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Emotional avoidance, self-coherence, and psychosis: Why affective regulation is a form of relational care

Conventional psychological wisdom holds that avoiding your emotional experience cuts you off from important data about yourself. After several years of specialized training in psychological testing, especially with the Rorschach Inkblot Test, I believe the reality is somewhat more extreme than this: I have become convinced that rejection of affective life leads many people to what I would call micropsychotic breaks. Specifically, habitually flinching from feeling can also lead to serious distortions of social cognition, lapses in conceptual coherence, and breakdowns in reality testing.

We usually think of psychosis in terms of psychotic disorders such as schizophrenia, in which people experience prolonged, frequently severe disruptions in the capacity to clearly and coherently perceive—and sometimes, even to interact with—the external world. However, transient psychotic experiences are actually quite common. Minor hallucinations, delusions, paranoia, and other experiences commonly occur in people who would not warrant a psychotic disorder diagnosis, and a surprising proportion of the population will experience something like this over the course of a lifetime (see, e.g., Johns & Van Os, 2001; McGrath et al., 2015; Rössler et al., 2007).

Thought disorder is another hallmark symptom of psychosis. Thought disorder usually manifests behaviorally as disorganized speech, but often reflects cognitive fragmentation, conceptual boundary disturbances, and extreme fluidity of thought. On the Rorschach, there are several indicators of perceptual and thought disorder that reflect, among other things, unmoderated blending of fantasy and reality, violations of conceptual boundaries, and difficulties putting ideas and objects in relationship. When such indicators show up in abundance, it suggests serious problems with thought disorganization.

Certain methods of analyzing Rorschach data allow you not only to see these indicators, but to place them in context and generate hypotheses about contributing factors. One key theme I have noticed is how thought & perceptual disturbances are linked to poor or confused handling of feelings, attempts to avoid or deny emotional experience, and troubles adequately containing affective stimulation.

In my work, I participate in psychological testing with people with treatment resistant psychological disorders. Sometimes these folks have psychotic disorders, but usually they don’t. More typically, they struggle with trauma and with disorders of personality and mood (often, all three and more). I say this to emphasize that the sorts of conceptual and perceptual slippage that I observe are not inherently or even accidentally linked to clinical psychotic disorders. The vast majority of people I work with do not have a diagnosable psychotic condition. Nevertheless, it’s very common to see breakdowns in reality testing, conceptual boundary violations, experiences of confusion and helplessness, and sometimes intrusion of aggressive and sexual fantasy in Rorschach protocols going hand-in-hand with poor affective processing.

The take-home lesson from this, for me, is that it is not simply that avoidance or compartmentalization of our feelings alienates us from important and vital aspects of the self—although that much is true and becoming increasingly and more commonly recognized. Rather, what I have learned is that people’s defensive handling of affect can quite readily lead to brief but significant breakdowns in psychic equilibrium that often contribute to distortions in social cognition and sudden degradations in overall psychological functioning. Usually, most people can regain their equilibrium fairly quickly when this happens, and emotion regulation skills can help in limiting the extent of these disturbances. But even if we can easily recover, extreme feelings can lead the best of us to lose our minds, however momentarily.

When these sort of “micropsychotic” events happen, intense affects can lead us to rely on less mature defense mechanisms such as projection, splitting, devaluation, and denial, which can have big impacts on our relationships. Falling into the grip of our worst fears and fantasies (often based in earlier experiences of deprivation, harm, and terror) can severely distort or even prevent our accurate perception of other people, and can lead us to lash out, withdraw, or otherwise inject chaos into interpersonal scenarios in ways that look quite strange from the outside.

From a theoretical perspective, what I have observed empirically in psychological testing comes as no surprise. The psychoanalyst Wilfrid Bion, in his gnomic and difficult 1962 work Learning from Experience, elaborates a theory of thinking in which thought emerges from the experience of absence and deprivation. It takes psychological work (which Bion called the alpha function) to transmute raw and often painful experience into genuine thoughts that we can contain and bear. Thinking, and therefore learning, entail frustration. If we cannot tolerate frustration—because it is (or chronically has been) too overwhelming—we cannot think, and we cannot learn. Metabolizing facts into genuine knowledge requires experiencing their effect upon us. Knowledge properly conceived (as something we do with [aspects of] the world, rather than a ‘thing’ we ‘have’) requires embodied participation with what is other than us and thus beyond our control. The attempt to evacuate ourselves of emotional experience therefore inherently involves the effort to eradicate the otherness of the other and return to a fantasied state of omnipotent control.

