Two Kinds of Fear in the Mind

Often when we are stressed, afraid or angry, feelings just come to us. Sometimes our responses make perfect sense. For example, if a car nearly misses you when you are crossing the street at an intersection your heart rate will instantly increase as you realize the danger. Shouting at the driver or stepping quickly away from the car are both reasonable and average responses. This kind of reaction is instinctive and understandable, but we can have other apparently built-in responses that aren't so understandable. For some people walking through a crowded shopping mall is enough to make them nervous. The feelings can seem overpowering and be confusing at the same time because we may be fully aware that there is no real danger. For some, overstimulating social situations may create irrational feelings and impulses to escape. Specific scenarios can trigger our fear and we consciously learn that there are basic tasks that we have difficulty performing, perhaps going out, driving a car, talking to new people, making phone calls, riding in elevators or other common tasks become difficult or impossible. A few "phobias" may just make you feel a little quirky, but after a while if they pile up you begin to think of yourself as paranoid and get the sense that something more general has gone wrong.

While anxiety can be a general experience that drags us down on a day to day basis, fear in the moment can be quite intense. Fear usually has an immediate stimulus. With fear, we see a snake and become apprehensive or we look down from a tall building with unease. Anxiety in contrast can arise without any physical stimulus, sometimes remembering a painful past event or thinking about something in the future that we'd rather avoid can lead to anxious feelings. There is a natural feedback loop that occurs between fear and anxiety. A shock in the moment creates an impression, one that we don't want to experience again, so we worry, and spend time planning to avoid an imagined unpleasant future event. If we spend a lot of time ruminating on fearful experiences our general levels of anxiety may creep upwards. Sometimes fearful thoughts become intrusive and can invade our experience seemingly out of our control. Anxiety driven by rumination and fearful experiences can turn into a painful vicious cycle that takes on a life of its own.

There is a part of our thinking that we can direct, and there is another part that seems to arise on its own. Even those of us who struggle with mental health issues have a strong measure of control over most of our own thoughts. We can plan, decide, make choices, and solve complex problems with varying degrees of effort. In contrast, some ideas arise spontaneously without our bidding; dreams, imagination and inspiration all fall into this category and are positive examples of spontaneous thoughts. The same sort of processes may also be at work with our fears. Some fears are rational and based on deduction and reason. While its troublesome to pay my taxes I know that I should because the consequences of not doing so can be unpleasant, and essentially, I fear those consequences. I don't do my taxes for love of the government, but more for fear of what will happen if I don't. I also have irrational fears, for example, when the phone rings my first instinct is to not answer it because I imagine that whoever is calling wants something from me and is going to make accusations and burn up a lot of my patience and time.

How is it that our thought processes become split? Do only some people feel this way? How can we be in conflict with ourselves? Joseph E. LeDoux described a fear response that is based on two pathways within the brain. LeDoux is an American neuroscientist whose research is primarily focused on the biological underpinnings of emotion and memory, especially brain mechanisms related to fear and anxiety. LeDoux studied fear using a simple behavioral model based on Pavlovian fear conditioning in rodents. This procedure allowed him to follow the flow of information resulting from a stimulus through the brain as it comes to control behavioral responses by way of sensory pathways. LeDoux identified two sensory roads to the amygdala (the memory and emotional center), with the “low road” being a quick and dirty subcortical pathway for rapid activation of behavioral responses to threats and the “high road” providing slower but highly processed cortical information. His work has shed light on how the brain detects and responds to threats, and how memories about such experiences are formed and stored through cellular, synaptic and molecular changes in the amygdala. LeDoux’s work on the amygdala's processing of threats has helped us to understand exaggerated responses characterized by anxiety disorders in humans. Studies in the 1990s showed that the medial prefrontal cortex (rational thinking part of the brain) is able to stop the threat response and paved the way for understanding how exposure therapy reduces threat reactions in people with anxiety by way of interactions between the medial prefrontal cortex and the amygdala.

LeDoux Fear Response From "Abnormal Psychology" by W.J. Ray

The LeDoux fear response is made up of two pathways for the processing of fear. One pathway is fast and outside of awareness, while the other is slower and has a conscious component. In the previous figure, visual stiumuli (a snake) are first processed by the thalamus which passes rough, almost archetypal information directly to the amygdala. This quick transmission allows the brain to respond to the possible danger by raising the respiration and heart rate and creating tension in the muscles so we are ready to act. Meanwhile the visual cortex also receives information from the thalamus and, with more perceptual sophistication and more time our mind can process the actual threat level and develop a clearer understanding of what is going on. This allows us to either dismiss the stimulus as not a real threat, or we can develop a plan of action more sophisticated than jumping out of danger's path. We have a sense of conscious control over this second pathway, and while our "jump" response may have already been triggered, with some thought we can choose a more comprehensive sequence of steps to deal with the situation.

While our initial reaction may be incorrect, there is an evolutionary advantage to being prepared for danger as soon as possible. We always have the second opportunity to consider in more detail whether the threat is actual or not. However, for some of us our initial response has become too sensitive. We feel always on alert, and we have begun to believe our intuitive response and accept it without considering it carefully. If we always believe this initial response we aren't using our rational facilities to reconsider what is going on and we are only seeing a portion of the picture. Can we then simply anticipate this response and crush down our irrational or instinctive nature? Given the absence of conscious control over this process the answer is no. Our initial response is determined by past experience, instinct, and other difficult to control aspects of our mind. So what can we do?

In the chapter titled "Intuitive Versus Discursive Thought in Temper" from MHTWT Abraham describes a dual response and argues that we have very little control over the initial response, but we need to be aware that we can exert a measure of control over the secondary response and that it is in this secondary response where we have the opportunity to change our experience.

 E: ... a temperamental outburst runs in stages. First, you explode and go into a rage. In a given instance, you may rave on for two or five minutes. During this time you are "out of your senses" and will not be likely to exercise a great deal of thought. You will certainly not stop to consult your memory recalling what I told you about control of temper. So I take it that during this initial stage of your explosion you will not think of the instruction I gave you. You will simply rave on until your anger will subside. I shall call this initial stage of your temper the "immediate effect of the temper outburst." I hope you realize that when I want you to practice avoiding intuitive conclusions, I do not ask you to do that during this stage of the immediate effect. But after the immediate effect is over, you enter a "cooling off" process which may last some ten or fifteen minutes. This is the temperamental after-effect. Once the after-effect sets in you begin to think, perhaps not very clearly, but sufficiently so to be able to remember what I told you. Whatever thinking you do during the immediate effect is intuitive, vague and dim. But in the after-effect your thought becomes discursive again. You can then reflect and meditate. The question is whether your type of reflection will be rational or emotional. If it is emotional you will continue to fume, will brood over the outrage of which you were the "innocent victim." Burning with righteous indignation, you will justify the explosion which you released during the immediate effect and will give it your endorsement. Once you endorse your outburst as justified, you are primed for another explosion; you fairly itch to pay that fellow back" and thus keep your temper boiling in anticipation of another bout. This is the last stage of the uncontrolled temperamental cycle which we shall call the stage of anticipation. It is called the stage of anticipation because in this third phase of the temper outburst you anticipate a renewed squabble in which you expect to come out on top. You anticipate a victory which will wipe out the "disgrace" of the present defeat. You will understand now that the so called temperamental cycle if left to itself without an attempt to control it consists of three discrete stages; (1) the immediate effect, (2) the after-effect, (3) the anticipation of a renewed outburst. Can you tell me now which stage of this cycle you must make use of for the purpose of remembering what I told you in matters of control?

P: You said it can't be done in the immediate effect. So I think it will have to be done after that.

E: That's correct. You will have to make use of the aftereffect. Of course, I do not expect you to succeed the first time, nor do I expect full success the fourth, fifth and sixth time. Instead, I presume you will become emotional in the first few beginnings of your practice and your after-effects will be spent in spells of fussing and fretting, with the result that the temperamental cycle will be run unchecked through its immediate effect, after-effect and the anticipation of the next temperamental "comeback." I hope, however, that after repeated practice you will finally manage to stop short at the end of the immediate effect and that henceforth the after-effect will be given over to a sane, rational appraisal of the situation in which you will refrain from endorsing your explosion, thus avoiding the anticipation of and preparation for the next outburst. This will come to pass if, after a few initial failures, you will not permit yourself to be discouraged and will continue practicing with solid determination. You will do that if you have the genuine will to remedy and check your temperamental habits.

