Counselling, Dreams, Hope, Narratives, Psychoanalysis, Psychotherapy, Reflective Practice, Religion, Spirituality, The Inner World, The unconscious

Messy people

I recently saw the exhibition “America’s Cool Modernism” at the Ashmolean museum , Oxford. It had paintings by Edward Hopper. I was struck by the absence of mess or untidiness in the pictures on display. There was a sterility to them which is at odds with any major city. The lack of people also made it harder for me to judge the dimensions of the buildings. Cities are messy, untidy places .There  is always a mixture of beauty and near chaos. Of life and of death. Each element sets up a contrast with the  other. The open top Porsche driving past the beggar in the street. The quietness of a church or cathedral contrasting with the noise outside. Cities epitomise thee contrasts. Yet in the Hopper works on display, mess was not in sight.

As a  counsellor I work with these contrasts each day. Although the contrast here is about people’s inner worlds. And of the interplay between these worlds. In any given session we will move between life and death. Order and chaos. A session may begin with a patient in tears of sadness about a loss and end with that same patient sharing a smile and laughter with me. (And, occasionally, at me!) These contrasts are part of the richness of people making-  soul making, one might call it. I’m often struck in my initial assessment with a patient about the gap between where we begin and where we end up. Someone will come for Anger Management and what emerges is someone who has never known a truly nurturing relationship. Or someone who comes with Anxiety who is suffering from an intergenerational message about the value of women. They themselves are anxious. Their mother had similar difficulties as did Grandmother-and possibly great-grandmother. The work then moves from Anxiety Management to  Self Esteem work and an affirmation of their worth and value.

So how do we move from Hopper to Anxiety? As I’ve said what struck me was the sterility of hopper’s paintings  -or those chosen for this exhibition.There was no mess. I live in an untidy home. I visit friends whose homes are models of neatness and tidiness. Everything has its place and everything is in that right place.  My home is hull of “things”. An empty wine bottle waiting to go in the recycling bin. Today’s bills on the kitchen table. Half read books on the table in the front room. And two very untidy dogs. I used to get cross at the “mess”. Every now and then one of us will tidy up. Which lasts for a couple of days! Then the “mess” takes over again. Curiously this feels comfortable. We are not a “neat and tidy” couple. Or not at home! The “mess” goes to define and shape us in some way.

I looked up the  etymology of “mess” because i had a hunch that its roots weren’t as critical as its current usage would suggest.  The earliest meaning is to do with food. Specifically  a prepared dish with a later sense of it referring to a group of people sharing a meal together. The idea of untidiness or chaos is much later. I was pleased by this! Partly because i can claim that our home is not untidy but convivial! Partly because it chimes with my clinical experience that when my patients bring me their “mess” we can begin to work. The “mess” provides a fertile bed from which new growth can occur.

The American writer, Mark Yaconelli summed it up well. “The way of the spiritual life”,he wrote”begins where we are now in the mess of our lives.” (He defines spirituality as being about intimacy. “Spirituality is not about perfection: it is about connection.”  Which demystifies “spirituality”and re incorporates it into the everyday |mess” of our lives.

 

 

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Borderline States, Counselling, Dragons, Dreams, Narratives, Reflective Practice, Religion, Spirituality, The Inner World, The unconscious, Ways of Being

Principalities and Powers

Saint Paul wrote that we wrestle not against flesh and blood but against principalities and powers,

This seems to be one way of thinking about the way values seem to get embedded. Whenever I assess a man for Anger Management there will be generations of men behind him sharing their values and instilling in him a view of how men behave and conduct themselves. Usually these values include emotional and physical abuse as a way of enforcing a power structure. These men then grow up with a view of themselves as needing to be ” hard”. Hard on their children and hard on their wives. Sometimes the control is physical, sometimes emotional. But always about control.

Similarly when I assess a woman who has come for help with anxiety or depression, there will be mothers and grandmothers who instil a view of a woman’s place and function. This will be that they are there primarily to serve their husband or children. ( To serve. Not to complement or share, but to serve. As one patient put it, her task was to help her husband become the man she saw that he could be!)

