Sh*t Happens: Lessons for dealing with life's ups & downs

Introduction

FOR OVER TWENTY YEARS I have sat in a chair and listened as people talked about their childhoods, their addictions, their sex lives (or lack of them), their pain, their traumas, their loves and losses, their dreams and their aspirations. After so many years I sometimes forget that these are conversations they may have never had before, and to talk openly like we do in my room is not something people do in day-to-day life.

I’m not a religious person, but over time a therapy relationship becomes a sacred space.

If you’ve come here looking for juicy work stories, I won’t be sharing anyone else’s secrets. Trust and confidentiality are the cornerstones of what enables therapy to work — so you won’t be reading any client’s details changed to protect their confidentiality type titbits from me.

Instead, this is my story, of what I’ve learned about life, emotions and how we function — or don’t — from my clients.

As therapists, we are of course trained to listen. We are also trained to do things that are helpful with the aim of alleviating intense psychological pain, the aftereffects of trauma, the emptiness of depression, and the unbearable tension of anxiety. Most people come to therapy because there is a clear problem to be solved, what therapists refer to as the symptom(s).

But curing the symptom rarely ends up being the only, or even the most important, outcome of therapy. Given the opportunity to talk, and unravel themselves and their struggles, most people find they want a deeper understanding of themselves, and in doing so to find deeper meaning in their lives.

To sit in a chair for two decades listening to people talk about their lives you have to find the human condition fascinating. It helps to be what I often describe as, psychotically optimistic. Life’s tough. Even if you feel things have gone well for you, there’s still grief, breakups, and accidents — not to mention global pandemics — to navigate.

The limited nature of life, and the fact we all stare down death — at one time or another — means no one finds this being alive business a walk in the park.

So, while various therapists, with their different approaches, will try to tell you the secret, or teach you various techniques to help — most of which are both useful and oversold — fundamentally we all must find our own ways to ease the pain of being, and make the journey of being alive a little more bearable.

And when push comes to shove, the only thing that helps is other people. This can be tricky if it’s also true that if your experience of other people is that they are also the problem. They often are.

Basically, this is how therapy helps. Not the techniques, the worksheets, the apps, the clever tricks, the new theories, or the psychobabble. It’s much simpler than that. Just having a consistent, attentive and validating person to whom you can express yourself freely and figure out what life means, takes us a long way towards where we need to be.

That doesn’t mean that anyone can do it. There is an old saying in design that making something look simple is incredibly complicated. The same goes for therapy. Even if it might look simple, it’s actually hard work to be fully present to someone else, day in and day out. That’s why it’s a job — albeit an enjoyable and deeply satisfying one.

So, this isn’t really a self-help book (even though that is likely where it will land in bookshops). From the point of view of therapy self-help is an anathema. We only get so far on our own before we need someone else.

In life Shit unavoidably happens. Of this, I can be absolutely certain. It is then up to us what we make of it. All of us have habits, built up over many years, of what we do with the shit.

Based on how honed our capacity to regulate — to feel but not get overwhelmed by our emotions — we will respond to situations in ways that are regulated or dysregulated. If we respond in a dysregulated way when we are overwhelmed, our emotions tend to take over the steering wheel. And emotions on their own generally aren’t great drivers.

Depending on a wide range of factors, we will also be able to react in a flexible, accepting, and even creative manner to the shit. Or we may be the kind of person who relies on controlling what we can — or, problematically, trying to control even more. These four factors (regulation/dysregulation, flexible/inflexible) interact, much like the points on a compass. Understanding these four responses to what life throws at us and how they interact, can help us better navigate our world.

So, think of this more as a map than a self-help book. Or a smorgasbord of helpful things I’ve learnt along the way. Because there is no shortage of techniques out there you can employ that may be helpful.

Hopefully, this map that I unfurl in front of you will show you some things that people learn in therapy, and then help you be more selective in the ways you approach your emotional world.

A map that is easier to use when we understand our own tendency to be regulated or dysregulated, flexible or rigid. That helps us understand our need for control or our unhealthy attraction to chaos, and how much easier it all becomes when those things are in balance.