I found reading about LeDoux's investigation in to the dual pathway to be quite interesting. Abraham Low's description of the stages of a temperamental response to a situation is mirrored by LeDoux's experimental biology. Learning to manage your feelings isn't necessarily about gaining complete control over them, or having the ability to squash unpleasant feelings whenever they arise. Within our brains the biology dictates that a portion of our emotional response will be instantaneous and automatic, so we will never be able to fully control every thought that we have. The goal is to recognize that while we can't control this immediate reaction, we can recognize it, and we don't need to let this intuitive response dictate our whole response.

In Recovery meetings we always acknowledge that you are "entitled to your initial response", we recognize that for everyone the immediate onset of a conflict, surprise, or upsetting situation is intuitive and outside of our rational control. All we need to do is observe the reaction and be aware of it and accept that while it may be reasonable there is also a good chance that it may not be reasonable. After the initial response you have the chance to work on it and this is the point where we can apply tools. In meetings participants practice this exercise by describing in a concisely reported fashion, first their initial response to a difficult situation, then their conscious efforts to understand and manage their responses. This formula allows us to learn new automatic responses over time, we effectively are changing our past conditioning. After successive attempts to understand our initial response and decide which parts must be addressed and which parts must be ignored we can reduce our tendency to see troubling situations as emergencies, and we can take the time to accept and understand our own reactions as average.


More Information

The Physical Response to a Fight or Flight Impulse

The Biology of Depressions Vicious Cycle

Feelings are Not Facts

Emotional Intelligence and Sales Resistance

"Emotional Intelligence" is a term that seems to define itself, and without thinking too hard about it we have a sense of what it probably means. We've all known individuals who are cool under pressure, tend to understand us, don't fly off the handle easily and are approachable, reasonable and expressive. We think of them as warm and being together, working well with others, and able to lead, follow, or compromise in all sorts of difficult interpersonal situations. There is a 2009 book Emotional Intelligence 2.0, written by Travis Bradberry and Jean Greaves, which provides a detailed definition of the term, and backs up most of its claims by pointing to an Internet EQ test (Emotional intelligence Quotient self-assessment test). Once you purchase their book you can learn your own EQ score by taking the test and find areas to focus on improving. This test has been taken by hundreds of thousands of individuals and the aggregated results, according to the authors, have provided enormous insights into the usefulness of working on improving your EQ. In the first chapter the authors write:

People who develop their EQ tend to be successful on the job because the two go hand in hand. Naturally, people with high EQs make more money--an average of $29,000 more per year than people with low EQs. The link between EQ and earnings is so direct that every increase in EQ adds $1,300 to an annual salary. These findings hold true for people in all industries, at all levels, in every region of the world. We haven't yet been able to find a job in which performance and pay aren't tied closely to EQ. In order to be successful and fulfilled nowadays, you must learn to maximize your EQ skills, for those who employ a unique blend of reason and feeling achieve the greatest results. The remainder of this book will show you how to make this happen.

The preceding description leaves me feeling, hopeful- that my high EQ score will translate into 10s of thousands of dollars of extra pay per year. It also leaves me feeling a little suspicious because this pitch really sounds like a make-money-fast advertisement. This book is primarily addressed to managers who want to improve their own performance and that of their work groups. I spent a number of years working for a junior corporate manager who talked about "passion" for software development, the importance of developing my own "personal-brand" and of being ready for "change". This kind of talk often comes across as being not entirely sincere whenever I encounter it these days.

It was this sort of talk about "readiness-for-change" that preceded the downsizing of the department that I used to work in. My job, and the jobs of a score of my peers were re-assigning to a team in Asia. Our group had decades of experience working together on the product and by all accounts our software was selling well and making good money for the company.  The company reorganized our division because, well... because they are a big company, and they could and somebody I've never met looked at my pay stub on a spreadsheet and figured they could hire 3 junior developers in another country for what they were paying me, who, despite lacking my years of experience would collectively fix about as many bugs as I was able to fix. That's business. So, this book engages my sales resistance and parts of it trigger my temper because talk of "passionate-synergistic-change" rings hollow for me. But, not to be thwarted by my own biases, and trying to maintain an open mind I forged ahead and read Emotional Intelligence 2.0. Briefly, here are a few of my thoughts:

Many of the ideas in this book are fine and worth thinking about. In the third chapter titled "What Emotional Intelligence Looks Like" the authors write:

The only way to genuinely understand your emotions is to spend enough time thinking through them to figure out where they come from and why they are there. Emotions always serve a purpose. Because they are your reactions to the world around you, emotions always come from somewhere. Many times emotions seem to arise out of thin air, and it's important to understand why something gets a reaction out of you. People who do this can cut to the core of a feeling quickly. Situations that create strong emotions will always require more thought, and these prolonged periods of self-reflections often keep you from doing something that you'll regret.

Self-awareness is not about discovering deep, dark secrets or unconscious motivations, but, rather, it comes from developing a straightforward and honest understanding of what makes you tick. People high in self-awareness are remarkably clear in their understanding of what they do well, what motivates and satisfies them, and which people and situations push their buttons. 

...

The need for self-awareness has never been greater. Guided by the mistaken notion that psychology deals exclusively with pathology, we assume that the only time to learn about ourselves is in the face of crisis. We tend to embrace those things with which we're comfortable, and put the blinders on the moment something makes us uncomfortable. But it's really the whole picture that serves us. The more we understand the beauty and the blemishes, the better we are able to achieve our full potential.

Emotional Intelligence is broken down by the authors into four basic categories: 1) self-awareness, 2) self-management, 3) social-awareness and 4) relationship-management. I found the first section of this book which discusses self-awareness to be the most insightful, although the other sections are also interesting. In particular for each category the book provides a list of practical strategies to work on. The self-awareness strategies discussed in this book are as follows:

1. Quit treating your feelings as Good or Bad

2. Observe the ripple effect from your emotions

3. Lean into your discomfort

4. Feel your emotions physically

5. Know who and what pushes your buttons

6. Watch yourself like a hawk

7. Keep a journal about your emotions

8. Don't be fooled by a bad mood

9. Don't be fooled by a good mood

10. Stop and ask yourself why you do the things you do

11. Visit your values

12. Check yourself

13. Spot your emotions in books, movies, and music

14. Seek Feedback

15. Get to know yourself under stress

Each strategy is presented in a 2-4 page writeup and in my opinion these are all fairly reasonable strategies for improvement. In Recovery meetings we talk very explicitly about several of these principles. We focus on dealing with discomfort, not necessarily assuming that feelings are equivalent to facts, the physicality of emotions, observing our own responses to stressful situations, and learning from these encounters. I also like the notion that EQ isn't necessarily a cure for the mentally ill, but rather something that anyone can learn and practice to improve their lives.

Sales resistance is a natural response that we all have to someone trying to get our attention, especially if their goal is to engage us in some sort of cash deal. It's the bane of the cold call salesman. If you've ever had a job where you went door to door either canvasing for a charity or trying to actually sell a product you will be familiar with the phenomena. People are suspicious of strangers, and rightly so. There are lots of individuals who unscrupulously want to take our money or time in exchange for whatever, not necessarily anything we might want or need. Automatically rejecting a sales call is an average intuitive response and often a very reasonable one. While I appreciated a lot of the ideas in Emotional Intelligence 2.0 it continued to trigger my sales resistance. When taking the EQ test online the experience strongly reminded me of the talks from my past corporate manager and how she use to brag about reading far more than anyone else in the office, and claimed that her broad base of knowledge was part of the reason why she was hired and would be very successful. The books that she read were books just like Emotional Intelligence 2.0. Several of her favorites are listed as recommended reading by Bradberry and Greaves. I also appreciate that many people feel this way when they first hear about Recovery meetings. Indeed, I was quite unsure of what I would encounter at meetings before I attended. I read a lot of the primary Recovery text to try to get a sense of what Recovery meetings would be about before I went. In the preface to MHTWT Abraham Low writes:

Since Recovery places the emphasis on the self-help action of the patients, it must ignore investigations and explorations which are not within the province of inexperienced lay persons. Complexes, childhood memories, dream experiences and subconscious thought play little part in the class interviews conducted by the physician and are entirely eliminated from the self-help effort carried on by the patients. The psychoneurotic individual is considered a person who "for some reason" developed disturbing symptoms leading to ill-controlled behavior. The symptoms are in the nature of threatening sensations, "intolerable" feelings, "uncontrollable" impulses and obsessive "unbearable" thoughts. The very vocabulary with its frenzied emphasis on the "killing" headache, the dizziness that "drives me frantic," the fatigue that "is beyond human endurance" is ominously expressive of defeatism. The first step in the psychotherapeutic management of these "chronic" patients must be to convince them that the sensation can be endured, the impulse controlled, the obsession checked. Unfortunately, the physician is far from convincing. His attempt to "sell" the idea of mental health arouses the "sales resistance" of the patient. "The physician doesn't dare tell me the truth," muses the patient. "It would be against his ethics to declare me incurable." The resistance is easily overcome in the group interview. The fellow sufferer who explains how he "licked" his frightful palpitations after years of invalidism cannot possibly be suspected of trying to sell something. That "colleague" is convincing. He convinces the novice that "chronic" conditions are not hopeless.

