TIFT #109: Back to School

Returning from vacation I’m finding young people and parents rightly concerned about intense and frightening symptoms connected with the demands and stresses of returning to school.They are understandably distressed about severe anxiety, suicidal thoughts, intense compulsions, and other serious signs of trouble. Things have changed. Today, far more than a few decades ago, we listen. Families pay attention to young people who feel near the breaking point. Their distress is intense and hard  for them to tolerate, especially with demands to perform. This post is about moving from an excessive emphasis on eliminating the symptoms towards a collaborative focus on their meaning and how to change that.

I see far too many instances where families, media, and even professionals focus exclusively on the symptoms. Those are the things the DSM diagnostic manual talks about. Magical treatments abound, promising to take away the pain. Sadly, trying to remove painful symptoms is so often not the answer, for a good reason.

Symptoms are solutions

It’s time to remember that symptoms are the vital products of an inner limbic problem solver, intent on survival. In TIFT #107 I talked about this most faithful and dedicated agent of the mind, working behind the scenes, independent of our conscious will, to secure our safety in a dangerous world. Sometimes it is appropriate to think of it as an inner child because its thinking is often childlike. At other times, it seems more like a limbic problem solver. It is often helpful to personify it because this inner self is so strong and independent in its mission to keep us safe.

So when the limbic problem solver sees a need for anxiety, suicidal thoughts, compulsive actions, dissociation, or any of many other symptoms, we do better to get to know their maker before trying to suppress this indominable and vital part of the self. Dialog will serve better than domination, and the best way to get to dialog is to show our interest.

Five Key Questions break the ice

When we, the partnership between therapist and client, let the limbic problem solver know we are listening, she will surely feel a pull. She perks up in the hope that her conscious, slow thinking partner might turn out to be of some help.

Let me digress a moment. I say slow thinking after Kahneman’s thinking fast and slow. The slow kind is our conscious, logical pondering. The limbic problem solver thinks fast for survival. It is wired for pattern recognition, predicting threats and opportunities with lightning speed. However, to be complete, the limbic problem solver can and does often take time. Faced with complex or difficult issues, it works overnight, remembering where you left your keys or grinding away at a dilemma with no easy solution. It performs feats of organization and prioritization of data to come up with solutions to troubles it has recognized, as well as the ones you give it to solve.

Like Nvidia’s AI computer chips, this part of the mind works differently and is of high value, even though it may sometimes seem misguided. So, with an appreciation of the inner self, the part responsible for generating troublesome symptoms, we will do well to apply our slow, thoughtful, conscious mind to listening and communicating with the limbic problem solver.

One more characteristic: The inner mind, is fascinated by stories. Since her job is to ensure survival, she always wants to know the outcome. A question is a story waiting for an ending, so she can’t resist going to work to find it. In posing questions, we do well to have faith that she is listening and won’t resist giving an answer, often sooner than we think but in some unexpected form.

Question one: What exactly is the nature of the symptom, the limbic mind’s solution to a problem?

In other places, I have stated it as, “What exactly is the nature of the Entrenched Maladaptive Pattern, EMP.” Thinking of the symptom as a solution may actually be more positive and conducive to collaboration. When we think of suicidal thinking as a solution, we are on the right track. It’s not necessarily about death, though it might be. But why death? The limbic mind has its own understandings of death. Is it a way out of something intolerably scary? Is it a punishment? Is it an indictment of some other person? Where does the symptom lead? What comes next? Does the anxiety arise out of a wish for some big person to take an interest? Is it justification for retreating from a scary challenge? Is it a way to escape some very bad thing happening?

By working as a partnership to understand the limbic problem solver’s solution, we will be ready to do reverse engineering, that is, looking at the solution and asking what was the problem or were the problems it was designed to solve.

