Fourteen months of a global pandemic has produced much to be worried about. We now live with the fear of death from the virus, the fear of physical injury due to class riots and the fear of yet another financial breakdown. All this can aptly be called traumatic and like all traumas, it brings overwhelming, confusing, unnerving and startling anxiety.

A friend confided in me that though he thought of himself as strong and macho, each time he saw a text from his doctor about to let him know of his last COVID test results, his heart would be racing. This is a sign of deeply repressed anxiety which we now can all relate to. We respond differently to these traumas and some adults have effective coping strategies, but some do not.

Trauma causes a desire to withdraw in order to avoid any re-exposure to the traumatic event. It can also produce sleeplessness, hypervigilance, survivor guilt, the overuse of alcohol and more. I would bet my bottom dollar that most of these newly established, nationwide symptoms and syndromes will go untreated. This brings up a more general question of why people who suffer serious emotional stress resist treatment.

Many years ago I did some field research with one of my interns to explore that question in detail. As a sport psychologist, my interest was in determining why athletes who are obviously suffering with anxiety or despair resist sport psychology. What we discovered was that although most readily admitted that they needed help, only a few had sought it out. The reasons usually included a lack of trust, a feeling that it would stigmatize them or that it would be far too costly.

We shall not address the trust issue here, but let us confront the simple question of the costs. Most people think of the cost of therapy but not the cost of untreated neurosis. When people resist therapy, they are alone with their neurosis and this leads to acting out.

Sexual acting out can lead to divorce, which will cost upwards of $250,000 on average due to lost income, legal fees, loss of home etc. Drug addiction can lead to illness, rehab, loss of work and even premature death. Anxiety, if left untreated, leads to chronic avoidance and the person will never earn up to their true earning ability. Depression is a crippling disease which leads to loss of work or even suicide.

In this light, it is hard to argue against effective therapy. Without it, people tend to act out in self-destructive ways. I have seen people give away $75,000 to a family member for fear they will otherwise be abandoned. I have seen people give away $350,000 out of pity to a poor “victim.” Altruism is a commendable trait, but don’t you think that’s carrying it too far?

In big money sports, untreated psychodynamics in a neurotic owner, GM, head coach or team superstar can cost the organization upwards of $50 million. If you need proof, just review the history of the Knicks or the Jets as typical examples.

On the PGA tour, for an athlete to endure a slump can easily cost them upwards of $5 million a year in lost revenue. And make no mistake that a big part of any slump is an intermingling of repressed rage, depression and anxiety.

So whether you are a person who has a regular life or an athlete with an irregular life, you will find that anxiety is a costly affair.

If the repressed anxiety is not “acted out,” it can be “acted in.” If the emotions are overwhelming but completely repressed, they must go somewhere and sometimes will go into the body itself, which is then left with the challenge of dealing with them. Hans Selye, the father of stress-related disorders, outlined how unresolved anxiety produces a variety of psychosomatic illnesses including migraines, back pain, forms of arthritis, hives, irritable bowel syndrome, colitis, hypertension and more.

In other words, these untreated and overwhelming emotions are costly indeed. The next question is how costly is therapy. Take the case of the person who spent $350,000 due to inappropriate pity. Even if that person went to therapy twice weekly for a year and spent $300 each week out of pocket, that would be $15,000. That is only 4 percent of the total cost that the neurosis cost him.

For a team to retain a part-time sport psychologist consultant, it would cost them about $150,000 per year. The interventions would certainly have a positive impact on the team dynamics and might, in fact, help them to avoid all the heinous legal actions, lawsuits and media scandals which cost the team owners many millions.

Sigmund Freud, Heinz Kohut and Ralph Greenson are three who explained why people resist therapy. They suggested that resistance is based upon narcissism, distrust, the guilty need to suffer, the desire to gain sympathy or the ill-advised attempt to relive traumas in order to master them.
Let us add to this list, yet another reason why patients resist. In our busy modern world, money is tight, so who has the time or the cash for therapy?There are new cars, new homes, vacations, new medicine and tuition costs.

The rejoinder to the above is as follows. Simply put, the cost of therapy is far less than the cost of your favorite neurosis.

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