CBT

This is a Controversial Post.

Many people have been helped by cognitive behavioural therapy. I'm not disputing that. From mental illness to anger issues, CBT is popular because it gets results. Quicker than other methods. And society is all about a quick fix. But CBT also has support because it teaches coping mechanisms and techniques for dealing with things on an everyday basis. It provides tools for future use. It's not a one-step miracle cure. CBT involves thinking. CBT can work.

A refresher/enlightener: cognitive behavioural therapy involves acknowleding three things. First, there's the event or thought that leads to an emotion being triggered. That emotion/feeling/whatever is actually the third part. The part in the middle is what CBT focuses on—it's the belief that leads to the emotion. That belief about the event/thought determines the emotion. CBT too often holds that there is always a belief there. That is really the whole point of the process: you look at the belief, analyze it, and try to change it. When the statement/belief regarding the event/thought is changed to something healthier, the emotion is healthier as well.

CBT works. All the literature says so. If you don't agree with it, you must be opposed to science. Or so you'll be told.

I've never been a fan of the idea of CBT. Why should I have to change my belief system just to get an emotion that someone else thinks is better for me? Why can't someone teach me how to deal with the emotion, negative or positive, rather than brainwash myself into a new belief system? Why isn't that emotion, positive or negative, valid? These are some of my concerns with CBT.

Yet I've determined another concern. In the case of domestic abuse, CBT is often used to treat the abuser, who must learn to deal with anger or control issues in a new way. CB therapists insist that there is ALWAYS a belief, after a thought or event, that leads to the emotional outburst. They'll even suggest that the belief may be condensed into something so small, so close to invisible, that it's practically nothing... but it's still there. I have to disagree with this. I have to.

Here's my idea on the matter: I think that some people condition themselves into certain emotions. Event/thought leads to belief leads to emotion so often or so easily that the actual trigger (belief, in this case), as happens in conditioning, fades out entirely. So this [very likely self-] conditioning causes an automatic leap from event to emotion. CB therapists can't stand this idea! Perhaps they have forgotten that Pavlov's dogs received food at one point. (Yes, I'm well aware that this analogy has flaws.) My point is that the association of an event/thought with an emotion becomes so strong that the middle step, the belief, disappears or becomes completely irrelevant. The reinforcement may not be something positive or negative; the reinforcement may be time. If I do something so many times, it becomes automatic. If I hit my spouse every time he/she questions me, eventually the belief between the questioning and the hitting disappears. Yes. There is a point where that belief disappears.

CBT is useful because it forces people, such as the abusers in this example, to CREATE the step of belief. Perhaps that has not been a step in the abuser's life for a very long time. Once the step of belief is introduced, things can change. The abuser has the idea forced upon him or her that he/she must have believed it was okay to beat someone up. And maybe the abuser did believe that at some point. And hopefully the recognition of beliefs or social mores will change the thought processes there, and therefore the emotion/action that is a result. (Please note that I am ignoring, for the sake of simplification, the act of separating the emotion from the action/abuse. Please also note that that is a very vital step.) I guess the important thing in that situation is that beliefs are introduced. Perhaps there weren't negative beliefs before, but the result was negative. With clean, healthy beliefs, the resulting emotion can be healthier. All it takes is introducing those sterilized beliefs.

Oh, and believing the new "beliefs".

Time is a reinforcer. It conditions that leap from event/thought to emotion. It certainly is good to sit back and reflect on your own belief system on occasion. It's good to know what you stand for and why. But it's also important to say, "Actually, I really did make the jump from event/thought to emotion. I'd know if I had the belief in there. I know I've had it in there before, and I can tell you what it was like then. But to tell you that there's a belief in there right now? That would be bullshit. I won't pretend such a thing. The belief isn't minimized. You can't pretend that there is always a belief there. For better or for worse—and yes, I'll admit probably worse—I made the jump from event to emotion. It's not the healthiest thing to do. But that's what I do in that case. Don't belittle me by saying there's something there that isn't. I can create something there, for sure, but it's not there now. I realize I've conditioned myself poorly, and I need to change that. But don't you dare tell me I have something there now that needs to be changed. What needs to be changed is that I need a healthy belief to fill that space where nothing is. But don't brainwash me. Give me my own healthy belief. One to counteract my conditioning. Give me tools. Just don't try to convince me that your way is the only way. Because, you see, I'm not an idiot. And to believe that there's always a belief? Always? That seems like some all-or-nothing thinking there. Or perhaps some overgeneralization. Better pull out your list of mental distortions that you CB therapists love. I think you need a review."

That wind out there? It sure is winding!

The worst part of the LLETZ procedure is not the burning flesh smell. The worst part is what comes afterwards, so don't deny it. You know what it is. Doesn't everyone? Yes, it's the flakes of smelly ash that work their way out of your body. Flakes. Black. Ash. Yeah, those are pretty unnecessary. And did I mention smelly? Let me also mention the smelly. Now, there's the smelly that comes from wearing the same shirt three days in a row because it hurts too much for you to lift your arms, but that's not so bad if you put on deodorant regularly. I'm talking about a stink that makes you want to clean everything around you... until you realize that it is your body stinking, and this is a smell that can't just be washed off. Say you have a big, pus-filled boil. And that boil pops and starts leaking pus and stink. You want to get rid of the stink, but it's a never-ending boil, and the pus doesn't stop. And the pus is the stink. So there's no end to the stink. That's what I'm saying. That's what I'm saying I'm living with. Never-ending black ash. And stink. Oh, the stink.

Loss and Gain

There must be loss with any surgery, even with something as small as fixing an ingrown toenail and cleaning the nailbed. Some of it may simply have to do with losing inhibitions while the anesthetic kicks in. Some of it is a greater loss, even if the surgery is minor. Part of this loss comes from the surroundings; places of medical practice are confusing, with a great deal happening at once. People go to the same clinic whether having abortions or giving birth. The emotions mix. There's a little crying at the unknown, and confusion at the loss. But isn't getting rid of pre-cancerous cells a good thing? And a LLETZ procedure is surely not the most invasive, despite having your cervix on display. (It does help to have the doctor remember something about you, like the fact that you're studying Icelandic, so you know that he's not just interested in staring at your nether regions.) But the loss. The loss of evil cells. Cells will grow back, but not those cells. And a part of you wants to say, "But those are my cells. Those are my cells, and I don't want to get rid of them." Logic has not entirely left, though. Pre-cancerous cells must be obliterated. Logic understands that the action must be taken. What logic does not completely understand is the loss, the stupid loss that results in a little crying, insecurity, exhaustion, and the desire to not be alone, at least for a little while.

The worst part was the stench of burnt flesh during the cauterization process. And maybe my inability to say that I was going to the Colposcopy Clinic. "The building where physiotherapy is," I planned to say, should the cab driver ask. Same building, different floor. Nobody wants to hear about someone else's vagina, anyway.

Health is gained, if all went well. And I found out that I will be part of The Hiss Quarterly's Sticks & Stones issue, out in November. That is also a gain.