Emotional pain & vulnerability and efforts to change consciousness

The cumulative burden of emotional difficulties, vulnerabilities and harm and their life consequences can leave those with emotional disorders vulnerable to being emotionally hurt. Apparently minor events of harm or difficulty can trigger a long history of pain and distress and manifest in reactions that seem disproportionate to the isolated event.

A strong disagreement over text message with a friend, about the actions of a mutually known person, resulted in Miss Wellne, a blogger who writes about her life and reflections, including experiences of borderline personality disorder, punching a wall and responding with multiple messages: “I was full of shame, anxiety, confusion and everyhing in between. I punched the wall, I wrote a bunch of shit to her, that I wasn’t trying to defend him and that I deserve to die because I’m his friend and shit.”

Though she deleted some of her emotional initial outpouring, her friend accused her of responding self-centredly and excessively, both in terms of emotion and content. Miss Wellne reflects: “So yeah, I guess now that I write all of this down I realize it all sounds pretty ridiculous and we’re both acting like preteens or something. But yeah, hello, Borderline. Again, I got so afraid of loosing someone that I drove them away by acting fucking crazy. If I just hadn’t written her like 15 messages after she stopped replying, we’d be all good.”

A “harmless” and “playful” comment made by the brother of blogger, Cherry Northern, that he should eat slower, caused Cherry to feel emotional pain, though he hid his hurt. The incident revived Cherry’s thoughts about moving out and living in isolation and away from scrutiny. He reflected on living with his brother: “I just feel a void within me and I can’t seem to fill it myself. And I hate to admit this, but I’m so robotic during conversations because there’s shit in my head that makes no sense for dinnertime talking. What I provide is minimal listening. I feel so inadequate.”

Cherry reflected: ” I’ve always felt that I’m not built of the toughest material. When I feel hurt, I feel the need to separate myself from human interaction. It’s the only balm that makes sense in the moment.”

The Amethyst Lamb, in a piece on practising gratitude, writes about turning attention to our personal sensations and appreciating small pleasures. She writes: “I want to be able to remember these truths in each moment. To keep them close to my heart. To allow all of this gratitude to flow freely from me always. What a different life that would be.”

Raised consciousness of oneself and moment-by-moment experiences, The Amethyst Lamb, suggests, can help control the triggering of “decades of my personal, unconscious reinforcement of that pattern of thinking”. She writes “…rather than focus on how upset and helpless I feel, I can focus on the fact that I have recognized this, that I am able to change it.

The Amethyst Lamb adds: “I may not feel different, but by following this intention and practicing it again and again, I will be different. Even if it’s hard to notice at first. And after all, what else have I got to do with all this time?” For writer, Emily Hawkins, the difficult first step is to simply slow down.

For Adrianna Carlesimo, her healing from social anxiety difficulties must include social awareness and activism: “If I heal my own social anxiety, on an individual level, I will live a much more peaceful life. My mind, heart, and body will be at ease in a way never before experienced. But what good is that if I’m not using my newfound voice, the voice that I had been suppressing to cope with my anxiety, to support humanity at-large?”

Social anxiety, in the grand scheme of humanity by Adrianna Carlesimo, The 30 Day Social Anxiety Experiment – January 24, 2021

Lost by Miss Wellne, The Life on the Borderline – January 27, 2021

Fresh by Cherry Northern, The Affliction Hunter – January 26, 2021

Practicing Gratitude by The Amethyst Lamb – January 26, 2021

Discontentment and Hurry by Emily Hawkins – January 23, 2021

Poems from a veil – 23 January 2021

The words go unread
like the rain

a bridge
of dusks.

upon the firs
the sun’s flock

watch them rise
to the tall trees
marking boundaries.

23/01/21

~

The rain
turned all around.

but not the ship
nor the sea

not the day
nor her night

the sparrows
will sing of walks
in other worlds.

23/01/21

~~

The night’s rain
heart opening

face of the stream

the fields
of white gulls.

