Zen Buddhism and displacement behaviour

Korean symbol for Zen

There are many psychiatrists who feel that the perspectives offered by Eastern philosophy are helpful and support the efforts of Western practitioners in mental health.

Whether it be in promoting meditation or yoga or simply utilising basic breathing techniques - eastern exercises that assist coping, focusing and relaxing are all useful tools.

Behind these approaches is an eastern philosophy that takes a very different stance from the Western scientific tradition.  In the West the only valued perspective is the objective one.  To understand something one must take a detached viewpoint and aim at removing oneself - one's feelings, emotions, biases and prejudices - from understanding the world.  In contrast, the Eastern tradition upholds that nothing can be truly know or understood without engagement, feeling and immersing.

Overcoming detachment is important to feeling more engaged with the world and with one's emotions, so it is unsurprising that eastern philosophy was so approved of by Jung, much to Freud's annoyance.  He believed in the hard scientific notion that psychology should stick to hard facts and not align itself with ideas and concepts that threatened to take it beyond the realm of science.

Detachment means that one places oneself outside what one is focused upon.  The object - that which is focused upon - must be held distinct from subject - that which is doing the focusing.  This goes to the heart of western scientific understanding that was philosophically enshrined by Rene Pascal's 'I think, therefore I am'.

This object-subject distinction is something that is part of the human experience.  We always feel a certain reflective distance from the world which means that in certain exceptional circumstances we speak of 'letting ourselves go', or 'forgetting myself '.  Usually this implies we have had a good time and this forgetfulness has allowed us to lose self-consciousness or detachment and allowed us to enter into the world with less reticence, shyness or embarrassment. In fact, we may long to feel that freedom all the time!

The problem for people with mental disorders is where the object-subject relationship between world and self becomes fraught with problems.  Freud wrote about the super-ego (or basically, conscience) that imposes an ideal morality upon the ego.  This torturing voice of self-criticism means that the individual cannot relax or feel at peace and my develop compensatory behaviours in order to achieve this.

This lack of harmony between the object (how we perceive ourselves) and subject (that which does the perceiving) is surely important to understanding self-directed or displacement behaviours too.  Automatic behaviours aim at bypassing the subject-object character of consciousness.  People lose themselves in automatic hair pulling, for example, and derive a sense of wholeness from it.  In short, they derive release from it but when they regain their subject-object awareness they later regret it whilst still longing for the peace that hair pulling brought them.  This viscious circle can go on for years!

Maybe Eastern approaches can and are being brought to bear on hair pulling and other unwanted behaviours.  Offering people alternative ways to switch off their minds, of attaining mental peace and a relief from the pain of subject-object detachment is important.  And in this stressful environment of modern living such relief may be ever harder to find for many people.

 

Mother always knows best...er, maybe not!

Sweet Dreams, by Belgian artist Firmin Baes

An interesting study was undertaken by Galski (1983) which noted that unhealthy symbiotic relationships may partially account for hair pulling. A symbiotic relationship is one where the boundaries of separation and independent functions become blurred. For example, where a mother makes her child dependent on herself as its primary need gratifier, so that all needs must be met through her, then learning that leads to mastery over the environment and independent functioning is prevented. As a result important stimuli are not presented at appropriate times and necessary types of interactions do not occur.

It is very possible that a child in such a situation will find itself over-stimulated by such a parent’s constant supervision which it may have no adaptive means to prevent, neither by a show of aggression (saying 'No!') nor proximity withdrawal (leaving home). Access to external objects in order to meet personal needs or solve personal problems may require protracted emotional engagement with the mother, who may also assume control over the use and handling of objects. As a result innate mechanisms that would be engaged under normal conditions are inhibited in their development. In Winnicott’s terms, the mother has failed to support the child as a suitable transitional object so that the child is unable to make the transition towards independent functioning within its cultural context.

Reference: Galski, T. (1983) Hair Pulling (Trichotilllomania), Psychoanal Rev, Vol. 70, 3, 331-46.

Hair pulling in the movies: Young Adult

On TV this week I caught a movie called Young Adult, starring Charlize Theron.  Mostly, movies and psychological realism do not go well together which is why I was suprised (blown away in fact) that hair pulling featured.

Theron plays the character of a rather disturbed woman called Mavis Gary, who moves back to her hometown to win back an ex-boyfriend.  The trouble is he and everyone else in the town have moved on in their lives, whereas her development is stuck in the past and like an angry teenager she spends most of her time berating others and putting them down. 

Hair pulling appears when she is sitting in bed, watching TV (see the previous post on pulling cues).

We watch as Mavis toys with her hair, searching for something until she eventually finds a suitable hair and plucks it.  She then studies the strand and root befor laying it on the table next to the bed where there are a collection of other hairs pulled earlier.  The camera pans to reveal a small bald spot on the back of her head.

In another scene Mavis visits her parents and whilst sitting at the table she goes to pull at her hair.  Her father asks, “Are you still doing that?” before her mother chimes in with, “It’s just that your hair is so beautiful…”

 

Trichotillomania doesn’t make another appearance in Young Adult, and it never features as anything more than an add-on behaviour to Mavis' complex personality.  But the fact that it was included in the movie is worth recording.  I know some bloggers have expressed dismay that hair pulling should be associated with a character (played brilliantly by Theron) bearing such serious personality issues but I do not.  I think Mavis' borderline personality problems, her extreme perfectionism and social isolation in adulthood reveal that these were her issues as a teen too. If so, her desire to escape her hometown and her extreme dissatisfaction with her own status in life reveal adaptive failures that might well lead to body directed behaviours. 

Mavis is caught in two minds throughout the film - she hates her hometown, but returns there; she wants to be viewed as a success by the world, but doesn't feel like one; she dreams of perfection, but her life is flawed.  At the very end she completes a narrative in which the protagonist achieves a happy ending - but her identification with such an ending jars with the film's own ending which sees Mavis scrutinizing her damaged car in a roadside carpark.  This dislocation towards one's environment is important to understanding hair pulling in my opinion. Hair pulling is what emerges when a prolonged environmentally rooted contradiction can find no resolution.

 

Hair pulling cues

ready, set....pull?

Cues for hair pulling in humans have been studied, most notably by Christenson et al. (1993).  Two distinct types of cues were recognised.  These are as follows:

Type 1. negative affect e.g. anger, embarrassment, shame, depression , anxiety, emotional hurt.

These type one cues point to extreme frustration, where a situation is leading to an emotion or state of mind that the individual cannot cope with and nor can s/he escape from it.  In other words, the situation cannot be transcended and the mind becomes trapped or stuck in an undesirable state. 

Type 2. sedentary contemplative situations, e.g. feeling alone, tired, relaxed, getting too little sleep.

In these type two situations a natural state of transition - whereby feeling alone or tired should lead to seeking social contact or sleep - has not been achieved.  Indeed, such a transition may be being avoided or negated.  Maybe a loss of continuity is feared; a loss of temporal identity.  The bottom line is that the organism falls back upon the body to offer comfort and exercise control over its immediate environment.

Cognitive behaviourists when dealing with hair pulling will try to remove pullers from those situations that seem to cue the behaviour.  They might tell the person to sit in a different chair than they would normally, as if the problem had something to do with the room's furnishings!!  This kind of lack of professional understanding is rather shameful in my view.   Instead, they should be focused on the function of displacement behaviour and how its stereotypical manifestation indicates the presence of a real problem in the patient's history which relates to their earlier environmental adaptation.  Psychology can only have credibility to the extent that it fulfills itself as a true science and does not confuse band aids for cures.