The bully I refer to often in this site was actually a real patient. Rather than give him a pseudonym, I'll use the name he coined for himself.

"Bully" came to see me complaining of phobias, panic, and a deteriorating marriage. While the phobias cleared up in about 20 sessions, the other issues took longer to resolve. His long path from childhood to my office provides a good illustration of being lost and stuck. 

Bully was raised by a highly anxious and "scatter-brained" mother and a violent, impatient, and unpredictable father. Early on, he was the schoolyard bully, dishing out unto others what he suffered at home. He could recall the pleasure he felt watching another person suffer the fear, confusion, and shame that he so hated feeling at home. In grade school, he managed to develop other outlets, to channel his need to control and dominate -- which compensated for his experiences at home -- into something more productive and socially acceptable. He became a star wrestler and something of a student leader. Later on, he went into the business world, aggressively and successfully working his way up the ladder of power and financial reward. During those happy years he got married, had children, and even became known as a gentle and forgiving department head. He skied, threw parties on his boat, played tennis with friends and colleagues, and in all respects had a full and quite gratifying life. 

As he entered his thirties, however, something began to sour in him; as he described it, "everything seemed to lose its flavor". No longer satisfied, he tried new hobbies, new business ventures, even dabbled in spiritualism and religion, but nothing seemed to stop his growing irritability. He was snapping at his wife, intolerant of his employees' imperfections, and impatient with his children's age appropriate needs and minor misbehaviors. One day, in the heat of an argument he slapped his wife. Vowing never to do that again, he and his wife agreed to "time outs" as soon as he felt his anger welling up. But his discomfort and irritability were so strong that he ended up taking "time outs" every time they tried to talk. Eventually they were hardly speaking. One day, riding in an elevator, he became short of breath, his heart raced, palms began to sweat, and he felt an intense need to flee. He tried to forget the incident, but soon every time he entered an elevator his heart would flutter and his stomach knot in anticipation. The same thing then happened on a bus, so he started driving everywhere. After a while, his life was riddled with phobias.

What happened? There were no events in his life to account for this change. How did "Bully" go from such apparent success and contentment to the symptom-ridden and unhappy man I met at the start of treatment?

As many people do, this fellow had developed a pattern of dominating and intimidating others in order to combat the discomfort of his own early experience of being dominated and intimidated. For a while it worked, first as the schoolyard bully and subsequently via more productive and socially acceptable pursuits. But, as happens to people as they hit around age 30, the defense began to fail. It no longer contained -- shielded him from -- the pain of his original experiences. The energetic and ambitious lifestyle that had previously protected him from those feelings wasn't helping anymore, so he began to regress to his former bullying ways, to earlier modes of defense.

These old habits didn't relieve the pressure either, so finally anxiety took over and the panic attacks started. Perhaps they started in the elevator because he had nothing to occupy himself with for the duration of the elevator ride, perhaps because in the elevator he was at the mercy of the machine cables and mechanisms (that is, he was not in complete control), perhaps because of some frustrating and unsatisfying experience that was on his mind at the time. But in any event, that's where they started. By the time he came to see me, this phobia had so generalized to other situations that he was almost agoraphobic, staying at home as much as possible in an effort to avoid triggers for his panic.

All of this happened outside of Bully's awareness. He did not know what was motivating his behavior and his feelings, nor even that something was wrong. He did not see himself becoming irritable, edgy, afraid, or intolerant. At the time he knew only that he was "restless". Only when he slapped his wife did he begin to realize that there was more going on. Nor did he know, of course, what was causing the discomfort. Once he did learn -- and by that I mean experienced at a gut level (more on this in Stop Lying and in other case examples) -- his anxiety symptoms eased; he no longer needed to bully, he was much more tolerant, and he enjoyed his life again. He did not lose his ambition or energy, but he did lose his dependence on them for any self-esteem.

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