Medicating Feelings

“I can't stand all this stress. I just want these feelings to go away.” And so, he typically pours himself a double martini and downs Valium (or two) in an attempt to make them go away. The trouble is the feelings don’t actually disappear; they just become alcohol-soaked and distorted.

It doesn’t have to be alcohol, though. There are as many ways to medicate away emotions as there are people. Some people drink; others use marijuana, cocaine, Oxycontin, Xanax, or some combination thereof. Still others eat their feelings, using food to find comfort. Sex can be another means for medicating feelings, as can gambling, watching TV, looking at pornography, playing video games or surfing the Internet for hours and hours.

Medicating uncomfortable emotions—making them “go away”—is a fairly common means of coping. It’s a quick “fix”. Unfortunately, self-medication does not offer viable, permanent resolution to the stressors of life. And in fact, self-medication often creates additional problems, addiction being most prominent.

I realize I've written about self-medication before (see Looking for that Magic Pill). However, the impulse to medicate away feelings through a variety of means is a common theme in my practice, one that clients return to again and again. And so, I return to it here.

We tend to make judgments about our feelings, deeming them “good” or “bad”, trying to exorcise them with “shoulds” and “oughts”, and sometimes developing habits designed to alter them. Uncomfortable feelings—pain, loneliness, anger, grief, anxiety, sadness, shame, guilt—are judged with special harshness and severity; they are the emotions we most want to be rid of and they are the emotions around which habitual self-medicating behaviors are likely to develop.

Significantly, we also develop beliefs about our feelings and self-medicating behaviors:

“It is not OK to feel certain feelings. My feelings are bigger than me and can destroy me. I’m not competent enough to cope with strong feelings and therefore need something to help me. I don’t have enough strength to manage. If I don’t immediately do or take something, I will be in the grips of this feeling forever.”

Or, "if it feels good, it must be OK."

These beliefs are often reinforced when we self-medicate. Habitually reaching for alcohol, turning on the television, surfing the web for internet pornography (or however we try to alter our emotional state) to escape or alter feelings has a subtle, but powerful, impact on how we think about and experience ourselves: our perceptions about ourselves and our thinking becomes distorted. We begin to believe that the power to cope, the power to soothe ourselves rests outside us. We begin to believe “I am not enough. I am inadequate.” On a deep level, we identify with powerlessness.

Self-medication—whatever form it takes, however it is done—often impedes our ability to live fully. It is a common path to addiction.

(A word about prescribed medications. There are psychiatric and medical conditions that necessitate the prescription of medications. These medications have a particular purpose and are typically monitored by psychiatrists, physicians, or other licensed medical professionals. These medications are meant to help regulate body and brain function and are not meant to eliminate emotional states. While these medications take the edge off anxieties and depressions, they are tools that support behavioral change and emotional coping. These medications are not prescribed to take away feelings.)

Feelings are part of life. Feelings give human life texture, color, and shading. Most of the time, we are not fully aware of our feelings. It is usually only when our feelings are strong that they command our attention. Nonetheless, feelings are in constant flux: they come and go, rising and falling naturally throughout the course of the day. Feelings do not last forever.

Feelings can be great teachers. However, they can only teach us if we are willing to be present with them, pay attention, and cultivate curiosity about them. Much of psychotherapy’s work centers on attending to the landscape of our feelings: learning about their nuances, discerning the pathways feelings travel, discerning relationships among feelings, and developing insights about them--insights that can transform our lives. Psychotherapy will also address the patterns of self-medication. Indeed, understanding those patterns can open a door onto the deeper feelings that are otherwise hidden, suppressed or distorted by self-medication.

Many people enter psychotherapy hoping that the therapist will “make the feelings go away.” Those seeking a quick “fix” will surely be disappointed. (Even prescribed psychotropic medications take time to begin working. There is no magic pill.) But those willing invest the time and energy to cultivate curiosity about their feelings will find their efforts rewarded with lives fully experienced.

Psychotherapy offers alternatives to self-medication. Therapy can help you learn to accept feelings and help you manage their rising and ebbing. Therapy can help you develop perspective on feelings and develop new beliefs about them. And therapy can help you develop insight into your feelings—insights that can eventually transform your life.

