It’s saying goodbye to all the good times you might have together if you didn’t have to say goodbye—all the fun, shared plans and dreams you had dared to believe in, building a future on the shifting sands of your hopeful, fragile optimism. It’s all gone now, and forever, and it is unutterably sad.

We have to say goodbye for lots of reasons. Someone has died or they are dieing. Or they don’t want to see you anymore. Or you have woken up to the fact that, though you really love them, you can’t love them in the way they need you to, or vice versa. Sometimes you’ve just had enough: the pain outweighs the gain—or you realise you have been in denial all this time about the pain and/or the gain you imagined was just a fantasy.

​Perhaps there has been abuse, betrayal, dependence, mixed messages, games, wasted time, passivity, boredom, endless conflict (often over minor things that represent major things—in Gabriel Garcia Marquez’ magnificent Love in the time of Cholera, the two protagonists’ differences were distilled and crystallised into an argument about soap). Your same old tired, unhealthy pattern, yet again. All kinds of hurt. You want different things. You have irreconcilable differences. It’s not you, it’s me. It’s not me, it’s you. You hate each other or, worse, feel completely indifferent. Sometimes it just comes down to choice between you or the other person. You have to choose you. Go on now go, walk out the door.

If you both try, you might be able to navigate through your turbulent waters, and find a way back to each other, and start over, perhaps with some new and different rules of engagement. But of course you might not be sure you want to--whether to stay or go is one of life’s toughest questions.

Perhaps this time, however, it really is the end. You might discover you can end this relationship without a moment’s hesitation, without a single backward glance, and you realise you only thought there was love. You were in love with the idea of love. But other times it is hard to say goodbye to love, and you are heartbroken. The amount of pain is proportional to the amount of love. If it hurts, it means you are human. You are alive.

It remains unopened. He can’t bear to say goodbye.

​Another client kept all the letters from a former partner that he still hankered for. One day, he decided to burn them all, and he was astonished how intense the flames were—the old love letters produced a great deal of heat and light. It was a symbolic experience: he realised how much energy his continued infatuation took from him. After the bonfire, he was able to reclaim that energy, rouse himself from his post-break-up doldrums, and move on in his life with vigour and confidence and a renewed sense of love.

• “A Doll’s House”: Ibsen’s play—written in 1879 but still highly relevant and much-performed—tells the story of Nora, trapped in a stifling bourgeois marriage, characteristic of so many traditional pre-feminist heterosexual couples of yesteryear. One piece of research from the 1970s showed generally elevated levels of psychological distress in single men—and married women. In many old-fashioned partnerships the man holds the power and control, while the woman is subservient, obedient, repressed. The union—controlling parent “ego state” meets submissive child “ego state”—has a dysfunctional kind of equilibrium that can last for years, decades even. Until—with or without therapy—the latter finds their voice, their power, and wakes up. (Or, in fiction, comes to a sticky end, punished for the temerity of wanting to shake off their shackles, eg. Anna Karenina, Madame Bovary and other desperate housewives.) In the last scene of Ibsen’s play, Nora rejects her enslavement to the marriage, motherhood and the tightly constraining, stereotypical role that she has been assigned. She slams the door on the Doll’s House and walks free.

What do these endings have in common?
• A decisive, dramatic finality
• An action taken with a great deal of courage
• A sense of wisdom prevailing over convenience
• Style, and some good lines. Yes, we’ll always have Paris.

But fiction is easy. Real life is messier and far more complicated.
 
Our time is up
How do you say goodbye to your therapist? Do you just stop coming without warning, despite the fact your therapist may have a termination clause in their terms and conditions (I ask for a notice period of at least two sessions). Such a clause may sound self-serving for the therapist but it’s really for clients, who are denied the benefits of a proper ending if they don’t show up. It’s an opportunity to review and consolidate all the work you've done, to say what you’ve been trying to say all these weeks, to offer up feedback, to have a sense of direction going forward. To say goodbye.

“Many clients come to therapy with issues about unsatisfactory endings or losses,” write Emmy van Duerzen and Martin Adams. “It is important that the client does not experience the end of therapy as something else that ended unsatisfactorily.”

A recent article in The Guardian—“Breaking up with a therapist”—quoted a 28-year-old woman from Seattle, who has ended three of her relationships with her therapists by “ghosting” them: “The whole point of having a therapist is not being emotionally invested in them, [and] they aren’t emotionally invested in you if they’re doing their job right,” she said.

