A recent article, “Screw Positive Thinking! Why Our Quest for Happiness Is Making Us Miserable” provides humorous perspective on the ways seeking too hard after happiness can make us unhappy – and, it seems, stupid as well! I’m going to argue that the same paradox also applies to other aspects of mental health, and that some of the major problems in current mental health treatment result from failing to take this into account.
The problem with trying too hard to be happy is that “positive thinking” can often backfire; affirmations for example can make people think less of themselves, and excessively positive thinking can lead to us making foolish choices that have serious, and negative, consequences. Also, there is a tricky effect called “ironic process” where trying to “improve” by getting rid of something in our mind often makes us amplify the very thing we are trying to get rid of (spend the next 30 seconds trying not to think about hippopotamuses and see what I mean.)
Another problem with trying to get rid of unhappiness, in order to become happy, is that unhappiness itself can be understood as part of an attempt to reach a greater happiness. That is, I may be unhappy with a paper I am writing because I want a better paper and the happiness that comes from that, or I am unhappy with a relationship because I want a better relationship, etc. If I suppress my unhappy feelings with my current paper or relationship, in order to be happy, I may turn in a lousy paper or fail to act to improve my relationship, which then leads to more unhappiness in the future.
I believe it is helpful to consider the possibility that pretty much everything that disturbs us can be understood as something that in some way is trying to help us. Even something as dark as a part of us that wants to make us kill ourselves can be understood as a part that is trying to free us from the ways we feel stuck in our lives, even if it is going a bit overboard in the means of getting unstuck that it is proposing. We may be disturbed by extreme rage, by sexual impulses we find unacceptable, or by voices which seem completely foreign to us, and we may see these things as the enemy, and think that our recovery depends on getting rid of them, but this very effort to get rid of them could be the primary barrier to healing. (Healing usually involves finding a place for something, where it doesn’t dominate but is allowed to make a contribution.)
A key part of “psychosis” is often the sense of having components in one’s mind which are foreign and distressing, whether these are seen as related to a brain implant, telepathy from neighbors, evil spirits, or just “voices.” The standard approach to these experiences is to try and get rid of them, through drugs and distraction. But if the thing disturbing us is actually trying to help us, and also if efforts to get rid of something can often make it worse (ironic process) then this whole mission of trying to get rid of what seems foreign and distressing may be entirely the wrong idea.
One voice hearer whose story illustrates this perfectly is Eleanor Longden. She was tricked into entering a mental hospital by people who were concerned about a single, non-distressing voice she was hearing. They convinced her she needed to get rid of this voice, that it represented “schizophrenia.” In a few months in the hospital, trying to desperately get rid of the voice, she found it multiplied and intensified and became 12 extremely distressing voices. She later described this process as a “psychic civil war.” It was only when she learned to balance limit setting with the voices with being curious about how the voices might be trying to do something for her and might be conveying important messages about herself (even if often not literal messages) that she was able to recover. She now still hears voices, but finds them more helpful than harmful. (I highly recommend the DVD on which she tells her story in detail, and I also recommend her insightful paper on hearing voices and dissociation.)
There is a lot of evidence that fear of madness plays a key role in becoming mad; for example Hirsch & Jolley (1989) found that 70% of those with a psychotic diagnoses reported that fear of going mad was their most common “symptom” before a psychotic relapse. It seems likely that the fear of going mad is not just a “sign” that one is going mad, but is actually part of what leads to the psychosis: trying too hard to stop the madness actually intensifies it. There is also evidence of the same process at work in people diagnosed with PTSD: the more they fear going mad, the more chronic their PTSD tends to be (Dunmore, Clark & Ehlers, 1999). The problem seems to be that if one interprets a memory or other disturbing mental content as evidence of “madness” then one is likely to try too hard to get rid of it, which leads to both the disturbing part of the mind fighting harder to be recognized, and also failure to integrate it.
It makes sense that if some part of our brain or mind is dissociated from our conscious awareness, but is trying to help us in some way, it will become angry and fight back if we try to get rid of it. Unfortunately, it’s very easy to see this angry response and intensified activity on the part of something in our mind that we don’t understand as a sign of something terribly wrong, an “illness” that has to be suppressed. This often leads both the person and the mental health system that is trying to “help” into a vicious circle of trying even harder to get rid of what is really part of the person. This then leads to that part fighting back in an even crazier way, prompting stronger efforts at suppression, etc. etc.
Of course, sometimes the drugs used for suppression do seem to “work” for at least a period of time, but this can also be unfortunate, as the suppressed part now is unable to contribute to the psyche, and of course, many other parts of the person may be suppressed by the drugs as well.
In “cognitive therapy for psychosis,” a psychological approach that I specialize in, one of the key guidelines we attempt to convey is to “try, but don’t try too hard.” This suggests we should try to be happy, to be sane, and to think independently of possibly domineering voices or impulses or disturbing emotions, but it also suggests that we shouldn’t try to do any of those things “too hard.” This means we should be aware of when our positive efforts may be backfiring, and when it might be time to back off, to accept unhappiness, to accept our own crazy experiences and perspectives, and to allow voices, impulses and disturbing emotions to influence us in some ways.
This balanced approach or middle way, allows us to fight with the “mad” disturbing or dreamy sides of ourselves when we think those aspects may be influencing us too much, but also allows us to accept that all those sides of us exist and even to become proud of them as we find better ways to make use of them in our lives. So cognitive therapy and rational thinking can incorporate “mad pride” – not pride in being dominated by “mad” sides of ourselves, but pride in including all the different sides of ourselves, including those that see things or manifest in a way that our culture does not easily understand. Real recovery comes not from trying to be completely sane, or completely happy, but from finding a lively balance on the edge of chaos, on the edge of rationality, a balance that allows us to find a place for all of our parts and experiences, even the “crazy” ones.
(For a few more ideas on how trying too hard can cause problems, check out my earlier post, Trying too hard to recover may make it less likely.)
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.