Saint Paul understood his battle to be with the spiritual forces that he thought lay behind everyday life and society. He saw these values as demonic and anti Life..

Looking at the Brexit decision, I’m almost inclined to follow him.

In broad terms, he had a point. Violence, rage, crippling anxiety and depression are anti Life. Which might be one way of characterising the demonic. That which is anti Life. Which begs the question of “Why?” Why does a man come to believe that violence is the only way to live? Where does he decide that hitting his wife and children are good ways to live?

Where does a woman decide that her task is to sacrifice all for her husband/ father/ family?

It seems that there is an alternative value system that ensnares us in its thinking. I recognise it in myself. My wife works full time in a job that she enjoys and which is demanding. I’m retired and work fewer hours. But if we run out of something at home, my all too frequent reaction is ” Why hasn’t Jenny done the shopping?” (I do try to remind myself that I am quite capable of going shopping.) And I consider myself to be a modern man. Some values run deep!

So how to understand the principalities and powers at work here? Much of the difficulty seems to stem from a sense of insecurity. I’ve yet to meet a man for whom Anger was a problem who was able to value himself very much. In all the men I’ve worked with, there was an underlying sense of low self worth. ” I’m just thick. I’m only fit to be a navvy” is how several of my men have put it. And even on the building sites, there’s no respite. Any comment on their work, justified or otherwise, is experienced as criticism. Any criticism wipes out their entire being, confirming their view that they are indeed ” only fit to be a fucking navvy.” Take this away and it’s hardly surprising that violence erupts in some form. If my self esteem is so fragile, then anyone or anything that threatens that will be met with an extreme response.

With depressed and anxious women self esteem also seems to be involved but in more subtle ways. We know how misogynistic our society can be. A woman’s place is still in the home. No matter how many important decisions she makes at work, a woman can still be undone if she forgets the milk! ( I wonder who does the shopping for Theresa May? I remember David Cameron shopping in Aylesbury. A large, black SUV parked illegally at the top of our street. No parking ticket was issued! His bodyguards got out first, followed by Cameron as he did a bit of shopping in Aylesbury. An everyday trip to the shops such as we all do.)

Women still see themselves as being subservient to men. The patient who told me she saw her task as helping her husband to be the man she thought he could be, was expressing a maxim from her mother and grandmother- which is usually as far back as records go. In this case all three generations had seen their marriages fail as the men they had chosen turned out to have agendas that didn’t match those of their wives. In each case the present generation managed to instil the message ” Do as I say and ignore what you see.” with no good outcomes.

We seem to be back to principalities and powers. Of powerful unseen forces shaping successive generations and influencing behaviour and values. Perhaps one way of characterising the work of the therapist is that we speak Truth to Power.

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Counselling, Dreams, Hope, Narratives, Psychoanalysis, Psychotherapy, The Inner World, The unconscious, Ways of Being

Cinderella continues

I wanted to take my musings on the Cinderella a bit further and look at the story in terms  of Freud’s paper “Mourning and Melancholia”. (These days we talk about depression, not melancholia. It is the same thing.) I started by thinking that Cinderella was depressed. The story well describes the feelings attached to depression. A sense of impoverishment (sitting in dirty clothes in the ashes).  A feeling of being persecuted ( her step family hate her). Feelings that any task is impossible,( the tasks set her by her step family).  An idea that everyone else is much better off than oneself ( her step sisters can go to the Ball but she cannot).  Then I began to think a bit more deeply. Cinderella is Mourning .Her mother has died and her father has, effectively, abandoned her. But despite all this, she can still have Hope. She can dream that she could, somehow, go to the Ball. She can believe that she  is worthy.This self belief is more than justified when the Prince falls in love with her. It is also her self belief that allows to try on the glass slipper. These are not the actions of a woman who is depressed. The depressive would have decided that nothing was ever going to be good again. That the ashes in which she sat were all she deserved and all she could expect. She would not have gone to the ball and certainly would not have tried on the slipper. What was the point? She was ugly inside and outside.

