Wednesday, December 19, 2007

Persecutory Anxiety

Positive feelings (about oneself or pertaining to one's accomplishments,
assets, etc.) - are never gained merely through conscious endeavor. They are
the outcome of insight. A cognitive component (factual knowledge regarding
one's achievements, assets, qualities, skills, etc.) plus an emotional
correlate that is heavily dependent on past experience, defense mechanisms,
and personality style or structure ("character").

People who consistently feel worthless or unworthy usually overcompensate
cognitively for the lack of the aforementioned emotional component.

Such a person doesn't love himself, yet is trying to convince himself that
he is loveable. He doesn't trust himself, yet he lectures to himself on how
trustworthy he is (replete with supporting evidence from his experiences).

But such cognitive substitutes to emotional self-acceptance won't do.

The root of the problem is the inner dialog between disparaging voices and
countervailing "proofs". Such self-doubting is, in principle, a healthy
thing. It serves as an integral and critical part of the "checks and
balances" that constitute the mature personality.

But, normally, some ground rules are observed and some facts are considered
indisputable. When things go awry, however, the consensus breaks. Chaos
replaces structure and the regimented update of one's self-image (via
introspection) gives way to recursive loops of self-deprecation with
diminishing insights.

Normally, in other words, the dialog serves to augment some self-assessments
and mildly modify others. When things go wrong, the dialog concerns itself
with the very narrative, rather than with its content.

The dysfunctional dialog deals with questions that are far more fundamental
(and typically settled early on in life):

"Who am I?"

"What are my traits, my skills, my accomplishments?"

"How reliable, loveable, trustworthy, qualified, truthful am I?"

"How can I separate fact from fiction?"

The answers to these questions consist of both cognitive (empirical) and
emotional components. They are mostly derived from our social interactions,
from the feedback we get and give. An inner dialog that is still concerned
with these qualms indicates a problem with socialization.

It is not one's "psyche" that is delinquent - but one's social functioning.
One should direct one's efforts to "heal", outwards (to remedy one's
interactions with others) - not inwards (to heal one's "psyche").

Another important insight is that the disordered dialog is not

The "normal" internal discourse is between concurrent, equipotent, and
same-age "entities" (psychological constructs). Its aim is to negotiate
conflicting demands and reach a compromise based on a rigorous test of

The faulty dialog, on the other hand, involves wildly disparate
interlocutors. These are in different stages of maturation and possessed of
unequal faculties. They are more concerned in monologues than in a dialog.
As they are "stuck" in various ages and periods, they do not all relate to
the same "host", "person", or "personality". They require time- and
energy-consuming constant mediation. It is this depleting process of
arbitration and "peacekeeping" that is consciously felt as nagging
insecurity or, even, in extremis, self-loathing.

A constant and consistent lack of self-confidence and a fluctuating sense of
self-worth are the conscious "translation" of the unconscious threat posed
by the precariousness of the disordered personality. It is, in other words,
a warning sign.

Thus, the first step is to clearly identify the various segments that,
together, however incongruently, constitute the personality. This can be
surprisingly easily done by noting down the "stream of consciousness" dialog
and assigning "names" or "handles" to the various "voices" in it.

The next step is to "introduce" the voices to each other and form an
internal consensus (a "coalition", or an "alliance"). This requires a
prolonged period of "negotiations" and mediation, leading to the compromises
the underlies such a consensus. The mediator can be a trusted friend, a
lover, or a therapist.

The very achievement of such internal "ceasefire" reduces anxiety
considerably and remove the "imminent threat". This, in turn, allows the
patient to develop a realistic "core" or "kernel", wrapped around the basic
understanding reached earlier between the contesting parts of his

The development of such a nucleus of stable self-worth, however, is
dependent on two things:

1.. Sustained interactions with mature and predictable people who are
aware of their boundaries and of their true identity (their traits, skills,
abilities, limitations, and so on), and
2.. The emergence of a nurturing and "holding" emotional correlate to
every cognitive insight or breakthrough.
The latter is inextricably bound with the former.

Here is why:

Some of the "voices" in the internal dialog of the patient are bound to be
disparaging, injurious, belittling, sadistically critical, destructively
skeptical, mocking, and demeaning. The only way to silence these voices - or
at least "discipline" them and make them conform to a more realistic
emerging consensus - is by gradually (and sometimes surreptitiously)
introducing countervailing "players".

Protracted exposure to the right people, in the framework of mature
interactions, negates the pernicious effects of what Freud called a Superego
gone awry. It is, in effect, a process of reprogramming and deprogramming.

There are two types of beneficial, altering, social experiences:

1.. Structured - interactions that involve adherence to a set of rules as
embedded in authority, institutions, and enforcement mechanisms (example:
attending psychotherapy, going through a spell in prison, convalescing in a
hospital, serving in the army, being an aid worker or a missionary, studying
at school, growing up in a family, participating in a 12-steps group), and
2.. Non-structured - interactions which involve a voluntary exchange of
information, opinion, goods, or services.
The problem with the disordered person is that, usually, his (or her)
chances of freely interacting with mature adults (intercourse of the type 2,
non-structured kind) are limited to start with and dwindle with time. This
is because few potential partners - interlocutors, lovers, friends,
colleagues, neighbors - are willing to invest the time, effort, energy, and
resources required to effectively cope with the patient and manage the
often-arduous relationship. Disordered patients are typically hard to get
along with, demanding, petulant, paranoid, and narcissistic.

Even the most gregarious and outgoing patient finally finds himself
isolated, shunned, and misjudged. This only adds to his initial misery and
amplifies the wrong kind of voices in the internal dialog.

Hence my recommendation to start with structured activities and in a
structured, almost automatic manner. Therapy is only one - and at times not
the most efficient - choice.

AUTHOR BIO (must be included with the article)

Sam Vaknin ( ) is the author of Malignant Self
Love - Narcissism Revisited and After the Rain - How the West Lost the East.
He served as a columnist for Global Politician, Central Europe Review,
PopMatters, Bellaonline, and eBookWeb, a United Press International (UPI)
Senior Business Correspondent, and the editor of mental health and Central
East Europe categories in The Open Directory and Suite101.

Visit Sam's Web site at

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