( By K. P. S. Kamath )

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Inappropriate Coping and Its Consequences

1.What is inappropriate coping?

Inappropriate coping means one is not properly handling his painful emotions (fear, hurt, anger, sadness, etc.) as well as the stressful events (death, divorce, etc.) and problems (family, job, money, etc.) that are causing them. Invariably, people who cope inappropriately believe that they are handling their stress just fine. There are basically two inappropriate coping ways.

  1. Denial: When upset about something, some people pretend that they are not upset at all. They often make statements such as; ?I am not upset at all. I am just fine! I have no problem.? To throw listeners off track even more they often make fantastic statements such as, ?Oh! Things could not be better in my life!? Or, ?Oh! Everything is so wonderful in my life!? Or, ?I am blessed with the most wonderful things in life!? Or some such hyperbole. When asked a specific question many reply, ?My husband (or wife) is great!? Or ?My boss is marvelous,? and similar exaggerated stuff.

    The problem is that these people are hurting like hell in their mind and every one around them could see it. Inevitably the question arises in the observer?s mind: If everything is so wonderful in your life, how come you feel so miserable?

    Picture 10: In denial one tries to fool himself and others

    Temporary denial to protect us from the shock of a very stressful event is common and normal. When we hear about a terrible event, say, the blowing up of Twin Towers, our immediate reaction could be, ?Oh! No! It can?t be! It must be just a movie!? Here denial gives us breathing time to absorb the shock of the event. After the reality hits us, we admit to ourselves that it was a terrible experience. We react with appropriate emotions to the situation and go on with life. Some people, however, keep on denying in the face of overwhelming evidence to the contrary.

    A young man, who hasn?t slept in two weeks and has lost 20 pounds in as many weeks says, ?My wife left me two weeks ago but I don?t miss her. It is all for the best!? A middle aged woman married to an alcoholic for 25 years complained of depression, anxiety and aches and pains all over the body of 24 years? duration. She has been making rounds with doctors for over 20 years for a dozen different maladies. When asked about her husband she replied, ?My husband is a wonderful man. He drinks and becomes violent sometimes, but that does not upset me at all! We have a wonderful marriage. When he does not drink (which is not often!), he is a wonderful man. I love him!?

    Denial is not always this blatant. Subtle forms of denial are very common. ?We haven?t made love in six years. We are still close. I don?t think my husband is having an affair. He simply does not have the time for it!? An alcoholic?s denial of his drinking problem, ?I don?t have a drinking problem? is well known. Or that of a sexually abused woman?s denial, ?My father was a great man. I loved him even though he sexually abused me for years. He had a heart of gold!? Denial gets more and more blatant and bizarre as the person gets sicker and sicker. We can not blame him for trying to protect his already inflated balloon from becoming aware of the emotional pain. Healthy people are always in touch with, aware of and acknowledge their inner emotions and outer realities of life.

    Denial interferes with the act of expressing painful emotions, an essential coping mechanism. I have seen people who, while weeping uncontrollably in the interview, claimed that their tears were due to allergy, not because they were upset! A few vain women told me, ?What good would crying do? It would only mess up my mascara!?

    Denial breaks down when the individual talks to a person whom he trusts and perceives as compassionate, empathic, supportive, non-critical and non-judgmental. They usually respond to people who acknowledge their pain and make genuinely empathic statements such as, ?You must be hurting like hell!? or ?You are going through some rough times, aren?t you?? Or ?You must be feeling devastated by what happened to you.? If you want to help a stressed-out friend, don?t just start giving him a lecture or advice, such as, ?Stop feeling sorry for yourself!? Or, ?Enough of this pity party!? Instead, just push your friend?s empathy button and let him/her boohoo a little! Unexpressed emotions gradually get buried in the hidden mind, go out of one?s awareness and cause havoc later.

