Freud goes gardening

As all good gardeners know, we are supposed to plant in threes or fives. This blog is my third “planting”. Five seemed too many given the amount of time we spend in our real and metaphorical gardens. As with all good work, I’ll begin in the here and now. I came in from the garden the other day feeling rather disgruntled. “How did you get on?” asked my wife. “Did you get lots of things done?” I grunted a reply and she carried on typing. I began my blog, I was disgruntled because I’d  spent several hours outside with nothing much to show for it. I’d dug up a couple  of clumps of couch grass and removed yards of convolvulus . But no “Wow!” moments. Just plodding away at routine maintenance. The chief thing I’d done was to plant some bulbs for later this summer. Neatly labelled: “Summer bulbs. Misc.” (I keep careful gardening notes, as you can see!) And at this point I’m going to risk sounding like ‘Thought for the Day’ by using this anecdote as a jumping off point to talk again about the garden as an image for that which I’m going to call “soul”.

I had somebody come to see me recently. He had a number of issues from his youth which he needed to resolve. He talked. I listened, and I made some observations en route. At the end of the session he commented that this had been helpful. He’d talked about more issues that he’d planned to and felt relieved. I asked him if he wanted to come  back. He thought for a moment and said “No. This session had been helpful enough.”  I wasn’t persuaded that he had resolved the underlying difficulties but it was his choice. Others stay much longer. With these patients I can spend a lot of time double digging, removing the entrenched weeds and trying to see what lies buried beneath years of bad planting and poor care. There is a satisfaction to this kind of work, although at times it feels like hard labour! Hard labour with no “wow!” factors to mitigate it. I remember one patient who spent two and a half years with me. Each session seemed to last forever. I did not look forward to seeing her. (It was probably mutual!) We met faithfully each week, seemingly getting nowhere new. Then, suddenly, six months before the end of her course, something shifted. In her. In me, I’m not sure. But new growth started to emerge. Like those early buds in spring. I think we did more work in the final six months than in the previous two years. Asked her why she had stayed when so often our work felt fruitless, she commented that she trusted the process- and me! We both learned a lot from that therapy.

The link here is, I think, about patience. My miscellaneous summer bulbs will flower in due time. I’ve done the preparatory work. Now I have to leave them alone and “trust the process”.  I find it hard , at times, not to want an instant result. I was discussing two of my patients recently with my supervisor. I complained that I was running out of ideas on how to help them. She commented on my sense of frustration, underpinned by a certain crossness. “I’ve been working with this one for several years. And still we go over the same ground, week in, week out. Then they complain at me that we seem to be spending a lot of time going over old material!” The indignation in my voice could have been heard throughout the town! She was sympathetic and reminded me of Bion’s maxim that one should approach a therapy session with neither memory nor desire. It’s a quote I knew but had lost sight of in these cases. She reminded me that it was not my task to make my patients better. My function is to manage the process and, thereby, help my patients towards their solutions. I’ve taken her reminder to heart and feel more relaxed and less irritated.

As a gardener I can’t make my plants grow. All I can do is to provide the right conditions for any given plant. The rest is, mostly, outside my control, which sometimes comes as a great relief and sometimes exasperates me. Just like my patients!

 

A good garden may have some weeds

My last blog made some links between being a therapist and being a gardener. My garden reflects the way I do therapy. I’ve never managed to plan a garden in the abstract. (I much admire those who can.) I work with what’s there now and plant around it. I tend not to slash and burn in the garden. I’ll work out from my Acer and see what will grow around it or underneath it. Given how much shade it produces, not much thrives beneath it. A few Arum lilies and some ivy. So I don’t do much here. Simply pull off the bindweed from time to time. Elsewhere in the garden I’m more active. I recently made a new bed and filled the space with dark purple geraniums. They still looked lonely so I added some low growing pink geraniums in front of them. It’s a work in progress, but I’m confident they will work well together. And so on over the length of the garden over 20 years. Adding some plants here, moving some there, creating new spaces.

