In early adulthood, I believed that the source of psychological disorders was conflict and trauma. However, that view changed when I became a caseworker at my state’s Department of Social Services in Adult Protective Services. In that position, my job was to assist people who were unable to meet their basic needs and had no one willing and able to help them. I assisted my clients with obtaining housing, medical care, income, and mental health services and provided financial management. Most of my clients needed help because of severe mental illness.
I started the job in the early 1980s, monitoring people recently released from mental health facilities as part of the move to deinstitutionalize the mentally ill. Psychotropic medication and caseworker services had made it possible for most of these people to live in the community. My clients were always prescribed these medications but often went off them. There would be a re-hospitalization and a reinstatement of medication, which I could see had a profound and positive effect on these clients. I saw people with severe delusions (such as believing people were walking through the walls or that snakes were entering their body) stabilize and become much more clearheaded.
This type of experience led me to believe that at least some severe psychological disorders were biological in nature. I concluded that since the medication provided a marked improvement in such people, their disorders must have a biological cause. In addition, it was hard for me to imagine that emotion from trauma would impact the brain to such a degree that not only would a person see people coming through the wall, but also strongly believe that they were real.
However, a conflict in my personal life not only made it possible for me to imagine, but also gave me many new insights about what can exacerbate a mental health disorder—and what can help heal it.
Hostility, Confusion, and Alienation
The conflict started when I rejected the romantic advances of a male member of a group of friends (I’ll call him Bill). This wasn’t done through open, direct conversation, where both parties make their viewpoints and positions clear, but rather spoken through what I’ll call “references.” He would speak of his thoughts, feelings, and viewpoints about a scene in a movie or a friend’s relationship problem but make it clear that he was actually referring to issues concerning me. If I attempted to have an open conversation, he would play dumb.
In response to the rejection, Bill alternated between acts of hostility/revenge and continued pursuit. For example, when angry, he would try different insults, clearly looking for a point of sensitivity. If I wasn’t bothered by the insult, he would frown. But if he found a sensitivity, he’d continuously attack me. At other times, he would express an expectation that we would have a relationship. I was initially sympathetic to his feelings of rejection and drawn in by his vulnerability. I was concerned for him.
Although I knew Bill was moody and in therapy, he seemed like a thoughtful, sensitive person— not someone who would abuse anyone. Had I known what I do now about psychological disorders, I would have realized by his behavior that he was potentially dangerous. But at the time, I didn’t understand the seriousness of the situation.
From the beginning, the emotions he directed toward me were extreme, unlike anything I had ever seen. More than in what he said, I could see the emotion in his eyes and hear it in his voice. His hostility didn’t make sense to me because it wasn’t over my rejection of a relationship we already had, but of starting one in the first place. In addition, he was well aware that I wasn’t available; I was in a good marriage and not one to have affairs.
Besides underestimating the danger, I was in, I failed to recognize how my confusion over Bill’s erratic and intense behavior could affect me psychologically. Since I couldn’t end contact with him without dropping out of the group, I thought I would give the conflict time to blow over. My expectation was that if it became a serious problem, I would simply leave our friend group.
But his acts of revenge had an unexpected impact, further entangling me. His hostile acts were left unexplained. What discussion there was, was in references. What was said in the references was frequently open to interpretation. Sometimes, it was unclear whether his comment was a reference to the conflict, or unrelated. This ambiguity made my head spin. One offensive action was just piled onto others as the conflict remained unresolved; as they built up, so did my emotions. Simply leaving becomes difficult when there are both unresolved issues and significant emotions connected to them.
There were other issues I hadn’t anticipated, such as how Bill would involve mutual friends in the conflict, spreading his negative narrative about me and then requesting secrecy from them. I also didn’t anticipate how multiple mutual friends would follow his lead, attacking me directly and spreading his narrative while simultaneously not admitting that anything was wrong or informing me what he had told them.
Eventually, his emotion became so intense, I felt my life was in danger. Enough emotional stress had built up in me that by this point it became difficult to get a clear picture of anything. Threatening, hurtful, maddening behavior of unknown origin mixed with denial is a damaging cocktail. The hurtful behavior creates emotional upset, the unknown origin prevents closure, and it all creates a vicious cycle that diminishes clarity of thought and memory. The denial prevents resolution or even an outlet to express one’s viewpoint and vent all of these emotions.
My focus now turned to how to safely walk away completely from this man. I decided on a strategy to calm him by not challenging him on anything and speaking favorably about him without actually accepting an advance. That tactic gradually calmed him, but he remained angry. I never knew what to expect, and his further vengeful acts left me very angry. All my effort was directed at calming him and all his effort was directed at upsetting me. Bill was now feeling better but I was feeling worse. He seemed to feel he had gotten his revenge. I felt that if there were a safe time to leave, this was it, and I ended our friendship.
