Tolerance is a word that comes up most often in two related forms of usage. In psychology and psychotherapy, following the term’s use in medicine (pain tolerance, drug tolerance), tolerance is constructed as a skill in need of development, as in “increasing one’s frustration tolerance” or “tolerating disappointment.” In the context of multiculturalism, as in “New York city needs make further progress tolerating diversity.” And so it is in some circles that tolerating anxiety and tolerating depression are seem as objectives of therapy.
The failed over-emphasis on tolerance is a feature of a broader misguided premise in the field of psychology, namely that emotional problems surely exist within the individual who experiences them. So the story goes, if an individual struggles in his or her encounters with the world, surely the problem is in his or her emotional makeup–skills for coping, management of irritations, struggle with anger. Difficulty getting along in the world, being irritated or angry–in short, intolerance is assumed to be a product of internal limitations and not a sensible response to problematic features of the world. If a person is irritated, the assumption is that this irritation is an emotional problem.
Therapy for tolerating anxiety or depression?
About once a month I receive a phone call from a prospective therapy patient who is seeking help from therapy to better tolerate his or her depression or anxiety. What’s implicit is that he or she has come to understand their depression or anxiety as a fixed state to which he or she is resigned rather than understanding therapy as a place where they might eliminate their depression or transform their anxiety. Yikes!
There’s a similar type of inquiry where I’m asked about our offerings for support groups. There may even be a conflating of therapy group with support group for anxiety or depression (or social anxiety, or stress, etc.). Again the premise is that these issues are fixed and psychotherapy is best organized as a context for support, not transformation.
What’s behind this expectation of therapy is a problem in hope. Perhaps this caller has given up hope based on previous experiences in therapy that didn’t help or didn’t help enough, or perhaps these callers have come to see themselves as not capable of changing because someone close to them has convinced them that they are beyond hope.
If we can reinvigorate that hope, in the context of great therapy, then the very objective of tolerance and support can be transformed. In fact, if tolerance is what’s being sought to begin with, transforming that objective is critical to making serious changes in therapy with anxiety and depression.
Too much tolerance for the pain and agony of anxiety and depression
Anyone whose been in a high school biology class or even seriously contemplated the issue is aware that, in spite of its unpleasantness, pain and discomfort serve a vital biological function. Physical distress compels us to attend to physical problems: My knee aches so I seek attention for my knee, which makes it likely that I’ll get help to identify and treat a problem with my knee that would have likely gotten worse had the pain not driven me to seek help. Imagine if you had a knee problem but didn’t have knee pain. Not great.
And yet many people seek to manage emotional discomfort using just that strategy: My heart aches, my body is trembling with anxiety so I’m going to try to get that symptom to stop–I’m going to sort out how to tolerate those symptoms rather than investigate the distress those symptoms belie. This isn’t a product of ignorance or even a lack of will to change; it results from a resignation that, in my experience, comes from a history of defeat.
It’s a shame what we tolerate, societaly
Here’s an example: The typical conversation around high school dropouts is that young people drop out because of emotional difficulties, a lack of motivation or because they’re not sufficiently focused on the future. All of these construct the problem as primarily psychological. But many high schools are terrible places in which to spend time. Young people find themselves bullied, are in schools with a high level of violence or are presented with curriculum that’s not relevant to their lives or future success. Perhaps helping them “tolerate” these conditions needs to be a much smaller part of the solution. Instead, we should look out how we can be less tolerant and engage everyone in making these environments more appealing places to learn and grow.
Martin Luther King, Jr. addressed this in his speech to American Psychological Association, arguing “There are some things in our society, some things in our world, to which we should never be adjusted. There are some things concerning which we must always be maladjusted if we are to be people of good will.”
My concern about tolerance as an emotional derivative is that it’s pacifying in the very circumstances that demand action. If we quickly assume that our own depression, anxiety or anger is internal to us and that it is problematic as a response to the conditions of our lives, it shuts down action at the very time we so desperately need to act.