For most of the doctors and counselors I've spoken to, and probably every self-help book I've read my sales-resistance has always been strong. Perhaps my initial reaction isn't always entirely rational, but my response to professional advice is that there must be some ulterior motive. I still maintain this perspective to some degree, in my opinion a little suspicion is healthy. I always laugh a little when I read Dr. Low's acknowledgement of this as an average disposition, and I have found that meeting individuals in a peer support setting who describe the benefits that they have attained can be quite convincing. While I think that Emotional Intelligence 2.0 says some interesting things, I'm not entirely convinced by the self-appraisal test that this book is based on.

The EQ 2.0 test is composed of a list of about 30 multiple choice questions that are blunt and completely subjective and answered with a range of "never", "sometimes" and "always". Self-reported measurements, like the EQ test, are susceptible to manipulation. I observed this first hand when taking the EQ test where if I answered "always" and "never" to appropriate questions I was easily able to generate an EQ score of 96/100 which put me in the highest category. To me this test didn't seem very objective or able to filter out my biases about my own ability. This is an issue because of the Dunning Kruger effect, a cognitive bias where people of low ability suffer from illusory superiority, mistakenly assessing their cognitive ability as greater than it is. If I have a low EQ, when asked a question like "Do I understand what others are really thinking?" I might honestly answer always! regardless of whether or not that is actually the case. If you think you have a high EQ you will do well on this test. If you think you have a low EQ you will do poorly. In my opinion you might as well just answer the question- rate yourself between 40 and 100 on your EQ. I took the test twice- first with the idea that I was an average person, but for my second trail I assumed that I was an expert. Some of my scores are reported below:

Wikipedia summarizes a collection of criticisms of Emotional Intelligence. From the Wikipedia page:

Landy distinguishes between the "commercial wing" and "the academic wing" of the EI movement, basing this distinction on the alleged predictive power of EI as seen by the two currents. According to Landy, the former makes expansive claims on the applied value of EI, while the latter is trying to warn users against these claims. As an example, Goleman (1998) asserts that "the most effective leaders are alike in one crucial way: they all have a high degree of what has come to be known as emotional intelligence. ...emotional intelligence is the sine qua non of leadership". In contrast, Mayer (1999) cautions "the popular literature's implication—that highly emotionally intelligent people possess an unqualified advantage in life—appears overly enthusiastic at present and unsubstantiated by reasonable scientific standards." Landy further reinforces this argument by noting that the data upon which these claims are based are held in "proprietary databases", which means they are unavailable to independent researchers for reanalysis, replication, or verification. Thus, the credibility of the findings cannot be substantiated in a scientific way, unless those datasets are made public and available for independent analysis.

Having pointed out these concerns with Emotional Intelligence 2.0, I'm not saying that this book isn't worth reading or that we can't learn better self and social management from the authors. I think we can learn these skills and I think the ideas in the book are good, although not necessarily for the reasons that the authors say that they are good. The "research" described by the authors seems questionable to me at best but that doesn't necessarily mean that all their ideas are wrong. Their motives seem to be fairly plain, they want to sell their Emotional Intelligence training programs to businesses, and present it in the most positive light possible to maximize interest in their product. I don't regret buying their book, they have some good ideas, I'm just pointing out that their approach may not be as shiny as they claim.

If you ever wonder about my motives for writing these blog pages they are also fairly simple: after years of attending Recovery meetings and watching my improvement and the improvement of the other attendees, I really want our group to thrive, and I want other people to have some ideas about what we are doing. I'm not an expert, I don't put my name on this blog, or collect any income from the group. I'm just a regular guy who has attended these meetings for years and found them helpful. In these blog pages I try to connect what we do in meetings with other self-help ideas that you may have heard of so you can make your own decision about whether or not what helped me might help you. I want to see the groups in Hamilton and the surrounding area grow and be well known. We have several good dedicated leaders in the area who provide their time voluntarily, and if you ask them why they continue to run meetings they all say the same thing; they have benefited from the program, they believe in the program, and by hosting meetings they receive support and help from the other members. We recognize that new attendees feel sales resistance, and that is average and okay. We hope that you will give our meetings a chance and find the same benefit from them that we have found.


More Information

The Imposter Syndrome, Competency, Self-Esteem and Rejection

Narcissism Self Esteem and Humility

Games People Play

The Physical Response to a Fight or Flight Impulse

You feel a racing heart, pounding away inside your chest, augmented by tunnel vision, and a mono focus on the details in front of you to the point where you are almost unable to hear any of the sounds in the room. Time slows down. In your mind you see flashes, truncated images, memories of the last time you were stuck in this situation. You imagine ways to escape and also the clearest and most effective attack. You feel a strong impulse to choose one of these options and act on it immediately. These are all classic physical and mental symptoms of a fight or flight response, where your brain increases your heart rate and blood pressure by dumping adrenaline, cortisol, and extra blood sugar into your system so you have the energy to sprint across the savanna (the moor, forest etc.) in response to a threat. The trouble is that you aren't actually being chased by a tiger, pack of wolves, or hoard of angry barbarians, rather you are stuck behind a desk, anticipating what you need to do to prepare yourself before making an unpleasant phone call. Nevertheless the threat seems real- it may be financial, legal, or social, and while real in a certain sense, your mind classifies it as physically dangerous, and your body responds as it is designed to. The physical symptoms that we experience as part of being angry, distressed, upset or afraid are built into our biological systems, and they are not well adapted to all of our actual needs. When faced with a difficult interpersonal conflict what we really need is to be calm, cool and collected, although often this is the opposite of where our mind goes.

In Recovery the first thing we try to recognize are our symptoms when we are confronted with a distressing situation. "Symptoms" is the general umbrella term that we use to describe immediate internally experienced responses to stress. Symptoms fall into two broad categories, the first, and perhaps most troublesome are the body's preparation for conflict, including an increased heart rate, attended shortness of breath, extra perspiration, sometimes on the palms or the face, and general tenseness of the muscles and internal organs. Our thoughts usually race through simple solutions, as our mind tries to come up with an instantaneous reaction so the threat can be dealt with a as quickly as possible. In all of this our prefrontal cortex, or higher reasoning center, is taking a back seat, or if engaged at all, is being driven by our simple fears.

Unless you really are out in the woods being confronted by an angry dog, or wandering down the streets late at night and being threatened by a mugger, what you need most of all is to *not* respond right away. This is difficult and will test your patience and self-control, but there is no easy way to shut down your high alert system once it has been activated. In Recovery we say “There are no uncontrollable impulses, only impulses that we chose to not control”. Our impulses are powerful, but aside from the extremely simple impulses (like inhaling after holding your breath for a minute or more), we can almost always control complex impulses.

In the Chapter “Symptoms Must Be Attacked Where they are Weakest” from MHTWT Abraham Low summarizes Roy’s symptoms:

Roy was 35 years of age when he was first seen in the physician's office. He was married, had two children, loved his home and was well liked by friends and neighbors. His employment record was good. He had held his present position for fifteen consecutive years advancing to the rank of a foreman. All in all he had done well until three years ago when suddenly, "out of a blue sky," his right arm and right leg went numb. The numbness had come on at the moment when he entered the plant to start on the afternoon shift. It disappeared as fast as it had come lasting a few minutes only. But Roy was frightened into a senseless fear that he was headed for a stroke. Ordinarily stolid and unemotional, he was now pale, trembling, restless. His fellow workers noticed the change and drove him home. The family physician ordered Roy to stay home for a week and to rest. The following week an electrocardiogram was taken and the doctor was heard to say that something in the graph was "flat instead of round." After that Roy developed violent palpitations, headaches, dizziness, fatigue, air-hunger, difficulty of sleeping, fears of physical collapse and mental breakdown. He saw specks floating in front of his eyes and once "nearly went blind" for a couple of minutes. Some of his sensations were bizarre and intensified his fear of a mental breakdown. Looking at his hands he saw them in a yellow tinge. He felt pains which settled in narrowly confined places, in the left wrist or in the space above the right knee. His teeth began to hurt. There was a pain around the heart. He lifted his little son and instantly felt a pain around his right ear. He lay on the left side and something clicked in the right flank. The fingers of the right hand might hurt and suddenly the pain shifted to the back of the head. He felt pressure of the throat, had night sweats which roused the fear of tuberculosis, pain in the chest, difficulty of sleeping, trouble in concentration and "confusion all the time."

