Psychological.....

Mental illness does not grow by the same physical mechanisms as cancer, but it often does spread into new areas when left untreated. We see this in its simple form with a phobia.

Most phobias are unconscious attempts to contain and redirect the anxiety that we feel about something in our life that feels far more realistically dangerous than the phobia.

Let me give you an example to show how this works.

Example—Sherry and her fear of crossing bridges

Sherry lives in New Jersey and I practice psychotherapy in New York City. To get to my office, Sherry drives across the George Washington Bridge. Sherry is an excellent driver.

Sherry entered therapy because she has been married for five years to Jerry, a verbally abusive and controlling man ten years her senior. Sherry knew Jerry was controlling, but in the beginning of the relationship she found this appealing.

Sherry’s father had died when she was a toddler, and she used Jerry as a father substitute. She didn’t mind being told what to do because she saw that as a form of being parented—-something she had longed for from a man. But when Jerry turned nasty and devaluing, she began to rethink the relationship. When Jerry threatened to smack her in the middle of a fight and threw a mug of coffee at her, that was the last straw for Sherry.

• Sherry was afraid to be alone

When Jerry refused to go to couple counseling, Sherry came to therapy to find the strength to leave him. We began to work on her early abandonment issues and her fears about not being able to cope with life without a man to “protect” her.

• Sherry develops a phobia

Just when Sherry had gotten to the point of hiring a divorce lawyer and telling Jerry that she was leaving, she suddenly developed a phobia about driving over bridges when she was alone in her car. She felt highly anxious and started having panic attacks when she tried to drive cross the George Washington Bridge.

Of course, her real panic was about leaving Jerry. All her anxiety about that was now hidden in the form of a bridge phobia. I suggested that we stop to work on her bridge phobia, but Sherry did not see it as important. After all, she reasoned, there were other routes she could take to my office.

• Sherry’s phobia spreads to tunnels

So, the next time Sherry came to my office, she drove miles out of her way to avoid having to cross the bridge. She used the Lincoln Tunnel instead. This worked for a few sessions, but soon Sherry’s anxiety spread to tunnels as well.

I was not surprised by this because I knew from the start that her fear was about leaving Jerry, not bridges or tunnels. Her panic attacks were real, although they were misdirected and attached to an emotionally safer target than leaving Jerry.

• Sherry still wants to leave Jerry

I explained my view of what was going on and the real fears about abandonment that her bridge and tunnel fears were masking. She agreed this made sense, and Sherry expressed her determination to continue with her plans to leave Jerry.

• Sherry develops agoraphobia

Unfortunately, part of Sherry was determined to sabotage her plan to leave. Her inner child did not want to leave her “Daddy Jerry.” Adult Sherry no longer wanted to stay with her husband, but her inner needy child part was even more determined to stay.

When we worked in therapy on this conflict and started to make progress again, Sherry suddenly developed agorophobia and got panicky at the idea of leaving her house by herself.

This left her more dependent on Jerry than ever. Now she would not leave her house without him. When she was with him, her anxiety diminished. This diminishment of her anxiety when she stayed close to Jerry confirmed that the real basis for her panic attacks was her fear of leaving him.

• Phobias generalize

When you start letting phobias stop you from doing what you want and try to work around them, your life starts to get smaller. Unfortunately, the phobia gets larger and spreads out to things that metaphorically connect to it.

It went from the George Washington Bridge to all bridges and tunnels. By analogy, it spread to all things that connected two different places. Sherry also became afraid to take subways, elevators, and escalators. Then Sherry could not leave her house without her husband.

• Phone Sessions

At this point, Sherry could only come to therapy if her husband Jerry drove her or we did phone sessions. Her fears about leaving Jerry had ironically tied her even closer to him.

I suggested that she needed to work on her phobias and reclaim her ability to drive, cross bridges, take elevators, etc. it was also obvious that she had to do more work on her fears about having to take care of herself by herself.

What had started out as a seemingly simple therapy, now showed its complex and deep seated origins. Its symptoms were spreading out like kudzu vines from one central deep wound—the loss of Sherry’s father at an early age and its psychological repercussions.

Ultimately, for the therapy to succeed, Sherry needed to temporarily shelve her plan to leave her husband and focus on this early trauma.

Punchline: There is a different underlying mechanism between the spread of cancer and the spread of mental illness. But…like invasive cancers, many mental illnesses will expand and take over more and more of your life, if you try and accommodate them instead of successfully addressing their source.

Elinor Greenberg, PhD, CGP