  2. Habitual Burying: When upset about something some people say to themselves, ?This is too upsetting to me, and so I will not think about it. I will not talk about it. I will not let this thing bother me. I will be strong. I will divert my attention to something else. I will do my best to forget it.? Painful emotions are transferred from the mind (the balloon) to the hidden mind (soda bottle). The balloon shrinks, the brain chemicals go back to their normal state, and stress symptoms disappear. One feels calm once again. Now he believes he has coped with his stress well, when in fact, all he has done is to transfer his emotions from his mind to the hidden mind. Once in the hidden mind, the painful memories are forgotten.

    Picture 11: Burying emotions shrinks the balloon and calms us down

    This process of forgetting is called bottling-up or burying. Psychiatrists use the word repression to explain it. (Repression is not same as suppression. In suppression one is fully aware of how he feels but he chooses not to disclose it.) Now one has fooled himself into believing, ?Hey! I am O.K.! I handled this upsetting situation very well! I have calmed myself down. I was strong through this entire ordeal!? As you will see, this is only a self-delusion.

    The habit of coping by burying painful emotions usually starts in childhood as children have difficulty in processing and expressing their painful emotions. But it is not uncommon to start burying in adulthood under trying circumstances. Burying is greatly facilitated by distractions such as vacations, cruising, skiing trips, trekking, etc. that take people away from the source of their stress. Through these and other multitude of mindless activities such as jogging, hot tub baths, driving around aimlessly, people often try to forget their pain. That is why you will find hordes of people who will swear by these activities. ?Drowning? one?s sorrow in alcohol; getting ?stoned? with illicit drugs; ?numbing? the mind with tranquilizers are also some of facilitators of burying. Burying gives fairly immediate relief from emotional pain. This quick relief further reinforces the habit of burying. In the long run, however, burying is bad news for its practitioner.

    To make bad matters even worse, our society today holds up people who bury emotions as an example of courage, strength, fortitude, and what not. Such misguided praise prevents one from normally expressing his painful emotions for fear of letting others down. ?I had to be strong for my children,? or ?I did not want my dying husband to see me fall apart,? ?I just could not let myself look ridiculous in front of all these people at the funeral,? are common statements I hear from people who ended up with depression and anxiety disorder weeks or months after the bad event. No one wants to be branded a chronic complainer, whiner, sissy, softy, milk toast and whatnot. Burying thus becomes a socially sponsored, promoted and reinforced habit. The type of burying we are dealing with here is habitual and permanent in nature, not temporary, as some people do to cope with an emergency situation.

2. What are the consequences of habitual burying?

While burying calms one down fairly quickly, it has many long-term disastrous consequences. It is inevitable that we get upset from time to time as life is full of bad events and problems. If burying becomes the standard way of coping with stress, soon one begins to feel as though the soda bottle is becoming saturated. The hidden mind/soda bottle does not have limitless capacity to stuff things in it. As time passes it becomes harder and harder to bottle-up emotions. The shock absorbing system now begins to break down. The result is that the hidden mind now becomes ?saturated? with painful, toxic emotions. The foundation for stress-related disorders is thus laid. Saturation of the hidden mind has two great negative consequences:

  1. Gradual return of stress symptoms: Over time one begins to notice that it gets harder and harder to shrink his balloon and to calm himself down. Emotions entering the balloon stay there and add to the ones in it already. As the balloon inflates, brain chemicals begin to change and stress symptoms begin to reappear one by one. Irritability, snapping at people, sleeplessness, sleepiness, anxiety, tension, sadness, poor concentration, memory problems, aches and pains, headaches, etc., follow. As the balloon gets closer to its breaking point, these people become increasingly intolerant of stress. When they get upset, they stay upset for longer and longer.
    Picture 12: Saturation of hidden mind makes balloon go up again

    How do we know this is happening? Listen carefully to people in this unfortunate predicament. They often make statements such as: ?Some years ago nothing used to bother me. Now I get upset at least little things, and I stay upset longer and longer!? ?I can?t take things like I used to any more!? ?Nowadays when I get upset, I stay upset. It takes me a longer time to calm myself down.? ?I am irritable all the time. I explode at least little things. I never used to do that before. I snap at people for no good reason.? ?I can?t stand noise or raucous any more.? ?I used to be a patient person. Now, I have no patience at all.? All these mean the same thing: One is not able to shrink his balloon any more; the balloon is getting fuller; one is not able to stuff things in the soda bottle anymore. These people now have low stress tolerance syndrome and are often labeled ?burned-out.? This is one step away from a full blown stress-related disorder such as major depression and panic disorder.

