This series is reprinted with permission from my friend and fellow mental health nurse Felicity Stockwell. Her complete writings can be found on her website at http://www.felicitystockwell.com/

I’m grateful to Felicity for agreeing to let me publish her work here.

UNDERSTANDING THE RELATIONSHIP OF BONDING WITH PSYCHO-PATHOLOGY

In an ideal world, the bonding process enables communities of people to live in harmony as they ensure their needs for nourishment and safety are met.

The other pages have given accounts of the knowledge and understandings about the Bonding Process (see adjacent panel for links), and there are a variety of factors that can lead to some individuals failing to have their  Social Needs met adequately at various stages in their lives. This lack generates anxiety and much distress, and where it is severe or prolonged it can lead to a variety of neurotic disorders.

There may be lack of reinforcement of the individual’s sense of worth, or some damage to it, as they learn to negotiate their way through a life, that of necessity means relating to lots of people.  The success of the negotiation will depend in part on the strength of the bonding process, in part on the individuals temperament and in part on experience and learning opportunities. Fortunately most people arrive at adulthood feeling ‘confident enough’ and well placed to hone their social skills further.

However, in the modern world, there are many factors that can limit the success of the Bonding Process and/or the social learning opportunites. This leads to a lifetime of difficulties in getting  Social Needs met adequately and this causes anxiety and leads to attention seeking behaviours when in company. The initial response to this, from the people around, takes the form of teasing, banter and sarcasm, and then become unkindness and rejection..

 Where this is constant or severe, some  mechanisms  come in to play that trigger various psychological manoeuvres, which eventually become the ‘symptoms’ of what are termed neurotic disorders.

 Mental Mechanisms

These are sub-conscious strategies by which the mind adjusts to the reality of social experiences which have, in some degree, threatened or damaged an individual’s self-esteem or confidence, so that they can ‘live with themselves better’.   There is a range of strategies that have been identified and described, and there are many lists of them. No two lists are identical and the definitions can not be exact, because the mechanisms are initiated at an unconscious level and can only be guessed at from observable individual behavious. It is agreed that there is a hierachy in terms of how severe the poor self-image is, that the mechanism is called upon to restore. The following lists a few of the most commonly described mechanisms, starting with the most benign.

Repression This is where small knocks to our esteem are side-lined and ‘forgotten’. It is the process that is the first stage to all the other mechanisms.

Rationalisation This is the most commonly used mechanism,  and is where we give ourselves an explanation for why we ‘failed’ to live up to our ideals or our hopes in some way. For example – a contented person fails to get a job they applied for and the mechanism comes up with ‘I did not really want it anyway, because it would have meant more paper work’

Sublimation This is replacing unacceptable or unachievable desires into another activity. For example a frustrated wife can do a lot of knitting for charity, or the frustrated husband can build a model railway in the attic.

Projection This is attributing to others, shortcomings that we are unaware of in ourselves. For example, a person who is sidelined in a group, might charge a popular person with being petty and mean.

Displacement This is where the feelings from a negative experience are attributed to another person, who is then treated in the same manner that caused the problem. For example, someone made to feel resentful or belittled at work, goes home and humiliates his wife, or ‘kicks the cat’

Suppression This is where some humiliating episode, that can not be managed with any of the other mechanisms, is prevented, at a subconscious level, from being recalled. For example, someone with very low status in an office, suddenly realises the implications of having forgotten to carry out an important task, can completely forget they were asked to do it.

Denial This is where some experience or action overwhelms self-cofidence and acceptance, and becomes completely ‘forgotten’. This is the most extreme of the mechanisms, being on the borderline between being normal and neurotic.

All these mechanisms help us to handle our anxieties, and feel better about ourselves. They are useful when used in moderation, but the more extreme ones make life worse.

The neurotic paradox

This is elicited when mental mechanisms fail to help someone feel comfortable in social situations where they are being rejected or diminished.

The neurotic paradox is a term that describes a reflex response that occurs when an individual fails to gain approval in a social situation and feels ignored and rejected. This unconscious reflex sets in action a range of behaviours (termed ‘attention seeking’ or ‘difficult’ behaviour) that, far from being useful, have the effect of alienating those from whom the individual most needs approval. The ‘paradox’ is,  that the more a person needs to be liked and approved by the people around, the more they come to see them as threat that has to be avoided.  The more this reflex is called into play, the more extreme the behaviours become, eventually leading, over time, to ‘neurotic’ disorders. When these disorders are severe enough to warrant treatment, it is understandable that the ‘paradox’ engenders severe ambivlence for the sufferers in their relationship with the treatment and care team, and equally, for the members of the treatment and care team.

People undertaking the care of others have to learn to recognise both attention-seeking behaviours and their own attention-rejecting behaviours and, through understanding, gain the skills that will  enable them to be kind and accepting, thus meeting the others’ Social Needs, raising their self-esteem, and giving them social confidence. Where the problem is severe it takes time and good teamwork, and much testing by the patient, before the strategy can be effective, and this is called Mental Health Nursing

Psycho-pathology

When there is severe lack of, or threat to the physical need system the reflex response is to fight or to flee, and the same response is triggered when there is severe lack of, or threat to the social needs system, but in social settings it is not appropriate or helpful to attack or run away from others. The strategies outlined above are therefore called into play, and will increasingly alienate (and perplex) the people they have to interact with, and the symptoms will become more severe.

Neurotic Disorders

These all arise to prevent a conscious awareness that the individuals are unloved and unliked to such a degree, that the protective strategies are insufficient to allay the anxiety, and progress to ’pathological strategies.’ These may be attempts to ‘flee’ from the anxiety, or attempts to ‘fight’ or control the anxiety. And then there are the addiction disorders that attempt to deny the distress.

The disorders that arise from the attempt to ‘flee’ from the threat of social situations are Personality Disorder, various Anxiety States and Panic Attacks. They are extreme expressions of the ‘attention seeking’ reflex, and they all trigger the ‘rejecting’ reflex in those from whom they seek help.

The disorders that arise from the ‘fight’ response are the Obsessional and the Compulsive Disorders where mental mechanisms are over used to control the conscious awareness of the individual’s social alienation. This is done by repetitive thoughts or actions that limit interaction with others, and are often kept secret until they become too severe.

The Addiction Disorders arise from a denial of social anxiety. There are a variety of things to which people can become addicted. Prescription and non-prescription drugs and alcohol form a major group. By their action on the chemistry of the brain they can counter the distress producing effects of adrenalin and cortisol and provide temporary relief, but do nothing to help to ensure the meeting of social needs and increase self-esteem. It is the nature of addictive substances that it takes increasing amounts to achieve the same relief, and over time if they are withdrawn there is a ‘rebound’ of circulating adrenaline and cortisol that is experienced as an extreme level of anxiety.  There are other forms of addiction that stimulate endorphin release in the brain, which provide a temporary feeling of pleasure. The excitement of gambling and promiscuous sexual congress in the absence of love or friendship, are two such triggers. It has only recently been shown that the area of endorphin release in the brain caused by such addictions, is different from the area that is stimulated by the meeting of social needs. It is interesting that adequately met social needs ensure contentment and enough is enough. In social situations, where people are driven to seek more and more fame, status or wealth in an addictive manner, it is likely that their social needs are not being adequately met.