Dogs have a sense of smell that is one thousand to ten million times more acute than humans do. Hawks have visual acuity equal to 20/2, meaning they can distinguish visual stimuli at 20 feet that would require a human to view them at only 2 feet away.
But humans have an ability no other species possesses, at least not to anywhere near human ability. And that is the ability to perceive across time: we can peer many years into our pasts and imagine and anticipate possible futures many years into the future. This ability makes us virtual time travelers.
You can probably tell by now that I like thinking about the implications of this ability. But today, I focus on a concrete aspect related to this ability, one that can affect our patients for good or ill. Our human ability to remember and learn from the past and to anticipate and plan for the future has many upsides, but in some contexts, it can lead to several dramatic downsides.
In short, when a human being is under duress, projecting one’s self too far into the past or into the future can lead to a sense of overwhelm and this, in turn, can lead to several maladaptive cognitive and behavioral strategies. Recall that when under threat, mammals can respond in one of three ways: fight, flight, or freeze. So, when under duress – a type of threat, often free-floating and multifactorial – a person can 1) become angry and aggressive towards others or self, 2) escape or avoid aspects of life that would more adaptively be addressed, which in extremes can lead to suicide as an escape from a situation judged as unbearable, or 3) go into shutdown mode which, in extreme cases can lead to lying curled up in bed for most of the day on most days. None of these strategies feel good – they are aversive – but they are maintained for various reasons: 1) alternatives feel even more aversive, 2) no alternatives are perceived, 3) cognitive narrowing, rigidity, and perseveration make a generation of new strategies unattainable.
Now, these strategies – fight, flight, freeze – have evolved because they are adaptive in certain circumstances. But in many circumstances encountered in modern life, these strategies backfire. Also, they are often useful acutely, when facing an immediate threat, but counterproductive when facing ongoing threats, broadly defined.
Imagine a person severely injured in a motor vehicle accident. This person may be left with inoperable scars, hideous burns, and loss of a limb. As this individual lies there in the hospital bed, coming back to conscious awareness, and are told the extent of their injuries, they can fall into a sense of despair and overwhelm. They can think back to what their life, now gone, was like. They can consider their futures and realize all the possibilities now closed off to them. They can feel deep grief over the past that is no more and the futures that will never be. The more they think about this, as the thoughts come racing, incessant and intrusive, into their minds, they will feel overwhelmed.
Next, imagine a patient with severe depression. Depressive disorders manifest a certain mood – often a despairing, doom-filled, or dread-inspiring one – one that colors every aspect of conscious experience. To consider a mood an emotion is to underestimate it. Moods are more basic, prior to, and more all-encompassing than is an affect, feeling, or emotion. The self, the world, the past, present, and future are experienced through the lens of this mood. It’s like wearing a pair of glasses that color everything that you not only can’t take off, but you don’t even know you’re wearing. It’s impossible (or nearly so) to perceive anything outside of a mood. The mood forms a person’s horizon of perceiving and understanding.
Thus, when a person who is in the throes of such severe depression considers … anything really, they will experience it through the lens of despair, doom, dread, or some such combination. Unsurprisingly, the more thoughts a depressed person under duress has about the self, world, past, present, and future, the more hopeless and overwhelming the situation is experienced, and the more helpless the individual feels. And from this, many types of maladaptive strategies arise, including heightened risk of suicide.
So, what is the solution? One crucial strategy to undertake during the time of despair, doom, or dread is to narrow the time window that is the focus of thought: the further into the past and/or into the future a person’s thoughts go, the wider the time window and vice versa.
For several years I was medical director and a clinician in a partial hospital program. I was managing patients who were on the cusp of needing to be psychiatrically hospitalized or who had been recently discharged. In nearly every conversation I had with the most unstable and overwhelmed patients, I had a similar conversation. The gist was, “What you are telling me about your past and your future is crucially important. I want to and I will discuss these parts of your life with you. But right now is not the right time. Let me ask you this: when you think back on your past or imagine your life far in the future, do you feel better or worse?”
Invariably the answer was the patient felt worse. I continued, “This is expected. When a person is not feeling strong at the moment, thinking about all of one’s life is overwhelming. As you said yourself, it makes you feel worse. This is what I propose to you: right now, let’s focus on today and tonight. When Friday rolls around and I won’t see you until Monday, we’ll focus on the two and a half days of the weekend. And by focus I mean we will work together to develop a plan, a plan for how you’ll spend your time in a comfortable and productive way and a plan of what to do if you feel you’re moving into a crisis.”
If the patient nevertheless continued to fall into thinking and talking about the far past and far future, I would say, “I understand the importance of discussing your past and your future. This is how I see it: imagine you’re standing in a field. The more depressed and overwhelmed you feel, the deeper you are in a hole in the ground. When you’re in a hole, you can’t see – or you can’t accurately see – the rest of the field that represents your life. When you’ll be less stressed and feeling stronger, the hole your standing in will become shallower and the further out onto the field you’ll be able to see without getting overwhelmed. This approach may seem frustrating – I understand. But you can prove to yourself that every time you think too far into past and future, the more overwhelmed you get. Sometimes going slower works better and gets you to your destination faster.”
Until next time,
“In response to threat and injury, animals, including humans, execute biologically based, non-conscious action patterns that prepare them to meet the threat and defend themselves. The very structure of trauma, including activation, dissociation and freezing are based on the evolution of survival behaviors. When threatened or injured, all animals draw from a “library” of possible responses. We orient, dodge, duck, stiffen, brace, retract, fight, flee, freeze, collapse, etc. All of these coordinated responses are somatically based- they are things that the body does to protect and defend itself. It is when these orienting and defending responses are overwhelmed that we see trauma.” – Peter Levine
“But there was nothing I could do to dim the supernovae exploding inside my brain, an endless chain of intra cranial firecrackers” – John Green
“I could no longer discern what was real and what was fake. Everything, including the present, seemed to be both too much and nothing at all.” – Clemantine Wamariya
“What emotion had so invaded me? Fear? It is sometimes curiously difficult to name the emotion from which one suffers. The naming of it is sometimes unimportant, sometimes crucial.” – Iris Murdoch
“The benefit of carrying the entire world on your shoulders was that you didn’t have to stare it in the face.” – Rhian J. Martin