Mental Note

Musings on therapy and psychological health by Avi Soudack, RP

Psychotherapy is a hack

Why do so many people struggle with their mental health? One key reason is the brain-world gap. There is a mismatch between our Stone Age brains and the modern culture and society we inhabit. Fortunately, there is a hack for that. It’s called psychotherapy.

Our brains, which evolved to respond to Stone Age challenges (think fight or flight), aren't always adapted to 21st century stressors. Culture and society are way out ahead of the brain. Some of the psychological tools evolution has provided are not optimized for the pace, scale, and abstract nature of modern life. Many of our mental health challenges—anxiety, depression, crippling shame, addictions, and behavioural disorders—are a result of this disconnect. That's where psychotherapy comes in. It hacks the brain-world gap.

Anxiety: What’s around the corner, a tiger or that presentation I have to give?

The phrase “age of anxiety” was coined in the 1940s but continues to apply today.² So much is uncertain, so much is threatening, there is so much to worry about. You know the feeling… the gathering tension in your chest, breathing shallow, mouth dry, hands cold or sweaty, the sleepless nights, recurring images of future calamity, looping thoughts of regret for past mistakes. It’s so unpleasant that it’s hard to grasp that the anxiety we feel is based on a very adaptive response. I like to think of anxiety as *anticipatory fear*. You are worrying about bad thing(s) that *might* happen. Predicting negative outcomes is desirable because thinking ahead, imagining calamity (tiger behind that bush, snake in the grass), prepares us to respond quickly and increases our chances of survival.

Here’s how it’s supposed to work. As we approach a place where tigers are often found or where we see suspicious paw prints our anxiety increases. Then, peeking around the corner, if we see a tiger we are already at high alert and ready to spring into action, to resist or to run. That bit of anticipation could be what saves us and so it’s a good use of all the energy and focus required. If, on the other hand, we see there is in fact no tiger, our brain calls “all clear” and our nervous system relaxes from its state of heightened readiness. Whew. Relax. Breath deepens, tension loosens…

Here’s how it doesn't. The process of extreme anxious excitation in advance of a threat makes sense if the danger is a rapidly approaching tiger, but not so much sense if the “threat” is a rapidly approaching exam or presentation to the executive committee. For our hunter-gatherer ancestors, this type of response happened in short bursts in response to immediate physical danger. They knew when they had succeeded—they survived. But the same response is counter productive if we are imagining bad things happening weeks in advance, if there is no threat to physical survival, and if deciding there is no danger or determining that we survived is a much more nuanced or even impossible task. The anxious state is the opposite of what we need to address modern “threats”. We don’t need to run from the exam, or fight it, we need to calmly face it. Unfortunately, once the anxiety response is activated, it can be really hard to turn it off. So here we have a perfect example of an “evolutionary mismatch”, where our biological equipment is not suited for the current environment.³

And then there’s therapy. When someone comes to therapy in the grip of anxiety, whether about their work, their future, the climate crisis, etc. it helps to start by recognizing that the body’s alert system has been activated. And, it’s stuck “on”. There seems no way to call “all clear” even if your recognize there is no immediate danger. The physical and mental experience continues to agitate often in painful and debilitating ways. A client of mine described this as a smoke alarm going off even though you know it’s only burnt toast—you can’t stop that horrible siren which is holding your nervous system hostage.

Psychotherapy can take several approaches to this problem: through the body with relaxation and grounding techniques, through the mind by identifying the distortions in thinking that perpetuate the state and by supplying alternative interpretations, and through the emotions by getting in touch with what deep, irrational fear may be making us more likely to see threats around us. Ideally, therapy can help reframe anxiety so you can use it for what it’s good at: helping you identify what is important and responding appropriately.

Shame on you

Shame and related feelings of inferiority, exclusion, and self-criticism often show up in the therapy room. Many of us have lingering feelings of being not good enough, not attractive enough, not lovable enough. If you see yourself in these ways, you can become stuck, isolated, self-defeating, and even self-destructive. Whatever the immediate causes, why would evolution have bequeathed us such an unpleasant and seemingly counter-productive way to respond?

Then. Shame developed as part of evolutionary pressures to ensure we are acceptable to the social group (family, community, etc.) that we require for our safety and chances of survival. Shame is an internal restraint against our tendency to exhibit aggressive or selfish behaviour towards people in our family or in-group. Shame, in that context, is reputation management. Showing that you are ashamed sends a signal to others that you are not a threat, that you should not be cut off, that you should not be considered unworthy of being part of the group. Having a capacity to feel bad about what you did (or might do) is adaptive—it helps you function as part of the group. If the group thrives, you survive.

