Guwahati,

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Problems are like Onions

Right in the very first class of my psychotherapy lessons, we were told that: problems are like onions. You remove one layer, the other layer shows up. You remove that layer and another shows up. So, don't take problems at face value. When a client/patient comes up with a specific problem, say for example 'physical pain', try to look beneath the pain and see if the pain is a cover-up for an emotion that the client may not be aware of, or is the pain a code for some unconscious emotional turbulence that may be masked. After what my teachers had told me, what I learnt years later from my own practice as a psychotherapist is 'the presenting problem is never the real problem, the real problem is elsewhere. It always begins elsewhere.' And hence, going back to the origin of that real problem becomes imperative in psychotherapeutic process.

When 24 year old Meera (name changed) came to me as a patient, her primary complaint was that she had been repeatedly throwing up at workplace. She would wake up at eight in the morning, and have some biscuits with a cup of tea and rush to her office. She worked as a content head in an organization, and had taken up the job newly. It was a new start up. They didn't have anyone else in the content team apart from Meera, and hence the work load was a bit too much. 
Of late. Meera started observing that she would repeatedly find herself going to the washroom and throwing up. Sometimes, even three to four times a day. Initially she thought it could be due to the morning tea or perhaps acidity and tried to ignore it. When it didn't stop, she visited a GP. The GP said that it was because of her erratic food habits since the workload was too much, and that might have led to gastritis. She went back to having a tablet for gastritis in the morning and would try to eat during the day at lunch and snack hours.
What turned out that she would throw up even more. And that would result in a bad headache. She went back to her GP and got all possible medical tests done. Nothing came out of it - for the problem was psychosomatic. And the origin of it lay elsewhere.
Our body is like a complex version of a traffic signal. It tells us when to stop, when to move and when to get ready. If a disease shows up in the body - be it a headache or cancer, it is only trying to tell us something about ourselves that we have not paid attention to so far. The disease is signaling, or more aptly, providing a secret code about an emotional conflict within our system that we have left unattended. In Meera's case, when we began work, in the first session itself, we came to know that her problem was not about anorexia or bulimia (both are eating disorders). I asked her 'what is the worst thing that will happen to you if you didn't throw up at your workplace?' She was a bit stunned at my question, not knowing what I meant. I tried to re-phrase my question, 'What is the worst thing that will happen to you if you ate properly at the workplace and not throw up?' She still couldn't answer. But she said that whenever she is at home, in the absence or her father and sister, she would eat a lot. In fact she would end up over-eating and nothing would happen. So she didn't know why she threw up at the office and didn't feel like eating. 
I asked her, how did the absence of her father and sister felt like at home? She revealed that she had lost her mother at the age of fourteen and since then she felt she needed to take the responsibility of her father and sister.
Sometimes she felt that the burden of the whole family was on her and if she had to take care of things, she better watchful. I felt the word 'watchful' was my doorway to her problem. I asked her, how would she feel about being watchful if she ate and didn't throw up at workplace. She didn't have a perfect answer to that but she said that food would make her feel sleepy. And what would happen to being 'watchful' then?
Meera had learned and believed from a young age that she should be responsible for her father and younger sister, after having lost her mother. She constantly felt she is the one who needs to maintain and take care of the house and manage everything from cooking food to resolving disputes. It was sad, but the truth was she had to be the proxy mother of the family. And in doing so, she would unconsciously find ways to protect that position - the position of responsibility. She firmly believed that "I must be responsible."
And that belief came out quite strong in many other places. At her workplace, she was the only person in her department. My assumption was, she perhaps attracted such a job into her life (unconsciously of course!) so that she could feel more responsible there - if we assume it to be an addiction to responsibility. Her body's response to throw up was to protect that position of responsibility. For if she ate well and didn't throw up, she would rest and feel sleepy. How would she be 'watchful' then? She believed that she must be watchful in order to fulfill her responsibilities. And
not being watchful would only mean that she evade her responsibilities. So what I initially thought of as a story of anorexia or bulimia was actually a story of responsibility.
She would then lose her hyper-vigilance, her alertness, and readiness - that one requires to be watchful and hence be responsible.
I call such beliefs, "survival postulates". Because if the body is able to react in such violent ways to protect such a belief system: I must be responsible, then clearly somewhere deep in her unconscious, her survival depended on it. In the subsequent sessions, therefore, my work was to figure out why did she feel so responsible after her mother's death? How did it become a question of survival? And how could we eliminate that postulate and heal that part of her? In my next column, I will perhaps talk more about postulates and how they are formed, but for now, it is fascinating for us to know how problems are like onions!
(Dr. Gaurav Deka is a psycho-therapist based in New Delhi)