Through my experience as a therapist and mental health practitioner l have observed that the societal attitudes towards crying are replicated in the therapy room. It is time that this problem is unpacked and addressed.

Although social attitudes towards crying vary greatly depending on cultural, societal, and individual factors, in Western society crying is seen as a sign of weakness and/or vulnerability. We have been socially conditioned to believe that certain things are good and bad, and we shouldn’t question why they are good or bad. We cannot always make any critical analysis of certain views, as it means deviating from the conventional opinions which always feel unsafe.

This is the case with crying, where there seem to be some implicit rules that forbid us from expressing emotions, and not crying in front of others as it is viewed as shameful and embarrassing. There is a lot of stigma around crying which also varies according to age, gender, and social status. Men are taught that to be masculine you must “toughen up” and not show emotions. The notions that “big boys don’t cry”, or “man up”, and for women, “it’s not cute to cry” and “crying makes you look silly” are embedded in our psyches.

Crying is often viewed as childish, a sign of immaturity, and juvenile because it is associated with babies. Babies cry a lot; because they cannot use language to express themselves or communicate their needs. Crying is also a fundamental part of the baby’s attachment behaviour, necessary for their psychological development.

The crying elicits a response in the caregiver which facilitates being taken care of. We know that in normal development, as babies get older and learn to use language, they tend to cry less. However, crying remains a fundamental part of our human make-up, in response to certain feelings and emotions such as upset, sadness, and hurt, and as a way of expressing emotional pain. It is therefore perfectly normal and healthy for adults to cry as an emotional expression when one is hurt, sad, upset and emotionally distressed.

Sadly, there remains a misconception that crying is anti-social, yet it is prosocial, driven by our innate drives, and the human part of us that emotes and seeks comfort. Crying remains an attachment-driven behaviour; when we cry, we invite others to attend to us and soothe us which fundamentally meets our attachment needs. The same process that happens in babies when they cry, it also happens in adults, and this is a perfectly normal human reaction.

Crying and the therapy room

I have learnt through my experience as a therapist, through interacting with other therapists, as well as from reading literature, that both male and female clients find it incredibly difficult to cry, or tend to apologise for crying in the therapy room if they do.

Therapists often have to remind some of their clients that they are human, it’s normal to cry, and normalise crying. This reminder often brings down the barrier to crying and enables the client to permit themselves to cry and allow a full expression of emotions. Suppressing emotions could be the reason why that individual may have ended up in therapy after all. In his book The Myth of Normal, Gabor Mate makes the link between the psychological and physical, highlighting that unprocessed emotions can manifest as psychic or physical pain and repressed emotions undermine the immune system.

I use the term “emotional constipation” to capture what happens when we suppress emotions. In the same way as unprocessed food (meals) causes physical constipation and tummy aches, unprocessed emotions also cause psychological constipation, which compacts our minds and causes us pain. The only way to process emotions is by allowing oneself to lean into them, as painful as it is, which will free one’s psychic space up, and create room for other emotions. Crying is a form of processing, and clearing up that psychic space.

Tears are pregnant with emotions, and we know that a good sob feels like an outpour of emotions and release. There are words embedded in those tears that should have been said, we should respect tears as a manifestation of the unspoken words.  Bearing the pain, and witnessing those tears in the therapy room, is a powerful and transformative experience, which is key to healing.

I often remind my clients that if they expect to sweat when they go to the gym, they should not shy away from sweating in the room; crying is a form of emotional sweating, and there is nothing wrong with it. Saying this is neither reassurance nor patronising; it is creating a human connection, and humanising myself as someone who emotes and does cry myself when the occasion arises.

Therapists are humans who are deeply emotionally moved by their clients’ stories and sometimes tear up. There is nothing wrong with that, as long as it’s not a matter of the client looking after the therapist who is clearly overwhelmed and emotionally flooded. Therapists have done many years of therapy and some still go to therapy. They do cry in their own therapy, and that makes them human.

Social status and personality

There is a perception that people of high status in society must remain stoic and not seen crying in public, as it is a sign of weakness and ineptitude. Although there is no direct message that crying is bad, modelling these defensive behaviours reinforces the notions that crying is anti-social, and a sign of weakness and perpetuates the negative attitudes towards crying. Many a time it is the parent, head of the family, or older sibling who is made to just carry on, no matter how much they are emotionally struggling and pretend everything is fine – “crying means l am weak, and l let everyone down”.

One’s personality and temperament is shaped by their unique experience growing up in their homes and the quality of care they received from their caregivers. Growing up in a home where crying is not permissible, or chastised, one internalises certain beliefs about crying and constructs “core beliefs” around crying. In adult life, this enforces the idea that crying is bad.

Core beliefs are conclusions about oneself based on life experiences. Core beliefs are fortified by rules for living which are standards in which self-worth can be measured, which supports the core belief. For example, one can have a core belief that “l am weak” and can build a rule for living that “l must not cry and remain stoic, otherwise l will be seen as weak”. These core beliefs are difficult to shake off or reframe particularly if they are supported by societal views, and modelled by people we look up to.

Crying and well-being

I am sure you can relate to the idea that “sometimes all l need is a good cry”. Crying can be cathartic, and lead to a release of emotions that cannot be accessed in any other way but a good sob!

The negative attitudes towards crying and full expression of emotions lead to suppressing emotions and hiding one’s true feelings. It also means we never learn to become emotionally literate as emotions are a big part of who we are which helps us understand what matters to us. They make life more meaningful and colourful, and crying is an expression of those emotions. Emotions make us want to act, and different emotions guide us towards different kinds of actions.

If you are watching a sad film or hearing a sad story, you are moved to tears – embrace it as it’s your emotions in action. The suppression of emotion is harmful as every emotion is valid. If emotions are suppressed, they will find a way to leak out – for example, unresolved grief/loss can manifest in depression, suppressed anger can manifest in depression or anger outbursts, and a traumatic event can lead to anxiety or PTSD symptoms.

In Gabor Mate’s book Myth of Normal, he highlights how unresolved trauma (suppressed emotions) can manifest in a physiological form, emphasising the need for emotional processing which may include crying. The same sentiment is echoed by Van de Kolk – The Body Keeps the Score – in his work on trauma addressing how trauma becomes embodied and translated into a psychological state.

By crying we are also able to soothe ourselves as crying releases oxytocin (love hormones and endorphins (natural painkillers), which support natural bonding. Bonding is a key element of our innate make-up as social beings. When we cry, we are likely to get attention from others who come forward to comfort and soothe us. This is a pro-survival skill which in many ways is linked to our desire to seek connection, comfort, and care from others. Crying can also make us feel calmer as one is likely to take in more deep breaths, balancing the oxygen-carbon dioxide ratio.

Dissociation

Dissociation is a state of emotional detachment from one’s thoughts and feelings which can lead to forgetting memories, periods in life, events, and experiences that would otherwise be readily accessible. Dissociation can happen on different levels – benign (zoning out) and more severe forms of dissociating which require professional treatment.

Dissociation develops as a defence mechanism against experiencing certain emotions which are deemed too painful or difficult at a young age, or in reaction to a traumatic event – for example, in the form of PTSD-related dissociation. When one dissociates, they do not experience any physical and emotional pain – they do not cry since they have no emotional reaction to the experience.

Dissociation is often a result of trauma – historic or acute. Trauma is not just what happened to you, for example, physical abuse, verbal abuse, sexual abuse, dictators, accidents, or loss, but also non-events such as the emotional deficit in not having an adult who is emotionally available to an infant who may be experiencing complex emotions.