Fight or Flight

https://en.wikipedia.org/wiki/Fight-or-flight_response

Roy is experiencing a fight-or-flight response. His mind senses danger in his day-to-day activities, and his body is preparing itself for a conflict, the trouble is that he doesn’t understand his physical response, and the feeling of being constantly on high alert is keeping him on high alert. Paradoxically, the threat that his mind perceives is his body’s preparedness for that threat, and so he is caught in a complex vicious cycle and he is quickly burning through real physical resources.

The fight-or-flight response (also called hyperarousal, or the acute stress response) is a physiological reaction that occurs in response to a perceived harmful event, attack, or threat to survival. It was first described by Walter Bradford Cannon in 1932. His theory states that animals react to threats with a general discharge of the sympathetic nervous system, preparing the animal for fighting or fleeing. More specifically, the adrenal medulla produces a hormonal cascade that results in the secretion of catecholamines, especially norepinephrine and epinephrine (adrenaline). The hormones estrogen, testosterone, and cortisol, as well as the neurotransmitters dopamine and serotonin, also affect how organisms react to stress. This response is recognized as the first stage of the general adaptation syndrome that regulates stress responses among vertebrates and other organisms.

Since the original work we have come to see that the stress response is accomplished by a variety of interacting systems that include the amygdala and other cortical systems, which results in the hypothalamus activating the sympathetic nervous system and the HPA axis.

The stress response mechanisms include the Autonomic Nervous System (ANS); a network of hypothalamic, pituitary and adrenal responses; the cardiovascular system; metabolism; and the immune system. The function of these pathways is to prepare the body for action. These pathways move physiological energy resources to the necessary organs and muscles. They create an overall shift from storing energy to using energy. In an emergency, priorities of the body move from flexibility, including past and future considerations, to focus on immediate circumstances. Your body no longer stores energy, pays attention to sexual matters, or has your immune system worry about long-term disease. Your mind focuses on threat-relevant cues and memories which become critical as they relate to the current situation.

The autonomic nervous system (ANS) is a control system that acts largely unconsciously and regulates bodily functions such as the heart rate, digestion, respiratory rate, pupillary response, urination, and sexual arousal. It keeps the heart rate and blood pressure in balance, it coordinates the body’s response to exercise and stress, and it regulates reproduction.

The second pathway is known as the hypothalamic-pituitary-adrenal (HPA) axis. The HPA axis involves cells in the hypothalamus that are released into the bloodstream and go to the pituitary gland. This causes the pituitary to release hormones that influence peripheral organs such as the adrenals as well as cells in the immune system. This system helps to convert stored fats and carbohydrates into energy sources that can be used immediately. The immune system is activated in stressful situations in anticipation of some injury. When our minds are emotionally stressed our bodies respond by expecting to be physically assaulted and are thus prepared to keep infections out of wounds.

These mechanisms are particularly sensitive to changes in the environment, and repeated stressful events can modify their functioning. Stress can influence brain processes by reducing the connections of one neuron with another, especially in the hippocampus and the frontal areas of the brain which coordinate abstract thinking and reasoning. Stress shows the opposite effect in the amygdala with the increase of neuron connections. This in turn leaves the person with more lower brain activity (emotional and impulsive) when responding to fearful situations.

In general, stress reduces our ability to think and plan while increasing our emotional response and preparing our body for action. Our mind is geared to compute life saving responses based on our past history, and rather than thinking carefully and clearly we respond impulsively with simple or obvious reactions. We feel energized because of an increased heart rate, higher blood pressure and elevated blood sugar levels. Our organs feel tense due to the additional blood flow and because of the stress associated with the flood of adrenaline and cortisol. Our whole body is prepared to react quickly and work double or triple time to deal with the threat as soon as possible; perfect for the forest or the battlefield, but not so good for the office, home, or shopping center.

In short bursts this kind of response is natural, and we are designed for it. We get into trouble when our state of anxiety lasts for hours, days, weeks or longer. Then our feeling of being energized turns to exhaustion, the constant tension in our organs, if persistent and chronic, can lead to serious long term disease.

While knowing something about the biology is interesting how does this help us? In Roy’s case, his physical symptoms created a negative and self-reinforcing feedback loop. Understanding that his symptoms are his body's response to his fear or anger and not indicative of anything else can help to allow him to ignore those symptoms and focus on his situation instead. Being aware of his high alert state can also help him to think more clearly by recognizing that he is likely to make an impulsive choice. He should slow down or stop and take a break, and make important decisions when his symptoms are reduced. It is also important to be aware that a high alert state can create a sense of unreality. In Roy's case these physical symptoms are his body's actual response to the stress, fear, anger or upset that he is experiencing; he is not simply imagining spots before his eyes, the dizzyness, fatigue, difficulties with hearing, peculiar sensations and the many other physical symptoms that he reports having are real. While the physical symptoms have a measurable cause, they are also natural and average, and do not indicate that his body is failing immediately, but that it is responding to fear, upset, anger and distress. Ultimately this fearful response is driven by Roy's thoughts, and as he starts to understand this he can change his thoughts, and with effort, he will be able to reduce his physical symptoms.

At Recovery meetings we discuss the physical sensations associated with negative emotions. These bodily responses are our first cue that we are in a precarious position and likely to react in an impulsive way to a situation. These symptoms will come and go if we let them, although if we obsess or worry about the symptoms they will intensify. While we can't immediately banish symptoms, we can recognize them. Physical symptoms of stress are driven by thoughts and ideas, and we do have control over what we think, say and do. While we cannot stop our racing heart, we can recognize when tigers are imaginary, and with this realistic knowledge we can make reasonable choices and with effort our physical symptoms will pass.

More Information

The Biology of Depression's Vicious Cycle

Does Depression have a Physical Cause?

About Recovery Hamilton

The Imposter Syndrome, Competency, Self-Esteem and Rejection

When you apply for a job, enter a contest or a race, or even ask someone on a date, you are making an evaluation of your intelligence, strength, charm and wit, and you are assuming that you have a reasonable chance of success. You are both guessing about the complexity of the challenge, and estimating your ability to meet that challenge. For some, repeated rejections can crush their internal sense of self-worth. We may get tired of trying, and only make efforts which are safe, that we are sure we will succeed at, or we may decide to avoid the activity completely in the future. Avoidance of rejection can become a way of life, and this can be crippling. For those who ignore feedback or simply don’t get feedback they may perform endlessly without improvement, believing that their talents are unmatched, and either torturing or alienating those around them.

In The Narcissism Epidemic the third chapter challenges several myth’s about the narcissist, specifically the idea that some narcissism is good. Twenge and Campbell write:

Our culture tells us it pays to believe in yourself as long as you aren't arrogant or narcissistic. However, this isn't really true [...]. A major review of the research on self-esteem and achievement found that high self-esteem does not cause better grades, test scores, or job performance. It's a problem of correlation not equaling causation. There is a small correlation between self-esteem and better achievement, but it is almost entirely explained by better performance causing higher self-esteem. Self-esteem comes after success, not before, because self-esteem is based on success (whether that's academic success or simply being a good friend to someone). Much of the rest of the already small link is due to confounding variables- rich kids, for example, have higher self-esteem and make better grades. Some children with low self-esteem do poorly, but it's because they were abused or had parents who did drugs- things that cause both low self-esteem and poor outcomes. On its own, self-esteem does not lead to success.

Think about it this way: if self-admiration caused success, American children, who have the highest self-esteem of children anywhere in the world, would also be the most successful. This simple prediction, however, doesn't match the data. In a recent study, 39% of American eighth-graders were confident of their math skills, compared to only 6% of Korean eighth-graders. The Koreans, however, far exceeded the U.S. students' actual performance on math tests. We're not number one, but we're number one in thinking we are number one.