I disagree with this point of view. Therapy without emotional investment is like decaf coffee—nice enough but missing the key ingredient. Without some sense of understanding, acceptance and connection, without feeling anything, the potential for lasting change is limited.

Clients often wonder how important they are to their therapist. “You must have a lot more interesting clients than me”—I’ve heard that a few times. Or the other day a client stopped midsentence and said: “Don’t you ever get bored of listening to this shit?” There’s an assumption that for the therapist, saying goodbye must be easy, maybe even a relief in some cases. It’s never written about, but for the therapist, too, goodbyes can be hard.
 
Dearly departed
One thing about goodbyes between people who love each other is that they are never really final. Maybe the goodbye doesn’t hold, and you get back together. Or you keep bumping into each other, or you haunt each other on social media. Even if you stop seeing someone you love, they have become part of you, and you part of they—powerful “internal objects” that continue to grow and influence you. The love, the energy, the relationship—these things keep evolving even in the absence of any further refuelling by each other’s actual presence. Human connections can thrive despite a lack of geographical proximity. Or even a lack of the loved one being alive. Jung was 21 when his father, a pastor, died. His father appeared in dreams throughout his adult life. He became a much greater guide and teacher to Jung in death than he ever was in life. Death shall have no dominion.

Last word
Goodbye!

​So it’s Thanksgiving Day in America, an annual tradition that dates back to 1621, a day for family, gratitude and generosity. A day of eating a big roast (all that tryptophan will make you sleepy—a whole nation sedated). A day of watching the big NFL games on TV (team sports are a safe proxy for aggression and violence—a whole nation pacified). And above all, a day to give thanks (a whole nation made grateful).

There is an idea from the positive-thinking end of psychology that regularly expressing gratitude makes you happy. Some people make every day a day of thanksgiving. There’s a lot to be said for that. You can spend your energies on the half of the glass that’s empty, or you can be energised by the half that’s full. As Victor Frankl wrote in his book on surviving the Holocaust, Man’s Search for Meaning: “Everything can be taken from a man but one thing: the last of the human freedoms—to choose one's attitude in any given set of circumstances.”

It’s one thing for you to choose your attitude—to accentuate the positive in your life, for example, or to give thanks. But it’s quite another for someone else to demand it. Not even your psychotherapist, or Bing Crosby, and certainly not your government, have the right to that. To eliminate the negative, even if that were possible, would be to deny the reality of your situation, your feelings, and an important part of you.

On a national level, positive thinking decrees carry a kind of totalitarian message of the continue-flogging-until-morale-improves variety. There’s something slightly creepy about Bhutan’s state-mandated “happiness” initiative, or the United Nations’ “International Day of Happiness.”

To Native Americans, Thanksgiving is a travesty—it should be a day of mourning. University of Texas professor Robert Jensen argues for turning it into a National Day of Atonement to acknowledge the genocide of America’s indigenous people. Not a day devoted to celebrating colonialism. Ben Norton recently summarized the double standard of powerful nations in Salon (“This is why they hate us”). Western governments will make stirring speeches about freedom and democracy at home, then hope no one notices when they prop up appalling dictators, fund terrorists and destroy democratically elected governments overseas. As president Franklin D. Roosevelt’s is alleged to have said about the brutal Nicaraguan dictator Anastasio Somoza: “He may be a son of a bitch, but he’s our son of a bitch.” Along similar lines, American scholar Noam Chomsky's novel idea for how his nation could reduce the level of terrorism around the world was: “Stop participating in it.”

One photograph. A little boy in a red T-shirt, blue shorts and tiny trainers. He is face down on a beach in Turkey. The toddler, just 3 years old, was Aylan Kurdi. He drowned alongside his brother and mother.

Aylan was just one story in the huge current refugee crisis—a mass exodus of 4 million Syrians attempting to flee war and the occupation of their homeland by Islamic fundamentalists. More than 2,600 have died attempting to cross the Mediterranean for the imagined sanctuary of Europe. In stark contrast to countries like Germany and Sweden, the response from the British government has been pitiful: only 216 Syrian refugees have thus far qualified for the official relocation program and Prime Minister David Cameron originally said the total would not rise above 1,000. “I don’t think there is an answer that can be achieved simply by taking more and more refugees,” he said, thereby blithely consigning thousands to staying home to face persecution, torture, imprisonment and death, or else risking escaping on leaky, overcrowded boats.