Wilfred Bion (1962a) writes elegantly about the baby’s caregiver’s function of receiving the baby’s complex emotions, handling them, detoxifying them, making sense of them, and handing them back in a palatable form. Bion (1962a) termed this function containment, which is related to the baby projecting into the mother and the mother being affected and responding to these projections, a term called projective identification. Bion (1962b) emphasised the caregiver’s ability to turn the Beta elements (unprocessed and unmetabolised affective experiences) into Alpha elements which the infant can think about and make sense of.

The absence of an emotionally attuned caregiver leaves the infant unable to process complex emotions, which can lead to dissociation as a way of dealing with what is for the infant viewed as life-threatening. People who experience some form of disturbances in this parental function are likely to dissociate or struggle with availing themselves to their emotions. They are likely not to cry as they are not emotionally affected.

Crying as a normal human experience

Crying is indeed a natural and healthy expression of emotion. It is not simply a reflexive tear production, but an emotional tear production. Crying can be seen as a way to release stress, sadness, or frustration, and is often considered a normal response to certain life events or situations.

If we are more accepting that crying is not a sign of weakness, but simply being human, we are likely to experience secondary physical and mental health problems related to suppressing emotions. When we embrace crying, we can even encourage others to express their emotions through tears and be vulnerable with us without fear of judgement. People tend to feel more comfortable crying openly when they know their feelings are validated and they will not be judged for it.

As a society, we must eradicate the stigma attached to crying, particularly for men, who may be expected to display emotional stoicism and not show any signs of weakness. I believe this is why both addictions and suicide are high in men in comparison to women. Women should also be allowed to express their anger, and cry despite it being viewed as “not being ladylike” and crying seen as “silly”. Embracing these emotions and fully expressing them through crying is healthy.

Overall, it is important that we create an environment where people feel comfortable expressing their emotions authentically without shame, and fear of judgement. In the therapy room a big part of our work as therapists is enabling clients to develop an emotional vocabulary, to help them better understand their emotions, and to allow a full expression of emotions.

When we can be vulnerable with each other, we can process emotions that we otherwise suppress, leading to depression, anxiety, problem anger, and other physical health problems. This also translates to people not carrying so much emotional baggage and utilise therapy as their only way to learn about their emotions and process.

Benefits of crying

1. Stress relief

Crying can help to alleviate emotional and psychological stress. It provides an outlet for releasing built-up tension and pent-up emotions, which helps in reducing anxiety and promoting relaxation and overall well-being.

2. Emotional catharsis

Crying serves as a form of emotional release. It allows individuals to express and process their feelings, enabling them to gain a sense of relief and clarity. It can help in dealing with grief, hurt, sadness, anger, frustration, or any intense emotions.

3. Mood enhancement

Crying triggers the release of endorphins and other feel-good hormones in the brain, which can improve mood and provide a sense of soothing and comfort. Crying helps individuals feel better and experience a sense of emotional release and renewal. Oxytocin and endorphins released in crying are natural feel-good hormones which promote physical and mental well-being.

4. Social connection

Crying can foster social bonding, empathy and connection with others. When others witness someone crying, it often evokes compassion and support, leading to a sense of connection and understanding. This can strengthen relationships, provide emotional support and foster connections.

5. Physical benefits

Tears help to lubricate and cleanse the eyes, preventing dryness and irritation. Crying can also stimulate the parasympathetic nervous system, which helps to regulate heart rate and promote relaxation. Deep breathing in crying helps regulate the body and bring it back into a homeostatic state.

How to tune into your human self

1. When you are emotionally affected by something, reflect on how you are feeling. Gently lean into those feelings and cry if you feel like it. Distancing yourself emotionally or dismissing any emotionally impactful experiences will only make it harder for you to tune into your emotions and cry. This also means not fully emotionally processing the meaning of the event.

2. Learn the habit of confiding in someone you trust. We tend to find it easier to cry if we feel safe, not shamed or judged. If there is something you are finding difficult to deal with, call a friend you trust, or arrange to meet and confide in them. If there is a compulsion to cry, embrace it.

3. In your therapy – if you have found it difficult to cry, explore this with your therapist. Understanding the reasons behind our behaviours is key to remedying them. Also, allow yourself to be human in the therapy room and embrace what unfolds.

4. It is important to note that excessive or prolonged crying without relief may indicate an underlying issue, such as depression or chronic stress. If crying becomes overwhelming or interferes with daily functioning, see an accredited therapist or mental health practitioner as it could be a sign of deeper issues that need addressing.

References 

• Bion, W. R. (1962a) Learning from experience. London: Karnac.
• Bion W.R. (1962b). The psycho-analytic study of thinking. Int J Psycho-Anal 43: 306–10.

The academic year is about to begin; many young adults will be leaving their family homes to start a new life at university. For many, this will be the very first of them leaving home (their nest) for an extended period, spending time away from their families, and social networks.

While this is an exciting time for these young adults, and parents seeing their children transition into higher education and gain independence, it is also a very vulnerable time for many. Some students struggle with the stress, separation, and adjusting to a new life away from home, which puts them at high risk of developing mental health problems.

These difficulties can at times get quite severe necessitating them to pause their studies or drop out. Some will continue their studies while receiving help, support, and treatment for their mental health.

Life stages and childhood – adulthood transition

The adolescent stage where most students are when they start university is indeed a crisis stage, where the child transitions into adulthood. This is not an event, but a process which takes time, with the adolescent oscillating between childlike states and tendencies, to being an adult who is able to look after themselves, and gain a sense of independence.

Many students who start university education are likely to be in their late teens -adolescents – or in their early twenties. These are not fully adults. Despite looking mature physically and outwardly, there are a lot of changes happening internally, pivoted by the surge of hormones. They are at a stage where they are learning a lot about adult life, exploring sexuality, and taking on an adult identity.

While the adolescent may have met all the developmental milestones physically and intellectually, it is important to keep in mind that they also have to meet the developmental milestones psychosexually and attain certain psychological abilities. It is indeed in the adolescent stage where personality and identity are formed; the child becomes an adult who has a solid sense of self and is autonomous in the world that they live with others.

The child also severs their dependence on adults – the parents – and develops into an adult, forming adult-to-adult relationships, instead of adult-child relationships. The negotiation between the outer and inner worlds can present a crisis to the adolescent and their parents, who are intrinsically part of this process. Some of the rebellious behaviours, the pushing of boundaries, and sexual exploration are all part of the negotiation, and identity formation.

Parents play a critical role in this tumultuous stage, where their presence and consistency in holding the adolescent through this transitionary phase is paramount. This stage is very critical, and it needs to be navigated very delicately, with parents being the moderator of what is acceptable and not.

Some young adults may not experience a smooth transition into adulthood and will see the emergence of mental health challenges including depression anxiety, self-harm, and eating disorders. Leaving home to start university can disrupt this already delicate process, making some students vulnerable to developing mental health problems during their time at university, away from their parents.

Attachments and loss

Leaving home, a familiar environment, means disconnecting from primary attachment figures (loss) – family, friends, home, etc. This spells a breakdown of emotional bonds the student would have built with their significant others and their environment. We may not see this as an attachment injury, however, this loss also means the student has to deal with absence and grieve for the loss of the significant attachments while fostering new connections in a foreign environment.

This loss can be profound for some students who become completely disconnected from their families, friends, support networks, and everything that is familiar to them. These are students who may have to move countries, cities etc. where there is not only an unfamiliar environment, but unfamiliar weather, climate, food, language etc. Foreign students and students who live far away from their homes often experience this loss more deeply than the ones who can visit home easily. However, this does not mean they do not experience loss in the same way.

Another form of loss experienced during the stage students start university is a loss of the old self – the child – and coming to terms with the new identity as an adult. This loss can stimulate ambivalent feelings about adulthood – while it brings a new sense of freedom, independence, and autonomy, being an autonomous and independent adult can be challenging – growing pains. Indeed, it comes with its own challenges of having to navigate everyday life without the watchful eyes of the parents and having to develop new relationships in an alien environment.