A map that might lead you to more satisfying relationships in your life, with others, yourself — or maybe even with a therapist.

CHAPTER 1:

Are we all a bit mad?

IN CHARLES DICKENS’S A Christmas Carol the main character, Ebenezer Scrooge is visited by ghosts who attempt to show him the error of his ways. Ultimately the only thing that helps him to see the impact of his heartless, wealth-focused life is the very real prospect of his death, and the view afforded him of what his life might look like from his deathbed.

Most of us spend very little time contemplating our mortality — and with good reason. Denial of death and the ability to set aside our mortality helps us to live unencumbered with dark thoughts about the finite nature of our existence. One of the features of clinical depression is a focus on death: either excessive thoughts about it or contemplating it in the form of suicide.

However, considering death — as Scrooge is forced to by the ghost of Christmas Future — can sometimes be helpful.

Perhaps the pre-eminent writer in terms of psychotherapy and death is Dr Irvin Yalom. He’s written books that most therapists have probably read — largely because they’re very well written (yes, I am a bit of a fan).

In his seminal text Existential Psychotherapy and his more recent — and more accessible — Staring at the Sun he writes at length about the way people’s experiences of terminal illness shape not just how they see themselves and their lives, but what they consider to be important. And in what can almost seem like a cliché now, he encourages us all to contemplate the question:

If you knew you only had six months to live, how would you choose to spend your time?

What would you do or not do? Who would you spend it with — and what would you want to say to them?

And who would you want to hold you when you finally slip away?

I hope you will come away from this book understanding there are no easy answers or silver bullets. But when it comes to considering what really matters, knowing how we want to feel when we die is one of the surest ways of informing how we want to live.

The problem of psychiatry

Over the twenty years I have been doing this therapy thing, there has been a significant and necessary shift in the way we talk about mental health — almost all of it for the better.

Destigmatisation campaigns have made it more possible for people to be open about their struggles. And the general level of knowledge about emotional health, depression, addictions and anxiety is a world away from what it was at the end of last century.

Yet at the same time, in the countries that measure such things, rates of depression, anxiety and other mental health disorders have increased, year on year, along with rates of suicide.

The recent pandemic and its multitude of impacts are likely to see this trend continue, even accelerate.

So, are we getting worse? Or is something else going on? Well, annoyingly it’s likely both. There is little question that events like the ongoing Covid-19 pandemic have had widespread impacts. But it is also true that as we have all become more familiar with previously medically defined psychiatric conditions, like depression, panic attacks, and OCD, these terms have entered our day-to-day understanding in ways that may be helpful, and unhelpful.

It’s well recognised that when people start studying what used to be called Abnormal Psychology or psychiatric diagnosis (most commonly in Aotearoa that means the DSM or Diagnostic and Statistical Manual of Mental Disorders) we see ourselves, and our quirks in the categories of diagnosis in its pages. Undergraduate psychology students routinely decide they have any number of psychiatric disorders they weren’t aware of!

They’re usually wrong. Why? Because in simple terms, for any of those things to be considered a problem, they have to, well, actually cause problems. Models of psychiatric classification (and yes there is more than one and they do differ) are not diagnosing medical, quantifiable physiological disease. They are inherently subjective, and prone to error, debate, disagreement and cultural bias. While in the main they offer a useful and reliable map, they are an invention of humans and should be viewed with a smidge of cynicism.

This is not to say, however, that the conditions and distress they attempt to imperfectly describe are not real. They most certainly are. But simply put, they describe human experiences of distress and pain, and in doing so we can all find aspects of ourselves contained within their pages.

For example, you might prefer tidiness and order. I know I do. I prefer my office, and generally, my home to be tidy. I prefer neat stacks, and things laid out well, and am not a fan of clutter. If there is a mess, it winds me up — and if I feel particularly stressed out, I can even clean up as a way to manage my stress. I find it easier to be calm in an ordered space, and I can get a bit rigid when under stress.

