The Country Shrink http://thecountryshrink.com A psychologist from rural America comments on psychology, psychiatry, religion, and politics. Thu, 27 Nov 2008 00:57:32 +0000 http://wordpress.com/ en hourly 1 http://www.gravatar.com/blavatar/9c9c98e99c187c96a0ae170ac4c983a0?s=96&d=http://s.wordpress.com/i/buttonw-com.png The Country Shrink http://thecountryshrink.com Darwinian Psychology-Part II: Why we eat junk http://thecountryshrink.com/2008/11/26/darwinian-psychology-part-ii-why-we-eat-junk/ http://thecountryshrink.com/2008/11/26/darwinian-psychology-part-ii-why-we-eat-junk/#comments Thu, 27 Nov 2008 00:57:32 +0000 thecountryshrink http://thecountryshrink.wordpress.com/?p=264 ]]>

There’s no doubt about it, the average American diet is atrocious. Give us the 44 ounce softdrinks, Big Macs, ice cream, and snack cakes, and we’ll take that every time over a healthy diet of fruit and vegetables. Obesity is referred to as an “epidemic” in America. I agree with all of that.[1] Here’s where I get off of the bus:

Maybe your mother didn’t cry, “Mangia!” when you ate dinner, like mine did. Still, you’re likely to whisper it to yourself. That’s because you possess a simple survival impulse: Eat until sated. Our neanderthink legacy is to store as much energy as possible, since calories were scarce and uncertain for most of human evolutionary history and our metabolism was set to guard against the possibility of starvation tomorrow. The problem is that eating more doesn’t sate us; we merely recalibrate how much we think we need.

Our evolved mind-set on food hinders us in several ways. Our instincts tell us to keep eating well beyond when we are sated. Worse, the foods we crave—calorie-dense fats and sugars—were once rare and valued as a bulwark against starvation; now they’re plentiful and harmful in excess. We don’t crave plants, precisely because they were more abundant in our past. And if we do manage to temporarily gain a handle on the gustatory Disneyland in which we live, our dietary rigor plummets once we’ve lost weight.(1)

So, the notion is that our Neanderthink makes us do it. For the sake of argument, let’s say I concede this point for a moment. What is the recommendation?

We’re good at rationalizations to avoid governing our food intake. We tell ourselves, “I can get away with eating this delicious morsel,” or “It’s too hard to deny myself this scrumptious ice cream.” By yielding to such urges, we ratchet upward the amount of sugar and fat we crave, because we are tampering with a hormonal system finely attuned to the lack of such concentrated energy. On the savannah, the sweetest confection was wild fruit.

Michael Pollan, author of The Omnivore’s Dilemma, famously summed up what you need to know to consume healthfully: “Eat food. Not too much. Mostly plants.” The method by which we might hew to this Paleolithic regimen can also be summed up in seven words: “Dieting gets easier if you don’t cheat.”

So the question is, how do the recommendations actually follow from the just so story? They don’t. It’s just, “Don’t eat too much, and eat mostly plants. Oh yeah, don’t cheat.” But this goes back to the premise of my original post, and that is that the Darwinian Psychology narrative is thought to add scientific authority to whatever is being discussed. Forget the fact that the conclusion does not follow from the premise in the article. That is irrelevant to why these folks invoke a Darwinian just so story. They think it adds credibility. For me, they just prevented the story from being printed out and handed to my patients, which could have been beneficial.

The same periodical also published an article entitled, How to Be a Good Storyteller not long before.(2)

Perhaps they find these articles unrelated, but I found them to be very related:

Stories also entertain, educate, and instill moral values—sometimes all at once. We can all tell narratives, whether in the classroom, the boardroom, or the living room, but it takes practice to become a fine raconteur.

It seems the folks over at Psychology Today have been getting their practice.

—References—
(1) Neanderthink: An Outsize Appetite, Courtesy of Evolution, Nando Pelusi Ph.D., (11/17/08), Psychology Today
(2) How to Spin a Good Story, Brian Andrew, (10/20/08), Psychology Today

—Footnotes—
[1] I have a simple experiment which I use to teach my patients about their diet. This one has to do with sugar, and more specifically folks who are addicted to soft drinks. Go two weeks without any soft drinks (it actually doesn’t matter if it’s a diet soft drink or regular), and then go out and buy the biggest soft drink you can. Then it will be clear to you what it does to your mind and body. This is something that has worked in each case. In fact, the research shows that drinking just one diet soft drink daily increases the risk of being overweight to an extent that is greater than regular soft drinks, although not by much. One diet soft drink daily increases your chances by approximately 42% whereas one sugar filled drink increases your chances by 38%. It goes up with each additional drink per day.

