Use Eagles if Necessary, Chapter 7: Making a Diagnosis
The emotional system is subject to illness just as are the various parts of the body, but to isolate an emotional illness, and put a completely accurate label on it, is often impossible. A bodily illness, on the other hand, may exist without interaction with another part of the body. Many cancers, if caught early, are isolated and can be surgically removed before they spread. Broken bones can be re-set and heal completely. Sprained muscles will, in time, heal themselves.
But mental illness must be treated holistically. Whatever the presenting symptoms — depression, anxiety, sleeplessness, phantom pain, panic attacks, phobias — none will stand alone. But the therapist must state a diagnosis for the insurance companies who insist upon them and often pay the bills. So sometimes we have to wing it. Back in the good old days the diagnosis was always, “anxiety condition,” no matter the presenting symptoms. We did not want to label people for the rest of their lives with a specific illness. Now we must, even though it’s often not accurate.
The America Psychiatric Association publishes a Diagnostic and Statistical Manual of Mental Disorders (DSM). It’s become the bible for diagnostic purposes and contains a dozen or so classifications with a sub listing of the symptoms. However, if you read the symptoms it becomes clear that few patients will match the classifications exactly. And for good reason. Emotional illnesses do not occur all at once, like measles, the flu or cracked ribs. Emotional illnesses are contracted in stages, as in ages, during our formative years, and they overlap. Nobody will have “just one.”
Human beings go through four distinct stages of emotional development before the age of 7, and each of these stages leaves permanent imprints on their adult personalities — both good and bad. It is fun to observe them, and anyone who has raised kids will recognize them. The four stages follow, the ages are approximate. The positives and negatives are not all-inclusive.
Oral — from birth to 18 months:
Adult Positives: Be able to communicate clearly, to enjoy food, to sing, and write. Be able to put trust in others.
Adult Negatives: Obesity, alcoholism, smoking addiction, eating disorders. Speaking at a barely audible level or, conversely, talking too loudly or too much.
Anal — from 18 months to 3 years:
Adult Positives: Be organized, be in control, be efficient, able to make decisions and stick to them. Artistic.
Adult Negatives: Being slovenly or obsessively neat; thinking in extremes – either black or white, good or bad, pretty or ugly. In other words, being unable to see the grays of life. Always being late for appointments, cheap, compulsive, hesitant and ambivalent.
Phallic — 3 years to 5 years:
Adult Positives: Be a leader, take reasonable risks, defend yourself and others, be accepting of life’s challenges, and be able to share. Not fearful of competition if the playing field is even.
Adult Negatives: Be physically and verbally abusive to weaker people, arrogant, daredevil, believing winning is everything, being insensitive to the feelings of those around you. Hunting — if you do so because killing is fun.
Oedipal — 5 to 7 years:
Adult Positives: Be able to maintain a long-lasting and intimate relationship with a member of the opposite sex.
Adult Negative: Be unable to do so.
Any of the negatives above qualify as symptoms of emotional problems. It then becomes a matter of degrees.
So rather than using diagnostic labels, another system to diagnose patients would be to use numbers — as in ages — the emotional ages of the patients. In a sense, to be emotionally ill is to be childish. For instance, a manic-depressive (now called bipolar) is a person who suffers from mood extremes from euphoria to despair. This is normal for an infant but not an adult. An 18-month-old lives in a delusional fantasyland of self-absorption, not unlike those with untreated schizophrenia.
A psychopath is a 2-year-old: “When nobody’s looking, I’m going to bite my baby brother.” A sociopath is 4 — “Stealing stuff is wrong if you get caught.” Those who can’t maintain friendships and those who can’t stay married are 5. Pouters are 3. Depression is the 4-year-old in the nursery school, off in the corner by himself, head down, not interacting with the other kids. On the outside he’s in a stupor. Inside he’s screaming, “I want my mom!” A pedophile is sexually attracted to children — just like children. He never grew up.
Because our dominant emotional traits, which we carry throughout our lives, have their beginnings in our formative years, each can be traced to a chronological age of emotional development and sometimes people get “stuck” at that emotional age (or ages). In other words, their adult personalities have retained childhood thought and behavior traits that should have been abandoned. The narcissist thinks he’s somehow entitled. He learned of his “specialness” when he was 3, but should have figured out that his entitlements were relative to his actions by the time he was 7. The stingy person learned the value of hoarding at age 2. He never got to the eminently more rewarding stage of sharing — at age 5.
Neuroses is a term we hear often. It’s a catch-all diagnosis and none of us are immune. We neurotics experience fears or guilts that have little or no basis in exterior reality. In other words, the fears and guilts are all in our heads. They are no less real to us, however, and can not only be debilitating but take many forms that initially seem unrelated. But nothing in the mind stands alone, and a purpose of psychoanalysis is to make emotional connections. The patient does this by first connecting with another person, the analyst, who then helps him make his personal connections with his own emotions and demonstrate how they are connected to his past. Patients eventually learn to do this alone. Emotional health is about connecting both within and without.
Neuroses may also manifest themselves in the body. Elusive pain, excessive perspiration, persistent diarrhea, constipation, headaches, stomachaches, racing heart, rashes, hypertension and ulcers often have neurotic causes. I have treated patients with all of those symptoms and, without addressing any of them directly, over time they mysteriously went away without any medication. It has been known for centuries that the mind and body have a psychosomatic relationship. Experienced MDs are aware that many of their patients are not physically ill. Although the symptoms are body-based, their causes are psychological.
