Dragons or Donkeys

Equanimity: Managing Anger -Comparing Narrative Therapy and CBT

I make myself rich by making my wants few

         Henry David Thoreau

Modern man no longer communicates with the madman . . …

  and expels from the memory all those imperfect words, 

of no fixed syntax, spoken falteringly, in which the exchange, between madness and reason, was carried out. 

Michel Foucalt, 1961, History of Madness

Foucalt: (15 October 1926 – 25 June 1984)History of Madness (1961)

In this article we discuss ways in which different approaches can benefit in defining an issue, taking the example of anger. Anger leads to loss of equanimity.       

The word equanimity comes from Latin roots meaning “even” and “mind”. Holding what passes through your mind in spaciousness to stay in balance, moving beyond the reactive mode is achieved by Equanimity. The chain of expectations, desires, wants, are broken leading to alleviation of suffering. 

The Madhouse (Spanish: Casa de locos) or Asylum (Spanish: Manicomio) Francisco Goya- 1812-1819

The following are some exercises which I have found useful in moving into Equanimity.

1-      Write down ways in which one starts becoming less balanced. 

A written record of the ways in which one starts going into the cycle of expectations, desires, wants, fears, greed, disgust can give a good opening into the habits of the heart and head. One way to sharpen this focus is to read a newspaper/news-site for 15 minutes and keep classifying under the headings of greed, fear, disgust the feelings evoked by the articles.

 2- Developing Borders and Boundaries:  Remembering Spencer (White, 1984; White, 2007)

Spencer, the young boy who had the issue of soiling was told to characterize in near and particular terms, how this issue is affecting and ruling his life. His parents were told to characterize how this issue rules and ruins their lives. Then Spencer was asked to give a name to this issue of Soiling. He called it Mr.Mischief. They went on to relate to this issue in a particular rather than general manner, and in a near rather than distant way, thus helping define the boundaries and borders of the issue, get a better handle on it and define their relationship to the issue. 

This example of Spencer, illustrates how to externalize and objectify an issue which is affecting one’s life, and then create a statement of position map, which can help one create a plan and monitor our process.

3-     Creating personal examples : Balance of the Lotus

Eastern traditions see the Lotus flower as an embodiment of purity, enlightenment and rebirth. The balance between beauty and adversity are shown in the growth process of the Lotus, as it emerges above mud and water. It symbolizes  harmonious balance between earthly struggles and divine purity.

Nature walks and creating living symbols of these experiences has been a way to enhance balance in my life.

4- Case Scenario: Anger seen through different counselling approaches (Narrative/CBT)

Mr. S, presents with anger, which has affected his work, relationships, standing in community

NARRATIVE THERAPY APPROACH

  • Externalize – The history of anger, as if it is a creature outside of oneself waiting to get inside you
  • Therapist Role-is on listening, accepting, non-judgmental, non-confrontational statements..to be like a Junior Partner, Investigative Journalist, 

CONTRAST WITH CBT APPROACH

BASIC ID-Behaviour- writes angry letters, throws plants 

Affect                feels humiliated 

Sensations        pounding heart

Imagery              sees himself being taken away from grandson

Cognitions          I am a middle aged man who is being deprived of my rights,

                             standing in unfair manner

Interpersonal     angry at wife , sons, in-laws

Drugs                 takes alcohol to drown the pain

NARRATIVE THERAPY approach uses interventions like externalizing, metaphors, mapping to develop a near and particular relation with the issue.

Mr.S went into the history of anger, by asking to see it as a creature outside oneself who is thinking of ways to trick him into losing his calm.  Mr.S told of his early years of immigration from Bombay, India to Canada, how he saw his mother being beaten by his alcoholic father, his being bullied in school. As he became a teenager, he stopped these things as best as he knew.The “Bullied became the Bully”. On being asked to give a name for Mr.Anger he came up with two metaphors. He first called Mr.Anger the “Dragon”. However, on reflection he said, “If I am still riding this creature and getting taken for a ride in my seventh decade of life, then I am riding a Mr.Donkey”.

 After establishing rapport, agreeing that anger-related issues are worth exploring and addressing, we set about seeing how Mr.S has constructed his life around anger by

1- Externalizing anger

2- Deconstructing anger narratives

3- Re-authoring personal stories

4- Exploring values and intentions

5-Creating alternative responses

1- Externalizing anger

       Encouraging Mr.S to treat Mr.Anger as a separate entity or character helped distance himself from anger and view it as something outside of his core identity. Be doing this he gained a new perspective on his anger, started seeing how his life would be without anger and create a map to challenge the dominance of anger in his life.

2- Deconstructing anger

         We explored the stories and meanings Mr.S attaches to his anger. Through telling these stories we were able to examine the underlying beliefs, assumptions, and cultural influences that contribute to his anger. For example, as he recalled the weekend discussions which turned into angry arguments in his family of origin, he became more clear about how issues of safety, and the way to deal with un-ease through lashing out or suppressing became a dynamic in his life. This has in different forms played out in his family of creation, and he can now see this pattern even in his interactions with the in-laws of his sons. Deconstruction helped gain insight into the origins and maintenance of anger.

Scripting of the scenarios which continue to trouble him in is life in the present, helped develop alternative interpretations. Through role plays, we started developing better results.We refined these approaches through counselling and keeping an Anger Journal (He called it Riding with Mr.Donkey journal)

3- Reauthoring personal stories: 

The scripts made through externalization,deconstruction tools above helped Mr.S gain the power to rewrite his narratives, explore alternative perspectives and be more aware of how his prejudices and projections are affecting his relationships. New stories began to emerge which offered new ways of understanding and creating his experiences.