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Darwinian Psychology-Part I: An Introduction http://thecountryshrink.com/2008/11/26/darwinian-psychology-part-i-an-introduction/ http://thecountryshrink.com/2008/11/26/darwinian-psychology-part-i-an-introduction/#comments Wed, 26 Nov 2008 09:05:06 +0000 thecountryshrink http://thecountryshrink.wordpress.com/?p=261 ]]>

I am going to write an ongoing series on Darwinian Psychology (aka Evolutionary Psychology). Unfortunately, my chosen field (psychology) has probably generated more “just so”(1,2) stories than has biology. Paleontologist and Darwinist, Stephen J. Gould, wrote about “Darwinian Fundamentalism”,(3) and specifically singled out Darwinian Psychology for criticism. He also noted the similarity between Darwinism and fundamentalism:

But since the modern ultras [Ultra Darwinists] push their line with an almost theological fervor, and since the views of founding fathers do matter in religion, though supposedly not in science, Darwin’s own fierce opposition does become a factor in judgment.(3)

Equivalent of Darwinian Just So Story

Equivalent of Darwinian Just So Story

I have noted an interesting phenomena among scientists and in “scientific” writings. Presenting a Darwinian “just so” story for the phenomena that you are discussing seems to provide the research with a veneer of scientific credibility. It is as if a Darwinian “just so” story is a suitable substitute for empirical data.

For those who study persuasion, they will note a similar phenomena in the general population. For example, people dressed in a suit and tie are more persuasive than those not dressed in this manner.(4) Authority is conferred to individuals dressed in this manner. For those of us who worked in an hospital setting in graduate school, we were always excited when we were able to wear a white lab coat, because the patients listened to us better and were more apt to follow our instructions.

As an aside, this may be related to evolutionary factors indicating intelligence. Intelligence among our ancestors may have been displayed by having unique abilities (such as making unique tools or being able to communicate in a way that less intelligent apes could not understand).[1] Over time, our ancestors would have developed a mutation to recognize these symbols as promoting survival, and would have thus been more attracted to individuals who displayed these symbols. [Yes, I'm being sarcastic here.]

So, I hope you enjoy this forthcoming series analyzing pseudoscientific Darwinian Psychology. There is a wealth of material upon which to draw. The motto for this area seems to be, “If it sounds good and references evolution, then it is science.”

—References—

(1) Just So Stories, Wikipedia
(2) Darwin Says “Just So…”
(3) Darwinian Fundamentalism, Stephen J. Gould, (1997)
(4) Perceived Symbols of Authority and Their Influence on Compliance, Bushman, B.J. (1984)

—Notes—
[1]. I have generated a Darwinian Just So Story to help provide credibility to this post. Did it work?

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A Heartfelt Response to a Reluctant Atheist http://thecountryshrink.com/2008/11/11/a-heartfelt-response-to-a-reluctant-atheist/ http://thecountryshrink.com/2008/11/11/a-heartfelt-response-to-a-reluctant-atheist/#comments Tue, 11 Nov 2008 23:55:56 +0000 thecountryshrink http://thecountryshrink.wordpress.com/?p=258 ]]>

A recent atheist commenter wrote:

so i stumbled upon… “No, it’s not impossible to maintain, and I’m of the opinion that no amount of skepticism is enough.”
Absolute skepticism is arrogance, or at least an utter lack of trust in the experiences and knowledge of others.
You hear something from a friend, but you’re skeptical, so you go look it up. You find ten other people that agree with what your friend said, but you’re skeptical of them. Where does it end?
When people say absolute skepticism is impossible to maintain, they’re not lying; it is impossible. Eventually you have to give in to trust.”

I recently turned atheist. You are right i didn’t have a good relationship with my father. but arrogantly i think i am an absolute skeptic. It hurts my brain, but i think i’m closer to the truth. I would like to be a theist again, when i was happy. now being a atheist, i am depressed. but none the less, I can’t justify believing in Christianity. I wish i could but i can’t. I see so many errors in it. How do you rationally believe in Christianity, [if even possible]?

