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

Containment 1

I’ve just had a short stay in hospital for knee replacement surgery. It’s  a disconcertingly quick process, once you’re admitted. I was admitted on Thursday and discharged home by the Sunday. Out with the old and in with the new. Literally. This was my third hospital visit over several years and the first one that was planned. The previous two had been crisis admissions. I don’t do well as a  patient – particularly as one who has been a nurse for most of his professional life. My overall recollection of my two previous admissions was of a gap between “hard” medical skills and the “soft” nursing ones. Between  the “male” skills of surgery and the “female” roles of nursing. I remember one nurse observing of me (to me) that “we’re all ill in our own way.” She was right. I’m not good as a patient. I’m far too impatient and independently minded. I hate being stuck in bed. I fear a loss of autonomy. My defence against existential anxiety is to become difficult and demanding. It’s a way of reminding myself – and everyone else –  that I will deal with this situation in my own terms. And if those terms don’t accord with your terms, well, so be it. Which means I’m never going to be “that nice man in bed 12”.

This admission was a markedly better experience. In part because I’d had a lot of time to prepare myself. I had a list of coping strategies. Chief of which was “Be nice to the nurses”! I was and it paid off. I could relax and allow myself to be cared for. Which created a virtuous therapeutic circle. I was content and contained.

The image at the top of this blog gave me a lot to think about. I Googled “Containment” expecting to find images of holding. A mother feeding her baby. A parent and child walking hand in hand.  Holding and held.  Instead I found a number of images like the one I chose. I thought about using another gentler image but opted to stay with the violent image that Google gave me. I wondered why? Partly on the basis of my two previous admissions. Partly on my own experience of being in analysis and also of my clinical work as a nurse and a therapist.

Psychiatric nurses don’t get many boxes of chocolates from grateful patients. In 25 years I got one box! I was reminded of this when I left Papworth hospital. I dutifully brought a box of chocolates. “Oh. Chocolates. How nice.” was the distinctly lackluster response. “I’ll put them with the rest.” It was a fair response. I was expressing my hate not my love.

“Damn”, I thought, “nice Adult nurses always get nice chocolates from grateful patients.” In  Mental Health this was not the way of things. We didn’t get “nice” patients nor did we expect to be “nice”. We expected to keep our patients safe. If that meant restraining them and forcibly medicating them, well then that was what we did. We contained them.

My two previous admissions highlighted this difference. The nurses expected to be liked. Why wouldn’t they? They were there to make us better and we were supposed to be suitably appreciative. So why wasn’t I being appreciative? I was being well looked after. My medication arrived on time and when I needed it. I was constantly monitored by a machine that bleeped if I even sneezed. I had drains, catheters, fluids and drips. All conspiring to keep me alive. So why my ingratitude? Mostly because I wasn’t contained. Nobody was asking me how I felt about having nearly died. Nobody asked me why I wasn’t eating or drinking enough. I was simply put on a fluid balance chart.

So the picture above sums up my first two experiences, My rage, fear, hatred couldn’t be borne. So I felt gagged. And murderously angry. Which I evidently conveyed. Powerfully.

 

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Counselling, Narratives, Psychoanalysis, Psychosis, Psychotherapy, Reflective Practice, The Inner World, The unconscious, Ways of Being

Emotional etymology

I realise how often I will look up a word’s etymology when writing a blog. It seems a way in which I can ground my thoughts and my writing. A literary “ground of my Being”. It gives me a sense of starting from somewhere honest, which is the original sense of the word “etymology”. It has to do with true meanings. But words don’t remain static. Thankfully. They “slip, slide, won’t stay still” to quote Eliot. ( A friend wrote a brave and fascinating piece on the word “cunt” I’m not sure I would have been as brave!) My thoughts then wondered off to my clinical work and the idea of clinical etymology i.e. what are the origins of this symptom, idea, fantasy etc.  (Freud’s essay on The Rat Man is a classic example of the beginning of a symptom and the ways in which these symptoms changed over time. It is also an exploration of the creative uses to which we put our symptoms. It is also quite opaque at times with Freud making extraordinary jumps of understanding and interpretation. But why should this be a surprise? If language is full of hidden histories, how much more so our unconscious lives?)

