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Me and my shadow

24/3/2023

 
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Are you a good person?

Are you kind to fellow humans—and all creatures great and small?

Do you support worthy charities, help those in need, and do good work?

Or do you have a dark side? Is there part of you that wants to lie and cheat and manipulate situations to your advantage? Are you interested in enriching yourself—even if that comes at a cost to others?

The answer is: All of the above. In the fine words of that great philosopher Paul McCartney: There is good and bad in everyone. Humans are capable of astonishing acts of courage and bravery, but under certain circumstances we might be utterly spineless, cruel, greedy or depraved. To deny these things in you—what Jung called the shadow—is to project them unconsciously onto others.

“I’m a good person,” a client said. But all around her—her husband, her children, siblings, parents, neighbours, immigrants, foreigners—were bad. This construction of the world left her lonely and disengaged, holding on only to her sense of superiority. She came to therapy when it came crashing down.

“I’m the bad guy?” says Michael Douglas at the end of the movie Falling Down. Robert Duvall, the cop aiming his pistol at him on the Santa Monia Pier, nods. 
​

“How’d that happen?”

A few weeks ago my therapist sent me a link to an extraordinary song that explores these themes. Hi Ren went live on YouTube on December 15 last year. When I first saw it, it had surpassed 5 million views. Today it’s reached 8.2 million and it's rising super fast. Word of mouth: This is the song of our time; a human anthem.

It starts with Ren, wearing a hospital gown, being wheeled into a semi-derelict room by a man with a pig’s head and a bloodied butcher’s apron. Ren is obviously a patient. He too is perhaps feeling derelict and abandoned—and powerless too in the hands of those charged with his care.

He starts playing the guitar.

It’s beautiful. An acoustic guitar. A pleasing melody. The incongruity of the surroundings. But he’s tugging at the nylon strings a bit hard. A bit twangy. Aggressive considering the sweet Flamenco notes that fill the room.

Then Ren opens his mouth and the melody is joined by a wail of wild, high-pitched half notes. It is otherworldly. It is perhaps something like the human mating call before we learned to speak, or the dawn chorus in Hades. We are drawn to this—we willingly enter his beautiful madness.

And then the rapping starts.

In his famous Red Book, Carl Jung attempts to commune with his own soul.

“ ‘My soul, where are you? Do you hear me?' he starts. 'I speak, I call you – are you
there?’ ”

In this piece of work, Ren opens with a salutation from his shadow to his ego.

“Hi there, Ren,” he hisses. “It's been a little while, did you miss me?”

This is the opening salvo in a blistering verbal assault from Ren’s inner critical voice.

Replies Ren:
“I’ve been taking some time to be distant,” he explains.
“I've been taking some time to be still.
“I've been taking some time to be by myself since my therapist told me I'm ill.
“And I've been making some progress lately,
“And I've learnt some new coping skills”

The critical voice is extremely skeptical:
“Ren, you sound more insane than I do,” he says.

He mocks Ren for imagining that some standard course of treatment—take another pill, the sound of white noise, a 10-step program—will make any difference, and ridicules his musical ambitions.

The argument hots up until the critical voice thunders his authority. He is the snake in Eden. Lucifer. Antichrist. Mephistopheles. Satan.
“I am you, Ren, you are me.”

Who is Ren actually? Where did this guy come from, this Keats-with-guitar? You could be excused for imagining he just picked up a guitar one day in a psych ward and discovered his madness instinctively knew how to play and had something to say.

Ren Gill was actually a talented musician in his youth. He started out making beats in his bedroom at 13, then went on to Bath Spa University to study music performance. One day in 2009, busking in his hometown of Brighton, he was spotted by a talent scout and snapped up by Sony Records.

The childhood dream swiftly turned into a nightmare however. Ren woke one morning feeling utterly lethargic, drained, and aching all over. He started having panic attacks. He’d stay in bed. He said: “My life changed overnight, I woke up one morning feeling like I'd been spiked—my personality disappeared.”

He entered the mental health system. He was put on antidepressants. Antipsychotics. It's not hard to imagine the kinds of interpretations psychology offered up for his illness—he was probably told for example that he was depressed, suffering from low self-esteem, bipolar, afraid of success, delusional, paranoid, mad. In some cultures he would be considered possessed, in need of an exorcism.

​The truth, discovered many years later, was that he had a longstanding untreated case of Lyme disease, the complications of which still impact him today. Ren’s health problems were not manifestations of some inner psychic conflict. He was bitten by a tic.

He has struggled. But perhaps the struggle, the suffering, is integral to his genius.

In the final stanza, Ren refuses to back down, and stands to face his demon:
“I go by many names also,
“Some people know me as hope,
“Some people know me as the voice that you hear when you loosen the noose on the rope.”

I’ve watched Hi Ren countless times now, but this passage, this lone shriek in the cold, silent void of a long and desolate night, this absolute guttural refusal to quit, still reverberates. This is courage. And if you going to live, stand in the fire, sing at the top of your lungs! Ferocious, persistent, immortal! 

The Hollywood movies might leave it there. The good guy narrowly defeats the bad guy, the evil forces are vanquished, and the credit roll as a beautiful melody transports us back to our lives.
 
Critical self
I have worked with many clients whose lives are made wretched by an invisible sargeant major who subjects them to a permanent harangue of negativity. It can come as quite a shock to discover that some of the nicest people are often subject to a totalitarian inner form of government—a brutal, relentless inner monologue that is with them 24 hours a day.

Perhaps it is an internalised strict parent, sibling, school bully, racist, sexist, homophobe, ableist. The child who is abused by a parent may conclude that love and abuse are indivisible. Lorna Smith Benjamin describes masochism as a gift of love to the original abuser.

Perhaps you experienced a traumatic event or time in your life, one that was so terrible it couldn’t be processed so was instead dissociated, divided up into images, sensations, stray thoughts and emotions. You bury these fragments in a deep hole at the far of the garden, but to your great dismay they keep coming back. The past reverberates in the present. Time in itself does not necessarily heal.

I’ve also met people who might have had perfectly idyllic childhoods yet still berate themselves mercilessly for every bone-headed move, bad-hair day or dumb remark. Perhaps your critical voice starts out by alerting you to where you might have room for improvement, acting in your best interests, but over the years it can become domineering and disempowering. 

Incidentally, if “the voice” is more than a thought or a feeling but is experienced as an actual, heard voice, some people might conclude that you must be mad, possessed and probably dangerous. And while such voices may point to the consideration of psychosis, it does not prove it. Many people hear voices at times for a variety of reasons.
​

Therapy might enable a client to develop a greater awareness and understanding of their inner critic. We might imagine it is an actual person—what age, gender? Remind you of anyone you know? The client might have a conversation with their critical voice. It can be useful to think of humans as being made up of multiple “selves,” lots of disparate strands in the tapestry. They all inhabit our being in a loose confederacy. And the client might find some other sentiments in this “community of selves” that can challenge and counter the inner bully.

The shadow
Sometimes, however, therapy attempts to go to far in expunging any negativity or nastiness. Jung argued we not born pure, but whole. We cannot edit ourselves to be merely good. We can never be untethered from our shadow. In Memories, dreams, reflections, Jung called the shadow—“everything that the subject refusers to acknowledge” about themselves (1995: 418).

Pure goodness becomes insipid. Heaven, with no shade, is no place for humans—a place, as David Byrne sung, where “nothing ever happens.”

Anyone who denies their inner propensity for evil as well as good will find that it manifests itself in unanticipated ways.

To make light—to live—is to cast a shadow. This is a chiaroscuro world. 

Artists, poets, writers, musicians, comedians, people who bring light to the world, must also experience darkness. 

And the shadow, by the way, doesn’t always have to be something bad. You might disavow your own brilliance, or talent, or potential for success. The more a person identifies with and invests in one polarity, the greater the opposite polarity grows in the shadow. 

We don't like bad stuff. The child who has not yet learned to tolerate and accept anger will hand it off, screaming at the grown-up: “Why are so angry with me?"

Any emotions, beliefs or characteristics that don't fit with your carefully-crafted, social media-ready self-image are simply projected onto others. Your partner—that's the easiest place to start. Then there are family members—one sibling is often cast as "the bad one"—neighbours, that asshole at work, men, women, black people, white people, those people over there, others.

