Repression

It's been a while since I've made time to do one of these essays. I've
been diverted in large part because we've been hard at work on a
redesign of the Mental Help Net website. Though the hard part is over,
there are lots of odds and ends to clean up and it will be a month or
so before we debut the changes. Now that most of the heavy lifting is
done writing should become more regular again.

So far as these essays are concerned, I've been doing a sort of survey
of some of the more important schools of psychotherapy recently,
focusing as I go along on some of the important technical contributions
that each school has made. We left off with a discussion of
Transference, an important contribution of the psychoanalytic, and
later psychodynamic schools of psychotherapy. Today's essay will cover
the topic of Repression, which is a major contribution of the
psychodynamic school.

Repression is a pretty simple idea at root. However, the way in which
repression becomes a psychological construct gets a little convoluted.
I'm therefore going to explain out some details that you might already
know about to try to take us step by step through how it all is
supposed to work.

To repress something means to put down something that wants to
express itself; to make it quiet and contained; to render that thing
harmless and controlled. Repression is necessary a social idea by
nature (meaning it cannot occur in isolation). It describes a conflict
between two or more things. It occurs when one thing puts another down;
it is not present when two things cooperate or find a harmonious way to
co-exist. Further, repression is necessary a sort of aggressive thing.
Repression conveys the idea of the use of force or pressure. It
involves a successful struggle between agendas that are not compatible,
with one agenda winning out over another and enforcing itself in place
of the other on a more or less permanent basis. For repression to
successfully occur, one agenda must have struggled against the other,
only to succumb to the dominant agenda, lose its public voice, and
become submerged and forgotten.

Sounds more like a description of warring nations than a description of
the mind, right? Well – right. Repression concerns struggle,
capitulation and resistance, and those are very much the sorts of
things that waring nations and political factions do to each other.
Before repression was a psychological term, it was a political term.
That the term was drafted to describe mental processes by Dr. Freud as
a core part of his early theory of the mind makes clear the point that
Freud saw the mind as a sort of battle ground where waring forces duked
it out and a metaphorical repression was seen to occur.

If you've ever taken a college class in abnormal psychology you're
probably familiar enough with Freud's early model of the mind to
venture a guess as to what the warring parties contained therein were.
Freud suggested that the mind could be subdivided into three entities:
the ego, the id, and the super-ego. These terms are so familiar today
that they go unquestioned. However, they are essentially Latin words
with specific meanings. In Latin, I am to understand, ego means "I" and
id means "it". The word "super" means "over" or "greater", or "on top
of" (as in "superior"). Thus, the super ego translates to something
like "the on-top-of-I", or more simply, "society". The use of Latin,
then as today, served to translate these relatively simple and
understandable terms into a jargon that makes them sound more special
and complex than they really are. All sorts of professionals do this
sort of thing routinely, then and today, so please don't blame Freud
for trying to make things sound complicated. If he hadn't of done it,
someone else probably would have.

Freud's three mental forces had three different and opposed characters.
The id was characterized as a sort of wellspring of spontaneous,
selfish, passionate, emotional and impolite urges which people innately
desire to satisfy immediately if not sooner: sex, appetite, aggression,
etc. The id was appetite personified; it wanted to be satisfied
immediately and it wasn't concerned with the consequences of its
actions very much.

In direct opposition to the id was the super-ego; a repository for
rules, regulations and guidelines handed down by family, authority,
society and culture. Unlike the id which was instinctually present from
birth, the super-ego was something learned over time during the
developmental process; a permanent memory of all the times parents,
clergy and other authorities told someone how to behave and/or punished
them for bad behavior while coming up. The super-ego is thus
essentially the conscience, always making a person aware of what they
should do; and discounting what they want to do.

The opposed characters of the id and super-ego should now be clear. The
id is about desire, while the super-ego is about restraint and
conformity. The id pulls people in the direction of selfish
satisfaction of animal need, and the super-ego pulls the person in the
opposed direction of self-less denial of individual needs for the
benefit of the "greater good". Where the id is concerned with pleasure,
the super-ego is concerned with morality and being good. Where the id
wants to have candy (e.g., to satisfy its self), the super-ego wants to
be thin (e.g., to satisfy others).