I’m responding here, not as a shrink, but as a Christian and fellow human being.

I appreciate your comment very much. I can tell from what you wrote that you are distressed by both your skepticism and your atheism. You want to believe, but you have deep doubts. You see all kinds of “errors” with Christianity.

Believe it or not, I at one time, was in a similar position. You have a lot of questions about Christianity. So did I. And we are not alone. All believers have doubts at times. In fact, I think doubt is a necessary part of faith. It wouldn’t be called faith, if there was no doubt. What I would ask you to do is to sincerely pray to God. Say something like, “God, here is what keeps me from believing in you. I want to believe, but I have trouble believing because… Please lead me to the answers of my questions.” And, start to listen for the answers. Do even more than that. Start to seek out the answers. God will accept you with all of your flaws. He accepts me, and I am as flawed as anybody. Don’t seek the answers to your questions because it will make you happy, because believers may have even more challenges. Seek the truth.

31 So Jesus was saying to those Jews who had believed Him, “If you continue in My word, then you are truly disciples of Mine;

32 and you will know the truth, and the truth will make you free.” (1)

You ask the question:

How do you rationally believe in Christianity, [if even possible]?

I answer you unequivocally, Yes. You can rationally believe in Christianity. There have been many atheists who have rationally examined the evidence and came to believe. (2,3,4,5,6) God can help you with your skepticism if you let Him.

(1). John 8:31-32 (NASB)
(2). Jesus Among Other Gods, Ravi Zacharias
(3). The Case for Christ, Lee Strobel
(4). The Case for Faith, Lee Strobel
(5). Who Moved the Stone, Frank Morrison
(6). Testimony of the Evangelists, Simon Greenleaf (Full Text Available Online)

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Method of Birth and Attachment http://thecountryshrink.com/2008/10/30/method-of-birth-and-attachment/ http://thecountryshrink.com/2008/10/30/method-of-birth-and-attachment/#comments Fri, 31 Oct 2008 00:25:51 +0000 thecountryshrink http://thecountryshrink.wordpress.com/?p=256 ]]>

Women who deliver vaginally may be more responsive to their newborns in the early postpartum period than those who deliver via cesarean section, new research suggests.1

This has been speculated about for a long time, but new research shows that it is the case. I think it only makes sense. As humans, I think we are automatically more connected with others with whom we have suffered together. But, I think the other point is that this method is more natural (as God intended perhaps). I realize that there are many situations where this is not an option, but I also know that over the years, the decision of vaginal versus cesarean birth has been a matter of convenience. I don’t necessarily mean the woman either. I’ve heard stories about a doctor having to come in on a holiday to deliver a baby, and in order to get it over as soon as possible, opted for cesarean. Or worse, induced the birth and utilized forceps for the most rapid delivery possible. Doctors like their holiday times as much as anyone.

The research also found:

“We found a significant difference in activity in certain cortical and subcortical areas of the brain in this group of mothers who delivered vaginally compared with those who delivered by cesarean section. Broadly speaking, the cortical brain regions are believed to be important for regulating emotions and empathy,” principal investigator James Swain, MD, PhD, FRCPS, told Medscape Psychiatry.

This research is part of a longer term study examining the relationship between bonding at delivery method. The researchers reported that cesarean deliveries have increased from 4.5% in 1965 to 29.1% in 2006. Based on my observations, people who were born via cesarean section are more reactive to sudden changes, scared of surprises, and have more difficulty with life transitions.

1 http://www.medscape.com/viewarticle/581065?src=rss

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The Defense Mechanism of Repression-Part II http://thecountryshrink.com/2008/10/20/the-defense-mechanism-of-repression-part-ii/ http://thecountryshrink.com/2008/10/20/the-defense-mechanism-of-repression-part-ii/#comments Mon, 20 Oct 2008 23:13:27 +0000 thecountryshrink http://thecountryshrink.wordpress.com/?p=252 ]]>

I became the victim of one of his most violent crimes, and repressed the memories for 43 years until 2005. Dickinson meticulously planned a gang rape in my honor several days in advance. My life was derailed. I told no one — not even the rapist. Confronting Dickinson would mean acknowledging to myself that the rapes had actually occurred … too horrible for my conscious mind to accept, and at that time, the words drugged or raped never occurred to me. I forced myself into denial, refusing to believe it ever happened. The mind rejects whatever it deems as “unimaginable”. More on that later.1

There is a general defense mechanism that seems to explain all others to one extent or another. That defense mechanism is repression. All defense mechanisms involve a blocking of information from awareness. With the specific defense mechanism of repressed memories, the information is from one’s past. The quote above is from an individual who experienced horrific trauma, repressed it, and then recovered it later.

