Embitterment, Posttraumatic Embitterment Disorder, and Wisdom Therapy E-Book

Michael Linden

• Herausgeber: Hogrefe Publishing
• Kategorie: Geisteswissenschaft
• Sprache: Englisch
• Veröffentlichungsjahr: 2022

Seitenzahl: 198

Beschreibung

Practical expert guidance on embitterment disorders - Learn about the evidence-base of PTED and wisdom therapy - Teach clients skills to overcome embitterment - Tips on social, legal, and medical apsects - Includes printable handouts - A companion book for clients is availableMore about the book Feelings of embitterment and posttraumatic embitterment disorder are common in our society and result from reactions to injustices, humiliation, and breaches of trust. They can lead to significant suffering in those affected and to those around them although the clients may be otherwise psychopathologically inconspicuous. The aggressiveness of this client group, as well as their rejection of help, among other factors, is challenging for practitioners and makes treatment complex. Help is hand with this practical evidence-based guide that provides models for the development and continuation of such embitterment states as well as outlines how to diagnose embitterment disorder. The reader is guided through the state-of-the-art treatment approaches for embitterment disorder: cognitive behavior therapy with wisdom strategies. Teach your clients how to process their internalized feelings of hurt and humiliation so that they can create the conditions to reconcile themselves with the events that triggered these difficult and long-lasting states. The book is full of practice-oriented tips to help clients actively gain closure with the past and enable a new orientation towards the future. One method to reach this goal is the reevaluation of the critical events and their consequences. Wisdom therapy provides various tools for this, and these techniques are brought to life with numerous case vignettes. The author also provides tips on the social, medical, and legal aspects associated with this disorder, for example, questions of work incapacity and criminal responsibility. Helpful information for clients is provided in the accompanying book, How to Overcome Embitterment With Wisdom.

Leseprobe

Michael Linden

Embitterment, Posttraumatic Embitterment Disorder, and Wisdom Therapy

Library of Congress Cataloging in Publication information for the print version of this book is available via the Library of Congress Marc Database under the LC Control Number 2022934712

Library and Archives Canada Cataloguing in Publication

Title: Embitterment, posttraumatic embitterment disorder, and wisdom therapy / Michael Linden.

Other titles: Verbitterung und Posttraumatische Verbitterungsstörung. English

Names: Linden, Michael, author.

Description: Translation of: Verbitterung und Posttraumatische Verbitterungsstörung. | Includes

bibliographical references and index.

Identifiers: Canadiana (print) 20220200610 | Canadiana (ebook) 20220200688 | ISBN 9780889376120

(softcover) | ISBN 9781616766122 (PDF) | ISBN 9781613346129 (EPUB)

Subjects: LCSH: Adjustment disorders. | LCSH: Adjustment disorders—Treatment. | LCSH: Emotions.

Classification: LCC RC455.4.S87 L56 2022 | DDC 616.85/2—dc23

The present volume is a translation of M. Linden, Verbitterung und Posttraumatische Verbitterungsstörung, published under license from Hogrefe Verlag GmbH & Co. KG, Göttingen, Germany. © 2017 by Hogrefe Verlag GmbH & Co. KG.

© 2023 by Hogrefe Publishing

www.hogrefe.com

The authors and publisher have made every effort to ensure that the information contained in this text is in accord with the current state of scientific knowledge, recommendations, and practice at the time of publication. In spite of this diligence, errors cannot be completely excluded. Also, due to changing regulations and continuing research, information may become outdated at any point. The authors and publisher disclaim any responsibility for any consequences which may follow from the use of information presented in this book.