I work in therapy in much the same way. I’m wary of patients who want to kill everything in their emotional garden. I explain to them that I don’t do “glyphosate therapy”. When we meet, I do an assessment of their current Soul garden. We look at what’s growing well. What has self-seeded and what is a weed, (You’ll know the definition of a weed. “A wild plant growing where it is not wanted.”)  We all have plenty of those!) We’ll look at their feeling about their soul garden. How do they feel about it’s current state? Too many penstemons and not enough buttercups? Too many hydrangeas and not enough ferns? That’s useful information. My task is not to make a new garden according to my preferences – I have my own garden for this. My task, with my patient, is to think about their garden. If this plant is not thriving, why not? Is it in the wrong place? If we moved it to a sunnier place, would it thrive? Similarly this plant might not be doing too well because it needs to be  in a more sheltered spot. The glare of full sun is too much for it.

The gardens for Chelsea flower show need to look good for a few days. My patient’s gardens have to last much longer. I can’t import a few tons of top soil, some trees and a water feature. The work we do together needs to last long term. This requires preparation. Deep rooted weeds do need treating. Trees do need pruning and cutting back. Poor soil needs enriching. Acid loving plants won’t thrive in alkaline soil. Plants need a soil that nurtures them and suits their needs. The wrong soil is toxic. Heathers love an acid soil whilst lavender needs chalk. It’s about knowing what grows best in any given place.

This observation from Liberty Hyde Bailey sums things up “ A garden requires patient labour and attention. Plants do not grow merely to satisfy ambitions or fulfil good intentions. They thrive because someone expended effort on them.”

 

Relativity

In our creative writing class last week we were asked to write a short piece about Time. for some reason the formula above cam e in to my mind. Im not sure whty. I don’t usually remember formulae. But it prompted me to do some thinking. Then i n the coffee shop recently i heard two people talking. One was talking to his friend about going on holiday.

“If it’s just the three of us, then we get along fine. We all slot into our roles and it works very well. Then my son comes along and everything changes .I’m not sure why. I guess we’ll just have to try and make it work.”

This reminded me of the Speed / Distance /Time  formula. Which them lead me on to musing about our psychic equations. The relationship between the different parts  of ourselves. The Ego / Id / Super Ego  combination of Freud’s work.  Or Melanie Klein’s two positions. Or Jung’s ideas about our shadow side. (All this whilst drinking my latte.) It was almost cold by the time I’d finished my reverie!) That we are  not single entities. We know this to be true in our bodies. They are designed to work as a system, not as separate little kingdoms. The speed / distance /time formula is also bot relationships within a system.

And the problem with systems is that they challenge our omnipotence.  Whilst my eyes know, logically, that they have to rely on my ears to help them, a part of them would love to declare UDI from the rest of the body. (Fortunately this doesn’t often happen!) So in the inner world. My love cannot function without an awareness of my hate. And vice versa.  My patients have to face this tension. My ability to help them comes at a cost to their omnipotence. By seeing me thee is an acknowledgement that they need help.

So, with all this as context, here is the piece that I wrote for my class.

Time is furious. She thinks that she reigns supreme. Controlling all galaxies, empires and lives. She measures our mortal span. Three score years and ten. She defines our galaxies .Defines the star Sirius, for example as being 8.6 light years from Earth. bt she cannot rule alone. If she is to be useful, she has to be  in relationship. In this formula she is defined by Distance and Speed. Much as she resents this fact, it is True. To be useful she must share with Distance and Speed. And they with her – which gives her some satisfaction. Distance needs her along with Time. Speed the same. In a perfect world, Time would be supreme. But this is not  the case. So like a haughty dowager,  treating Distance and Speed as her servants. Ignoring the fact that she is dependent on them. Thus keeping intact her fantasy of self-sufficiency. The doxology comes to mind. “As it was in the beginning, is now and ever shall be, world without end. Amen.” Time is always relative.

In my preparation for this blog I found this quotation. I think it sums things up very well. (I\m only glad i found it  at the end of my work, not at the beginning otherwise I might have felt I had nothing new to say!)

“There is no Jesus without Judas; no Martin Luther king, Jr, without the Klan; no Ali without Joe Frazier; no freedom without tyranny. No wisdom exists that does not include perspective. Relativity is the greatest gift.”  (Chris Crutcher, King of the Mild Frontier.)

