“What you choose to forget, comes back in disguise.”

Freud’s Psychoanalytic theory and the field of Health Psychology have one thing in common – Both approaches seek to help individuals, ‘feel better’. We typically associated Health Psychology and Behavioural Medicine within the context of cognition and behaviour. However, there is extreme power found in gaining insight and our ability to connect our lived experience with current health outcomes.

In today’s episode, we provide an overview of the Psychodynamic approach in the context of trauma, with an analysis on the resulting cognitive and behavioural impact on health. While the line between trauma and health outcomes is not clear upon first glance, gaining an understanding of their relationship has the potential to significantly improve wellness.

Welcome to Episode 59: Psychodynamics and Psychoanalysis – Relevance in Health Psychology

1. What We Do:
   
   • Behavioural Medicine and Health Psychology
     
   • Providing easily accessible content designed to help you design your own transformative experience.
     
   
   
2. Today:
   
   • A review of Psychodynamics and Psychoanalysis and relevance in the field of Health Psychology.
     
   
   
3. Services Review:
   
   • Finding My Psych offers three core services focused on promoting physical, emotional, and spiritual wellness.
     
     • Foundations: Wellness Planning Workshop
       
     • Walking For Vitality: Powering Up
       
     • Running For Fitness: 5k Build-Up
       
     
     
   
   

What Is Psychoanalysis an Psychodynamics?

1. Psychoanalysis is a Psychological theory by Signumd Freud (1856-1939) to explain human behaviour.
   
   • Popular Psychodynamic practitioners you may know: Carl Yung and Erik Erikson.
     
   • The Basics: Id, Ego, and Superego – The Ego battling with three forces: The Id, the Superego, and the outside world.
     
   • Psychic energy moving through the system until catharsis.
     
   • Mechanisms and Ego Protection:
     
     • Sublimation (appropriate release)
       
     • Repression (unconscious purposeful forgetting)
       
     • Denial (conscious refusal to admit)
       
     • Rationalization (explain away)
       
     
     
   • Insight driven therapy designed to explore the impact of emotions, thoughts, early-life experience and beliefs on adult behaviour.
     
   • Nutshell: “What you choose to forget comes back in disguise.”
     
   
   

Relevance in Health Psychology and Behavioural Medicine

1. Behavioural Medicine is Additive:
   
   • Historical Trauma – Building Confidence through Awareness then Action:
     
     • Intent in exploring trauma is too, “feel better.”
       
       • The first step is to acknowledge the trauma and see how it shows itself today.
         
       • Feeling better starts via, “doing” (e.g. running for fitness) regardless of trauma.
         
       • Doing intensive physical activity leads to confidence. “I am stronger than I think.”
         
       • Trauma history is unchanged, but cognition becomes untangled from history.
         
       
       
     
     
   
   
2. Insights Connection to Cognition:
   
   • Insight is the act of connecting experiences, resulting in awareness.
     
   • Insight on self-hate from sexual trauma and weight management:
     
     • Realization that self-hate (sexual trauma) impacts body image (regardless of reality).
       
     • Secondary realization that self-hate manifests as depressed mood – Low mood equals negative self-talk.
       
     • What I think, I become and do! – “I can’t do” —> Don’t start —> negative health outcomes.
       
     
     
   
   
3. Persistent Emotional Pain and Illness:
   
   • Unmanaged grief leads to chronic anxiety, and thus negative health outcomes (anxiety is a killer).
     
   
   

0:10
Hello and welcome. This is your host Jerod Killick of the Finding My Psych Podcast. We are so glad that you have joined us today. If this is the first time that you have are checking out our show, we are all things Behavioural Medicine and Health Psychology, we are really focused on providing you the tools you need to design and implement your transformation focused journey.

Today is no exception. We are actually going to do an episode today based on popular request on psychodynamic psychoanalysis, specifically by Sigmund Freud and how it relates to health outcome and health psychology. Then therefore, I think at initial glance, we might not think that there’s much of a relationship that Behavioural Medicine and Health Psychology as they are driven mostly by theories in cognition and behavioural psychology. But actually, it turns out that our history, potentially our trauma history, or intergenerational trauma, and that kind of stuff that we’re carrying along with us on our back like a massive anvil, actually can have health outcomes. And while initially, it might not look like that link is super clear, I’m hoping today to provide some insights around how those two things can be related.