The number of forcibly displaced people around the world reached a staggering 59.5 million by the end of 2014, compared to 51.2 million a year earlier and 37.5 million a decade ago. The massive increase in people in search of refuge over past decades is no accident. It is the direct result of globalisation, a Third World crisis born to a significant degree of First World politics. As long as there are great disparities between economic, social and political conditions between countries in the world, migration in large numbers is inevitable.

The easiest way to justify such a profoundly unequal and unfair world order is to blame its victims, through a process of “othering” or what Edward Said calls “Orientalism.” Dominant powers establish “truth” about both themselves and those over whom they exert power. “We” are surely rational, developed, humane and good, while the “other”—foreigner, immigrant, refugee, asylum seeker, eastern European, Muslim, African, Asian, black, nonwhite—is portrayed as inherently barbaric, inferior, backward, aberrant, criminal, corrupt, violent, poor, lazy and dirty. The mobilization of such negative stereotypes by politicians and press in the U.K. has been going on for generations. Both of the two main political parties compete in a dismal race to the bottom for the perceived electoral asset of “toughness” toward outsiders, while sections of the British media, which have a long, horrible history of xenophobia, compete to see which can attract the greatest number of readers by publishing the most hostile, fearmongering stories. A columnist in The Sun recently called the refugees “cockroaches”; the Daily Mail wondered why the government could stop Hitler but not “a few thousand exhausted migrants.”

As Noam Chomsky writes: “Propaganda is to a democracy what the bludgeon is to a totalitarian state.”

And then, on Wednesday, a photograph appears, the corpse of a little boy, washed up on the shores of “Fortress Europe.” And through the democracy of social media, the public responds, magnificently, with great humanity, putting the politicians and tabloids to shame with campaigns (eg. #refugeeswelcome), fundraising and relief runs, petitions, marches, banners at football matches and all kinds of extraordinary, individual offers of help.

“I’ve worked for the UNHCR for more than seven years and, to be honest, this is the most generous response I’ve seen in terms of the way it has touched people and their willingness to offer help on a very personal level,” said Laura Padoan of the UN refugee agency.

Therapy—for better or for worse?
In psychological terms, the demonizing “othering” process is called projection. All the unpleasant parts of us are ascribed instead to the “other” such that we can preserve a self-image of purity. This happens individually, between us, and it happens collectively, between nations. What Jung called “the shadow” does not live in foreigners from Third World. It lives in all of us.

Psychotherapy, too, has a tendency to project, to “other,” to blame the victims. Social environment psychologists like Erich Fromm, Harry Stack Sullivan and Karen Horney have pointed out that so much human psychological distress and suffering is born of dire circumstances, the result of a ravenous capitalism machine that mankind used to master but has now enslaved us.

Rather than looking for insight, the late British psychologist David Smail argued that therapists should look for “outsight”—an awareness of a person’s environment, of the oppressions of a deeply-unfair social order; an indefensible hierarchical power structure that keeps people down.

Not surprisingly, studies have shown considerably higher rates of psychological distress among refugees, including PTSD, depression and somatic complaints compared to the general population or other kinds of migrant. Let’s hope that the traumatized refugees who do manage to arrive at our green and pleasant land aren’t then exposed to the kind of counselling that invites them to consider their dysfunctional “negative automatic thoughts” or unhelpful “repeating patterns” of behaviour.

Writes Smail: “I can think of no mainstream approach to psychological therapy which doesn’t harbour at its core a humourless authoritarianism, a moralistic urge to control, that has the ultimate effect of causing infinitely more pain than it could ever conceivably hope to cure.”

The ways that counsellors and psychotherapists seek and work with both insight and “outsight,” the extent to which they “other” their clients, and the power dynamics in the consulting room determine whether they are part of the problem or part of the solution. Therapy, for better or for worse, operates at the intersection of the personal, the professional and the political,

Togethering
In his 1955 book The Sane Society, Erich Fromm concludes: “In the nineteenth century the problem was that God is dead; in the twentieth century the problem is that man is dead.” The future, he argued, will either see a grand, mutual destruction—or else a rediscovery of our shared humanity.

Sometimes we are woken up to that shared humanity. We meet someone who rocks us out of our complacency. Or something dreadful happens to us that makes us see things afresh. Or we see a devastating photograph that completely stops us in our tracks.

The image of Aylan’s lifeless little body cuts through all the stereotypes, the xenophobia, the UN reports, the statistics of war (the greater the number of people suffering, the greater the likelihood of a collapse of compassion). He could have been your child, or a friend’s child or any child. He could have been you.