To repeat myself, “The mind is a metaphor engine.” Pattern recognition is done by seeing the similarities between things. It is foundational to the limbic problem solver’s thinking fast. A “thing” can really be anything, and the mind works by seeing connections between things, even when the conscious mind thinks they are completely different. The original inner version of the danger that called for a response may be vague and shapeless. After all, thinking fast is mostly nonverbal. The limbic problem solver is precise but not articulate. We will have to work at translation. In addition, the inner mind may avoid being explicit and use a less scary, metaphorical equivalent. Psychodynamic thinking has known this forever: one thing can represent another. As a result, suicidal thoughts, anxiety, and other symptoms may focus on something more palatable, leaving us to identify the original version.

We can make metaphor a friend, not an adversary. When we work with our client to articulate just what the symptom is, does and leads to, the limbic self will go to work to find the answer. And it will often express the answer in some unexpected, metaphorical way. I recently asked such a question, but it didn’t seem to go anywhere. The client then went off telling me a story about a painful adult experience. Whoa! That adult experience was a highly revealing metaphor for exactly what lay behind the symptom.

Second Question: What is the dread?

Dread is a powerful word. It speaks the language of the limbic system. And it is a good word for the inner limbic emotion that is the driver of the solution. Ecker calls it the “symptom requiring schema.” Remember that unconscious emotion has been demonstrated in the laboratory as nerve impulses, but we don’t know exactly what they “feel like” at that limbic level. Thinking fast is good at finding a metaphor for describing an inner emotion. From detailed examination of solutions in the form of symptoms, we can infer how the limbic problem solver finds ways to lower the likelihood of encountering the dread. When it is predicting a likely encounter with the dread, it mobilizes its resources to make sure that doesn’t happen.

I recently had the experience of asking a client what it was that she “dreaded.” I had explained a bit that the thinking fast mind uses dreaded inner emotions as warning signals like a lighthouse, to warn of shoals and rocks on the shore and keep the ship of self from disaster. The word “dread,” itself, caused a powerful rumbling inside. An involuntary vocalization showed that I had activated something deep and unknown. The context gave us a beginning for understanding the dread. From that moment, we began to use the word as a metaphor for some terrible unconscious emotion, and that has been the focus of our inquiry. The answer may take time to fully reveal itself, but the word gives us a handle on the most central and important element to understanding the symptom.

Question three: What is your theory?

Perhaps the most important thing about the dread is its context. If the inner self is dreading feelings of guilt, then why? What circumstances were causing feelings of guilt? What personal value might have been transgressed? The question is still one for both participants and maybe the supervisor, too. Or maybe the dread is the fear of entering into adulthood alone. Rights of passage are great at the end when aloneness has successfully been faced, but at the beginning, going out into one’s own personal wilderness is incredibly scary. Could it be an image of some kind of terrible failure? One client, as a young person, had heard talk about a relative who had a mental breakdown. Could that happen to me? That became a lifelong source of dread. Theory is uncertain. It’s a working hypothesis. Even Einstein’s theory of relativity, when invented, was an idea yet to be tested. Theory is like that: today’s best version of what caused a prediction of dread, re-triggered by present events, to bring the current symptom “out of mothballs” to its implementation today.

What’s important here is to remember that symptoms, by themselves, tell us very little about the dread they are intending to avoid or about the context in which life is seen as threatening. Similar circumstances and symptoms can be built on very different and surprising circumstances. One of the best examples I know is the man whose mother told him, when he was of pre-school age, that one day he would be 18 and would have to fend for himself. As a small child, eighteen had only the meaning of something scary that could happen any time. Much of his life became oriented around making sure he would be able to fend for himself. The downside was that he was then blocked from learning to receive support through relationship. We need, then, to be very open minded about the theories we build. It helps to be aware of how events are interpreted differently at different points in development, as well as the unique and individual meanings humans attach to their life experiences.

Question four: What is the rule being applied.

