Psychoanalysis, Counselling, Ways of Being, The Inner World, Religion, The unconscious, Hope

Aleppo

aleppoI have nothing new to say about the battle for Aleppo. Many better writers than me have written reams about it. Psychoanalysis knows all about war, murder, envy and hatred. Both within and without. It also knows about love, care, compassion and kindness. Within and without. Aleppo has seen both of these worlds-the internal and the external. I want to use Aleppo as a metaphor for the inner journey.(I know something of this battle zone. I know nothing of a physical war zone. Thankfully)

I was watching the news last night. A Syrian man was interviewed walking among the ruins of the city. He was surrounded by rubble which he was looking at despairingly.(I was reminded of Hercules and the Augean stables.) He commented that if only the rubble could be cleared, others would return to the city. This seemed a powerful image for  the work of therapy. We all have our own rubble. Sometimes it’s a relatively small pile-or seemingly small. I don’t think any rubble is truly small, representing, as it does, the ruins of some kind of demolition. That pile was once something else. A building. A planned project. Something left behind by a previous owner.

The Syrian man was faced with a painful task. He had no clear idea who or what he might he find underneath the rubble. His family. His home. His life. In some ways it might have been easier to go somewhere else and leave the past buried where it was. Except that he has a right to see what might be buried there. To see what he can salvage that might help him begin again.

His comment about others coming back if the rubble is cleared struck me. I’ve seen so many people  over the years who have lost their friends and family because they can’t get through the rubble. That’s why I think counselling can be so helpful. It provides a space for someone to begin the rubble clearing process. We can’t move al the rubble as counsellors. But we can help the individual find the courage to begin some of the work. Week on week we can think about what might be involved. Where to begin. When to stop. We can offer a space to talk about what has been found in the rubble. What to do with that memory? How to find a way to  the past without being irrevocably dominated by it. It’s slow and often painful work for both the therapist and the patient. Frustration is present. Along with fear and loss. (Also joy and hope.) As a therapist one has to hold all these feelings until the patient can carry them home. Or leave them behind. Move the rubble and others can come along and help.

Freud characterised this struggle as the conflict between id, ego and super ego. Rubble clearance is another way of thinking about this.

 

Standard
Counselling, Dreams, Narratives, Psychoanalysis, Psychotherapy, Religion, Spirituality, The Inner World, The unconscious, Ways of Being

Home is where we start from

“We shall not cease from exploration, and the end of all our exploring will be to arrive where we started and know the place for the first time” . T. S. Eliot

131211-three-magi

 

Matthew’s gospel notes that the Magi ” Having been warned by God in a dream,  that they should not return to Herod, departed into their own country another way.”  I would have  liked to have eavesdropped on the conversation the Magi had on their way home. But now I want to pick up on Mathew’s comment. Many of my patients tell me that coming for counselling is the hardest thing they’ve done.But in the end they go back home-albeit by a different route. And know the place for the first time.  If I come home a different way I see things I had not previously noticed. It takes a while for me to orient myself. Then familiar landmarks come into sight and I know where I am.

This coming home via a different route is a common reaction from my patients. They go back home but with a different perspective. The major perspective shift is usually their view of themselves. Which in turn alters their view about family, work, hopes and dreams. Rarely do people not go home (although that’s not unknown).

The Magi did not go to Bethlehem empty-handed. They brought their gifts of Gold, Frankincense and Myrrh, which they left with the Holy family. In return they left with gifts. They’d seen something that would stay with them for  a long time. Even if they were unsure about some of its’ implications. There is no record of how this group of travellers lived post Bethlehem. The same is true for therapists. Rarely do we get to see what our patients do post therapy. We have to trust that we have done our work well enough for them to go home. Wherever that may be. To know it for the first time.

Standard
Counselling, Dreams, Hope, Madness, Narratives, Psychosis, Religion, Spirituality, The Inner World, The unconscious, Ways of Being

Jack and the Beanstalk . A risk Assessment story.

jack_and_the_beanstalk_by_rogan519-d3hdboxThis is a coming of age story. About a young boy discovering his capacity to be potent. To make  a difference. But to do this there is Risk. Any sensible person would have done a risk Assessment and decided to stay in the comfort zone. One old cow. One market place. One purse of money. One knacker’s yard. Deal done. Not Jack. He sells the cow for some beans. How stupid is that? (His mother makes her feelings known very clearly. She is, of course, a Sensible Adult.)

Jack is unrepentant. He plants his beans to see what will happen. Nothing much. That’s the trouble with Taking a Risk. One is never sure of the outcome. Cinderella couldn’t guarantee her Prince. Dick Whittington his streets of gold. Aladdin his lamp.  That’s just the Way Things Are. No Risk. No Gain. (And, of course, no Pain.)

We are in the country of Kiergaard and his Leap of Faith. Of Pascal’s Wager. Both should be seen as a Bad Influence. Suggesting that taking a leap of Faith is a worthy practice. (But, surely, the whole Christmas story is about Leaps of Faith .Mary and Joseph; the Shepherds; the Magi ; God. All involved in one lemming like leap. How unwise. Look how all that ended.)