We look at that photograph and we feel outraged. We are impelled to do something. We might not get it right. We might be clumsy and make mistakes. But we try to come out from behind our own borders and boundaries and barricades. We join forces, we connect, we act. We are One World. And so, instead of “othering,” we tiptoe towards some kind of “togethering.”

• How you can help

Oliver Sacks, 82, died on Sunday. The New York-based British neurologist spent a lifetime working with complex cases, along the outer margins of human experience, at the intersection of brain, mind and the mysterious electricity that runs through our lives and connects us all.

Sacks was a gifted and generous writer, too, and shared what he knew in a wealth of highly-accessible books and articles, mostly in the form of extraordinary case studies—dispatches from the far-flung fringes of consciousness (including his own, such as his memorable memoir to weekend drug-taking during the 1960s).

He wrote of bizarre cases of brain damage; savants, amnesiacs, colourblind artists; a surgeon with Tourette’s, a man who developed a passion for music after being struck by lightning, and—the title of his bestselling book--The Man Who Mistook His Wife for a Hat.

Many neurologists lack Sacks’ sense of wonder. They are fixated on the machinery of the brain; Sacks was interested in the ghost in the machine, too. In his lifetime there has been an avalanche of new neuropsychological knowledge born of extraordinary advances in functional neuroimaging techniques. Brain scans are fascinating, but perhaps tell us little of human souls. They are the flickering shadows on the walls of Plato’s Cave.

An atheist by disposition, Sacks nevertheless had many encounters through his work with something larger, with the numinous. He was perhaps a kindred spirit to Albert Einstein, who described himself as both an atheist and a devoutly religious man.

Also evident in Sacks’ writing is his humanity; a deep compassion for his patients and an appreciation for the courage and dignity they brought to their peculiar, individual challenges. And for the never-ending creativity, resourcefulness and power of human brains, minds and spirits. Writing in The New York Times on the first day of 2011, Sacks said: “I have seen hundreds of patients with various deficits — strokes, Parkinson’s and even dementia — learn to do things in new ways, whether consciously or unconsciously, to work around those deficits. That the brain is capable of such radical adaptation raises deep questions. To what extent are we shaped by, and to what degree do we shape, our own brains? And can the brain’s ability to change be harnessed to give us greater cognitive powers? The experiences of many people suggest that it can.”

In fact, deficits in one area can stimulate extraordinary growth in another. Sacks wrote in An Anthropologist on Mars that illnesses and disorders “can play a paradoxical role in bringing out latent powers, developments, evolutions, forms of life that might never be seen or even be imaginable in their absence.” 

There are many examples of this notion that you need grit in the oyster to make a pearl, that roses grow out of the dirt, that some disadvantage can create unexpected advantage. In the book David & Goliath: Underdogs, Misfits and the Art of Battling Giants, Malcolm Gladwell  speaks of “desirable difficulties," citing one study that claims a third of entrepreneurs have dyslexia. “We see so many entrepreneurs who have dyslexia," he writes. “When you talk to them, they will tell you that they succeeded not in spite of their disability, but because of it. For them, they view their disability as desirable.”

Many great pioneers, creators and agents of social change have personal histories of hardship and trauma. Life’s hurdles can trip us up. But they can also make us extremely good at jumping.

Sacks' personal hurdle was his sexuality. Tragically, he felt he had to keep the fact that he was gay hidden from view. For more than half his adult life he was celibate, and alone, only finding a partner and falling in love at the age of 77. Perhaps such a famine in his personal life was not entirely unrelated to the extraordinary feast of his work and other interests.

Wake up call
Dr. Sacks is perhaps best known for his work with patients who had spent decades frozen in a catatonic state caused by encephalitic lethargica. He describes entering a ward of such patients in 1966: “I suppose the first impression was that I had entered a museum or waxwork gallery,” Sacks told NPR in 1985 (it’s worth listening to the interview to get a measure of his eloquence). “They were motionless figures who were transfixed in strange postures — sometimes rather dramatic postures, sometimes not — with an absolute absence of motion, without any hint of motion.”

Sacks was able to defrost these utterly frozen patients, to bring them back to life, sometimes quite suddenly, by administering the-then brand new Parkinson’s drug Levadopa or synthetic dopamine. Like Sleeping Beauty, these patients woke up. Their experiences became the basis for Sacks’ 1973 book Awakenings, which was adapted into a film starring Robin Williams and Robert DeNiro, and the Harold Pinter play A Kind of Alaska.