    How do people with low stress tolerance behave? People in this unfortunate predicament avoid stressful situations as though they instinctively know that their balloon is just ready to pop. They become increasingly intolerant to sensory stimuli such as noise of children or dogs, driving on high traffic highways , horror movies, crowded grocery shops, football stadium, etc. So they become increasingly ?withdrawn? from various activities, especially social activities, which have potential to upset them. This is their defense against anything that might pop their balloon. Unable to tolerate the tumultuous nature of full life, many of them sleep a lot and become recluses. They actively avoid parties and gatherings. They stop inviting people home for entertainment. They become less and less productive at work. They look increasingly stressed-out to others around them. Unable to focus in their work, many start making mistakes. Their productivity at work goes down. Over time they become dysfunctional at work as well as at home.

    If the unfortunate person seeks psychiatric help at this stage, depending upon predominance of his symptoms he would get one of many diagnoses. If one complains primarily of depressive symptoms, he could get a diagnosis such as ?dysthymic disorder? (minor, chronic depression); if one mainly complains of tension, nervousness and anxiety, he would get a diagnosis of ?generalized anxiety disorder? (low grade chronic anxiety); one reporting diffuse aches and pains would get the diagnosis of ?fibromyalgia?; one complaining of severe tiredness or exhaustion would get the diagnosis of ?chronic fatigue syndrome.? Some are diagnosed with high blood pressure. Others are diagnosed with irritable bowel syndrome. You get the idea.

    Almost all of these people deny they have any stress in their life, or, if by fluke they admit to it, they minimize its importance. Common statement I hear goes something like this, ?Oh! This is not stress. My mom had it. It is my genes! It is chemical imbalance!? Or, ?Of course I have some stress. Who doesn?t? I am handling it quite well!? Careful review of their past, however, tells a different story. Most of them had been trapped in a chronic, difficult-to-solve, life-problem such as bad marriage, bad job, financial problem, etc. And they had coped with their life situation stoically (being strong). By the time they see a psychiatrist, they have suffered from various stress symptoms for years.

    Some of these people?s balloon finally pops triggered by an upsetting new bad event or problem. This triggering event or problem is called the precipitating event. A precipitating event is the proverbial straw that breaks the already overloaded camel?s back. A precipitating event could be a major bad event such as death of a loved one; or a minor event such as loss of a purse. In the latter instance, the seemingly minor precipitating event brought up old buried trauma, and the fizz (buried emotions) spewing up into the balloon from the soda bottle caused it to pop. Now they suffer more serious symptoms. Again, depending upon the predominance of symptoms, this time around they get more serious diagnoses: Major depression; panic disorder; bipolar disorder; psychotic disorder and the like. As to what major disorder one comes down with depends upon one?s genes.

    Here is an example: A middle aged woman became severely depressed following the death of her 2nd husband of 6 years (her balloon popped). Her first marriage, which lasted for 16 years, was marred by severe verbal and physical abuse. She had coped with it by denying (making excuses) and burying (not thinking about it). By the time she divorced her first husband 8 years ago, her bottle was full and her balloon was almost full. She suffered from chronic low grade depression and anxiety for many years. Only because her second husband was supportive and kind to her, she was able to tolerate her symptoms and go on with her life. When the second husband died suddenly, the stress of his death caused her balloon to pop and she came down with a major depressive episode with psychotic features. Her diagnosis now was ?Acute on chronic depression.?

