Wednesday, April 17, 2024
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Lost in the loop

THE WASHINGTON POST – Many of my patients come to me because they feel dissatisfied in their relationships, with the same hurtful and destructive patterns replaying over and over. As several of them have said, “It’s like I’m stuck in a cycle, and there’s no way out.”

One of my patients believed she was not good enough for any partner. Another patient worried about his family and was constantly advising or doing things for them. Yet another patient had trouble with criticism about her work, becoming tense and mute when someone fairly or unfairly pointed out her errors.

We all have had relationships and situations like these that bother us, take up a lot of our mental space and bring out versions of ourselves we may not like. This may be because many of us replay unhelpful behavioral patterns that were formed in early childhood in response to dysfunctional environments.

We are not, however, locked into these patterns. We can change, allowing ourselves to become more flexible and understanding in our relationships.

EARLY LIFE IS CRITICAL

To know why we become stuck in certain difficult relationships and situations, and how we can get unstuck, it is useful to look at what happens to our brains in childhood.

In the first several years of our lives, we are in what is called the “sensitive period” of brain development. During this time, our environments (including interactions with caregivers) have their strongest and most lasting impact on how our neural circuits are shaped.

As we engage with our surroundings, we form patterns of what happens under certain circumstances (“if-then” contingencies), including what to expect from other people and how we feel during and after interacting with them.

PHOTO: ENVATO
PHOTO: ENVATO

In childhood, our “emotional brain” (areas gauging safety or danger levels and activating stress hormone release) can mature more quickly than our “thinking brain” (areas involved in forming memories and with cognitive flexibility). Our brains prioritise encoding our emotional responses to the environment before encoding our understanding of why we feel as we do.

Evolutionarily, this makes sense. Knowing what to approach and what to avoid is key to survival – if we encounter a dangerous animal in the wild, stopping to think wastes precious seconds; we need to assume the worst and run.

As we move through childhood, the sensitive period starts to close, and a working map of our environment is “locked in” by the brain, making it harder for these circuits to be changed.

This underlines how critical early life can be in shaping our understanding of ourselves and the world.

If we grow up in nurturing and loving environments, our sensitive periods last longer, helping us develop more flexible and nuanced thinking. If the environment is harsh or overly critical, however, higher levels of stress can shorten the sensitive period, causing the brain (and other biological systems) to develop quickly and incompletely.

This limits our ability to flexibly think through situations (especially stressful ones), leaving us with strong emotional reactions to our environment and difficulty in breaking up negative thought loops.

We find ourselves caught in repetitive ways of relating, with a narrowed sense of self and others. Notably, challenging experiences during sensitive periods can increase the risk of psychiatric conditions such as depression.

CHILDHOOD EXPERIENCES

My patient with trouble in romantic relationships grew up with parents who gave her positive attention only when she excelled in school, expressing strong disappointment when she did not.

Being herself was never reason enough to be loved. This led her to be hypercritical of herself.

When people tried to reassure her, she would withdraw, convinced that they “just didn’t get it” and would be better off without her.

My other patient, who worried excessively about his family, was the oldest of five children.

Growing up, he had to frequently help his single mother take care of his siblings.

Conversations with his mother always revolved around the other children. “I never once remember her asking me how I was, and after a while I stopped asking myself that, too,” he said.

As an adult, he continued to treat family members like children, causing them to view him as overbearing and intrusive.

My patient who was uncomfortable with criticism blamed herself for her parents’ divorce, which happened when she was a child. Neither parent reassured her that she was not to blame.

“I felt that I had broken something precious,” she said. “My power to do damage suddenly seemed so much greater than my power to do good.” She felt it was overly risky to take chances, as her “mistakes” had proved too consequential and costly.

Whenever a mistake was pointed out to her at work, she felt an accuser was putting her worst self on display, causing her to shut down.

RELATIONSHIP PATTERNS

As my patients show, the way we perceive the outside world is often a reflection of our internal world.

If we hold negative views of ourselves and others, we may interact with people in ways that confirm our expectations, as though each person already had an assigned role and a script to follow. It does not have to be this way.

The impact of early experiences can be significant, but our brains do not stop developing after the end of the sensitive period. New connections and pathways are established through learning, lifestyle changes and psychotherapy.

Our patterns of relating can also be changed by subsequent relationships, especially if they do not conform to the early models we have known and lived through.

We need to maintain supportive, welcoming connections in our lives, which can offer us healthier ways of interacting.

As we try to nurture flexibility and understanding in our relationships, there are some strategies that may be helpful.

FIND SPACE FOR STILLNESS

Find space to reflect on how your mind works and how you came to be in your present situation. This is an important step in reshaping relationships – with yourself and others. As self-awareness deepens, change will seem increasingly possible.

When pulled to do or say something unhelpful while interacting with others, stop and think about what is happening.

We can be quick to be hurtful to one another, often without giving it much thought. Creating space for contemplation helps us not repeat harmful response patterns.

Giving up control was difficult for my second patient. By constantly looking “out there” into the lives of others, and by turning to action instead of thought, he was avoiding looking inward, a place he had never been allowed to consider worthy of attention.

As we worked together, though, he began to allow his own mind and emotional world to be discovered, finding value within himself for the first time.

BE PATIENT WITH YOURSELF

Your feelings and behaviours might be frustrating, but they were necessary at some point, given your early experiences.

Our minds have needed to make sense of a lot of information; the solutions and compromises that are reached may not be easy to understand.

My first patient took time to grieve the idealised relationship she never had and never would have with her parents. She realised that relationships in which no one felt diminished or devalued were the most sustainable ones.

She also learned to love “the flawed version of myself, since that is the real me”, she said. “I was never meant to be perfect.”

KEEP THE SUFFERING OF OTHERS IN MIND

In the midst of an unpleasant interaction with someone, remember that something from their or your past might be finding its way into the present.

My third patient began to think about why she defined herself by her mistakes, with no room to consider anything constructive or creative she did. She realised that she was often recognised by others for the quality of her work, and that people’s negative opinions should not carry as much power as she was giving them.

She also figured that people who unfairly criticised her felt, like she did, that mistakes could have terrible consequences and needed to be avoided.

Focusing on my patient’s mistakes might be their way of managing self-doubt – viewing others as flawed was a way of feeling in control and less exposed.

Whether our hypothesis about others is correct, simply taking this curious, empathic approach softens our stance, and we will inevitably go into the next encounter with a different outlook.

When we create space for kindness toward ourselves and others, we can break the cycle of misunderstanding.

Christopher WT Miller, MD, is a psychiatrist and psychoanalyst practicing at the University of Maryland Medical Center and an associate professor at the University of Maryland School of Medicine. He is the author of ‘The Object Relations Lens: A Psychodynamic Framework for the Beginning Therapist’. – Christopher W T Miller, MD

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