The targets for projection and scapegoating are plentiful. Twitter is a very shadowy place indeed.

Writes Robert A. Johnson in Owning your own shadow: “Probably the worst damage is done when parents lay their shadow on their children...If a parent lays his shadow on a young child, that spits the personality of the child and sets the ego-shadow warfare into motion."  (1991: 34).

So how do you find your shadow? Ask yourself: Who do you judge? Your enemies, the people you dislike the most, have much to teach you. For they are you.

Projecting your shadow isn't just bad for others. It's bad for your too. Continues Johnson: “To refuse the dark side in one’s nature is to store up or accumulate the darkness; this is later expressed as a black mood, psychosomatic illness or unconsciously inspired accidents. We are presently dealing with the accumulation of a whole society that has worshipped its light side and refused the dark, and this residue appears as war, economic chaos, strikes racial intolerance. The front page of any newspaper hurls the collective shadow at us. We must be whole whether we like it or not” (1991: 26).

You want world peace? To start with, stop pointing accusatory fingers every which way, and instead take a look inside.

If we can own our shadow we can develop some conscious control over it, rather than have it unconsciously express itself in disastrous ways. And if we can accept that we are all flawed, vulnerable, insignificant, ignorant, that life is hard but also beautiful, that not one person on this planet knows how or why we are here, then we can perhaps be more empathic, more forgiving, kinder. We can greet each other. The words “human” and “humility” come from the same root, the Latin word “humus,” meaning earth or ground. We are not celestial beings. We return to the earth. Ashes to ashes, dust to dust.

”No one can escape the dark side of life,” writes Johnson. ”The balance of dark and light is ultimately possible—and bearable” (1991: 15).

Let's dance 
At the end of Hi Ren, this remarkable young man puts the guitar down, looks right into the camera and delivers a powerful soliloquy.

“It wasn't David versus Goliath,” he says, “it was a pendulum eternally swaying from the dark to the light. And the more intensely that the light shone, the darker the shadow it cast.
​
“It was never really a battle for me to win, it was an eternal dance, and like a dance, the more rigid I became, the harder it got. The more I cursed my clumsy footsteps, the more I struggled. And so I got older and I learned to relax, and I learned to soften, and that dance got easier. It is this eternal dance that separates human beings from angels, from demons, from gods. And I must not forget, we must not forget, that we are human beings.”

Weekly news round-up #39

1/4/2016

 
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The big match 
Who do you support?
Team Body—or Team Mind?

The former adopts the “medical model” approach to psychological distress: the root causes are largely found within the biology of the unwitting individual and the best treatment is medication.
Sample narrative: “I am stressed and can't cope. The chemical levels in my brain are slightly off—I need medication to restore the balance.”
 
The Mind team, by contrast, regards symptoms as manifestations of underlying, unresolved inner conflict which needs to be explored, processed and resolved through talking therapy.
Sample narrative: “I am stressed and can't cope. I am such a workaholic and brutally hard on myself—I now see this as some kind of loyalty to my very strict and punitive. parents.”

Longstanding debate 
In his article “The 'drugs v talking' debate doesn't help us understand mental health," in The Guardian on Wednesday, Simon Wessely, chair of psychological medicine at King's College London and president of the Royal College of Psychiatrists, attempts to build a bridge across the yawning divide.
The longstanding debate, he writes, often “has been caricatured as ‘psychiatry v psychology’, or equally unhelpfully ‘drugs v talking’, or ‘brain v mind’. But these are false distinctions, which don’t help in understanding mental disorders, don’t help mental health professionals, and most of all don’t help patients.”
Wessely argues instead for a pluralistic approach: “As there is incontrovertible evidence that physical, psychological and social factors contribute to the development of mental health problems – in different degrees and mixtures according to the type of illness and the particular individual – it follows that treatments that psychiatrists use can be physically, psychologically or socially based, either singly or more often in combination.”
And, according to Wessely, a pluralistic, multidisciplinary approach is precisely what patients get: “The truth is that up and down the land psychiatrists, psychologists, social workers and other mental health professionals work together in multi-disciplinary teams for the benefits of patients.”
 
All that is missing from the picture he paints is a rose-tinted sky filled with smiling cherubs.

Read more


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U.K. NEWS

​Stressed out teachers are turning to drink and drugs
Mirror.co.uk
 
Teachers’ union NASUWT recently conducted a survey of more than 5,000 teachers—the results will be published later this year but the Mirror had a sneak preview:
 
Teachers are resorting to drugs and drink to cope with the job’s stress, a shock poll reveals today.
A tenth say they have been prescribed anti-depressants due to work-related pressures – and 47% have seen a doctor in the last 12 months over job-linked physical or mental health problems.
A total of 22% claim to be drinking more alcohol, while 5% are smoking more tobacco and 7% are using or have increased their reliance on prescription drugs.
Disturbingly, 2% claim job stress has driven them to self-harm.
 
 
Kelly Holmes backs mental health campaign after her own battle with depression
Mirror.co.uk
 
Olympic legend Dame Kelly Holmes has given her backing to the Sunday Mirror’s campaign to raise awareness of mental ill health.
The retired British athlete pledged her support as she prepares to run the London Marathon to raise funds for the charity Mind.
The 45-year-old suffered with depression as she struggled to overcome injuries a year before her double Olympic triumph in Athens in 2004.
Dame Kelly reached such a low point she even self-harmed, cutting herself in the bathroom behind a locked door.
She said: “Having suffered from depression myself, I know how horrendous it is to feel so low and so desperate that you actually want to harm yourself.

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​Holding the government to account
Luciana Berger MP
 
Luciana Berger has been busy in her role as the first ever shadow Minister for Mental Health. In her latest newsletter she writes:
 
“Time to Talk day happened and was a great success. The night before, I spoke at a mental health rally in Parliament and Everton FC became the first Premier League football club to dedicate a themed match day to break the stigma around mental health. On Time to Talk day itself I spoke at a Business in the Community event on the importance of mental health support in the workplace, visited the 02 in Slough with Jeremy Corbyn, and spoke at the MQ conference on the importance of research. That weekend I took part in the Southbank Centre's Changing Minds Festival - you can listen to the discussion here.”
If you’re interested in Berger’s newsletter you can sign up here.
 
• Ministers 'letting down mentally ill people' by not collecting data (The Guardian)
• We're being forced to fix our own mental health. And it's not working - video (The Guardian)
• I worked in mental health - and after seeing the effects that austerity had on people, I had to leave (The Independent)
• Wentworth Miller pens powerful essay on mental health in response to body-shaming (The Independent)
​

U.S.A. NEWS
 
Mobile platform Talkspace is the 'Future of Therapy'
New York Daily News
 
After a positive experience of couples therapy, software developer Roni Frank wanted a career change. The result is Talkspace, which offers unlimited access to a therapist for $25 a week:
 
Two years into her journey toward a master’s degree, she “started to realize the mental health system in America is completely broken,” she said. “One in five Americans suffers from mental health issues each year.”
Yet, roughly 70% of those who need help don’t receive it, Frank said. The three main obstacles? Cost, stigma and accessibility.
Most face-to-face therapy runs at least $100 an hour, many feel embarrassed about needing psychological help and getting to appointments can be difficult. Frank was convinced she could do something.
Four years ago, the Franks launched Talkspace with $13 million in venture capital funding. They now have over 500 licensed therapists, who report to supervisors.
Some 200,000 people have used the service, which runs $25 a week. Clients can text, record a voice message or leave s video on the firm’s app as often as they want. Therapists get back to them within the day. 

 
Obama administration pushes Medicaid expansion as mental health solution
U.S. News & World Report
 
The White House on Monday released a report saying Medicaid expansion will help those with mental health and substance abuse disorders, but advocacy groups said more needs to be done to remove other barriers that prevent people from getting care.
The Department of Health and Human Services in its report cited those affected by the country's opioid epidemic and people with untreated mental illness as a needy population that could be helped if states that are resisting expanding coverage to their needy populations under Obamacare committed to the move. Doing so, the agency said, could reach the nearly 2 million low-income people in non-expansion states who have these conditions, even resulting in 371,000 fewer people having symptoms of depression.
"The conclusion is clear: If states are serious about tackling mental illness and opioids, then expanding Medicaid offers a unique opportunity to do so," Richard Frank, assistant secretary for planning and evaluation at HHS, said in a call with reporters Monday.
 