  2. Sudden reappearance of stress symptoms: Burying has another undesirable consequence. As we read before, a current precipitating stressful event could cause sudden resurfacing of buried emotions related to a bad event in the remote past. This means, the balloon gets a blast of painful emotions from the pump (a current precipitating event) as well as spewing up painful emotions from a major past trauma (fizz from the vigorously shaken soda bottle). When this happens, the balloon inflates fully instantly and one suffers sudden and severe symptoms, far out of proportion to the triggering event. Very often this leads to popping of the balloon and precipitation of a major disorder such as major depressive disorder or panic attack. Most people suffering from this double whammy are not aware of the role of the past trauma in their current misery. It is the job of the therapist to explain the same to the patient. More than 75 percent of emergency visits to my office are due to a double whammy.
    Picture 13: A Current event can make buried emotions to spew up

    Example: A woman who had completely forgotten the trauma of sexual abuse as a child suddenly developed massive panic attack after discovering that her eight year old daughter was inappropriately touched by her boy friend. She was very upset over her daughter?s sexual abuse (current precipitating event, coming from the pump); but this bad event also caused resurfacing of the long-forgotten trauma of her own sexual abuse as a child (fizz from the soda bottle) by her stepfather. Unable to withstand the double whammy, her balloon popped. The result was a massive panic attack resulting in a visit to the local emergency room and subsequent hospitalization.

    Another example: A middle-aged man became very depressed and suicidal two weeks after he was promoted to the position of the manager upon his boss's retirement (current event). He was never depressed before. He was completely baffled by his symptoms. He said he was very happy with his promotion. The real reason for his suicidal depression was discovered in the interview: He was very close to his boss, who was a mentor and father figure to him for over 30 years. At age 8 the patient had witnessed his own father?s accidental death from electrocution. Now, forty-two years later, the loss of a father figure triggered resurfacing of those buried old traumatic emotions related to his father?s tragic death. This was a heavy-duty double whammy which popped his balloon resulting in suicidal depression. How do we know this to be the case? Well, once the patient became aware of it, he grieved over both losses, shrank his balloon and got on with his life. Smart man.

    Here is another interesting story: A forty year old woman, mother of two boys, woke up one fine morning and felt an irresistible desire to shoot herself in the head. Her husband found her in bed with a loaded gun to her head, sobbing uncontrollably. She was brought to my office on an emergency basis. When asked why she wanted to die, she said she did not know. The only precipitating event was her 18 year old son leaving home to join the navy a week earlier. She said she was very happy for him as that was all he wanted to do.

    Further digging revealed that she herself was in the navy 19 years earlier. She had met a navy man with whom she fell in love. One day, while they were enjoying a cold, snowy weekend in a warm motel room in a big city away from the navy base, she told her lover that she was pregnant. At this, her lover got up from his bed, put on his navy uniform, told her, ?I will be back shortly? and disappeared into the snowy night never to be heard again. She waited in bewilderment for two days for him to return. He neither called, nor returned. She quietly buried her rage in her hidden mind, quit navy, moved in with her parents in a distant city and moved on with her life. Later, she married another man. Now nineteen years later, the occasion of her son joining the navy brought up a tsunami of buried emotions leading to popping of her balloon. She got well after she expressed her anger, disappointment and outrage in therapy, and moved on once again with her life.

    The resurfacing phenomenon can manifest itself in various ways.

    1. Acute post traumatic stress disorder: In this condition, a person suddenly re-experiences various recently or remotely buried traumatic memories, say, rape, and suffers serious recurrent stress symptoms. Invariably there is a clearly identified current triggering event. The soda bottle is fizzing furiously and the balloon has popped. Flashbacks, anxiety, depression, panic attacks, extreme withdrawal, etc. are common. A 25 year old single woman became very sick after an older man pulled the strap of her bra at a party. A few years earlier she had been traumatized by an serious attempted rape by another man. She had buried emotions related to that event. The current bad event shook her soda bottle and buried emotions fizzed up. As a way of coping with the tremendous pressure in her balloon, she became mute, bedridden and non-responsive for several days.