In the middle of this tug-of-war between id and super-ego is the ego
which forms as a means of satisfying the tension between the opposed
forces. Because the ego bridges the demands of the id and the
super-ego, it ends up having characteristics of both sides inherent in
itself.

A wonderful illustration of the ego, in relation to the id and super-ego was provided in the 1978 college comedy movie Animal House.
There is a scene in Animal House where a young fraternity brother is
faced with a decision as to whether to ravish a young woman who has
just passed out in front of him. A little angel and a little devil pop
into existence, one on each of his shoulders and start giving him
advice. The devil tells him to ravish the girl, while the angel tells
him to be a good boy. If we take this scene as an analogy for
id/ego/super-ego, the devil is the id, the boy is the ego and the angel
is the super-ego. When confronted with a tension between what is
desired, and what is morally acceptable, the ego can go either way,
depending on which force (id or super-ego) is better developed in each
individual.

It says something about Freud's character and the society that shaped
his thinking that he referred to id forces as "it" and ego forces as
"I". By doing this, he was essentially identifying himself with the
rational appearing ego and disowning the instinctual animal urges that
all people share. In effect, he was suggesting that the animal urges
were foreign things that were fundamentally separate from the ego – the
self or "I". I've never liked this formulation very much. This sort of
attitude suggests a fear of the animal nature which is unnecessary, and
doesn't help people to take responsibility for their actions too well
either. Sexual and other selfish appetites are very much a part of most
people's definition of self, and for good reason, as they are a
fundamental part of human nature. Self-acceptance of these appetites is
an important part of maturation too. You can't easily grow into a
mature independent adult if you spend your entire life delaying
self-gratification in favor of being "good" all the time. Such a person
is too easy to manipulate and too conforming to be considered adult.
We'll come back to this theme when we deal with humanistic techniques
in another essay. For now, I'll simply point out that Freud's desire to
disown the animal nature was consistent with the larger judeo-christian
moral and cultural environment he was raised within – complete with its
personification of the devil as an animal-like being (e.g., with fur,
horns, hooves and a tail) and of angels as spirit beings of great
morality, rationality and power. This consistency is probably part of
why Freud's theory became as popular as it did. It is also why when the
Animal House writers went looking to put words in their angle and devil
characters' mouths, the angel talked like the super-ego and the devil
like the id.

What does this have to do with repression? A whole lot actually. If the
ego, id and super-ego are the parts of the mind, repression is one of
the main ways that these parts were said to interact. The structures of
the mind are not static or solid, but rather fluid and dynamic. They
are constantly in motion and constantly maneuvering for advantage
throughout each person's life. It is not like the ego develops as means
of managing id and super-ego demands and that is the end of the story.
It is more like the ego is a piece of taffy being pulled back and forth
by competing demands. It changes its shape as the demand landscape
changes from moment to moment.

One of the main ways that the ego changes its shape to accommodate
super-ego and id demands is by changing its degree of awareness. If the
id comes up with a desire that is in conflict with a dictate from the
super-ego, the ego can resolve the tensions that would otherwise be
created by disowning or repressing that desire. Freud thought the ego
accomplished this by refusing to acknowledge and accept that the desire
existed, and by distorting and misinterpreting perceptions and evidence
that might suggest that the desire existed. The desire is not so much
smacked down by force in this way of thinking, as it is ignored until
it goes way. By refusing to acknowledge the existence of a desire, the
ego relegated that desire to the "unconscious"; which was simply the
place where unacknowledged things lived. They don't stop existing just
because they are not looked at, mind you. They just aren't noticed.
Many id-generated desires were thought to be relegated to the
unconscious, as many of those urges were considered shameful or
otherwise unacceptable.