University culture – small fish in a big pond phenomenon

Many students who end up going to university are likely to have been academically superior, and popular in their former schools. They may have enjoyed the success of being in the top sets in their classes. When they start university, they realise they are just one of many others who are just as capable. There is often a lot of competition among university students, which can trigger a sense of being inadequate or being not as smart as the next person.

The rigorous nature of university studies, and the competencies they are expected to meet fuels this competition, which often becomes unhealthy, leading to anxiety and imposter syndrome. Many students find that they suddenly feel very small when they have always felt powerful; this creates a real blow to their confidence and self-esteem.

These secondary issues have a huge impact on their mental health, and how they navigate their new life at University. The newfound freedom and absence/loss of parental figures who keep a close eye on them can also lead to substance and alcohol misuse as a way of coping. This has a huge impact on one’s mental health.

Many students struggle with stress and coping with juggling their studies, academic life, social life, and independent living. It is not unusual for some students to end up experiencing severe mental health problems that require treatment from mental health professionals. At times parents have to be involved to support the students and keep a closer eye on them. In worst-case scenarios the students may end up deferring their studies, leaving University. This is indeed very sad and painful for the students and their parents.

Tips for students and parents to cope with University life

It is not unusual for students to struggle with their mental health in the first years of starting university. If you feel that you are one of them, here are the self-care tips to keep your mental health at an optimal level:

• Have a routine and prioritise rest from the library, classes, lab etc.
• Maintain a healthy and balanced diet, do not rely on takeaways-make your own meals.
• Make sure you get enough sleep and exercise sleep hygiene.
• Build a staple group of friends who are mutually supportive.
• Join University clubs and other social clubs so you can spend time with other people.
• Do not isolate yourself – make new connections and seek out new hobbies.
• Do not compete with your peers. We are all different – be mindful of the small fish in a pond phenomenon!
• Be mindful of peer pressure and how easy it is to lose focus. Peer pressure encompasses partying, drug use, truancy, and other delinquent behaviours.
• Maintain a positive relationship with your tutor where you can share your worries, concerns and anxieties.
• Stay in touch with your family and friends back home.
• Register with a local GP.
• Identify your University student counselling service and investigate the referral process.
• Self-refer to the student counselling services if you feel that your mental health is deteriorating.
• If you have a history of mental illness, identify your local CMHT and CRT.
• Parents – keep an eye on your children and try and have an open channel of communication.
• Parents – visit your children and make sure they are settling in well, and be curious about their new life.
• Do not ignore any signs of acopia or unusual behaviours, for example not answering phones etc.

For some people, relationships with their siblings, which are meant to be loving, caring, nurturing, and fulfilling, are a source of great pain and anguish. You share so much history, the same genetic makeup, you share the same parents (or parent), you made so many memories together – good and bad. There is just so much to reflect on and laugh about; what really goes wrong for this unique relationship to become so adversarial?

Rivalry and conflict between siblings are more common than is talked about. As a society, there seems to be reticence to accept it exists, yet it is at the core of my people’s suffering in life. This may be because when sibling rivalry is talked about, it stimulates some powerful feelings, including shame, guilt, blame, anger, defensiveness, sadness and fear.

In some families, there is often a desire to maintain a united front or a façade, while harbouring so much resentment towards each other. In other families, the rivalry turns into an all-out war, dragging others into it, creating an “us and them”. This muteness in not acknowledging sibling rivalry, viewing it as taboo, and not openly addressing it means many people go through life carrying many unseen and deep emotional scars, due to the relationship challenges they have endured, and the emotional damage caused by their own siblings. It is only in therapy that many get to learn to speak about it, and feel safe to do so, without judgment or the fear of being seen as the” troublemaker”.

Having recently read Prince Harry’s memoir Spare, it is clear that the running theme throughout this book is that of rivalry between him and his older sibling, and his feelings of growing up experiencing himself as the “spare”, the second best, the auxiliary. In the public eye, these are boys, now men, who have always been seen as close, united, and the model version of perfect brotherhood. This highlights how prevalent sibling rivalry is; it touches on every family regardless of race, social class, gender, ethnicity and culture.

When there is a perception that parents give one child preferential treatment, or if there is real evidence that the parents are favouring a particular child over the other, it often creates conflict, fuelled by jealousy and envy. Underneath the jealousy and envy are more complex feelings – anger, shame, guilt, sadness, grief, and resentment.

For the subject, there is often a sense of being deprived of something of huge significance (love, affection, attention, nurturance) that was made abundantly available to the other sibling/s. If the experiences that are deemed to be favouritism, or preferential treatment by the parents are not addressed, it can lead to deep-seated feelings of resentment towards siblings, which can breed throughout life.

What lies behind sibling rivalry

Sibling rivalry often originates from very early on in life, and it is fundamentally shaped by some underlying factors and unconscious processes. In some cases, the rivalry creates conflict that is difficult to mend, leading to ongoing relationship tensions between siblings. Here are some of the causes of sibling rivalry.

Birth order

Firstborn

We are competitive beings; it made us survive through generations where the unfit perished and the fittest thrived. Competition is healthy, and it also happens between siblings, even though we may not be conscious of it. It is however the nature and degree of it which determines whether it is healthy or unhealthy. Despite being born to the same parents, each child is a unique entity in a family, which has its own set of needs, and developmental journey to make.

One’s personality is built through a combination of many factors, the key one being how they experience their relationship with their parents. The proximity to parents, and age difference, can have a huge influence on the perceptions each sibling creates on how they are being treated. We all thrive when we feel loved, cared for, prioritised and we feel seen. However, if one sibling is always towering over the other, the child who is behind is often left feeling unseen and unheard, despite the parent’s efforts – this stimulates competition.

This is common in families where the firstborn tends to become a surrogate parent and, therefore, is seen as the one who gets more attention and exercises authority over the younger siblings. The firstborn child may be experienced by the younger siblings as harsh, controlling and powerful. It is a fact that the first-born child already had an established relationship with the parents before the younger siblings were born. The arrival of a younger sibling/s may stimulate jealousy, and envy, in the firstborn, and being replaced, therefore getting less of the parent’s attention.

The firstborn may also experience the parents as harsher on them, as they tend to be more forceful and robust in channelling the first child to success in life. This can stimulate a range of feelings in the subject – anger, frustration, guilt, strife to please the parents. The younger siblings may also perceive this as the parents giving the older sibling more attention, deeply impacting their relationship with the older sibling. All these factors, which may be unconscious, are foundational in the genesis of sibling rivalry.

Last born 

The last-born child is often seen as the baby of the family and tends to be viewed as the one who gets special treatment. By the time the last sibling is born, it is true that most parents would have become more competent, and confident in their parenting skills, and would have developed their unique parenting style. They tend to be more relaxed and less cautious, which can stimulate feelings of jealousy and envy from other siblings who may have experienced the parents as being harsher and harder on them.

The younger sibling is likely to remain home with the parents, while the older siblings leave home to start university or work. This also means they get to spend more quality time with their parents, which other siblings may not have experienced. This can be a source of jealousy and anger towards the younger sibling from the older siblings for being denied the same level of relaxed and due attention.

Middle child

The middle child syndrome is undeniable – it is often the middle child who feels unseen and unheard in a family. The first siblings get special attention, the youngest child gets a different type of attention as the baby of the family, while the middle child is often left boxed in these two powerful juxtapositions, deprived of attention.

The middle child tends to develop mechanisms to get attention from the parents, at times through academic excellence, looking after the parents, or just being the good child who doesn’t cause the parents any trouble. This can also mean the middle child not psychologically developing in the same way as other siblings who get the parents’ full attention, as they have to mould their needs around others.

