Wednesday, November 21, 2007

Inertia and Shame

I often notice myself avoiding eye contact with Dr. X. Almost every appointment I begin by explaining how I am feeling and what has taken place the past week. During this time I always look away, staring at the corner of the door, or the books on his shelf; looking anywhere else but at the person I am talking with. During this time I almost always feel ashamed of myself. Ashamed for not getting better, ashamed of the way I act, ashamed for not doing the things I know I need to do to get better; like exercise, eat better, and spend more time with other people.

Usually about half way through my session I begin to feel less anxious and my gaze moves towards Dr. X's face. Yesterday this never happened. I spent almost my whole appointment staring at the bookshelf. I recognize this is a problem. My avoidance of eye contact is a reflection of my fears of being rejected by Dr. X., my low self esteem, and how much guilt and shame I carry inside me.

The last two sessions I have noticed that my chair has been positioned so it is directly facing Dr. X. If I sat in the chair as it was I would have a hard time avoiding Dr. X. Both times I have repositioned my chair so it faces away from Dr. X. I never thought he might have positioned the chair facing him on purpose until last night. Now that I think about it I think he intentionally positioned the chair so, when I sat down, I would have no choice, but to face him.

I have thought about this before. Part of why I move the chair is because I feel like I am too close to him (proximity wise) when facing him. I need more space. This feeling happened when I first began seeing him in another office. I began thinking he was moving closer and closer to me to test the veracity of my claim that I felt uncomfortable when others got to close to me. Now that I know him I do not think he was doing that. I believe he simply became more comfortable with me over time. I do however think he repositioned my chair the last few weeks. The chair was too sharply angled towards him.

This post is not to fault him for that, but to help myself participate in his scheme. I think it is unhealthy for me to avoid eye contact with him. I believe my doing this only serves to reinforce the feelings of shame and guilt I have about my increased inertia. My feeling this shame and guilt is like my buying into the scorn others heap on me about my not trying hard enough, not doing what I need to do to get better. This shame about who I am when severely depressed ignores such depressive symptoms as the severe inertia and amotivation that encompasses me when I am depressed and even the fact that the shame itself is a symptom.

I am going to address this in my next session. I have a difficult time challenging my avoidance of eye contact when I am in the moment. It is only afterwards that I regret missing the opportunity to address it. I will ask Dr. X. to help me take a behavioural approach to this problem, to help me redirect my gaze towards him when I speak; especially when I speak of things I feel bad about.

I believe if I can look at him while I tell him the things I feel ashamed about it may help dissipate those feelings of shame and guilt. I also believe by looking at him while talking I am asserting my self esteem and acknowledging that it is my illness, and not some lack of character on my part, that keeps me from becoming well. I am hoping a behavioural approach to this situation will reduce the amount of self-stigmatization I feel about having treatment resistant depressive symptoms.


jcat said...

shit. once write about me better than I ever could!

I fiddle with about three things on his desk (yeah, traditional layout of office; desk, him behind it, two chairs on patient side plus one more that could be pulled forward...) - no choice about facing him directly. But lots of things to touch/look at instead, and - like you - it takes me most of the session before I start making eye contact erratically.

Have achieved none of the things I had really really intended to. Not even shaving my legs, although there is no way in hell I would tell him that.

Just want out. Enough already....

So maybe tomorrow is the day it all comes right - today sure as shit wasn't.

You give me hope because you make me feel that there is someone here too and i figure that when one of us gets to feel good/do something can only help us both.

til tomorrow,

'xhccgthl'. wtf!

Polar Bear said...

Good on you that you recognise this and you are willing to face it head on (pardon the pun).

I find that I too avoid my therapist's eyes. I look at the white board behind her, or cast my gaze on the floor. I kinda sit facing her, but I turn my head slightly so I'm not facing her. I spend most of my session not meeting her eyes. I find it uncomfortable, and I think it relates to shame, as you point out here, but I'm unwilling to change this.

Aqua said...

Obviously I have achieved none of the things I planned this past week either (thus the guilt for not finishing and shame for being like this) you are right, once again we are peas in a pod. funny how two girls on either side of the world have so many of their idiocyncracies (sp??) in common. Glad someone shares these with me...sorry it has to be you:>(i.e. I really wish you were happier than me for your sake)
p.s. What does 'xhccgthl' mean??? Am I missing something? I get the WTF...I feel like that ALL the time, ha, ha.

