Think Like a Shrink
I have always thought it horribly unfortunate that there is such a tremendous gap between psychiatry and popular culture. Psychiatrists are regularly vilified in entertainment, media, and common thought, and our patients are regularly stigmatized. Indeed, I've yet to see a single movie that accurately portrays what we do. From Silence of the Lambs to The Prince of Tides, we shrinks have a reputation as crazy unbalanced people who can read people's minds. Even the hit comedy The Santa Clause made us out to be bimbos.
To some degree, we've gotten just what we deserve. We've allowed ourselves to become, in the public mind at least, mere pill-pushers and to have our uncommon sense dismissed as having zero significance—when, in fact, it applies to every moment of every person's life. It is our failure to educate our patients and the general public about the deeper principles of human functioning that have left us so isolated from our communities.
Most patients come to psychiatrists because they recognize that, to some degree, their perceptions contain some distortions. These are usually defensive. For example, a 40-year-old woman may begin her first session with a psychiatrist complaining of a "biological depression" and demanding Prozac. By the end of the hour, however, she may acknowledge that her husband's 10-year refusal to have sex may have as much to do with her unhappy mood.
In my practice, I've engaged in a kind of educational psychotherapy, explaining simply to patients what they are doing and why they are doing it. The result has been not only remarkably effective but catalytic in speeding up the process of psychotherapy The same approach can help the general public delve beneath social images and better understand the deeper struggles of the people around them, and of themselves as well.
Ideas and principles can be introduced directly without the jargon psychiatrists normally hide behind in professional discussions. Doing this in a compassionate and empathic way could lead to a broadening of the vocabulary of the general public and bring about a wider acceptance of certain basic psychological truths.
The core of what we do as psychotherapists is strip away people's protective strategies. If you understand these defensive strategies and the core issues people tend to defend themselves against, you can see through people and, to a lesser extent, yourself.
Here, then, are some general principles to help you think like a shrink. Master them and you will—in some cases dramatically—increase your understanding of the world around you. You can see through people. You can read their minds.
1. If you want to know how emotionally healthy someone is, look only at their intimate relationships.
Good-looking, athletic, charismatic, confident, rich, or intelligent people are not always emotionally healthy. For example, chronologically, they may be adults, but emotionally, they may be two-year-olds. You will not really be able to make any kind of accurate, in-depth assessment of people until you learn to distinguish their superficial physical qualities from meaningful emotional ones.
There are at least three key things you want to know:
o Most importantly, how long-lived and committed are their current intimate relationships?
o Secondly, how much negative conflict do they experience in their work environments and how long have they held their current jobs?
o Finally, what was theft childhood experience like in their family of origin? Or, in plain English, did they get along with their family?
2. How you feel about yourself (your self-esteem) is significantly determined by how nurturing your mother, father, and siblings were to you when you were growing up—especially your mother, though it is not politically correct to say so.
It is not that mothers are to blame for all of a patient's problems. It is simply that stable healthy mothering is a strong buffer against a tremendous amount of pathology.
3. How you relate to intimate people is always based on how you related to your family when you were growing up.
Basically, we all keep our families with us forever. We keep them in our heads. For the rest of our lives, we will have tendencies to either take on the roles of our childhood selves or those of our parents.
Examine carefully your relationships with your family. It will tell you a lot about who you are.
4. We all play to a hidden audience—Mom and Dad—inside our 'heads.
You often see people do strange things in their interpersonal interactions. "Where did that come from?" you often ask. It came from a hidden screenplay that was written in that person's head.
Ostensibly, he's reacting to you, but in his head, he's reacting to his mother. In fact, the less he remembers of his childhood, the more he is going to act out with you.
This leads nicely to...
5. People who say they "don't remember" their childhood are usually emotionally troubled.
Physically healthy individuals who can't recall their youth have frequently endured some painful experiences that their minds are blocking out. As a result, they really don't know who they are. They have what we psychiatrists call a diminished sense of identity.
6. Victims like to be aggressors sometimes, and aggressors are often reconstituted victims.
People actually may become more actively aggressive when they feel forced into a passive position.
7. Yes, Virginia, there is an "unconscious" or "non-conscious" mind, and it basically determines your life, everything from what job you choose to whom you marry.
All the feelings that you had about yourself, your parents, and family are buried in this "unconscious mind." Also buried here are some very deep fears which will be touched on below.
The more aware you are of your unconscious mind, the more freedom you will have.
8. Sex is critical, no matter what anyone says.
Sex has become passe as an important explanatory factor of human behavior. Nowadays, it is more politically correct to emphasize the role of feelings, thoughts, and emotions than the role of sex. Nonetheless, sexual functioning and sexual history do tell you a tremendous amount about what people are really like.
9. Whenever you have two men, or two women, in a room, you have homosexual tension.
It is a core truth that all people have both heterosexual and homosexual drives. What varies is how you deal with those drives. Just because you have a homosexual impulse or idea has absolutely nothing to do with your sexual orientation. You are defined by your sexual behavior, not your sexual impulses.
The people in our society who are most against homosexuality are the people who are most uncomfortable with their own homosexual impulses.. These impulses are banished from their conscious awareness.
10. Yes, children do want to be sexual with the opposite-sex parent at some point in their young lives, often between the ages of four and six.
Just about everyone is grossed out at the thought of their parents having sex. This is because there is a significant resistance against one's own memory of sexual feelings towards one's parents.
It does not mean, however, that you have to remember your sexual impulses towards a parent to be emotionally healthy. In fact, one of the most common issues an adult has to deal with is the incomplete repression of this core conflict.
