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It's Not the Negativity but Your Reaction to It

The root of neurotic conditions is negative reactions to negative feelings.

Neurotic conditions are states of psychological distress and mental ill-health that involve heightened levels of negative emotion (i.e., states of emotional pain that include depression and anxiety primarily, and secondarily hate/anger and guilt/shame), as well as problems with coping, relationships, and identity. I sometimes refer to these conditions as “negative affect syndromes,” and they are the primary things that drive people into psychotherapy.

The neurotic conditions correspond to the following mental health conditions in the Diagnostic and Statistical Manual: adjustment disorders, generalized anxiety, social anxiety, and major depressive episodes of mild to moderate severity. They are also closely related to long-term relationship problems, low self-esteem, and problems associated with personality disorders, such as avoidant, dependent, and borderline tendencies. And much substance misuse stems from people self-medicating to escape negative feelings.

There are three primary ingredients to neurotic conditions. The first is a “neurotic temperament.” This refers to the basic set point of the negative emotion system. That is, how sensitive it is, how strongly it reacts to negative events, and how long it takes after a stressor to return to baseline. People high in the trait of neuroticism are more easily stressed, feel negative feelings more strongly than average, and take a longer time to cool down.

The second primary ingredient is the stressors themselves. That is, real-life problems in living that threaten core psycho-social needs. These include the need for relational value (being known and valued by important others), the need for achievement, the need for resources to obtain wants and desires (i.e., money), the need for play, growth, and exploration, and the need for safety (which is violated when folks are traumatized).

It's Not the Crime But the Cover-Up That Burns You

The third reason is the most important, as it is the one that leads to poor coping and feeds neurotic conditions over the long term. And it is the one that is often hardest for people to recognize. That is, when people come into therapy, they are generally aware of the first two elements. They know stuff is stressing them out, and they know they feel like crap. But they are not nearly as cognizant of this “third force” driving their distress.

But the good news is that it's the one element that people have the most direct control over, if they are taught about it and learn to do it differently. What is it? The fundamental root of neurotic conditions is negative reactions to negative feelings. In a manner that parallels the old saying that it is not the crime, but the cover-up that burns you, it is this secondary negative reaction to the primary negative feeling states that screws people over and creates vicious, neurotic cycles, which result in negative affect syndromes.

As a clinician, one of the most important things I pay attention to when listening to a client—in addition to their recounting of their stressors and histories and the negative moods they are feeling—is how they feel and react to how they feel and react. Yes, I intentionally typed that out twice. There are primary reactions, and there are secondary reactions to primary reactions.

Of Two Minds

There are these two layers of psychological reactions, because the human mind is really two streams of consciousness wrapped up into one. Once we disentangle these two streams and see how they relate to one another, then we can understand why we have secondary reactions to our primary feeling states.

Let’s label the first stream of consciousness your “primary process mind.” You can also call it your “primate mind” or your “feeling mind” or your “heart.” This is the core driver of your psyche. It's the part of you that looks out and sees the world, has motives and urges (ranging from food to sex to status), and is energized by emotions to respond to events. It is crucial to understand the nature and function of emotions. They give information about goals relative to what is happening. And they serve as ways to orient you to seek and approach “good” things and to avoid and withdraw from “bad” things. The roots of these feelings are pleasure and pain, and they give rise to more complicated states of positive and negative emotion.

In terms of negative emotions, we can effectively map them by thinking of them as having a core of emotional pain, with two primary negative emotion mood states (depression/despair and fear/anxiety) and two negative social emotional states of shame/guilt (negative feelings about self) and hate/anger (negative feelings about others).

The second stream of consciousness, which we can call your “secondary process mind” (or your “person mind” or your “deliberative, self-conscious mind” or your “head”), is the part of your mind that talks and deliberates and reflects and makes explicit claims about reality. Importantly, it comments or reacts or responds not just to what is, but also to what ought to be. That is, the deliberative mind has ideas about what is justifiable and what is not. It makes these claims referenced against ideas about the way that people ought to be.

What Is Vs. What "Ought to Be"

These two minds are very different. The primary mind is quite automatic, fast and reactive. It feels things based on what it perceives relative to its goals in the immediate situation. If it perceives the situation as being one in which the individual is isolated, it will feel lonely. If it perceives the situation as involving one’s goals being intruded upon by others, it will feel angry. If it sees that the individual has failed or is inferior to others, it will feel shame. If it feels defeated, it will enter a state of defeat or helplessness.

The deliberative mind is more complicated. It not only thinks about what is, but also thinks about what ought to be. When the secondary mind is pointed toward the primary mind, it means that one can decide whether the primary mind is feeling what it should. Or it might decide that the individual is not feeling what they should, but instead it might decide the individual should be feeling something else. This is a crucial thing to be aware of.

Where does the deliberative mind get the ideas for what an individual ought to feel? Originally from other people, either directly or indirectly. Perhaps your dad wanted you to be tough. Perhaps your friends did not want you to be angry. Other people are often quite clear about when they want folks to be happy or angry or guilty. And because people want to be liked and accepted and have status in the eyes of others, they turn those judgments onto themselves.

Negative reactions to negative feelings are the fundamental root of the neurotic conditions. It is hard to overstate the importance of this claim, because the neurotic conditions are the single biggest driver of mental illness. And they are getting worse and worse in modern society, perhaps because too many people are taught to be afraid of their negative feelings, or that they shouldn't have to feel them, or that they are disease states.

It is possible and desirable to work toward shifting the attitude of the deliberative mind in how it relates to the primary process mind. Rather than being critical, reactive, and controlling in our deliberative mind regarding our primary feelings, we need to cultivate a different attitude, one I encapsulate in the acronym C.A.L.M. M.O.

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