Wikipedia describes the Dunning–Kruger effect as a cognitive bias where people of low ability suffer from illusory superiority, mistakenly assessing their cognitive ability as greater than it is. The cognitive bias of illusory superiority derives from the metacognitive inability of low-ability persons to recognize their own ineptitude; without the self-awareness of metacognition, low-ability people cannot objectively evaluate their actual competence or incompetence. This isn't necessarily a problem of an overactive ego, or excessively high self-esteem, but rather it is our own inability to estimate how good we are at doing things that creates the problem.



There is a good video on YouTube titled: Why incompetent people think they're amazing. It describes several studies, one done at two separate computer companies where the programmers were asked to provide a rating for their own performance. At the first company 32% rated themselves among the top 5%, while at the second company over 60% of the programmers rated themselves in the top 5%. In another study 88% of American drivers described themselves as above average and more competent behind the wheel than most others. This same effect, where individuals overestimate their ability can be demonstrated for all sorts of skills, activities, and attributes. The vast majority of people simply believe that they are above average at most things. Numbers like these violate the simple law of averages which states that the odds of you being a little worse than average at some task are about equal to the odds that you are better than average at some other task. Those with the least ability are most likely to overrate themselves by the highest degree. Poor performers lack the very expertise needed to understand the problems with what they are doing.

People are exceptionally bad at estimating how good they are at something, and not only does this apply to the incompetent who wildly overestimate their abilities, but it also applies to experts who tend to do the opposite and underrate their abilities.

Graduate students, professors, and other high achievers often suffer from a phenomena called the imposter syndrome. Wikipedia provides a good overview:

Individuals who suffer from the impostor syndrome have a marked inability to internalize their accomplishments and a persistent fear of being exposed as a "fraud". The term was coined in 1978 by clinical psychologists Pauline R. Clance and Suzanne A. Imes. Despite external evidence of their competence, those exhibiting the syndrome remain convinced that they are frauds and do not deserve the success they have achieved. Proof of success is dismissed as luck, timing, or as a result of deceiving others into thinking they are more intelligent and competent than they believe themselves to be.

[Several behaviours are common to those that suffer from imposter syndrome]:

Diligence: Gifted people often work hard in order to prevent people from discovering that they are "impostors". This hard work often leads to more praise and success, which perpetuates the impostor feelings and fears of being "found out". The "impostor" person may feel they need to work two or three times as hard, so over-prepare, tinker and obsess over details. This can lead to burn-out and sleep deprivation.

Feeling of being phony: Those with impostor feelings often attempt to give supervisors and professors the answers that they believe they want, which often leads to an increase in feeling like they are "being a fake". If shown evidence of their competence or that they may suffer from a case of impostor syndrome, they tend to doubt themselves even more.

Avoiding display of confidence: Another way that a person can perpetuate their impostor feelings is to avoid showing any confidence in their abilities. A person dealing with impostor feelings may believe that if they actually believe in their intelligence and abilities they may be rejected by others. Therefore, they may convince themselves that they are not intelligent or do not deserve success to avoid this.

As described by social psychologists David Dunning and Justin Kruger, the cognitive bias of illusory superiority results from an internal illusion in people of low ability and from an external misperception in people of high ability; that is, "the miscalibration of the incompetent stems from an error about the self, whereas the miscalibration of the highly competent stems from an error about others." Hence, a corollary to the Dunning–Kruger effect is that persons of high ability tend to underestimate their relative competence and erroneously presume that tasks that are easy for them to perform are also easy for other people to perform.

While the imposter syndrome is not described in the standard manual of psychiatric disorders (DSM-IV or DSM-5), it is a risky state of mind. Underrating your physical abilities might deter you from joining an exercise group which would otherwise welcome a new member, and this might represent a missed opportunity for socialization. Such decisions, while not catastrophic, are unfortunate. Genuine mental health issues often result from similar distorted perceptions of reality, and these can take many forms. In extreme cases, a person may begin to doubt their competency at relatively basic tasks. When feelings of incompetency and being an imposter make their way into your day-to-day life, like being unable to ride the bus because you believe you won’t understand the route or the schedule, or feeling rejected by others in simple situations like going to a grocery store or a bank, then a false self-evaluation can wreck real havoc in your life.

In MHTWT there is a chapter titled: “The Passion for Self-Distrust”, Low writes:

My patients have gone through months or years of torture and in the process developed sustained tenseness and symptoms attending it. Their weariness, their pains, fatigues, pressures and spasms have made them self-conscious in the extreme. Hence, they lack the feeling of vitality and accomplishment; they have lost their self-confidence, are unable to relax or enjoy things. Required to formulate plans and intentions they are instantly gripped with the fear that their muscles will fail them, that they will not be ready to carry out what they are asked to do. Being the victims of an unrelenting self-consciousness they question their capacities, watch and check every one of their moves and perform with hesitation and anxiety. Their attitude is that of an abiding pessimism; they feel whipped and defeated; their guiding philosophy of defeatism has hardened into a settled conviction. They are "sure" and "certain" and "positive” that acting is impossible, that their muscles will defy orders, that their power to get things done is lost, that their personality functions are doomed. Their philosophy of "I can't" has assumed the status of a dogma; it is implicitly believed, hotly defended and fondly sheltered. The calamity is that the relatives and friends do not share the patient's defeatism and refuse to subscribe to the cult of "I can't." They look at the sufferer and notice a blooming complexion, a strong voice, a lively facial expression. They observe the patient in a fit of his frequent tantrums and witness a display of force and energy which belies the claim to invalidism. Their conclusion is that the patient could but would not do the things which are to be done. The idea is forced on them that he is unwilling instead of unable to perform his function. They upbraid him, urge him to make an honest effort and with this they accuse him of shamming disease, of playing a game, of practicing deception. They indict his character, his honesty; they charge him with deliberate neglect of duties and obligations and fasten the label of irresponsibility on him. This strikes at the root of his self-respect, of his personal value and social position. This savage assault must be repelled. The patient feels he must bend every ounce of his energy to the vital task of convincing the others that he "really" can't, that he is "truly" incapable of acting, that he is "positively" helpless. The patient is now a crusader for the philosophy of "I can't." He concentrates on the effort to win over the others to his dogma of defeatism, to make converts, to spread the gospel of his incurability. In order to convince those about him, including the physician, he must engage in a veritable campaign of complaining, wailing, lamenting. In his interminable moaning and groaning he is compelled to overemphasize the utter unreliability of his organs and functions. His body is forever about to crumble, his mind is constantly ready to disintegrate. As he continues on this career of self-denunciation he fairly gorges himself with the idea of distrust and in the end develops the PASSION FOR SELF-DISTRUST. His untiring crusading for the philosophy of "I can't" has netted him one faithful and unswerving convert: himself.

Rather than thinking about this information in the context of judging or criticising someone you know who claims that they are either awesome or incompetent, when you are sure that they are perfectly average and neither an expert nor a total failure, it’s more valuable to apply this information to yourself. In Recovery we say “Expectations can lead to disappointments”, and while it’s true that when you apply for a job (ask someone on a date, enter a marathon race etc.), you have a certain expectation that you are probably qualified and might get what you are hoping for, it is important to remain less focused on the outcome and more focused on putting in a good effort. Keep in mind that you will probably not have a good understanding of exactly what the other person is looking for, or who you are competing against, and that you may misjudge your own abilities. This confusion is average. It is average for people to need to experiment to understand their own abilities, and it is average to never get a full picture of how you rate against everyone else. In Recovery we say “Mistakes are healthy, wholesome and necessary” and that without mistakes we can’t learn.

Having unrealistic expectations for yourself and others is a cognitive distortion that can lead you into serious trouble. Asking for feedback from someone you respect and trust, and learning to seriously listen and accept the advice that they offer, regardless of how difficult it is to hear, can go a long way towards helping you to understand your own abilities. Recognizing your mistakes and removing your expectations about the outcomes that a task might have can provide you with a tool that will ultimately make you feel better about your progress, and help to improve the progress that you do make. At Recovery meetings we don’t assess, criticize or evaluate members, instead we try to help attendees build skills that will allow them to be self-critical in a realistic way, without being self-congratulatory or self-condemning. We discuss being average, reducing or eliminating our expectations, and being tolerant of our own mistakes and the mistakes made by others. It's hard to know what you can or can't do without trying, and when we try new things we risk failure and rejection. While this is difficult, it is an important path towards mental health. We encourage you to come and meet us. All of our members were new at one time, we understand how difficult it can be to be the new person at a meeting.