 
Probing the complexities of transgender mental health
NPR
 
Do transgender people suffer more from psychological distress because of discrimination, lack of support and a generally hostile response from society? Or is it inherent to the transgender experience, resulting from gender dysphoria and the conflict of feeling different from your assigned identity at birth? A recent study attempts to find out:
 
The study published Monday in JAMA Pediatrics reveals the difficulty in picking apart this question. It examined mental health and substance use among nearly 300 young transgender women in Chicago and Boston.
Only a quarter of the women were white, and all were between ages 16 and 29. The researchers, led by Sari Reisner, a research fellow at Harvard Medical School and Boston Children's Hospital, found that the rate of psychiatric disorders and substance dependence among these women was 1.7 to 3.6 times greater than in the general population.
 
• Doctors are failing to help people with gender dysphoria (BMJ)

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RIP Patty Duke:
A mental health pioneer

Los Angeles Times
 
Long before celebrities shared their private struggles on talk-show couches and social media feeds, actress Patty Duke broke a Hollywood taboo by speaking publicly about her mental health struggles.
Duke, who died Tuesday morning at age 69, was diagnosed with manic depression (now called bipolar disorder) in 1982. Known at the time as the goody-two-shoes child star of "The Miracle Worker" (for which she won a best supporting actress Oscar at 16) and "The Patty Duke Show," Duke revealed revealed a much darker reality in her 1987 memoir, "Call Me Anna," written with L.A. Times film critic Kenneth Turan. In the book, she graphically detailed her turbulent life, drug and alcohol abuse and childhood mistreatment at the hands of cruel managers.
In talking candidly about her mental illness, Duke took on the stigma long attached to the issue. In the years since Duke's disclosure, actresses such as Catherine Zeta Jones, Carrie Fisher, Rene Russo and Kim Novak have spoken publicly about their own bipolar diagnoses, while countless other public figures have talked about their depression.
Upon her death, Duke's son, actor Sean Astin, sought to continue his mother's legacy of bringing attention to mental health, launching a crowdfunding campaign to establish the Patty Duke Mental Health Initiative.
 
 
Legal MDMA could happen by 2021
UPROXX
 
Everything old is new again! Now that we’re finally understanding that some drugs — like marijuana — can be helpful when it comes to treating physical and psychological disorders, more and more studies are popping up suggesting that other drugs such as MDMA and Ketamine might also be helpful… in a medical setting. Don’t put your party hat on just yet (this isn’t happening until 2021 at the earliest), but new research shows that MDMA can be helpful in the treatment of post-traumatic stress disorder (previously, it’s been used in couple’s therapy) and the team that’s been conducting the research will soon meet with the FDA to discuss exactly how to proceed when using Molly as an assist in psychotherapy.
 
 
WORLD NEWS
 
Mapping global mental health research funding
RAND Corporation
 
Rand’s new report maps the global funding of mental health research between 2009 and 2014. Among the findings:
 
• The field of mental health research is large (and growing) and diverse – over 220,000 papers were published between 2009 and 2014, supported by over 1,900 funders.
• The US dominates the mental health research field, being both the largest producer of research (36 per cent of publications) and accounting for 31 per cent of government and charity/ foundation/ non-profit funding organisations.
• Charities, foundations and non-profits form the most numerous group of mental health research funders (39 per cent of the funders identified), but governments fund the most papers, accounting for over two-thirds of the papers with funding acknowledgements.
 
• India: Govt hires stress counsellors for paramilitary forces (India Today)
• Queen Rania of Jordan attends counselling session with Syrian refugees (Daily Mail)
• Psychosocial counselling helps earthquake survivors in Nepal overcome loss (Big News Network.com)

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SILLY STORY OF THE WEEK
 
Psychotherapy for depressed rats
EurekAlert
 
Genes are not destiny in determining whether a person will suffer from depression, reports a new Northwestern Medicine study. Environment is a major factor, and nurture can override nature.
When rats genetically bred for depression received the equivalent of rat "psychotherapy," their depressed behavior was alleviated. And, after the depressed rats had the therapy, some of their blood biomarkers for depression changed to non-depressed levels.
"The environment can modify a genetic predisposition to depression," said lead study investigator Eva Redei, a professor of psychiatry and behavioral sciences at Northwestern University Feinberg School of Medicine. "If someone has a strong history of depression in her family and is afraid she or her future children will develop depression, our study is reassuring. It suggests that even with a high predisposition for depression, psychotherapy or behavioral activation therapy can alleviate it."
 
What on earth is psychotherapy for rats, you may ask:
 
Redei and colleagues wanted to see if they could alter the rats' genetically caused depression by changing their environment. They took the depressed rats and put them in large cages with lots of toys to chew on and places for them to hide and climb - sort of a Disneyland for rats. The rats were kept in the playground for one month.
"We called it rat psychotherapy," Redei said, "because the enrichment allows them to engage with the environment and each other more." The results of a month in the playground: the rats' depressive behavior was dramatically reduced.
After the playground psychotherapy, the rats were placed in a tank of water. Their behavior in the tank is a measure for depression. The control rats will swim around, looking for a way to escape. Depressed rats will simply float, showing despair behavior. After the month in the playground, the genetically depressed rats energetically paddled around the tank, looking for an exit.
"They did not show despair," Redei said.
 
The lab-coated boffins also found that it’s possible to make rats depressed (as if being part of this whole sorry enterprise wasn’t demoralising enough for the rats):
 
Northwestern scientists also wanted to see if environmental stress could trigger depression in rats bred to be the non-depressed control group of the experiment. These rates did not show despair behavior originally. The control rats underwent a psychologically stressful situation, which involved being restrained two hours a day for two weeks. After the two weeks, the stressed, control rats displayed depressed behavior when placed in a tank of water.
 
Conclusion: rat depression is not hereditary. A fun, stimulating environment where rats can play makes them happy. Strapping them down for two hours a day makes them sad. I think we knew that already, no? We can draw on decades of qualitative research into depression in another mammal: humans.
This weekend, take a look around your “cage.” Do you metaphorically speaking have “lots of toys to chew on” and “places to hide and climb”? And what restrains you? Unlike the lab rats, we are born free. But, as Rousseau noted, we are “everywhere found in chains.”


The Big Match

1/4/2016

 
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Who do you support?

​Team Body—or Team Mind?

The former adopts the “medical model” approach to psychological distress: the root causes are largely found within the biology of the unwitting individual and the best treatment is medication.
Sample narrative: “I am stressed and can't cope. The chemical levels in my brain are slightly off—I need medication to restore the balance.”
 
The Mind team, by contrast, regards symptoms as manifestations of underlying, unresolved inner conflict which needs to be explored, processed and resolved through talking therapy.
Sample narrative: “I am stressed and can't cope. I am such a workaholic and brutally hard on myself—I now see this as some kind of loyalty to my very strict and punitive. parents.”

Longstanding debate 
In his article “The 'drugs v talking' debate doesn't help us understand mental health," in The Guardian on Wednesday, Simon Wessely, chair of psychological medicine at King's College London and president of the Royal College of Psychiatrists, attempts to build a bridge across the yawning divide.
The longstanding debate, he writes, often “has been caricatured as ‘psychiatry v psychology’, or equally unhelpfully ‘drugs v talking’, or ‘brain v mind’. But these are false distinctions, which don’t help in understanding mental disorders, don’t help mental health professionals, and most of all don’t help patients.”
Wessely argues instead for a pluralistic approach: “As there is incontrovertible evidence that physical, psychological and social factors contribute to the development of mental health problems – in different degrees and mixtures according to the type of illness and the particular individual – it follows that treatments that psychiatrists use can be physically, psychologically or socially based, either singly or more often in combination.”
And, according to Wessely, a pluralistic, multidisciplinary approach is precisely what patients get: “The truth is that up and down the land psychiatrists, psychologists, social workers and other mental health professionals work together in multi-disciplinary teams for the benefits of patients.”
 