    2. Chronic post traumatic stress disorder: Resurfacing of emotions does not have to happen suddenly as noted in the above case. For example, one might chronically suffer from numerous stress symptoms as a result of resurfacing of one?s prolonged traumatic childhood memories and emotions merely by watching one?s own children grow up. I have known many a parent suffering multitude of low grade symptoms such as depression, anxiety, headaches, sleeplessness, and the like in this manner, perpetually wondering what is happening to him/her. As the child reaches a certain age, the parent would relive the trauma he/she suffered at that age. Chronic post traumatic stress disorder is common in people with rough childhood as well as people who have suffered sustained periods of high level of stress such as serious combat. Soldiers required to bury their terror under fire often suffer from chronic post traumatic stress disorder upon their return to civilian life. Even the noise of a fire cracker, of a helicopter or gun shot is enough to bring on serious stress symptoms. In these people, the balloon inflates every time the fizz from the soda bottle comes up.

      The fallout from chronic post traumatic stress disorder could be devastating to the family members living with the patient. A young man witnessed deaths of several friends in Viet Nam and was himself injured. Upon his return home, he suffered from chronic posttraumatic stress disorder. He became increasing hostile, violent, hateful, irritable and abusive of his wife and seven children. He refused to get help. Years later, due to the sustained nature of the stress of living with him, his wife and all seven children developed serious psychiatric disorders: major depression, alcoholism, drug addiction, panic disorder, bulimia, etc. Several of them attempted suicide.

    3. Therapy-induced resurfacing: Many patients get much worse immediately after starting therapy with inexperienced therapists, and end up being hospitalized. This is because aggressive and indiscriminate probing by the therapist caused buried painful emotions to resurface suddenly. Asking a question in the very first session, ?Tell me everything you remember about sexual molestation by your uncle when you were eight-year-old,? could be devastating to some patients. In effect, the therapist shook up the soda bottle too vigorously and the patient?s balloon, already full, popped due to the surging fizz from the soda bottle.

    4. Hypnosis: In hypnosis, the therapist puts the patient into a deep state of relaxation, opens the lid of his bottle, reaches deep into it, and brings out memories buried there long ago. Hypnotic suggestion is a process by which the hypnotist plants an idea or thought in the bottle which changes patient?s behavior accordingly. Quitting smoking by hypnosis is an example.

    5. Resurfacing of emotions, good or bad, from remote past could be triggered by just a sound, a word, a smell, a touch, a sight, a gesture, a smile or frown, a look, a glance, a taste, a season, a cloud, a dog, a cat, a T. V. show, or for that matter any object that is even remotely connected to the past good or bad event. The person might not have a clue why old memories resurfaced. These people often make comments such as, ? I don?t know why, I felt sad all day yesterday. Nothing happened to make me feel that way.? Or, ?All of a sudden I felt happy this morning. Nothing happened to make me feel so.? A patient dropped out of treatment for three years after I made a casual remark to her in the course of therapy, ?Trust me.? This was what her uncle had told her repeatedly before molesting her when she was a child. It is the job of the counselor to teach patients to become increasingly aware of the connection between a current sensory input and appearance of a stress symptom.

    6. Anniversary reaction: In the so-called anniversary reaction, one suffers from severe stress symptoms on the anniversary of a bad event, say, death of a child. Clearly, this is caused by resurfacing buried emotions. Holiday blues are often due to resurfacing emotions related to bad childhood memories around Christmas time.

    7. Borderline personality disorder: In a serious psychiatric disorder known as borderline personality disorder, the patient experiences wild mood swings, frequent panic attacks, angry outbursts, inability to get along with others, seeking closeness and rejecting it, and many other highly uncomfortable symptoms. These people have been through serious stressful events and situations in their childhood in addition to emotional deprivation. In a person with this disorder, his balloon is always full and it gets continual blasts of fizz from the soda bottle triggered by even minor everyday events. In other words, their capacity to hold down fizz in the bottle is almost nil due to the tremendous pressure in the bottle. A borderline patient called me shortly after she left my office threatening suicide by jumping off the bridge on the Mississippi. She was in a good mood when she left my office a few minutes earlier. When I asked her what happened between our meeting and her phone call, she was not able to explain. Suddenly it occurred to me that just as she was leaving my office, I had been distracted by a phone call, and had failed to shake hands with her before she left. This apparent ?rejection? triggered resurfacing of all past rejections resulting in her balloon going up instantly. When I apologized to her for not shaking hands with her before she left, she calmed down. I used this opportunity to give her some insight into this matter.
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