience. This wall is not a static entity but it stands in a fixed place at any given point in time. We only "know" what is on our side of this wall while what is on the other side is not "known," at least in the conscious sense. The problem is that even when we exhaust all the answers on the conscious side, we do not venture into the "other" side of conscious experience. We have a dim awareness that this other side is dangerous, perhaps mystical, perhaps horrifying, at any rate, to be avoided at all costs. So we keep looking in the same places, hoping to find something new and safe. 

The important idea is that the other side does not have to be a threat. Since the beginning of psychotherapy, there have been efforts to normalize the hidden parts of the self. Freud believed that if a person could say anything that came to her mind, or analyzed her dreams, and other such practices, she would realize that the "unconscious" material did not need to be cut off or "repressed" from conscious awareness. Jung illustrated many forms that hidden awareness can take, reflecting archetypes found in the cultures of the world. His idea of the "shadow" highlights the same issue of what is hidden but can be eventually seen, perhaps with the help of a psychoanalyst or psychotherapist. There have been many other contributors to this concept from all sides of the psychotherapy spectrum. Some that come to mind are Assagioli's ideas on Psychosynthesis, Schwartz's Internal Family Systems theories, Beck's notion of underlying schema, McCullough's
Affect Phobia and Bromberg's self-states. The mechanisms are cognitive and emotional in nature and utilize processes having labels such as denial, repression, dissociation or avoidance. However, all of these theories and theorists expound the idea that rather than a hostile part of the self that needs to be cut off, there is a misunderstood part of the self that needs to be integrated into conscious awareness.

The benefits of this perspective are enormous for mental health. This approach can help replace the internal conflict between unconscious motivations and conscious frustration. Our cut off parts can become more integrated and visible, and we can access more sides of ourselves in our daily lives. To extend the metaphor a bit more, we can go from being our own worst enemy to being our own best friend. As many patients can attest, it is better than it sounds.