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Old mindset, new limitations

Old mindset, new limitations

Against the advice of her parents, Karen Horney decided to attend medical school in 1906, at the University of Freiburg in Germany. At the time she was one of few women seeking a career in the traditionally male-dominated discipline of medicine, and one of even fewer women involved in the burgeoning school of thought called Psychoanalysis.1

Karen Horney is an important and often overlooked author of 20th-century psychology. As a whole, her work is fascinating, particularly on historical grounds. At the same time, I take issue with psychoanalysis as a school of thought. Many of its claims rely heavily on anecdote and appeals to authority, with terminology that is often vague and obfuscating. From a historical perspective, however, I enjoy reading about it.

As a metaphor, there are two concepts of Horney’s that I find pretty straightforward and useful: The ideal image, and The Tyranny of the Shoulds.2 The first holds that some event in life, or some ongoing situation, leads one to imagine the ideal of who they need to be in order to escape the difficulty. The Tyranny of the Shoulds is what maintains striving towards the Ideal Image. For example, if one is striving towards the ideal of perfection, they might come to think, “I should be prepared for all possible negative outcomes, I should not let people see me like this, I should do better than that, I should not make such stupid mistakes, I should have known, I should look better than I do, I should try harder, I should be able to do what ever I set my mind to,” and so on.

Since my RA diagnosis, I often have my own tyranny of shoulds. For example I often think: “I should still be able to compete in the sports I love, I should be able to ignore this pain and keep going, I should be able to read without getting tired, I should be able to carry the groceries up the stairs, I should be doing more than I am, I should set a better example, I should get up and keep going,” and so on. The “shoulds” stem directly from the contradiction between my reality, and my ideal.

The unfortunate truth is that my image of who I am and who I strive to be was built during my lifetime before I developed rheumatoid arthritis. The knowledge of what I am capable of persists, despite the new limitations. The harsh truth is that I can’t start over, work really hard, tackle difficult tasks, and end up with the exact same ability I had before. Yet, I can persevere. The disease continues to surprise me and knock me flat, and I keep getting up again. The frustration the disease brings is a constant battle. We don’t need our own tyranny of the shoulds and self-imposed guilt making it worse. It is enough to do the best we can.

This article represents the opinions, thoughts, and experiences of the author; none of this content has been paid for by any advertiser. The team does not recommend or endorse any products or treatments discussed herein. Learn more about how we maintain editorial integrity here.

  1. Karen Horney. Encyclopædia Britannica. 2016. Updated May 12, 2005. Accessed July, 1 2016.
  2. Horney K. Neurosis and Human Growth: The Struggle toward Self-realization. New York: Norton, 1950.


  • Pwilcox
    3 years ago

    After being pain free for 62 years and only annual well visits, my 2014 routine mammogram showed breast cancer. Early detection, contained, only lumpectomy and 10 radiation treatments required. I worked through it all except for 2 days after the lumpectomy. Should be the end of the story, right? Two days after my radiation ended, I developed excruciating pain in my shoulders radiating to my hands. It was a mystery to everyone, my long time family physician, Neurologist Specialist, Oncologist, Cancer surgeon, Chiropractor, Pain Clinic, etc. An Orthopedic Surgeon said my shoulders were ‘crushed’ and I needed total shoulder replacement. Not knowing any better I went through with it thinking the surgery would end my pain. By then 18 months had passed and my hands looked deformed and I was dragging my foot. Back to my family Dr., sobbing telling him I just wanted to die. He looked at my hands and foot and finally ran a simple lab test for RA. My inflammation numbers were off the chart. Finally a diagnosis and referral to a Rheumatologist. Up until this time I had never read one word about RA, nor did I know anyone that had been diagnosed with it. RA has changed my life in ways I never imagined. I was forced to give up a job of 40+ years that I enjoyed because of the pain. I gave up all benefits including employer Insurance. October, 2016 was one year since my diagnosis and I still have much to learn about RA. I will always wonder about the mystery of absolutely no pain or sickness for 62 years – For real, I never took a sick day – then sudden onset of RA after radiation. Still, I am thankful for each day and look forward to the future. My husband and I traveled extensively during our working years and are learning how to travel within the limitation of RA which is not easy because it is such an unpredictable disease. Flying has become a concern because, what if the morning of flight, I can’t walk without pain and cannot navigate airports? We are traveling within our state of NC and nearby states where we will not be far from home and I don’t have to walk a lot if it is a bad day. I am learning to say no and not apologize if I have to cancel plans or just don’t feel like doing something but sometimes it does work pyschologically on one’s mind if you wander to ‘what you used to do’. I pull myself up and shake off the pity party and focus on what I can do. Visiting Nursing Homes is a great inspiration for my husband and me because it puts everything into perspective. Life goes on, we go on the best we can and give Thanks for each day. All my Best to you Michael! P.S. It might make a good book to collect all the different experiences of people that have been diagnosed with RA. No one story would be the same and I would buy the book!

  • btcavanaugh1720
    3 years ago

    This is a perfect day for me to read this message. I have been struggling with increasing pain and limitations for many months due to sacroiliac and hip problems. Doctors have been consulted with , new DMARD has been added, PT and Pilates Trainer is now part of the team. But the pain increases and limitations grow. And I’m not very cheery. Thank you.

  • Lawrence 'rick' Phillips moderator
    3 years ago

    Indeed we have enough of the bad stuff without added more stuff on the pile.

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