More Information

About Recovery Hamilton

Narcissism, Self-Esteem and Humility

Sarcasm, Humour and Ambiguity

Diagnoses, Labels and Sensitivities

The list of labels available to those seeking a diagnosis can be long. Depression, anxiety and being stressed are common terms that many people feeling unwell use to describe their own state of mind. Generalized anxiety disorder, bipolar 1 and bipolar 2, manic depression, dysthymia, cyclothymia, major depressive disorders, obsessive compulsive disorder, or persistent depressive mood disorder are more complex diagnoses that might be provided by a psychiatrist. Schizophrenia, multiple or split personality disorder, dissociative identity disorder, and borderline personality disorder are diagnoses which many people confuse and think are related, although have very distinct symptoms. Fibromyalgia, post traumatic stress disorder, chronic or persistent pain, autism spectrum disorder, panic disorder, and misophonia are other labels which many people are aware of. Given all of these terms and specific disorders, how is one to proceed?

A diagnosis is helpful if there are clear and well known cures for an ailment, and this is the case with some physical diseases. The flue and a broken arm are easily differentiated by a layperson and knowing exactly what is wrong with you in cut-and-dry cases like these will facilitate a good recommendation from a doctor; a plaster cast for the broken bone, rest and fluids for the flue. Psychiatric illnesses are sometimes well defined, although even common varieties like depression may not be obvious to an individual when they first encounter the symptoms.

The psychiatrist I saw in the late 1990s agreed with my report that I was depressed, and at one point during the time that I saw him he suggested that a diagnosis of cyclothymia might be more accurate, but he didn't lean on this idea too much. At the time I was pleased to have this better and more precise diagnosis- to me it meant that I had something unusual wrong with me, not just garden variety depression! My psychiatrist didn't make much of this idea and as I recall he only commented on it once or twice which I think was ultimately helpful. The precise label that was applied to what was going on in my life wasn't nearly so much an issue as the symptoms that I had, and this is what we worked on.

There is an unusual 1995 film called "Safe" starring Julianne Moore. Julianne Moore plays Carol White an unremarkable suburban homemaker living in the San Fernando Valley. She lives in a lavish pastel home and spends her time decorating the house with the assistance of a Spanish speaking house keeper named Fulvia and the various hired workman who paint, deliver furniture and assist her. She goes to aerobics classes. She meets her friends for lunch and discusses bland topics with them like the new fruit diet that she tries briefly, and the fact that she seems to not sweat during exercise. In the first part of the film she feels "unwell", and after having several fainting spells, and vomiting in unusual scenarios, often after exposure to cosmetics or car fumes, she decides to seek treatment. She goes to see her doctor who can find nothing wrong with her, and after several visits he refers her to a psychiatrist.

Carol doesn't feel comfortable talking to the psychiatrist, and eventually sees an allergist who confirms that she does have reactions to certain substances that seem to be responsible for her attacks. Carol finds a flyer at her gym that asks the question "Do you smell FUMES?" and after attending a seminar she decides that the best explanation is that she is suffering from "environmental illness". At the mid point in this story it turns very dark. Carol stops wearing makeup, gives up her fashionable skirts for loose track pants and sweaters, and struggles with her relationships. As she begins to look more unhealthy and bedraggled she starts to carry a small green oxygen tank and mask with her so she can breath easily. She rejects her affluent chemical based lifestyle and sets up a toxin free room in her home completed by simple wood furniture upholstered with non-toxic white cotton materials. Eventually she decides that the chemical free room in her house in the valley is not pure enough and she leaves her husband and step son to go stay at a desert retreat for people with environmental illnesses called the Renwood center.

Every time I watch this film I have a number of strong reactions to it. What makes this film so difficult to watch isn't a the cool relationship between Carol and her distant generic businessman husband Greg, or the depiction of the peculiar illness that Carol has or the presentation of environmental issues. What is unpleasant about this film is Carol's conduct and values. She is dull, disengaged, mono-syllabic and stilted in the way she expresses herself. Initially she seems entitled, unaware of her privilege and easily upset- one of her major crises at the beginning of the film is an argument between herself and a furniture store clerk about the color of the couch that was delivered to her house. The clerk shows her the original order and points out that it specifies a black couch, she plaintively whines that this is "...impossible because black doesn't go with anything we have". This quick sketch of superficiality and poor interpersonal skills in many ways defines who Carol is.

While the film presents seriously the idea that living in a chemically laden environment is unhealthy, and seems to convince us that this is a large part of Carol's problem, environmental illness is not the core theme of this film, rather it just provides a backdrop and is what frightens and drives Carol. Carol's confusion, lack of depth and poor choices are at the heart of this story. While watching Carol deteriorate is difficult, its how this film makes me feel about Carol when I watch it that makes my skin crawl. I always find Carol's demise both terrifying and pathetic at the same time. Julianne Moore's outstanding portrayal of Carol leaves me feeling repulsed by her lack of sincere and meaningful values, judgmental about her inability to acknowledge those around her and feeling sympathy for the predicament and illness that her vacuous life has resulted in.

No one in this story seems to genuinely care about Carol. Her husband, doctors, psychiatrists, friends, and even the people at the retreat are dismissive with her and speak to her with either shallow reassurances, or condescending indifference. Ultimately what is frightening about Carol's illness is imagining ourselves in that position, a person suffering from a vague and undiagnosable disease, who generates little sympathy from her family and friends and is largely ignored by those around her.

She connects briefly with a group of patients at the retreat who make her a cake for her birthday and ask her for a speech, she says:

"I couldn't have done it without you... I don't know what I'm saying, its just that I really hated myself before I came here, and ... um, so I'm trying to see myself hopefully ... um, more as I am, more ... um, more positive, like seeing the pluses, like I think its slowly opening up now people's minds like ... um educating and ... and AIDS and other types of diseases ... 'cause ... 'cause, and it is a disease 'cause its out there and we just have to be more aware of it ... um make people aware of it, even ourselves like and going ... reading labels and going into buildings ..."

This film doesn't provide a standard narrative of illness, where we might expect the protagonist to die, leaving friends to mourn or revile their passing, or gets better and rediscovers life and possibly is forced to atone for past misdeeds. Instead this film simply doesn't give a lot of answers. One interpretation is that Carol is cursed with an undiagnosable illnesses that isn't resolved as the price for failing to find solid values in her life, but I think this may be highlighting the wrong message from the story. It may be simpler than this; that toxins and meaninglessness are part of American affluence and can happen together, that medicine doesn't have all the answers, that there are many individuals who are chronically unwell and don't have accepted explanations for what is wrong with them. While the Renwood retreat offers Carol some support the cure provided there doesn't seem effective as Carol's condition deteriorates up until the end of the last scene of the film. Ultimately Carol is isolated and unwell at the Renwood retreat living in a tiny igloo-shaped porcelain lined environmentally-pure safe-house. The thin meaning that Carol finds in learning about the toxins of modern living and how to minimize the impact of those poisons is not enough to cure her physically or spiritually.

I've watched this film many times over the years. The first time I saw it I hated it, but I remembered every detail. I've come back and watched it several times since then, I think partly because I struggle to understand it. "Safe" is an eloquently painted train wreck, a modern fairy tail of the most hideous kind. It isn't a psychological thriller or horror film in the standard sense, its a tragedy of a person consumed by a vague and undefined illness, for whom grasping at a diagnosis doesn't lead to a cure, and who doesn't get better. "Safe" is a compelling film because it plays on common, but often unacknowledged fears; a vague malaise, odd labels, whether others see us as inventing and diagnosing our own problems, the coldness of modern medicine, and whether unconventional group therapies can have any effect, or provide a refuge for an empty life.

While there are truths embedded in this film, Carol's story is not an average one. One of the key truths is that illnesses are often mysterious, and treating a diagnosis as a definition of who you are is not helpful. Carol's trajectory from meaningless affluence to commune therapy based isolation is something that we fear, but not something that frequently happens.

At Recovery meetings we follow a simple recipe for change through Cognitive Behavioral Therapy. The methods we employ are well documented, and there are numerous scientific studies that attest to their effectiveness. We don't try to diagnose what is wrong with those who attend, and we don't discuss psychiatric conditions in any depth. We accept that people struggle with fear, anger and other complex negative feelings and we provide simple recipes for dealing with these issues. We strongly recommend that attendees have a doctor evaluate any physical symptoms that they have to rule out physical conditions. We understand that many attendees have met with a psychiatrist or a therapist and may have been given a specific diagnosis, although we don't delve into these details. We acknowledge that nervous persons are afraid of being permanently handicapped, and afraid of set-backs. While these fears may be real and common, they are only based in partial truths. Depression is the common cold of mental illness, and while difficult, destructive and hard to understand, it is something that people recover from.