Freud rejected his earlier notion of widespread sexual abuse as fantasies. He simply could seem to deal with the implications. Later, therapists and shrinks in their exuberance, implanted many false memories through suggestion into their patients. As a result, many psychologists, completely rejected the notion of repressed memories. When what they should have learned is to be very careful, and to understand the issue in great detail. Part of the duty of a physician is, “first, do no harm.” This is also the duty of a shrink. By rejecting out of hand, the possibility of repressed memories, there are folks who will be harmed. I’ve seen a number of folks who thought “something might have happened,” but as far as I can tell nothing did. This is not generally how truly repressed memories emerge.

One also has to be very careful with the use of hypnosis in the recovery of repressed memories. This can easily implant false memories. That said, a very competent psychologist may help someone to recover memories in a very objective and sensitive way.

1 http://www.georgia-tech-rape-victim2.blogspot.com/

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Some Psychological Aspects of Atheism-Part V http://thecountryshrink.com/2008/10/19/some-psychological-aspects-of-atheism-part-v/ http://thecountryshrink.com/2008/10/19/some-psychological-aspects-of-atheism-part-v/#comments Sun, 19 Oct 2008 12:25:26 +0000 thecountryshrink http://thecountryshrink.wordpress.com/?p=247 ]]>

I write on the psychological aspects of atheism, because academic psychology and academic tradition has been biased and focused on the psychological aspects of belief in God.  I feel there needs to be a little balance to this issue.  Recently, there has been some research that seems a little more even-handed in the study of belief and disbelief.  It is a very large and ongoing study.

I have noted before, the association between a poor relationship with one’s father and atheism.  Paul Vitz noted this association for the most extreme atheists.  The recent study presents some data on the issue in terms of what atheists and believers say about their relationship with their fathers.

There certainly is a correlation here.  It looks as if approximately 56% of atheists believe that they had a good relationship with their father, whereas, 62% of believers believed they had a good relationship with their fathers.  Granted, that’s only about a 6% difference.  So, while the association I’ve noted between relationship problems with the father and atheism exists.  It does not appear to be the whole story.  I would also point out, that in treatment, that beliefs about one’s relationships with one’s parents often changes during the course of treatment.  Patients often come to see their relationship with their parents in a new light–the light of today’s understanding.  So, I will admit that the relationship may be less strong than what I have presented before, but certainly does exist.  This factor with the mother, is not associated.  The study also did not examine the strength of belief and association with the relationship with one’s parents (which is the notion of Paul Vitz).

I’ve also asserted the following before:

4). They portray themselves as enlightened, intelligent, tolerant, moral, caring, accepting, loving, peaceable, and kind.  And sometimes, they really and truly are.  I’ve known them and met them.  However, they are not tolerant, in general, of the beliefs of “believers.”  They can tolerate anything but that.

I think the data broadly supports this assertion.  You can see more graphs here.

The data does seem to show that atheists (on average), view themselves as more intelligent than the rest of the population.

So, as you can see, 68% of atheists believe they are more intelligent than the average person, whereas, 52% of Christians believe they are more intelligent than the average person.  This is a stronger association than the assocation between the relationship with the father and atheism.  So, this confirms what I’ve stated with respect to intellectual elitism and atheism.  However, I would also state that I have never seen a study of IQ scores of believers vs. atheists.  So it is at least possible that their beliefs about their intelligence are accurate.  But on average, in my opinion, this intellectual elitism does exist.

I will continue to examine these issues in Part VI.

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Super Secret Shrink Quotes–Part I http://thecountryshrink.com/2008/10/13/super-secret-shrink-quotes-part-i/ http://thecountryshrink.com/2008/10/13/super-secret-shrink-quotes-part-i/#comments Mon, 13 Oct 2008 18:45:33 +0000 thecountryshrink http://thecountryshrink.wordpress.com/?p=243 ]]>

((FOR THE EYES OF A SHRINK ONLY))

Other folks, please read at your own risk. Do I have your interest?