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?

 

 

 

The Black Dog goes Home

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.

 

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…

The Black Dog

This is the last part of the story of the Black Dog of Aylesbury as told me by one of my patients.. It’s a frightening story and easy to dismiss as the product of too much alcohol or other dubious substance. But my patient made it very clear that he was absolutely sober.  I believe him. So, what to make of this story? Jung would view the Black dog as an archetypal figure raising from a shared unconscious. Not being a Jungian, I chose to interpret this story as a kind of waking dream. Dreams being  seen as the Royal Road to the unconscious by Freud. In the earlier blogs  I’ve spoken about one view of what this event might have meant for my patient. I now want to look at how we might understand what happened to his friend. (Although like all therapy sessions, this might take longer than initially planned.)

In the story my patient and his friend both go out to challenge the dog. The friend beats it up and it vanishes. But the consequence of this is that he goes in to a kind of coma and is hospitalised. At the time I was seeing my patient his friend had been like this for several months.

“What do you think happened, Terry?” my patient asked.

This was not a question I knew how to answer in simple terms. In fact the whole saga stretched me to my emotional and intellectual limits. I found, and still find, the whole event disturbing. Here is a summary of what i suggested to my patient.

What did he know about trench blindness, for example? Or of soldiers who developed paralysis in their hands when it came to shooting a rifle. He said he’d vaguely heard of this idea.

“Weren’t they seen as skivers or cowards and either shot or court marshalled? Or both?” he asked.

“Yes, that was often what happened. Psychological thinking wasn’t very sophisticated in the forces in those days.”

“So”, asked my patient, “what does this have to do with the dog? It was real. We both saw the damned thing.”

I took a deep breath and started.

“I think something like this happened. Both of you wanted to visit this woman at the end of the lane. Both of you wanted to have sex with her. Both of you were stopped by this dog. This dog represented the bit of you that felt guilty about this. You wanted this woman but also knew that you had a family at home whom you loved. The dog ‘worked’. It kept you faithful-which you wanted it to.”

I paused.

“I sort of get that.” said my patient. “You’re saying I invented this dog to stop me from doing something dangerous like having sex with this woman.”

“That’s close enough .I’m not sure I’d use the word ‘invented’ but that’s pretty much what I’m suggesting.”

I went on to suggest that the dog had served its purpose. (We rarely ‘state’ or ‘tell’ as therapists. We ‘suggest’. We ‘muse’.  There are all sorts of reasons for this…) It had given him a  chance to think about what he was doing. To decide that he wanted to keep his marriage, home, family etc. In a sense the dog was no longer needed by him.

“OK. I see that and it’s true. Mostly.I did want to keep my marriage more than I wanted to have sex with this woman. But, it would have  been fun finding out …”

“Agreed. It might have been. We don’t know what else you might have found out.

We left this thought hanging and returned to his friend. And since that is the end of our time for today, the story of the friend will have to wait for another session.

The Black Dog Understood

I hoped it might be interesting to write about my own responses to this story and my patient’s thoughts.

My first association was that this black dog stood guard over a long, dark entrance at the end of which stood something both desired and forbidden. The  idea of the vagina dentata the vagina with teeth or the vagina that bites. My patient desired the prize but was also forbidden by his own moral standards. He was a married man with two children. This precluded him from having an illicit liaison. Thus speaks the super ego, the inner policeman. But this was in conflict with his more basic instincts (the id) that says, simply. “I want it.”  What was he to do? He couldn’t say “Yes” and  didn’t want to say “No.” So he comes up with an ingenious answer. He sets up an impassable barrier in the form of a ferocious Black dog. (A lovely representation of his super ego.) This works very well up to a point. So long as the dog is in place, he is safe. But if the dog goes, then what will stop him from pursuing his desire for this woman? He needs the dog alive which may account for why he never tries to kill it. The problems begin when his friend apparently succeeds where he cannot.But more of his friend later.