All that is missing from the picture he paints is a rose-tinted sky filled with smiling cherubs.
 
Three points:
• Wessely doesn’t address the economic and political forces that have a vested interest in promoting a biologically reductionist, medical model of mental health which, despite his claims to the contrary, remains the default setting in the NHS.
There is much commerce in pathologising aspects of the human experience that are deemed problematic, itemising them according to their symptoms, then prescribing drugs which promise to reduce or eradicate them.
Facilitated by enormous amounts of sponsored “research” and marketing, one in 10 people here and in America now have a prescription for an antidepressant. You are shy? OK, you need to take a pill for that. The diagnosis of “bipolar” has risen by 4,000 percent since the mid-1990s when, not entirely coincidentally, the patents for the best-selling antidepressant drugs began to run out.

• Psychiatrists of course vary in their outlook, but some—perhaps most—have limited tolerance for non-biological explanations of psychological distress, and non-pharmacological treatments. In some settings, blank stares will greet any mention of psychotherapy, or suggestions that a patient’s symptoms might have some meaning or purpose, or point to some deeper underlying, unresolved conflict, or are borne of dire socioeconomic circumstances (yes there's another team—they believe that mental illness is not from mind or from body but from the psychologically toxic waters we swim in; a sane response to an insane, unfair, oppressive world).
I have listened to consultant psychiatrists debate a patient’s treatment—the conversation is generally about meds, along the lines of: “How about a little bit more of this one, a little bit less of that one?”
This is modernist, one-person psychology: the expert hands down the objective truth of the condition to the grateful patient. In “The Wounded Storyteller,” Arthur Frank describes how as patients we must surrender our own narrative of our dis-ease and submit to the narrative provided by the expert. Some proverbial “men in white coats” seem to have very little interest in what a patient might have to say about the condition that belongs to them.

• When talking therapy is offered, in most cases that means CBT. There will likely be a waiting list, then a handful of sessions devoted to cleaning up your thoughts and actions. There is a great debate about the wisdom and effectiveness of this. Other approaches get squeezed out. Unless you go private, you’ll be hard-pressed to experience care at greater depth, such as psychoanalysis, which attempts to uncover unconscious processes, or integrative, humanistic therapies that depend on building a healing, accepting relationship with an emotionally available therapist.
 
Thesis-Antithesis-Synthesis
If the medical model—a strictly biological/genetic/chemical approach to psychological distress—is dangerously one-sided, equally preposterous is the converse, the kind of guilt-gave-you-cancer psychological determinism peddled by the likes of Louise Hay (see The worst self-help book ever).
Wessely is right when he says that mind and body cannot be separated. Such “Cartesian dualism” is to be rejected; we ignore the complex, mysterious interaction between them at our peril. I like the enigmatic Zen perspective of Shunryu Suzuki: “Our body and mind are not two, and not one. If you think your body and mind are two, that is wrong; if you think that they are one, that is also wrong. Our body and mind are both two and one.”
Of course, for all illness, medications have a vital role to play. Many of us are incredibly grateful for a daily dose of pills that allow us to function better. But for mental health care, increasingly the old paradigm is crumbling, to be replaced by a new, postmodern outlook, one that offers a broad array of different therapies to match the broad array of human struggles; that honours qualitative research as well as quantitative; and that listens to the person in distress rather than talks at them.

One example: Anyone who told a doctor in the past that they hear voices would have been labelled schizophrenic and prescribed major tranquilisers to make the voices—and much else besides—go away. Now, however, thanks to initiatives like the 
Hearing Voices Network, we don’t automatically sedate. We listen.
Writes Frank: “Postmodern times are when the capacity for telling one’s own story is reclaimed.”

This trend towards a synthesis of body and mind also reunites psychology with its philosophical history, following a century of trying on the ill-fitting, positivist clothes of science. When it comes to the infinitely complex, fluid and diverse experience of being human, there are no objective certainties. We are not just machines—there are ghosts in the machine, too.

Psychology is not a hard science. It is so much more than that.

Perfect love

15/2/2016

 
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It's Valentine's Day, in case you hadn't noticed. What kinds of love are in your life? ​Are you satisfied? Many clients come for counseling with one complaint or another about love.

Last year I worked with a client called Jim (not his real name—“Jim” gave me permission to write about him but I have changed his name and the details of his story to protect his anonymity). Jim worried that he was incapable of lasting love. “I just can’t trust it or commit to one person,” he said. “I am a commitment-phobe.”

A few months earlier he had ended a four-year relationship. It was fine, he said, but he knew in his heart she was not “the one.” Instead of feeling free, however, he was miserable. “It’s as if I fired the gun,” he said, “but it backfired and blew up in my face.”

The ex—who he described as “the nicest woman in the world”—was moving on with her life; Jim meanwhile couldn’t stop crying. He had to keep taking bathroom breaks at work so he could sob.
In one session, Jim was really struggling. He had just met his ex at the flat they’d shared to sort out the remaining stuff and hand over the keys to the landlord. At the exact moment they said goodbye, Jim realized how much he loved her—the exact opposite scenario to getting cold feet when walking down the aisle. But it was too late.

Jim was inconsolably sad. Here was a smart, successful and worldly man who felt an utter failure. He was worthless, he said.

We explored Jim’s story. When he was very young, Jim’s parents split up—his dad had met someone else. More than three decades later, this event was still casting a long shadow. Young Jim had gone to live with his mum—a terrible Oedipal “victory”—and quickly learned to adapt to the new configuration. Children are so very good at adapting.

​Survival strategies

In therapy, Jim reflected on what might have been going on for his young self at the time. Young Jim, he felt, came to three conclusions, perhaps largely unconsciously:

• The divorce was all his fault; if he could be really a perfect little boy perhaps he could be forgiven—and even bring his parents back together;
• He had to spare his distraught, bereft mum from any further pain by being good—the perfect son, student, happy, successful;
• Being left was really painful—much better to dump someone than be dumped by them.

These “rules for living” allowed Jim to navigate his childhood. He did a near-perfect job of being near-perfect. He was the consummate little diplomat in all dealings with his parents. He worked exceptionally hard and truly excelled at school. But inside he was consumed by feelings of guilt and worthlessness.

As an adult, Jim had extremely high standards, both for himself and others. He was by his own admission “an asshole boss.” Romantically, too, everything had to be perfect. Instead of being himself, Jim felt under enormous pressure to be a kind of idealized storybook partner—charming, thoughtful and magical. Jim’s “false self” brought great rewards, but he felt it all to be a grand illusion. Sooner usually rather than later, Jim or his girlfriend would fail to be utterly unimpeachable and the relationship would completely unravel.

The therapy began with an exploration and identification of these patterns, followed by an acceptance of them. The “false self” was a very necessary part of Jim. It allowed him to survive as a child and thrive as an adult. But there was so much more to him. In therapy, Jim felt his way to connect more with the parts of himself that are “a bit rubbish” and this freed him up to connect more with others; to stop being a chameleon and start listening to his own emotions and desires.

When a new relationship started, Jim tried a new approach: honesty. He allowed himself to express his feelings and be vulnerable. He gave up some control, including in the bedroom. With an enormous sense of relief, Jim discovered he could be himself.

Jim was not a commitment-phobe. What he was not prepared to commit to any longer was the demand that he be perfect.

Perfect Jim? He got dumped by the much more likeable Imperfect Jim.

Perfection is not love. It is the imperfections that make a person lovable.

Happy Valentine’s Day!
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An interpretation of Freud

22/1/2016

 
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​Long considered a sexist dinosaur with a cocaine habit and some bizarre ideas—does anyone believe that little boys literally fear castration, want to kill their fathers and have sex with their mothers?—Sigmund Freud is enjoying something of a renaissance.

As Oliver Burkeman recently outlined, the therapy Freud invented, psychoanalysis, is at last gaining some much-needed empirical support, while at the same time the default treatment on offer in the U.K., quick fix, symptom-focussed cognitive-behavioural therapy (CBT), is increasingly looking like some sort of snake oil.

CBT appeals to our common sense. But common sense isn't as common as we'd like to believe.

Freud’s revelation was that we are not necessarily always logical, rational beings making optimal choices as we navigate through life’s vagaries, that we are in fact to a large extent strangers to ourselves.

