Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Choose your actions, not your feelings

Steven Reidbord, MD
Conditions
May 29, 2016
356 Shares
Share
Tweet
Share

Again and again in therapy I find myself emphasizing the distinction between feeling an emotion and acting on it. Many patients, and non-patients too, take undue responsibility for their emotions, as though feelings were volitional behaviors, the result of a choice.  Often there is a stated or implied should: “I should feel this, not that.”  Note how commonly people blame themselves for feeling, or not feeling, a certain emotion:

“I should be more grateful after all she’s done for me.”

“It’s wrong of me to get angry at other drivers; they’re just trying to get home too.”

“It’s silly to mourn the death of my dog.  He was just a pet.”

When feelings are viewed this way, we hold ourselves to an impossible standard.  We expect to control what is essentially not ours to control.  If we prefer chocolate ice cream to strawberry, no act of will or rational choice can convince us otherwise.  When someone or something strikes us as irritating or funny or repulsive, these reactions arise unbidden.   We do not choose to feel depressed, and cannot opt to feel happy.  Sexual attraction to one type of person, and not another, occurs whether we like it or not.  It’s true that we can gradually temper negative emotions, particularly global ones such as depression and anxiety, by willfully altering our thinking — cognitive behavioral therapy (CBT) is based on this idea — and even more reliably by choosing situations and relationships that promote feelings we want.  But on a moment-to-moment basis, feelings come and go of their own accord.

The mistaken belief that one can and should be in control of felt emotions leads to unwarranted moral condemnation, a sense that having certain feelings is the mark of a bad person.  Self-condemnation of this sort is tragic and can last a lifetime.  By the same token, it is unhelpful to criticize or overanalyze the feelings of another, e.g., one’s spouse or child.  He or she didn’t choose those feelings, and may not know why they arose.  Calling on another to account logically for feelings often has an aggressive edge; it banks on the fallacy that emotions are rational and controllable when they are not.  Analysis of emotions is quite valuable — if done in the spirit of curiosity, not criticism.

Curiosity is the healthy response to a new awareness, including awareness of a previously unrecognized emotion.  It is a new piece of self-knowledge.  Emotions arise in the limbic system, the non-verbal, more primitive brain centers we share with other animals, not from the neocortex, the seat of rational thought. The neocortex “notices” and is affected by activity in the limbic system. This is why we can’t always immediately name or identify an emotion when we feel it, and why strong feelings can temporarily flood or short-circuit rational thought.

Actions are different.  Unlike emotions, they are, or should be, essentially under our control.  (Just as willful application of CBT can influence emotions, behavior driven by strong emotion sometimes feels compulsory, e.g., crying when feeling sad.  However, both of these are exceptions that prove the rule: feelings aren’t chosen, behaviors are.)  Anger or sadness or lust do not, in themselves, compel anyone to do anything.  Our ability and responsibility to exercise choice occurs when deciding to act, not at the point of having the feeling.

Our actions have real consequences for ourselves and others.  They can get us fired or arrested or divorced.  They can hurt our loved ones and coworkers.  This is why it is so crucial to differentiate behavior from internal feelings and emotional states.  Yet many fail to make this distinction, and suppress or deny feelings, often imperfectly, out of fear of the consequences resulting from acting on that feeling.  According to traditional psychoanalytic theory, unconscious effort to avoid awareness of these “dangerous” feelings results in anxiety and other symptoms.  Much of the value of psychoanalysis and analytically based psychotherapy is experiencing emotions in a safe setting, by separating this experiencing from adverse behavior and its consequences.  (When this separation fails to occur, the technical term is “acting out” if the adverse behavior occurs outside the therapy session, and the lesser-used “acting in” if it occurs within the therapy itself.)

Distinguishing feelings and actions is part of the “special sauce” of psychoanalysis and dynamic psychotherapy.  As with free association, transference, the relative anonymity of the therapist, and other aspects of dynamic work, I believe nothing is gained by keeping patients in the dark about the process.  When a patient speaks of emotions as though they were volitional actions, or fails to separate feelings from behavior, I point it out in the hope it leads to insight and greater self-knowledge.

Steven Reidbord is a psychiatrist who blogs at Reidbord’s Reflections.

Image credit: Shutterstock.com

Prev

This is why health care is not a system

May 29, 2016 Kevin 76
…
Next

The alarmist approach to medical errors solves nothing

May 30, 2016 Kevin 3
…

Tagged as: Psychiatry

Post navigation

< Previous Post
This is why health care is not a system
Next Post >
The alarmist approach to medical errors solves nothing

More by Steven Reidbord, MD

  • How drug prices are manipulated

    Steven Reidbord, MD
  • Which is better: Psychotherapy using video or in-person while wearing masks?

