Wednesday, July 19, 2006


***I have several speaking engagements today, so I am reprinting a post from last year. I should be back posting late this afternoon. Have a great day!***

The puprpose of this post is to explore how valuable feelings are in perceiving the world; particularly when an individual does not let feelings alone dictate his or her behavior, but instead uses emotion, tempered by reason or reason, tempered by emotion as the basis of action.

Of course, you knew that.

But somehow, our culture, once founded on and dedicated to rational thought is slowly evolving into a cult that worships emotion and whim at the expense of reason.

Some years ago I used to moonlight and perform psychiatric evaluations for the prosecutors and public defenders in the county where I lived. Personality disorders have always been an interest of mine, and you can find many examples in the jails and prisons.

One particular case stands out in my mind. I was asked by the public defender to evaluate a young man who was accused of murdering his girlfriend. The man was adamant that he was innocent and his lawyer wanted to believe him, but something didn't seem quite right to him, so he decided to ask me for my psychiatric opinion of his client and evaluate the possibility that there might be a psychiatric defense.

Steve was, to all intents and purposes, a model citizen in many ways. He held a responsible job; had no prior legal problems. He had been going with his girlfriend for about 3 months when her body was found in a wooded area--not too far from the apartment complex where he lived. Naturally, he was the prime suspect in her murder (she was strangled). There was also some physical evidence present that linked him to her death, but he insisted that she had left his apartment earlier that morning to go to work after spending the night with him and he had not seen her after that.

When I met with him, I experienced what we used to call in my medical school a "positive Gorney's sign"--meaning that the hair on the back of my neck stood on end. It is a "gut feeling" that something very strange is going on--something that may not be readily obvious to a casual observer, or on first inspection.

In my career, I have learned to respect such feelings. It almost always means that I need to look more closely at a patient and pay more attention to what they are saying or doing that might be stimulating my instinctive emotional response.

Occasionally, I find no corroborating evidence in their behavior for such feelings, and in those cases I simply file the emotional data away and make a conscious decision not to act on it for the time being. Sometimes I find negative evidence that contradicts my primal emotional response. Both situations are cues to me that I must try to figure out what it was that triggered my emotion, and the first step is to look within myself for an explanation. Does the patient remind me of someone I have ambivalent feelings about? Am I upset at something going on in my life? Am I having a bad day? Because it is important to realize that gut feelings can be communicating false data about others, but correct data about one's self.

A person's visceral response to another individual is usually based on mostly unconscious factors that are in play in the responder's life. To make an assessment of the gut feeling's appropriateness, the contents of the unconscious must be explored and brought to the conscious level and considered. Those unconscious internal conflicts can easily mask the inappropriate aspects of the feelings, making them worthless as a means of understanding the external world.

Taking this kind of action as a method of checking and understanding one's own feelings is a process called "insight" or "self-awareness". Some people do this quite naturally and honestly. Some learn in therapy or when they are in crisis. But if insight is absent then one's feelings have the potential to do great harm --both to one's self and to others.

Some unconscious factors, or psychological defenses, that can make one's feelings untrustworthy are: 1) the person you are responding to has become symbolic of someone else in your life (displacement, fantasy, or perhaps distortion); 2) focusing on one particular aspect of a person, you ignore other, more objective data that are available to you about the person (denial); 3) you place your own unacceptable feelings onto the other person--e.g.,I'm not an angry person, -- he's an angry person! (projection or full-blown paranoia).

The truth is that there are countless ways that unconscious processes within ourselves can distort our responses to others and to reality itself.

Growing up and attaining maturity requires that we take a moment to consider such factors playing a role in our emotions before we act on those emotions. If we come to know ourselves and understand our own weaknesses, vulnerabilities, limitations and secrets; then our emotional responses to people or to the world can be very valuable tools to help interpret the world. But they are only tools, and if not used wisely, they can do more harm than good. Feelings cannot be used in a court of law--for good reason. And they are not ultimate truth in the court of reality, either.