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ISBN 978-0-88937-612-0 (print) • ISBN 978-1-61676-612-2 (PDF) • ISBN 978-1-61334-612-9 (EPUB)

https://doi.org/10.1027/00612-000

Contents

1 The Emotion Embitterment

1.1 Emotional Reaction to Humiliation, Vilification, Breach of Trust, and Injustice

1.2 Theory of Emotion

1.3 Function of Embitterment

1.4 Violation of Basic Beliefs

1.5 Belief in a Just World Psychology

1.6 Injustice and Embitterment in a Societal Context

2 Resilience and Protective Factors Against Negative Life Events

2.1 Wisdom

2.2 Forgiveness

2.3 Intelligence and Problem-Solving Skills

2.4 Emotional Intelligence

2.5 Sense of Coherence

2.6 Morality

3 Posttraumatic Embitterment Disorder

3.1 Clinical Picture

3.2 Definition and Diagnostic Criteria of PTED

3.3 Differential Diagnosis of PTED

3.3.1 Differentiation of Intrusions, Rumination, and Associated Symptoms

3.3.2 Differentiation Among PTED and Other Mental Disorders

3.3.3 Differentiation Among PTED and Other Forms of Bitterness

3.4 Embitterment and Aggression

3.5 Epidemiology and Course of Embitterment and PTED

3.5.1 Frequency

3.5.2 Course

4 Diagnosis of Embitterment Disorder

4.1 Self-Rating and Screening Instruments

4.2 Standardized Diagnostic Interview for PTED

5 Treatment of PTED

5.1 General Therapy Problems

5.2 Building a Therapeutic Relationship

5.3 Examination of the Critical Life Event

5.4 Examination of Intrusions, Emotions, Fantasies of Revenge, and Changes in Everyday Life

5.5 Agreement on Treatment Goals and Motivation to Change

5.6 Wisdom Therapy

5.6.1 The General Structure of Wisdom Therapy

5.6.2 The Method of Insolvable Problems

5.6.3 Identification With a Fictional Victim

5.6.4 Perception and Acceptance of Emotions

5.6.5 Change of Perspective

5.6.6 Empathy and Compassion

5.6.7 Contextualism

5.6.8 Value Relativism

5.6.9 Self-Relativization

5.6.10 Self-Distancing

5.6.11 Emotional Serenity and Humor

5.6.12 Relativization of Aspirations

5.6.13 Long-Term Perspective

5.6.14 Uncertainty Tolerance

5.6.15 Knowledge of Facts and Procedures

5.6.16 Goal Clarification and Model Problem Solvers

5.6.17 Aphorisms Expressing Wisdom

5.7 Exposure

5.8 Salutotherapy and Promoting Activity and New Perspectives

5.9 Endangerment of Self and Others

5.10 Treatment Efficacy

6 Socio-Medical and Juridical Aspects

6.1 Incapacity to Work

6.2 Forensic Aspects

6.3 Criminal Liability

7 Conclusion and Outlook

8 References

9 Appendix: Tools and Resources

Dimensions of Wisdom

Notes on Supplementary Materials

Peer commentaries

|1|1The Emotion Embitterment

1.1 Emotional Reaction to Humiliation, Vilification, Breach of Trust, and Injustice

Embitterment is an emotion that is known to everybody as a feeling in reaction to negative life events (Alexander, 1966; Znoj, 2008, 2011; Linden & Maercker, 2011). People understand what is meant by the term “embitterment” without professional knowledge, similar to how everyone knows what fear or anger is. According to the Old Testament, even human history began with a case of injustice and embitterment. The sons of Adam and Eve had brought a sacrifice to God, and “the Lord had regard for Abel and his offering, but for Cain and his offering he had no regard. So Cain was very angry, and his face fell … and Cain rose up against Abel his brother, and slew him” (Gen 4:1 – 16). Cain experienced this setting back as offensive and even more as injust. His reaction was rancour and the resulting behavior highly dysfunctional. Similarly, cases of distinct embitterment are already described in antiquity – for example, in the person of Ajax in the Iliad or as described by Aristotle:

Sulky people are hard to appease, and retain their anger long; for they repress their passion. But it ceases when they retaliate; for revenge relieves them of their anger, producing in them pleasure instead of pain. If this does not happen they retain their burden; for owing to its not being obvious no one even reasons with them, and to digest one’s anger in oneself takes time. Such people are most troublesome to themselves and to their dearest friends. (Aristotle, Nicomachean Ethics, Book IV, Chapter 5)

Embitterment typically arises in response to injustice, breach of trust, or vilification (see Clinical Vignette 1). To inflict injustice on a person and/or to vilify them is a form of aggression. A typical reaction is then counteraggression. If, however, a negative life event cannot be altered or undone, there may be a bitter counteraggression, which means to fight back without regard for losses (Alexander, 1966).