Growing up in this position can in later life stimulate feelings of being unloved, and the need to look after everyone else in order to get attention and love. These middle children can also easily become servitude to their other siblings in order to seek to gain their attention and approval. This learned behaviour and internalised way of relating is carried into adult life. Experiencing the other siblings being favoured can be a source of jealousy, and provoke a need to put oneself as secondary in later life.

Gender

In some families, the children’s gender determines how they are treated by the parents and other siblings. This is most common in BAME and other minority communities where boys – sons – are seen as tokens in the family, and daughters are viewed as less than, secondary. These unspoken notions are not often explicitly voiced, yet they are powerfully felt.

Daughters are seen as liabilities, and they do not hold the family legacy in the same way as sons do. Some first-born daughters therefore feel the need to strive in life in order to match up the parents’ expectations of a son. Brothers who are in second and third place can also end up feeling competitive and rivalrous towards older sisters. If the son is the first child, daughters who come second are often treated less favourably. Parents’ own projection play a big part in how the children relate to each other. Unchecked this can be a source of huge rivalry and conflict in families.

Parentification as a contradiction

Parentification is when the child is given duties and responsibilities that are not age-appropriate. Parentification can occur in two different forms – emotional and instrumental. Some people may experience one of the other, while others experience both.

Emotional parentification is when the child provides emotional support to the adult, while instrumental parentification is when the adult assigns and ascribes adult roles and duties to the child. In practice, the adult may simply offload on the child, confide, ask questions, and seek advice from the child. It can also happen when a child is given adult chores, that are not age appropriate. When this happens, there is a role reversal where the child becomes the adult, the provider of emotional containment to an adult, and an involuntary provider of practical support.

Many a time parentification happens covertly, and the adult may not recognise their emotional and practical dependence on the child. In any situation where there is emotional parentification, there is neither a sensor in the adult nor a recognition of boundaries of what is appropriate to share, how much can be shared with the child and what is and isn’t age-appropriate. Children do not only grow and develop physically, but they also develop psychologically and have certain milestones they need to reach and accomplish. Parentification interferes with the natural development of the child, and accomplishing their own developmental tasks, as they are pivoted into adulthood.

It is not unusual for parents to have a close relationship with a particular child, at certain stages in life, or throughout life. In most families, it is the oldest or youngest sibling. When there is instrumental parentification, it is typically the oldest child who becomes the surrogate parent or the one to whom the parents offload all their troubles. The conundrum is that this may be experienced as a form of closeness with the parents that other children do not share, yet it is indeed a form of emotional abuse-parentification.

In some families, the youngest sibling, the one who leaves home later than everyone else, becomes the parent’s confidant and handyman. Where parents have relationship challenges, or separation/divorce, this child is left bearing a lot of the parents’ own struggles. Again from the outside, this may be a sign of closeness, which stimulates jealousy and envy from other siblings, internally it may not be the same, there is a contradiction.

Trauma

At times parents may have closer relationships with a particular child than the others due to the child’s developmental journey. When there is developmental trauma for example sickness, disease, disability or some form of injury, accident etc. the parents tend to pay a close eye on that sibling and develop a closer relationship. Temperament from birth, how smoothly the child reached their developmental milestones, and academic and intellectual abilities also determine the quality of relationships the parents develop with the child.

The parents may become overprotective, cautious, and more careful when dealing with a child who is seen as vulnerable than not. This response to trauma can indeed impact the relationship between the other siblings who may feel deprived of the same level of attention developed with the particular child who had a traumatic or challenging upbringing. In other families, it is the brighter child who gets more attention from the parents, overshadowing the not-so-bright siblings. This can also be a source of conflict and rivalry.

Narcissistic parents, generational traumas, and transference

We often forget that parents were children once upon a time, and they remain children at the very core. Despite being physically mature, psychologically, parents may be still growing, and have a lot of psychological maturing to do. No one has a manual or tool kit on parenting; parents learn to parent on the job, and they learn from mistakes. Parents can see themselves in their own children, as they were children themselves once upon a time. It is not unusual for parents to unconsciously project their own unmet needs onto their children, thereby stimulating or fuelling rivalry between them.

Sibling rivalry is common in dysfunctional families. The dysfunction lies in the parents, in their own conflicts, their unmet childhood needs, and how they were parented – it has a generational constellation. Parents who are “narcissistic” are unable to accept responsibility for their own failures or insecurities, they risk having a narcissistic psychic collapse. It is often the case that the drama that the children unconsciously play out is on behalf of the parents who are not able to confront their own traumas and address their own unmet needs from their childhood.

For example, a mother who felt unloved by her own mother can develop a perverse relationship with her daughter where she lives vicariously through her – there are no boundaries and she will do anything to make sure that child is given special treatment over others. Another example is a father who may have had a harsh father himself; he either becomes very harsh towards his own son/s, or too relaxed and unboundaried to the detriment of his relationships with other siblings.

A parent or parents may like a child who reminds them of a past figure grandparent etc. or resent them for the same depending on the type of relationship with that lost person. This is a transference, a way of relating that is based on an internalised early figure. If it is a negative transference, the child is treated favourably and if it is a negative transference, parents can become very harsh towards that child as they remind them of an early life figure.

Freud (1913) described transference as an unconscious phenomenon that is omnipresent in relationships we create with others; it is an act of projecting an internal experience into the external world. With this unconscious drama being played out, rivalry breeds, with the parents being the creators and choreographers. This type of sibling rivalry is very common and most harmful as it often engulfs the whole family with parents taking sides, due to their close identification with one or more of the children. This is a painful place to be, due to the powerful nature of the projections, and how we often act out what is being projected.

Managing an unhealthy relationship with a sibling

If you are someone who has an unhealthy relationship with a sibling, here are some ways to manage it:

• Maintain a respectful and boundaried relationship with your sibling, don’t force things.
• Do not compare your sibling relationships with other families. Each family is different, and it comes with its own unique generational traumas.
• Create healthy relationships with other siblings and family members where you can have mutually nurturing relationships.
• Be curious and ask your parents stories about their own childhood and life. There is a lot to discover from people’s stories and how they grew up which may explain some of the dynamics.
• Remind yourself that not having a healthy relationship with a sibling is not a sign of failure, and it doesn’t mean you do not deserve other loving relationships.
• Consider therapy for you and your sibling if you really want to talk things through in a safe space.
• Consider family therapy if the sibling rivalry spans into the whole family dynamic. This form of therapy can help you all heal as a family and find the language to describe your experience in a more reflective way without blaming and shaming.
• Consider individual therapy to address this form of relational trauma. It can be very confusing and unsettling to not feel loved and valued by people who should be closest to us.
• If you are a first child, try and reflect on the impact of your position and behaviour on your younger siblings, and your relationship with your parents – were you parentified in some way? What is the impact on you?
• If you are a middle child, reflect on your needs and identify what you consider unmet and how it relates to the way to deal with relationships as an adult.
• If you are the last-born child, try and reflect on your position and what it meant to you and your siblings.
• If you are a parent, and you have children in conflict, do reflect on what you are bringing in from your own past. Address it separately, in therapy. That’s an act of love for your children.

Toxic positivity is when we respond to situations that would naturally cause emotional distress with false reassurances and positive feelings.

Toxic positivity is dismissing of genuine human feelings that are deemed negative, displaying only positive feelings, despite the circumstances. This can be very harmful as dismissing negative feelings and only focusing on positive ones can mean that we are not in touch with our true selves, denying ourselves what it fundamentally means to be human.

People who display toxic positivity never get to fully appreciate distressful situations for what they are as they feel huge pressure to remain positive. There is nothing wrong with acknowledging negative feelings when things are not going well, or when faced with disappointment. And it’s healthier to be honest with true feelings if one is struggling than forge a positive attitude. Toxic positivity can occur on a subjective level, informed by core beliefs that we may have created around help-seeking, competency, and failure. It could be from another person who disqualifies someone’s experiences by telling them to focus on the positives – no matter how it hurts, “Chin up, positive vibes only.”