To take this idea a little further, we can follow Lacan in suggesting that the unconscious  is  structured as a language. Which might give us access to wondering about what part of speech any given symptom m might equate to. Thus a symptom may serve several functions. It might work as a noun, having a naming function which also serves as a limiter i.e. it is this thing, not that thing. It is depression, not anger. A symptom may also  be a verb. a doing word i.e. I”do” psychosis. It is an active process that needs a subject and an object to fully make sense. (Which is why whenever we take a clinical history, we try to put a symptom into a context. When did this symptom first begin? How do you use it? There is really no such thing as an isolated symptom .Somewhere in the unconscious we will find the rest of its family.

And like any good piece of writing, I’m now struggling to find a satisfying way of ending my blog. I think M.Scott Peck sums it up beautifully when he writes, in The Road Less Travelled “The fact of the matter is that our unconscious is wiser than we are about everything.”

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Hope, Madness, Narratives, Psychoanalysis, Psychosis, Religion, Schizophrenia, The Inner World, The unconscious, Ways of Being

The enemy within?

Like so many others I’ve watched with concern Donald Trump’s attempt to ban certain groups from entering America. His argument is that they are  a threat to national security. I suspect that America is quite capable of producing home-grown terrorists without importing them. Psychologically his attitude is fascinating – albeit dangerous.

 

In psychoanalysis there is the idea of two states of mind in which we live. Technically called the paranoid-schizoid position and the depressive position. In the paranoid-schizoid position the infant has two mummies. The good mummy who comes when called, feeds me when I’m hungry, changes me when I’m wet and so on. I love this mummy.  Then there is the bad mummy. She leaves me too long, does not instantly respond to my needs and so forth. I hate this mummy. Eventually the child comes to recognise that the two mummies are one person. The bad mother is also the good mother. And vice versa. The child is faced with a problem. How to live with its responses to this mother. How do I reconcile my love of the good mother with my hatred of the bad one? What does this say about me? I have to live with my capacity for hatred as much as I live with my capacity for love. (R.D.Laing explored this tension brilliantly in his book “Knots”.) It is the problem Juliet faces in Romeo and Juliet when she falls in love with Romeo and laments that her only love has sprung from here only hate. Bringing these two positions together is what we call the depressive position. It takes courage to live in this place.

I think we are seeing something similar being played out with the rise of far Right political groups. The enemy is the immigrant who is taking our jobs, stealing our benefits and generally being parasitical. We then go to our hospital and are grateful to the Pakistani doctor who cares for us. The African   nurses who look after us. The Chinese Radiographer who scans our bones. These are good people! The bad ones are the other kind. (Whoever they may be.)

We separate good “mothers” from “bad” ones. Why? Because to recognise the split within ourselves would be too painful. We would be forced to acknowledge our own ambivalences. We see this splitting off in men who murder prostitutes. In women who will allow a dangerous partner to look after her children. In the killing of gay men by straight men who fear what they desire.And in the psychotic states of mind like schizophrenia where the denied part is heard as voices which can be disowned.)

It seems to me that this is Donald Trump’s agenda. In banning Muslims from coming to America he is attempting to banish split off parts of his psyche. And that of a segment of America. He can hate the poor, the needy , the vulnerable. In much the same way as some religious groups demand “modesty” from women. (If I lust after  a woman’s body, why is it that this is the woman’s fault? Why should she wear a burka and cover up all but her eyes? Why should some christian groups demand that wives are submissive in all things to their husbands?) In Trump’s terms, we might wonder what parts of himself he is putting into the poor etc-from whichever country they come. I suspect from his bombast that he cannot tolerate his own needy parts. His narcissism stemming from a profound insecurity. What makes him dangerous is, of course, that he has mobilised a part of America that feels dispossessed and unloved. Perhaps with some justification.  Brexit in the UK seems to me to demonstrate something similar.

As a counsellor, I have some idea about how I might work with a patient exhibiting these attitudes. Where does the hatred come from? What triggers the fearful self loathing? I would hope that, over time, we would build a strong enough relationship for my patient to let go of some of their fears. To come to a place where they could grow some self-love and nurture the parts of themselves that they so despise. (The despising coming from a fear of vulnerability and neediness)

But I am not a politician. Trump is not my patient. Nor are the Brexiteers.  Perhaps it is time for the clinicians and politicians to sit round the table together and share some insights. Then we could move the social narrative on from a split, paranoid-schizoid position to a more integrtated depressive position.

 

internal-conflict

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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.

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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

 

 

 

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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…

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

The Black Dog

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.

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