    Steven Reidbord, MD
  • Dopamine fasting, debunked by a psychiatrist

    Steven Reidbord, MD

Related Posts

  • Facing the pressure to choose a specialty

    Jamie Katuna
  • In the face of uncertainty, choose hope over fear

    Shreya Kumar
  • Physicians choose love, science, and healing

    Kellie Lease Stecher, MD
  • After the pandemic, would I choose medicine again?

    Sarah Becker
  • Successfully navigating advance directives to choose your best one

    Althea Halchuck, EJD
  • Gamification of medical education: Choose Your Own Medventure

    Chris Carroll, MD

More in Conditions

  • Lazarus: the dead man brought back to life

    William Lynes, MD
  • The psychoanalytic hammer: lessons in listening and patient-centered care

    Greg Smith, MD
  • 5 essential tips to help men prevent prostate cancer

    Kevin Jones, MD
  • Changing the pediatric care landscape: Integrating behavioral and mental health care

    Hilary M. Bowers, MD
  • Unlocking the secret to successful weight loss: Curiosity is the key

    Franchell Hamilton, MD
  • The teacher who changed my life through reading

    Raymond Abbott
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Why it’s time to question medical traditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy
    • The dark side of immortality: What if we could live forever?

      Ketan Desai, MD, PhD | Physician
    • Lazarus: the dead man brought back to life

      William Lynes, MD | Conditions
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

CME Spotlights

From MedPage Today

Latest News

  • Doc Moms, Mind the Gap -- $3M Earning Difference by Sex
  • Clinical Note Writing App Powered by GPT-4 Set to Debut This Year
  • Helping Patients Get Fit -- One Walk at a Time
  • TB Cases Rebound to Near Pre-Pandemic Levels, CDC Data Show
  • Marginalized Groups May Benefit More From Decreasing Air Pollution

Meeting Coverage

  • Switch to IL-23 Blocker Yields Deep Responses in Recalcitrant Plaque Psoriasis
  • Biomarkers of Response With Enfortumab Vedotin in Advanced Urothelial Cancer
  • At-Home Topical Therapy for Molluscum Contagiosum Gets High Marks
  • Outlook for Itchy Prurigo Nodularis Continues to Improve With IL-31 Antagonist
  • AAAAI President Shares Highlights From the 2023 Meeting
  • Most Popular

  • Past Week

    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Healing the damaged nurse-physician dynamic

      Angel J. Mena, MD and Ali Morin, MSN, RN | Policy
    • The struggle to fill emergency medicine residency spots: Exploring the factors behind the unfilled match

      Katrina Gipson, MD, MPH | Physician
    • Breaking the stigma: Addressing the struggles of physicians

      Jean Antonucci, MD | Physician
    • Beyond the disease: the power of empathy in health care

      Nana Dadzie Ghansah, MD | Physician
    • Deaths of despair: an urgent call for a collective response to the crisis in U.S. life expectancy

      Mohammed Umer Waris, MD | Policy
  • Past 6 Months

    • The hidden dangers of the Nebraska Heartbeat Act

      Meghan Sheehan, MD | Policy
    • The real cause of America’s opioid crisis: Doctors are not to blame

      Richard A. Lawhern, PhD | Meds
    • Nobody wants this job. Should physicians stick around?

      Katie Klingberg, MD | Physician
    • The fight for reproductive health: Why medication abortion matters

      Catherine Hennessey, MD | Physician
    • The vital importance of climate change education in medical schools

      Helen Kim, MD | Policy
    • Resetting the doctor-patient relationship: Navigating the challenges of modern primary care

      Jeffrey H. Millstein, MD | Physician
  • Recent Posts

    • Why it’s time to question medical traditions [PODCAST]

      The Podcast by KevinMD | Podcast
    • The hidden gems of health care: Unlocking the potential of narrative medicine

      Dr. Najat Fadlallah | Physician
    • The realities of immigrant health care served hot from America’s melting pot

      Stella Cho | Policy
    • The dark side of immortality: What if we could live forever?

      Ketan Desai, MD, PhD | Physician
    • Lazarus: the dead man brought back to life

      William Lynes, MD | Conditions
    • Revolutionizing COPD management with virtual care solutions [PODCAST]

      The Podcast by KevinMD | Podcast

MedPage Today Professional

An Everyday Health Property Medpage Today iMedicalApps
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...