In Freud's way of thinking, repressed id desires are energetic things
that worked tirelessly for their expression. They are not content to
lie there and be ignored. Instead, they continually exerted pressure on
the ego to acknowledge their existence The ego must thus continually
spend energy to keep itself insulated from repressed desires. There are
varying ways that this energy gets expended, but typically, people
either keep themselves busy and distracted so that they don't have to
think about what they don't want to think about, or they make either
impulsiveness or self-control into a fetish and thus protect themselves
from id-desires through excessive devotion to spontaneity or to order.

However valiant they may be, efforts spent on ignoring desires are
often not enough to keep those desires down fully. If repressed desires
cannot find direct expression and acknowledgment, they may find ways of
expressing themselves indirectly, in the form of dreams, undesired
thoughts and feelings, or irresistible compulsions. There may be no
awareness of a particular desire per se, but the body knows what it
wants and the body reacts even when the mind is clueless. A good
example illustrating this principle comes from a study of male
homophobia I read some years ago. Multiple men varying in their
self-reports of tolerance for homosexuality were shown erotic pictures
of men while fitted with a device that measured the width of their
penises (penises get wider as they get erect, so a measure of penile
width is also a measure of sexual arousal). You can probably guess the
result of this study. There was a direct relationship between expressed
intolerance for homosexuality and erections, with men who were most
intolerant having the largest erections in response to the erotic
pictures. There are several ways you can interpret this result, but one
way is to assume that the intolerant men "protested too much" (to riff
on Shakespeare) as a means of pushing down or repressing their shameful
actual attraction to male erotica.

Repression in Psychotherapy

Repression is a significant technical contribution to psychotherapy,
not because it is a technique in of itself for manipulating people, but
rather because it offers a framework for understanding how certain
types of psychological problems occur, a set of guidelines for making
sense of a therapy patient's behavior, and an abstract therapy goal
towards which to work. Freud thought that many forms of psychopathology
(that's a fancy term for "mental illness") were caused by repression.
For example, the whole spectrum of "neurotic" (mild) mental problems
(e.g., anxiety, hysterical dissociation, depression) were thought to be
due to repression gone awry. For instance, depression might be caused
due to unacceptable feelings of anger felt towards a spouse or a parent
that were not allowed to be expressed but which nevertheless leaked out
and colored the patient's experience. The original basic cure was
therefore to analyze the patient's mental process so as to understand
what was being repressed in the first place, and then to interpret that
repressed material back to the patient so as to make the patient become
aware of the repressed material. By making the unconscious conscious,
the patient would have to actually come to terms with the conflict
rather than avoiding it, which ought to remove or reduce the illness
itself. Freud was about half right in this assumption.

So far as I am aware (and while I am an expert, I don't hold myself out
as an expert's expert), uncovering repressed desires and making them
conscious can have a therapeutic effect – for some people with
particular kinds of problems. For other people, the various methods
psychoanalytic therapists might use to uncover patient's repressed
desires won't help, or might even make things worse.

Consider these factors. First, not all problems are caused by
intrapsychic conflicts and repression. Emotions like shame and guilt
are, but other emotional problems may not be. Some instances of
depression and anxiety may be caused by physical issues having nothing
to do with repression. Secondly, successful analysis of repression
depends heavily on patients having good language skills and a capacity
for self-examination. To the extent that patients aren't much for
language, or are extremely impulsive, they are not going to be good
candidates for an "insight therapy". Third, insight therapies like this
sort of analysis of repression are inherently passive in nature. The
best a therapist can hope for when analyzing a patient's repressions
back to them (assuming that is all they do) is that the patient will
become more aware of their conflicts. Mere awareness will not teach
patients how to cope with those conflicts in a better way than
repressing them, however. Patients who don't know better ways of coping
with their conflicts might actually get worse when those conflicts are
rubbed in their faces if further steps are not taken to teach
alternative coping methods.