The other association that came up for me was Freud’s notion of The Uncanny. Particularly his commentary on the idea of heimlich or homeliness. The central idea is that homeliness stands for warmth, security, safety, etc. But the shadow of this is that it suggests something hidden and private. So a faithful black dog may be a family pet protecting its owner. But  the shadow can turn this feature into something dangerous and unknown. A ghost or demon or some other paranormal being. So my patient sees the heimlich of his own two dogs. The Black dog is only an extension of his own dogs. The ghost dog, like his own, his there to protect and keep out intruders. (And here we are again back with that vagina dentata. Something that protects and defends its owner.)

So, these are my own brief thoughts and associations on this account of a haunting.There are a few more notes to come but that’s enough for one reading.

What do others make of this story? And of the supernatural in general?

 

Black dog

This is the second part of my work with a patient and his story of the Black Dog of Aylesbury (www.mysteriousbritain.co.uk/england/…/aylesbury-black-dog.html )

In the previous session he had told the story of a mysterious black dog and how his friend had attacked it with disastrous consequences. Here are some more notes from another session.

He is describing the place where the dog is on guard.

P.”It was stood at the far end of a field. There was a lane on the other side. Just one cottage was down there. A bit lonely, I’d have thought…”

A long pause.

T. “Where have you gone?”

P.”Oh! Nowhere. Just wool gathering. ‘A head  full of nonsense’ my mother always used to say. ‘You’ll get into trouble one day if you don’t mind those thoughts of  yours.'”

T.”I wonder if you feel you’re in trouble now?”

P. “Trouble? No. Not me. I’m a good boy these days. A wife and two children to think about.”

T.”And what do you think about them? This family of yours.”

P.”They’re great. The best thing that ever happened to me.”

At this point my patient has  a coughing fit that lasts for several minutes.  I ask if he would like glass of water.

P. “Yes. Please. Thank you.”

I get him his water which he sips slowly.

P.”Thank you. I don’t know where that came from.” Pause.

T.”Well it seems to be triggered by talking about your family. As if something got stuck in your throat and threatened to choke you.  That quite a powerful reaction…”

P. laughs uncomfortably but says nothing. He sighs deeply.

P.”I reckon that dog was a blessing in disguise…”

T. “Mmm. A blessing in disguise?”

P. Sighs. “I know who lives at the end of that lane. A young woman. Pretty. Always looks as though she wants a good time. I’ve met her in the pub a few times. Chatted with her. Brought her a drink.She told me where she  lives. Asked if I knew it. I said I did. That I sometimes walked the dogs that way. She  made it very clear that I’d always be welcomed to call round.  She lived by herself, she said, and often got lonely. Then she’d smile, finish her drink and leave. I think every man in the pub fancied her. Hard not to. After that I’d use the dogs as an excuse to go down that way. At least once a week. I never let myself know why I was going that way. But I knew…”

T.”So you wanted to have sex with her?”

P.”That makes me sound awful, doesn’t it? Here I am. Married with two children and still I want to go after some girl.”

T.”You said the dog was a blessing in disguise. What did you mean?”

P. “As long as that dog was there I couldn’t go down the lane, could I? No matter what I wanted, that dog stopped it. I hated that animal. If I could have shot it I would. But somewhere  I was relieved. It meant I couldn’t cheat on Anna and the kids.” Pause. “Listen to me. I sound a complete lech. Longing for  a quick shag with a young woman. But it’s true .I really wanted her. But I also know I love my family.”

T. “I wonder, then, how you felt when your friend did destroy the dog?”

P. “I’m not sure. Terrified, mostly..”

T. “Terrified…”

P. “Yea. Terrified. One  minute there’s this bloody great dog in front  of us. Them it’s gone and my mate is lying on the ground. Not moving. I thought he was dead. Had a heart attack or something. I rang 999 and waited for an ambulance. They came and took us both to hospital. They said I was only suffering from shock but that my friend was very ill and they had admitted him. I rang  Anna and she came and picked me up. Her mum looked after the kids until we got home.”