23/01/21

Social anxiety symptoms can give rise to genuine social vulnerabilities

Cognitive behavioural models of social anxiety disorder are based on the idea of thought distortions in individuals giving rise to disproportionate experiences of fear. The use of the word ‘anxiety’ in the name of the condition, as opposed to ‘fear’, is sometimes explained as to distinguish the presence of an unknown threat or an internal conflict rather than an external threat. When assessing social anxiety disorder amongst individuals who experience stuttering, medical professionals more readily acknowledge the reality of threats, harm and vulnerabilities, arising from the impediment of stuttering.

In the case of individuals who have no obvious physical condition to explain the root of their social fears, CBT models sometimes tend towards denying validity to their overall experience, presenting fears as wholly irrational. Central to this approach is to present social anxiety as a fear of social evaluation or scrutiny, which limits the reality of the extent of social interactions. Social attack or harm can go beyond judgement, whether advertantly or not, to include words or actions to isolate, humiliate, dominate, manipulate or exploit. The most extreme social attack is threat of attack or actual physical attack.

The National Institute for Health and Clinical Excellence (NICE) guidelines defines social anxiety disorder as the “persistent fear of one or more social situations where embarrassment may occur and the fear or anxiety is out of proportion to the actual threat posted by the social situation as determined by the person’s cultural norms.” The Diagnostic and Statistical Manual (DSM-5) of the American Psychiatric Association (APA) adds that: “The individual fears that he or she will act in a way or show anxiety symptoms that will be negatively evaluated (i.e., will be humiliating or embarrassing; will lead to rejection or offend others).” Social anxiety disorder is diagnosed when symptoms are persistent, interferes significantly with normal functioning and recognised by the individual to cause unreasonable or excessive fear.

For people who stutter, social attacks and harms “typically commence in early childhood, including experiences of bullying, teasing, victimization, exclusion, and rejection.” Social and speaking difficulties might then be intensified by experience of negative reaction in social situations. Some of the social fear of people who stutter is considered to have a rational basis, such that, up until quite recently, the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR; APA, 2000) excluded the diagnosis of social anxiety disorder in people who stutter, if the fear was related to the stuttering.

Non-stuttering individuals who experience social anxiety disorder experience dysfluency and affected speech, including changes in voice acoustics and a reduced rate of speech with greater pauses in some anxiety provoking situations. It has been speculated that whilst other speech effects might be disguised, slower speech and more frequent pauses are difficult to conceal as they may relate to changes in cognitive activity. Working memory may be degraded by social anxiety in some situations – especially, in relation to information not connected to social threat.

Performance deficit is considered to be a factor in the maintenance of social anxiety, as safety behaviours such as avoidance prevent the exposure and practice necessary to develop social skills, increasing objective social deficits which may already exist due to the cognitive effects of anxiety. Anxiety and bullying were correlated in a study on university students, though the nature of the correlation is not clear.

Social anxiety disorder is said to restrict educational achievement, job performance, social functioning, personal relationships, and quality of life. It is associated with “low self-esteem, suicidal ideation, lower education and socioeconomic status, unemployment, financial dependency, and being single.”

The original vulnerability of non-stuttering individuals with social anxiety may not be physically apparent but the secondary vulnerability of its symptoms are often apparent. The fear that arises from the condition affects social functioning in some analogous ways to stuttering and can expose individuals to low social status or influence and to social harms, from rejection to victimisation and a lesser quality of life. Such experiences may contribute towards the maintenance of social anxiety.

The overt acknowledgement that social harm or threat exists as a cause of fears is a first step towards a more holistic approach to treating social anxiety. Whilst the initial vulnerability may not have clear rational basis, the secondary vulnerabilities, affecting cognitive and physiological functioning, do. For socially anxious stuttering individuals seeking treatment, speech and language therapy has been recommended, alongside CBT treatment which includes graded exposure. For non-stuttering individuals, treatment for individualised vulnerability, as well as CBT’s rationalisations and exposure will likely be beneficial. Recognition of the reality of social threat and harm and individual vulnerability will likely better enable patient and therapist to identify suitable gradations of fear exposure to reduce fears.