So, Jack and a handful of beans. What to do? Obvious. Plant them. Bury them. Take a chance that they will find favourable conditions and grow. (That’s also the story of therapy. Create favourable conditions for growth and see what emerges. It is of course the story of any conception .Create the right conditions and see what grows. Even if the result is not what we were expecting)

The beans having been planted, something breaks the surface. A small shoot at first. Then it keeps on going. And growing. And growing until its’  tops are out of sight. What to do now? Fence it in and invite the public to come and see it. Charge an entrance fee. That would solve their money problems. Hire  an accountant to give them the best return on their money. Jack has a different idea. (He always will have.) He climbs the beanstalk. To who knows where or what. Life or Death. Heaven or Hell. Angels or Giants. Poverty or Riches. Or all these.)

We know what happens. A golden goose. A magical harp. Oh. And a giant.That ‘s just the way things are. Music and money. But also giants and danger. Giants who resent having their things stolen.  The giant comes down. The tree is felled. No more giant. Everyone lives happily after. Except the giant. That’s another part of these stories. They accept that not everything is fair all the time for  everyone. The giant loses out. Jack’s happiness is gained at a cost to someone else. That’s unfair. But this is not a cosy morality play. It’s about the harshness of things.

Bettelheim puts it like this“The unrealistic nature of these tales (which narrow-minded rationalists object to) is an important device, because it makes obvious that the fairy tales’ concern is not useful information about the external world, but the inner process taking place in an individual.”

That works for me! I know my generosity is tempered by my meanness. My kindness by my cruelty. My wealth by my poverty. That’s what makes me human.

Standard
Borderline States, Counselling, Dreams, Hope, Madness, Mindfullness, Narratives, Psychoanalysis, Psychotherapy, Reflective Practice, Religion, Spirituality, The Inner World, The unconscious, Ways of Being

Advent

advent7All this was a long time ago, I remember,
And I would do it again, but set down
This set down
This: were we led all that way for
Birth or Death? There was a Birth, certainly
We had evidence and no doubt. I had seen birth and death,
But had thought they were different; this Birth was
Hard and bitter agony for us, like Death, our death.
We returned to our places, these Kingdoms,
But no longer at ease here, in the old dispensation,
With an alien people clutching their gods.
I should be glad of another death.

Extract from “Journey of the Magi”

T.S.Eliot

 

The extract above is from T.S.Eliot’s poem  “Journey of the Magi”. I first heard it when I was at college and it has stayed with me. He captures the struggle of the Magi to  make their journey. These are  not triumphant warriors coming home. These are  men  who are tired. For whom the journey is uncertain. “Were we led all that way for Birth or Death?” That is a question that arises so often in therapy. “What am I doing here? I thought counselling was supposed to make me feel better.  I feel like shit.”

The Magi responded to a sign which they saw as significant. They were unsure what it signified, but they understood it to be important. The same is often true of my patients. They see a sign. A difficult marriage or relationship. Tensions  at work.  Perhaps feelings of depression and anxiety. These are read as signs. Signs that need to be attended to and understood. We only know that the Magi came from the East following a star. Bethlehem was an unknown destination. The  parallels to clinical work are obvious. We start from a different place. Frequently the place of our beginnings. Our place of birth. Those earliest moments of conception, pregnancy and birth which seem so far from our current places. Yet each time I see a patient we end up back at their beginning. The men whose fathers leave months after  their birth. The men whose mothers abandon them. The women who feel overwhelmed by their father’s expectations  of them. This is where the journey has begun. This is what has shaped their life to date. The woman who has had  six children with six different men. And each of her children taken into “care”. The successful business man who always has a lover whom visits regularly.  Whose wife pretends not to know and not to mind. These journeys are more like death than birth.

The biblical account of the Wise Men is only found in Matthew’s gospel. He places this visit at the end of his genealogies “The book of the generation of Jesus Christ, the son of David, the son of Abraham…” (Matt. 1:1) Matthew is telling his readers their history. As counsellors we don’t share your histories but  nonetheless draw on them in our work. (Unlike Athena who emerged fully armed from the skull of Zeus we have learned our histories the hard way with journeys that seem to have made the Magi’s travels look easy!) We share our patient’s journeys in many ways.We, to, have slept badly at times and have wondered where our journey will take us. To birth or to death?

My aim is to write more about Journeyings. Meanwhile I shall end with some Advent music. Enjoy, as they say!

Standard
Aylesbury, Counselling, Madness, Narratives, Psychoanalysis, Psychosis, Psychotherapy, Religion, Schizophrenia, Spirituality, The Inner World, The unconscious, Ways of Being

Black dog- a postscript.

What started out as a creative writing exercise morphed into a Psychoanalytic shaggy dog story. I wanted to take an unexplained event and offer one kind of interpretation. ( I think I made the assumption that there was never an actual black dog. I suppose that gives away my underlying rationalism. That’s one of the many reasons that I left Fundamentalist Christianity behind.)

So. My black dog. My attempts at offering a psychological reading left me thinking about other “supernatural” stories. How to think about divine visitations. Virgin births, for example. Or burning bushes. Or the finger of God writing on stone tablets.( I’ll use biblical stories because that’s the tradition I know best.)