Bion has, I believe, reclaimed a more natural, easeful, and relational stance toward the human mind. Only a worldview saturated with dualism and materialism could conceive of thought as essentially or necessarily opposed to feeling, rather than integrated with it. Only humans who have mistaken science for a worldview rather than a utilitarian method for uncovering a certain domain-limited category of truths could manufacture a logic that must split off the turbulent frustrations of emotion to feel ontologically secure. Indeed, Bion (1962) wrote that “[the] weakness [of the scientific method] may be closer to the weakness of psychotic thinking than superficial scrutiny would admit” (p. 14). This thought merits sustained reflection from a decolonial perspective.

For these reasons, coming into relationship with your emotions, learning to tolerate and move through difficult feelings, and developing the poise to maintain self-reflective capacity (the ability to notice and think about what you are doing as you are doing it; what psychoanalysts would call the observing ego) when under the strain of intense affects are crucial personal and interpersonal skills.

For people with esoteric or magical practices, emotion regulation skills also provide an important check against wishful thinking, biased interpretation, and even paranoia and delusion. To spell this out a little, less mature defense mechanisms such as splitting and projection blur or even eradicate the boundaries between self and other in ways that we cannot control. When this happens under the strain of intense experience, we may lose the capacity to accurately discern between inside and outside, and thus can fall prey to illusion—for example, believing we have made spirit contact or had a magical experience when in reality we have simply lost affective control and slipped into cognitive confusion. When this becomes a pattern, our practice becomes mere autoeroticism rather than participation in the divine.

In general, emotions are crucial indicators of relationship. They also carry psychological force. To fluidly, mutually, and compassionately participate in relationships, we must be able and willing to bear that force with grace and dignity. Emotional regulation is therefore not just a “tool” for mental health, psychic coherence, or self-care, but also an offering to the people and beings in your life who depend on healthy connections to you for their own well-being.

This reflects the truth that self and other are not two. Relational coherence and self-coherence go hand in hand. They reciprocally interact and intertwine. Taking care of your emotions is not just a way to take care of your own mind, but also to take care of your relationships. The psychoanalyst D.W. Winnicott (1960) wrote that there is no such thing as an infant (because the idea of an infant alone, absent the affordances of maternal care, makes no sense, and vice versa—they reciprocally imply and depend on one another). In a similar mood, there is no such thing as a self or a mind, and there is no such thing as an emotion, since these constructs constitutively imply a whole relational universe. Bion (1962) wrote that “an emotional experience cannot be conceived of in isolation from a relationship” (p. 42). In a certain sense, our minds just are our relationships.

Approached from the other side of things, emotional avoidance is not just a form of self-alienation (one that, as I have sketched above, can also lead to self-fragmentation). When we avoid and suppress our affect, we hinder our ability to actually think about and authentically respond to those beings implicated in the emotional experience. Consequently, we can say that emotional avoidance just is a shirking of relational responsibility, since emotional avoidance denies others an experience of your own coherence. To the extent that emotions carry the force and meaning of relationships, emotional avoidance may indeed be a kind of subtle violence toward relatedness itself, and so respectful contact with your feelings might be seen as a kind of moral imperative and necessity for community caretaking.

References

Bion, W. R. (1962). Learning from experience. Routledge.

Johns, L. C., & Van Os, J. (2001). The continuity of psychotic experiences in the general population. Clinical Psychology Review21(8), 1125-1141.

McGrath, J. J., Saha, S., Al-Hamzawi, A., Alonso, J., Bromet, E. J., Bruffaerts, R., … & Kessler, R. C. (2015). Psychotic experiences in the general population: a cross-national analysis based on 31 261 respondents from 18 countries. JAMA Psychiatry72(7), 697-705.

Rössler, W., Riecher-Rössler, A., Angst, J., Murray, R., Gamma, A., Eich, D., … & Gross, V. A. (2007). Psychotic experiences in the general population: a twenty-year prospective community study. Schizophrenia Research92(1-3), 1-14.

Winnicott, D. W. (1960). The theory of the parent-infant relationship. International Journal of Psycho-Analysis41, 585-595.

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