When Therapy Works, Life No Longer Fits

How we learn to function from an early age, and what happens when we stop

Therapy is considered successful when a person suffers less. What this definition leaves out is that they may suffer less and still lose a marriage, leave a job or break with their family. Psychiatrist and psychoanalyst Hans-Joachim Maaz, who has worked clinically for decades, does not treat such ruptures as incidental. They may reveal what the old life depended on.

Adaptation begins early

No child decides to adapt. It learns adaptation in much the same way it learns language, through what receives a response and what is left unanswered. Which feelings are welcome. When closeness is safe. What might lead to rejection. When affection is conditional, adaptation becomes more than a social skill. It becomes the price of belonging.

Maaz describes this pressure in stark terms. A child who is alienated from itself and taught how it is supposed to be can experience adaptation as a matter of life and death. The child cannot leave its family or find another environment. It does what it must to preserve the bond. Anything that threatens that bond recedes into the background: feelings, wishes and perceptions.

“Denial is essential for survival.”

Hans-Joachim Maaz in the interview

In his book Das falsche Leben (The False Life), Maaz traces this back to a distinction that runs through his entire argument: upbringing or relationship. Upbringing works through praise and punishment. It divides children into easy and difficult, and their behaviour into right and wrong. Relationship begins elsewhere. It asks what reaches the child before deciding what adults believe should reach it. For Maaz, this is not a matter of educational taste. It helps determine whether a person will later live a genuine life or a false one.

“Relationship rather than upbringing means love rather than power, community rather than competition, natural striving rather than artificially exaggerated effort.”

Hans-Joachim Maaz, Das falsche Leben, p. 13

Sigmund Freud had already argued in “Civilization and Its Discontents” that civilization demands renunciation and that the superego moves external authority inside the person. Maaz shifts the focus. He asks how early relationships and social expectations can turn necessary adaptation into lasting self-alienation.

Donald Winnicott gave this phenomenon a name in 1960: the False Self. It is not a fraud but a protective structure. It conceals a living, spontaneous core when the environment leaves too little room for its expression. Not every act of politeness is false. The problem begins when functioning takes over almost the whole of life and a person can barely sense what they feel or want.

Avi Assor, Guy Roth and Edward Deci examined an important part of this process in 2004. In their studies, parental conditional regard was associated with stronger internal compulsion and more frequent enactment of the expected behaviour. It was also linked to fluctuating self-esteem, ill-being and resentment toward parents. The adaptation worked. The cost simply appeared on another account.

A False Self does not remain without consequences. Maaz describes splitting, projection and reaction formation as mechanisms that stabilize alienation. What relieves the individual psychologically can reappear socially as enemy images, camp thinking and moral certainty. The False Self protects itself by locating the problem no longer in one’s own life, but in other people.

Normopathy: when normality itself becomes pathological

At this point, Maaz moves beyond the private sphere. For him, individual alienation is not merely the result of a difficult family. It also reflects the expectations of society. At school, those who sit still, perform and follow established routines are rewarded. The same standards continue at work, in institutions and in social groups. Recognition often goes not to the person who knows themselves well, but to the person who functions reliably.

“The alienation of the individual is always a symptom of the alienation of society as a whole.”

Hans-Joachim Maaz in the interview

Maaz uses a term for this condition that also appears in the subtitle of his book, Causes and Consequences of Our Normopathic Society: normopathy. It describes a form of adaptation that no longer looks pathological because almost everyone shares it. The person affected does not appear ill. They appear dependable. What is striking is precisely how unremarkable they seem, and how completely they can fulfil expectations while leaving no space for their own experience.

“The ‘normopathy’ of a society (…) is, so to speak, the accumulated and concentrated energy of false selves, which need social structures in which their disturbances can successfully unfold (…).”

Hans-Joachim Maaz, Das falsche Leben, p. 116

The psychoanalyst Joyce McDougall used the term normopathy before Maaz. Christopher Bollas described a related phenomenon as “normotic illness”: a person who appears perfectly adapted from the outside but has little interest in their inner life and treats the self almost like an object. Winnicott’s False Self and Maaz’s normopathy meet at this point. They are not identical, but they describe the same loss of subjectivity at different levels.

The social critique behind this idea also has a history. In 1955, Erich Fromm wrote about the pathology of normalcy. A society, he argued, can produce forms of behaviour that serve its continued existence while distancing people from their own needs. Mental health cannot then be measured by how smoothly someone fits in. Perfect adjustment may itself be evidence that a person has become estranged from who they are.

Theodor W. Adorno condensed this tension into one sentence, rendered by his English translator E. F. N. Jephcott as “Wrong life cannot be lived rightly.” Maaz cites the German original in his book. It is not a therapeutic maxim, but it touches the experience at the centre of this discussion. A person can change internally without the conditions around them becoming healthier. The question is no longer only how to function again. It is what, exactly, one is being asked to adapt to.

R. D. Laing took the argument to its most radical conclusion in 1967. He distrusted a psychiatry that treated social normality as synonymous with health and described alienation as something produced in ordinary relationships and institutions. Children do not merely learn rules there. They may learn to trust the interpretation of their environment more than their own experience. The adapted child becomes an adult who knows their place but hardly knows themselves.

Why change disrupts relationships

Therapy can make this old contract visible. A person begins to take their feelings seriously, set limits and speak where they once remained silent. They become, in Maaz’s words, more critical, autonomous and self-confident. They know more clearly who they are. That sounds like personal growth. In practice, it changes the entire arrangement in which they have been living.

