Sunday, May 01, 2005

So hard to say no

Many bloggers are engrossed with the runaway bride, who faked her own abduction on the eve of her enormous wedding. Not all of them are forgiving: "...if I were the groom I'd be running away myself, now," says Instapundit.

I've promised, "no armchair analysis on this blog," because it is too easy, often baseless, and frequently boring.

But in deference to those who scan my blog, searching for some reference to "psychology" (I see you on my statcounter!), I offer the following:

The story of the "runaway bride" suggests certain themes that are common in our consulting rooms. In the simplest terms, they involve the need to be special, or admired; the need to be perfect, or unassailable; the need for approval; the need for a sense of control; and the inability to say "no" (especially if saying "no" brings humiliation and disapproval, in spades).

Fourteen bridesmaids, with groomsmen, may translate to 28 people that one is unable to say "no" to. The actual list may run to the hundreds - including, of course, her fiance, her parents, her church...perhaps, most of the town where she lives. What was it like to imagine their reactions, if she had simply called it off?

It's not easy to say "yes" to one's own needs and desires, when that entails saying "no" to so many, and when the thought of saying "no" causes intolerable conflicts and a feeling of entrapment. Fleeing might seem like the best of many poor options.

Often, these themes will come tumbling out during sessions. They are "issues" that are rarely sorted out in a PCP's office, when patients complain that they are sad, anxious, or overwhelmed. Antidepressants fall woefully short of addressing them.

Enter the therapist, who explores how these situations come about, and how they might change. In psychotherapy, patients can untangle conflicting motives, increase their self-understanding, and explore other options. Fleeing is not the only way to cope.

This is one reason why neurology cannot entirely "take over" psychiatry, and why we will always need psychotherapists. The meds are just one piece of the puzzle.
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