As a shrink, you really need to have several quotes at the ready–quotes possessing wisdom.  Folks come to see you for wisdom, believe it or not.  This is a piece of wisdom taught to me by my mentor.  When folks come to see a shrink, they expect shrinks to have some wisdom.  I’ll present some of the gems that I have acquired over the years.  These are few and far between.  I don’t learn these very often. I quote myself here a couple of times. I hope that’s not too vain.  Are you a non-shrink and still reading?  Hmmmmm.  (Shrink raises one eyebrow, and then looks away while observing non-verbal behavior out of the corner of his eye).

ANGER

“No man is ever made braver through anger, except the one who would never have been brave without anger. It comes, then, not as a help to virtue, but as a substitute for it. And is it not true that if anger were a good, it would come naturally to those who are the most perfect? But the fact is, children, old men, and the sick are most prone to anger, and weakness of any sort is by nature captious.”1

“Be ye angry, and sin not.” (Ephisians 4:26).

“If you do not wish to be prone to anger, do not feed the habit; give it nothing which may tend to its increase.” (Epictetus).

“If you are patient in one moment of anger, you will escape a hundred days of sorrow.” (Chinese Proverb).

“Violence is the last refuge of the incompetent.” 2

“Anger is part of being human. You’ll never get to a place where you’re never angry. That doesn’t happen for humans. At times, anger drives us to address things that we would not otherwise. So, it can be a positive motivation at times. You can tell it’s not positive by thinking about whether the other person is put beneath you as a human being. If so, then you are out of line.” — The Country Shrink

SUICIDE

“Suicide is a permanent solution to a temporary problem.” (Author unknown)

“Folks who commit suicide make it more likely that their children or relatives will do the same. There is nothing more harmful to family members than for one of the family members to commit suicide. I’ve worked with people who had a family member commit suicide as a child. There are few traumas that are worse.” –The Country Shrink

…. To Be Continued–You didn’t expect me to reveal all of the scant wisdom I have in one post, did you? ….

What, you’re not a shrink and you’re still reading? For shame. For shame. Who woulda thought it?

1 http://praxeology.net/seneca2.htm
2 http://www.quotationspage.com/quote/29885.html

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Repeating Life’s Patterns–Part II http://thecountryshrink.com/2008/10/11/on-repeating-lifes-patterns-part-ii/ http://thecountryshrink.com/2008/10/11/on-repeating-lifes-patterns-part-ii/#comments Sun, 12 Oct 2008 02:18:27 +0000 thecountryshrink http://thecountryshrink.wordpress.com/?p=240 ]]>

Some concepts in psychology are very difficult to explain. Part of the reason is that some concepts apply to one individual, but not to another. One of the challenges of being a shrink, is being patient enough to figure it out. Another thing is, that when you see a new patient, you never know for sure how long they will stick around.

What if the first session is the only session? Do you want to work to make it maximally therapeutic? But will that cause them to only come in for one session?

I find that as a shrink I have to pay attention to what I’m thinking and feeling and what I’m saying to a patient. If I find myself trying to convince a patient to stay in treatment for the long-term, I’ve very liked picked up on, an unconscious level, that they may well not stay in treatment. So far, every time I’ve noticed myself doing this, the patient doesn’t stay in treatment for very long.

They seem to stay a little longer if I point this fact out when I notice myself doing this, and we analyze their historical patterns for sticking with things. But still, it often ends up being a short-term treatment, when I think it really needs to be a longer term treatment. Perhaps, with time, I will figure out how to address these patterns in such a way that these folks stay in treatment.

As some examples, I’ve worked with a number of folks who have only seen a ‘therapist’ (I hate that term), for one to three sessions. Often they’ve seen several therapists for this many sessions. When I encounter this, I try to analyze the reasons why this occurs with the patient. Often, my experience is that that will stay two to four times longer in treatment with me, but then they drop out.

This is difficult for a shrink (or me), because I want to see good outcomes in every case. But this field teaches me on a daily basis to know my limits, and to strive for more understanding. So, while I strive to help my patients change their life patterns, I try to improve the patterns that I have with my patients. In the end, I am human, and make mistakes on a daily basis. Unfortunately, that is part of the human condition. All I can do, and you can do, is to work to see what mistakes have been made in the past, and work to prevent them from occurring again in the future.

