All posts by Bruce Hearn

Getting to “Know Thyself”

Most frequently attributed to Socrates in several of Plato’s works, the expression “Know Thyself” is heard today as an exhortation to get in touch with and clarify your innermost wants, fears and desires. When we hear it, you can almost see the liberal arts college Valedictorian speak: “go forth, young graduates, with the self-knowledge that our college has (presumably) helped you acquire!” If we take a step back from our information-grazing to inquire, in the midst of our lives, what can it mean for us today to pursue self-knowledge?

The question touches on the ways in which our thoughts and actions can be mediated by our emotional reactions, what is sometimes called the unconscious, what some today call “implicit knowledge.” Socrates encouraged his companions to investigate their thoughts and he would sometimes identify what he saw as the reactive emotion that gave rise to them. If you can work to become less reactive to your emotional triggers, you can still allow your experience to inform your perceptions without being overwhelmed. Fast forward to the 21st Century and in some regards not much has changed. Awareness of our emotional experience is even more central to what we now consider self-awareness.  Each age answers the Oracle’s “know thyself” with a new answer. Today we can see our emotional picture as a fundamental form of self-knowledge, a knowledge that precedes philosophical inquiry which deeply informs our perceptions.

Socrates was mainly concerned with the content of thought, using dialectical reasoning to encourage his companions to deepen their ways of thinking. It took until the early 20th century before Sigmund Freud revolutionized the way we think about emotions by proposing the existence of the unconscious, working to free his patients from repressed emotions. Since Freud, what we know about emotions has grown to include knowledge about how the brain and its structures work, which has changed the way we think about emotion and the language we use to describe it.

We now know that emotionally laden memories are processed differently than more regular memories. A brain structure called the amygdala is involved in storing emotional memory and such memories cannot be easily recalled by the conscious mind but are cued by association and may be experienced as fragmentary and surprising. We often react out of fear without knowing why we are reacting that way.

You can develop greater self awareness by paying attention to the ways in which you are triggered. It helps if you can allow some time to reflect on what happened, to question a reaction or decision you made in retrospect.  It also helps to develop an awareness of your in-the-moment emotional experiences. One path to take is that mindfulness. People have practiced mindfulness for thousands of years. Mindfulness can help you to observe the chatter of the mind as it happens, and if you do it enough you will see patterns emerge. In the West, mindful meditation often seems to be practiced in solitude. By contrast, in traditional Buddhist practice, there is always a mentor, a more experienced guide who can give the disciple confidence in their unrealized potential.

This person can reflect back to us some of what they have seen, and therein lies the chance to gain self-knowledge. They can sometimes be off the mark, and we usually have a felt sense that this is the case when they are wrong, but this can also clarify for us what is not emotionally true, which moves us along the a path of dialectic reflection. With this person you can experience being known, of seeing yourself come into view. This attuned companionship can help you see beyond the explicit level of conscious awareness. And this is where it is clear that this type of relationship is the province of psychotherapy, but not exclusively. You might be fortunate enough to experience this in another kind of relationship with some kind of mentor, or a friend or relative who has developed a high degree of emotional self- and other-awareness. Yet what makes experiential psychotherapy such a powerful resource in the project of self-awareness is the sustained focus on the careful unfolding of the self.

Socrates attributed the phrase “Know Thyself” to an inscription at the Temple of Apollo in Delphi, where people would go to ask the Oracle questions about themselves. Perhaps the Oracle would be satisfied with the paradox that to better know yourself, you must be known by another. We are fortunate to be able to have a kind of emotional experience that has the potential to change our perspective on the world and our place in it. To deepen the way you can know yourself is to deepen your relationship with another.

Becoming a Better Partner Through Empathy

Your partner is upset and lets you know about it. You want to make her feel better, so you say, don’t worry about it. You’ll feel better in the morning. Don’t let it ruin the evening. Let’s put on some music. How about going out for a drink? Let me tell you about my day so that you don’t have to think about yours. Let me tell you what I’d do in that situation. Or perhaps you feel offended, hurt that she’s criticizing you, so it’s hard to take in anything else she’s saying. Does this sound familiar? We all do this to some extent and we’ve all had it done to us.

Your partner won’t always appreciate your efforts. And if she does, there will still be a part of her that won’t feel understood. She might get angry with you, tell you how selfish you’re being. She won’t feel like going out or listening to music. She might even seem to be hell-bent on ruminating and wallowing. Nothing seems to help. Then you might get frustrated and hurt. You might give up, play a videogame, watch TV. Now you’re disengaged, trying to distract yourself from the tension that has come between you.

Wanting to approach your partner’s pain is hard, you try to avoid pain. Most of us don’t like being put through the wringer. The bad news is that you have to be willing to feel some of what she’s feeling yourself, to let it in, and this is a lot to ask. This is where we can use our relationships as a gym, a place to work out the emotional muscles, gradually increasing the load that you are able to lift. This is the empathy zone, the place to develop emotional muscle, or if you prefer, emotional intelligence.

When you slip up and notice that you did it again, going too quickly into problem-solving or minimizing mode, trying to preserve your mood without letting her affect you, know that this does get easier with more exercise. This is a long term relationship, and you’re in a long-term training program. When she sees you’re making an effort to hang with her in that dark place, it can make her feel that maybe she can rely on you. Even if there are no immediate solutions that would help, you’re there with her, and that’s really the main thing that matters. Leave the problem-solving for later, if it turns out to be needed at all.