More Information

The Biology of Depression's Vicious Cycle

Mental Health Myths, Inkblot Tests and Electroshock Therapy

Fear is the Mind Killer

Narcissism, Self-Esteem and Humility

A 2008 New York Times article states that narcissism has become the go-to diagnosis for "... columnists, bloggers, and television psychologists. We love to label the offensive behaviour of others to separate them from us. 'Narcissist' is among our current favourites." While 'Narcissist' may be a pointed and popular label, it is also a real category of psychological dysfunction. Understanding the narcissist can help us to recognize this difficult trait in others, and more importantly this same understanding can help us to recognize problematic issues in our own behavior that we can work on changing.

The film "Wall Street" provides an archetypal portrayal of 1980s excess and narcissism. Michael Douglas plays the role of Gordon Gekko a wealthy and unscrupulous corporate raider. Gekko is suave, charming, powerful, and seemingly an expert at making money by working the stock market. The idea that self-fulfillment at all costs is a reasonable value and a higher truth- is what many remember this film for. While the film focuses on the conflict between Gordon Gekko and Bud Fox (played by Charlie Sheen), a junior stock broker that Gekko works with and who ultimately betrays Gekko to the authorities for insider trading, the most frequently quoted line from this film are the first words from a speech given by Gekko where he declares that "Greed is Good." Gekko is the classical embodiment of the narcissist; vain, self-assured, charming, aloof and disinterested in the plight of others. Characters like this force us to pause and ask the question; is there value in greed? Is Gordon Gekko right in some sense?

Narcissism has become a popular buzzword used to explain the behavior and apparent success of individuals ranging from Donald Trump, through the late Steve Jobs and the infamous Paris Hilton. As a label it is often used as shorthand for "self-absorbed jerk". From a psychological perspective Narcissistic Personality Disorder is a codified set of behaviours that often present together and can create havoc for both the narcissist and those around them. There is an excellent book called "The Narcissism Epidemic: Living in the Age of Entitlement", written by Jean Twenge and Keith Campbell that investigates narcissism, how it originates in our culture, the impacts of this disposition, and what we can do about it.

According to Twenge and Campbell narcissists are not just confident, they are overconfident, and- unlike most people high in self-esteem- they place little value on emotionally close relationships. Their belief in their superior attractiveness, competency, and intelligence is usually not based in reality but nevertheless is their driving force and both defines their motivations and the rewards that they seek. Maintaining the fantasy of their inflated self-importance is expensive, and the narcissist will happily destroy others or themselves in the maintenance of their narcissistic supply, or those people and activities that reinforce their unrealistic ideas of self. Twenge and Campbell write:

Understanding the narcissism epidemic is important because its long-term consequences are destructive to society. American culture's focus on self-admiration has caused a flight from reality to the land of grandiose fantasy. We have phony rich people (with interest-only mortgages and piles of debt), phony beauty (with plastic surgery and cosmetic procedures), phony athletes (with performance-enhancing drugs), phony celebrities (via reality TV and YouTube), phony genius students (with grade inflations), a phony national economy (with $11 trillion of government debt [USA in 2008], phony feelings of being special among children (with parenting and eduction focused on self-esteem), and phony friends (with the social networking explosion). All this fantasy might feel good, but, unfortunately, reality always wins. The mortgage meltdown and the resulting financial crisis are just one demonstration of how inflated desires eventually crash to earth.

...

Narcissism causes almost all of the things that we had hoped high self-esteem would prevent, including aggression, materialism, lack of caring for others, and shallow values. In trying to build a society that celebrates high self-esteem, self-expression, and "loving yourself," we have inadvertently created more narcissists- and a culture that brings out the narcissistic behavior in all of us.

Many believe in the message from Wall Street, that "Greed is Good." This myth is in part what allows narcissists to influence society. They are often promoted within organizations, sometimes because they can perform well in the short run, but often because they seem like a good choice and are able to charm their way to the top. As romantic partners they can seem exciting and interesting, and the collection of traits that they exhibit, even if only indulged in moderately, can seem pleasurable and reasonable when we act them out on a small scale. Twenge and Campbell provide a summary of several myths about narcissists, and include notes on the relevant studies that illustrate their point.

Myth #1: Narcissism is "Really High" Self-Esteem

Narcissists do have high self-esteem, but narcissism and self-esteem differ in an important way. Narcissists think they are smarter, better looking, and more important than others, but not necessarily more moral, more caring, or more compassionate. Narcissists don't brag about how they are the most thoughtful people in the world, but they do like to point out that they are winners. People merely high in self-esteem also have positive views of themselves, but they also see themselves as loving and moral. This is one reason narcissists lack perspective- close relationships keep the ego in check. Narcissists have no interest in caring for others, which is why their self-admiration often spins out of control.


Myth #2: Narcissists are Insecure and Have Low Self-Esteem

Many people believe that narcissists are actually insecure and "hate themselves deep down inside." Their self-importance, this theory goes, is just a cover for their deep-seated doubts about themselves. This idea can be traced back to the speculation that narcissism is a defense against an "empty" or "enraged" self, hidden low self-esteem, or a deep seated sense of shame. The "cover for insecurity" model of narcissism is pervasive in our culture. On TV's ER, a coworker confronts a mean, bitingly sarcastic surgical resident by saying: "What is it about your need to belittle other people? Does insulting someone make you feel like a man, bolster what little self-esteem you're clinging to? I can't even begin to imagine what happened in your life to make you the kind of person that everybody hates." The usually confident surgical resident looks flustered and promptly drops the papers he's carrying, which is TV shorthand for "You're right, you discovered the hidden truth about my poor wasted soul".

While the idea that the narcissist has secret low self-esteem is popular, there is no evidence that the extroverted narcissist is insecure underneath- they like themselves just fine, and even more than the average person. Adults who score high on narcissism tests typically score high on self-esteem tests as well. The most common self-esteem tests include items such as "I feel I am a person of worth, at least on an equal basis with others," and "I feel that I have a number of good qualities." Someone who thought he was entitled to the best will easily agree with these statements. There is a small subset of "vulnerable narcissists" who do have occasional bouts of low self-esteem, but these individuals are rare and don't follow the most common patterns of the narcissist.

Psychological tests can measure self-esteem by asking respondents to pair keys for "me" and "not me" with positive and negative words that flash quickly across a computer screen. These tests are structured to measure response time in fractions of a second, which should reveal unconscious ideas or thoughts that a person is attempting to hide. People with high self-esteem find it easy to associate themselves with positive words like good and wonderful, but react much more slowly when trying to pair "me" with awful and wrong. Tests like these were used to ascertain whether narcissists were just saying that they were great, but secretly did not believe so. Several researchers have used this technique to discover how narcissists actually feel about themselves, and it turns out that narcissists think they're amazing people deep down inside. Their claims that they are awesome aren't just another fluffed up sales pitch; this perspective of personal greatness is one they truly believe.


Myth #3: Narcissists Really are Great/Better-Looking/Smarter

There is very little evidence that narcissists are actually any better on average than non-narcissists. Two studies found that narcissists didn't score any higher on objective IQ tests, and another found no correlation between narcissism and performance on a test of general knowledge. Studies on creativity are mixed, with one finding a positive correlation and another finding no relationship. Narcissists also aren't any better looking: across two studies, strangers who rated head shots found narcissists no more attractive than others, even though the narcissist thought they were better looking than average. Narcissists do know how to pick out a flattering picture of themselves. For example, the pictures that narcissists chose for their personal Web pages were rated as more attractive by observers. Overall narcissists believe that they are smarter and more beautiful than they actually are.


Myth #4: Some Narcissism is Healthy

Is some amount of narcissism healthy? The real question is "Healthy for whom?" Selfishness, for example, might allow you to get a bigger piece of dessert after dinner, but will hurt your longer-term relationships with your companions and might cost you a dinner invitation in the future.

If we are arguing that narcissism is bad, does this mean that belittling or disrespecting yourself is the right choice? The claim that ignoring your self-worth is the alternative to loving yourself is a false dichotomy. A small number of people do hate themselves and could use some self-admiration. However, consider that focusing on the self is only one of many possible routes to self-improvement, and enjoyment of the world. As alternatives consider your relationships with others, your work, or the beauty of the natural world. Think about the deepest joy you experience in life- it doesn't typically come from thinking about how great you are. Instead it comes from connecting with the world and getting away from yourself.