11. There is indeed such a thing as castration anxiety.
In fact, it's the most frightening core fear that people have. It's probably not only evolutionary adaptive, but emotionally important.
12. Women do not have nearly as much penis envy as men do.
Men are all deep down very preoccupied with their penis. Concerns usually revolve around how big it is, how long, how thick, and how deep it goes.
This is an important issue that will likely never be researched because it makes everyone way too uncomfortable to talk about. There is more mythology on this subject than the Greeks ever wrote.
13. The Oedipus complex is what keeps psychiatrists in business.
Though lay people tend to think only of the complex's sexual aspects, it really boils down to competition. It's commonly about being bigger, richer, more powerful, a winner or a loser. The feelings surrounding it are universal—and intense.
Getting through the various stages of psychological development—oral, anal, and Oedipal—can be summarized as teaching you three key things:
o To feel stable and secure, to depend on people reasonably
o To feel in control
o To feel able to compete successfully and to feel like a man or a woman.
14. People are basically the same underneath it all; that is, they all want to satisfy similar deeper needs and quell identical underlying fears.
In general, people all seem to want money, power, and admiration. They want sexual gratification. They want to, as the Bible notes of Judah and Israel, "sit under their vine and fig tree and have none make them afraid." They want to feel secure. They want to feel loved.
Related to this principle: Money and intelligence do not protect you. It is only emotional health that keeps you on an even keel; your feelings about yourself and your intimate stable relationships are the only ballast that matters in life.
15. People often act exactly the opposite of the way they feel, especially when they are unhealthy.
Or: the best defense is a good offense. When people act egotistical, their underlying feeling is that they are "dick-less" or impotent.
16. More on defenses...
Here is human nature in a nutshell. My favorite line from the movie The Big Chill is voiced by the character played by Jeff Goldblum. "Where would you be, where would any of us be, without a good rationalization? Try to live without a rationalization; I bet you couldn't do it."
We distort reality both outside and in our minds in order to survive.
Distortions of our inner world are common. Regression, one of the most intriguing defenses, can be particularly illuminating to acknowledge; it means acting like a kid to avoid the real world.
"Outside" distortions can get us in very serious trouble.
Denial can be fatal whether it involves alcohol abuse or a herd of charging elephants.
Devaluing, or, in simple terms, throwing the baby out with the bath water, comes in handy when we want to insult somebody But it can be detrimental—for example, causing us to miss a lecturer's important points because we consider the teacher to be a "total jerk."
Idealizing, or putting people on a pedestal, can be hurtful—say, when you realize your ex-Navy Seal stockbroker has been churning your brokerage account.
Projecting feelings onto others is a common defensive distortion. Guilt is a painful feeling, so sometimes we may see other people as angry at us rather than feel guilty ourselves. "I know that you are angry that I forgot your birthday," you say. "Don't deny it."
Finally, splitting our view of the world into good guys and bad guys is a distortion, even if it makes for a great western.
17. To be successful in the highly competitive American business marketplace requires a personality ethos that will destroy your intimate relationships.
At this point, you are probably experiencing some confusion. After all, I've been saying, that it is unhealthy to be striving continuously to compensate for feelings of inferiority or impotency. Yet most people know that it is in fact the strivers who achieve enormous power and success in the world around them.
In order to be emotionally healthy, however, it is necessary for these "winners" to leave their work personalities at the door of their homes and become their natural selves once they cross the threshold. It is absolutely essential that the driven, rushed, acquisitive capitalist ethos not enter into the realm of intimate relationships.
CEOs of corporations and doctors are particularly at risk for this type of contamination of their family life. People who have the best of both worlds—career and relationships—are those who realize that success in the workplace does not make up for lack of success at home.
18. How well people deal with death is usually identical to how well they have dealt with life.
19. How people relate to you in everyday life can tell you a lot about their deeper issues, even in a very short time.
You can tell a tremendous amount about somebody's emotional stability and character by the way they say good-bye to you. People who cling or drag out good-byes often have deep-seated issues with separation. Of course, we all have issues with separation; it's a matter of degree. Those of us from loving, stable backgrounds carry around a warm, fuzzy teddy bear of sorts that helps us cope with saying good-bye and being alone. Without this security blanket of loving memories, being alone or saying good-bye can be hell.
A stranger who tells you his entire life's story on the first interview, even if you are a psychiatrist, is also probably emotionally unhealthy because there is no boundary between that person and you—and there should be. After all, you are a stranger to that person.
20. Listen with your third ear.
One of my mentors at Duke University Medical Center once defined the third ear as follows:
"While you're listening to what a patient is saying, with your third ear listen to why they are saying it.
Psychiatrists listen in a unique way. A family practitioner examines your ears with an otoscope.
A psychiatrist examines your feelings with himself as the tool.
When you are interacting with another person, if you notice yourself feeling a certain way, the odds are that your companion is somehow intending you to feel that way. You have to be emotionally stable to accurately use yourself as the examining tool.
When you become adept at identifying what you are feeling, the next step is to determine why. There are usually two reasons. Number one, it may be because you are resonating with what the person is feeling. A second possibility is that you are being subtly provoked to play a complementary emotional role in a scene that has an often-hidden script.
The process of using one's own heart as a "scope" is hard work. The fancy term for this process is "countertransference."
21. Behind every fear, there is a wish.
Wishes that are often consciously unacceptable can be expressed more easily as "fears." Related to this principle is the maxim: "Beware unsolicited denials." A common example is the seemingly spontaneous statement, "I don't really care at all about money!" Hold on to your wallet.