Although embitterment is a reaction to an experience in the past, it also must be understood as an anticipatory action and a target-oriented emotion. The target-related part of embitterment reflects the frustration (blocked |2|target) or disappointment (missed target), the anticipatory part anticipates the emotional assessment of future events (e.g., nothing can amortize my shame).

Clinical Vignette 1. A Case of a Severe and Lasting Embitterment Reaction

Mr. S. was a manager in a big company. He was very engaged with his work and worked hard carving out a career for himself. He was seen as especially competent and entrusted with projects which were in trouble. For one of these that did get in trouble, Mr. S. worked all day and night to save what was possible. His superior who was responsible for the problem said one day during a project meeting: “If you cannot fix this, I will have to call in a ‘real’ manager.” Mr. S. responded with acute agitation and a dissociative state. He left the building but was not able to drive home and his wife had to pick him up. From that day on, he did not go back to work. He felt deeply hurt and embittered. He thought constantly about the injustice and vilification, and he felt powerless and helpless. He began a legal campaign against the company, which used up his assets and even those of his grandmother. The less successful he was, the stronger his hatred became against his former boss. He harbored violent fantasies, such as laying fire to the company buildings and killing himself, to find peace, but also to send a signal, so the world’s attention would be drawn to such injustices in the business world.

1.2 Theory of Emotion

According to cognitive theories of emotion (Scherer, 2004), emotions are products of cognitive evolution processes. They are psychophysiological reactions to the meaning of a situation. Cognitive variables, which explain the quality and intensity of emotional reactions, include the relevance, congruence, and controllability of the given situation. Relevance describes the importance of an event for the person. Whether the emotional reaction is negative or positive depends on the congruence of the event with the targets, wishes, and norms of the person. Congruent events facilitate target achievement and trigger positive emotions such as joy, pride, or gratitude. Incongruent events facilitate negative emotions such as anxiety, anger, or disappointment, and complicate or prevent target achievement. A further important cognition is the assessment of responsibility for and controllability of events. Based on the attributions of the cause, controllability, and responsibility of events different emotions will occur. Furthermore, there can be several subsequent steps of evaluation.

|3|Targets that are not reached result in disappointment and frustration. If the target was important, the emotion will be strong. If it is seen as a personal failure that the target was not reached, then shame will occur. Following cognitive emotion theories, bitterness can result from:

(a)

a rejection or injustice, which is perceived as a threat;

(b)

a loss of resources, persons, important targets, or physical functional ability; and

(c)

the assessment that the possibility of coping with the situation is low.

Figure 1. Psychological classification of embitterment in the context of related emotions (adapted from Znoj, 2011, p. 8).

According to Znoj (2011; see Figure 1), embitterment can be located in a circumplex model with the orthogonal dimensions hope/pessimism (“Can the situation be changed or not?”) and internal/external locus of control (“Can I do something or not?”). Target incongruent events can be associated with four emotional states in relation to the axes of the quadrant: (a) challenge and development, (b) anger and aggression, (c) alienation and embitterment, and (d) guilt and self-blame. Embitterment stands between aggression and self-blame. This helps to understand the reactions of people who are cut off from socially rewarding situations and to see the cause of this situation in external causes (other persons; destiny).

|4|Embitterment can be understood as the final stage in a sequence of evaluations with interconnected emotions:

If something goes wrong, people react with frustration.

If another person is responsible, the reaction is anger.

If that other person could have done better, there is reproach.

If the other person has acted with intent, this leads to a response of aggression.

If it is not possible to defend oneself, this results in a feeling of helplessness.

If it is probable that nothing can be changed anymore, that indicates hopelessness.

If one feels belittled, this means it was an insult.

If this is referring to something very important, which defines someone’s life, then the consequence is embitterment, from which comes desperate counteraggression with some kind of self-destruction, and the driving and accompanying emotion is bitterness, which includes all of the emotions above.

Embitterment is a reaction to injustice, harm, breach of trust, or vilification. It is a mixture of resignation, down-heartedness, a sense of hopelessness, and at the same time of aggression, an urge for justice and retaliation, impulses to fight back, and acceptance of self-destruction.