The tension between a faith interpretation of events and a psychological one is not new. Consider the nuns who had themselves walled in until they died of starvation. They saw this as evidence of their devotion to Christ. We might see it differently. Or Madame Guyon who ate her own faeces as evidence of her self abnegation.

In psychiatry there is a similar schism. The psychiatric saints and mystics see their experiences as evidence of breakthrough. A uniting with a more spiritual self. Others see hearing voices etc as evidence of psychosis. A breakdown.

So, black dogs, hauntings, angels and miracles. Divine intervention or psychological mechanisms? Or both, perhaps?black-dog

 

 

 

Standard
Aylesbury, Counselling, Madness, Narratives, Psychoanalysis, Psychotherapy, Religion, Spirituality, The Inner World, The unconscious, Ways of Being

The Black Dog goes Home

black-dog

I feel as though I should preface this piece with a “New readers start here” summary. I shan’t. This dog has had its’ day and it’s time for it to go back into its’ kennel. We are  left with my patient’s friend whom I suggested was suffering from conversion hysteria. I suspect that in some way he identified himself with the dog. My patient had already said that his friend could be violent at times .”He would never back down from a fight. It didn’t matter if he knew he was going to get a beating, he couldn’t back down. As if he was hard-wired for aggression and violence.”  I asked about  his friends attitude to women.

“He was an odd mixture. He both loved and hated women. He’d been in arrested several times for domestic violence but none of the women would ever press charges. He go home  and for a bit it was all flowers and chocolates.Then something would happen and the violence would erupt. We often saw his girlfriends walking about wearing dark glasses. After a bit we stopped asking  ‘why?'”

With this in mind I contacted the friend’s psychiatrist and wondered if abreaction might be worth a try.

Here is a very brief definition of abreaction:

“Abreaction is a concept introduced by Sigmund Freud in 1893 to denote the fact that pent-up emotions associated with a trauma can be discharged by talking about it. The release of affect occurred by bringing “a particular moment or problem into focus”… and as such formed the cornerstone of Freud’s early cathartic method of treating hysterical conversion symptoms.”

In simple terms, if one can help the patient talk about an event, it brings it into consciousness where it can be thought about and discussed, in the hope of resolving the conflict.

We used this with the friend. We asked him about the black dog. At first he just laid there and shook his head. Which was a kind of progress! Then he said “That black dog was my life. It was me. I loved it. I hated it. I needed it and I loathed it I always knew that one day one of us would kill the other.It had to be that way. I always hoped it would kill me. But that’s not the way it was meant to be,” With this he relapsed back into his “coma”. And has never since moved or spoken. My patient came for  about a year longer then left, happy in himself and settled his marriage.

 

Standard
Aylesbury, Counselling, Madness, Narratives, Psychoanalysis, Psychosis, Psychotherapy, Religion, Spirituality, The Inner World, The unconscious, Ways of Being

Black dog

black-dog

I wanted to finish off this story with a brief exploration of the other person in this story. Namely the friend. This is really a clinical note to myself rather than an explanation given to my patient. I include it in case it is of interest or value to anyone else. The explanation that seems best suited to this event is conversion hysteria. Defined as

“The diagnostic criteria for functional neurological symptom disorder, as set out in DSM-V, are:

The patient has ≥1 symptoms of altered voluntary motor or sensory function.
Clinical findings provide evidence of incompatibility between the symptom and recognised neurological or medical conditions.
The symptom or deficit is not better explained by another medical or mental disorder.
The symptom or deficit causes clinically significant distress or impairment in social, occupational, or other important areas of functioning or warrants medical evaluation.”

In layman’s terms there is a mismatch between the event and the symptoms. Why should killing the black dog be so problematic for my patient’s friend? One would have expected a feeling of relief .A problem had been solved. There might have been some feelings of loss. A rare and strange creature is no longer present. A challenge has been met and won. But to end up completely paralysed? This makes no sense. During the World Wars it was nor  uncommon for some soldiers to be sent home because they had become blind .Or because they had lost the use of their shooting arm. Other expressions of this disorder are:

“In practice, the term is limited to findings on neurological examination that imitate neurological disease, but do not conform to anatomical or physiological patterns. It includes paralysis, somatic and special sensory disturbances, involuntary movements, pseudo seizures, speech, gait, and memory disorders…”

The body acts on behalf of the mind to provide a way out of an impossible solution. If a soldier can no longer tolerate the fighting, what is  he to do? He can’t simply go home. He can’t desert. Nor can he stay where he is. One answer is for him to develop a physical condition that allows him a way out. Albeit a physical problem with no organic cause. That way he can leave the fighting and stay alive at the same time.

To return to my patient’s friend. We know from my patient that he and his friend desired the young woman at the end of the lane. For my patient he decided that he had too much to lose by visiting her. His black dog was, ultimately, helpful. It made him evaluate his  behaviour in a new way. It seems that his friend reacted differently Which suggests that the black dog had a different meaning for him.

And, as I say to my patients, that is the end of this session. You might want to continue with this material in our next meeting…

Standard