When you add these factors up, what you find is that a therapy based on
analysis of repression is going to be best suited for use in helping
people who are already quite capable and resourceful but who are
nevertheless stuck or hung up in some manner due to internal conflicts
that are keeping them from being happy. The classic conflict where
analysis of repression will be useful is one between desire and duty,
and the classic patient will be one who has been choosing duty over
desire for a long time and it just isn't working out for them, perhaps
resulting in mild depression or anxiety. The analysis of repression
will be useful to bright people stuck in developmental crises that
inhibit them. It may prove useless or even harmful to less verbal
people, or to people who have biologically driven mental illnesses
(such as bipolar disorder or schizophrenia), serious debilitating forms
of anxiety or depression (where insight will not be enough to effect a
cure), trauma-based disorders (where uncovering of conflicts might
trigger some sort of re-traumatization if done carelessly) and
under-controlled emotion conditions such as an anger problem. In the
latter instances, a more active approach to therapy that takes care to
teach alternative means of coping, and/or provides medical
intervention, perhaps in combination with the insight approach, would
be wiser choices. Get a better understanding of your mental health with our anxiety test.

I should mention that the original version of psychoanalysis as
conceived by Freud and partially described above is largely a
historical relic today so far as I can tell. Hugely influential, the
therapy has been reworked and reinterpreted countless numbers of times
so as to emphasize the insights of new thinkers and to respond to the
changing needs of the therapy environment. My incomplete understanding
of modern psychoanalytic theories (there are several) suggests to me
that repression is not as prominent an idea anymore as it used to be.
Modern practitioners seem more concerned with analysis of patients'
social relationships and "object relations" (e.g., transference) than
with intrapsychic battles between id and ego. Repression is still an
important and critical idea, but it doesn't seem to be the center of
attention within psychodynamic circles these days.

Other Understanding of Repression

I've framed repression in psychodynamic and psychoanalytic terms in
this essay thus far, mostly because those folks invented the concept
and made it prominent, and also because it is my desire here today to
talk about psychodynamic technical contributions to therapy. I don't
want to let the essay end, however, without pointing out that other
schools have also dealt fairly extensively with the idea of repression,
and that the whole concept has been enriched by this cross-pollination.
For example, there is a whole non-psychodynamic literature concerning
coping styles that has extensively examined repression. Within this
literature, repression is thought of as part of a coping spectrum
called "repression-sensitization". Everyone can be placed somewhere on
this spectrum, either towards the repression side of things, towards
the sensitization side, or somewhere in the middle.

In this "repression-sensitization" literature, repression is regarded
as a strategy that some people use for coping with disturbing,
stressful information. This is a trait-like strategy, meaning that it
is a habitual style that people become dependent upon and use
preferentially over other possible coping strategies. People who employ
a repressive coping strategy basically react to disturbing information
by employing denial, avoidance and a carefully honed failure to pay
attention. They might avoid conversations that convey disturbing news,
or prefer to maintain uncomfortable silences even when a confrontation
might clear the air. They make extensive use of distraction as a means
of coping; if they are worried about something they'll go do something
else to occupy their minds. Their motto is "It's not happening", and
their basic assumption about danger is that what they don't know won't
hurt them.

The polar opposite coping method to repression is called sensitization
Where repressors avoid learning disturbing news, sensitizers go the
opposite direction and seek out more disturbing news until they know
everything. It's not that sensitizers don't find the news disturbing
(they do); rather, it has to do with their basic assumption towards
danger, which is that the more they know about dangers, the better they
can navigate them so as to minimize damage to themselves and those they
love. Sensitizers seek out as much information as they can in an
attempt to keep themselves more informed, and thus more in control and
ultimately safer. Just as repressors go overboard in the avoidance
department, sensitizers frequently go overboard in the worry
department. They tend to play "what if" games to try to figure out what
might happen in every possible circumstance. Their basic motto is
"information is power". They will pursue this motto even when the
consequence to them is information overload and a whole lot of
unnecessary worry and strain.

