Tolerating Discomfort

"If some longing goes unmet, don't be astonished. We call that Life." - Anna Freud

This is essentially the argument for affect tolerance, the ability to tolerate all of our feelings and continue to function; being able to feel all our feelings without compulsively needing to anesthetize ourselves from them. There are always discomforts, disappointments and even tragedies in life. Our ability to bounce back from these experiences is resiliency. We can learn from our feelings, particularly the uncomfortable ones, so long as we are open to having them. If we choose to close ourselves off from these feelings we do so with the cost of impoverishing our genuine experience. 

So many of my patients come to me initially seeking relief from "anxiety" or "depression" by which they mean a subjective experience, a feeling, that is uncomfortable or unbearable. Our culture tells us that there is no need to tolerate an uncomfortable feeling. There are medications or new consumer products that can take these feelings away, banish them to the unknown.

But in doing so we flee the here and now for imagined comfort of somewhere else.  We trade our lived experience, the only true reality, for some imagined talisman that will end our suffering.

Michael Balint, a Hungarian psychoanalyst, argues that advertising, art, the longed for relationship, all depend upon our yearning for what he calls the transformational relationship. If we could possess that thing or relationship our lives would be transformed and made better. 

The hard sell in psychotherapy is that rather than taking uncomfortable feelings away, we work to increase the capacity to tolerate the full range of feelings, including the "bad" ones. So question is not "how can we take that feeling away?" but rather, "how much of that feeling can be tolerated?"

As you can imagine, not everybody wants to take that on. Why not just make the thing that causes discomfort go away? The point is that once a greater capacity to experience feelings without being overwhelmed is reached, greater emotional flexibility and resilience is attained, and that is the proper goal of growth oriented psychotherapy. 

Resilience from a psychoanalytic perspective

In 1932, addressing a gathering of medical students, Sigmund Freud made the famous and often quoted statement "where Id is, there ego shall be" (New Introductory Lectures). For a long time, before I read Freud more closely, I took this to mean that over time the ego could be trained to better dominate the unwieldy Id and that he was really talking about domination of the impulses.

As a review, the ego is that part of the mind with which we are most familiar. It is the seat of our conscious thoughts, sense of the here and now and the experience of the ourselves at any given moment.  The Id is the source of energy in the mind; all the instincts and drives as well as the parts of ourselves that we find uncomfortable or unacceptable. (As a side note, Freud's language was much more familiar and less scientific than the Latinized "ego" and "Id" suggest. Freud's translator, James Strachey, wanted the theory to sound more scientific and so dressed up the English translation using Latin terminology). 

At any rate, my initial understanding of this famous phrase could not have been more wrong. Freud was not suggesting that we increase our censorship and banish more of our experience to the Id, he meant the opposite; that as the ego grows stronger, more of the Id can be tolerated in our everyday lives. This enables us to benefit from all the energy of the Id and function more flexibly. 

Anger is a good example of this process. Many of us are uncomfortable feeling anger and even less comfortable expressing it directly. We are led to believe, through growing up, that it is impolite to express anger so we squelch it at every opportunity. The problem is, there is a lot of energy to be had in anger and anger can be an important signal that our needs are not being met. If we divert anger out of our awareness and into the Id, we loose this resource and impoverish our ego. 

This is not to say that we should be yelling at people all the time or making unreasonable demands. Rather, we should learn to tolerate anger (and all of out feelings) without resorting to defenses that negate reality and squelch anger. 

If the Ego can be strengthened so as to tolerate all our feelings, comfortable as well as ugly, then we expand the Ego and allow it occupy territory once claimed by the Id. We function more flexibly, get overwhelmed less easily, and experience life more fully.  That is resilience from an analytic perspective.