Psychic Pain: Mood and Anxiety Disorders

Psychic pain: Most people who come to my practice are suffering from what I call psychic pain. That is, they are feeling low, upset, afraid or anxious (or all of these things together). These people are searching for a way out of their pain and to further their own psychological development. Their suffering points to problems which need to be attended to just as much as physical problems need to be attended to, when physical pain is experienced. As miserable as it is, psychic pain impels the person experiencing it to think about his or her own self and what he needs to change. It can be a motor of person growth. Even unreasonable or inappropriate anger can sometimes be seen in this light, if it drives the person experiencing it to seek the true roots of his or her own discontent.

Some level of psychic pain is usually felt by all of us on a regular basis and can be handled by us on our own. With some thinking and effort, we can often discover the roots of our misery and find a way out of it by ourselves. For this reason, psychic pain is not usually diagnosed as a clinical problem unless it continues to exist for a period of at least 2 weeks and reaches a level of intensity, which interferes with normal life functions and enjoyment. In this case, the individual’s problems are over-whelming the person’s defenses and therapeutic assistance is needed just as much as a broken leg needs a splint.

When psychic pain continues for a longer period of time, disrupting normal functioning and enjoyment of living, it may be symptomatic of a Mood Disorder, such as depression and its cousins, manic-depression, hypomania and Dysthymia, or of an Anxiety Disorder, such as panic disorder, general anxiety disorder, phobic disorders and obsessive-compulsive disorders. They are given separate diagnostic categories and exhibit many significant similarities and differences, which affect the manner in which psychotherapy is applied. Psychic pain may also signal the presence of a Posttraumatic Stress Disorder (PTSD; see also “Victims of Abusive Relationships”.), resulting from one or more traumatizing experiences. PTSD has also been placed among the mood disorders by the American Psychological Association.

Mood Disorders: Most people have an intuitive sense of the meaning of mood. Everyone knows what it means to be in a good or bad mood. But what does “disorder” mean here in this context? When a machine is out of order, it doesn’t work, but when a person has a mood disorder, his or her mind is not damaged in the sense that a machine is damaged, which isn’t working properly. The basic functions of the brain and nervous system are still in tact so that the native ability of the mind to learn and adjust are still available and enable the person to benefit from therapy and to heal. Studies have shown that there are indeed some genetic elements which contribute to the sensitivity of individuals to stress and make them more or less vulnerable to some types of mood disorders, in particular to manic-depressive disorder, but these genetic elements are not determining factors in the course of most mood disorders. Depression, for example, is usually a result of general strategies a person has developed during his or her life. By analogy a car, even when in good condition, will not get the driver to where he wants to go, if the map is wrong. Similarly, if we find that our lives have taken a wrong turn, it is necessary to correct our course, by correcting our behavioral reactions, our situation, our view of ourselves, of the people around us or of the world we live in. Even when depression develops as a reaction to unfortunate or tragic events, our mind can heal us under the proper conditions, if given the time and space for this healing to take place.

These facts should give anyone suffering from a mood disorder good reasons for optimism. Even those people suffering from a mood disorder suspected of having contributing genetic factors should know that psychotherapy, as well as medication, can help them avoid manic and depressive episodes. Studies indicate that changes in the functioning of neural transmitters in the brain, such as serotonin, or in the activity of the frontal cortex of the brain, are strongly affected by psychotherapy, indicating a physical effect at least as powerful as that of any anti-depressant, with the difference that the patient, in the case of psychotherapy, has been able to achieve healing through his own efforts in a natural way without experiencing disturbing side-effects. People who over-come their depression with the help of psychotherapy can be proud of their own achievement.

What are some of the main mood disorders and what are their typical characteristics?
The most common one, of course, is Depression. Common symptoms of depression include feeling sad, having a markedly diminished interest or pleasure in normal activities, including a loss of interest in social activities and a loss of energy. Often people feel a sense of hopelessness or helplessness. Depression can also express itself in disagreeableness, a feeling of emptiness, a loss of appetite or even in over-eating. It may be accompanied by a reduced libido, difficulty sleeping, or over-sleeping. Restlessness, fatigue, low self-esteem, excessive feelings of guilt, a reduced ability to concentrate and indecisiveness are common. Thoughts of suicide may also be present. People with it often experience a morning low, making it hard to get up and get going in the morning, even though they may wake up very early and can’t get back to sleep. Depression occurs in different degrees and can be felt by individuals in different ways. Symptoms vary from person to person. A person may not even be aware that he or she is stricken with the disorder, although they may sense that something isn’t working right in their life. A professional needs to determine, if the symptoms they experience meet the criteria for depression.

Bipolar I Disorder, “Manic-Depression”, is diagnosed when a person has also experienced one or more episodes of extremely high moods, or Mania, in addition to depression. Bipolar II Disorder, also a form of Manic-Depression, is diagnosed when a person has experienced one or more episodes of less severe mania, called Hypo-Mania, which does not interfere with the functioning of the individual to the degree that the more extreme form does, in addition to depression.

Dysthymia, is a mood disorder characterized by a depressed mood for most of the day, for more days than not, for at least two years, with no single break longer than two months at a time. Dysthymia does not have the same high intensity that an episode of full depression does, but it can continue for years, sapping a person’s pleasure in life. With it a person may experience problems sleeping, feel irritable, have low-self-esteem, have difficulty making decisions and have feelings of helplessness or hopelessness.

Anxiety Disorders: As in the case of depression, everyone knows what it is to be anxious. Anxiety reaches clinical levels, when it continues over a longer period of time and interferes with the person’s normal functioning and pleasure in life. Some of the types of anxiety disorders include Phobias, which is fear of a specific thing or situation, Obsessive-Compulsive Disorder, where anxiety and fear is coupled with repeated, obsessive thoughts and behaviors, generalized anxiety, where anxiety seems to be present much of the time for no apparent reason and panic-attacks, where the person experiences discrete moments of intense anxiety or fear, often without warning, at various times and places.

Particularly in the case of anxiety disorders, drugs can bring welcomed, short-term relief, but no cure for the cause of the suffering. Even worse, drugs against anxiety often cause dangerous side-effects, including tolerance and dependence on the drugs, which, in the end, can intensify symptoms, when they are withdrawn.

There can be many causes for an anxiety disorder, but, luckily, they can usually be found and can be treated effectively by affective-cognitive-behavioral psychotherapy, most often avoiding the use of drugs.