This does not mean I have OCD (obsessive-compulsive disorder) — even though that is a diagnosis that is increasingly misused to describe people who prefer tidiness and order. (Technically — and somewhat confusingly — this would actually be Obsessive Compulsive Personality Disorder and I don’t have that either.) OCD is not about tidiness. It’s about behaviours — compulsions — that people need to do, often repeatedly, to reduce an intense fear of a dreaded outcome. The death of a loved one for instance.

Simply put, managing my emotions and the spaces I live in in this way doesn’t cause me a problem. While I can tend to be a bit rigid when stressed, I can also be flexible, and tolerate mess and clutter when I need to — or have to. In terms of diagnosis, I can still live, love and work — and for something to technically be considered a mental illness it has to cross one of those thresholds. Namely it needs to cause problems in terms of our ability to work, to have and maintain intimate relationships and/or friendships, and impair our day-to-day functioning in the world.

We all have our ways of regulating our emotions, and you likely are familiar with yours. For example, you may be someone who needs people around them or conversely needs to be alone to process feelings. You may exercise to manage distressing feelings or need to retreat under the duvet with nothing but Netflix for company. You may prefer to eat when stressed, or find your appetite diminishes when faced with unexpected challenges. You may tend towards more rigid approaches, or find you need to freely express yourself and be a bit more flexible in your regulating strategies. Most of us have a mix of both.

These coping strategies, or what psychotherapists sometimes call defences — internal and external strategies to manage distress and painful emotional states — are not necessarily pathological. We all have them, and they are normal and necessary ways of managing our emotional lives.

Again, they’re only a problem if they’re a problem.

Throughout this book it’s safe to assume that if I’m using a clinical term — say addiction or depression for instance — I’m meaning it in a clinical sense.

I think it’s important to find new ways to talk about distress and differences without pathologising everyday human experiences. There are some exceptions, but my view is that we need to resist what some people see as concept creep. For instance, broadening the terms we use to describe psychiatric disorders to include more and more everyday versions of human behaviour — as in my liking of order. Another example of this is when we utilise terms like trauma to describe almost any upsetting event, thereby pathologising distressing emotions and experiences.

Language matters when it comes to how we organise our experience, how we describe what is happening inside ourselves to others, and how we define ourselves and our identity.

When a problem is a problem

When feelings overwhelm our capacity to think, and perceive ourselves or the world around us, then it’s a problem.

Everyone comes to therapy to solve problems, and most of those problems can be traced back to how we regulate (or don’t) our emotions. I’ll cover this in much more detail later, but in simple terms, we all have the capacity to tolerate a certain level of emotions. And all emotions can come to dominate our thoughts and shift how we perceive reality — if they’re strong enough.

In general, our internal experience can get so distorted by our distress and how we perceive it, we can experience things that aren’t experienced by others, e.g., hallucinations and voices. If this is chronic and disturbing enough, we call this psychosis — a break from consensual reality.

If our feelings distort how we experience other people’s intents, motives or behaviour, or mean we experience our emotional states as unquestionably real, and struggle to have insight into those distortions (for instance, intense jealousy in response to a faithful partner) then generally we call it emotional dysregulation. In its most severe forms, where all aspects of our lives are impacted, we think of this as a personality disorder. The most well-known personality disorders are borderline personality disorder and narcissistic personality disorder. Being most well-known also means they are the most likely to be thrown around willy-nilly in a clear example of concept creep.

Generally, if we feel things intensely enough that it influences our behaviour — for instance, we avoid situations that cause us distress — then we call it a neurotic disorder. An example of this is social anxiety. The feelings are intense, but with neurotic disorders people have insight into the fact that it’s their feelings that are the problem.

Incidentally, Freud described the aim of therapy as not being cured but achieving normal neurosis.

What I’ve just described above — psychotic disorders, personality disorders, and neurotic disorders — is a way of thinking of the severity of psychological distress from modern psychodynamic theory, the family of theories that I’m largely trained in as a psychotherapist. It’s a map, and like any map, it’s a representation of reality, which is more or less accurate.