T.”It sounds terrifying but that is the end of our session. I’ll see you next week

 

A sense of place

 

This piece came out of an assignment for  my creative writing class. I thought at the time that I would probably use it as a blog. And so I am using it, albeit in modified form. Our assignment was to choose a familiar route and describe it in such a way that it conveyed a sense of place. As I wrote, the parallels between my short journey to work and the work itself seemed to merge.

My route to work takes about five minutes at most.  I leave my 300-year-old cottage in Aylesbury’s Old Town and cross Castle Street to the Mound. That’s my first bit of history. There is no castle nor ever has been but a version of the name remains. Home represents a past that has been adapted to the present but which still influences how we live today.We have low ceilings and windy stairs both of which set limits on what we do with the house. In my clinical work I constantly meet with the ways in which my patients have adapted their present to their past. Their internal structures set limits on what they have been able to build emotionally and intellectually. From home – which is, as Winnicott points out where were we start from – I go across the road, past the next landmarks to the next stage of my journey.  I cross  what is  known locally as the Mound, an open space enjoyed by many. The drinkers with their cans, the teenagers “just chillin’ “, the couples all but making love in the summer, the drug addicts at the top corner who leave their gear in the bushes for the local wildlife to find. (We have some of the happiest foxes for miles.) It’s sometimes very hard to know where to look – or not!

Without making the story overly allegorical, there is a link here to my work. How do people use their open spaces? Can they relax with a book? Or sit on the grass chatting with friends? Or is there a need to blot out the present with drugs, sex or drink? Anything to numb the pain of Being. These more squalid  aspects are juxtaposed with an attractive border of a variety of flowers and shrubs. This again seems to mirror so much of what I see in my counselling and have seen over the years in my nursing. Something alive and thriving sitting next to something deathly and squalid.
My short walk continues along a cobbled path which if I’m cycling I fondly imagine is the Paris-Roubaix ride, famous for its cobbled sections (known as the Hell of the North and challenging to ride). It doesn’t take long working as a counsellor to find out how quickly smooth tarmac gives way to bumps, lumps and cobbles. As I continue I can see in front of me the nursery that began as a church. Childcare obviously pays better than God. Sometimes I see the children having their playtime, their noses pushed through the railings. (Another useful image for my work which so often moves through time. We begin with the remembered – or forgotten past – and on to childhood memories and recollections. Of parents who were sufficiently or insufficiently present or absent. Of being popular or unpopular at school.)
After the Hell of the North life gets easier. It’s tarmac all the way down to the main road. I turn left at the bottom past another terrace of new houses built, I guess, in the late 1990’s. I see today that one them has just been Let. (I hadn’t realised it was for Let in the first place.) I don’t much like these properties. They are soulless. “Little boxes made of ticky tacky.” I go left up the hill, passing a mixture of old and new Aylesbury. The first new development is a block of “Luxurious New One and Two Bedroom Apartments.” situated in what was an office block. I was amazed when the work began. I couldn’t see how this building could possibly house people. I still don’t. But they will sell quickly enough. As so often, I’m ambivalent about this development. I’m pleased that homes are being made available but wonder about the kind  of  life that they will engender. I doubt there is room for children in these flats. Having family and friends to stay in a one bedroom flat might prove a challenge. As so often the environment shapes much of the life that goes on in it.
I carry on up the hill to work, passing Morrison’s on my right with its very convenient car park. I always tell my patients to leave their cars here. (I hope they at least buy a can of beans.  Just as a token “Thank You”. Maybe I should offer the store a donation. But I doubt they need it.) As I go up, I pass our local OCD lady with her rituals. She takes a certain number of steps then stops. She crosses yellow lines carefully, not treading on them. She often spends time looking for her keys which she has dropped down a drain. Several times a week. (A generous friend once spent 20 minutes trying to retrieve her keys before realising that she had not lost them at all. This was part of her OCD. He didn’t volunteer again.)
I carry on the few hundred yards more, passing offices, one or two grand houses, solicitors, and an engineering company. Then I’m at work. I key in my passcode and go into the Quaker Meeting house where I have my counselling room, where I repeat emotionally the physical journey I’ve just made. What has changed in my patient’s world since we last met? What memories did our last session evoke? What new developments have received planing permission?