Feeling like scum – A psychology lecture through the eyes of a former mental health patient, part III

Today was Dr. Bla´s lecture again, and, again, held by Dr. Crazy. I still appreciate his informative style, but I am mad as hell about the things he said. Today´s topic were forms of psychotherapy used to treat anxiety disorders.

I don´t know why I bother to go through all this again. It doesn´t feel particularly good, and I don´t want to think about the stuff that made me angry. It will just give me racing thoughts again, and there will be a vicious, apparently neutral voice in my head seeding doubts every time I state my view on the things Dr. Crazy said. Given these conditions, this might not be particularly coherent, but I´ll do my best.

He started his lecture with talking about secondary gain once more. He didn´t say anything illuminating about it, he just reinforced the message. People with anxiety disorders are socially inept people who use their disorder to control social situations.  If you teach them some social skills, their phobia loses at least part of their function, and there is a chance they might get well. Fantastic. So my anxiety does not just make me suffer, it is also a character flaw. It is probably the punishment for my secret, subconscious desire to control everyone and everything. I suggest, Dr. Crazy, you add working on the patient´s self-esteem to the treatment plan. *sarcasm off*

So after the first five minutes I already felt 1) like crying and 2) like it would be the most satisfying thing in the world if Dr. Crazy developed a phobia himself – and was told by a therapist that he only remains ill because he gains something from it.  Seriously, the feeling all this gave me was: Nobody really likes you. Your relationships are based on emotional blackmail. You´d deserve to be abandoned by everyone. If you weren´t such a loser, you wouldn´t be suffering from anxiety in the first place. Or, even more poignant: You developed anxiety because you have nothing else to make people stay with you. You have nothing to give to them, you have nothing to offer, there is nothing about you that makes people love you. Has he ever thought about what kind of message he delivers by insinuating secondary gain?

Normally, somewhere at this point the racing thoughts start: “But that´s not what he means! This is just in your head! You do have a lot to offer, you just subconsciously feel like you have nothing to offer, and that´s why you developed anxiety! To make sure people stay with you, even though – in your head – you are a complete POS!” I allow myself to disagree with that oh so neutral and rational voice. The feeling of inadequacy Dr. Crazy´s remark gave me cannot be at the root of my anxiety. It was, after all, caused by Dr. Crazy´s remark, and I´ve suffered from anxiety for much longer than from Dr. Crazy. I wouldn´t doubt that I have some deep-rooted self-worth issues if his remark can hurt me like that. I never believed, though, I need anxiety in order to make people stay with me – not until Dr. Crazy indirectly gave me the idea. Most of the time, I´m scared that people will abandon me precisely because of my anxiety issues!

I believe Dr. Crazy´s insinuations are dangerous for the patients. Not only do they hurt and have the potential to cause or contribute to self-esteem issues and feelings of guilt over one´s anxiety. They could also lead to distrust among friends, partners and family. And moreover, if you give a patient the idea that he needs his anxiety, you do not exactly encourage him to recover, do you?

Dr. Crazy said something about anxiety and panic attacks that I realized myself only yesterday: That often patients are at a loss to describe what they feel during these attacks. It really isn´t easy to describe, for the simple reason that you are typically focused on the thing that scares you, not on how you feel. Dr. Crazy acknowledged this, but also gave another reason and that one really pushed by buttons. He claimed that people who suffer from anxiety are usually so good at avoiding anxiety-inducing situations and objects that their anxiety rarely gets kicked into full gear; and if it happens they “prefer” to busy themselves with searching for someone to save them from the situation instead of looking at how they feel.

Uh huh. Successful avoidance might be possible if you are phobic of snakes, tigers and elephants (You might still be paranoid they are around, though, and you might hate it when people even say the words, so don´t underestimate such phobias.). When you are phobic of your own bodily functions, though, your anxiety will be kicked into high gear very, very often. There is no failsafe avoidance strategy – and tragically, you still get trapped in avoidant behaviors.

