When we do not feel, we have no choice, either we act in or we act out; either the force remains inside and gnaws away at our system, or the force is acted out in the form of neurotic behavior. In the latter, we are driven by the feeling to act-out and in the former we keep that force well-hidden and repressed.
If we want to know what are our hidden feelings look for the act-out. One actress I treated was constantly acting out on the set, “I will be anything you want. Just love me.” She would play any role the director wanted and played it well because love was at stake. She tried in every way to be loved by her mother, also an actress, but alas, it was not to be because her mother was also acting-out, running from audition to audition looking for approval/love. She had no time or interest in being a mother.
Or if we look at the act-in we note how deep is the symptom, how mid-line it is in order to see if it is first-line, very deeply driven, trauma. Colitis and ulcers generally inform us of remote pain. Is it migraine? Generally a matter of oxygen deprivation during gestation or birth where the blood system was the first line of defense against the trauma. Lack of oxygen meant conserving energy and oxygen supplies, constricting oxygen circulation until the constriction gave way to massive dilation and the propensity for a headache later on.
In events of stress, the prototypic reaction sets in immediately. It can be any stress where we feel under threat. This is due to resonance; the original prototype was coded and registered on higher levels as they came on line. When there is a current threat, the system retreats to origins which informs us how to react. It relies on the prototype to guide us and it relies on the original defense to protect itself. Even when that defense is no longer appropriate. It was appropriate back then. That is in essence, neurosis, acting in the present for something that was appropriate in the past. The aforementioned actress was trying to feel loved by her mother decades earlier, and did everything she could, with no reward. She still acts in the present that way; only now it is symbolic.
That is the key to understanding proper therapy now; we do not try to rid the symbolic from the system but rather use the symbolic behavior to see what feelings are being acted-out. And it is those feelings we must deal with.
To remain focused on the symbolic and trying to change it is a useless exercise because the person will only change symbolically, not organically. So we take the obsessive and try to treat her symptoms; helping her over her need to clean everything including the cans holding food in an obsessive manner. We no doubt could get her to stop by slapping her head over and over but is that therapy? But she is feeling, something is wrong and “I do not know what it is,” and so I will focus on making things right in the present. “That is why I have to hang all my shirts carefully in a row. I want things to be right; for there to be order.” This person may have lived in chaos in her early household. Something was terribly wrong but she never knew what it was. She will understand what is driving her if she can feel what she is really saying through her act-out.
Or we treat the phobia in elevators by walking hand in hand with the patient, step by step into an elevator. We are treating symbolism with symbolism and the patient will never get well. Yes, you might say the patient feels better, and you might be right, but he did not get rid of the terror inside that drove the phobia. Unless you think it is rational to fall into panic at the sight of an elevator. The elevator may well be the channel or focus for a panic during birth when being trapped and enclosed might have been fatal. Again, it is acting the present as was necessary in the past.
Let me state again that treating a symptom after the critical period is over, achieves nothing. The only help is actually to return to that critical period with the brain most developed at the time and enter into the critical period again where change can happen. After the critical period where love and nurturing was primary the only therapy is, as I have said, symbolic.
If we understand that there is a timetable of needs and a timetable for their fulfillment. Right after birth touch and caress are essential. No fulfillment right away and the person may be left with a lifetime fear of being alone (only one of many examples). The amount of pain felt now is commensurate with the need during the critical period. That is what makes terrible pain; need. After the critical period need is not nearly as important. Yes fulfillment is necessary but deprivation may not leave a residue of hurt for a lifetime; or it may not change organ or brain development.
When the critical period is ignored, many current symptoms are symbolic of that period. The treatment is, in short, neither organic nor systemic; and that is why there are no profound changes occurring. And that is why the therapy has to go on and on as in psychoanalysis. It only skims the surface. The patient thinks she is getting well because she has rented a caring parent. She becomes addicted to him or her. She is being “fed” symbolically; the doctor comes to need the patient as much as she needs him; a mutual symbiosis. They both feel better because they are symbolically filling their needs; he for approval, idolatry, and she for a caring not indifferent father. The therapy goes on, ad nauseum.
The truth is many patients want it this way; it is more human than Prozac and more in the flesh. They do not want to change; they want their neurosis to work. And now it does. The same may be said for the doctor. He is being adored, something his parents never managed to do with him. I treated one psychiatrist he cried, “My parents never cherished me. Never thought I was important.” His patients do. He too is being fulfilled symbolically.
Freud thought, as do many analysts, that one could analyze the transference and counter-transference(by the doctor)and get rid of those pesky needs. But it was just more cognitive nonsense, keeping it intellectual so no one has to really change. If we do not focus on need there will be no change; just as in any society that neglects need there will be no democracy. We are creatures of need. When society neglects need it must build compensations—hospitals and prisons; for bad things happen when we are deprived; and more medication for everyone. When a society or a parent fulfills need there is no longer a requirement for compensations such as pain-killing drugs. What dictatorships do is suppress need and then punish those who ask for fulfillment. The victims can never win.
So now we see that with pain we must act-in or act-out. There is never a choice; we may think we are free but we are aren’t. We are prisoners of history, chained to our past and can never undo the bonds until we visit that past again.





