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The Healing Power of Expressing Emotions
By James W. Pennebaker
The Guilford Press Copyright © 1997 James W. Pennebaker, PhD
All rights reserved.
Confession and Inhibition: The Beginnings of an Approach
Long before the Spanish conquered the New World, the natives of what is now North and South America had elaborate confession rituals wherein tribe members disclosed their transgressions to others. Indeed, rituals of confession are currently prominent among most Eastern and Western religions.
A growing number of Americans pay millions of dollars to therapists and self-help groups so that they can divulge their secrets.
A large percentage of people write about their very deepest thoughts and feelings in diaries or letters but do not disclose the personal sides of themselves to the close friends they see every day.
On airplanes, buses, and trains, people are likely to disclose intimate sides of themselves to individuals they have never met before.
Why do people throughout the world seek to tell their stories? Is there some kind of urge to confess? Is it healthy for us to divulge our deepest thoughts and feelings? Or, conversely, is it unhealthy not to disclose the private sides of our lives? Questions such as these have captivated psychologists, anthropologists, journalists, and others for generations. This is the story of my own journey to find some answers concerning the nature of secrets, self-disclosure, and health.
The main discoveries of this project indicate that actively holding back or inhibiting our thoughts and feelings can be hard work. Over time, the work of inhibition gradually undermines the body's defenses. Like other stressors, inhibition can affect immune function, the action of the heart and vascular systems, and even the biochemical workings of the brain and nervous systems. In short, excessive holding back of thoughts, feelings, and behaviors can place people at risk for both major and minor diseases.
Whereas inhibition is potentially harmful, confronting our deepest thoughts and feelings can have remarkable short- and long-term health benefits. Confession, whether by writing or talking, can neutralize many of the problems of inhibition. Furthermore, writing or talking about upsetting things can influence our basic values, our daily thinking patterns, and feelings about ourselves. In short, there appears to be something akin to an urge to confess. Not disclosing our thoughts and feelings can be unhealthy. Divulging them can be healthy.
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These are the most basic ideas of the book. But, there is much more to the story. Before detailing the nature and implications of confession, let me explain how I got into this business. Several years ago, I became fascinated by three seemingly unrelated phenomena: the joy of talking, the nature of lie detection, and the role of self-understanding in affecting the mind–body link. Piecing together these observations laid the groundwork of an intriguing model of inhibition and confrontation.
I was originally trained as a social psychologist—someone who studies attitudes and social behaviors. After graduate school, I found myself teaching a class of 300 freshmen about basic psychology at the University of Virginia. Because graduate training emphasizes research skills rather than teaching abilities, I quickly learned that class demonstrations were a wonderful way of hiding one's lack of knowledge about a topic. Furthermore, if the demonstrations were set up right, I could actually conduct research and teach at the same time.
In one of the first class meetings, I split the students into small groups of people who didn't know one another. Once in their assigned groups, the students were told just to talk for 15 minutes about anything they wanted. As you would expect, they talked about their hometowns, why they had come to college, what dormitory they lived in, friends they had in common, the weather, and related topics—the usual cocktail-party fare.
At the end of 15 minutes, the students returned to their regular seats and estimated how much of the time every person in the group talked, how much they liked the group, and how much they learned from the group. Two rather surprising findings came from this and subsequent demonstrations. First, the more that people talked, the more they liked the group. Second, the more they talked, the more they claimed to have learned from the group. In other words, as a group member, the more you dominate the conversation, the more you claim that you have learned about the others.
In general, we would rather talk than listen. Most of us find that communicating our thoughts is a supremely enjoyable learning experience.
Not long after this, I was introduced to the world of lie detection. Up to that time, I had been interested in how students felt when they talked about superficial topics to their classmates. I was now in a position to learn what happened biologically to people in the real world when they talked about crimes they may or may not have committed.
There is something frighteningly magical about the idea of lie detection. Machines that can accurately read others' private thoughts have been the basis of dreams by police officers, poker players, and parents. A crude approximation of this magical lie detector is the polygraph—an instrument that continuously measures several physiological indicators such as heart rate, blood pressure, breathing rate, and perspiration on the hand.
In law enforcement, polygraph exams and related lie-detection methods assume that when suspects try to deceive their interrogators, their biological stress levels will increase relative to when they tell the truth. Although numerous studies indicate that polygraph techniques do much better than chance at catching truly guilty suspects, they are far from perfect.
