samedi 7 février 2009

Limitations of CBT

Like I said before, CBT doesn't cure anything. It doesn't cure any organic damage to the brain, although it can help you manage life with mental illness. But also, it doesn't cure all uncomfortable feelings, because some things cannot be changed by changing your perspective or your behaviour, particularly guilt and grief. If you've lost someone or something, you can't get it back no matter what, and if you've taken someone or something away from someone else, you can't give it back no matter what. Some things can't be made whole, and that's life, so you just learn to live with it somehow.

You can't go around like a Greek tragedy mask all the time, so you learn to be a Greek comedy mask instead, and pretend to be all normal and well, because other people want you to. So, you become two people: the Greek mask that talks to people, and the broken-down you that lives inside. The two operate pretty much independently of each other. The Greek mask has friends and a normal life, and the real you on the inside never talks to anyone again. If you have a crappy therapist like I did, you learn to suppress the real you with cognitive therapy until you're trapped in a vacuum between the Greek mask which isn't you, and the painful cognitions of the real you that you've learned not to listen to.

If you do this long enough, you feel like a ventriloquist with a phantom puppet on your hand. People talk to the puppet and you do the voice of the puppet and give the answers they're looking for, and you're not even sure who they're talking to.

This is life. Not all pain can be taken away. In that way our culture is very dysfunctional, because we pretend that it's a Care Bear world where everybody can learn to get along and no one ever has to be hurt. It's a lie, and it isolates the people who know better. If you live here and you've lost a child to illness, people don't like to think about it. They want you to look gay and merry and normal and not remind them that your child died, because they don't want to believe there is pain so close to their sheltered little world. Whereas if you live in Zimbabwe and you've lost a child, many people around you have also lost a child or a sibling or a spouse, and while it probably doesn't hurt any less, at least the world around you isn't in denial of the fact that pain happens.

So, I've always found it helpful to remind myself that "life is pain", which is the first principle of Buddhism. Because some times, there isn't really anything you can do other than acknowledge your pain. Or someone else's. Pain is real. Cognitive therapy teaches you not to make yourself miserable for no reason, but it can't make real pain go away.

And that's pretty much what I have to say about it.

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