The Hurt Underneath

Something happened to trigger the client's rage just before group was to begin, and the client came into the group in a fury. He had enormous difficulty reporting the incident. But once the details emerged, it became clear that his angry response was out of proportion to the actual event: loudly explosive, with an energy that signaled an imminent loss of control, mere steps from actual violence. Over the years, I’ve had a lot of experience with helping angry clients, but I felt a bit anxious in the presence of such volatility, concerned about being able to insure safety while helping the client and the group manage and work through it. Nonetheless, the group helped the client regain enough control so that he was able to recognize what had happened. He spoke of feeling that “my brain is like scrambled eggs right now”—a vivid image that illustrated the level of his activation as well as his confusion and his experience of being out of control. He described his rage as “like being suddenly trapped in a space that gets smaller and smaller. I’m determined to get out and will do whatever it takes to get myself out of it.” Another client commented that “When I get angry I hurt people. I know how to hurt people; getting mad and getting violent is how I survive. I hurt them so they wouldn't hurt me, or so that they would stop hurting me. I don’t want to hurt people, but it’s what I do when I’m in that space." Yet another client said "I don’t get angry; I go right to rage. And when I’m in that place, I lose sight of all the consequences that can occur. When I think about it, it really scares me because I realize that I’m capable of anything. And then when the anger is over, I regret what I did.”

These men have all experienced rage; they have all experienced the consequences of out-of-control anger. They are slowly, painfully learning about their anger’s triggers, patterns, and nuances; and they are learning specific techniques for better managing it, without violence or negative consequences. They are learning about and trying to change their own thinking. Indeed, the group’s members are encouraged to look at their beliefs about anger while also developing new skills for managing it. And they are admitting that they are actually frightened of their anger.

But the most challenging aspect of the work centers on perceiving the connections between anger and the pain that anger can mask. The hurt underneath the anger is acute, and getting at that hurt is a slow, delicate process. The hurt underneath is a vulnerability. For most of us, acknowledging the pain, fear and vulnerability that arises in tandem with anger/rage is very difficult.

It’s all too easy to see only the anger. It’s dramatic and gets attention. The trouble is, anger is an effective means for hiding pain. Anger can be defensive. It can push people away, preventing anyone from touching what is most painful. Quite frankly, anger and rage can be scary. (The men I've quoted know just how scary they can be; they know just how frightening they appear to others, and they know how close they can come to outright violence—and most of them are afraid of themselves when they feel themselves veering toward rage; they are afraid because they often feel powerless to control their anger.) Paradoxically, what many people—the men in the group included—really want is to feel connected with others so that they can safely connect with and heal their pain. However, it’s hard to be around angry people, and most of us keep angry people at arm’s length whenever we can. And so the deeper pain remains raw and unhealed.

Anger that is out-of-proportion to its immediate cause almost always has roots in deeper conflict and pain. So too with displaced anger. Psychotherapy—both individual and group therapies--reaches for that pain and tries to help each person understand it; psychotherapy helps clients understand how pain manifests as anger, and learn how to manage anger and pain’s impact in the present. The pain can be rooted in traumatic events, unresolved conflicts, profound losses, abandonment. Identifying the hurt beneath the anger is an important step toward healing and being able to manage anger in a healthy manner. Many of the men in the group have difficulty acknowledging, much less being in touch with, the pain underneath and instead have learned to enact it—usually with terrible consequences to themselves and others. But until the hurt beneath the anger is identified and worked through, explosive, destructive anger will continue to manifest.

The group helped the client understand that the anger he was expressing was largely rooted in his past, and that the immediate trigger merely tapped into all that repressed anger. The group helped him separate the past from the present and helped him develop strategies for managing the here-and-now anger, and encouraged him to work through the older anger in individual psychotherapy. At the group’s end, he thanked his peers for helping him and expressed hope that he could continue the work that would help him “be a better man.” The group had done its job.

*Note: In order to respect and protect the confidentiality of the clients, I've omitted identifying information. I've drawn upon and condensed material that had developed over a long period of several group processes. I received permission to quote the men. As one of them said, "if my experience helps someone else, it's important to share it."