Polar Bear,
ha, ha...very punny! Each of us does and changes what we can, what we are able and what we want to change. It's okay to not want to change things.

I hope this isn't an intrusive question, but I am curious as to why, if you recognize it to be a product of shame, you would not want to address it in therapy?

You do not have to answer that, but if you would like to I am curious as to your perspective. Thanks,

jcat said...

xhccgthl was just the captcha text, which, at some hour way after I should have been asleep, was almost too much! Not being paranoid (yet), but it does seem like the later at night it gets, the more challenging the words become...

Anonymous said...

Some tips and comments from a french reader. (English NOt my first language)

Some info about me:
High level of education,
I have been working all my life but I got so depressed that I had to stop working last year. I started to see a therapist. I procrastinate a lot...

I spent over the years quite some time reading material about motivation / procrastination / Selfcontrol. That did NOT help.
I stumbled one day on the "ego depletion" theory: Basically, it says -among other things- that the energy needed to self-control comes from the same limited "energy tank" necessary by individuals to manage, control their emotions.
Last month, after 8 months of therapy, my therapist asked me to fill the "Young Schema Therapy " questionnaires. (Ask Google). I discovered that Shame was MY major disfunctional schema. Shame is usually often unconscious and often "masked" by other emotions (Anger, for example). Experiencing shame usually pushes individuals to hyde (from others and/or from themselves). Once again, trying to hyde who you are -because you think you are worthless...-, consumes a lot of psychic energy, the same very energy needed for self-control.
So basically, I concluded that an individual suffering from a high level of shame, may not have any energy left for self-control mental activities. No energy left for self control,and you end up with procrastination and apathy.

Some comments now:
You write: « I often notice myself avoiding eye contact... »
= When people are ashamed, they don't want their shame to be seen by other people. that might explain the eye contact avoidance.=

You write : « shame … about not doing what I need to do to get better ».
= I believe that the reason you (And I) can’t DO is because of the shame. Work on shame issues with your therapist and you will free up some of the energy needed for you to « self control » and finally get into « action » mode.=

You write : « … shame itself is a symptom. »
= Guilt is about what you did or not.
Shame is about who you are.
I believe that for healthy individuals, not doing the things they should have done will give them a sense of guilt, but will not attack their sense of who they are, will not distroy their self esteem, will NOT shame them. Shame is not always bad, but there is healthy shame and toxic shame. Perhaps shame is a symptom because you are suffering from toxic shame. As said before, I do believe that toxic shame is the root cause of you suffering from inertia, not the symptom.=

You write : « I think it is unhealthy for me to avoid eye contact with him… »
= I believe you are right, and that the only reason you do that is your abnormal high level of shame. =

You write : « I will ask Dr. X. to ….help me redirect my gaze towards him when I speak; especially when I speak of things I feel bad about…. I also believe by looking at him while talking I am asserting my self esteem …»
= I think that’s a great idea. I believe this may force people to face, experience their shame in front of someone else –the therapist-. Remember : there are few things people fear more than having their shame being seen by someone else. The reason being that they fear to be rejected. (Shame is about the fear of breaking, weakening social bonds). Looking at the eyes of a human being – who is NOT rejecting you, even though you show him your shame (by telling him your deepest secrest for example, or acknowledging that you are weak, ..) – can do wonders.

Take care
Eliade111 (AT) Yahoo (dot) com

Anonymous said...

I have spent the last 2 hours trying to find definitions of inertia.After wading thru'alot of clinical jargin,this is the first site i could read each word.I would love to be more productive,however by the time I start feeling like doing anything the day is almost over.My husband arrives home after a hard days work and Im still in the mess he left me in the morning.I can relate to the chair thing.I thought that was ocd.The shame inertia is such a vicious circle.The only thing that gets me motivated is when my kids or grandkids need help.Why can't I help myself? (shaving legs??? I hate getting into the shower!)

Anonymous said...

You and I can't help ourselves without others recognizing the illness exist and providing as close as possible a living model of eventful memories and routines that spark positive motivation to repeat the cycle daily. Sleeping at night only would help as would keeping busy throughout the day with overload in the form of recreational physicalness for 90 minutes max, but not less than 30 minutes.