Ironically, the real value of the polygraph is in bringing about confessions. A particularly skilled polygrapher uses a suspect's biological responses to various questions as an indicator of what topics provoke the most anxiety. Once the "hot" questions are isolated, the polygrapher may note, "Gee, I really believe what you have told me, but my machine shows a huge reaction when you answered that question. Why do you think this is happening?" In more cases than not, deceptive suspects try to rationalize their physiological responses. In so doing, they often contradict their earlier stories. Finally, the more they are confronted with these contradictions, the more likely they are to ultimately break down and confess to the crime.
Because of my interest in physiological responses to stressors, I was invited to give a series of talks to some of the top-level polygraphers of the FBI, CIA, and other secret agencies with initials of which I had never heard. Fortunately, I spent several late evenings talking with the polygraphers about their jobs. As a group, these people were unusually bright and insightful. What most impressed me was a remarkably similar experience that many of the polygraphers reported in interrogating some of their suspects—something I call the polygraph confession effect.
A San Francisco-based polygrapher first alerted me to the polygraph confession effect in recounting an exam he had given to a 45-year-old bank vice-president who was a suspect in an embezzlement investigation. When initially run through the polygraph exam, the bank vice-president's heart rate, blood pressure, and other physiological levels were quite high. This is normal for both innocent and guilty people, because such an exam is almost always threatening. Nevertheless, the polygrapher suspected that the bank vice-president was lying or holding back information, because his physiological levels went even higher when the vice-president was asked about some of the details of the embezzlement. With repeated questions and prodding, the vice-president finally broke down and confessed to embezzling $74,000 over a 6-month period.
In line with standard procedures, after the bank vice-president had signed a written confession, he was then polygraphed again to be certain that his confession was itself not deceptive. When hooked up to the monitoring apparatus the second time, his overall physiological levels were extremely low. His hands were no longer sweaty. His heart rate and blood pressure were extraordinarily low. His breathing was slow and relaxed.
You can appreciate the irony of this situation. This man had come into the polygrapher's office a free man, safe in the knowledge that polygraph evidence was not allowed in court. Nevertheless, he confessed. Now, his professional, financial, and personal lives were on the brink of ruin. He was virtually assured of a prison term. Despite these realities, he was relaxed and at ease with himself. Indeed, when a policeman came to handcuff and escort him to jail, he warmly shook the polygrapher's hand and thanked him for all he had done. Several months later, the polygrapher received a chatty Christmas card written by the former bank vice-president with the Federal penitentiary as the return address.
Even when the costs are high, the confession of actions that violate our personal values can reduce anxiety and physiological stress. Whereas dominating the conversation in a group may be fun, revealing pent-up thoughts and feelings can be liberating. Even if they send you to prison.
There was a third phenomenon that had a significant impact on my interests surrounding confession and health. It dealt with the nature of psychological insight and the mind–body link. I was probably drawn to the area of psychosomatics by virtue of having asthma as a child. I grew up in West Texas, a very dry and flat part of the world. During my adolescence, asthma attacks became a routine feature of the windy part of winter (as opposed to the windy parts of spring, summer, and fall). Clearly, I reasoned, pollen and dust that had blown in from New Mexico and Nevada were to blame.
In college, I never had any wheezing bouts except when I went home for the Christmas holidays. The pollen and dust again. During my last year in college, however, my parents came to visit me in Florida in late November. The day they arrived, I developed asthma. All of a sudden, the profound realization hit me that there was more to asthma than pollen. Conflicts with my parents were undoubtedly linked to my upper respiratory system. Interestingly, once I saw the parent–asthma connection, I never again wheezed. It was too embarrassing.
Asthma, wheezing, congestion, and other respiratory changes have long been known to be related to psychological conflict. In fact, two pioneers in psychosomatic medicine, Harold G. Wolff and Stewart Wolf, documented effects such as these in a book with the intriguing title The Nose (together and separately, they also published books entitled Headache, The Colon, and, of course, The Stomach). In landmark studies spanning three decades, Wolff, Wolf, and their collaborators developed "the stress interview," whereby volunteers would be asked a series of psychologically threatening questions while, at the same time, relevant bodily changes were monitored.
The stress interview serves as a medical version of a lie-detector exam. For most people, there are a limited number of psychological issues that account for most psychosomatic problems. Current stress interviews, for example, routinely touch on issues of loss, rejection, sexuality, parental problems, uncontrollable trauma, and failure. Depending on the person's health problem, the interviewer might measure muscle tension in the neck (for tension-headache sufferers), blood pressure and heart rate (for hypertensives), breathing rate or oxygen consumption (for those with respiratory problems or panic attacks), or one of a few dozen other biological indices.