Family therapy offers a sober description of what follows. Don D. Jackson introduced the idea of family homeostasis in 1957. Families behave like systems that defend an established equilibrium, even when it is costly for the people involved. Murray Bowen described what happens when one member begins to differentiate, holding a position of their own without cutting off the relationship. The response often follows a familiar pattern: You are wrong. Change back. If you do not, there will be consequences.

Relationships develop their own order over time. One person explains while the other gives in. One demands while the other calms things down. One becomes responsible for the emotional atmosphere in the room. Once that person leaves the old role, everyone else must move as well. Some can. Others experience the change as an attack, even when the person has simply stopped abandoning themselves.

“The existing relationship no longer works, the disturbed relationship.”

Hans-Joachim Maaz in the interview

The social cost of getting better

“In successful therapy, it can happen that a person no longer fits into the family, a political party, their professional position or a religion.”

Hans-Joachim Maaz in the interview

This is the price. The symptoms diminish, but old forms of belonging become uncertain. A job that was bearable only through self-denial suddenly feels intolerable. A partnership built on constant submission enters a crisis. A family becomes irritated because the person who once balanced everything is no longer willing to perform that role.

This does not mean that every separation, resignation or estrangement proves that someone has recovered. Therapy should not create a new certainty in which other people are always the problem. Anyone who moves from a false life into an equally rigid counter-position has not left the structure behind. They have only reversed the sign. What therapy can offer is a finer distinction. Where is compromise possible? Where does adaptation become self-abandonment? Which relationships can carry change, and which work only as long as someone makes themselves smaller?

“I live a false life when I must always be perfect and successful, when I cannot admit weakness or limitation, and when I must hide fear and mistakes at all costs.”

Hans-Joachim Maaz, Das falsche Leben, p. 114

Not fitting in again, but becoming alive

Perhaps this is the most uncomfortable insight in the conversation. Therapy does not necessarily return a person to their old life. It can reveal that some things which long appeared normal worked only through alienation. Success then no longer means becoming better at meeting the same demands. It means no longer sacrificing one’s own perception simply in order to belong.

Edward Deci and Richard Ryan describe autonomy, competence and relatedness as basic psychological needs. Autonomy and connection are not opposites. People often feel most connected to those who support their independence. Bowen likewise understood differentiation not as distance, but as the ability to remain oneself in close relationships. Autonomy does not mean living without attachment. It means being present in relationships without disappearing inside them.

It is striking that Maaz does not end his book by diagnosing other people. He closes with a chapter about his own self-alienation. Anyone who writes about normopathy is not standing outside it. This is more than a gesture of humility. It follows from the argument itself. To diagnose a false life in others without suspecting it in oneself would repeat the very movement Maaz describes.

“I understand my life as an ongoing struggle to learn, as best I can, to overcome the alienation imposed on me and then continued under my own responsibility.”

Hans-Joachim Maaz, Das falsche Leben, chapter 27, p. 251

What remains is not a simple message but a question. If I no longer have to function at any cost, which parts of this life still fit me? The answer may be painful. It may also be the beginning of a life that does not merely work from the outside, but feels like one’s own from within.

Sources and further reading

Adorno, T. W. (1974). Minima moralia: Reflections from damaged life (E. F. N. Jephcott, Trans.). NLB. (Original work published 1951)

Assor, A., Roth, G., & Deci, E. L. (2004). The emotional costs of parents’ conditional regard: A self-determination theory analysis. Journal of Personality, 72(1), 47–88. https://doi.org/10.1111/j.0022-3506.2004.00256.x

Bollas, C. (1987). The shadow of the object: Psychoanalysis of the unthought known. Free Association Books.

Bowen, M. (1978). Family therapy in clinical practice. Jason Aronson.

Freud, S. (1930). Das Unbehagen in der Kultur [Civilization and its discontents]. Internationaler Psychoanalytischer Verlag.

Fromm, E. (1955). The sane society. Rinehart.

Jackson, D. D. (1957). The question of family homeostasis. The Psychiatric Quarterly Supplement, 31(Suppl. 1), 79–90.

Laing, R. D. (1967). The politics of experience and The bird of paradise. Penguin.

Maaz, H.-J. (2017). Das falsche Leben: Ursachen und Folgen unserer normopathischen Gesellschaft [The false life: Causes and consequences of our normopathic society]. C.H.Beck.

McDougall, J. (1978). Plaidoyer pour une certaine anormalité [A plea for a measure of abnormality]. Gallimard.

Ryan, R. M., & Deci, E. L. (2006). Self-regulation and the problem of human autonomy: Does psychology need choice, self-determination, and will? Journal of Personality, 74(6), 1557–1586. https://doi.org/10.1111/j.1467-6494.2006.00420.x

Ryan, R. M., & Deci, E. L. (2017). Self-determination theory: Basic psychological needs in motivation, development, and wellness. Guilford Press.

Winnicott, D. W. (1965). The maturational processes and the facilitating environment: Studies in the theory of emotional development. The Hogarth Press and the Institute of Psycho-Analysis.

About the interview

In this episode of Reclaim Your Reality, I speak with Dr. Hans-Joachim Maaz about emotional suppression, the false self, early relational experiences, chronic stress, conformity and normopathy, the limits of adaptation, and the path towards authenticity, autonomy and personal agency.

https://youtu.be/iEDzgqlgMWM