The more I have thought about it, the more I am convinced that the limbic problem solver’s thinking fast ends up with a simple if-then logic, accurately described as a “rule.” Much of the literature talks about “schemas” and about “internal models” of how life works. My thinking is that, in reality, they are more like images of if and then. When the mind identifies, by pattern matching, a set of circumstances that predict the dreaded limbic emotion, then it goes right to images or metaphors of several possible solutions. To slightly complicate things, research has shown that the mind rapidly performs an assessment of which solution is most likely to work, then puts that solution into action. Think of an animal confronting a predator. There has to be a quick assessment: fight, flight, freeze, depending on the size and scariness of the adversary. The best answer, like the triggering circumstance, is stored in memory as a unit, a clump of behavior or strategy, to be applied instantly when required.

Non-clinical example:  A debater counters the adversaries point. The best ones use their limbic problem solver, not their logical slow thinking, for an almost instant response. An instantaneous assessment culls the ineffective responses as the most effective point gets fired off.

How is the theory question different from the first question, namely, “what is the nature of the EMP?” For this question, instead of focusing on the surface, we ask about the implied strategy. What is the “if,” the situation that warrants a response, and what is the “then,” the response most likely to enhance survival? Even though the if and then are stored in some nonverbal, metaphorical form, this question asks for a higher level of analysis. It asks us to boil down the why and the what. Why is this important? It’s because it is exactly the logic stored in limbic memory that needs to change. It is the logic that needs to be replaced with an updated, improved if-then unit or rule. As Ecker points out, when the client can articulate that rule with emotion, it means the critical memory location is in a volatile state, ready to be rewritten through memory reconsolidation. A common example: It’s better to share the dreaded pain with an empathic witness than to act out so as to distract from it. And that leads to the last question.

Question five: What is the disconfirming antidote?

A recent experience brought home the potential subtlety of this question. The dread was loss of freedom and connection. Because the original triggering circumstances took place early in childhood and were later reinforced by severe adult experience, this dread was an absolute. It was a “must never happen.” Now, in life, that is problematic. People in authority have the right to take away our freedom. Police and judges are fallible. Mistakes are made. The rule was, “I must never be deprived of freedom to be where I want.” This absolute becomes a source of constant anxiety because there is no absolute protection against a possibility that cannot be fully controlled. Childlike thinking is often black and white. “This must not happen ever,” is not an uncommon rule. Its a red line that needs to be changed to pink. From an adult point of view, the rule needs to be one where exceptions are conceivable and survivable. What, then is the antidote? It is not an idea, but an experience. The antidote has to be an imagined situation where the dread becomes reality, and there is a way to deal with it. Only then, can the anticipation be softened. Only then can an absolute dread turn into a relative dread.

At first glance, the idea of an antidote seems simple, but this situation illustrates both how that is not necessarily so easy. Disconfirming an erroneous perception might seem obvious, but turning an unthinkable event into one that could be survived is a much harder transformation. Furthermore, it is not simply a perception but an experience, and that turns out to be an experience of a very interesting kind.

Changing a red line to pink involves growth, meaning a step of psychological development from a more primitive binary thinking to a more subtle ability to handle different shades. In fact, this is often the kind of transformation that therapy needs to bring. The inner child has gotten stuck and needs to get back on a track of growth. Most EMPs, Entrenched Maladaptive Patterns, are the result of a young mind grappling with a problem of existential significance, for which there is no satisfactory solution. That’s when the mind says, “This must never happen.” An absolute means controlling one’s environment, and nature doesn’t negotiate. The troublesome result is holding a stance against reality. And rules like that are held tightly because they are guarding against a life-and-death peril. The inner mind can’t let go because that would open the door to an unthinkable, unspeakable horror.

What helps a stuck inner child grow? It is not logic, but a human catalyst. It is the experience of trust and safety. That, in childhood and in therapy, is what makes it possible to navigate and learn to change the unthinkable to something that can be navigated.

I have said in past writings that the way to create that kind of safety is seeking “Accurate Empathy.” My client feels that is too clinical and strongly prefers a term we thought up together: Complex Caring. It has the same definition–“an ever deepening, emotionally sensitive and detailed understanding.” That is what allows a young, limbic mind to cross the chasm from the absolute to the real.

Jeffery Smith MD