And so before I jump into all of that, let me just spend a little bit of time talking about our three core services that we offer at Finding My Psych. If you jump onto our website, at https://findingmypsych.com/services/, you will find three core services. The first one is really designed to provide you the skills you need to start your journey and runs for four sessions. We cover a theory called the CHANGES model, a bio-psycho-social model for change. And that workshop is called the Foundations: Wellness Planning Workshop.

The other two are very fitness oriented, because we recognize that being a, ‘getting things done‘, getting out there and being a physically active kind of person, actually has very positive health outcomes. And so we have two. One is called Walking For Vitality: Powering Up. This is for anyone who’s just getting started on their physical fitness journey. And the last one, which does run about three times longer, is called Running For Fitness. It runs 12 weeks and is our version of the popular couch to 5k program. We are very excited about these services, they are free, they are cohort services.

So look at the one that fits for you that’s offered. And we take a maximum of 10 in each cohort. And then you go along with those 10 people for however many weeks the program run. Foundations, our wellness planning workshop is four weeks as is Walking For Vitality. And then of course running for fitness is 12 weeks. We’re very excited about this and it is free. It will remain free as long as we can possibly get away with that. There are of course costs incurred. We don’t ask for donations, we don’t run ads, at least none of that at this point. Because again, this is working for us. And I think we can float that cost for now and in the future. If that changes, you know, we’ll find ways that aren’t obtrusive, you know, to help support our efforts.

We are running cohorts right now. And we are extremely satisfied. We’re learning along the way about what works and doesn’t work for the cohorts and how we deliver the information. And this is a very exciting process for us. So if there’s anything that I get out of it, it’s really just connecting with others. And yeah, having a project that is very fulfilling for me, and we hope that’s fulfilling to those who participate.

Okay, so it’s time to get into the meat of this. Today’s topic can be a bit too academic, but I guess I’m just going to run with that, because I have a sense that this is material that people can really relate to. There are show notes for you to be able to follow along with and so I strongly encourage you to run to findingmypsych.com to follow along – This particular episode is number 59.

4:46
And just to be able to get your head around each of the steps, I’ve bulleted out everything I’ll be talking about and I will try to stay on task with that and not go down too many kind of rabbit holes but You know, psychodynamics is, it’s a very interesting kind of approach. And if you think about our history in psychology, Freud was essentially the first and the first person to really focus on the individual and their needs, in an effort to promote well being. And while, of course, you know, already walking into this, is a lot of challenges around the theory historically, kind of embedded in sexism, and sexualizing people in his explanations.

5:48
As uncomfortable as all of that is, there is so much amazing material that comes out of psychodynamics. Psychodynamics, just so that you know, is a general term for all people that practice in this particular genre. One that you may know will be Karl Jung. Erik Erikson is another one. And so, again, it started with Freud. He really needs to be given credit for being our first true therapist, as offensive as some of the parts of his particular approach may be. Many of his followers and students such as Carl Jung, took what he did, and really branched off and cleaned up some of the peculiar stuff in Freud’s original approach.

So Freud was born in 1856, and died in 1939. He was a neurologist. Sometimes people try to call him a psychiatrist, or a psychologist. Those fields did not exist at that time. And he was very interested in development. So from birth, as people move through various stages of development, you know, how did they present and children went through various stages, one being an oral stage as an example, one being a phallic stage, etc. And so he just believed and understood actually, that there are sensitive zones during certain periods of one’s physical development. And one of those, of course, would be an oral stage, which is the first. And this is where there’s excess extensive sensitivity around an infant’s mouth. And of course, that is there to promote and stimulate breastfeeding. So Freud was very hung up on these particular neurological realities, but how they related to, for instance, how a mother breastfed, and he would explain various disorders on how your mother breastfed you; this is where it gets very, of course, controversial.

