Medicating Feelings

“I can't stand all this stress. I just want these feelings to go away.” And so, he typically pours himself a double martini and downs Valium (or two) in an attempt to make them go away. The trouble is the feelings don’t actually disappear; they just become alcohol-soaked and distorted.

It doesn’t have to be alcohol, though. There are as many ways to medicate away emotions as there are people. Some people drink; others use marijuana, cocaine, Oxycontin, Xanax, or some combination thereof. Still others eat their feelings, using food to find comfort. Sex can be another means for medicating feelings, as can gambling, watching TV, looking at pornography, playing video games or surfing the Internet for hours and hours.

Medicating uncomfortable emotions—making them “go away”—is a fairly common means of coping. It’s a quick “fix”. Unfortunately, self-medication does not offer viable, permanent resolution to the stressors of life. And in fact, self-medication often creates additional problems, addiction being most prominent.

I realize I've written about self-medication before (see Looking for that Magic Pill). However, the impulse to medicate away feelings through a variety of means is a common theme in my practice, one that clients return to again and again. And so, I return to it here.

We tend to make judgments about our feelings, deeming them “good” or “bad”, trying to exorcise them with “shoulds” and “oughts”, and sometimes developing habits designed to alter them. Uncomfortable feelings—pain, loneliness, anger, grief, anxiety, sadness, shame, guilt—are judged with special harshness and severity; they are the emotions we most want to be rid of and they are the emotions around which habitual self-medicating behaviors are likely to develop.

Significantly, we also develop beliefs about our feelings and self-medicating behaviors:

“It is not OK to feel certain feelings. My feelings are bigger than me and can destroy me. I’m not competent enough to cope with strong feelings and therefore need something to help me. I don’t have enough strength to manage. If I don’t immediately do or take something, I will be in the grips of this feeling forever.”

Or, "if it feels good, it must be OK."

These beliefs are often reinforced when we self-medicate. Habitually reaching for alcohol, turning on the television, surfing the web for internet pornography (or however we try to alter our emotional state) to escape or alter feelings has a subtle, but powerful, impact on how we think about and experience ourselves: our perceptions about ourselves and our thinking becomes distorted. We begin to believe that the power to cope, the power to soothe ourselves rests outside us. We begin to believe “I am not enough. I am inadequate.” On a deep level, we identify with powerlessness.

Self-medication—whatever form it takes, however it is done—often impedes our ability to live fully. It is a common path to addiction.

(A word about prescribed medications. There are psychiatric and medical conditions that necessitate the prescription of medications. These medications have a particular purpose and are typically monitored by psychiatrists, physicians, or other licensed medical professionals. These medications are meant to help regulate body and brain function and are not meant to eliminate emotional states. While these medications take the edge off anxieties and depressions, they are tools that support behavioral change and emotional coping. These medications are not prescribed to take away feelings.)

Feelings are part of life. Feelings give human life texture, color, and shading. Most of the time, we are not fully aware of our feelings. It is usually only when our feelings are strong that they command our attention. Nonetheless, feelings are in constant flux: they come and go, rising and falling naturally throughout the course of the day. Feelings do not last forever.

Feelings can be great teachers. However, they can only teach us if we are willing to be present with them, pay attention, and cultivate curiosity about them. Much of psychotherapy’s work centers on attending to the landscape of our feelings: learning about their nuances, discerning the pathways feelings travel, discerning relationships among feelings, and developing insights about them--insights that can transform our lives. Psychotherapy will also address the patterns of self-medication. Indeed, understanding those patterns can open a door onto the deeper feelings that are otherwise hidden, suppressed or distorted by self-medication.

Many people enter psychotherapy hoping that the therapist will “make the feelings go away.” Those seeking a quick “fix” will surely be disappointed. (Even prescribed psychotropic medications take time to begin working. There is no magic pill.) But those willing invest the time and energy to cultivate curiosity about their feelings will find their efforts rewarded with lives fully experienced.

Psychotherapy offers alternatives to self-medication. Therapy can help you learn to accept feelings and help you manage their rising and ebbing. Therapy can help you develop perspective on feelings and develop new beliefs about them. And therapy can help you develop insight into your feelings—insights that can eventually transform your life.

Danger Ahead, Danger Behind

What do you worry about? What keeps you up at night, tossing and turning? What triggers anxiety for you? Chances are whatever it is is not actually happening in the present moment. Whatever it is is something you anticipate or something that has already happened that continues to echo in your mind. Whatever it is is not happening right now, in this present moment.

One of the most insidious aspects of anxiety centers on a pattern of thinking that takes us out of the present and focuses us on the future. We worry about what lies ahead and create narratives for ourselves, often based on past experiences, about what might happen. Or we ruminate about past traumas, reliving them in our minds and asking ourselves what might have been different, if only… When we do this, we separate ourselves from the present moment. We take ourselves out of present time. And the further we project ourselves out of the present, the more anxious we become. Indeed, we lose ourselves because we are no longer grounded in the here-and-now. And when we do this, feelings of anxiety and dread take hold and grow. We are lost and anxious because we are no longer present to ourselves.

One of the techniques I offer to clients with anxiety is aimed at bringing the client into the room, into the here-and-now. It’s a simple technique: I ask the client to bring their attention to the weight of his/her body in the chair and to look directly at me (or if eye contact is too intimate, to focus on a spot just above my head). As they do this, I ask them to attend to their breathing and ask them to answer several questions: what is going at this moment that is creating anxiety for you? What, if anything, in this room is making you feel anxious? What am I doing that is creating anxiety for you? The answers to these questions are typically “nothing is happening right now, but…” I stop the client, and draw attention back to the breathing and observe that right now nothing is happening to create anxiety. I’ll observe that whatever follows the word “but” is something that is not actually present in the room—something that lies either in the past or the future. We’ll continue to do this until the client is grounded in the present moment. (Often, the client visibly relaxes.)

(If something is actually happening to create anxiety in the here-and-now, the focus shifts and we will attend to whatever is presently happening. Sometimes, this means creating a more open physical space and changing the milieu; other times, it means attending to some aspect of the therapeutic relationship. In any event, it is critical to discern the here-and-now dynamic that triggers anxious responses; it is critical to differentiate between the present and past/future orientation.)

This technique is not meant to eliminate anxiety, but rather to put it in perspective and ground it in the appropriate tense (present, past or future). The exercise reorients us to the present moment. Grounding in the present changes our relationship to our experience and ourselves; it helps us perceive and think about what is actually happening in the present moment. And then, from the perspective of the present moment, we can then explore the roots and paths of the thinking pattern and the origins of the anxiety itself. We can also plan for the future. (Planning for the future and actually living in the future are two very different experiences. Effective planning is predicated on the ability to be grounded in the present, having put into perspective the lessons from the past.) However, we can only effectively do the deeper work by staying firmly grounded in the present moment.

Whatever worries you, whatever keeps you up at night need not control your life. Being oriented in time—being grounded in the present moment—is an important first step to managing those worries. While you may have been exposed to danger in the past (which undoubtedly offer lessons for the present) and while danger may indeed lie ahead (which you can plan for, if you stay grounded in the present), you can only live in the present moment.