“It seemed to be the dawn of a new day, the birth of a new life,” said Sacks of the resurrections he performed. “There was great joy and a sort of lyrical delight in the world which had been given back. I remember one patient stroking leaves and looking at the night lights of New York on the horizon and everything was a source of delight and gratitude. This was the quality at first. But then, there were problems....”

The problems, Sacks goes on to explain, were ones of excess, going from one extreme to another. “The patients had had not enough life, not enough movement, not enough emotion, not enough dopamine, and now they started to have too much, and things started to run away.”

Most patients crashed and burned, but eventually climbed down from their manic, frenzied highs to reach some kind of balance, a middle way, a peace. They became philosophical about their lives.

“I think illness and deep illness may force one to think, even if one hasn't been a thinking person before,” continued Sacks. “Many of the patients seemed to be poetic, to have become poetic. Auden has a phrase about being ‘wounded into art’ and I sometimes felt that was the case with many of the patients.”

They came to accept that they had been asleep through much of their lives, and were grateful at last for the opportunity to live.

How many of us on this earth, too, have spent lengthy spells of our lives “asleep” in various ways? Who is too busy, afraid, angry, defended, depressed, anxious, stressed, numbed, stuck or otherwise diminished to see and to feel and to be? To be fully alive?

Two weeks before he died, Sacks wrote a final essay in The New York Times entitled “Sabbath.” It concludes: “And now, weak, short of breath, my once-firm muscles melted away by cancer, I find my thoughts, increasingly, not on the supernatural or spiritual, but on what is meant by living a good and worthwhile life — achieving a sense of peace within oneself. I find my thoughts drifting to the Sabbath, the day of rest, the seventh day of the week, and perhaps the seventh day of one’s life as well, when one can feel that one’s work is done, and one may, in good conscience, rest.”

Before we too find ourselves on our deathbed, before it’s all too late, we could all use some awakening. There is still time to engage and be moved and grateful for the wonders and experiences of the world. To live perhaps a bit more like Sacks, who described himself in February as a man of “extreme immoderation in all my passions.”

We should all be stroking leaves.

—John Barton

It’s summertime, that supposedly easy-living season when you might be able to slow down a little, maybe take a holiday, and possibly even read an actual book. If so, my personal top-10 ranking of the best self-help books can be found here.

Since it began in 1859, the self-help publishing industry has grown into an $11 billion business that shows no signs of slowing down. There are thousands upon thousands of self-help books, and some are truly terrible. But the worst I’ve ever encountered is the pernicious bestseller You Can Heal Your Life, by Louise Hay, which inexplicably has sold over 50 million copies.

“I believe we create every so-called illness in our body,” declares Hay. If you can limit yourself to having only “joyous, loving thoughts,” she says, you won’t get ill. And if you already are ill, you can cure yourself—all you have to do is “consciously release any mental patterns ... that could express as dis-ease in any way.”

Psyche+Soma
I do believe that the physical and the psychological cannot be separated, despite Western medicine’s tendency sometimes to do just that. There is a delicate interplay between the two—as the book Why Do People Get Ill? argues, we are psychosomatic beings and illness could certainly better be treated in a more holistic manner. And as a counsellor, I have found it can be enormously useful in the therapy room to explore the possible psychodynamic or symbolic meanings of clients’ symptoms.

But Hay goes to the absurd, simplistic extreme of arguing that the cause of any illness—or even any accident or injury—is all in the mind. It’s the kind of rigid cause-and-effect certainty, based on nothing more than Hay’s imagination, that would make that old Scottish skeptic David Hume turn in his grave.

More seriously, Hay rejects every basic principle of biology and medical science—most doctors, she says, only work “in one of two ways: They poison or they mutilate.” Peddling false hope for profit is dangerous and unethical. Anyone who follows her lead and shuns modern medical help in the wishful hope of being able to think themselves better is taking a huge risk. They are taking their life in their hands.

Hay represents a return to the Dark Ages, The Unenlightenment, when disease and disability were seen as some kind of divine retribution for moral lapses or sins. If you’re guilty these days of the crime of not thinking positively enough, of finding life difficult, unfair or frightening, well then, says Hay, you will be punished with some ghastly affliction. So not only are you ill, you must now also suffer the additional toxic burdens of shame and guilt, born of Hay’s oppressive judgement that you did this to yourself.

Here’s an extraordinary excerpt from a 2008 interview in The New York Times: 
When I asked her if, since people’s thoughts are responsible for their conditions, victims of genocide might be to blame for their own deaths, she said: “I probably wouldn’t say it to them. I don’t go around making people feel bad. That’s not what I’m after.” I pressed harder: Did she believe they are to blame? “Yes, I think there’s a lot of karmic stuff that goes on, past lives.” So, I asked, with a situation like the Holocaust, the victims might have been an unfortunate group of souls who deserved what they got because of their behavior in past lives? “Yes, it can work that way,” Hay said. “But that’s just my opinion.”

