Beheading the Hydra: Getting Beyond Symptoms to Their Source

Hercules and the Hydra of Lerna

Source: Nicolo Van Aelst (Flanders, 1527-1612), Antonio Tempesta (Italy, Florence, 1555-1630), Los Angeles County Museum of Art / Wikimedia Commons, public domain

This post is Part 1 of a series.

Psychiatric symptoms are just that—symptoms—or expressions of some underlying psychological, emotional, spiritual, philosophical, or sometimes physiological or neurological condition, conflict, imbalance, mistaken attitude, or distorted core belief. Most popular psychotherapies today tend to be symptom-focused, meaning they take the symptom, such as anxiety, depression, mania, or substance abuse, at face value and try to suppress or eliminate it. This can sometimes feel like a futile effort.

Hercules and the Hydra

In Greek mythology, the Hydra was a hideous serpent-like creature with nine venomous heads, one of which was immortal. The legendary hero Hercules was tasked by the gods as punishment to perform 12 labors, one of which was to slay the dreaded Hydra. Cleverly luring it from its lair, each time Hercules lopped off one of the Hydra's heads, two immediately grew back in its place. Preventing their return required an even more invasive intervention. With the assistance of his nephew, he cauterized the decapitation wounds with fire, which prevented the poisonous heads from regenerating. But, even then, Hercules was not able to completely kill the Hydra, resorting in the end to burying its immortal head under a boulder.

Symptom Substitution

In psychotherapy, this myth can be related to a controversial phenomenon known as “symptom substitution”: the idea that merely treating and suppressing one of the patient’s presenting signs or symptoms can cause it to reappear in a different form or lead to others suddenly taking its place. Indeed, attempting to eliminate, stifle, or cut off certain symptoms psychologically or pharmacologically can, in some cases, cause even more complex and potentially dangerous symptoms such as psychosis, depression, or mania. These are the potential perils of taking a strictly symptom-focused approach, as do most psychotherapies today. But is so-called symptom substitution a real thing?

The fundamental difference between those psychotherapies today that dismiss or recognize the phenomenon of symptom substitution is the acceptance or rejection of the traditional psychoanalytic concept of the "unconscious." Practitioners of typically short-term, symptom-focused therapies, such as cognitive-behavioral therapy, solution-focused therapy, trauma-focused therapy, eye movement desensitization and reprocessing, hypnosis, and behavioral therapy, cite various scientific studies conducted over the decades that, for them, debunked the psychoanalytic concept of symptom substitution once and for all, presumably proving that symptom substitution simply does not occur clinically and that there is no scientific evidence confirming the existence of this phenomenon. (See, for instance, Kazdin, 1982; Tryon, 2008.)

Critics of this controversial theory argue that the patient's presenting psychiatric symptom is the problem itself and does not necessarily stem from or represent some deep-seated unconscious conflict. So, they contend, there is no problem with targeting and eliminating specific symptoms such as panic attacks, manic or depressive episodes, obsessive or compulsive behaviors, or substance abuse directly during therapy. But this conclusion is based on an extremely dogmatic, rigid, and literal interpretation of what symptom substitution really is and what actually causes it. Symptom substitution isn't something that always, inevitably, and automatically occurs in every case, and, when it does, it may not necessarily manifest as we expect. While I am unaware of any legitimate research studies that have unequivocally disproven this possibility, at the same time, there is not, to my knowledge, any study that strongly supports the existence of symptom substitution. But in either case, this could be due to the difficulties and complexities of quantitatively or qualitatively researching this controversial phenomenon. (This might make a good dissertation topic for you psychology graduate students out there.)