As Wolff, Wolf, and a generation of psychosomatic researchers soon learned, different psychological conflicts are linked to specific changes in our bodies. One person's blood pressure may increase when forced to discuss the death of his or her parents, whereas another might respond to the same topic with the beginnings of a migraine headache. A third person may not show any biological changes to the death topic but may react selectively to issues surrounding sexuality.
That many, perhaps most, illnesses have a significant psychosomatic component is not surprising. More peculiar is that we rarely see the relationship between psychological events and illness in ourselves. When we do, however, the course of the illness often changes for the better.
Why are we blind to many of the psychological precursors to illness? One problem lies in our abilities to perceive cause–effect relationships. When we see something happen, we naturally look for something that preceded the event by no more than a few seconds or, at most, hours. If our car doesn't start because of a dead battery, we might blame the battery's demise on last night's cold weather or our failure to turn off the headlights. It makes no sense to think back to the way we drove the car 2 weeks ago. Our bodies are a different story. If we come down with a cold, it probably has nothing to do with last night's weather or what we had for breakfast. It could be that our immune system was compromised by the breakup of a significant relationship a week earlier.
Another reason for our myopia concerning the causal links between psychological issues and illness concerns denial. Virtually all of us have actively avoided thinking about unpleasant experiences. Some issues are so painful that we deceive ourselves into thinking that they don't exist. Sigmund Freud persuasively argued that we employ an arsenal of defense mechanisms, such as denial, compulsive behaviors, and even dwelling on physical symptoms in order to screen out anxiety and psychological pain. Wheezing when around parents or headaches in sexually threatening situations can be safely attributed to purely physical causes (e.g., pollen or caffeine). Admitting to struggles concerning one's autonomy or feelings of sexual anxieties is a far less pleasant strategy when less threatening alternative explanations are around.
Fortunately, once we become aware of the psychological causes of recurring health problems such as headaches, back pain, or asthma, the problems often subside to some degree. There are several reasons for this. Once we see the psychological basis for a particular health problem, we can then use the health problem as a signal of distress. By focusing our energy on reducing the cause of the distress, we more quickly resolve the underlying psychological issues that we may not have known were issues in the first place. Another reason that seeing the cause–effect relationship is beneficial is that it makes the health problems more predictable and, hence, controllable. Perceptions of control and predictability over our worlds are essential to good psychological health.
One of my first experiences in discovering this sometimes-invisible link between a psychological event and biological activity was with Warren, an extremely bright student who had been the valedictorian of his high school class. After performing quite well his first year and a half of college, he suddenly developed test anxiety. Midway in his fourth semester of college, he began to fail every test he took. He was soon placed on academic probation and later forced to withdraw from school. Over the next year, Warren saw a therapist who specialized in behavioral treatments. Several weeks of relaxation training and behavior modification failed to produce significant improvements.
A year later, Warren visited me and explained his predicament. He agreed to be interviewed about his life while I measured his heart rate. Not until years later did I learn that heart rate was not the most reliable psychological indicator for most people. Warren, fortunately, was an exception. During the first hour-long interview, it became clear that Warren's body was telling a different story than Warren's words.
As is shown in the table above, Warren's heart rate increased dramatically whenever the topic of his parents' divorce was discussed. No other issues influenced heart rate to a comparable degree. Despite the fact that Warren claimed to be unaffected by his parents' divorce, it was a significant event. Indeed, he first learned that they had separated about a week before his developing test anxiety. In the two intervening years, he never saw the relationship between the divorce and his poor performance during exams. When confronted with his heart-rate data, Warren was flabbergasted. Over the next few days, he discussed his feelings of anger and despair over the divorce with me and, later, with his parents. Although he still harbors some of these feelings, his test anxiety disappeared.
We are often blind to the psychological causes and correlates of our health problems. Many illnesses and recurring health problems have a psychosomatic component. Awareness or insight into the psychological bases of illness can help in the healing process. If we are aware of the conflicts influencing our bodies, we can act to overcome those conflicts.
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These were the beginning pieces of the puzzle. When we talk a great deal in a group, we claim that we enjoy it and learn from it. After confessing a crime, our minds and bodies appear to be relaxed. Once we understand the link between a psychological event and a recurring health problem, our health improves.
Each of these phenomena deals with the psychological state of holding back versus letting go. As my students and I began systematically to examine the holding back–letting go continuum, an organizing framework began to emerge. Although it is still evolving, it can be summarized as follows:
Inhibition is physical work. To actively inhibit one's thoughts, feelings, or behaviors requires physiological work. Active inhibition means that people must consciously restrain, hold back, or in some way exert effort to not think, feel, or behave.
Excerpted from Opening Up by James W. Pennebaker. Copyright © 1997 James W. Pennebaker, PhD. Excerpted by permission of The Guilford Press.
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