Now. Shame as expressed and experienced today may be a distorted version of the mechanism by which small groups managed cooperative and collaborative behaviour. What worked in small groups can become counterproductive and self-punishing when societies are large and hierarchical. This deep and instinctive pattern gives rise to extremely painful emotions, even when they are not warranted, even when they are counterproductive. People become crippled with shame in social situations that are NOT life-threatening or problematic and, critically, are not their fault. A person can experience “too much shame”, feeling so ashamed that they do not engage socially to improve their situation.

Shame is an exquisitely sensitive inner barometer to help us avoid being devalued, but it is imperfect. For instance, it is affected by early childhood experience: What were you shamed for? How often and how severely were you shamed? And shame is ungoverned in societies characterized by high levels of competition, stratification, and social instability and low levels of social support and caring. Family, culture, and social norms all twist and mold the shame response. These early experiences shape our adult minds. What started (and continues to be) a way for us to limit our aggressive, self-assertive tendencies can result in self-defeating, painful, irrational self-directed shame.

Therapy can help unpack this baggage and identify the self-negating aspects of shame. We can examine if shame is even justified; identify the roots of shame in a core negative self-image rather than any actual transgression; and, approach, express, and accept the things we feel shame about.

Depression makes no sense

Why would we have a pattern of thought and behaviour that incapacitates, reduces motivation, saps energy, and makes us think bad thoughts? Depression likely has many sources. One source of depression may be its function as the flip side of anxiety. After a period of heightened stress and anxiousness, withdrawing into ourselves puts us in a restorative state, just as fever and fatigue are unpleasant but necessary in recovery from an infection. Problems arise when the intensity and duration of the stress is too high or when the response pattern never lets go. In modern society, protracted high levels of stress may cause an echo effect in which we bounce between anxiety and depression not benefitting properly from either.

Another possibility is that the constellation of symptoms may be a programmed response to threat. Humans may have developed a set of responses indicating submissiveness when faced with a threatening other person. When one of our ancestors was defeated in social competition, their reduced activity and lower mood may have indicated that they accepted the outcome. Because of the great risk of being thrown out of the group, they needed to signal that they were OK with a subordinate role. Back then, such “depressions” were transient. Once they served their purpose, there would be no reason to maintain the state and it could lift.

What is the optimal response to an attack or challenge we can not overcome? Repeatedly trying to fight leads to frustration, exhaustion, or worse. A better response, in the short term, may be withdrawal, expressed as low mood, low energy, and no motivation. If this experience is repeated too often or too strongly, then we may learn that we are helpless and a chronic state of depression may set in. Feelings of helplessness and purposelessness are all too common in modern life.

Losing someone or not being able to connect with others can be the source of deep pain because those connections are the source of safety and acceptance so essential for survival in primitive groups. When we lose someone who is a source of comfort and care for us we are vulnerable. When our hopes for social connection are disappointed we are exposed to the threat of isolation. Our highly mobile and relatively isolated lives provide few opportunities to repair such critical broken connections. Whatever the source of the depression, conditions indicating stability and safety and supporting recovery are impoverished.

The therapeutic response to these sources of depression vary but they include promoting exercise, instilling a sense of self-efficacy, activating social supports, encouraging interpersonal connection, and investigating the conditions and self-perceptions that led to the depressive pattern. As with other conditions, recognizing our patterns, acknowledging ourselves and being acknowledged as valuable, understanding where and how we learned the depressive response can give us the insight and strength to overcome.

It’s glitchy, but hackable

Our wonderful minds, the results of millions of years of evolution, are far from perfect. The design is glitchy. And the world the mind needs to work in is changing fast. That leaves a lot of processes and reflexes which are not suited to current demands. What was “adaptive” 500,000 years ago is not always desirable today.

One tool that our evolved brain does provide us with to address these challenges is our ability to learn and change. And that’s the superpower that psychotherapy taps into. That flawed mind of yours and mine is, ultimately, flexible. The brain’s neuroplasticity means we can get under the hood and hack some of those problems.

A reframe. Problems of mental health are not a sign that you are broken. Often they reflect a brain-world gap. As an eminent evolutionary psychiatrist says “there are good reasons for bad feelings”.⁶ So, having therapy is not something to be ashamed of a sign of weakness. Think of it as a strategically smart and creatively improvised solution to a looming challenge or an unexpected problem. Think of it as a life hack.