However, I still didn’t understand the reasons behind everything that had taken place. There is always a slim hope for some resolution or closure while you’re still in a relationship, but that ends when you leave. And it was after I left that I was hit the hardest with all the emotion that had built up inside me.
In addition, I continued to have problems with our mutual friends. Any attempt at a conversation with anyone in the know met with the friend playing dumb. Also, it became obvious that anything I’d said to any individual member was later shared with the whole group. However, anything Bill or a member of the group said about me was kept secret from me.
Untangling the Mess
This may seem like a pretty weird situation, but I don’t think it’s all that rare. In my work, I saw abusive behavior of many types conducted in secrecy, mainly sexual abuse. I’ve seen denial not just from the perpetrators, but throughout the families involved. I once read an article by a survivor of child abuse who said that the worst thing his father did wasn’t breaking his bones—it was denying he’d done anything at all.
It would be nice to just be able to forget my problems with Bill and our friend circle and move on to other things. Many argue that whether or not you know what drove a behavior and the thinking behind it, you should be able to let go of it once that person is no longer in your life. That may be true of something minor, such as if someone once insulted you, but a conflict of a more serious and long-lasting nature is an entirely different matter.
The brain doesn’t ask whether you want to concern yourself with wondering What was that about? or whether you want to stew in all of the intense emotion you felt during these incidents. If it did, I’m sure anyone would say NO. I certainly would have.
Unfortunately, when people experience conflict and/or behavior that we wouldn’t expect and we can’t incorporate it into what we understand about human behavior, the brain typically just sits on the emotion and we become mentally stuck in the emotional state generated by the negative experience. And it’s more than just the emotion generated by the events that is trapped inside us. It’s our very identity: who we are, the emotions we feel toward others, our perceptions of relationships and our role in them.
Now, all of the emotion I felt –whether it was about the situation with Bill and our friends or anything else— became ridiculously intense. Staying trapped in a high level of emotional upset takes its toll. In the beginning, I could remember who I was prior to what happened. Over time, I no longer could. I could physically feel the strain of the conflict on my nervous system. It felt as if my brain were floating in a toxic fluid.
As I said previously, I had believed psychological disorders categorized as psychoses were due to a chemical imbalance. But recognizing the high level of stress that trapped intense emotion puts on the brain, it now makes perfect sense to me that people can develop delusions and/or auditory and visual hallucinations based on stress alone. Studies have found such symptoms occurring when people are deprived of sleep, for example.
That is what seemed to be happening to me. I was constantly battling paranoid thoughts. I didn’t sleep much; I was in such a chronically agitated state, I was surprised I slept at all. My moods shifted from one intense feeling to another. By this point, my psychological problem had become too severe for me to continue to look for ways to cope with it. I needed to find a way to reduce its intensity before I could get back to being myself.
I started out very determined that there had to be a way out of this mess. I noticed early on that whenever I was able to bring some positive feelings to the surface, I felt a corresponding reduction in the intensity of my negative emotions such as anger, hurt, and fear. So I actively tried to do so, but it isn’t as easy as it may sound. The psychological problem I’d developed caused my thoughts and perceptions to turn much more negative.
For one thing, I felt like a drain on others, of less worth. When you’re mentally healthy, it’s relatively easy to have good relationships. But a severe psychological disorder comes with the inability to feel connected to others, as well as irritability, mood swings, impulsivity, and so on. Also, the problem I was having resulted in criticism and attacks from many around me. People didn’t understand why I had this problem, saw symptoms that were out of my control as being in my control, and had an opinion about what I should do about it. My failure to follow others’ recommendations led to the withdrawal of their support and more criticism. In short, I struggled not only with the disorder but also others’ reactions to it.
Still, I was determined to find a way out of the mess I was in.
I began to notice that the intensity of my emotions went down after some buried emotion came to the surface. Some see mood swings as just an abnormality, but I saw mine as a positive thing: the mind’s way of surfacing and releasing emotions. Barring any resolution of the conflict that created the emotion in the first place or closure on the confusing elements of that conflict, I think this process must be how the brain heals itself.
During this period, I was hesitant to take psychotropic medication because I understood that it wasn’t a cure, just a tool for symptom control. My thought was that if the medication would control the mood swings, but my mood swings were actually serving to reduce the severity of my disorder, then the medication could actually keep my disorder in a stagnant state instead of helping it to improve over time. Without improvement, I was in an unlivable situation.
Unfortunately, I can’t say I found an easy solution. It has taken several decades for me to heal psychologically from this experience, but I did reach a complete resolution of my symptoms rather than merely symptom management.
Based on my experience, I gained three insights.
