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“I’ve done some bad things.” Patient tells me she can’t sleep well, is nauseated, depressed mood, worried with perseverating thoughts about acts that shame her and ramifications, doesn’t feel as much pleasure in life, isolating, tearful and more. I was alarmed! What could she have done that deserved this kind of self-flagellation? When she told me, I didn’t realize it.
I was still waiting for the rest of the story. I got caught up in her own self-judgment and found myself sitting beside her “in court.” Once I realized what I was doing, I was chagrined. Here I was collaborating with her in her inappropriate guilt. It took me too long to register that her reaction was not proportionate to the offense. I told her I was sorry she was going through all this emotion. She said, “It’s my own fault.” Is it though? We needed to start looking at additional reasons that might be influencing the way she felt.
Start looking at other paradigms when the emotional response is out of proportion to the event(s).
An analytical approach would look at unconscious reasons, such as other personal choices that conflict with a core beliefs. Or perhaps, something like unresolved anger coming out in physical and emotional symptoms. Ask about our “closets,” peel away pretense and let your flawed self into the air. Keep it real.
Another paradigm is medical. Inappropriate guilt is a symptom of Major Depressive Disorder, a debilitating disease process of the brain that affects the whole person/body systems. When distorting things out of proportion, personalizing too much, we must ask if there is a depression going on. Ask yourself. Ask others. But don’t let it continue if at all possible. Major Depressive Disorder is a progressive disease that does more damage to the brain the longer it goes untreated. In other words, the brain is affected more over time, it is harder to treat and it is more dangerous to the person. The average length of an episode is 2 years and the more times it returns, the more chance to have the disease process continue for life. Treating sooner and for longer, decreases the chance of relapse.
Excellent for us are the many treatment options for this potentially devastating disease. Even in the “lifer,” when staying on medications, the relapses are much easier to get through and shorter in duration. The medication has a protective effect on the brain. Prophylactic against further insult.
In the woman I told you about, there was another emotional spectrum disorder, anxiety. Anxiety and depression are like brother and sister. They often go together. But for today, we’ll leave it on the symptom of inappropriate guilt and let it rest on the reminder that the brain is human, mortal, attached to our neck and not an aura. When the brain gets sick, it shows how it is doing the only ways it can, often through emotions.
Self Care Tip #46 – Look at all the reasons influencing the way we feel. Be a friend to yourself.
Question: What do you think? Agree or disagree? What is your story?
How is the medical cause differentiated from the cause(s) identified in the analytical approach?
Great question. They are traditionally viewed as different paradigms. The analytical approach has a Freudian origin that has since colloquially morphed into different varieties of psychotherapy including insight oriented. That is really more of what I was talking about, insight therapy. Although original Freudian psychotherapy didn’t take into account biology, there is room for it in insight oriented psychotherapy. When we use the term, “medical,” we generally are considering the biological pathology, at the cell level. The way insight oriented psychotherapy can cross ground with that, is through education, higher learning, and applying that to our emotions and behaviors. That is a stretch though as insight therapy is classically described as finding out where emotions or behaviors come from in terms of development and adjustment issues.
I hope that helps. I know it is lengthy. Let me know any further questions any time! Thank you for reading!
If the cause is both biological and that requiring insight therapy, would medical treatment be sufficient alone or would a deficit remain by not treating the non-medical condition? For example, if a learning disorder (biological) results in chronic frustration and damage to self image (insight), which treatment(s) would be effective? Could one treatment stand alone?
both scenarios of course would be effective. Generally it is safest to say psychotherapy in conjunction with medication is the best approach. However, one w/o the other is often helpful to a degree also. There are some disease processes that I would recommend 1st meds prior to integrating psychotherapy but it is not usually a roadblock. thanks for reading!
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