But a word of caution: If you have a physical symptom you should see a medical doctor before visiting a shrink. Chances are your headache is caused by the fact you hate your job, despise your spouse, are in the middle of bankruptcy, or lost someone dear. But you never know.
Our emotional make-up is in our unconscious minds. To change it we need help from another human being because our emotional systems were developed by interactions with other human beings — when we were kids. One of the interesting aspects of this phenomenon is that parents tend to stifle their children at the same stage(s) of personality development that they were stifled. They’ll be doing it without conscious awareness, however.
When we get into late teens and early 20s we all agree on just how poorly we were raised by our parents and vow not to do the same to our kids. But we do. Let’s say a man is a super tightwad and pack rat who only begrudgingly spends a nickel, just like his dad. From this personality defect we can infer that his toilet training (and his dad’s) did not go smoothly. But when he has children he also will also err with his 2-year-old. Chances are his offspring will be just like him, so tight they squeak, or just the opposite, spending money with abandon. He will create an “either/or” person as his kids pass through the anal phase. He can’t help it. “We should do unto our children as was done unto us,” is a program on hard drive in our unconscious minds.
Parents raise their kids the same way they were raised, psychologically, because it’s the only model they know. This is unfortunate. We live (and always have) in a world of jealously, hatred, indifference, pettiness, selfishness and greed. These are childish emotional qualities that should have been outgrown. As a species we have been psychologically slow to mature. I’d say the more advanced among us are about 4 years old emotionally — the phallic stage. Whether between nations or within our own families, we can’t seem to quit fighting.
Most people, I think, are about 2 years old — the anal phase. The need to control others is their preoccupation — think like me, act like me, believe like me. They wear righteousness and narcissism as badges of honor. They are self-absorbed, unable to explore, or even listen to, the unfamiliar.
Years before I became a psychoanalyst I had a friend who grew up in Brooklyn, fought in the Pacific during WWII, became a Trappiest monk for 18 years then rejoined the outside world as a diocesan priest. He preached a sermon once on this very topic of emotional aging, saying that the church is an evolving institution and, in his opinion, was currently about 4 years old. This upset many parishioners, but I loved it and never forgot it. The point he made was that the church was preoccupied by innumerable rules, regulations, trappings and ceremonies which obstructed her essence — teaching the messages of Christ. “There’s nothing Christlike about a cathedral!” he said, adding that the grandeur blinds us to Jesus’ messages of love, simplicity and forgiveness. “We lost our way centuries ago and now we’re stuck!”
Unfortunately for us we cannot construct our own emotional systems. That was done by others before we were aware enough to pay attention. Therefore, we can not undepress ourselves any more than we can give ourselves depression. We can, however, take charge of our intellectual growth to become doctors, lawyers, scientists, and mathematicians. We can also consciously set out to be CEOs, senators, presidents, and popes. And if we work hard enough, are smart enough and get the proper breaks along the way we can achieve these goals.
“Sheila,” (who was 22) another shoplifter, came to see me as ordered by the court. She was very talkative and in the first session informed me that she did not “believe in psychotherapy” and she also hated men. “They are all assholes,” she said, looking me right in the eye. Sheila made me laugh.
But over time we connected and she told me of the numerous sexual encounters she endured from her two older brothers from the age of 7 until she left home for college. “I told my parents about it but they didn’t believe me. My lying bastard brothers denied it and my parents believed them instead.”
So Sheila was emotionally stuck at age 7, making it difficult, if not impossible, to have a healthy relationship with a man. We spent many painful sessions re-living those years of her life when her brothers took advantage of her. One day, after perhaps six months, she came to her session smiling and said, “Last night I thought of something. I have put my complete trust in you — told you things I’ve never told anyone — yet you are a man. Maybe I was wrong about men. Maybe they’re not all assholes.” That’s how analysis is supposed to work — re-live childhood to correct the harmful input, and replace it with the healthy.
Although it would be diagnostically sound to use ages rather than the often nebulous labels of the DSM, it is probably best if we stay with them. To tell a 35-year-old with a compulsive personality that he is emotionally a 3-year-old would be insulting. Better to simply label him OCD, or whatever, and be done with it. Besides, whether we use names or labels for diagnostic purposes, the psychotherapeutic approach will always be the same: “Tell me about yourself.”
The psychological community can not take credit for discovering the importance of childhood on the human personality, except for defining the specific phases of its development. One’s family background was always a barometer of a person’s character. Thus the expression: He or she is from “good stock,” (not unlike a Hereford). In the 18th century, 150 years prior to modern psychology, the concept acquired a sophisticated voice when the English poet, William Wordsworth, simply stated, “The child is father of the man.” In the 19th century William Ross Wallace wrote another profound truth, “The hand that rocks the cradle is the hand that rules the world.”
Waynesville resident Jim Joyce’s memoir, Use Eagles if Necessary, is being published in weekly installments in The Smoky Mountain News. Each week we begin a chapter in our print edition and then put the entire chapter on our Web site. All previous chapters are available online. The book can be purchased at rockpublishing.com/eagles.htm, and may be ordered through bookstores after May 31.