Making Hay
Hay, 88, is a former fashion model who was diagnosed with cervical cancer in the 1970s, something she attributes to her fury and lack of forgiveness over the abuse she suffered as a child, including reportedly being raped at age 5. She refused medical treatment for the cancer, and claims to have cured herself with positive thinking, diet and enemas. Writes The New York Times: “There is, she says, no doctor left who can confirm this improbable story.”

She wrote a small pamphlet of “cures” in 1976. This became the book Heal Your Body which spawned a vast New Age publishing empire whose innumerable titles promise health, wealth, and visitations from angels.

A big chunk of the book is “The List”—a compendium of various ailments and their causes:

• Cancer, for instance, is “caused by deep resentment held for a long time until it literally eats away at the body....the individual lives with a sense of self-pity....people with cancer are also very self-critical...carrying hatreds.” How does that message go down at, say, Great Ormond Street Children’s Hospital, or in oncology wards the world over, or among families that have been impacted by cancer, which by the way is most families: cancer will afflict 50 percent of us in the U.K. at some point in our lives.

• I’d like to see Hay address a roomful of people with diabetes and tell them its supposed cause: “Longing for what might have been. A great need to control. Deep sorrow. No sweetness left.”

• Aids is not caused by the HIV virus but from “a strong belief in not being good enough. Denial of the self. Sexual guilt.”

• “Most bladder problems come from being ‘pissed off,’ usually at a partner.”

• Old people increasingly find walking to be difficult, not as a natural consequence of the aging process but because “their understanding has been warped, and they often feel there is no place to go.”

• Strokes are caused by “negative thinking”; miscarriages by “fear of the future.”

• Animal bites are caused by “anger turned inward. A need for punishment”; bug bites by contrast happen when you have “guilt over small things.”

• “Accidents are no accident. Like everything else in our lives, we create them.”

These deranged ramblings would be funny if they didn’t inflict so much pain on vulnerable people who are already suffering. Blaming the victim is an insult to anyone who has ever got sick; to the memory of any family member, friend or colleague who has died of anything other than natural causes. As someone who has struggled with chronic illness I find Hay’s philosophies to be at best highly presumptuous and at worst deeply offensive.

Such irresponsible quackery should come with a health warning.

• psychogram #5
• psychogram #4
• psychogram #3
• psychogram #2
• psychogram #1
• https://instagram.com/world_of_therapy/

DYING WITH DIGNITY

In America in 2009, there was a proposal for Medicare, the government’s health insurance program for the elderly and the disabled, to provide end-of-life counselling. There was an outcry—Republican vice presidential candidate Sarah Palin for instance screeched about  the spectre of government-sponsored “death panels” deciding when the game was over for hordes of frail and befuddled elders. It became a divisive issue that threatened to derail President Barack Obama's health care law.

This week, Medicare finally announced that it intends after all to proceed with end-of-life counselling. There were only a few murmurs of dissent. If the proposal is accepted, the elderly and their families will be able to have conversations with doctors and nurses in advance about what kind of care and interventions they want as they face the final curtain—and what they don’t want.

Giving people greater control over their death seems like an eminently sensible idea. Just because we have the technology to extend life with with a roomful of machines, tubes and drugs doesn’t always mean that’s the right thing to do, especially when the person involved has clearly expressed their desire not to “live” in this way.

A civilized society should help people to die with dignity. In some countries that means not just withholding excessive though potentally life-saving treatments but actively allowing doctor-administered death, especially when the person is suffering or in great pain from a terminal illness. Switzerland has allowed doctor-assisted suicide since 1942. Voluntary euthanasia—where the doctor actually administers the fatal dose at the patient’s request rather than merely prescribing it or handing it over to the patient—was made legal in the Netherlands in 2002, but only under strict criteria. The patient's request, awareness and level of suffering must be clear and sustained, suitable information and consultation must be provided, there must be absence of reasonable alternatives, doctors must consult with other doctors and they must report euthanasia to a review committee. Belgium followed the Netherlands later in the year, followed by Luxembourg in 2009 and, this year, Canada and Colombia.

The practices of assisted suicide and voluntary euthanasia are both illegal in the U.K., but that may change. According to a 2007 survey, 80 percent of Brits are in favour of giving terminally ill patients the right to die with a doctor's help.