As I have gained experience in psychiatry, more often than not, when I trust such feelings and proceed to analyze what is bothering me about the situation, I discover a wealth of information that would have otherwise remained hidden. Sometimes that "wealth of information" is only about myself; but even in that case, I learn something new --frequently something insightful that I didn't want to know--about myself.

For example, I recently became aware that I was extremely annoyed and inappropriately angry at a 70 year-old woman, who was not getting better in treatment because she refused to acknowledge that she had a severe drinking problem.

My anger at this sad, elderly lady was completely out of proportion to the situation-- after all, I have numerous patients that do exactly the same thing, and their behavior does not typically bring out such intense feelings in me.

"Why doesn't she tell herself the truth?" I thought. Then I realized that this thought was what I used to verbalise with some anguish to my own mother--who died of her alcoholism at age 72; refusing all my entreaties to get help and treatement.

My entire interaction with this elderly patient was all about my own unresolved anger and grief toward my mother's death and not about the patient at all. Once I appreciated that I had to deal with my issues separately and not force my patient into a role she hadn't asked for, I could respond to her for who she really was; and maybe even help her. The reality was that she wasn't my mother, though my mind had made her so.

In psychiatry, we refer to feelings like those that I projected onto my patient as "Countertransference". We are generally aware that our own feelings are not always a reliable tool for interpreting reality. In fact, they may misdirect us or even completely interfere with our attempts to help another person.

What a person feels in a particular situation is also an incontrovertable fact; but it may or may not reveal any real information about the situation--and only reveal information about the person who is experiencing the feeling. To remember that this is the rule, rather than the exception about feelings, all we need do is to observe the chaotic lives of most of our patients, where thinking is almost always subsumed by emotion.

With all those caveats, it is still true that using one's own feelings as a clinical barometer can at times be very helpful. I am aware, for example, that I have a very reliable emotional reaction to those patients with borderline/narcissistic/antisocial personalities. To put it simply, I find mysef feeling amused and entertained by patients with these personality traits.

This is in stark contrast to most of my colleagues, who generally come to feel extremely frustrated and angry at such patients. My emotional response is probably the reason why I don't get "burned out" professionally in dealing with these difficult patients, while many of my colleagues run like hell from them.

So, when I am evaluating a person for the first time, and I find that I am responding in an amused fashion or if I have a feeling that I am being lied to or manipulated--or even if I sense that there is something I can't quite put my finger on-- these emotional data points/reactions can add to the other evidence I collect in order to make specific diagnoses.

In contrast, when dealing with a depresed and passive patient, I frequently find myself responding to their plight with feelings of frustration and often experience a transient fantasy of wanting to shake the person and say, "this is your LIFE! Why are you wasting it?"

Clearly, I try to reign in this response since it is counterproductive and not particularly useful for my patient in their current state of emotional distress. But it can confirm the diagnosis of depression, if I had any doubt about it.

Now, back to Steve.

My reaction to him was very revealing. Besides the sign I mentioned above, I found myself amused at his attempts to manipulate my response to him and began to suspect that there was a serious personality disorder behind the civilized facade that he presented. Although I felt he was trying a little too hard to convince me of his bona fides, I was impressed when he told me he had received a community award for rescuing a woman the year before.

He remained adamant about his innocence. I found that I didn't believe him, despite his obvious passionate protestations of innocence. I began to understand the unease that my attorney friend was having about the case, but after almost 2 hours of talking to Steve, I had no other data except for my gut feeling that he wasn't telling me the truth; and my suspicion that I was dealing with someone with strong psychopathological personality traits at the least and a full-blown antisocial personality at the other extreme.

If my feelings had been the sole data point, I would have determinedly ignored them. To confirm my unease, I would have to search for some objective data to support my unease about Steve.

So I asked for the hundreds of pages of documents that are generated from a criminal investigation. These are the pages and pages of notes from the first policemen on the scene and the interviews of all the people connected with the case. Eventually I read the detective's notes from the first interview with Steve at the beginning of the case, before he became the prime suspect.

