A psychological symptom is a physical manifestation or a
behavior that reflects emotional conflict within the individual.
Symptoms are a way of acting out our inner conflicts without
dealing with them. Thus they tend to perpetuate the fragmentation
of the psyche. Our behavioral symptoms and the negative thoughts
and impulses that direct us to them seem to us on some level
as solutions to our emotional turmoil. Like symptoms of physical
illness, psychological symptoms have direct connections to
the disease. Sometimes these connections are fairly obvious
if we are looking for them. For example, a person who picks
at himself may be unconsciously trying to remove a blemish
because he feels flawed. Most commonly the connections between
our symptoms and our trauma are not obvious, especially to
the person having the symptom. There are a lot of possible
symptoms and each person has his or her own set of usual symptoms
and the occasional unusual ones.
Possible symptoms of emotional disease include excesses and
addictions such as overeating, overdrinking, excessive sex,
excessive gambling; even excessive reading, excessive exercising
and excessive working. Then there are the self destructive
behaviors such as nail and cuticle biting, picking at scabs,
pulling hair out, hitting ones self, biting ones self, burning,
cutting, and so on. Another category of symptoms we can refer
to as the psychosomatic ones. These include headaches and
migraine; digestive system problems such as indigestion, stomachaches,
irritable bowel, constipation, etc. Another group is the musculoskeletal
ones such as aches and pains, fatigue, stiffness, numbness,
tingling, tightness, heaviness, etc. There are the breath
related ones such as asthma, shortness of breath, sighing,
holding ones breath, feeling like you can't get a full breath,
etc. And there are probably other psychosomatic ones in addition
to those that have been listed here. Another category might
be called self-neglect. This would include not getting enough
to eat or drink or enough sleep or exercise or not eating
the right kinds of food.
There are several ways in which we address symptoms and all
of them work more or less well for each person. That is to
say that some work better for one person and others work better
for another person. The most direct approach is to try to
simply stop or change the behavior. This can be easy for some
people in some cases, like the person who just decides to
stop smoking and does so "cold turkey". Some times
we can use tricks to get ourselves to stop, like the client
who stopped smoking by telling himself that he could still
smoke any time he wanted. He was just cutting down, lengthening
out the time between cigarettes. It had been fifteen year
since his last one. Another approach is to give our selves
something with which to replace the symptom, a new or more
frequent ritual, a new interest or hobby, a new project, endeavor
or quest. Another approach that I think is a fairly frequent
one is what is known as "substitution of symptoms".
The father of my best friend in college had an interesting
pattern. He alternated between periods of being an active
alcoholic and periods of being a religious zealot. As a zealot
he took much better care of himself physically. But regrettably
he was much more likeable as an alcoholic. The moral of the
story is that if we are going to try substituting symptoms,
we need to weigh the potential consequences of the new symptoms.
Generally it seems that stopping unwanted and undesirable
behavior is pretty difficult for most of us most of the time.
When I was first in training to be a therapist, I thought
that gaining insights that would cause symptoms to go away.
This does in fact work a good part of the time, but not quite
as dramatically as I had thought it would. Although sometimes
it is even pretty immediate and dramatic like my client who
overcame a fear of bridges by figuring out what the psychological
association was between bridges and her past trauma. More
commonly insight brings symptomatic relief in a way that is
much more subtle and gradual. Little by little as we better
understand and reprocess our past trauma, there are shifts
toward healthier behaviors and/or a diminution of psychosomatic
symptoms. But sometimes the impact of insight on symptoms
seems to be negligible or non-existent.
The reason that our symptoms don't easily go away is that
we need them or at least we think we do. I am using "think"
in the broadest definition of the term, i.e. brain activity.
It's not that we always tell ourselves that we need our symptoms.
Mostly they just occur. Strange as it may seem the primary
function of symptoms is the regulation of affect. Our symptoms
were designed by us in the first place in an attempt to repress
overwhelming affect in the face of trauma. Now the trauma
is no longer occurring but we still experience the overwhelming
affect. Clients often report not feeling comfortable in their
own skin. In a sense a component of all symptoms is dissociation,
i.e. disconnect from our experience when it gets to feeling
like it's too much for us. Our symptoms are designed to take
us away from consciously experiencing. Mostly this choice
is made on an unconscious level. Sometimes it is pretty conscious
as in when we say, "I really need a drink!" However,
most of the time the only information that we consciously
get is the impulse to do our behavioral symptom(s) and/or
the onset of our psychosomatic ones.
There is an interesting phenomenon among people who have
Dissociative Identity Disorder (formerly less accurately known
as Multiple Personality Disorder). These people can exhibit
a symptom in one of their identities that is not present in
another of their identities. And this is true of both behavioral
and psychosomatic symptoms including extreme physical discomfort
such as in the case of migraine headaches. This is pretty
compelling evidence for the psychological basis of these symptoms.
The argument is further reinforced by the much more common
occurrence of the non-DID client whose symptoms go away once
they gain insight about their origins and meanings.
So obviously what we need to do is learn to regulate our
affect in more appropriate ways. We are all, with few exceptions,
in fact very capable of regulating our affect. We have built
in mechanisms in the hardware and the automatic systems of
our brains. This is evidenced even in a small child. When
my grandson is upset and starts throwing a tantrum, my daughter
sometimes holds him and asks him if he can calm himself down.
He says, "Umhmm", and he calms down. In trauma what
we thought we learned was that we can't self-regulate. What
we actually learned was that when we are being tortured physically,
sexually, verbally or emotionally, when our world is chaos
around us and there is nothing we can do about it, it is best
to dissociate and not even try to self-regulate. And we were
right. The problem was that there was no one there to tell
us any of this. We didn't have the words with which to think
about it and so it got laid down in our memories as feelings
and sensations rather than as word thoughts, concepts and
conclusion. So now we are going back and re-experiencing and
rethinking/reprocessing those events and our responses to
them. We are drawing new more conscious conclusions about
all that. These new conclusions and new perspectives are helping
us to see that we can self-regulate and no longer have to
always be re-victimized by our symptoms.
Desired Outcome:
To reduce the amount of symptomatic behaviors and manifestations
and replace them with non-harmful self-soothing and self-regulating
behaviors.
Discussion Starters: Examining your own life experience,
consider the following:
-
What are my symptoms? What symptoms do I most frequently
exhibit?
-
When am I most likely to exhibit symptoms, where, at
what time of day, with what people and under what circumstances?
-
What meanings and insights can I extract from the nature
of my symptoms?
-
What healthy ways of self-soothing and of regulating
my affect have I learned?
-
What new healthy ways of self-soothing and of regulating
my affect am I learning?
-
What techniques have I developed and am I developing
to redirect myself from harmful symptoms to non-harmful
responses to distress?
John C Flanagan, LCSW
818 NW 17th Avenue, Suite 7
Portland, OR 97209-2327
503-228-7574
www.johncflanaganlcsw.com
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