When the Pain Is Greater Than the Gain, Change Takes Place

Harry Stack Sullivan once observed that there can be no doubt that the first tool of prehistoric man was the abstract idea. An idea, once formulated, enters the world virginal and uncovered in its aboriginal ingénue state. As it moves along an incline it may pick up parasitic vegetation, which cling to and affect the naïve host. It is in this sense that ideas can be subtly influenced by external as well as internal factors; and it is in this manner that they are rendered susceptible to the vagaries of intrapsychic and interpersonal forces affecting potential change.

As haphazard as this may seem, ideas do not exist in a vacuum. They are impacted by interactions with the environment. Paradoxically, they may also stand alone amidst a dynamic context. While some ideas are evanescent, others, if denied their voice, occasionally dig in and take hold. The reasons for this are as varied as they are numerous: the zeitgeist is finally right; the idea has ripened into a form that is now edible, digestible, and can be assimilated into the body politic; or, the converse, in which the idea is seen as dangerous to the status quo, the people in power, church dogma, governmental control, current customs, long-standing traditions, or previously accepted views. One would think that wrong-headed ideas would be relegated to the junk-heap of time, but while that is

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sometimes true, it is not always the case. Inane ideas along with profound ones have existed for ages and continue to do so. In fact, one of the cornerstones of prejudice is based upon pre-judgments; that is, unreasonable ideas without truth or merit, which seem to persist despite evidence to the contrary.

But ideas and attitudes, while potentially powerful in and of themselves, do not achieve their potency unless coupled with action. And it is under these circumstances that ideas can take root and either grow into nutrients for the advancement of civilization or produce toxins that poison the underbelly of humanity.

An idea remains an abstraction, a distant and remote notion until acted upon, wherein it moves from potential to kinetic. But the idea is not the same as the action. Marxism is not equivalent to an actual revolution, even if the idea subsequently stimulated one. I may hate my boss and wish he were dead, but his actual demise is unrelated to my wish—unless, of course, I murder him.

In the psychoanalytic orbit, a failure to make the crucial distinction between thinking/feeling vs. doing often results in obsessional guilt. In the latter instance, the individual frequently feels guilty for merely thinking certain thoughts or experiencing certain feelings. Analytic canon used to hold that such thoughts or feelings were typically erotic and/or aggressive in nature.

For change to occur, the analyst must join in and connect with the patient’s “system” in order to help the patient eventually understand that there are no abnormal or negative thoughts or feelings. They are just that—thoughts and feelings, not actions or deeds. To be sent to jail, it is insufficient to merely think of robbing a bank or to consider some other kind of dastardly deed. One must actively commit the crime; otherwise we would have to lock up the likes of Wes Craven, Stephen King, Edgar Allan Poe, Hieronymus Bosch, and a whole flock of fiendish fomenters of phantasmagoria simply because they thought, wrote about, or otherwise depicted themes that radically and dramatically departed from socially accepted motifs.

Yet, numerous individuals suffer from so-called “guilty consciences,” despite never having performed the illicit act of which they stand accused in their own minds. They equivocate racy ideas with doing the damning deeds. Were this scenario to persist, it can become debilitating merely because the thought is experienced as tantamount to the action.

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Because of this erroneous equivalence in meaning, I have overheard parents say to their children “don’t think that way,” or “how could you feel that way?” No differentiation is made between the idea, its verbal expression, and the child’s ensuing activity. The strict caveat is to never think/feel that way! It follows, therefore, that this statement may become an agent of inhibition, so much so that merely having certain normal-occurring thoughts becomes impermissible.

If I can’t think them, what am I supposed to do with my thoughts? Moreover, if this is the case, how then can creativity flourish, much less arise spontaneously (as it often does as a matter of course)? Of greater importance, how does one work with individuals who are ridden by archaic prohibitions that berate, reproach, and condemn them for their unacceptable ideas?

Cognitive-behavioral therapy (CBT) approaches attempt to ameliorate these issues by essentially teaching the patient to block the “bad thoughts” from coming up via a process called thought-stopping. I am told that in some instances this is successful. Pragmatically speaking, I am fine with that, if it truly works and is long-lasting. However, several patients of mine who previously received CBT felt that it did not get to the cause of the offending thoughts/feelings.

What is more, biopsychiatry has heralded the specious conviction that there are so-called negative thoughts or affects and that they are the result of chemical imbalances. They have sponsored the notion that they should and can be ameliorated via chemical solutions, namely prescribed drugs masquerading as “treatment.”

Rather, uncovering the reasons why we think or feel a certain way allows one to obtain a deeper understanding of the meaning and purpose underlying those thoughts and feelings. In fact, according to the latest research by Jonathan Shedler, psychodynamic approaches consistently result in long-standing, rather than mere symptomatic, relief (“The Efficacy of Psychodynamic Psychotherapy,” American Psychologist, 2010). This is because symptom manifestations are overdetermined; that is, they have multiple layers of meaning. So, even though one symptom may be directly opposed by behavioral treatments, other symptoms are often substituted in their stead, which we can expect to continue until the full meaning of the symptom is explored and worked through.

This calls for a more intensive uncovering psychotherapeu-

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tic treatment, such as what is seen in a psychodynamic approach. The latter method recognizes that each symptom serves a purpose and the patient will not easily “give up the ghost.” To compound the situation, even though symptoms cause considerable discomfort and suffering, the mind resists their ablation. It is only when the symptom becomes inconvenient, sufficiently uncomfortable, or too painful that the patient is alerted to its downside. Until that point, the symptom has adaptive value to the person, even if outsiders may judge it otherwise.

Also, it is only when the pain is greater than the gain that the individual is motivated to make some changes. This is seen most clearly in individuals who are cautioned to change their life style in order to avoid serious illness, but initially ignore such warnings. However, when they suffer a heart attack, for example, they may finally be ready to hear and respond to the alarm that was sounded earlier.

In order for some individuals to change their ways, they must hit the proverbial rock-bottom, a phrase that is frequently associated with the turning point in alcoholism or other addictions. The problem is that what constitutes “rock-bottom” is different for each individual. Each human being has a different ability to deny, disavow, defend against, or otherwise dissociate the experience of personal pain. It becomes the complex task of the psychotherapist to discern how to differentially dose the subjective experience of each subject’s pain in accordance with a kind of phenomenological “Goldilocks Principle.” Do not expose the patient to too much or too little distress. This is no mean achievement.

It is an interesting paradox that therapists who may have gotten into this profession in order to alleviate pain may find themselves utilizing pain on behalf of the patient. This is not meant to imply that therapists willfully or sadistically create pain for the patient, but rather the recognition that allying with the patient’s pain may be motivational and might actually increase the patient’s genuine desire to get rid of it, despite how well it may have served the patient in the past. As a close friend of mine once quipped, the nice thing about banging your head against the wall is that it feels so good when you finally stop.

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