Harmfulness of toxic positivity

Toxic positivity can lead to depression and feelings of isolation, through never getting to fully appreciate, communicate, or share true feelings. The more we shut down, deny, or suppress our feelings, the more we distance ourselves from them, and feel disconnected from ourselves. We also end up feeling disconnected from others as we are not being our authentic selves.

If someone wants to share how they are feeling, and they are being told to concentrate on the positive, it can lead to shutting down and not sharing after all, which is harmful in the long term. This often happens when there is a loved one who is struggling or going through a difficult time, and we want to pick them up, “Come on, you can do it, stay positive!” While there is a good intention, when we only focus on the positives, we never get to appreciate situations and contexts for what they are. That also means we never get to reflect and learn from them.

When we suppress, dismiss, invalidate, or deny feelings, we are simply burying them. We internalise them and they are likely to manifest in uglier and unanticipated ways. This is true for anger, which when suppressed, can manifest as depression (anger turned inwardly) or aggression and rage that gets acted out. Toxic positivity can manifest in relationships – familial, romantic, friendships, and in workspaces. The body is intricately linked to the mind. When we bottle up emotions, they can manifest physiologically in the form of bodily aches and pains.

In his book, The body keeps the score, Van Der Kolk, a trauma expert writes about the link between the psyche and soma in relation to trauma. His work is based on empirical studies on how trauma reshapes the brain, and manifests physiologically, the body becomes the main platform where feelings related to a particular traumatic event is experienced.

Avoidance of negative emotions

The main reason why people engage in toxic positivity is because they want to avoid certain feelings and emotions that are deemed negative.  Toxic positivity is a defence against feelings that would make someone feel vulnerable. These feelings cause unpleasant physical sensations due to the physiological changes that take place in our bodies in response to them; this is why they are experienced as negative.

Humans are emotional beings. And our emotions make our lives colourful, rich, and meaningful. Every experience we have is coloured by emotions – that’s why when one remembers a memory, it  evokes feelings of  either sadness, happiness, joy, anxiety, anger, etc. Even in sleep, our emotional life is active, helping us process. Dreams are a rich part of our subconscious and are emotionally charged.

Without emotions, life would be a dark landscape, just like an empty, arid desert land with no rain, plants, and no life.

Despite emotions being a significant part of who we are, we live in a society where we make rules about certain feelings and emotions, which are deemed negative, bad, or intolerable. This is true of anger, rage, fear and sadness. Even love can be a negative feeling if we anticipate rejection, and if we love someone who does not love us and  there is no reciprocity. However, the reality is that there is no such thing as negative or bad emotions. Every emotion and feeling is valid and they happen for a reason. The only way to understand the validity of our feelings is to experience them, reflect on them, and understand the validity of their source. The quickest, albeit detrimental thing most people do in response to certain emotions, is to suppress, ignore, invalidate, or distract themselves from experiencing them. Toxic positivity is a tool for doing exactly that (“good vibes only”), and not giving ourselves the permission to really sit with how one truly feels.

One of the key reasons why some people end up self-medicating anxiety, sadness, worry, shame, and anger with alcohol, narcotics, and sometimes food is to regulate how they are feeling as certain feelings become unbearable. When we suppress feelings, we are denying ourselves who we are as humans. The macho attitude is a key element of toxic positivity.

Low self-esteem and anxiety

Low self-esteem plays a big part in toxic positivity as fundamentally one does not have the inherent trust in themselves to be able to cope with situations that are deemed risky, leaving them feeling vulnerable and powerless. Due to this deep-seated insecurity and fear of judgement, it’s easy to deny or invalidate a situation with positivity, than engage with how it truly leaves that person feeling.

Being able to talk about our feelings in context, expressing them, and acknowledging them for what they are is essential to our personal growth and improving our self-worth. People who adopt toxic positivity tend to be anxious individuals; people who may ‘follow the crowd’ due to a lack of self-belief. By not confronting the issue at hand and turning it into a positive, it deflects anxiety. They are likely to view the world in all-or-nothing terms, and overgeneralise without considering the meticulous and real issues at hand.

Emotions and their meaning

Feelings and emotions are simply feelings and emotions. No feelings or emotions are negative or positive. Our defence-related feelings – anger, fear, anxiety, sadness – are related to the primitive (evolutionary) part of us which seeks survival. These feelings provoke unpleasant physiological responses because the alert us of impending danger, and prepare us to deal with it. This is why they become unbearable; its not because they are meaningless or menacing. On the contrary, pleasure-related feelings – happiness, joy, euphoria – are considered more tolerable, we want to repeat things that bring us pleasure.

There is no such thing as having emotional problems. Not being able to handle emotions is not because of being weak or a character flaw; it happens because emotions work in powerful but subtle ways, demanding expression and attention. When we deny or suppress them, it is usually something we have learnt to do from a young age. But these feelings may find ways to ‘leak out’, and we may struggle with regulating them appropriately so they do not cause discomfort.

Emotions and feelings guide us to what’s important to us. Here is what key feelings may mean to us.

Anger

Anger is a normal feeling. When we feel angry, we should pay attention to it rather than suppress it. We feel angry because there is a sense that an injustice has been made, and one has been treated unfairly. Anger helps us understand more deeply what one is passionate about, what you care about, where your boundaries are, and what you believe should be done accordingly. Anger only becomes detrimental when we either suppress it, hold on to it, or deny it.

Sadness

Sadness is a normal feeling we experience which helps us understand the depth of our care for others and what matters to us. The reason we feel sad is because we care about the person or situation. If we didn’t care, we wouldn’t feel sad about it not being what we wanted it to be.

Guilt

The reason we feel guilt is that there is a sense that we violated our moral standards, and we want to do better. It’s the part of us that hold conscience that fuels the guilt feelings. Guilt feelings can help us recalibrate our moral compass and learn to do better in the future.

Anxiety

Anxiety means you are alert, and you want to remain safe and in control. Anxiety is normal, it is our evolutionary tool that has kept us alive though a millennial. Anxiety only becomes problematic when its excessive, chronic , and  life limiting. Reminding oneself that you are safe, and normalising anxiety is is a key aspect of managing anxiety.  The reason why it causes discomfort if because it provokes unpleasant physiological responses which at times lead  to anxiety related disorders- panic disorder, generalised anxiety, OCD, agoraphobia, health anxiety, social anxiety and PTSD.

Combating toxic positivity

There are some potential ways to combat toxic positivity, such as:

• Being able to accept that we cannot get things right all the time and that things can go wrong is a key part of combating toxic positivity and is primary to personal growth.
• Understanding the language of our emotions is key – there is no such thing as negative emotions. Feeling sad, angry, and scared at times is normal. What’s crucial is that it is expressed appropriately; not supressed.
• Developing emotional vocabulary by tuning to and leaning into emotions that you tend to avoid, identifying their source. By understanding them, you can give these feelings a meaning, and they become less scary.
• Learning to share how you truly feel with people you trust when things are not working out and when you are feeling sad, angry, overwhelmed, angry, etc. By stating happiness and optimism in situations that evoke sadness, anger, or anxiety is undermining yourself as human.
• Journaling your true feelings, even if you feel you need to keep a positive attitude in front of others. By journaling, you are able to learn more about your feelings and understand their source.
• Starting to give yourself the permission, freedom, autonomy, and power to make choices about your life. Failure is not the end of the world, its OK to be sad if you fail or if things don’t go your way.
• Surrounding yourself with people you can be vulnerable with and you feel safe to be around.
• Building your self-esteem by taking risks – do something that feels unnatural. Allow yourself to be imperfect and learn from the mistakes.

