How do adults develop emotionally over time? A model

Adult emotional development

The idea I want to explore today is that while the tools of psychiatry have been collected together because of their effectiveness in making people less distressed or less behaviourally disturbed, they are from a variety of different basic philosophies that don't fit together in any other way. Because of this they are not very useful if we are trying to divine fundamental truths about the human condition. And fundamental truths are what I am after, in order to have an integrated basis from which to provide help. Psychiatric tools have been partially helpful to the individual or to society. They have, as is natural, been subverted in one way or another by capitalism or state control or whatever. But the basic problem remains that in psychiatry we don't have a reliable framework for understanding all human distress that points to solutions for individuals. 

One of the biggest and most persistent complaints from outside the system is the transition from child and adolescent to adult services. That when a person reaches a particular but arbitrary age they step over a particular philosophical divide that is entrenched in our culture:

BASIC ASSUMPTION OF CHILD SERVICES	BASIC ASSUMPTION OF ADULT SERVICES
A child is under our protection	An adult is not our responsibility
Because the their healthy physical and psychological development is the future of our society	Unless they ask for our advice or force us to act to prevent them killing themselves or protect society from them

BUT

Adults are the ones driving the hate and fear in our society right now.

AND

Adults can and do develop over time. 

This is the lesson we can learn from mid-life crises and the hero's journey. That with time we change how we are in the world, and how we see the world, and that this change with time brings us a more helpful perspective. 

What's important to understand about this is that the change at these times in life is not about just using a new technique or tool on ourselves. It isn't that we've finally learned how to organise ourselves better or how to handle unhappy feelings. It's more of a meta-realisation because we have had enough experience to be able to see the effects that our preferred decisions have made in our lives. And we can finally see at least some of the time that our own closely held ideas about ourselves have been the cause of many if not most of our problems. That it is not so much the circumstances of our lives but our relationship to ourselves, our thoughts and feelings, and to the world outside us which dictates our problems, our resilience to obstacles and the satisfaction we derive from life. 

Some parts of this are known and used to help by some parts of the psychiatric universe, of course. The basic assumptions exercises in CBT spring to mind. But the fundamental difference between a focussed tool for immediate change and a perspective change for the rest of one's life is something that is not as central to psychiatric care as I think it should be. And this is something that the general public seem to agree on.

This meta-shift of perspective in adults over time is a fundamental and good thing we in mental health services need to examine and learn how to catalyse. It is a thing I have seen in my own life and in my psychiatric practice. In fact my last team was full of people who had been ghettoised into a diagnosis of hopeless chronic schizophrenia but over time had developed and changed to the extent that they no longer needed or wanted services. And personally I'm happier now than I have been at any other time of my life, simply because of a broadening of my perspective on what it is to be human.

How do adults develop over time?

So what do I mean when I say adults can and do develop over time? I mean that with age and experience our relationship to the rules in our heads changes. I like to use the analogy of cultural hegemony to explain how I see this. 

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Antonio Gramski gave a definition of cultural hegemony which goes something like this: The ruling class's world view misrepresents the social, political and economic status quo as natural, inevitable and perpetual conditions that are universally required rules for living rather than as artificial social constructs that benefit only the ruling class. It's in their interest to believe that the social arrangement that led to their success is the best arrangement possible. For most of us this is not news. It's easy for us to see this happening in our society right now, given current events relating to people who having attained high office due to their social position, arrange for their friends and family to obtain the most lucrative positions and shamelessly rethink the balancing restrictions on them doing so. 

So what if, instead of being about society as a whole, we think of this as describing the status quo within the personal universe of each one of us. That our personal universe is dominated by a class of thought and rules for living that we think of as natural, correct and unchanging, which are in fact an artificial construct that benefits us only in certain external conditions. 

Thinking about other people's inner hegemony

It's easy to see that this hegemony applies in most other people's inner world. We look at other people we know and they have obvious rules for living that benefit them in some way (or have at some point in their life benefitted them) and that they believe everyone else should also follow. We can all no doubt think of people who are driven to tell us how to live because they see their way as the only right way. But you will see that it also applies to people who have rules about not telling anyone else what to do - they resent it when other people try to influence them. 

And the solutions that individual people come up with for real problems are driven by these inner rules rather than by the reality of the situation. So you might hear people suggesting fining patients for missing outpatient appointments or increasing systemisation of staff-patient interactions or open-ended Rogerian counselling for psychosis or creating yet another team boundary for your average patient to cross. All of which in my opinion are mis-prioritising and likely to be counterproductive. (But then that may be because they are different from my ingrained solutions! You decide.)

So for me the most important word in the definition of cultural hegemony above is misrepresents. We all see our rules as the right ones, but they are not. After all we have often had to fight for them, or have learned them through pain and suffering. They are the rules that have led to our survival. But just as we can see that other people's behaviour and thinking is often wrong, the irony is that they can see through us just as easily. Our rules, despite our convictions, are not the best for everyone. They are not even the best for us.