Addressing hopelessness and fear of the future

Trauma experts state that recalling and articulating a traumatic episode is a vital aspect of recovery, by virtue of integrating the experience into the individual’s life experience. Judith Lewis Herman, in her book, Trauma and Recovery, quotes Freud: “His illness must no longer seem to him contemptible, but must become an enemy worthy of his mettle, a piece of his personality, which has solid ground for its existence, and out of which things of value for his future life have to be derived. The way is thus paved… for a reconciliation with the repressed material which is coming to expression in his symptoms while at the same time place is found for certain tolerance for the state of being ill.”

At some stage, trauma sufferers also need to make the future part of their existence too. Herman writes of a stage of recovery from trauma: “She has mourned the old self that the trauma destroyed; now she must develop a new self. Her relationships have been tested and forever changed by the trauma; now she must develop new relationships.”

Loss of any sense of having a future can be a symptom of depression, as The Amethyst Lamb writes in a recent blog post, referencing the book Time Warped: Unlocking the Secrets of Time Perception by Claudia Hammond. The Amethyst Lamb writes “…depression also effects one’s ability to imagine the future. So not only do they feel like every moment is taking longer than it objectively is, they also cannot visualize a future for themselves. Granted, being depressed, they may only imagine an awful, bleak future if they can imagine one, but they are incapable of imagining things getting better. They can’t imagine things ever changing in general.”

The Amethyst Lamb goes on to suggest that inability to imagine a future for oneself may be used as a diagnostic indicator of depression and the increased likelihood of experiencing suicidal ideation.

The importance of addressing the present/future was presented in a study of major depression disorder sufferers from 2011. The study found that patients responded more favourably to what was called Future-Directed Therapy (FDT) rather than cognitive behavioural therapy (CBT) that focussed on changing negative thoughts about past events.

The patients treated with Future-Directed Therapy (FDT), conducted in a group environment, received support in skills for positive thinking about the future and in taking action to change their circumstances, for example, through goal setting. Whilst the sample in the study was small, the outcomes for those who received FDT was considerably higher for depression, anxiety and well-being scores.

Brain activity can vary from task focused modes, when the prefrontal “executive” network, which governs planning and impulse control, amongst other things, dominates brain activity to periods of anxious rumination, when the “salience” network, which processes emotions, takes charge, overriding other networks. Treatment for depression and anxiety which strengthens task focussed prefrontal network activity, may assist in an individual’s capacity to manage decisions and experiences.

In a recent blog post, The Meaning of Your Life, AP2 writes of hopelessness: “They stop believing that there is any point to life. They start believing that their suffering is in vain. So they choose to live their lives in pursuit of immediate gratification. Nihilism consumes and they choose pleasure over purpose.”

He writes, addressing his newborn son: “The truth is our lives hold as much meaning as we give them. Which is why you must give yours as much meaning as you possibly can. In your relationships. Your work. Your family. You must fill every corner of your precious existence with it.”

Hope and optimism is said to arise when, according to FDT, one feels the capacity to achieve a desired future state and reach what one wants. Obstruction to achieving or imagining a future desired state causes distress. One of FDT’s principles is that: “Preparing for the future is essential to thriving and much of human functioning has evolved for the purpose of creating the future.”

Judith Lewis Herman, in Trauma & Recovery, suggests that reconnection with oneself, others and a community, are necessarily aspects of recovery. Imagining a future for oneself, for anxiety and depression sufferers, will also likely involve these connections in safe environments – as well as connection with painful memories. In the meantime, meaning in one’s life may, as AP2 suggests, be found in its meaninglessness and the opportunity this offers us.

Mental Health & Time Perception by The Amethyst Lamb – 14/01/21

The Meaning of Your Life by AP2 – 06/01/21