So I encourage you, that when you look at Freud, completely leave all of that stuff behind. Leave his stages of development behind. If you’re really interested in a good application of psychodynamics and stages, kind of look at Erik Erikson, who was truly the master at this and refined it and made it less offensive. But the basics in psychodynamic practice, came, comes in, the form of you developing an understanding of the Id, Ego and Superego. And if we were in a classroom and I was up on a board, I would draw kind of this egg shaped image for you to be able to see kind of where the Ego and superego sit.

And so Freud believed that all of us have, you know, psychic energy that is moving through us and moving through our consciousness and subconscious, which is something that’s out of our awareness. And that as that energy moves, it is being battled for across these three pieces. This is where the term dynamics comes from. So there is the Id, Ego and Superego. I’ll break them down like this. I will keep it simple, I promise.

So the most basic need and the one that’s kind of the most powerful when you are first born is the Id. This is primarily a subconscious need. So it’s out of your awareness. It’s the most basic needs, a kind of fixation on, for instance, again, the mouth to breast, promoting your drive to eat. As you get older, of course, these other drives might be sex. So your Id can be thought of as a very unsophisticated basic human drive, like eating instinct for instance. And that if not kept in check, of course, you would, it would run rampant and you wouldn’t be a functioning adults. So if you only live with an Id, the only things you’d be trying to achieve in life are these basic base needs.

10:27
The other side of that, or the opposite is what Freud called the superego. So the superego is a very interesting component. And I like to think of the superego, which sits mostly in consciousness somewhat in the subconscious. And the superego is really kind of the parent of all of it, pointing its finger down at you saying you shouldn’t. So if you’re, for instance, your need is food, right? You could steal that food or you could purchase that food. So the morally right thing to do is to purchase, say, a loaf of bread, as an example, the Id is saying, “Grab that baguette and run,” the superego is saying, “No!”

So what that leaves us with then is the Ego. What is the purpose of the Ego? This is where things get a little bit complicated. So the Ego, its role is to literally try to satisfy the needs of the Id, these kind of base, organic animalistic needs, with the demands of the Superego. And you can think of the Superego as the societal framework that sits around the individual. The Ego, I always like to say, is a bit of a sociopath, because the whole thing with the Ego the Id’s desires. It is about getting the base needs met, while following the rules, no matter how, right or wrong, whatever the person’s need is. And so unfortunately, what happens, I’ve heard other people say, in lectures, you know, the, the Ego and the Superego are extremely separated from each other. And that the Ego is a separate entity that’s just trying to do battle with the Id. It’s actually not, it’s actually trying to satisfy the desires of the Id, but again, without getting busted, so to speak.

So this is Freud’s basic crux, and he, you know, believed that, again, there’s this kind of psychic energy that moves through our system, that the only way to get rid of that energy is through some kind of cathartic event. And that this energy expressed these base needs. The Ego gets beat up on a lot, right? It’s got two masters so to speak, one that it’s trying to satisfy. And so, we develop over time, these protective mechanisms and these mechanisms come in the form of defense mechanisms, literally. And they come in the form of tools that the Ego uses to help the system survive.

So I do have four examples and there are many more. I would do a Wikipedia search for psychoanalysis and you will be able to definitely find this. But um, one of the ones that I like the most, even though it’s probably the least spoken about is sublimation. Think of sublimation as the Egos attempt to provide an appropriate release of base needs, typically sexual. An example of sublimation might be working out.

So it was thought back in the day, that during the Victorian era that Freud lived in, is that if you participated in sports, and boys in particular, it was a way of controlling sexual energy. This is a perfect example of a Freud’s obsession with sex, which is, again, just a bit bizarre, but somewhat based in neurology. But it’s certainly a sign of those times in the Victorian era. No doubt. And so the whole idea is that you replace the physical activity, you know, with the thing that could get you into trouble. This is very common. Sublimation could be identified in all kinds of areas of our life, if we actually pay attention to it.