1.3 Function of Embitterment

Emotions are linked to actions in congruence with a given situation. Anger leads to retaliation, disgust rejection, and fear avoidance. Emotions have a motivating function. They guide the attention of the person to a special event, advise strategies of coping, and furnish physiological preparedness. From an evolutionary point of view, emotions are strategies to cope with recurring challenges in the social and material environment.

Embitterment can help us to cope with desperate situations in which there is no way out, where we are cornered, and the enemy has succeeded. It then still gives us a last chance of fighting back regardless of the consequences, and even accepting self-destruction. Embitterment can be seen as a last-resort emotion, similar to panic. Panic in life-threatening situations can activate unimagined reserves of strength, which can even make survival possible. Embitterment also arouses the power to fight back against an overwhelming enemy and allows a self-determined response, while disregarding consequences. In certain cases, such behavior may surprise the enemy and |5|lead to an unexpected victory. If someone is exposed to a serious injustice, vilification, breach of trust, aggression, and loss of face, then embitterment is the last chance to fight back and regain a feeling of self-determination.

The concept of embitterment as “aggression by self-destruction” is based on the work of the psychoanalyst Alexander (1966). Examples are the dissipation of money in legal battles that cannot be won, or ruthless behavior in professional controversies, or child abduction or even murder–suicide in order to “save” a child.

Embitterment and aggression with self-harm can already be seen in children. If they feel overpowered – for example, because of the superiority of their mother – they can fantasize, or even threaten, “to go outside in the snow and die to punish Mum.” When children, for example, are hindered in visiting the fun fair, it can happen that they will say they “now no longer want to go,” although by this, they deprive themselves of the opportunity to go to the fair, with possibly greater generosity from their parents.

A well-known figure that shows the development from injustice to unbounded aggression is described in the novella Michael Kolhaas by Heinrich von Kleist. This is based on a true story. In Berlin there lived a rich businessman Hans Kohlhase, from whom, in 1532, the Saxon nobleman Günther von Zaschwitz stole two horses. As a state-supporting, tax-paying, and respectable citizen, Kohlhase went to court, where he failed to obtain satisfaction, as the judges were also noblemen. Kohlhase experienced this not only as an injustice but as humiliating, so in response, he started a revenge campaign, during which he set the city of Wittenberg on fire and finally attacked even a silver transport of the Elector of Brandenburg Joachim I. That Kohlhase was in a pathological state of mind can be seen from the fact that he did not take the stolen money for his own sake or used it to buy new horses, but in revenge and retaliation for the injustice he felt he had suffered, he threw the silver coins off a bridge into the river Havel. This example illustrates the connection between injustice, helplessness, and finally dysfunctional counteraggression, which found its expression in the completely absurd campaign to steal money and throw it away. Revenge not problem solving was the name of the game.

Embitterment also has a strong social appellative character. Emotions control interpersonal relationships by communicating one’s own situation to others and by evoking complementary reactions in other persons. Children who express their emotion in a conflict about a toy (e.g., anger or sadness) are able to keep it more often than children who do not express their emotions (Camras et al., 1988). Embittered people have a need that the world should see how badly or unfairly they were treated. They even decline offers for help, because this would mean, as they see it, that the injustice would be undone.

|6|Embittered individuals tend to focus on their environment. They see the cause of their problems in other people and expect an improvement through changes in others – for example, in professional reemployment, the return of the spouse, or the denunciation of the aggressor. While depression is characterized by self-blame, embitterment is defined by blaming others. Patients are not able to realize that their problem is no longer the earlier critical life event but rather their persisting embitterment reaction. They therefore seek help in the courts and not from therapists. This is one reason that the pathological nature of severe embitterment has for long not been recognized in psychiatry and psychotherapy, although already Kraepelin, the father of psychiatric classification, had described this syndrome at the beginning of the last century (Linden & Arnold, 2021).

Embittered people have clear ideas about the cause of their situation and of what should be done to restore justice. They are not able to see that the problem is their present and persisting emotional reaction. Embitterment is a complex and potentially dangerous mixture of feelings. The strong craving for justice can lead to dangerous acts of revenge.