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On Long-Term Psychotherapy http://thecountryshrink.com/2008/10/06/on-long-term-psychotherapy/ http://thecountryshrink.com/2008/10/06/on-long-term-psychotherapy/#comments Mon, 06 Oct 2008 21:55:20 +0000 thecountryshrink http://thecountryshrink.wordpress.com/?p=237 ]]>

I’m not exactly sure why, but the majority of my patients seem to require long-term psychotherapy (1 year or more of psychotherapy). On rare occasion (probably 20% of the time), treatment can be completed in less than 12 sessions. Perhaps it is the nature of the referrals I receive. The problems tend to be more complex and at a personality level. But perhaps it is that the prevalent paradigms for psychotherapy are not interested in the best possible outcome. I don’t really know yet what the answer is.

But I do know, that recent research1, shows that long-term psychodynamic treatment is the best approach for complex problems. And it also seems to me that a vast majority of my patients have complex problems. What I am uncertain of, is “Do I see problems as being more complex than other psychotherapists?” or “Do I see patients with more complex problems than the average psychotherapist?”

Regardless, what I do know is that I have done absolutely no advertising in a town of less than 10,000 people. One of my biggest referral sources is a bar in a town 45 miles away (that I have never been to). All of my recent new referrals have come from this bar. The comment from my new patients is, “I know you treated ‘Jane,’ she had a lot of problems. I thought to myself, ‘If she can change, I can too. I saw all of the changes that she made, and I was amazed.’” The patients talked to each other and started car-pooling to get to sessions with me. Other than one individual, their problems were very complex, requiring long-term treatment (treatment duration greater than 1 year).

So, on average, I’ve seen longer-term psychotherapy have great outcomes. Along the way, there have been a few short-term treatments with great outcomes. But on average, “Longer treatment is better treatment.”

On occasion, probably 10% of the time, treatment is a failure. The patient drops out without completing treatment, and continues to have problems. This percentage is fairly subjective, but I think it’s a fairly accurate representation. I’d like to get this down to 1 to 5%, and feel that this is possible if I can get better at my job. I think the main point I’m trying to get across to you, is that long-term treatment may be one of the best solutions to many problems that folks have.

1 http://www.sciencedaily.com/releases/2008/09/080930164454.htm

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Repeating Life’s Patterns-Part I http://thecountryshrink.com/2008/10/04/repeating-lifes-patterns-part-i/ http://thecountryshrink.com/2008/10/04/repeating-lifes-patterns-part-i/#comments Sun, 05 Oct 2008 00:45:21 +0000 thecountryshrink http://thecountryshrink.wordpress.com/?p=232 ]]>

I remember one fellow I saw. He was a bartender. Over the years, he joked to all of his friends, “I’ve been a bartender since I was six.” He started out by getting his father a new beer whenever requested (which was often). He didn’t know any different. This was normal family life to him. Then his father was killed in a truck driving accident when he was 8-years-old. His mother became extremely depressed and couldn’t function (couldn’t cook, couldn’t comfort, couldn’t provide parental correction, and so forth). So, he became the perfect boy (independent, high achieving, extremely helpful, protective of those with emotional needs, and so forth).

Unfortunately, he missed out on his childhood. When he became an adult, he dropped out of college, started using drugs, hooked up with women who were bad news, and generally disappointed his mother. She didn’t give him any attention or concern after the death of his father (she couldn’t). He missed his dad horribly. He became a bartender to repeat the early pattern (serving beer and liquor to folks). He also repeated a number of other patterns from his relationship with his father.

These things represent an unconscious wish “for a better outcome.” The person wishes greatly that things had not turned out the way that they had. They keep repeating, in ineffective ways, the early traumatic experience. Unconsciously, they are trying to resolve the early problem–to make things turn out differently. On another level, their symptoms are communicating the problem from their past. When they end up finding a shrink who can understand these things, they are finally able to communicate, verbally, what bothered them so horribly. Unfortunately, with today’s training, there are not many shrinks who can understand this unconscious communication. It’s rare that I don’t see this communication. I see it every single day in my practice. The symptom communicates the problem.

Just as when you have an intense pain in your shoulder communicates that there might be a physical problem with your shoulder. This prompts you to seek medical attention. Life patterns and problems also prompt people to seek psychological help. Too often, this is not recognized in my opinion.

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