The only way you learn and grow is through failure. It gives you an opportunity to reflect and figure out the areas you needs to work on. A big part of why we don’t try is because of the core beliefs that we hold about ourselves around failure ,“I am not good enough; I am not entitled to be successful”. These are ancient notions and they should not have so much power over you.

Lastly, there is nothing wrong  with a good old cry if you are feeling down & dejected. Crying is cathartic; by crying you are simply being human.

Our world is fast changing, more so as we live in a digital age. Language is evolving; new words are appearing in our vocabulary, and some are formally recognised in our dictionaries. Traditional and conventional ways of being and relating are now at par with alternative and unconventional conducts that never existed a decade ago.

The “Woke culture” is central to this paradigm shift; pop psychology is here and it’s here to stay. It is truly a privilege to live through these changes and be a part of it. Despite the positive aspects of this paradigm shift, we are also living in a world where pop psychology is leading, buzzwords are getting thrown around, and people are diagnosing themselves with all kinds of diagnoses.

Social media perpetuates this problem, and so does access to the internet where a plethora of information exists, most of it unverified and unreliable. Therefore there is a real need to engage in a dialogue between real psychology and pop psychology, so these two worlds can be bedfellows.

Many clients come to therapy having diagnosed themselves with all kinds of mental disorders – ADHD, autism, depression, anxiety etc. after watching TikTok videos or Instagram posts. Most of the social influencers who are diagnosing people and giving advice are not qualified to make the diagnosis or give clinical/professional advice. They are typically people who are good at speaking, editing videos and have made huge investments in social media as a paid source of income.

Mental health becomes an easy target to raise one’s profile as most people want quick fixes. This is harmful, not only due to potential misdiagnosis, but it also undermines real human experiences. Normal reactions are seen as “pathologies”. Some mental health professionals are equally caught up in the game of diagnosing people injudiciously.

The recent BBC Panorama documentary highlighted the poor standards in the assessment, diagnosis and treatment of patients perceived to have ADHD, in some private clinics in the UK. The standards of these clinics fall short and the reason why this was happening in the first place is due to the long waiting lists for assessment and diagnosis for ADHD patients in the NHS. This leaves many people vulnerable to seeking quick fixes, diagnosing themselves through social media.

A big part of who we are is in response to our environment. Our environment is constantly in interaction with our internal world, the space in between these worlds is where we create meaning. When we deny our feelings or try to view normal human feelings and behaviours in response to our environment as pathologies, it invalidates our existence as humans. This is problematic.

We live in a society where we make rules about certain feelings, emotions and behaviours. Some words or concepts that get adopted in pop psychology perpetuate the medical model which tends to view our human experience in response to trauma, loss, adversity, and suffering, as a cluster of symptoms that can be used as empirical evidence to diagnose and treat with medication for one’s health to be restored to normal. This model also views normality and abnormality as binaries, and there is no in-between.

There is no consideration of external events and the environment and how they may be impacting or influencing one’s mental health. This is where therapy becomes significant. While formal diagnosing can be helpful in validating and meaning-making for some people, overreliance on it also means we deny the essence of who we are as humans and focus on a diagnosis, not the individual.

Our emotions are a significant part of who we are; they guide us to what’s important to us. If we validate them and interrogate their source, we enrich our lives and grow.

Words used in pop psychology and how to reframe them

Here are some of the words that are used in pop psychology and here are ways to reframe them:

Depression

Feeling sad is not depression. Not everyone who is feeling sad or low is depressed. Depression is a condition that can only be diagnosed by a medical practitioner. For you to have a clinical diagnosis of depression, you need to meet a certain threshold of symptoms and experience them for at least six weeks period of time.

Sadness is perfectly normal, and so is dejection and hopelessness if things are not going well or didn’t go well. Depression tends to focus on the past – regret, shame, and rumination. Sadness shows you the depth of your feelings; the depth of how much you care for others and yourself. That’s why you feel sad when you lose someone or something you love. You feel sad because you cared for that person or that thing.

Co-dependency

Having needs and seeking to have them met by your partner is not co-dependency. Being in a loving, caring, synergetic relationship does not mean you are co-dependent. Having a partner that you trust and turn to is not co-dependency.

Co-dependency is when there is an over-reliance on the other person emotionally, however having an emotional connection with someone and seeking closeness and emotional intimacy is not co-dependency. Many people are deterred from opening themselves emotionally, to develop more intimate connections with their partners or friends, for fear of being seen as “co-dependent”. This is harmful to one’s personal growth.

Trauma

Not every unpleasant event in life is trauma. In psychology, trauma is a word which is used very loosely to define the adverse experience one experienced in their course of life.

The overuse of this word invalidates real trauma which has a lasting impact on the individual. For example, being late to school is not a trauma, however, being repeatedly shamed for being late to school can be considered a trauma. Trauma has an impact on the subject – it could be a one-off event, repeated events or even non-events deficits.

Narcissist

Not every individual you have negative feelings towards is a narcissist and not every ex-partner who you hate, or dislike is a narcissist. It’s very easy to use the word narcissist as a label to demonstrate how one feels about the other person. This word can be dehumanising and used to deny the individual of their other qualities, other than them being seen as a narcissist.

We are bound to like and dislike some people in life, and that’s perfectly normal. However, not everyone we dislike is a narcist. Not everyone who has hurt us is a narcissist. Calling others narcissists is an act of projection, “It’s that persona’s fault and l have nothing to do with it”. This also means we never get to reflect on the role we played in the dynamic and learn from it.

Gaslighting

Having a disagreement with someone and having them question your view on things is not gaslighting. The notion of being gaslighted is behind why some people struggle with resolving conflict, exploring difficult subjects, and negotiating. Communication is a two-way process where there are individuals who are listening and requiring at the same time.

Some people experience being questioned as gaslighting because they have been told that someone challenging their view is gaslighting. This creates communication breakdown, and we never get to grow.

Being triggered

Taking offence when something does not sit well with you is perfectly normal, it doesn’t necessarily mean you are being triggered. It’s normal to have a response to things, our brain functions by making connections. When there are things that remind us of an event, situation, person, or place we have a reaction, not just a memory but a feeling as well. This is part of our sophistication as humans.

Being triggered is a more extreme form of reaction which occurs when there is an “emotional allergy”. By this l mean there is an experience in the past which has provoked powerful, familiar, uncomfortable feelings.

The reason why these feelings are triggering is that they are associated with certain anxiety/trauma-related physiological changes in the body which we do not readily register, however uncomfortable. These may be muscle tension, heart palpitations, chest tightness, sweaty palms shortness of breath etc. The body is reacting in a way that it is primed for survival.

Love bombing

Showing interest and pursuing someone you desire is not necessarily love bombing. Neuroscience postulates that falling in love can feel like a form of madness – that’s why even Romeo’s words to Juliet conveyed how madly in love he was with her.

Falling in love is not just an emotional and physical experience, it creates a “crisis” in the brain. It produces physical and emotional responses: racing heart, sweaty palms, flushed cheeks, feelings of passion and anxiety. Stress hormone cortisol levels increase to help the body cope with “crisis”. As cortisol levels rise, the neurotransmitter serotonin becomes depleted. Low levels of serotonin bring on intrusive, maddeningly preoccupying thoughts, hopes, and terrors of early love: obsessive-compulsive behaviours of infatuation. High levels of dopamine activate the reward circuit, helping to generate euphoria similar to the use of cocaine or alcohol – this is why, in the initial stages, one ends up feeling the mad rush, and the need to pursue a love interest.

These reactions are perfectly normal, however, can lead to obsessive behaviours which can be interpreted as love bombing. This is problematic in dating, especially where taking a slower pace can be considered disinterest while being more robust can be seen as love bombing. Love bombing is normal, it’s our primitive brain that seeks connection at work.