A few years ago, a relative had a terrible holiday in Italy. On returning home, in retaliation, she boycotted her favourite local Italian restaurant and has not been back since. This marvelously illogical yet so very human protest is typical of how inventive and fluid our psychology can be.

Unlike my relative’s very deliberate restaurant boycott, however, Freud argued that much of what we do operates “under the hood,” out of awareness. Our conscious, stated desires can be different from or even completely opposed to our unconscious ones. We might say we want to give up smoking, or find a partner, or start (or finish) a big project, or do something bold and courageous, but somehow we find ways to ensure it doesn’t happen. We make mistakes, and we vow never to be so foolish again, but then we find ourselves doing the exact same thing. Over and over. Freud called this “repetition compulsion.” Britney Spears called it “
Oops, I did it again.”

According to Freud, our unconscious motivations generally can be traced back to our formative years. We learned how to be in the world as children, and decades later this blueprint remains. Sometimes it’s as if we were insisting on still using a crutch long after our broken leg has healed. The blueprint includes an imperative to repress disturbing ideas, thoughts, emotions, events, memories and conflicts from long ago. But they are not so easily silenced—they retain some kind of energetic charge which can find all manner of expressions, sublimations, projections and other creative outlets.

One of Freud’s patients, five-year-old “Little Hans,” had an intense fear of horses—Freud said they represented his father. “Rat Man” had an obsessive, intrusive fear of torture involving rats and bottoms which Freud linked to early experiences of discipline and sexuality. “Dora” had a suicidal breakdown after being propositioned by a family friend because, claimed Freud, she was repressing a lesbian attraction for the man’s wife. Freud’s most notorious cases are summarized here.

Freud argued that neurotic symptoms, when unmasked, usually make some kind of sense. They have an intent, a meaning; they exist to resolve something or defend us from pain, guilt or shame. Merely removing the symptom without addressing the cause—the CBT approach—might just lead to another symptom.

And anyway, a symptom is not so easily removed. Since it serves a purpose, writes Freud, a patient will “make the most of it, and when it comes to taking it away from them they will defend it like a lioness her young.”
​

Freud defined his invention of psychoanalysis as “the science of unconscious mental processes.” The power of the unconscious is his greatest legacy.

Darwin told us about ourselves as members of the animal kingdom. Marx told us about ourselves as members of society. Freud told us about ourselves as individuals.
​The battle within
A cornerstone of Freudian psychology is his 1923 structural model of the human psyche. The idea—which wasn't original: Plato proposed the same thing two millennia earlier—is that we have three parts to our interior system of government, which Freud called the id, ego and super-ego. The selfish, erogenous, childlike id seeks gratification. The autocratic finger-wagging super-ego by contrast is a sanctimonious, guilt-inducing presence, forever hectoring you about what you should be doing. Mediating in between is the harried, democratic ego, trying to keep everyone happy. It’s like having Caligula, the Pope and Bill Clinton sitting around the negotiating table. On different days, some voices are louder than others. Freud likened the internal conflict between the three constituents to a legendary 5th century battle between Attila and the Romans and the Visigoths.

The battle is as old as the hills and most people—and families, cultures, countries—generally have a default setting, either on the side of the super-ego, favouring restraint, prudence, safety and being “good,” or on the side of the id, living their lives with more freedom, spontaneity, creativity, passion and throwing caution to the wind. Many clients belong in the former category, paralysed by a brutally harsh inner self-critic. The more you try to please the super-ego by doing the “right” thing, the more demanding and punitive it can become. The super-ego usually has its origin with parents, but also can come from teachers, bosses, governments and religions. Freud writes that it “rages against the ego with merciless violence.” That violence can be the cause of much psychological and somatic distress.

Therapy is about shining a light on these and other haunted caverns of the unconscious, understanding them, accepting them—making the unconscious conscious or, as Freud put it, “where id was, there ego shall be.” To be enlightened is perhaps to have no fears, illusions or deceptions about one’s propensity for darkness.
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Case vignettes*
• After a lifetime of short-term relationships with troubled men, Karen is lonely and desperately wants to settle down. She has a social life, she does various evening classes, she has joined a dating site. “But there are no good men out there,” she complains. Her checklist of criteria that must be fulfilled is so long that she has effectively ensured it will never happen. She is thus spared the pain of rejection. In therapy we learn that Karen’s father left the family when she was 10 and was barely spoken of again.

• Dave lives under a blanket of depression. He collects evidence everywhere for his worthlessness. Every chance remark, askance glance or unsuccessful outcome is added to the rap sheet and presented as evidence that there’s no point. He is thus relieved of having to take responsibility for his life and the possibility of real failure is averted. Dave initially dismisses the fact the he was born into an acrimonious divorce—which he feels was his fault—as irrelevant “ancient history.”

• Jessica is a workaholic with no time for relationships. She has risen to the top of two professions and is considering starting a third. She has a history of unexplained physical complaints and finally sought out therapy when one morning, on her way to work, she inexplicably burst into tears. She came to realize how as a teenager, after her father had died, she had become “the man of the house,” helping her depressed, bereaved mother, looking after her younger siblings, getting a part-time job to make ends meet. She held the family together; now she lives alone.

​

*These are fictionalized, representative stories; names and details have been changed

PictureFreud's facial expressions run the gamut from utter foreboding to grim disdain.
Therapy today
Freud’s influence was far-reaching and profound. But he was a flawed character. You get the feeling he started to believe in his own myth. Patients often had to fit into his theories rather than the other way round. Any dissent might be met by indignant harrumphing or an ended friendship. He was capable of exploiting his position as a white male authority figure for personal ends. His work was sometimes more to do with furthering the legend of Sigmund Freud than with healing.

Some of his ideas and speculative musings have great metaphorical and symbolic value, yet he invited ridicule by insisting on speaking in absolutes and the rigid certainties of hard science. He was somewhat obsessional, detached, and ironically perhaps not so much of a people person, once writing, “I have found little that is ‘good’ about human beings on the whole. In my experience, most of them are trash.” The best they could hope for was “common unhappiness.” In photographs, his facial expressions run the gamut from utter foreboding to grim disdain.

Freud claimed psychoanalysis worked. He would identify unconscious motivations and unhelpful patterns, explain them to the grateful patient and, thus fortified, the patient would make better choices going forward. Except that very often they didn’t.

Today’s therapists who work at any depth will, like Freud, want to uncover your blueprint, your patterns, your unconscious processes. They might explore your childhood, interpret significant memories, analyse your dreams, which for Freud were the “royal road” to the unconscious. But they know that, while self-knowledge is helpful, it only takes a client so far. Lasting change and healing comes from the heart as well as the head, through acceptance, support and love. Research shows it is the therapeutic relationship itself which heals.

Good therapists are not inflated with their own importance, nor blinded by their own certainties. They treat clients ethically, not just because there are codes of ethics to abide by, but because ethical therapy is inherently good therapy. Above all, they are fully engaged with the client, noticing what is happening between them, and always working in partnership with them, in their best interests, rather than lording over them as they lie on the couch, prostrate and exposed (whether as a client or a therapist, I prefer to sit chair to chair and eye to eye). A good therapist cares.

It’s not enough to know and be known. To thrive in this life it helps, too, to love and be loved.

Sometimes a cake is just a cake

16/11/2015

 
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​An important ending warrants cake. And at a meeting of therapists, what better than a cake bearing Sigmund Freud’s face?

How very Freudian. The father of psychoanalysis would likely regard biting into his face as a highly Oedipal act. He might note our obedience to the pleasure principle: we get cake, we eat too much, then the reality principle sets in—we feel gross and our super-ego makes us feel guilty. He would chuckle at our cake-related repetition compulsion. He'd probably say the whole thing was all about sex.