Shifting from being defined by anger to seeing himself as capable of change and growth, and being a channel of peace, understanding, and kindness has helped Mr S and his family be very different from where they were a year ago.

4- Exploring values and intentions: 

As Mr.S evolved from a “Head over Water” Survival level recovery to a more wholesome bigger version of himself, he began to examine his values and vulnerabilities, intentions and impact regarding anger. As we explored pivotal life moments, the purpose anger has served in his life, he changed his way of looking at his teenage years, and also his work, family and community. This led to a deeper understanding of his emotional experiences.

 This exploration  paved the way for aligning anger with personal values, he rebuilt his relationship with his estranged wife and children, and has started exploring healthier ways of expressing his needs, feelings, situations and story.

5- Creating alternative responses: 

The list of alternative responses to Mr.Anger (Dragon/Donkey) helped challenge the dominant narrative that aggressive or destructive behaviours result from anger. He started developing new strategies to harness anger constructively. His strengths, resources, alternative stories enabled him to respond to anger in ways more in life with desired outcomes.

Key points and summary

Creating balance through understanding the borders and boundaries of an issue helps one come up with creative ways to enhance life. Through keeping a written record of the way issues like anger speak in one’s life, how they disturb equanimity, we saw two different approaches to this issue- a classic Cognitive Behavioural therapy (CBT) approach and a Narrative therapy approach (NT). Creating a positive journal of values, symbols and metaphors (Lotus, dragon, donkey, map, territory, journey) helped co-create better life options. 

Exercise

       Do you have an issue which you need to see through a different lens? Write how it has spoken to you in your life and discuss as appropriate. Alternatively, write a letter to the issue.

White, M. (1984). Pseudo-encopresis: From avalanche to victory, from vicious to virtuous cycles. Family Systems Medicine, 2(2), 150–160. https://doi.org/10.1037/h0091651

White, M. (2007). Maps of narrative practice. WW Norton & Company.

Modern man no longer communicates with the madman . . 

. There is no common language, or rather, it no longer

 exists……..The language of psychiatry, which is a monologue 

by reason about madness, could only have

 come into existence in such a silence.

Foucalt, 1961

Sissified

Gendered Socialisation Navigating Alexithymia in Immigrant Families

Boys are taught to value and lead to certain parts of them. Girls are taught to do the same but with other parts.Boys were nurtured by their caretaker, till around 4-5 years, and then for fear of being “sissified” they were wrenched away and may even be shamed for showing emotions. 

Schwartz, 2023

In the cultural context of immigrant families in North America, I found many men who are unable to express and explore their emotions.

Case scenario: Relationships, Un-Manliness and Cultural Messaging

 Tanmay (a composite), a 27 year old graduate student, struggling after the break up of his second online relationship came to me feeling uncertain, confused and hesitant to restart another relationship. As we went into his family of origin to see for underlying patterns, he told of how his parents stayed in the Middle East before shifting the family to Canada, while the father continued to earn and support the Canadian journey. This is a common theme found in Subcontinent origin families. As we went into the way emotions were expressed (or suppressed) in the family, the dynamic of a long distance parent, the emotional instability with no proper economic roots in this society came forward.

Themes around “un-manliness” and what it is to be the “typical male” came up.

Terry Real, in his book,  I don’t want to talk about (1998) talked about difficulty with intimacy, workaholism, alcoholism, abusive behaviour and rage as being failed solutions to escape depression.

The Toronto Alexithymia Scale  can get one started on becoming aware of the patterns and messages which one has imbibed

Alexithymia and Immigrant journeys

Coined by Peter Sifneos in 1973, the term comes from Greek roots meaning “no words for emotions.” Alexithymia is often observed in various psychological, medical conditions and in the context of immigrant families can be experienced in varying degrees depending on the level of assimilation, marginalisation, integration and separation. (Akhtar, 2010; Sifneos, 1973)

Therapeutic Process: Third Wave-Cognitive-behavioral therapy (CBT) approaches like Acceptance and Commitment therapy (ACT) with focus on emotional awareness and expression can be useful in addressing these issues

For example

  1. Journal of Emotions: T was encouraged to keep a journal where he noted daily events and attempted to label his feelings associated with those events.

The story of how emotions were expressed in his family of origin was started by making some jottings on how he remembers his own parents relating to his grandparents. These cultural messages can be more nuanced as we see the effect of immigration and the early years (first three to five years in Canadian society are very difficult, especially for de-credentialied professionals who try to make it through using labour market or delivery jobs)

  1. Mindfulness Practices: Polyvagal theory informed approaches will help tune to one’s internal states, aiding in the recognition of subtle emotional cues.

The polyvagal journal will be aware of the dorsal vagal (freeze), sympathetic (fight , fright) and the ventral vagal (social, tend, befriend) and use this format to be more aware of one’s tendencies (Dana,2020)

  1. Psychoeducation: Awareness of emotions, their importance, and how to recognize different emotional states in himself and others can lead us to a life of greater connection and fulfilment.

References

Akhtar, S. (2010). Immigration and acculturation: Mourning, adaptation, and the next generation. Jason Aronson.

Dana, D. (2020). Polyvagal exercises for safety and connection: 50 client-centered practices (Norton series on interpersonal neurobiology). WW Norton & Company.

Real, T. (1998). I don’t want to talk about it: Overcoming the secret legacy of male depression. Simon and Schuster.

Schwartz, R. (2023). You Are the One You’ve Been Waiting For: Applying Internal Family Systems to Intimate Relationships. Sounds True.

Sifneos, P. E. (1973). The prevalence of ‘alexithymic’ characteristics in psychosomatic patients. Psychotherapy and Psychosomatics, 22(2-6), 255-262.