People who are phobic, paranoid, and obsessional—and everybody else
Each of us comes to believe certain things about the world. We take for granted that our perspective is objective and accurate—whether it has to do with religious or political ideas, or simple facts, such as historical or scientific facts. We know other people think differently; but, plainly, they are wrong and we are right. Usually, the people we know really well, including our families and friends, and including also the particular sources of information we listen to—whether it is the New York Times or Fox news—agree with us.
We all understand that there are strange people out there who live in strange, foreign countries, who dress in strange outfits, who think differently than we do; but we tend to think of them in the same way we think of people who lived long ago—in the time of the Roman or Chinese Empires. They were and are human beings, just as we are—but we understand the world the way it really is. Those people who lived long ago had absurd, even amusing, religious views. However seriously they held to them, those beliefs are what we think of today as mythology. Their political ideas were overly simple. Kings ruled by divine right. The histories of their countries seem to have been merely one war after another. We live in a more sophisticated time.
This sort of self-delusion is true of ordinary people. It is true for all of us. What we believe—what we think we know—is a function of our past experience, colored, in turn, by what others have taught us.
It is only when we are suddenly taken away from our familiar places that we suddenly see that there are radically other ways of living and behaving. This is sometimes referred to as “culture shock.” America, being what it is, is full of people from different places and backgrounds who are always bouncing up against each other. Perhaps for that reason we are more tolerant. Or maybe not. Putting aside those out-and- out prejudices we are all familiar with—anti-Black, anti-Irish, anti-Semitic, anti-Hispanic , and anti-practically everyone by some people, there are more subtle, less invidious, prejudices. These are simply habits of mind.
I notice some issues coming up all the time. For example, immigrants to this country expect their children to take care of them when they become old. Their children, if they have been brought up in this country, are more likely to arrange for someone else to care for them, including placing them in a nursing home. It is easy in this situation for parents to get their feelings hurt. Immigrants are more likely to be religious than their children, more likely to take seriously family life, and, I think, more inclined to work very hard. Or so it seems to me practicing in the same community for many years.
Certainly, the values of immigrant parents are likely to conflict with those portrayed on television and in the movies. Attitudes about sex, especially pre-marital sex, are generally different. Some immigrant parents strongly oppose their children marrying out of their faith. Some go further. They want their children to marry people from exactly the same background that they themselves came from.
I remember an Italian family who was very upset when their child was threatening to marry someone who was Irish.
I remember another woman who was expected to marry not only someone who was Muslim, as she was, but Shiite Muslim, as she was, and, further, the exact offshoot of Shia that she was.
These social intergenerational conflicts are well-known, but what people know of the world itself may be different from one place to another and one generation to another. One generation knows all about plants and how to grow things. The other knows about financial instruments.
But their knowledge of the physical world around them is also determined by their background. People see things they expect to see. I have a patient who listens to his ancestors who are all around him. He is not deluded. He came from a culture that believes in ancestor worship. I once had a different patient who used to communicate telepathically with his mother in Puerto Rico at a set time every Friday. He was not crazy either. His mother was a willing participant in this practice which was common in the community in which they grew up. A similar practice is “talking in tongues,” which seems bizarre to some, but which is encouraged in certain Christian sects.
These prejudices operate all the time in small ways. Once we make up our mind to see something a certain way, that is what we continue to see—even if there is no sense to what we see. It is a kind of ignorance.
I grew up in a parochial atmosphere in New York City. I knew all about New York City, which I thought, was like knowing all about the world. When I moved to suburbia, I was startled to see all the squirrels running about. “Who was feeding all the squirrels?” I wondered. The only squirrels I had ever seen lived in New York City and survived on handouts from elderly women who sat on benches in Central Park. Similarly, I was startled to discover that dandelions, those wonderful little plants that looked like a ball of cotton—and you could blow their seeds all about—were the same flower as that little yellow flower that also appeared randomly on the grass. And It was only when I saw my elderly neighbor on hands and knees on my lawn digging up the dandelions that I discovered that they were undesirable weeds, even though practically every part of the dandelion was beautiful, and also edible.