The idea that anti-social behavior is wrong should inform our stance on whether self-admiration is healthy. Narcissism at the expense of one's own performance is also not healthy. Narcissism that helps performance but does not hurt others, such as the confidence you might need before a big public performance, is the healthier aspect of narcissism, although there are probably other ways to get the same result without focusing so much on the self. Narcissism is by definition a focus on the self at the expense of others, and this almost always leads to problems for both the narcissist and everyone around them.


Myth #5: Narcissism is Just Physical Vanity

Although vanity is certainly one of the negative characteristics of the narcissists it is far from the only one. Narcissists are also materialisticly entitled, aggressive when insulted, and uninterested in emotional closeness.


Twenge and Campell reviewed a collection of articles where college students filled out the Narcissistic Personality Inventory between 1979 and 2006. Results from a total of 85 articles aggregated data for 16,000 college students. College students in the 2000s where significantly more narcissistic than Gen Xers and Babyboomers in the 1970s, '80s and '90s. The Baby Boomers, a generation famous for being self-absorbed, were outdone by their children. By 2006, two thirds of college students scored above the scale's original 1979-85 sample average. This represents a 30% increase in just two decades. One out of four recent college students answered the majority of questions in the narcissistic direction. To put this change in perspective it is as though in 20 years the average height of all men went up up by about an inch. You might not notice this immediately when say for example comparing yearbook photographs of a highschool football team from 1985 and 2005, but the measured change is unmistakable and indicates a shift in society for the worse.

Youth have unrealistically high expectations for themselves. In 2000, 50% of highschool students expected to attend law, medical, dental, or graduate school, double the expectations of students in the 1970s. However, the number of people who actually attain these degrees has not changed. In addition, more than two-thirds of high school students now say that they expect to be in the top 20% of performance in their jobs.

Dealing with narcissism in others can be quite difficult. People generally don't change unless they want to, and narcissism is a particularly unpleasant state of mind where a person generally believes that everything about themselves is really quite great. Spending a lot of time thinking about what is wrong with narcissists, or how a particular individual in your life that you believe is a narcissist is a huge pain doesn't help much. In Recovery meetings we don't talk about changing others but instead we talk about changing ourselves. We can look at the narcissist as a catalog of things to not do, and rather than accusing others of being narcissists we should instead ask, which of these behaviours have I allowed into my life, and which ones can I change.

Narcissistic attitudes have the potential to be extremely self destructive, in the chapter from MHTWT titled "Temper and Symptom- Passive Response and Active Reaction", Dr. Low examines (E) Peter (P), a man suffering from a large number of physical symptoms including uncontrollable anger, difficulty swallowing, concentrating, and uncomfortable bouts of belching. What disturbed Peter most was his lack of self-confidence and the inability to check his temper. In this interview Abraham Low is uncharacteristically blunt with Peter, he writes:

E: What seems to trouble you most is the fact that your self-confidence is reduced to a level in which you are no longer as cocky, argumentative, conceited and intellectually snobbish as you used to be. If my sharp wording displeases you I shall remind you of the pertness with which you used to voice your political opinions, the intolerance you used to display in your tiffs with friends, wife and co-workers, of the delight you took in out-arguing anybody who might engage in an exchange of views with you. As I see it, you do not suffer from any lack of self-confidence. You merely resent the fact that your former vanity and inflated sense of importance are now gone. You consider that a loss, thinking you have become a dish rag; I regard it as a gain, thinking you are on the way to develop a measure of humility. What interests me is your failure to curb your temper sufficiently. As long as you continue to indulge your temperamental habits your symptoms will persist. Eliminate your temper and you will do away with your symptoms.

P: I have tried the hardest to get rid of my temper and it seems to me I accomplished a good deal. At home I have few arguments, and in the shop I keep quiet most of the time. But of course I fly off the handle once in a while. And, good Lord, once I let myself go there are the palpitations and the confusion and some air-hunger and belching. Can't I ever be natural and human like others?

E: I am not at all concerned with your being natural and human. My sole objective is to rid you of your symptoms. You seem to think it is your natural and human privilege to exercise your temper. It is just as natural and human to eat steak. But if a man is suffering from a gastric upset he'd better relinquish his "natural and human right" to steak dinners. Are you willing to give up your temper for the sake of your health?

P: I guess I am willing. But this thing's got me licked. I try to be calm and I do pretty well most of the time. But if the boss is unreasonable and rides me the worst way I cannot hold back and tell him where to get off.

E: Give me an example of the manner in which the boss is unreasonable. Tell me what he does to "ride you the worst way."

P: The other day when I came to the shop a tool was missing. I asked the boss whether he had seen it and he said, "You lost it and you will have to find it." That just burned me up. I came back with a saucy remark and he laughed out loud. That dirty laugh made me boil. I let loose and gave him a mouthful. It didn't take a minute and I had my belching and it took me hours to get rid of it.

E: From what I know about you it seems to me that this example is representative. It represents your customary habit of reacting to minor frustrations. You asked a question, and the boss returned a gruff answer. Instantly you became irritated to the point of "burning up." The next link in the chain of events was that you came back with a "saucy" remark. The boss, refusing to become temperamental, laughed and made your blood "boil." The final result was that you belched for hours. You will realize that what "burned" and "boiled" was your temper. You know, however, that temper will neither burn nor boil unless you form the idea that you have been wronged. From this we conclude that prior to releasing your temper you thought or decided that the boss was wrong and you were right. It was this temperamental thought in your brain that touched off the temperamental commotion in your body. This again led to the "saucy" remark and ultimately to the sustained fit of belching. Let me repeat: there was (1) the temperamental thought, (2) the temperamental commotion, (3) the "saucy" remark, (4) the belching. You will understand that the thought "he is wrong and I am right" can be rejected, suppressed or dropped. You will also understand that your "saucy" remark could have been checked. In other words in this fourfold series of incidents, two lent themselves readily for control. You could have rejected the thought of being wronged by the boss and could have prevented your muscles of speech from voicing the "saucy" remark.

When we read this chapter in our most recent meeting people laughed out loud at Low's initial remarks to Peter. This interview is quite unusual for Dr. Low, while often firm in his discussions with his patients he is rarely this direct and harsh. Peter is caught in a difficult place, where the recommended cure is for him to find some humility, and he feels that by being humble he has become a "dishrag".

Peter, in many ways, is suffering from some of the characteristics of the narcissist. He is self absorbed, abusive with his family and with his boss and coworkers, and the suggestion that he should be more patient, less argumentative, and less full-of-himself seems to him to be a terrible idea. Yet Peter's symptoms are extremely severe, the stress that Peter puts himself though by constantly arguing with his boss and his family cause him to belch uncontrollably, resulted in an emergency trip to the hospital after he feared he would physically collapse, and have left him a worried wreck.

Dealing with someone like Peter is exceptionally difficult. In this excerpt where Peter is soliciting Dr. Low's help even Dr. Low seems to feel frustrated as he tries to convince Peter that his troubles are rooted in selfishness. Twenge and Campbell note that narcissists are extremely difficult to change, and rarely do they show up for treatment. Usually what happens instead is those hurt around them are the ones who end up in distress. If you recognize a full blown narcissist in your life the recommendation is to be extremely cautious if you must deal with them, and get away from them if you can. If you recognize these behaviours in your own life these are things that you can and should change. You may feel like Peter, that giving up your old habits is tantamount to becoming a dishrag, however try to recognize this as a growing pain. Change is difficult, and letting go of selfishness is not the same as letting go of self-respect.

When I read The Narcissist Epidemic it made me rethink the notion that self-esteem was extremely important and my lack of it might be the root of my troubles. The conclusion offered by Twenge and Campbell is that while negative perceptions of the self can be a problem in some limited circumstances they are not nearly as problematic as over-confidence, and an unrealistic over-valuation of the self. Humility may seem like an old-fashioned value, and according to the authors of The Narcissism Epidemic it has largely fallen out of favor, but they also present compelling evidence through a broad survey of scientific papers that focusing too much on the self provides no advantage, and if done at the expense of others, can be detrimental.

Recovery meetings are organized not by professionals, but by volunteers experienced in the method. We work together to continue to learn good habits and discuss strategies for managing our fears and anger. One of our basic tools is the reminder to be "Group Minded", or consider the impact of your words and actions on everyone around you. While the narcissist fails to consider anyone but themself, there are also those that fall into the opposite trap, and ignore their own needs and do whatever is asked of them. Striking a balance between your own self-interest and the interests of others is important, and is one of the core values that we discuss at Recovery meetings.


More Information

How to Deal with Difficult People

Sarcasm, Humour and Ambiguity

About Recovery Hamilton