I remember hearing a story by the psychiatrist R.D.Laing. He recounted an incident where a mother who lived in a multi storey tower block held her young child by his ankles over the balcony. She said to him “See how much I love you. I don’t let you go.” Laing did not comment on what the child made of this! It seems an odd way to demonstrate love. I wonder if the mother wasn’t trying to reassure herself of her love for the child.”See how much I love him. I don’t let him go.” We might wonder to whom she was speaking. Certainly not to anyone who gave her much self esteem. The imaginary listener sounds very persecutory. And in continual need of being soothed and mollified. It also seems likely that the child’s mother would dearly have liked to drop her accuser from a great height. We can only marvel at the murderous rage she must have spent her life containing. We don’t know what lead this mother to this desperate act. Whatever it was, one hopes she got the help and support she badly needed.
If this mother was referred to psychiatric services today, she would be Risk assessed to within an inch of her life. Her child would be put on the At Risk register and she would no doubt get lots of visits from Social Services. She might be referred to Parenting classes. She might, even,be offered 6-8 sessions of CBT with a psychology graduate who had read the relevant chapter the night before. (But who had little or no idea about her own neediness. Or Vulnerability. Or Inner world in general.)
In his novel Never Let Me Go, one of Ishiguro’s characters asks “Poor creatures. What did we do to you? With all our schemes and plans?” This woman might ask the same question. “What did you do to me, with all your schemes and plans?” (Actually, she might better ask “What did you do for me, with all your schemes and plans?” ) One of my favourite writers is Joseph Berke, a psychoanalyst a who is (or certainly was) director of the Arbours Crisis Centre in London. In his paper The Right to be at Risk he comments on this tool called a Risk Assessment. He says very many things of which I thoroughly approve. But, regarding Risk assessments he says “… risk has now become an additional diagnosis. While the ‘Risk Register’ has become a new form of hospital file or pathological or criminal categorisation.” He continues “… diagnoses are not linked with context… we see the decontexualisation of life.”
To return to the Laingian mother, who will spend the time with her to understand what it was she was asking for? Will anyone be willing or able to listen to her? To hear her own story and to understand what it was she was asking by her actions? It is much more likely that she will receive a diagnosis of Personality Disorder- the most damning diagnosis it is possible to be given. It guarantees one will always be pathologised. And, as a consequence nearly all actions, thoughts and behaviours will be dismissed as Attention seeking. The two go hand in hand. A “P.D.” is, by definition, “attention seeking”. (Curiously, nobody stops to ask why they might want some attention!)
Berke ends his paper with these points:
De-patholgise Risk. Avoid Labelling and categorisation.
Re-contextualise the risk. Containing relationships are an essential part of this process.
Soak up projections. Digest them. Don’t pass them back to the person struggling with difficult impulses or feelings.
Encourage benign introjections.
As I was writing this blog, I realised it is Mothers Day in the UK. And that I am not writing a piece about flowers, butterflies, chocolates and the like. I am also aware that this is a more than averagely technical blog. I apologise for these sins of omission and commission but hope that there are still enough good things here for everyone to gain something nourishing.