Good, so he has no clue, but that is forgivable. The unforgivable part is the second part of his statement. I do not prefer to seek for help. When you are panicking, you cannot think – leave alone rationally. Nobody can, that is the point of panic, isn´t it? And the most natural thing to do when you are terrified and panicky is to CALL FOR HELP!!! It is even a healthy thing to do!!! If there was a real danger, say some masked intruder attacking you, it would be very troublesome if you stopped and reflected on your emotions and bodily reactions. Crying for help might be a better idea. And if you are phobic, you might perceive a danger when there is none, but you still perceive a danger! Of course during therapy you will have to learn to look at your reactions instead of focusing on the “danger”, since in the case of phobias there is none or almost none. But nobody is to blame or ridicule for not being able to do so in a moment of panic. Not to mention, of course, that crying for help and reassurance when you are really scared has nothing to do with trying to control or manipulate anybody.

After this part of the lecture, I felt like either giving Dr. Crazy a black eye, or like cutting myself. I did neither, but this might indicate how much distress his remarks caused me (I guess, though, cutting myself is just another way to dominate relationships *rolls eyes*). Now, the feeling all this gave me was something along the lines of: You don´t deserve anybody to rescue, help or reassure you. You don´t deserve compassion and comfort for being in a panic. And, interestingly, at some point I started to feel a little sick. I was a good patient and looked at my bodily reactions and realized that my shoulders were extremely tense, and there was a tension in my chest, too. I relaxed them, and immediately I felt better. This made me even angrier at Dr. Crazy, though. *insert “neutral voice* “See, he is right about this, so he is right about everything. You really owe him, and you should stop being childish and stop being mad at him.”  For the rest of the lecture, I just set there bracing myself for the next punch in the stomach.

Dr. Crazy also introduces several methods of treatment. Some of them focused more on relaxation, others focused on exposure. Exposure means that you have to endure whatever you are phobic of for some amount of time, no matter how scared you get. He explained there are various forms of exposure therapy. You can start out slowly, or you can do something called “flooding”. In the latter case, the patient is confronted with the strongest phobic stimulus straight away. Dr. Crazy explained that if you directly confront somebody who is phobic of snakes with a snake, he might at first have a strong reaction, but if you don´t let him “run away”, he will calm down eventually and he might even start to approach the snake. I admit I´m a bit skeptical here. Being confronted with something you fear, and with no possibility of escape – is somehow reminding me of how trauma works. So if a patient starts to approach the snake, is it because he realizes there is no danger, or is it down to some kind of Stockholm Syndrome?

I realized some interesting things about being a student versus being a patient at this point. I had wondered if I should voice my skepticism and ask if it wasn´t likely that the patient would be traumatized – and I decided against it, because I feared I would reveal myself as 1) not being a psychology student and 2) being somehow emotionally involved, and therefore probably a patient. I had a strong feeling that as soon as somebody realized this (particularly that I suffer from mental issues myself), I would no longer be taken seriously as a participant in a discussion on mental health matters. I don´t think I´m completely off track in thinking so. Dr. Crazy emphasized several times today how patients might try to avoid facing their fear by talking about childhood traumas (a point of view I find extremely insensitive and invalidating) and other things.  As a student or a professional, you might have a chance to voice skepticism towards certain types of treatment or even diagnoses,  but as a patient, being skeptical towards some particularly anxiety-inducing type of treatment might be laughed off as a form of resistance.

Last but not least, I realized just how much of a condescending asshole Dr. Crazy can be. Be careful reading this if you have arachnophobia. So Dr. Crazy explained that a patient with arachnophobia might be asked to imagine a spider crawling over his face and into his mouth. Half the students in the audience shrieked and pulled faces. I strongly felt like doing so, too, but I restrained myself. I was fairly proud of that, and even more so when Dr. Crazy laughed and said: “Well, maybe I shouldn´t have said that, some of the girls in here really have a problem with spiders.” Like he couldn´t have guessed so before! Now – when you are a therapist treating phobias, it might be necessary to be cruel sometimes since you will need to expose people to things they fear. But there is no need to enjoy it so much, is there?






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