Posted by OddipusRex on December 29, 2002, at 9:41:13
I thought this was interesting. But it says therapy is not about creating new explanations-isn't that what a lot of CBT is doing? And doesn't CBT tend to say that thoughts create emotion not the other way around?
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December 17, 2002
The Mind Explains It All
By ANNA FELS, M.D.
One afternoon in my psychiatric practice, I saw two patients suffering from depression in back-to-back sessions.Each had classic symptoms, including what is called diurnal variation of mood: depressed patients typically feel worse in the morning and get better toward evening. The pattern is believed to be caused by the daily fluctuations of hormones and neurotransmitters.
This theory was not, however, how my patients understood their symptoms. The first patient explained that he felt bad during the day because of work pressures, and he improved in the evening because he was alone and could relax. The second patient, a musician, said her solitary days made her depressed; it was only when she arrived at work in the evenings and was around people that she felt like herself.
I suspect that the two patients' reasoning reflects a phenomenon that crops up constantly in therapy: the post hoc "explanation" of feelings and behaviors. Patients attribute their symptoms to specific life events — an approach that appears to make sense.
But this drive to come up with the causes of events is hardly limited to therapy patients. Neurophysiologists discovered the same phenomenon in a radically different context. While mapping the brain, they were amazed to find that when the area responsible for an emotion was electronically stimulated, subjects experienced the mechanically induced feeling, then instantly came up with reasons for their responses.
If you activate the area of the brain that generates laughter, for example, the subject may happily "explain" that his hilarity stems from an overly earnest looking doctor or an odd diagram on the wall.
Neurologists also happened upon the mind's tendency to concoct explanations for puzzling events. In rare instances when the left and right sides of the brain become disconnected, the verbal left half seamlessly fabricates stories to explain actions initiated by the right half.
Apparently, the mind abhors an explanatory vacuum and rushes in to fill the void, with no compunction about creating "reasons" out of whole cloth.
This powerful pressure to create explanations presents a challenge to therapists. They are, after all, hardly exempt from the need to create satisfying cause-and-effect story lines. Quite the contrary.
Freud himself, besides being a brilliant clinical observer, was a world-class spinner of explanatory tales. He rationalized the roots of everything from moral development to foot fetishes using elaborate childhood dramas. Theorists following in this tradition provided a treasury of narratives to "explain" virtually every psychological ailment.
But the most complex issues regarding our need for explanations arise in psychotherapy. Therapy, by its very nature, involves unresolved questions, and this ambiguity can be uncomfortable for patient and therapist alike. There is a temptation to come up with quick answers, an impulse that Keats, in another context, famously described as an "irritable reaching after fact and reason."
In therapy, as in the composition of poetry, premature conclusions can abruptly stop the process. After the first moments of relief, the patient and therapist find themselves stalled, with little change in the patients' symptoms.
Still, explanations have a place in therapy: often, they form its very core. But therapy is not about creating new explanations; it's about unearthing old, primitive ones. Such notions of causality are devised in childhood to explain baffling experiences: an unresponsive parent, an ill sibling, social rejection.
They can persist long after they have outlived their usefulness, embedded in a patient's way of interpreting experience. A therapist listens for moments when these habitual ways of thinking are clearly revealed. Often they emerge in ambiguous situations where real information is lacking. In the breach, the mind falls back on its old explanatory devices.
One patient recently described such an event. His boss had walked into his office, asked to speak with him and hesitated for a moment by the door. My patient instantly "knew" what was going on.
He noted that his boss was smiling, with what he took to be condescension, and had remained standing, making the patient feel small and trapped at his desk. In the seconds before his boss spoke, the patient was convinced that he was going to be fired. He had done a good job, but his boss disliked him.
"And," I asked, "what happened?"
He paused for effect. "He gave me a raise."
We both burst into laughter. There it was.
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