Creating our own problems

Our rules may have been tools we needed to get through difficult times in the past, but they are not natural or inevitable or perpetual or life-savers that we have to cling to in order to survive now. They are more like the steps for a particular dance. When dancing that dance we had to stick to them to avoid being stepped on or be embarrassed, but now we are dancing a different dance in every situation it is not in anyone's interest if we stick to the old steps because we mistakenly believe they are the only way to keep us safe. It's quite easy to see that when other people do that they are actually creating almost all of their problems for themselves and many for other people by doing it. By following the steps for an earlier dance they are now the ones stepping on other peoples' toes.

An obvious example of this that I have seen repeatedly in my career is a young man who has grown up believing that he needs to be constantly on the alert for aggression and disrespect from other men. Now just to be clear I am not saying that this was all in their head. I have no doubt that in some families and some subcultures such alertness is necessary in order to protect oneself from harm. What I would say, though, is that having this alertness can and does make the person get in another man's face in a way that leads to them attacking 'back'. These are the people who again and again get into fights but are not aware that they were the one who started them. And because of this repeated experience continue to see the world as a dangerous and unfriendly place that you can only survive by asserting dominance.

For another example, take the person whose rule is that you should control your actions so as to be absolutely certain of something, and that the solution to all problems is greater control. Now again, this would be an appropriate rule if in your childhood there was no one managing the necessities of life for you. Or if your main carer was also running this rule you may have absorbed the expectation that terrible things would happen if you relaxed. It's easy to see that if you live by this rule you will have more certainty in the short term, but in reality you will never reach a point of enough certainty to feel able to relax and enjoy yourself. So you will be tormented by a very tense and unhappy life in which your only reward is the intermittent and inevitably short-lived feeling that something is under control. 

Another example which is familiar to mental health professionals is the person whose self-imposed rules require them to think of themselves as fundamentally flawed and a waste of space, leading them to be apologetic to the point of making themselves invisible and then feeling lonely, rejected, unfairly ignored. It's not that they consciously did this to themselves, more that it seemed like the only solution to an early dilemma in their lives and they haven't wanted to risk changing the rules for fear of being demolished by a world they imagine is constantly judging them and finding them wanting.

I'm guessing you can think of a lot more examples of this kind of counterproductive rule just focussing your attention on the 3 or 4 people you know best. Why not have a go before you move on to the next paragraph?

Focussing on the person we think we know best of all

Being honest with ourselves for a moment, we can see that there have been times in our lives, perhaps major events or perhaps minor setbacks on a weekly basis say, when our rules have not just led us astray but have been the cause of difficulties in relation to the tasks or the people in our lives. For example, my rule that what I do is the only relevant measure of whether or not I'm a good person, leading me to be driven to achieve at the expense of being aware of myself and my own needs. Which has the inevitable consequence that eventually I am unable to continue doing much at all for a while. Or to choose a more trivial but frequent example, I have a rule to never be late and this can easily result in my leaving the house without important things (like tickets) so I end up not being able to do the thing that I was so admirably on time for.

Have a look at yourself. How do your own rules bring you grief in your life? If you, like most people, find it difficult to see this in yourself, you might find that those nearest to you have a shamefully clear idea. (Or you might recognise what they say about this as yet another example of them projecting the rules of their own universe onto you).

How does this model help us decide how to help?

Just like with cultural norms there are three ways of moving away from a cultural hegemony. 

    1. Revolution: We can violently reject the hegemony and attempt to overthrow it with a revolution of blame and punishment, razing it all to the ground and suppressing the good with the bad. 

    2. Submitting to the status quo: We can somehow identify ourselves with what is and make the best of it for ourselves and other people without wishing or attempting to improve it.

    3. Taking a larger perspective: We can accept that the rules are not fixed, that even the wrong rules can be right sometimes and you can therefore be open to other possible arrangements and tools which can then be integrated gently into the life of the society, producing gradual progress in the good without demonisation of any person. 

We know that revolutions often, if not always, eventually result in a different hegemony taking over, with its rules and its own particular underclass. We know that the cliche tendency of adolescents is to do the former - aggressively rejecting the status quo in favour of what they think works for them personally. And that this doesn't generally get them what they want which is acceptance for who they are by the people who have apparently been oppressing them. 

I would argue that the second way, while relatable and understandable, is denying ourselves hope and truth. It's the chicken submitting to the battery life, or Neo taking the pill of forgetfulness. Only in real life there is no true forgetfulness and we dream of freedom and chafe under the yoke of it. 

The third way, in my opinion, of understanding that we are not our rules and the world is probably not as we imagine it to be and therefore tentatively experimenting with different ways of being in the world, is a more productive way to go.

'At it's heart there is a strong but completely unsentimental compassion for human beings suffering and perishing from their very attempts to save themselves.' Alan Watts from The Way of Zen