The other one that gets talked about actually a lot is repression. And not to be confused with the denial, which I’ll talk about here in a little bit. So repression is an unconscious, purposeful forgetting, of something. So when you repress something, it can sit in consciousness initially, but there’s a mechanism that scoops that painful set of thoughts or occurrences that happened, and represses it into the subconscious, quite out of your awareness. You literally don’t choose to do this. It just kind of happens because of the extent of the traumatic event that may be focused on here. And that gets into the subconscious. Now, when it sits there. Again, it’s energy, it’s got to move, something’s got to happen. And so we will be connecting those dots a little bit about how that energy works. So when you repress something, something’s gonna happen there in your subconscious. And so, repression, again, is the unconscious purposeful forgetting of typically traumatic observations or traumatic experiences.

The one that’s a conscious refusal to admit something would be denial. And so we see denial all over the place, right? So denial is just like, “Hey, nope, that really didn’t happen.” You know, it happened, whatever the thing is that you’re doing – Maybe you got caught drinking, when you’re not supposed to be drinking. It is a conscious refusal to admit what you did or a refusal to admit that you have a challenge with it. So again, if we use the drinking example, you hear the term denial used all the time, denial here being you know, “I don’t have a drinking problem,” when there’s evidence that you’ve been checked into hospitals with acute pancreatitis, you know that you got a jaundice look. And so, denial is not connecting the physical consequences of drinking with reality of drinking. And so I don’t have a problem.

This one is extremely common, and the language really does come from the field of psychodynamics. Not to be confused with repression, which again is subconscious purposeful forgetting of traumatic material. We could do a lecture on just defense mechanisms. But the last one is rationalization. And rationalization is extremely straightforward.

17:44
Rationalization can be something like, “Yeah, they made me angry, and I yelled at them. They pushed me over the edge.” That’s rationalization, not taking responsibility for your actions and the consequences.

All right, um, the whole crux of Freud’s theory, is again an understanding that energy moves throughout our consciousness and our subconsciousness, things get repressed, things get pushed out of awareness, things somehow come up from the subconscious into awareness, all through the powers of the Ego and the superego. And the whole point of psychoanalysis is an insight driven therapy with questions that explore history. It’s designed to explore the impact of our emotions, our thoughts and our early life experiences, and beliefs on our adult behaviour.

In a nutshell, I’ve got a bit of a better expression for you that I want you to really think about. I mean, I’ve studied this material for many, many years. And I remember tripping on to a book, I think, was called, The Knowledge of Water.” It’s not the most memorable book, but it was about the Victorian era. There was one line in there that I’ve just hung onto, because it’s exactly psychodynamics in its best form, and something that we can relate to. So in a nutshell, in that book, the quote that I use all the time, is, “What we choose to forget comes back in disguise.” And so since it is psychic energy that’s moving around, there are things that we forget whether it call be repression, whether it be denial, or whatever, that energy being repressed must show itself. And that coming back in disguise typically is physical symptoms.

In Freud’s time, he call it hysteria. So people that would kind of go limp or have kind of bizarre and physical presentations. neuroses was a kind of kind of the overall expression that encapsulates it hysteria. And so what you choose to forget comes back in disguise, it could be headaches, it could be stomach pain, it could be migraines, it could be all these physical symptoms, Freud would try to see if any of them connected to kind of dynamic in Ego, Superego, using tools and defense, the defense mechanisms to promote, you know, intra-psychic challenges, that show itself come back in disguise, as headaches, or whatever. I think to me, again, that is psychodynamics in an absolute nutshell.

So, I guess now the question is, is how does this theory that goes back, you know, well over, you know, many, many decades, relate to health psychology, what does insight have anything to do with improved health and awareness. And I’m just going to walk through three kind of ideas, I want to just acknowledge right up front, that these ideas are abstract in nature. And again, go back to the show notes, and just really spend some time thinking about this.

21:13
This is not a discussion on how, say psychodynamics and health psychology are similar, but that how more so how our history definitely has a grip on how we feel today. And all of that manifests manifests itself in various health outcomes, I guess, going back to this idea of what we choose to forget comes back in disguise. So I guess the first thing I would say then, is that behavioral medicine, the field of Behavioral Medicine, and health psychology is very additive. And by the way, when I say Health Psychology and Behavioral Medicine, and I am using them interchangeably, they they are different in the sense that health psychology is more about kind of the systems and the general profession, professions that, you know, promote health and awareness, like public health, behavioral medicine is much more about the actual practice. And so I do use them interchangeably.

