MIND
When Self-Knowledge Is Only the Beginning
By RICHARD A. FRIEDMAN, M.D.
Published: January 17, 2011
It is practically an article of faith among many therapists that self-understanding is a prerequisite for a happy life. Insight, the thinking goes, will free you from your psychological hang-ups and promote well-being.
Lars Leetaru
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Perhaps, but recent experience makes me wonder whether insight is all it’s cracked up to be.
Not long ago, I saw a young man in his early 30s who was sad and anxious after being dumped by his girlfriend for the second time in three years. It was clear that his symptoms were a reaction to the loss of a relationship and that he was not clinically depressed.
“I’ve been over this many times in therapy,” he said. He had trouble tolerating any separation from his girlfriends. Whether they were gone for a weekend or he was traveling for work, the result was always the same: a painful state of dysphoria and anxiety.
He could even trace this feeling back to a separation from his mother, who had been hospitalized for several months for cancer treatment when he was 4. In short, he had gained plenty of insight in therapy into the nature and origin of his anxiety, but he felt no better.
What therapy had given this young man was a coherent narrative of his life; it had demystified his feelings, but had done little to change them.
Was this because his self-knowledge was flawed or incomplete? Or is insight itself, no matter how deep, of limited value?
Psychoanalysts and other therapists have argued for years about this question, which gets to the heart of how therapy works (when it does) to relieve psychological distress.
Theoretical debates have not settled the question, but one interesting clue about the possible relevance of insight comes from comparative studies of different types of psychotherapy — only some of which emphasize insight.
In fact, when two different types of psychotherapies have been directly compared — and there are more than 100 such studies — it has often been hard to find any differencesbetween them.
Researchers aptly call this phenomenon the Dodo effect, referring to the Dodo bird inLewis Carroll’s “Alice in Wonderland” who, having presided over a most whimsical race, pronounces everyone a winner.
The meaning for patients is clear. If you’re depressed, for example, you are likely to feel better whether your therapist uses a cognitive-behavioral approach, which aims to correct distorted thoughts and feelings, or an insight-oriented psychodynamic therapy.
Since the common ingredient in all therapies is not insight, but a nonspecific human bond with your therapist, it seems fair to say that insight is neither necessary nor sufficient to feeling better.
Not just that, but sometimes it seems that insight even adds to a person’s misery.
I recall one patient who was chronically depressed and dissatisfied. “Life is just a drag,” he told me and then went on to catalog a list of very real social and economic ills.
Of course, he was dead-on about the parlous state of the economy, even though he was affluent and not directly threatened by it. He was a very successful financial analyst, but was bored with his work, which he viewed as mechanical and personally unfulfilling.
He had been in therapy for years before I saw him and had come to the realization that he had chosen his profession to please his critical and demanding father rather than follow his passion for art. Although he was insightful about much of his behavior, he was clearly no happier for it.
When he became depressed, though, this insight added to his pain as he berated himself for failing to stand up to his father and follow his own path.
Researchers have known for years that depressed people have a selective recall bias for unhappy events in their lives; it is not that they are fabricating negative stories so much asforgetting the good ones. In that sense, their negative views and perceptions can be depressingly accurate, albeit slanted and incomplete. A lot of good their insight does them!
It even makes you wonder whether a little self-delusion is necessary for happiness.
None of this is to say that insight is without value. Far from it. If you don’t want to be a captive of your psychological conflicts, insight can be a powerful tool to loosen their grip. You’ll probably feel less emotional pain, but that’s different from happiness.
Speaking of which, my chronically depressed patient came to see me recently looking exceedingly happy. He had quit his job and taken a far less lucrative one in the art world. We got to talking about why he was feeling so good. “Simple,” he said, “I’m doing what I like.”
I realized then that I am pretty good at treating clinical misery with drugs and therapy, but that bringing about happiness is a stretch. Perhaps happiness is a bit like self-esteem: You have to work for both. So far as I know, you can’t get an infusion of either one from a therapist.
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