In the U.S., a Supreme Court decision left rulings about assisted suicide to the discretion of individual states. Oregon swiftly passed a law allowing doctors to prescribe lethal drugs for people who have been given less than six months to live. Washington, Montana and Vermont now have similar laws in place.

Opponents of such laws are concerned that they could be abused. A compliant or confused parent for instance might be coerced into literally signing their life away by uncaring offspring who are eager to get their hands on an inheritance as soon as possible.

“I don’t want to be a burden,” the elderly often say.
“Ok, well sign here then,” the heartless son or daughter might reply.

But the problems, the violations, the abuses, do not alter the principle. Just because some people might exceed the speed limit, jump a red light or drive without a license does not mean that all driving should be banned.

We have some choices in how we live. Perhaps an enlightened government can offer some choices in how we die, too.

Medicare plans to pay for end-of-life counseling
From the Boston Globe:

Medicare, the federal program that insures 55 million older and disabled Americans, revealed plans Wednesday to reimburse doctors for conversations with patients about whether and how they would want to be kept alive if they became too sick to speak for themselves.

The proposal will be open for public comment for 60 days, but it is expected to be approved and take effect in January. If adopted, it would settle a debate that raged before the passage of the Affordable Care Act, when Sarah Palin labeled a similar plan as tantamount to setting up “death panels” that could cut off care for the sick.

Medicare’s plan comes as many patients, families, and health providers are pushing to give people greater say about how they die — whether that means trying every possible medical option to stay alive or discontinuing life support for those who do not want to be sustained by ventilators and feeding tubes.

“We think that today’s proposal supports individuals and families who wish to have the opportunity to discuss advance care planning with their physician and care team,” said Dr. Patrick Conway, the chief medical officer for the Centers for Medicare and Medicaid, also known as CMS, which administers Medicare. “We think those discussions are an important part of patient- and family-centered care.”


U.K. NEWS

Will George Osborne's budget give our children Hikikomori - Japan's new mental health problem?
Mirror.co.uk:

George Osborne's budget will create a generation of young people too scared to leave their bedrooms and rendered mute by fear of the future, according to a British expert.

They will be suffering from Hikikomori a condition believed to affect as many as ONE MILLION Japanese.

Symptoms include hiding away from society and only interacting with the world to surf the Internet and reading fantasy literature.

The Chancellor's plans to limit the living wage to those aged 25 and older, along with scrapping grants to university students, increasing fees in line with inflation and cancelling housing benefit for 18-21 year olds are all likely to make matters worse.

Hikikomori is a huge problem among Japanese youth and can lead to people locking themselves away from the outside world for months and sometimes years on end.


Children's mental health must be cared for. Or the consequences will be dire
From former minister for mental health Paul Burstow, in The Guardian:
 
The chancellor tells us that he is putting into law the obligation to generate budget surpluses in the “interests of our children”. But the axing of funding for children’s mental health in the service of economic dogma will condemn a generation of young people to a life of misery for want of the right mental health support in their early years.

Half of life-long mental illness has its first signs and symptoms in the teenage years. Poor maternal mental health can have profound consequences for them, for their children and their children’s children. The LSE put a figure on this of £8.1bn.

Yet while one in 10 children and young people has a treatable mental illness just one in four receives treatment. It is a shocking indictment of our mental health services.

• School accountability triggering pupil mental health problems, research warns (The TES)

• Exam focus damaging pupils' mental health, says NUT (BBC News)

 
More provision needed for mothers during pregnancy and after birth
Medical Xpress:
 
More research is needed to improve the identification and treatment of women with perinatal mental health issues, according to a new editorial co-authored by Professor Susan Ayers, the lead of the Centre for Maternal and Child Health Research at City University London.

Along with co-author Judy Shakespeare, from the Royal College of General Practitioners, Professor Ayers' article highlights how between 10 and 20 per cent of women suffer from mental health problems during this period, costing the NHS £1.2 billion a year. The editorial is published in the journal of Primary Health Care Research & Development.

Mental health problems can arise in pregnancy or after birth and most commonly consist of anxiety, depression, post-traumatic stress disorder (PTSD) following a difficult birth and stress-related conditions such as adjustment disorder. Severe postnatal mental illness, such as puerperal psychosis, is less common, but is one of the leading indirect causes of maternal death.