What actually did Freud have to say about cake? A quick online search of The Standard Edition of the Complete Psychological Works of Sigmund Freud reveals a handful of mentions. A retelling of an interpretation of a cake-related dream. An analysis of an irritating, unfunny joke involving cake. A 1909 letter to Ferenczi offering “most cordial thanks for the very splendid holiday cake.”
​
And this little tale, courtesy of one of Freud’s closest chums, Dr. Hanns Sachs:
​“Our maid is particularly fond of a certain kind of cake. There is no possible doubt of this, as it is the only thing that she always makes well. One Sunday she brought in this particular cake, put it down on the sideboard, removed the plates and cutlery of the previous course and stacked them on the tray on which she had brought in the cake; she then put the cake back on the top of this pile instead of on the table, and disappeared with it into the kitchen. Our first idea was that she had noticed something that ought to be put right about the cake, but when she failed to appear again my wife rang and asked: ‘Betty, what has happened to the cake?’ ‘How do you mean?’ replied the maid, not understanding. We had first to point out to her that she had taken the cake away with her again. She had put it on the pile of dishes, carried it out and put it away ‘without noticing’.

“Next day, as we were about to eat what remained of this cake, my wife noticed that there was just as much as we had left the day before—in other words, that the maid had rejected her own share of her favourite dish. When asked why she had not eaten any of the cake she replied in some embarrassment that she had not wanted any.

“The infantile attitude is very clear on both occasions: first the childish insatiability which did not want to share the object of her wishes with anyone, followed by the equally childish defiant reaction: ‘If you grudge it me, keep it for yourselves; I don't want anything at all now’.”

In praise of uncertainty

19/9/2015

 
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In 1817, in a letter to his brother, the poet John Keats wrote about how people of achievement had a quality he called “negative capability.” They were capable, he said, “of being in uncertainties, mysteries, doubts without any irritable reaching after fact and reason.”

Negative capability is an acknowledgement of complexity, a mature respect of life’s shades of grey, an understanding that despite what the strident headline, indignant tweet or demanding placard says, the situation is probably not quite so simple.
Negative capability is an embrace of doubt. It is greeting the world and people in it as if for the first time, without preconceived ideas or old habits, scripts, stereotypes. It is the opposite of prejudice. A willingness to say three simple yet hard to utter words: I don’t know.

The western world, however, is defined by irritably reaching after fact, reason and certainty. In case you hadn’t noticed, life is complicated, and we’re hungry for clarity and simplicity. We tend to be extremely doubtful as to any merits of doubt.

We like to think in black and white, left and right, good guys and bad guys, mars and venus, heaven and hell. We demand decisiveness from our politicians, generals and CEOs—being unsure is a much greater crime than being wrong. All the question marks must be changed to exclamation marks. We want bullet points to help us lead our lives: 10 commandments, 7 habits, 5 ways to achieve success, fame, fortune, happiness. We want yes or no in a world of maybe.

But to live without negative capability is to be enslaved (there’s supposedly a Sanskrit word that means both “certainty” and “imprisonment”). It is to be closed-minded, dogmatic, fanatic, having a resolute, immutable opinion about everything, or an unwavering fidelity to one or another “ism” or “ology.”

It is sticking rigidly to an absurd little book of rules, and ignoring all the red lights on an uncompromising march to the completely wrong place: to war, ethnic cleansing, bigotry, economic collapse, physical collapse, psychological collapse.

Certainty blinds us to possibility. We’re so fixated on some notion of how things are “supposed” to be that we totally miss the gift of how things are. We march right past the treasures in the Louvre because we’re on a grim, joyless Mona Lisa box-checking mission. We’re so frenetic, addicted to our busy-ness, that we don’t notice when someone we love needs help or is trying to tell us something important. We’re so wedded to an idea of the person we think we should be with—our “type" or our “soul mate”—that we don’t even look at the amazing person in the very next cubicle. We are completely surrounded by beautiful opportunities, gifts and invitations which we are oblivious to because we are not present, stuck in the past or marching ahead in search of some imagined, more certain future.

We attempt to navigate the turbulent waters of love, too, with an out-of-date map of a different ocean. The English poet-philosopher David Whyte summarizes this beautifully in Consolations, his new book of spare and soothing reflections. He offers this profound incantation:
• Yeats: “The best lack all conviction, while the worst
are full of passionate intensity”

• David Foster Wallace: “A huge percentage of stuff that I tend to be automatically certain of is, it turns out, totally wrong and deluded”

• Voltaire: “Doubt is not a pleasant condition. But certainty is absurd”

• Pliny the Elder: “The only certainty is that there is nothing certain”

• Margaret Drabble: “When nothing is sure, everything is possible”

PictureCan we hold on to love to see where it takes us?
“We can never know in the beginning, in giving ourselves to a person, to a work, to a marriage or to a cause, exactly what kind of love we are involved with. When we demand a certain specific kind of reciprocation before the revelation has flowered completely we find ourselves disappointed and bereaved and in that grief may miss the particular form of love that is actually possible but that did not meet our initial and too specific expectations. Feeling bereft we take our identity as one who is disappointed in love, our almost proud disappointment preventing us from seeing the lack of reciprocation from the person or the situation as simply a difficult invitation into a deeper and as yet unrecognizable form of affection.”

Click here to take a short, one-minute test, then read on
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A digression: Do you feel lucky today?
Richard Wiseman, a magician turned popular psychologist, conducted some research on luck. He advertised for people who considered themselves very lucky, or very unlucky and received many replies. The lucky people seemingly had led charmed, successful, happy lives. They were always in the right place at the right time, and good things inevitably just happened to fall in their lap. The unlucky people? The opposite. An extraordinary catalogue of calamities, disastrous romances, failed businesses, missed connections, lost harvests.

Wiseman conducted a series of tests on these people. One was to count the number of photos in a newspaper. The unlucky people took a few minutes to complete the task. The lucky people took just seconds. Why? Because on page 2, half the page was devoted to a notice that said, in large letters: “Stop counting: There are 43 photographs in this newspaper.” The “unlucky” people, blinded by the certainty of the task, never saw it.

According to Wiseman, people make their own luck. The house of uncertainty holds no fear for lucky people.

Which side are you on?
Our brains have two hemispheres: the intuitive, holistic, creative, transcendent “right brain,” and the more logical, rigid, pedantic, detail-focused “left brain.” Iain McGilchrist calls the former the “Master” and the latter the “Emissary.” The problem, he says, is that the Emissary is supposed to be in service to the Master, but somehow he has taken over the controls. As a result, he has profoundly changed us—and our world. All power, says McGilchrist, now rests with the Emissary “who, however gifted, is effectively an ambitious regional bureaucrat with his own interests at heart. Meanwhile the Master...is led away in chains.” (A simplistic binary split of the brain into left and right perhaps shows a lack of negative capability—it ignores all the shades of grey matter. But we'll stick with it.)

Instead of working together, our bird-brained inner accountant turned on our wise and thoughtful inner poet and, in a desperate ontological battle, the latter was slain. The poet, needless to say, embraced negative capability; she lived it. The accountant however, clipboard, ruler and calculator in hand, can tolerate only certainty. He has created a fragmented, western world of technology, mechanisation and bureaucracy, a world of alienation, where love is hard to find, and beauty gets bulldozed, a world of spreadsheets instead of sonnets, a world where everything is measured, itemized, indexed, where the little picture matters and the big picture doesn’t.

Einstein had a sign hanging in his office which read: “Not everything that counts can be counted, and not everything that can be counted counts.”

Doubt in the consulting room
The Emissary’s hand can be seen in every detail of our lives—in tax returns, Ofsted reports, market research. In doomed attempts to deconstruct jokes or works of art. And, as I wrote earlier this week, in the field of mental health.

The Emissary wants to shoehorn your troubles into a neat, clearly-labelled pigeonhole. He wants to eradicate your symptoms with a drug and, if you insist, a bit of talking in the form of some short-term cognitive-behavioural therapy (CBT). A little adjustment to your levels, a bit of soldering under the bonnet, and you should be good to go—back to your spreadsheets.

If it were that simple, we would not be human. On the first page of the introduction in her book The Impossibility of Knowing, psychotherapist Jackie Gerrard writes: “I am sure that I, like many of my colleagues, started my training eager to learn and to know, and I have subsequently spent the years post qualification learning that I do not ‘know,’ cannot ‘know,’ and, indeed, should not ‘know’ . . . by saying I do not ‘know,’ I am continually endeavouring to hold a state of mind that can tolerate remaining open, bearing uncertainty, and avoiding, wherever possible, omnipotence and omniscience.”