So my apologies if that that does create confusion, but I do see health psychology and behavioural medicine as being additive in nature. So if we take someone with a historical trauma, you know, we can build confidence through awareness and action. And the whole, the whole idea here is that both, you know, psychodynamics, and health psychology have the intent of an individual feeling better. So whether that you know, that feeling better is due to emotions, or due to the consequences of physical activity, or whatever it really is, the ultimate goal here is being more functional, feeling better is the very start of that.

The first step here would be then on with just acknowledging the additive nature of behavioural medicine and health psychology is that we have to acknowledge the trauma that’s happened, and see how it shows itself in our day to day life. That is insight building that is spending time probably with a therapist or journaling or whatever, really trying to look at what is the impact of your sexual trauma as an example, to your thoughts, feelings and behavior today. But what I think, where Behavioural Medicine kind of steps in here, to maybe change the course is that insight is sufficient, but is necessary but not sufficient.

Insight truly is necessary for being able to move forward in a wholesome way, but it’s not sufficient. So for instance, picking up an activity like you know, running as an example, regardless of your trauma, so if there’s any expectation that you will solve the impacts of your trauma today, and then therefore, you can kind of do other things like, you know, running or eating better, I would say you’ve got it backwards.

Basically, what we promote here s that all things start by doing. You really do need to do the work concurrently, or after you get going on making some pretty regular changes in your life regardless of the trauma. That is the most important thing here. Doing intensive physical activity definitely leads to confidence. And partly what you’re doing here is helping the individual really understand that they are stronger than they think.

The challenge with trauma is that it can lead us to believe that you’re defined by it, that you can’t do anything because of it. And it becomes, it can become, for people, the singular focus and the singular way of explaining all things about yourself. And what I’m really trying to say here is that there are many parts of yourself that you can cultivate. So while you’re doing that insight building, trying to look at the impact, you know, of your trauma on your day-to-day and your health, it does require you to actually get out there and try to build something else as a separate bucket. That’s compartmentalize that could be, you know, really seen as that thing that’s a positive builder for yourself, you will start to think that, “I am stronger than I think, right?” Again, your trauma can be a tricky devil,
and lead you to thinking that you aren’t strong. And until you feel better about the trauma, you can’t do anything, you can’t focus on any other parts of your life, you can’t develop your career, etc. It’s just simply not true. It is concurrent.

Our trauma history is static, its history, it’s done. But our cognition, in specific, becomes untangled from our history, when we try to build other parts of our lives independent of our trauma, I now want to just go to the second point, and take some time to make a connection to how our lack of insight or insight is a contributor to our cognition one way or the other. And so, I guess, again, we can think of, you know, insight as the act of connecting, say, two different experiences at minimum, and just connecting those two kind of experiences, builds awareness, and so.

For instance, it could be brainstorming an idea here real quickly, it could be that your relationship with your father always felt strained, because he rarely asked you how you were actually doing emotionally or whatever in life. And then you realize that the trauma that you experienced, your dad, of course, was not the perpetrator of that trauma, but was very aware of the trauma while it was going on, or after. So then you connect, just through some conversations with your father and your therapist, I suppose that the reason why he didn’t ever ask is because he was worried it would come up. That’s insight. And so while you could spend a lot of time, you know, in understanding that the two of you had a very vacant relationship, emotionally, because you can never really talk about what was going on in your feelings, you now understand that that is insight, and that is extremely powerful insight.

And so what I’m saying is that as you gain insight, for instance, on your own self hate, secondary to sexual trauma, and the resulting challenges with weight management, right, that’s a whole thing of its own. There first is kind of a realization that self hate from sexual trauma impacts body image. And that connecting those dots is extremely powerful. It’s not horribly in depth, in terms of insight, but it’s an easy connection to make. I think with a little bit of self-exploration, it would be how your self hate originating from your sexual trauma, impacts your body image, regardless of reality. You might not have anything wrong with your body at all, by whatever standard, but it’s your perception, which is truly what counts. There’s the secondary realization that self hate manifests itself as depression. So again, the realization that your trauma impacts body image and making that link to see how that same self hate is also showing itself as depression; depression and your body image are connected. This is what Insight is all about. It is really important. And I think this is where Behavioural Medicine steps in here. We need to all realize that what I think I do and become.