Boundaries

Being rude, rigid, difficult, and aggressive is not the same as having boundaries. Boundaries is knowing what you want, what you value, and being able to communicate it in a mature and respectful way. Equally, being reasonable, accommodating and kind, does not translate to a lack of boundaries. You can be all that with boundaries in place.

Boundaries have a lot to do with being a sound human being who has an awareness of their needs and can advocate for themselves while mindful of others having their unique experiences, and minds of their own. Many people are so eager to create boundaries, however, their lack of understanding of what they mean and how they can set them, leaves them very isolated as they push other people away in the process.

ADHD

Finding it hard to have a routine, being disorganised, and struggling to feel settled does not mean you have ADHD. Some people may have some ADHD traits, without necessarily having ADHD perse. Poor organisational skills, lacking discipline, and chronic stress can create symptoms that mimic ADHD symptoms. Our bodies need sufficient time to recover, reset, and replenish themselves. Just like any machine we use, we need time to switch it off, clean it, oil it, service it and repair it. Without doing so, it breaks down.

Our environment also needs to be conducive to whatever we do. We live in a world where we are constantly on the go. This can be problematic as stress can lead to burnout and other physiological symptoms such as fatigue, brain fogginess, difficulties organising oneself, and chaotic behaviours.

Depression, anxiety and ADHD-type symptoms can be secondary to chronic stress. Before you consider having ADHD, try and improve your self-care and give yourself some time to rest and recuperate. A healthy sleep pattern is key as well as a healthy diet, exercise, work-life balance and boundaries around work and rest. Furthermore, try and make sure you create structure in your environment and reflect on whether your environment is good enough for you to grow in it.

Note from Counselling Directory: If you’re keen to move away from pop psychology and closer to psychology, working with a professional who has training is key. Contact Dr Joyline to learn more or use our search tool to find a therapist.

Are we a generation that is riddled with high-functioning depression; is depression endemic? I pose this question to start with, as it helps us interrogate what high-functioning depression is and investigate the impact it has on our 21st-century generation.

We live in a fast-paced, capitalist world; everyone is in a rat race, chasing the next best thing, and striving. Resultantly, stress and burnout are rife, yet normalised, it’s a part of everyday life. We seldom pause and check in with ourselves, or our loved ones. There’s a warped notion that if one is getting up each day, keeps a job and earns a salary, they’re fine.

What we do not understand, is that some people are struggling internally and living with high-functioning depression, which is debilitating in many ways. Sadly, it often takes a person having a complete mental breakdown and psychic collapse for them, and the people around them, to have an appreciation of how work-related stress can lead to serious mental health problems – acute or chronic.

In my role as a therapist, I have encountered many people who come to therapy with chronic and debilitating mental health problems; the most common one is high-functioning depression. What is bothersome, is that some of these people are not even cognisant of their suffering from depression.

What is high-functioning depression?

High-functioning depression, also known as dysthymia, is a form of depression where the person experiences all the symptoms of depression, but they are typically milder. The symptoms tend to be chronic, low grade and don’t necessarily impair day-to-day functioning. As a result, people with high-functioning depression can carry on with their life as usual, and present as if all is well externally. At times, the sufferer may not even recognise that they have depression, albeit high-functioning, and so this is also easily missed by family, friends and health professionals.

People with high-functioning depression tend to struggle internally and, in many situations, present quite differently outwardly. For example, if they are aware of the low mood or what is often described as “being constantly in a funk”, they may mask their symptoms or become highly performative to disguise the depression. Therefore, it is easy for symptoms to be excused as one’s personality, or as dismissed as one being “moody”.

What are the symptoms of high-functioning depression?

Like frank depression, people with high-functioning depression experience:

• chronic low mood
• difficulties concentrating
• brain fogginess
• hopelessness and pessimism
• sleep disturbances – lack of sleep, broken sleep, or sleeping too much
• low energy levels and lethargy
• low self-esteem and self-regard
• poor appetite or increased appetite
• mood swings (anger, guilt, frustration, sadness) and tearfulness
• apathy – lack of interest and motivation
• general sense of overwhelm and acopia
• low libido

Risk of comorbidities

People with high-functioning depression are at a much higher risk of using narcotic drugs and alcohol as a form of self-medicating, to numb and/or elevate the low mood. This can create a vicious cycle, detrimental to a person’s mental health since alcohol is a depressant and narcotics are stimulants (exacerbating symptoms).

This is common and problematic in corporate environments, where there is a culture of drinking after work and social events where there is access to alcohol and narcotics. It’s not unusual for people who have depression to end up developing alcohol and substance misuse, which feeds into the depression, creating a vicious cycle.

Toxic work environments and high-functioning depression

Many companies are beginning to develop systems to promote mental well-being in the work environment, and there is a drive towards normalising mental health while reducing the stigma around mental illness. Employee Assistance Programmes (EAPs) are also drawn in to provide short-term therapy and support to employees who may be struggling with their mental health.

However, I believe that the main objective is often to get the employees back into work as quickly as possible and minimise loss. The reality of these high-pressured environments where performance is constantly monitored, is that employees are at a much higher risk of developing and living with high-functioning depression.

The work pressures lead to chronic stress, which easily turns to burnout. This can provoke secondary mental health problems, such as anxiety and depression, which can become chronic and low-grade high-functioning depression. Individuals in these environments are less likely to pay attention to their mental health, as their focus is on their work.

If they are less productive, they risk being engineered out, and being put on Performance Improvement Plans (PIP). Bumper bonuses and commissions also reinforce the culture of pushing one beyond capacity, risking their mental health. These environments tend to be highly competitive, and poor performance is associated with incompetence, which creates additional issues around one’s self-esteem and self-image. There is very little empathy for each other and it can be cutthroat.

The toxic cultures in these environments result in some people being pushed to their limits mentally; they continue working while experiencing depressive symptoms. Not attending to these symptoms is what turns into high-functioning depression, where a person is functioning but struggles internally. The stigma around mental health also acts as a barrier for these individuals to access help. Taking time off for mental health can be seen as a sign of weakness or failure.

Suicide and high-functioning depression

Social media and the digital world have given us access to news from different parts of the world. It’s not unusual to read about people who lost their loved ones to suicide, where the individual’s struggles went unnoticed by those around them. Many stories that continue to shock the world are those of celebrities and entertainers reported to have died by suicide: Robin Williams, John McAfee, Alexander McQueen, Stephen “tWitch” Boss, and Kurt Cobain, to mention but a few.

How is it possible that these people, who seem to be coping well with life in the public eye, entertaining others, end their lives? I believe this indicates that they may be struggling internally, and experiencing high-functioning depression, seemingly coping on the outside. Living with this contradiction between the internal and external world can be a real struggle as one lives in duality. Ending one’s life ends up being the solution, albeit a painful one for those left behind.

Many studies have confirmed a correlation between depression and suicide. The World Health Organization (WHO) estimates that 90% of all suicide victims have some kind of mental health condition, depression being primary. People with depression are more likely to end their lives by suicide than any other illness. This is not to exclude anxiety, which often co-exists with depression.

Self-care tips

Identifying symptoms of high-functioning depression is key. If you suspect that you have high-function depression, there are some ways to manage your mental health:

Could l be experiencing high-functioning depression?

People who are experiencing high-functioning depression are not always cognisant of it. In many cases, it takes one small thing to tip them over the edge, and for them to notice how poor their mental health is. When this happens, suicidal ideation emerges; due to the untreated depression. If you think you may be experiencing high-functioning depression, it’s important to seek help in a timely manner and galvanise additional support around you.

High-functioning depression is normal, but it is not a life sentence. With the right treatment, people with high-functioning depression can recover, and continue living their lives normally, feeling more wholesomely.