Not “knowing” is not the same as indecision or ignorance. In Tales of Un-knowing, existential therapist Ernesto Spinelli says therapists should aspire to be un-knowing—as opposed to “unknowing”—they should “attempt to remain as open as possible to whatever presents itself in our relational experience.”

The Emissary therapist reaches for theories, models, personality tests and questionnaires about your mental state so that he can enter your score on a spreadsheet. He reaches for the manual to find a clinical diagnosis such as “generalized anxiety disorder” or “oppositional defiance disorder” and some techniques to make it go away. American existential therapist Irving Yalom marvels that anyone can take diagnoses seriously, adding: “Even the most liberal system of psychiatric nomenclature does violence to the being of another. If we relate to people believing that we can categorize them, we will neither identify nor nurture the parts, the vital parts, of the other that transcends category.”

The Master therapist, by contrast, see you—all the vital parts, all of you. All her senses are alive to you and your experience of distress. This level of presence and empathy was memorably expressed by British psychoanalyst Wilfred Bion, who wrote that every therapeutic session should be approached “without memory and without desire.” Even the therapist’s wish for their client to be, say, less depressed is, according to Bion, an imposition that will cloud that therapist’s mind. He believed that in every session there had to be a genuine open-mindedness and freedom.

All too often therapist and client conspire to flee from uncertainty. The therapist who claims to be “sorted” might be cut off from their own vulnerability and woundedness, and perhaps not be the best guide to accompany a client as they traverse a landscape of despair.

Integrative psychotherapist Diana Voller writes: “The tension of the experience of being in uncertainty brings the person of the therapist well and truly back into the therapy.” The therapist, too, needs “the scariness and excitement of being willing to be in the unknown, allowing oneself to be temporarily overwhelmed, feel stupid for a while...gaining new perspectives and growing.” (I am grateful to Voller for a presentation she made on negative capability years ago in London—thank you.)

Increasing your negative capability
So perhaps we would be better people if we could cultivate a little more negative capability in our lives. There'd be more good things like luck, love, empathy. Negative capability transforms a profane world into one of poetry. 

For Keats, ways to cultivate more negative capability were: “books, fruit, French wine, fine weather and a little music out of doors played by someone I do not know.”

Voller suggests that films, TV, art, literature and the theatre are all “rich everyday resources for choosing to be temporarily unsettled and ready to be ultimately changed by other ways of seeing things.”

Here are 9 tips for a greater capacity for uncertainty:

1. Have therapy
There’s no better way to experience the discomfort of uncertainty, to encounter those frontiers of yourself that you have for long retreated from, than to be a client. The consulting room is a safe place to explore your distress, your history, your way of being in the world, all your secrets and shadows. Processing such dark matter affords some control over it rather than the reverse.

2. Keep a journal
Another great way of exploring, of cultivating a better relationship with our self—or rather, disparate selves. Start the conversation.

3. Improvise
Now and again, put away the instruction manual, or the sheet music, or the cookbook, and just do it.

4. Meet new people
Hurl yourself into unfamiliar social situations. Interact with a wide range of people. Richard Wiseman wrote of how some of his “lucky” participants often sought out ways to force them to meet different people. One noticed that whenever he went to a party, he tended to talk to the same type of people. To disrupt this routine, he now thinks of a colour before a social event and then speaks to people wearing that colour of clothing.

5. Get lost
Take a different route to work, take your watch off, travel without a map, go somewhere new on holiday, camp in the wilderness, explore a very different country, travel alone. Develop a sense of what psychoanalyst Nina Coltart called xenophilia. Lose yourself in nature. Gaze at trees, clouds, thunderstorms. Waste time.

6. Spend time with children
Learn from their streams of consciousness and ability to play, and to be spontaneous and joyful and un-selfconscious. They haven’t yet learned, as we have, to filter, to not see. Negative capability is the antidote to old age. Viewpoints, like arteries or neural pathways, can become clogged, fewer, narrower, less fluid.

7. Have new experiences
Sign up for that retreat, workshop, meetup.com event. Do things that you’ve always wanted to do but haven’t because they scare you a little. Try different genres of art and music and film and food.

8. Be with your body
Dance. Play. Sing. Act. Exercise. Move. Do yoga. Touch and be touched. Our psychology affects our body—the reverse can also be true: putting your body into unfamiliar, freeing positions can also free your mind.

9. Stop making lists!

Ultimately, negative capability is a stance, a state of mind, an awareness. A willingness to give up the life you planned in order to have the life that is waiting for you, as American mythologist Joseph Campbell so succinctly put it.

It’s not easy. There are times when we need to be on autopilot, or seek refuge from the world under a giant metaphorical duvet. But we are only fully alive in those fleeting moments when we are brave enough to throw away all the old rules and maps and guidebooks and lists and embrace living in a state of uncertainty, eyes wide open to the world, engaging our fluid self with a fluid environment in original, creative and spontaneous ways.

I’m pretty sure there some truth in that.

But of course, I can’t be certain.

Minister for Mental Health

16/9/2015

 
PictureLabour's mental health advocate Luciana Berger.
Yesterday the newly-elected Labour Party leader Jeremy Corbyn unveiled his shadow cabinet. Part of the line up was a position new to British politics: shadow “Minister for Mental Health.” Liverpool Wavertree Labour MP Luciana Berger, 34, assumes the role. She was first elected to Parliament in 2010, served as shadow Minister for Energy and Climate Change, and then shadow Minister for Public Health, campaigning for the NHS.

Regardless of where you or I stand on the political spectrum, this seems like an eminently sensible idea. Partly thanks to the efforts of former Deputy Prime Minister Nick Clegg in the last government, mental health issues have become a major political talking point lately and featured prominently in the election campaigns this past spring. But actions speak louder than cheap political rhetoric: over the last Parliament, mental health service budgets, already on their knees, were slashed by more than 8 percent. Services are inadequate. Last year, 7,000 vulnerable people in the U.K. with mental health problems—a lot of them children—ended up being held in police cells, because there were no beds available.

Freedom of information requests by Berger earlier this year showed that NHS clinical commissioning groups on average spend just 10 percent of their budget on mental health, which accounts for almost a quarter of the NHS’ burden of disease.

One in four people in the U.K. experience mental ill-health every year, causing an annual loss of £26bn to the economy.

Berger said: “Mental health should be treated no differently to physical health. People with mental illness shouldn't have to expect different standards of care simply because of where they live.”

In a speech in Parliament in February, Corbyn said: “All of us can go through depression; all of us can go through those experiences. Every single one of us in this Chamber knows people who have gone through it, and has visited people who have been in institutions and have fully recovered and gone back to work and continued their normal life.”

On Sunday, his first morning as leader, Corbyn snubbed the BBC’s Andrew Marr show and instead visited his local NHS mental health trust, Camden & Islington.

PictureJeremy Corbyn: “All of us can go through depression; all of us can go through those experiences."
The ghost in the machine
One priority for any politician who wants to improve mental health services in the U.K. should be to promote a much greater diversity of available treatments. The NHS is far too therapeutically monocultural, wedded to the symptom-treatment medical model of clinical psychology, one that attempts to apply simplified, uniform labels to the vast diversity and complexity of human psychological distress, and a one-size-fits-all miracle cure-all in the shape of short-term cognitive-behavioural therapy (CBT). Psychotherapy and other more holistic and sophisticated approaches get squeezed out. Too often the notion of “stepped care” ends up being just one step—and not a very big one, either.

For more than two millennia, from the time of Socrates, psychology was essentially a philosophical endeavour. With the dawn of the Enlightenment, however, the Industrial Revolution, and a new age of reason which pledged its allegiance to rationality and logic, it abandoned its roots in favour of modernist ideas of “science.”

This shift was especially marked by the publication in 1913 of John B. Watson’s influential manifesto of radical behaviourism, which recognized “no dividing line between man and brute.” Watson was only concerned with the observable, measurable human responses to stimuli. What went on in between, in that messy “black box” of the human psyche, was of no concern. For the past century, this kind of “positivist” psychology that treats humans as machines has prevailed. It is still taught widely in universities. It directs much flawed, quantitative industry research that is influential yet of limited practical value to psychotherapists (the French existentialist Merleau-Ponty regarded the “science” of psychology as “always both naïve and at the same time dishonest”).