1.4 Violation of Basic Beliefs

Embitterment occurs in reaction to extraordinary but nevertheless everyday negative life events such as divorce or dismissal from a job (Baures, 1996). The question is why and under which conditions these result in a pathological reaction.

Critical life events always trigger negative emotions such as fear, uncertainty, disorientation, anger, or impairment in mood. Traumatic events lead to pathological emotions – that is, states that are no longer under the control of the affected person and which develop into dysfunctional behavior with strong suffering for the affected person as can be seen after strong spells of panic, which can lead to posttraumatic stress disorder (PTSD). Another form of traumatic events are those that violate basic beliefs (Janoff-Bulman, 1992; Magwaza, 1999). Basic beliefs or cognitive schemata are a cognitive reference system which structures our perception of the world, and decide about what is seen as important or not, and what is necessary to be done. They enable us to develop trust in other people, the world, and ourselves. They are usually not put in question and are associated with positive feelings as long as the world complies with them. These basic beliefs, cognitive schemata, worldviews, or ideologies are of great individual and social importance.

|7|Basic beliefs are culturally mediated, similar to language. When growing up as English, American, or Irish (or any other nationality), the imprinting that occurs during childhood will last a lifetime. This is true for someone’s mother tongue including the regional intonation of language, but also someone’s culture of origin, which means, the ideology or basic beliefs that are mediated by the parents, the school, youth groups, or television. Basic beliefs allow us to behave coherently across our lifespan. Someone who has been raised with the view that a God-fearing person has to work and not waste money, will do this for the rest of their life. They will take sandwiches when visiting the zoo, to avoid the expense of a restaurant, because that follows from their basic beliefs.

Just like other socially mediated phenomena, basic beliefs are also a part of group identity (e.g., “belief in Christ rather than Allah,” “supporting the American national team rather than the English”). Since these are cross-generationally transmitted worldviews, this explains why someone will feel like a Puerto Rican, because their grandparents came from Puerto Rico, although they were born and grew up in America. The difference between people in Geneva and Grenoble is not one of language or race, but only basic beliefs, according to which the one group feels Swiss, the other French, with all of the consequences that follow. Basic beliefs are responsible for the fact that people in Cologne continued to build their cathedral over centuries while immigrants from Istanbul are now building mosques in Cologne.

The link between basic beliefs and behavior is mediated by automatic thoughts, which means situation-specific attributions and judgments. Behavior which is congruent with one’s own basic beliefs leads to a positive emotional experience. Questioning or violations of one’s own basic beliefs create negative emotions. This is what conscience means.

This psychology, which is so powerful that it is able to determine the behavior of people throughout their lifespan and accross generations, holds together nations and defines cultures over the centuries and can lead to severe reactions if it is put in question. The defense of basic beliefs can make martyrs.

Therefore, it is also understandable that in individual cases, people defend their basic beliefs if these are questioned through life events – that is, an event which is in conflict with their own values and self-concept. If an event is too important to be ignored and any assimilation of the event into existing schemata or basic beliefs is not possible, or a change or adaptation of these schemata (accommodation) is unthinkable, this can lead to an adjustment disorder. Embitterment arises when basic beliefs are questioned, attacked, disproven, or degraded through a life event or the behavior of others.

The theory of violation of basic beliefs explains why events, which seem to be trivial for some people, can be of importance to others. What is seen |8|as injustice, insult, or humiliation depends on personal beliefs and values (Linden, 2013a). Whether somebody reacts emotionally to a rejected promotion depends on their individual beliefs. Whether premarital loss of virginity leads to suicide or self-confidence can be explained by basic beliefs. Basic beliefs, schemata, and automatic thoughts decide how behavior and events are evaluated. This is the basic paradigm of cognitive psychotherapy (Beck, 1976). Basic beliefs can be understood as personality traits in the sense of a disposition to behave. There are as many different cognitive schemata as there are people (Schwartz, 1997). The objective triviality of an event is no criterion for its traumatic effectiveness in the individual person. What is traumatic and leads to a pathological reaction can only be decided after knowing the individual’s basic beliefs.

1.5 Belief in a Just World Psychology

In the context of embitterment, the belief in a just world psychology (Lerner, 1980) is of special importance. Janoff-Bulman (1992