Alice Miller is a psychotherapist. She is interested in the importance of emotions in understanding seemingly irrational behaviour. Her thesis is that our emotional life governs our behaviour. Seemingly irrational behaviour becomes explicable once one understands a person's emotional life.1
Miller believes that our emotions are formed in early childhood. If we have happy childhoods then our emotions develop naturally and we behave in a rational way. However, if our childhoods have been unhappy, as a result of physical, sexual, or emotional abuse, our emotional world is damaged. Emotionally damaged adults may harm themselves or others or suffer with psychosomatic illness. Why is this?
Children who are being abused are in a frightening and dangerous situation. Children need to believe that their parents love them. If they react in a natural way to the abuse, by showing their anger and outrage, they risk further abuse from their parents or carers. An abused child, A, represses her anger and outrage and does not feel it consciously. This is a healthy response to abusive parents as it optimises A's wellbeing while she is dependent on them. By repressing her anger and convincing herself that everything is OK really, A does not antagonise her parents and so maximises the chance that they will continue to give her the good things they can, such as food, shelter, and a home. She also helps herself to cope with an intolerable situation. When A grows up the situation changes. The repression of her anger is no longer necessary and is, in fact, counterproductive for A's wellbeing. Sadly, because A is herself unconscious of the anger it will probably remain repressed. She lives with the unconscious anger inside her and is compelled to express it in some way. The anger may be expressed towards herself (as in depression, self-harm, or psychosomatic illness), her children (as child abuse), or towards others over whom she has power (as in violence or bullying).2 Conversely, she may re-experience her own anger by developing relationships with other people who will abuse her.
This unconscious anger is usually maladaptive in adult life. It causes harm to A, her children, and other people. It no longer plays any useful function. If A is able to recognise her anger consciously and express it directly then she may be able to free herself from the compulsion to harm herself and others. Miller believes that people like A can be helped by communicating with people who understand her experience. This is the aim of psychotherapy.
GPs meet many patients who have suffered some form of abuse and express this in the form of depression, self-harm, or psychosomatic illness. A may make our heart sink if we try to understand her behaviour on a superficial rational level. However, if we are able to sense the emotional experiences lying behind A's behaviour then this may be therapeutic.
- © British Journal of General Practice, 2007.