The new modernism is neuroscience. Brain scans are fascinating, but as explanations of minds, souls or consciousness, they are about as useful as a map of London is as an explanation of London. These neuroimages are but the flickering shadows on the walls of Plato’s Cave. They are fixated on the machine instead of the ghost in the machine.

At its best, psychotherapy dances with the ghost as well as the machine. It rejects attempts to delimit, confine or manualize the complicated business of being human and looks instead below the surface, considering historical causes of symptoms, unconscious and conscious motivations, intrapsychic and interpersonal conflicts, and environmental constraints and challenges. It embraces uncertainty (Voltaire: “Doubt is not a pleasant condition. But certainty is absurd”).

In a postmodern world, there are no absolute, objective truths when it comes to human beings and their psyches. Subjectivity rules, and my truth, my reality, my experience of being anxious, depressed, bipolar, schizophrenic, suicidal, disabled and so on might be entirely different to yours.

PictureNietzsche
As Nietzsche famously wrote, there are no facts, only interpretations.

The consulting room should not be a place where we go to learn how to live up to a CBT therapist’s modernist standards of how to think and behave. It is, instead, a place where we go to wake up, to discover our subjectivity, our beauty, our power—to find ourselves.

psychogram #1

8/6/2015

 
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Psychedelics revisited

4/6/2015

 
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Magic mushrooms and LSD could play an important role in treating mental health problems, according to a leading U.K. psychiatrist.

“Hundreds of papers, involving tens of thousands of patients, presented evidence for their use as psychotherapeutic catalysts of mentally beneficial change in many psychiatric disorders, problems of personality development, recidivistic behaviour, and existential anxiety,” writes James Rucker, honorary lecturer at the Institute of Psychiatry, in last week’s British Medical Journal. “This research abruptly ended after 1967, when psychedelics were legally classified as schedule 1 drugs under the UK Misuse of Drugs Regulations and as class A drugs under the UK Misuse of Drugs Act 1971 ... This classification denoted psychedelic drugs as having no accepted medical use and the greatest potential for harm, despite the existence of research evidence to the contrary.”

Rucker goes on to say that psychedelic drugs, more legally restricted than heroin and cocaine, are not habit forming, and not harmful in controlled settings. They could play a crucial role in alleviating psychological distress.

Meanwhile, across the pond, other great minds are thinking alike. Researchers in California have been given permission to experiment with the party drug Ecstasy to see if it could enhance psychotherapy and help alleviate anxiety for terminally ill patients. According to a report in The Science Times, Ecstasy or MDMA, banned by the U.S. Drug Enforcement Administration in 1985, “is known for creating feelings of euphoria, empathy and heightened energy. According to co-researcher Julane Andries, MDMA has the ability to help an individual ‘experience awe, and that eases anxiety and depression.’ She adds that ‘later, you can hold onto that memory of feeling vital, alive, happy and full of awe.’ ”

Participants in the research, conducted by the Multidisciplinary Association for Psychedelic Studies in Santa Cruz, will have psychotherapy sessions after taking the drug, while some will unwittingly be given placebo capsules instead. At the end of the trial, participants will undergo psychological testing and counselling and the mental health of the two groups will be compared.

After decades of just-say-no prohibition, psychedelic drugs seem to be making something of a comeback, helped along by people like psychopharmacologist David Nutt, a latterday Copernicus or Galileo who idiotically was fired as the drug-policy adviser to the Labour Government, in 2011, for suggesting that psychedelic drugs could be beneficial. Or Amanda Feilding, the Countess of Wemyss and March, whose Beckley Foundation in Oxford was set up to investigate the therapeutic possibilities of psychoactive substances. Research shows that psychedelics aren’t particularly dangerous—less so than alcohol—and may indeed prove profoundly beneficial to mental health. Already, Ecstasy is starting to be used as a treatment for post-traumatic stress disorder (PTSD). In other studies, psilocybin, the active ingredient of magic muhsrooms, has been used to reduce anxiety and depression in terminal cancer patients; in Switzerland LSD has been used to treat anxiety.

In an excellent overview in The New Yorker, Michael Pollan writes: “Many of the researchers and therapists I interviewed are confident that psychedelic therapy will eventually become routine. Katherine MacLean hopes someday to establish a ‘psychedelic hospice,’ a retreat center where the dying and their loved ones can use psychedelics to help them all let go. ‘If we limit psychedelics just to the patient, we’re sticking with the old medical model,’ she said. ‘But psychedelics are so much more radical than that. I get nervous when people say they should only be prescribed by a doctor.’

“In MacLean’s thinking, one hears echoes of the excitement of the sixties about the potential of psychedelics to help a wide range of people, and the impatience with the cumbersome structures of medicine. It was precisely this exuberance about psychedelics, and the frustration with the slow pace of science, that helped fuel the backlash against them.”

Intimations of immortality
Many ancient civilisations placed great importance on the use of psychedelic experiences derived from plants like water lilies, acacia, magic mushrooms, or peyote cacti, and the lure of altered states of mind continues today. Miley Cyrus was filmed in 2010 smoking Salvia divinorum from a bong—the plant has long been used by the Mazatecs of Mexico. Ayahuasca is an ancient concoction used in traditional healing ceremonies in the Amazon rainforest—today seekers from around the world congregate there on spiritual retreats to experience its long-lasting psychological effects. Apple founder Steve Jobs described taking LSD in his youth as “a positive life-changing experience.”

“Many of us find Wordsworthian ‘intimations of immortality’ in nature, art, creative thinking, or religion; some people can reach transcendent states through meditation or similar trance-inducing techniques, or through prayer and spiritual exercises,” writes celebrity neurologist Oliver Sacks, who spent his weekends in the 1960s taking drugs on an industrial scale. “But drugs offer a shortcut; they promise transcendence on demand. These shortcuts are possible because certain chemicals can directly stimulate many complex brain functions.”

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The manifesto for the benefits of psychedelics is English novelist Aldous Huxley’s famous, slim volume, The Doors of Perception, in which he describes an afternoon in Los Angeles in 1953 when he was transported to a profound altered state of being, courtesy of the hallucinogenic, magic-carpet drug mescalin. (The title comes from William Blake: “If the doors of perception were cleansed everything would appear to man as it is, infinite.”)

Huxley argues that drugs can offer a kind of liberation from the confines of our nervous system, a voyage beyond Plato’s cave out into the unknown, into intense, chromatic other worlds that we can otherwise only glimpse, worlds that offer heightened experiences of love, creativity, understanding and transcendence.

He writes: “To be shaken out of the ruts of ordinary perception, to be shown for a few timeless hours the outer and inner world, not as they appear to an animal obsessed with survival or to a human being obsessed with words and notions, but as they are apprehended, directly and unconditionally, by Mind at Large—this is an experience of inestimable value.”

On his deathbed, in 1963, Huxley had his wife inject him with LSD.

We have explored, mapped and catalogued every inch of our planet. We have walked on the moon, sent spaceships to far-away stars and studied ever-distant galaxies. Perhaps, however, the final frontiers are within—what Huxley calls the “antipodes of the mind.” It can be a difficult journey, fraught with peril, the dangerous ravines of madness never far away. But with exploration—whether through self-reflection, therapy, meditation, religious practice or hallucinogenic drugs—it’s possible that we can discover new realms, expand our consciousness and become ever-richer, fuller, truer versions of ourselves.
—John Barton

 • Ecstasy and Acid in your medicine cabinet? Doctors explore psychedelics (Newsweek)

• Magic mushrooms should be used to treat mental health problems, psychiatrist says (Telegraph.co.uk)

• The Trip Treatment (The New Yorker)

• Could Ecstasy be the next big anti-anxiety medication? (Science Times)

• FDA approves Ecstasy-assisted psychotherapy in Marin County (KQED—a 52-minute radio show)

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    John Barton is a counsellor, psychotherapist, blogger and writer with a private practice in Marylebone, Central London. To contact, click here.

DR JOHN BARTON IS A PSYCHOTHERAPIST, BLOGGER AND WRITER WITH A PRIVATE PRACTICE IN MARYLEBONE, CENTRAL LONDON
© 2023 JOHN BARTON