Выбрать главу

Avoidance is also healthy when it is a defense that provides a welcome resolution of or escape from reactive inner turmoil. It is healthy to want to escape from one’s own sadistic impulses by avoiding wild kingdom animal shows that rub one’s nose in the laws of the jungle, and even to want to avoid facing sexual desires that provoke guilt— staying away from X-rated movies less for the moral reasons generally cited and more because the close-up anatomical view revives uninte-grated/unmanageable primal-scene experiences or activates quiescent prior traumatic sexual molestations. A particularly bright side of the defense of obsessive-compulsive avoidant procrastination is pause thus allowing time to think. That permits internal conflicts and difficult real life situations to be resolved implicitly, and in the longer run by simply waiting for the tincture of time to kick in.

NORMAL AVOIDANCE

Avoidance that is not entirely healthy can still, under certain circumstances, be within normal limits. For example, avoidance is within normal limits when, as part of grief, it permits the individual to be alone with his or her nostalgia, with his or her faded clippings and reminiscences, dwelling on a pleasurable past to deny an intolerable present, indulging in a better-days, if-only fantasy. One patient, after the death of his wife, retreated into arranging and rearranging his old photos and the sympathy cards he got when his wife died, doing so in order to keep alive her memory to avoid suffering the pain associated with having to live his life without her. He also stayed alone in the large house they once occupied together just so that he could continue to be surrounded by the pleasant memories there, even though the house was too large for his needs, too difficult for him to keep up, and in the suburbs, although all his activities were in the city. And at a shore house they once shared, he kept and nurtured all his wife’s plantings, even though, or in a sense just because, the yard, although it was becoming overgrown and wild, still remained in its “original” state.

However, a continuum exists between normal and pathological grief, with pathological grief becoming avoidance when it is excessive, overly intense, continuous, and prolonged, as in the following case.

A Case Example

A patient informed me, “One of my friends made his first million right out of college writing some kind of innovative software, so he retired and followed his dream to sing folk songs with his guitar. He got a gig at a famous restaurant and bar. Later on he married, then divorced, but apparently he still loved his ex-wife. Then she died a few years after the divorce. Now he had to stop singing because he would unpredictably start crying at the thought of her death. When he wrote to me to express his condolences about my own wife’s death, he told me all of this and how he now lives out in the woods somewhere, like a hermit, telecommutes for an advertising company, and has for his only ‘friends’ the business cable channel, which he leaves on all day. He never leaves his home, and never will, according to him. And the tears still come, unexpectedly.”

Avoidance can also be within normal limits when it is part of the normal developmental process, for example, part of “adolescent turmoil,” where adolescent rebellion has the beneficial purpose of paving the way for the child to grow up and become an adult who, having turned into a more independent man or woman, can now leave home without second thoughts and free of guilty regrets.

Avoidance is also normal when it is a rational reflexive response to a difficult partner. Is this the case here? (And who in the following exchange is avoiding whom?)

A Case Example

I recently got the following letter:

Can you please direct me (well, my husband) to someone in or

near Fargo, ND who might be able to help him. He has avoidant

personality disorder and has “ended our relationship” countless

times. I am not only heartbroken each time, but am at my wit’s

end, and his doctor has recently referred him to a social worker who specializes in women’s addictions of all things. I just don’t know where to turn, as I love this man dearly and don’t know how to get him the help he needs, and I don’t know how I can cope with this, short of ending the relationship which I really don’t want to do.

I replied that I wished I could help but I didn’t know of anyone in her area. She shot back in what I thought might be a somewhat passive-aggressive fashion, as follows:

Dear Dr. Kantor. Thank you for answering my email. I am not very hopeful for my husband finding the help that he needs in this town.

Was she expressing anger toward me—for being less than helpful—in the form of disappointment? At any rate, I felt bad, and wished I were somewhere else. Was I being highly attuned to her unspoken anger, or was I just being hypersensitive out of my sense of guilt?

Avoidance is also normal when it is an interim, transitional, planned part of psychotherapy. In fact, therapy well done works partly by temporarily enhancing avoidance—by offering the avoidant not only a sanctuary from everyday cares, but also a time out where he or she can temporarily stop, take stock, retreat, and reconsider life options and goals: becoming more avoidant for now, in preparation for becoming less avoidant in the future.

AVOIDANT PERSONALITY DISORDER

The following section attempts to clear up what appears to be widespread confusion about the differences between avoidant personality traits and the full avoidant personality disorder (AvPD) syndrome as well as about comorbidity, where AvPD coexists with one or more di-agnosable Axis II disorders, resulting in a mixed personality disorder. (Comorbidity is discussed at length in chapter 7.)

Personality Traits

In this book, although I do not always spell it out, many of my discussions of AvPD are in fact discussions of avoidance; that is, they are not about AvPD, but about the individual traits that together go into making up the AvPD. These traits by themselves do not constitute the personality disorder, which consists of a cluster of personality traits.

Personality traits are primary behaviors, the product of rigid, armored attitudes that are in turn set ways of viewing things, coming from within, weakly and only with effort influenced from without: overly rigid, fixed, repetitive, predictable, and often inappropriate responses barely subject to the dictates of reality and common sense. Traits resemble overvalued ideas—preoccupying beliefs, close to convictions, that lie somewhere on the continuum between rational beliefs and irrational delusions. An example of an overvalued idea is emotionally based, rigid, inflexible, unvarying, and off-the-mark ideology from the politically far Left or far Right. Some traits, like excessive worry, are ego-dystonic, that is, they feel like unwanted foreign bodies in the mind, while others, like withdrawal, can be ego-syntonic, that is, they feel acceptable, desirable, and enjoyable.

Dynamically, traits originate in developmental fixation or regression; are products of learning and experience; can be the result of identification with others with similar or the same traits; constitute the behavioral manifestations of active defenses; can be the product of an unpredictable (sometimes overly lax and sometimes overly harsh) superego or conscience structure; and can represent the lingering legacy of early, unintegrated trauma.