I’ll say it, again, insight is necessary, but not sufficient. And it really does require in the first example, I’m telling you, hey, look, don’t spend your time forcing insights, you know, you need to start taking some action and build other parts of your life. That is the contribution of health psychology in here or behavioural medicine. But the next one is that as you really dive into insight, and you’re looking at how all these things are connected, you have to start to really incorporate into your thinking that what you think you become and you do. It’s directly attached to motivation. And behavioural medicine and health psychology are very interested in motivation, what keeps us from doing things.

Let’s say you’ve committed to a running program. your confidence is just constantly challenged. For all of the reasons that we’ve described, you spend a lot of time thinking you can’t do it. So you just don’t start for that day, you don’t get out and do that run. And this certainly does create future negative thoughts. Because you know, probably deep down that you can, but you chose not to, and you feel a little bit like a failure, and that, in the end, you’re not going to see the health improvements that you’re wanting. This also can lead to negative health outcomes, if you just never get any exercise waiting for you to always just feel better emotionally before you do things. So again, in both examples, “do” first. Insight is something that builds along the way for sure.

Now, for the last item, I’m going to talk about how persistent emotional pain and illness are connected. Unmanaged grief can lead to chronic anxiety. First, there is just grief and bereavement, and then we have this other phenomena called a complicated bereavement. And one of the characteristics of complicated bereavement is chronic anxiety, and chronic anxiety, as we know, definitely leads to negative health outcomes.

Anxiety is definitely a killer. We tend to normalize anxiety through, for instance, our work. We tend to celebrate a lack of sleep from getting to work extra early as someone who works hard. Carrying around free floating anxiety and low mood related to complicated brief, which can look a whole lot like depression, definitely has negative cardiac outcomes. It definitely negative weight outcomes – If you’re constantly in this kind of state of fight or flight, cortisol levels are always up, which has a negative impact on belly fat. What I’m saying here is that persistent emotional pain and illness are certainly connected. Working through grief is extremely essential. In this example, I’m not really talking about Insight, I’m really saying that there’s emotional pain that one’s going through because of someone that’s passed away. And that’s where psychodynamic makes sense. It is possible that you are repressing feelings or denying some realizations that you had. And it’s really just leading to just this steady state, low grade anxiety, that’s chronic, or, and or low mood anxiety and depression or you know, 80% of the time kind of co-morbid.

35:36
Okay, guys, there it is. Why I really like this topic is that health psychology tends too, again, really focus on cognition and behaviour. We tend not to spend enough time acknowledging the importance of kind of shining a light on our own history, and how our emotional challenges of the present are oftentimes linked, or oftentimes linked, to trauma from the past.

Health Psychology really does promote the idea that we concurrently, or, as a precursor, build other parts of our life. But we also acknowledge that along the way, the things that can derail us is that lack of insight, and that lack of ability to really look at how our history is attached to our current behaviour. Our current behavior does not need to be dictated by our history. And I think that’s maybe the most important point here. We do need to give our history its due credit. And we do need to give it its due focus. But it isn’t “the focus”. It is a focus, and one of those things that you’re juggling and managing for your overall wellness.

All right, guys. I’m gonna leave it there. We are almost 40 minutes in. Thank you so much for joining me. And if you like this episode, hit us up on Twitter, we are @findingmypsych. We would love to hear from you. Tell us what you thought about this episode, what you would like us to do in the future. We also have a subreddit, which we don’t use a ton, but we certainly love it. We also have a phone number where you can drop us a text or leave us a voicemail. If you’re interested in being a guest. If you want to leave a comment about what you’ve heard here today, we can also play your voicemail on a future episode. And then we’ll comment on what you had to say or ask. Peace and light.

Transcribed by otter.ai