If you suspect that your loved one is experiencing high-functioning depression – you notice some of the symptoms identified above – it’s important to try to engage them and encourage them to seek professional help. Therapy is key in the treatment of depression – some people end up taking antidepressants, adjunct to therapy. I always remind others that taking antidepressants or going to therapy is not a sign of weakness, quite the opposite, a strength.

It’s more painful to watch a loved one struggle or die by suicide without doing anything about it than to reach out and have honest conversations. You may very well be the only person who has reached out.

It’s hugely significant that we keep re-evaluating our attitudes towards mental health and be open to our experiences being unique to ourselves and different to others. Instead of being quick to judge other people – changes in behaviour or temperament – let’s be open to it being a result of poor mental health. Compassion for each other will always take us a long way.

Family relationships are supposed to be anchoring, a source of nurturance, care, love, and support, where there is respect and acceptance of each other as unique individuals. Healthy familial relationships are made up of individuals who can communicate openly with each other, respect each other’s opinions, and have boundaries that are mutually respected.

Sadly, some people do not have the blessing of healthy family relationships, and they go through life dealing with toxic relationships with family members. The contradiction is that the relationships which bring them the most pain are the ones that should bring them joy. This is indeed a painful place to be, one that also leads many people into therapy, to address and work through.

There is a need to manage the relationships in a tactful and consistent manner to minimise the distress that is created. Some family dysfunctions run through generations, which is a result of unresolved relational traumas from the previous generations. Therapy is a way of addressing, and healing from that generational trauma.

It is very easy for one to feel isolated and question their reality, due to the constant gaslighting when dealing with family members who are toxic and where there is dysfunction. By ‘toxic’, l mean people who violate other’s personal boundaries whether it’s by disrespectful behaviours, controlling behaviours, gossip, lies, manipulation, blaming, envy, and jealousy.

The conflict, toxicity, discord, dysfunction, and negativity, whether it’s a single event or ongoing, can lead to some family members distancing themselves, and estrangement. Often there is stigma and negative stereotypical attitudes towards the individual who is estranged, and a failure to understand their position and the underlying dynamics at play.

Distancing oneself from negative family relationships and dynamics is indeed a form of self-care and a way of creating boundaries and safety for oneself. Many people hold on to toxic family relationships that cause them pain because of poor self-esteem and an inability to self-validate – the lack of conviction that they can survive in life without these negative relationships.

Group mentality (basic assumptions) and family dynamics

A family is made up of a group of people, albeit a complex one. Familial relationships are shaped by unconscious dynamics, just like any other group where people are brought together for a common purpose.

Sibling rivalry is one of the common features in families where there is underlying dysfunction. There are often two siblings, at times more, who get into conflict and play this out within the family. While the “drama” is acted out by the siblings, the dysfunction often lies in the parents or the family as a whole.

Wilfred Bion’s study of groups during World War Two can shed some light on some of the unconscious processes at play in the family as a group. Bion (1962) defines this pairing of individuals in any group that is gripped by unconscious anxieties as a basic assumption pairing (BAP), where these two individuals are unconsciously acting out the underlying conflicts on behalf of the group. The source of rivalry is not always to do with whatever issue that is consciously fought over, but rather the underlying issues that are avoided and denied by the family and therefore acted out by the pair.

In some families, the dysfunction manifests in one individual who is the “outcast” or the “scapegoat”.  This induvial becomes the one who holds all the badness on behalf of the family. This is all a function of projections of unwanted aspects of a family member, or the family as an entity onto and into the individual.

Under the sway of these powerful projections, it’s very easy for that individual, who is a recipient of these projections, to act out these projections.

Melanie Klein (1946) would call this ‘projective identification’. It’s also easy to internalise these notions leading to limiting/negative core beliefs about oneself – “I am a terrible person”, “No one likes me, even my own family”, etc. Having these family fights leading to an individual family member, or an individual family within a wider family, being ostracised would fit what Bion (1962) considers a basic assumption fight-flight (BAFF) where there is a turning away from the issue at hand, increased hostility, rage and aggression directed at the enemy, and fighting between group members. This perpetuates the issue as alienating and vilifying the individual, leaving the underlying issues unresolved.

In other families, there is an individual, typically an elder, who is seen as a source of wisdom and cannot be challenged, no matter how wrong they are. This person is seen as omnipotent and the person who is meant to resolve all the issues for the family. This can be very harmful as this member is unchallenged, regardless of how unsound their opinion is; they are protected at all costs. This way of functioning is what Bion (1962) considers a basic assumption dependency (BAD), where there is a dependency on an individual; the phantasy is for that individual to save the family.

This powerful basic assumption often leads to despair and, as that individual is unconsciously seen as the problem solver, however, they do not have the ability to save the family. The underlying issues in the family which can be solved by open and honest communication are avoided which perpetuates conflict and toxicity.

Narcissistic parenting 

In most families, the dysfunction and sibling rivalry lies in the parents and their relationship with their children and how they raised them. “Narcissistic” parents are parents who are unable to accept responsibility for their own failures, shortfalls, feelings, or insecurities. To deflect their own feelings – a sense of shame, guilt, or failure – the individuals who are unconsciously picked in any of the BAP, BAP, or BAD, are simply acting out a family drama.

If the underlying issue is not addressed and communicated openly, thoughtfully, and responsibly, the drama only perpetuates. This hurts everyone else but the people who are responsible which is either one or both parents. Narcissistic parents typically don’t take responsibility for their own failures. Instead, they unconsciously project it onto their children, leading to a lot of conflict and rivalry in the family and between siblings or family members. The sad part is that the people who are in conflict are acting on behalf of everyone else and the root cause is often the family and their lack of dealing with acknowledging their own dysfunction.

How do you move on from an unhealthy family dysfunction?

Open, honest, mature, and respectful communication about family issues that are deemed difficult or risky is central to families moving from unhealthy dysfunction into healthy, nurturing relationships, and cohesiveness. It may mean confronting each other; however, if this is done respectfully, it is likely to lead to growth and meaningful relationships. Avoidance and denial of the issues only perpetuate the dysfunction.

If you are estranged from your family, here are some tips to manage this situation:

1. Create healthy and meaningful relationships with friends and loved ones (not parents or siblings) who you can have mutually nurturing relationships with. This helps you replenish and foster a sense of community and security.
2. Create firm boundaries with family members and be consistent – how far one can go with contact and how they communicate and treat you?
3. Limit contact if it causes you distress – consider blocking on apps if necessary. Protect your peace, you owe yourself that.
4. Remind yourself that you are not responsible for other peoples’ feelings, behaviours and what they think of you. People will always judge no matter what. They have never walked in your shoes.
5. Self-validate – remember you are enough without the family. The toxicity will only weigh you down. You are not responsible for the dysfunction. Your family dysfunction doesn’t define you.
6. Create a routine and find new hobbies where you can expand your social circle. This will make you feel less isolated and foster a sense of belonging and community.
7. Find ways to self-soothe – yoga, mindfulness, sport, and other self-care routines. Do things that enable you to regulate yourself emotionally whenever you are overwhelmed, instead of lashing out at the toxic individuals or others around you. You simply perpetuate the dysfunction of if you lash out.
8. Do things that you enjoy, and that mastery, that gives you a sense of purpose. Meaning is derived from how much we feel integrated, take part, and value in life.
9. Be kind to yourself – therapy helps you heal from this trauma. Remember it’s a family trauma and you just happen to be the victim.
10. If you are that elder who is there to solve everyone’s problems, step back and relinquish that role. Other people have minds of their own and their opinions matter.

References

• Bion, W. R. (1962). Learning from experience. London: Heinemann.
• Klein, M. (1946). Notes on Some Schizoid Mechanisms. International Journal of Psychoanalysis, 27, 99-110.