Psychodynamic theories are a broad family of theories. Originating with Freud, they have evolved to understand in broad terms that the emotional environment that we grow up in — and the first relationships we have with our parents and caregivers — shape our emotional development, for good, bad and everything in between. I’ll take this up more soon, but it’s important to say here that while Freud gets much criticism from many of the social sciences — and not entirely without reason — when we talk about psychodynamic psychology it has developed a lot since the early twentieth century. And to be fair to the good doctor, many ideas we now take for granted — the importance of early attachment relationships and the value of the first three years of life for instance — are cornerstones of psychodynamic thinking.

It’s also true that much of what we will talk about when it comes to the impact of early life is about influence, as opposed to trauma and pathology. We all have a family, we are all shaped by our environment, and from that place, we all develop ways of coping with the world. Being shaped is not the same as being traumatised. Being influenced and developing ways of coping with the world is not necessarily pathological — it’s only a problem if it’s a problem.

And yes, this way of categorising human experiences and difficulties is as flawed as the rest of them, and not without its problems and criticisms.

For instance, we now understand much more about the influence of genetics on our responses to the environment we find ourselves in, and epigenetics — where our environment can shape our genes. And we also understand that cultural differences play a large part in the ways emotional distress is expressed.

You’re probably familiar with various campaigns over the years that quote statistics like, one in five people experience mental illness, and while the exact proportions may vary, the message remains the same. At any time probably more people than you would think are struggling with intense distress. It unhides the problem.

They were helpful campaigns, no doubt. However, it’s also true that those ways of presenting the data can still lead to othering — I’m normal, but those people over there are struggling. Distress, mental illness, and depression are still things only a small number of people suffer from.

What, in my view, is more illuminating, is the data from the world-leading study taking place here in our backyard — the Dunedin Longitudinal Study. Having tracked around 1000 people for just over 50 years — and still going — they were able to show that around 80 percent of people will at some point in their life experience mental illness if you include addictions to alcohol and other drugs.

To put that another way, four out of five people will at some point in their life struggle in ways that are serious enough to interfere with their day-to-day lives.

Maybe so-called abnormal psychology — what studying psychological diagnosis and psychiatry was called when I did my degree — isn’t so abnormal after all?

Wellbeing and the dangerous myth of normal

One of the biggest problems with trying to define abnormal is it implies the existence of a normal. A healthy, stable, calm being that we might aspire to be.

The perfectly balanced, emotionally healthy human.

It’s not uncommon for people who land in therapy to believe that everyone else has it together. Happy marriages, healthy children, and successful careers. Regular trips to the gym, and a balanced diet. Contentment. Success. Two-point-four children, and a picket fence.

I understand how it can seem that way. Social media — and Instagram in particular — does us no favours here, with its tendency to present the holiday snaps of our day-to-day lives in a montage of smiling mediocrity, the complicated reality of life taking place off camera. Of course, even before social media, we’ve always tended to keep the reality of our lives hidden, to mask up, say things are fine when people ask how we are. To all walk around like there’s nothing wrong. It’s a necessary skill, even if it does mean to some extent, we’re all hiding.

But I truly believe the idea of normal is not only a myth but a deeply dangerous myth. A myth promulgated by advertising agencies trying to sell us sugar-laden carbonated water that will bring us spiritual fulfilment.

And of course, in good late 20th-century fashion, people figured out how to utilise that insecurity, that worry there might be something wrong with us — for profit. As a business model, it has always existed in one form or another. And I’d be re-writing history to suggest that there isn’t an overlap between the history of psychotherapy, and the self-help and wellbeing industry.

But whether it’s the 1970s and self-actualisation, the second-hand bookshops awash in self-help books, or the more recent online world of wellbeing influencers with a silver bullet secret that will set you on the path to Nirvana, they’re all cut from the same cloth.

There is no shortcut, and in many ways, there is no secret. All these approaches are fundamentally flawed because they seek to defend against the truth of the messiness, pain and at times outright despair of living a