by Robert Lanz, LCSW
From my friend and colleague Dr. Drew Pinsky
“You want to know the common denominator among my patients? They all had traumatic experiences in early life that caused them to feel helpless, powerless and in grave danger…There is no trust. If you can’t trust, you can’t connect with anyone.”
If it had only happened once or twice maybe I wouldn’t have noticed it. I never saw any research in the social work or medical literature about it and never heard my colleagues mention it. But I’ve always had a decent eye for coincidence and combining that with what Malcolm Gladwell calls “thin-slicing,” the ability to find patterns in narrow windows of experience, which gave me a handle on this particular problem. Sometimes, I was able to pass that handle on to our patients as well.
A basic premise in mental health is that you can’t always tell much about people by the way they act in public. (Maybe “act” is the operative word here.) Having grown up in Hollywood, I knew a lot about show business people who were famously cool in the movies but infamously uncool at home: great actor; bad parent. Not a fresh concept where I lived, but there wasn’t a lot of research on the subject either. So the stuff I’ll be talking about here is purely anecdotal. As for that movie persona, there is a term for letting our heroes get away with bad behavior: Suspension of morality.
I’ve often thought – and my experience bears this out – that more often than not it is bad mental health that propels some people upward, in the same way that it can make people do bad things. I’m talking about heads of movie studios who like to be tied up and peed on; famous stars who want their spouses to have sex with other people while they watch; macho action figures who want to be spanked and put in diapers. Of course, I didn’t see many of these people in the ER where I worked. But let’s just say that in my neighborhood, this behavior is part of the social fabric that is weirdly woven together and something the neighbors usually don’t get too worked up about. They just accept it as normal. For the most part, the rest of us don’t pass judgment, but we don’t invite these people over for barbeques, either.
The patients I am talking about may have been at a barbeque with me or they may have sat next to me at the dog park carrying on a conversation about the entertainment business, reveling in their successes. In retrospect after meeting several of these types of women in the ER, I began to wonder how many of them I had unknowingly met, possibly in a yoga class, or sharing a ski lift while engaged in a brief but pleasant conversation. I may even have admired one as she walked past my beach chair one sunny afternoon while I was reading a book down at the Venice Beach pier.
In the ER I saw them at their worst and they seemed to have several things in common: they were professionals, and physically attractive. They had the kind of drive and focus that can make others jealous, pursuing and achieving their goals through a pure force of will.
On the outside are the apparent signs of success. But on the inside, is pain beyond imagination. Pain so terrible, that the only way they can tame it is to deny its existence, and always focus outward. Through their successes, they set out to prove that they are powerful women, covering their fears through achievements much the same way an insecure man might: believing he would feel better about himself if only he had a bigger house or a cooler car or a prettier wife or more money. Always more, more, more – never realizing that more wasn’t the answer, yet believing it even after they had achieved the honor of having a building named after them or an airport or some such thing.
What both the men and women in this group have in common is the false belief that their internal pain can be cured by the external trappings of accomplishment. The men I knew in this group often showed up drunk and behaved stupidly: less a shock to me being a man, and also because I have been surrounded by over-achievers most of my life. I believe I am able to see through this behavior.
The women, however, were a surprise. Most of them averaged about twenty years worth of incredible drive and accomplishment and admiration by friends and colleagues. Then one day (more likely one night) when they reached a point where their bodies and minds could no longer keep up the charade, they ended up in the ER as a result of a drunken car crash, or an intentional overdose of prescription medicine no one knew they were taking. For most of them, the self-destructive act came out of nowhere. But the ‘nowhere’ they all had in common was something that happened thirty or so years earlier, when they were molested by a family member or trusted family friend. What happened to each of them was a violation of trust so profound that their sense of self and safety was redefined, setting them on a irresponsible journey of avoidance and denial. And on a night when the strength needed to cover it up is somehow diminished, the woman finds herself back where she started, vulnerable and alone, without even the fantasy of holding it all back by overcompensating. The fortress built by over achievement can no longer keep the pain in check. Death might seem a better alternative than another moment of intolerable fear and vulnerability.
In my experience, patients like these would not willingly admit they had been sexually abused as children. Usually, once they awoke from a near-death experience, they would reinforce their defenses enough to look at us and lie: to me, the nurse, the doctor, their friends and their family. The lie did work on me a couple of times before I caught on to the sexual abuse connection. In the middle of whatever manipulative story they were trying to put over on me, I began to ask, “Were you molested as a child?” It only took a couple of seconds before their tears and sobs informed me that I had guessed right. After thirty years of overcompensating, everything fell away with one simple question. The beginning of the hell of getting better.
This guessing is one of those skills you develop, yet are never proud of: the ability to light lives on fire, knowing that – like with a burn victim – recovery is a long and painful journey, for those willing to take it.
The ones who chose not to take it might end up in another ER, disintegrating further into a life of drugs, sex, violence or other attempt to escape their pain.
But there is no easy way around this pain. Like s a swamp, you must slog through it to make it out the other side.