Similarly, my first few days walking around the campus of Princeton University, I saw students wearing sweat shirts that said, P.U. in capital letters.” P.U.,” usually spelled “Pooey” in the comic books, meant something that smelled bad. If I did not have that prior association to that expression, I like to think I would have figured out a little quicker what the letters stood for. And it did come to me after a few moments that P.U. might refer to some college, University of Pennsylvania, perhaps. All this while I was walking around the campus of Princeton University.
I am not stupider than everyone else. I was simply seeing the world through a rather narrow set of experiences.
There is a small bus that travels around near my office. It has written on its side, “Invalid Coach.” I thought to myself, “Why is that coach not valid?” It was some time before I realized that the bus I was looking at was used to drive around people who were physically disabled. I was reading the sign wrong, and once I thought of it that way, it was hard to see what it was actually saying.
I have written in a different blog post about how mirrors lie. People look in the mirror and tend to see what they expect to see. An anorexic can see herself as just a mite overweight when she really looks, as she described herself after looking at a photo that had been taken of her, as a “concentration camp victim.”
It seems sometimes like truth is barely relevant to what people believe.
The essential element of all forms of psychotherapy is to disabuse patients of certain prejudices that they have about themselves and about the world. Take for examples, a phobic person who believes he is going to go crazy if he is ever trapped in an elevator; or the hypochondriac who believes skipping a bowel movement for two days will endanger his health, or the anxious worker who thinks she will be fired if she makes a single mistake, and so on. Some worried men and women exaggerate all sorts of risks. Some who are depressed imagine being abandoned if someone looks at them crossly.
The therapist, however he conducts therapy, argues against these misinterpretations of the world, And, it turns out, the truth of things does matter. With the right sets of experience treatment is successful. But it is hard work. People are stubborn. I often have to demonstrate by example my feelings that it is okay to jump up and down in an elevator– or, for another example, to eat food off the floor. (Eating off my particular floor, which one patient accused me of purposely dirtying up, may not convince a patient that doing so is safe, but it will convince him/her that at least I think it is safe.) Sometimes, if a patient is afraid of the side effects of a drug, I take the drug first.
I once had a patient who was convinced on no evidence at all that she had hypoglycemia—low blood sugar. Not only that, but she said she could feel when her blood sugar was dropping. I told her that was not so, but her own experience proved that she was right, she said. It was important for her to know the truth because she was going through life with a tranquilizer in one hand and a carrot in the other—“just in case.” So, I brought her into the hospital and took blood whenever she felt her blood sugar dropping. On every occasion her blood sugar was normal. But I did not convince her she did not have hypoglycemia; I convinced her that our laboratory was incompetent. It was only much later, when she had put aside the carrot, and fasted, as a way of provoking a possible hypoglycemia, that she finally understood that her symptoms were simply those of anxiety. Cognitive-behavioral therapy is an attempt to change ideas and behavior in similar ways by introducing a more or less prescribed set of learning experiences.
Naturally, the goal of treatment is for the patient to see the world and to see himself/ herself realistically—not entirely accurately, since that level of objectively is impossible—but well enough to manage life successfully. I would like patients to consider that they do not yet know themselves as well as they think. People fall in love sometimes with just the kind of person they always disliked. They are capable of feats of heroism—and cowardice—that they could never have imagined themselves doing. Given just the right circumstances—the wrong circumstances—most people are capable of committing acts they disapprove of. Even criminal acts. But it is hard to give up the idea that we really know ourselves—having lived with ourselves throughout life. And we are likely to believe that, at least in some ways, deep down, we are better than others
So, when patients find themselves falling short of their expectations, I would like them to be forgiving of themselves—and of others too. Those who occupy themselves much of the time with looking down on other people usually are overly critical of themselves also. (c) Fredric Neuman 2013