Interestingly, Steve apparently knew the detective who had interviewed him in this murder case, from a previous interaction with him almost a year ago. In our interview, I remembered that Steve had mentioned his positive feelings about the detective from their previous encounter, and his optimism that evidence would be found exonerating him.

Even more interestingly, this previous interaction with the detective was in connection to the event Steve briefly mentioned to me about earning a community award.

My gut feeling returned even stronger. THIS IS IMPORTANT!!!, was the message it transmitted to me. I immediately obtained records about the incident of one year ago, and here is the information as I pieced it together.

A year earlier, a woman jogger had been shot by a sniper. This crime had taken place fairly close to the apartment building that Steve had lived in at the time, near a park. Steve reportedly had also been jogging, heard the shot, and saw the woman fall. He immediately ran to her aid, calling 911 and then administering CPR and keeping the woman alive until help came. Sadly, the woman jogger later died of her wound in the hospital. But Steve was honored with a "Good Samaritan" award from the city.

The police detective who interviewed him for that murder case was the same one that took his statement a year later in the murder of his girlfriend.

Do you begin to see where this gut feeling was taking me? This could most certainly be an amazing coincidence, but my gut feeling was telling me it wasn't a coincidence at all. On the contrary, my instinct--my feeling--told me this was no coincidence.

The police had not yet made the connection between the two cases (I have no doubt that they eventually would have, without my help) I called the detective and asked him if he remembered Steve. He did not. When I prompted him about the other case, there was a short silence, then a faint gasp.

That murder had never been solved. The detective assured me he would look into it; and sure enough, a few weeks later, he called me to report that they had found the sniper's gun for the previous crime in a locker at Steve's workplace.

Steve's public defender had to fire me, since --not only could I not help his current case, but I had implicated his client in another murder.

If only Steve had not needed to tell me about his "community award" -- a statement which didn't feel right in the context of our interview; then I probably would never have made the connection. But Steve provided the connection, and my emotional reaction to Steve motivated me to follow through and Steve's civilized cover was blown.

He was eventually convicted of the woman jogger's murder as well as the strangulation of his girlfriend (which was motivated by her telling him she was pregnant). Police were actively looking into several other unsolved murders of young women in that area of the city to see if there could be any connection to Steve.

So, why am I telling this story? Because I believe that feelings are an extremely important resource all people have at their disposal for understanding the world around us. In some situations, the only thing we have we have to help us make decisions are our feelings. This is not the ideal, but sometimes it can suffice.

Humans are both feeling and thinking beings. If we ignore our feelings we have psycholgoically blinded ourselves to important information about the world; and if we ignore our mind and our reason, we have done the same thing. If we do not use both faculties together, we do not see the whole inner and outer world of reality.

The unquestioning reliance on one's feelings as the be-all and end-all of perceiving reality has some MAJOR, MAJOR snags associated with it. It leads to chaotic, dysfunctional relationships, instability, histrionic and impulsive behavior, and a lack of concern for the needs and feelings of other people.

It has been my experience that many people have a sort of primitive, childlike reverence for whatever they feel. That's all they know and all they need to know, seemingly. They never bother to try to understand why they feel the way they do; or even to objectively understand the source feelings. Indeed, it isn't always necessary to do so, but for many, living has become a matter of, " I feel, therefore I am."

Well, I am here to tell you that this is the motto of the Steves of the world--who function exclusively on the basis of their feelings--and who have no room or inclination to bother with anybody else's feelings or needs. Why the Steve's of the world are all wrapped up in themselves and their feelings, and why--despite their verbalizations to the contrary, they are truly incapable of the empathy with other people.

Empathy, or the ability to feel what others are feeling, is actually a healthy form of psychological projection; but (and this is a very important "but") it is projection with high degree of personal insight and sensitivity to one's self as well as to others.

I will let the reader mull over the application of all this to the political topics that are regularly spotlighted in this blog.

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