Research examining the repression-sensitization coping spectrum
suggests that repression may be best thought of as a mild variety of
dissociation; that same mental process that is responsible for some
forms of amnesia and for multiple personality disorder, and for the
phenomena of hypnotism. Dissociation occurs when some mental contents
become cut off from the main stream of consciousness and hang out in a
kind of bubbled off existence For instance, dissociation can occur
during a traumatic event. When this occurs, the trauma victim finds
himself spaced out and kind of not in reality, even while the trauma
event continues to unfold. A rape victim might find herself watching
herself getting raped as though it was a movie, for example. Trauma
dissociations can sometimes become "repressed memories", meaning that
they get avoided so aggressively and for so long that they are
successfully forgotten. This kind of thing sometimes happens to abuse
victims and also to combat veterans. Repressed or dissociated memories
are not so much put into a special place called the "unconscious" as
they become so strongly avoided that the entryways to those memories
get forgotten (or are quickly and automatically diverted to safer
thoughts through a distraction mechanism). Since nothing is allowed to
bring those memories to mind, they appear to cease to exist. They don't
really cease to exist, however. Sometimes they reappear unbidden after
years of disuse. I recall one case where a combat veteran reported that
after many years of normal existence he one day walked into a store and
was triggered into remembrance of a dissociated trauma memory when a
clerk's last name (on his name badge) was the same as the last name of
the officer who had run his combat unit. That officer had apparently
been blown into bits in front of my patient. Once the bridge back to
the old memory was reestablished, the memory came back vividly, making
his life very difficult, and leading to his diagnosis with
Posttraumatic Stress Disorder (PTSD).

That repression is likely a mild form of dissociation casts light on
the ways that psychologically traumatized patients (with PTSD) are
treated. Trauma memories involve death and dismemberment, horrible
abuse or violation, torture, and similar intense and horrible
occurences. Trauma memories are avoided and pushed out of consciousness
as best as possible because they are truly too horrible and too intense
for a given patient to digest and process. The path of 'repression'
(e.g., avoidance) is chosen for dealing with trauma memories because
there are no other alternatives for such patients in their naive state;
they would otherwise be in a near-constant state of anxiety if they
didn't try to push this stuff away. Breaking down the power of trauma
memories is the goal of any therapy for traumatized people. This is
typically accomplished in multiple ways, but all of those ways attempt
to accomplish the goal of therapeutic "titration", which is a fancy way
of saying that you want to simultaneously gently push patients to
address their trauma memories and thereby process and digest them when
those memories can be tolerated, and also help them to avoid and dampen
those memories when they become overwhelming. Dampening is accomplished
with medication, by teaching self-soothing and relaxation techniques,
and through supportive psychotherapy that addresses problems in living
unrelated to trauma. The pushing to address and process trauma memories
is accomplished by providing a safe environment, either individually or
in a group setting, where trauma memories can be discussed. This latter
task is not exactly like the sort of analysis of repression
intervention that a psychodynamic therapist might provide a client, but
both interventions similarly seek to help patients make their
unconscious avoided material conscious again. I think that is worth
noting.

My Personal Research Story About Repression

I said above that some research suggested that habitual repression was
likely a mild form of dissociation, but I didn't describe what that
evidence looked like. It looks something like this. In the early years
of repressor-sensitizer study, a particular questionnaire was used to
identify who was a repressor and who was a sensitizer. A large body of
research was conducted, and then all called into question, when the
validity of that questionnaire was itself questioned. It seemed that
the questionnaire was measuring how willing people were to describe
themselves as anxious, and not measuring repression per se. There ought
to have been a way to differentiate people who were truly low in
anxiety from repressors, who should be people who were dealing with
some emotional arousal by denying the basis for that arousal. The old
questionnaire couldn't make that distinction, however, so a new means
of measuring repression needed to be developed.

The new means that ultimately was developed took this form. A group of
researchers was able to differentiate a group of truly low anxious
people from repressors through the use of two separate questionnaires,
one asking people to rate how anxious they are, and the other a measure
of how rigidly they followed social conventions and rules (e.g., such
as "if you found a wallet with money in it, would you return it to the
owner without taking any money out of that wallet first?"). The
questions this test contained were all geared to be things people were
supposed to do but often didn't do in practice. This latter
questionnaire was called a measure of people's degree of "social
desirability" but it actually seemed to measure a kind of defensiveness
and desire to conform and be seen as a moral person.

