What is Actually Healthy? Part 2

 The first part discussed how what is healthy and what is not may not correspond to what our diagnostic manuals say. Someone may meet criteria, but may be healthier than someone who doesn’t, who projects their covert illness onto other people. This post is about how, even if someone is highly symptomatic, it may still be the healthiest state for them.

Imagine a couple presenting with sexual difficulties. The husband has erectile dysfunction, has low desire, difficulty feeling arousal, and low motivation to improve sex. His wife considers this to be pathological and pushes the husband to get help.

As I gather more info, I learn that the husband feels highly criticized by his wife–most interactions are her asking him for something or telling him something she is dissatisfied about, particularly sex. He has noticed her interacting flirtatiously with some of the men at the country club. Whenever he tries to tell her about his painful emotions, she responds with criticism. He feels shut down, or on-edge around his wife. His survival mechanisms are activated, which usually diverts blood and energy away from sexual function.

So, this man’s “sexual dysfunction” is actually his body responding exactly as it should to the kind of stress it is facing. It would be more pathological for him to have sex with someone he doesn’t feel safe around.

Another quick example:

Parent: “My daughter doesn’t talk to me about anything. I think something is wrong with her, but she doesn’t tell me what it is, or how she is feeling.”

Therapist: “What would happen if she were to tell you she was feeling angry and ashamed?”

P: “I’d try my best to find ways to help her stop feeling that.”

T: “That makes sense, but I wonder if she feels invalidated by your attempts to fix her feelings. She won’t feel safe expressing feelings unless she feels that she is allowed to have them. Also, when the emotional brain is activated, receiving logical suggestions and advice often feels violating–the emotional brain can’t process logic. It sounds like your daughter has adapted very healthily by refraining from expressing feelings, because doing so would likely make her feel threatened by your response. Maybe we could work on some skills that will help her feel safe talking about hard things with you?”

So, the conditions that the husband and daughter have are diagnosable, but they are actually signs of healthy adaptation. The issue isn’t the injuries, the issue is that it is unsafe to try and heal from emotional injuries (through expression and processing), because it leads to more injuries.

Obviously, these issues are cyclical: the wife feels more critical the more her husband shuts down; the parent reacts with more anxiety the more the child doesn’t talk; and so on.

So, we need to redefine what is healthy, what is not healthy, and what is a healthy adaptation to an unhealthy system. When we refrain from quickly pathologizing behaviors or feelings, we can find that they make sense, and actually might be healthier than their alternatives.

See "How We Keep Injuries From Healing"

"Mental Illness Needs Context"

"Covert Depression"