U.S. NEWS

Researchers: Vampires are people, too, and need as much psychotherapy as the rest of us
From the Washington Post:

Vampires are real. No, not the impossibly perfect Cullens in the "Twilight" movies or tortured but well-dressed souls in CW shows. But human beings who self-identify as vampires and may drink blood or sleep in coffins. And these people need as much psychotherapy and medical help as the rest of us.

That's the conclusion of a study by D.J. Williams, director of social work at Idaho State University, and published in the July issue of the peer-reviewed journal Critical Social Work.

Williams and his co-author, Emily E. Prior, a researcher at the College of the Canyons, interviewed 11 vampires from across the United States and South Africa and found that they were reluctant to come out to clinicians because they were fearful about being labeled as being psychopathological or "perhaps wicked, and not competent to perform in typical social roles, such a parenting."

However, he noted that the people he interviewed "seem to function normally, based on demographic questions concerning their psychiatric histories, in their social and occupational roles, and some have achieved considerable success in their chosen careers."


WORLD NEWS

India: counselling reveals anger, helplessness
From The Hindu:

Counselling sessions of the victims of the child prostitution case revealed their anger and helplessness at their precarious plight.

The victims are believed to have told counsellors arranged by the Child Welfare Committee that they were angry with themselves and with those who had pushed them into prostitution.

They reported feeling guilty and disoriented, and having haunting memories and an inability to remain calm according to information from the sessions overseen by the CWC.

Apart from the anxiety about the future, there was also fear about being recognised in public.


VIEWPOINTS

Sex therapy is making its way into couples counseling, and it's about damn time
From Lea Rose Emery, in Bustle:

Some “renegades” in the field of couples therapy are bringing sex into counseling, The New York Times reports. Although couples therapy and sex discussion may seem like obvious bedfellows, discussions of sex have often been, counterintuitively, absent during couples counseling. The reasons for this may be that the two arenas, couples counseling and sexual counseling, developed as completely different strains, meaning that overlap between them was limited. Often relationships counselors often have no sexual training, as there are currently no requirements for sexual education in traditional counseling licensing.  And the opportunities to receive sexual training are limited. According to The New York Times there ”is only one certification program for sex therapists, the American Association of Sexuality Educators and Counselors, which means aspiring sex therapists may find access to courses and supervisors a challenge.” 
But luckily the increased acknowledgement of the importance of sex in relationships may help change this. Some therapists are now “emphasizing the importance of good sex in relationships and sometimes suggesting the radical idea that couples fix the sex before tackling other issues”. This makes me so happy. 

 
Psychiatric drugs are false prophets with big profits. Psychiatry has been hijacked
From Robert Berezin MD, Mad In America:

We have repeated the same mistakes over and over again, and we are doing so today. It doesn’t seem to matter that the chemical imbalance theory has been discredited. It doesn’t seem to matter that the multibillion dollar pharmaceutical industry and its influence peddling in academic psychiatry has been exposed as financially and scientifically corrupted and manipulated. The drug companies have engaged in study suppression, falsification, strategic marketing, and financial incentives. A complete picture of the studies that pretended to validate antidepressants has now emerged which confirms that they do absolutely nothing. (See – “No, it’s not the Neurotransmitters, Depression is not a biological disease cause by an imbalance of serotonin.”) It rakes in a whopping $70 Billion a year for the drug companies. Unfortunately once people embrace a false belief it is so hard to think clearly again. I’m told its irresponsible to be so extreme. A thoughtful psychiatrist would use both drugs and psychotherapy. Apparently this sounds reasonable in today’s climate. Doing harm is never reasonable.
Human struggle is now, and always has been, the real issue. The very idea that drugs can cure what ails is an insult to the human condition.


The magical healing power of caring and hope in psychotherapy
From Allen Frances in the Huffington Post:

There are three consistent research findings that should make a world of difference to therapists and to the people they treat.

First, psychotherapy works at least as well as drugs for most mild to moderate problems and, all things being equal, should be used first.

Second, a good relationship is much more important in promoting good outcome than the specific psychotherapy techniques that are used.

Third, there is a very high placebo response rate for all sorts of milder psychiatric and medical problems.

This is partly a time effect -- people come for help at particularly bad times in there lives and are likely to improve with time even if nothing is done. But placebo response also reflects the magical power of hope and expectation. And the effect is not just psychological -- the body often actually responds to placebo just as it would responded to active medication.

These three findings add up to one crucial conclusion -- the major focus of effective therapy should be to establish a powerfully healing relationship and to inspire hope. Specific techniques help when they enhance the primary focus on the relationship, they hurt when they distract from it.