While both repressors and truly low anxious people described themselves
as low anxious on the anxiousness questionnaire, the repressors scored
very highly on the social desirability questionnaire, while the truly
low anxious group did not. Here is the kicker. In addition to giving
these folks questionnaires, the researchers also hooked them up to
machines that measured their heart rate and skin conductance. Heart
rate and skin conductance are measures of body arousal that cannot be
consciously controlled (by most people). These body measures tend to go
up when you are anxious whether you want to hide the fact that you are
anxious or not. While the truly low anxious group didn't show much in
the way of body arousal, the repressor group did become aroused. The
interesting finding was the discrepancy (or dissociation) between the
repressors' verbal denial of anxiety in the face of their volatile body
arousal measurements. The repressors were either lying about being
anxious or they were really not paying attention to what their bodies
were doing. Long story short, further research studies seemed to
suggest that as a group the repressors were not lying, but rather
really were just not very much in tune with what their bodies were
doing. Like they weren't paying attention to their inner sensations and
feelings much at all.

I became fascinated with this whole line of research as a young
psychology student and assistant professor back in the 90s and made
some attempts to add to the literature before getting frustrated and
going on to a new career. Here is more or less what I came up with:

The method for differentiating repressors from truly low anxious people
that I described above required the administration of two
questionnaires, one about anxiety and one about social desirability,
and using the scores on these tests to differentiate the groups. The
method basically created four groups of people based on high and low
scores which looked something like this table just below:

As you can see, those folks who produced high anxiety scores, but low
social desirability or defensive scores were considered to be truly
high anxious people, those folks who scored low on both questionnaires
were considered to be truly low anxious people, and those who scored
low on the anxiety test and high on the social desirability test were
considered to be repressors. Then there was this tricky group who were
supposed to score high on both tests. I say that they were a tricky
group because you'd never notice that they didn't really exist if you
didn't try to give these tests and identify a group of these people,
but the long and short of it was that you could never really identify a
group of these people try as you might. They didn't exist in reality;
they were just implied by the table you see above. The table above
implies that there is no relationship between measures of anxiety and
social desirability, but there actually is. If you are defensive enough
to score high on the measure of social desirability, you are very much
unlikely to identify yourself as a highly anxious person. Apparently,
it just isn't cool to be anxious (duh!).

There had to be a better way to think about who was a repressor and who
wasn't a repressor than this misleading table. My proposal for a better
way looked like an inverted triangle rather than a square table. Think
about this: If you are a low anxious person by nature (by genetic
inborn temperament), you really don't ever get motivated to develop a
way of coping with stressful events, because you are naturally prone to
let them roll off your back. Low anxious people (people who personality
psychologists refer to as being low in the trait called "Neuroticism")
just don't get aroused easily. Naturally high anxious people (high in
Neuroticism), on the other hand, are easily aroused and prone to
anxiety and depression. Such folk are very reactive to bad news, and
would tend to figure out a way to cope with stress so as to minimize
their discomfort. What shape would those stress coping methods take?
Why, none other than the repression-sensitization spectrum of coping
methods we talked about above. Some would become repressors while
others would go the sensitization route. The natural triangular shape
that emerges from this more naturalistic view of the repression
phenomenon avoids the problem of having to account for the "Tricky
Group" entirely.

I had a set of fancy tests set up designed to help me demonstrate that
my triangle model fit the phenomenon better than the square model, but
alas, while designing experiments was always quite fun for me, I wasn't
the best person for writing them up and my data tended to come out
squigly. By the time my experiments had born (partial, inconclusive)
fruit, however, I had already decided that I no longer wanted an
academic career. I was pretty sure my triangular model idea was right,
but the whole enterprise no longer seemed worthwhile enough to bring to
a conclusion. I went off to the next phase of my life and left that
research behind, unpublished and probably unpublishable. I was
heartened some years later, however, when my friend from graduate
school (who is still a professor) told me that he encountered some
researchers at a conference who were (a decade later) coming to more or
less the same conclusion based on their own studies that I had come up
with years before. I don't know who these researchers were or where
they published their work (if they ever did), but knowing that I
probably was on the right track way back when made me feel good just
the same.