Brene Brown, a well-known psychologist, studies emotion and empathy. Take a look at the video she presents here on empathy. It’s a few minutes long but captures an important quality of empathy.

Thinking about Medication for Depression?

If you have felt down, discouraged, isolated, lack motivation, or no longer enjoy work or personal relationships as you used to, you might be clinically depressed. Many people consider antidepressant drugs when they feel this way. It can be an easy step to take, though many have reservations. Today, anti-depressant drugs are viewed as the first-line treatment for clinical depression, but there are good reasons to think twice before signing up for the pills, which experts agree are not effective except in cases of severe depression.

When you lose employment, it’s normal to feel sad, discouraged and anxious. Experiencing the loss of a loved one can be very intense and complex, overlapping with symptoms of depression. Modern life has many people living physically isolated from one another, with one quarter of American adults living alone, and even when the isolation is not geographical it can be emotional; the lack of direct emotional contact with others is an increasing social phenomenon. One of the most painful forms of isolation can be the experience of living with a partner with whom you do not feel connected.

Modern Times

The impact of loss and isolation and the technology-mediated societal changes we are living through today do not directly signify an increase in psychiatric disorders. Yet feelings of meaninglessness can easily infiltrate the sunniest of dispositions. People are often quite resilient and recover from losses on their own or perhaps with a little help from a spiritual counselor, family member, friend or therapist. Sometimes, normal sadness turns into a more serious depression. Depression can be recognized because of how much it impairs normal functioning. It becomes increasingly clear to friends, colleagues and family that something is wrong, though men and women may show it differently; men can isolate themselves, experience increased fits of anger and turn to substances or sex for comfort. Isolation doesn’t help matters.  Suicidal thoughts can turn towards planning, energy levels plummet, you can’t bring yourself to eat and lose the sense of pleasure in the things you used to enjoy. If you, or someone you know fits this description, it can be cause for alarm, and it becomes important to visit a doctor or therapist to assess your condition. Sometimes symptoms of depression may be caused by physiological issues, so it’s important to get a full physical to rule this out. In the rest of this article, I’ll be considering the implications around the use of anti-depressants on mild and moderate depression.

The Stats

To get a sense of the state of medication in the US, here are some numbers: the Center for Disease Control (CDC) reports that a full eleven percent of Americans over twelve years old take an anti-depressant. Primary care doctors are responsible for the majority of this prescribing. Most primary care doctors lack specialized psychiatric training in depression, anxiety and ADHD yet are the main prescribers of medications to treat these conditions, and physician office visits tend to be quite brief.

Few people wish to identify themselves as having a mental illness and don’t feel at ease in starting to take a drug. This may partly explain why doctors usually don’t diagnose people with clinical depression even when prescribing anti-depressants. People often have trouble consistently taking their medications, and some drop out as soon as they start to feel a little better, or perhaps a little worse. Side-effects of anti-depressants can range from dizziness, drowsiness, upset stomachs and loss of sexual appetite.

Consider that after hundreds of studies, we now know that anti-depressants are only marginally more effective than a placebo in clinical trials for mild to moderate depression. This is a shocking finding given how antidepressant medications are considered the first line treatment for depression.

The Chemical Imbalance Theory

From a medical perspective, the practice of treating depression with a pill comes from the chemical imbalance theory, the view that chemical imbalances in the brain give rise to mental illness. The assumption behind this traditional view of depression is outdated by modern research. Most of the time, it is not faulty wiring, but the effects of one’s isolation, of common sadness and self-defeating thoughts arising from difficult life circumstances or transitions that can lead someone to depression. Many people who suffer from depression experience constrained thoughts that seem to be stuck in a loop. When feelings of sadness and isolation lead to negative self-evaluations and unhelpful actions or inactions, a vicious cycle can be set into motion. Taking a drug like an SSRI to alleviate depression does not directly address the cognitive or emotional processes that gave rise to the imbalance. At best, in cases of severe depression, chemical treatment can help the brain to break away from the vicious cycle of depression. At worst, prescribed for mild depression, it can cause severe side-effects or even lead to the emergence of psychotic symptoms, hence the importance of regular checkups.

Non-Medical Interventions for Depression

It is commonly known that exercise helps with depression in mild and moderate cases, but it can be difficult for people who are depressed to get motivated to exercise. One study reported by the Harvard Medical School Health Publications showed that to gain a benefit from fast walking, it must be done for 35 minutes a day 5 days a week, or for 60 minutes 3 days a week. This sort of exercise has been shown to be ultimately more effective than anti-depressants as it leads to lower recurrence rates for depression. Studies of Yoga practice have shown similar results, with two 90-minute sessions of Hatha Yoga classes each week leading to significantly reduced depression, anxiety and pain. Group activities such as yoga can also help by providing a sense of belonging to a group, which people who otherwise feel isolated often can find very reassuring.

Therapy for Depression

Of the treatment options that seem to work well, group therapy, couples counseling and relationally and emotionally-focused individual psychotherapy have all been shown in studies to be comparable or more effective than anti-depressants around relapse. Couples counseling promotes supportive emotional bonds between couples that shield individuals against adverse conditions, so that you potentially lead a life reassured that your partner has your back. Groups can offer a valuable sense of community and the sense that you’re not alone, that others face issues as bad or worse than your own. The interpersonal connection of individual psychotherapy can allow people to develop internally, reshape their relationships and develop new perspectives on the world. When therapy provides the space to talk through difficult feelings and foster greater self-awareness, depression may gradually yield, allowing for a more honest accounting of one’s life and prospects.