The first is that emotion from trauma can have an extreme impact on the brain. I don’t believe even the most extreme delusions indicate a physical abnormality. While I was battling my psychological disorder, I would try to explain to people that although psychological disorders are not the result of a biological abnormality, they are also not usually preventable nor quickly remedied. The response I often heard was that a long-term disorder must be biologically based or due to a person’s choice to ruminate over the past. Some people would say that if my problem wasn’t biological, then there was no excuse for it. I would argue that the psychological problems people experience are their brain’s normal response when severe emotional upset is mixed with confusion, and that people don’t choose to place themselves in the many situations where this occurs.
One might say, “Well, that may have been true for you, but that doesn’t mean it’s universally so.” But I spent my 30-year career working with people suffering from mental health issues. Although everyone’s psychological disorder will manifest itself differently because everyone’s experience is different, there’s much that is universal. Even among these differences, there are common clusters of symptoms, which in turn produce similar feelings. The DSM simply takes these clusters and puts labels on them. However, I disagree with calling a cluster of symptoms a disease.
So I’m encouraged that there are people challenging what has been promoted as known truth: that psychological disorders are (at least in part) caused by a genetic defect or a biological abnormality resulting in a chemical imbalance in the brain. Of course, biological brain diseases do exist. But the vast majority of people experiencing psychological problems are not suffering from them.
The second lesson is a confirmation of my belief in what causes people to develop intense drives. Being driven to do something is not necessarily a bad thing. Sometimes people are able to direct their drives toward positive goals. For instance, an obsessive interest in science may result in important breakthroughs. But there are also people with very harmful drives that hurt themselves or others.
Drives are very clearly tied to suppressed emotion, not just in their presence but in their strength. When I felt ridiculously extreme emotions, I also felt ridiculously extreme drives that I wouldn’t want to give in to. In particular, I felt a drive to re-engage in problematic relationships. I can see that drives can be of such high intensity that is hard to prevent them from affecting behavior. My drive gradually diminished as I released my “stuck” emotions until it was gone.
Third, and most importantly, I learned how much of an impact my stuck emotions had not only on my perceptions but also on how strongly I believed those perceptions. I found that my perceptions were more farfetched when my emotions weren’t yet processed. For example, I would feel that conversations I overheard in a restaurant were references to my personal conflict. I would believe that the diners speaking had an association with my friend group and were speaking on their behalf. I knew that this was unlikely, but my mind kept going back to it. I realized that my thoughts were undoubtedly untrue, but at the same time, it was quite hard for me not to believe them.
It’s not a good feeling not to be able to trust your own perceptions, and it’s very problematic to believe and follow inaccurate ones. I didn’t want to do that. So when I perceived something in a way that brought up a lot of emotion, I would wait for the emotion to subside and think about when I’d felt that way before. Invariably, I would remember that I had felt that way all the time during the conflict that had triggered my mental health problem.
This is just a hypothesis, but I believe another way the brain releases emotion (other than shifting between emotions in a mood swing) is to alter one’s perception in such a way as to surface emotions that need to be released. For example, people often repeat the same conflicts in different relationships. I believe this is because people believe in their perceptions, act on them, and thereby create a conflict similar to one they have experienced before.
Ultimately, my recognition of the way a psychological disorder affects perception— making it less accurate but more intense—allowed me to understand the confusing personal conflict I’d had. Several years after I had ended my relationship with Bill and a year after dropping out of the friend group entirely, I received a call from a woman in the group looking to resolve the matter. During that conversation, she said she understood that I had had feelings for Bill prior to his pursuit. One day I thought about that conversation, and realized: What if a person strongly believes a perception is actually true—even if it is not— and continually believes it to be so in spite of any evidence or statements to the contrary? How might one act?
Then every piece of the puzzle fell into place. I hadn’t realized that Bill had been telling people that I was coming on to him before he began pursuing me. If I had, I would have thought he was lying to gain support. But now I realize that someone can very passionately believe in their gut that something is occurring that isn’t. I knew this to be the case with people in psychosis, but until then I hadn’t recognized that it also occurred in people generally living in reality. And that when people passionately believe what they’re saying, others believe them.
I also saw that, as with destructive drives, the greater the amount of suppressed emotion within a person, the stronger their belief in a distorted perception will be. And similarly, with the release of the suppressed emotion, the distorted belief will disappear. Obviously, many personal and societal problems can develop from false perceptions; combine them with extreme drives, particularly anger, and it’s a recipe for trouble.
Today, I believe that an increased understanding of the nature of psychological disorders will lead to better treatments. Dangerous traps could be prevented with such knowledge. People could be provided better support that would put them on the path to healing over time.
My experience has been that helping others to understand their own symptoms as well as helping them to unravel others’ behavior does seem to be healing. And it’s driven home to me how important it is to recognize that when you speak to someone with a mental health problem, remember that they are most likely a person who has a legitimate problem that they couldn’t have prevented, not someone with a physical disease that precludes their recovery.
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.