The F**k-it Button in Clinical Practice By Ariel Nathanson, MA, MPsych on 4/23/19 - 2:05 PM

A patient who worked as an airline cabin-crew described how she used to look after passengers in a placatory and compliant manner. As long as people were nice to her she felt effective and benevolent. However, when conflicts arose and she felt attacked or harassed, she was unable to produce any assertive response. Instead, she would remain overtly compliant whilst covertly humiliated, furious and vengeful. As soon as a cabin-incident would end, she would press the f**k-it button in her mind, secretly aware that she was now “doomed” to go through a familiar escalation that was unavoidable and inevitable. This led to an immediate relief; the reality of conflict, humiliation, rage and aggression was deleted and replaced with toxic excitement. Later, at her first opportunity, she would take her phone out of her pocket, go on a sex-dating app, and swipe many profiles looking for someone to fit her need to “hook up with the sleaziest man in the bar.” She would arrange to meet, get intoxicated and have unprotected sex. This was later understood as her need to feel both harmed and harmful—an aggressive aim camouflaged and equilibrated by self-harm.

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As a side note, before going back to the main argument, I would like to make a general observation here: Mobile phones are hives of f**k-it buttons for those who need them. As such, people hold the gate to a highly addictive world of potential toxic enactments in their pockets. Clearly, most people might not feel compelled to press these buttons but I suspect that many would do so anyway, just because the buttons are there, whilst those who rely on a f**k-it buttons for psychic survival would find not pressing them very difficult to avoid.

Most of my patients press the f**k-it button when they need to transition from a passive state into action. Once the button is pressed, the reflective and pained part of the personality takes a backseat from which it can only watch the unfolding enactment, usually rehearsed, ritualized and harmful. Significantly, the passive backseat observer is not an innocent victim. Instead, it is often the part of the personality that secretly presses the button in order to summon the enactment demon. It might then proceed to passively watch in horror (or voyeuristic excitement), later to report what happened with shame and guilt, projecting helplessness and asking for sympathy and protection.

People with whom I have worked who have been groomed and abused, or those who had to endure other chronic and oppressive relational trauma, rely on internal structures that helped them survive their experiences moment by moment. I often imagine these structures as protective systems that have been hacked into, their codes and algorithms changed from within, allowing access to intrusion, neglect and abuse by disabling or perverting benign protective aggression.

Like many of my patients who rely on f**k-it buttons and enactments, the airline crew worker I described was unable to use aggression in a protective, self-preservative way in the moment. It is hard to be anything but compliant and kind when all eyes and ears are on you in a closed cabin at 35,000 feet. Instead, she pressed the button, re-evoked the old hacked-into structure of her traumatic past, and transformed her aggression into a toxic, harmful and sexualized mix that she psychologically depended on in order to survive moments of intrusion and humiliation.

Most of my patients are initially surprised to find that they press the button a long time before they actually act destructively. Tracing it back to that point rather than focusing on the action at the end is very helpful. It usually shows that the button is pressed with great relief and even excitement, very different to the patient who later describes his actions with shame, guilt and regret. Rewinding a bit more usually leads to the emotional level of unbearable rage, humiliation or at times depression. Further rewinding often leads to an original relational trauma that needs to be explored in order to understand the creation of the initial structure.

Tracking the route back allows for a truthful path into the core, one that does not neglect collusion, sadomasochistic excitement or other addictive and gratifying states of mind. Clinically, I try to make sure that all parts of the patient’s personality act as my guides on this journey back, not just the shamed victim or the callous perpetrator. Exploring the f**k-it button, which part of the personality presses it internally, when and why, makes this therapeutic journey very accessible.

Lately, when I talk about this dynamic to other professionals, they often associate it to the political and social parallels of the current era: fake news, hacking, collusion and pressing the f**k-it button as a political choice--watching with glee at the destruction that follows. F**k-it buttons are in the mind. However, their concrete representations are abundantly available and easy to use in order to distract from any sense of oppression and convert aggression into excitement, envious attacks or sadism. Harmful aims are easy to hide behind screens, swiping and clicking away.

I believe that avoiding the buttons has become much harder these days. Spotting them in the consulting room and using them as a metaphor to enhance thinking and reflection is very helpful. One of my patients summed it up very effectively when he said, “So really, what you are actually saying is that I should stop pressing the f**k-it button and take the difficult way in rather than the easy way out.”  

File under: The Art of Psychotherapy, Musings and Reflections