This, of course, is one of the difficulties with depression. And the difference between Mourning and Melancholia. Freud puts it like this “In mourning it is the world that has become poor and empty. In melancholia it is the ego itself.” Cinderella’s mourning for her dead mother eventually allows her to begin to hope. (Or this is so in the Perrault version.) From a place of mourning she can begin to heal. Things are transformed. A pumpkin becomes a Carriage. Mice become Horses. A rat morphs into a Coachman and a lizard becomes a Footman. The things around her that are ordinary and commonplace become a source of pleasure and optimism. Not only for Cinderella but also for the Prince. And, by implication, for a new dynasty since Princes and Princesses always continue a Royal line and hopefully, rule well and wisely.

The picture at the top of this blog is Durer’s “Melancholia”. In it the central figure is surrounded by all the riches of the world but is unable to take any comfort from them. Durer obviously had a keen understanding of Depression! It is one  of the challenges of working with someone who is depressed. Along with the sadness, there is frequently a profound rage. (An extreme example of this rage being acted out is in suicide, which, amongst other things, is an attack on those around. Born out of a fury.)

Cinderella was sad. Understandably. But she had enough good things inside her to allow her to grow. To hold on to Hope. She could accept her sadness and mourn the things she had lost. But she did not need to destroy herself in the process.

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Counselling, Psychotherapy, Spirituality, The Inner World, The unconscious, Uncategorized, Ways of Being

Computerised CBT

computerised-cbt-imgThis is an extract from a conversation between Anne, a 16 year old girl with M.E. and her computerised CBT programme. Anne is in her bedroom in front of her computer. she is making a first attempt at using the programme which is called James -for no apparent reason.

Anne types in http// http://www.anxietyanddepression/cbt/ login/

Anne “God. I could be dead by the time I’ve typed this in. But here goes. http//wwwanxietyanddepression/dbt/login/.”

She waits for several minutes for a reply.

James. “I’m sorry but I don’t recognise that instruction. Please try again.’

Anne “Fuck. What does it fucking want? Blood?

She tries again.
“http://anxietyanddepression/cbt/login”
She waits again. Then

James. “You have reached http://www.anxietyanddepression. I am here to listen to you and help you resolve your difficulties. But first, for the sake of our record, please will you answer the following questions. Then we can proceed. Please type “Yes” or “No” to continue.

Anne types “Yes”

James “Thank you. This is the first question. What is your gender?”

Anne thinks. Then types “Bi.”

James “I’m sorry. I don’t recognise Bi. Please give your gender.”

Anne types in “Trans.”

James “I’m sorry I don’t recognise Trans. Please give your gender”
Anne swears again. Loudly and profanely using words she didn’t know she knew. But now does.
Anne “Sodding stupid programme. If I knew the answer to that question, I wouldn’t be here in the first place. So much for a non binary identity.” She types in “Female” Waits for a minute then types in “Female / Male.” She sits back and folds her arms.

Anne “Alright dickhead. Get out of that and still stay fashionable”

James “I’m sorry. I don’t recognise Female / Male. Please give your gender.”
Anne now takes a razor and begins scoring lines on her forearm. After a few minutes she is calm enough to return to the screen where James is waiting. She presses the Enter button and he comes to life. “Hello. You have reached http://www.anxietyanddepression. I am here to help you resolve your difficulties. But first for the sake of our records please will you answer the following questions…”

Anne “Christ! Not again. Where are my tablets?”

Anne looks in her bedside cabinet and begins counting.

“10 Valium. 20 Paracetamol. 15 Prozac .20 Mogadon.”
She then looks under her bed and brings out a bottle of Vodka. She  puts it on her bedside table and begins to swallow her tablets. She puts the bottle neatly back on her table and lied back comfortably. In a few minutes she is asleep. The  last voice she hears is

 

“You have reached http://www.anxietyanddepression…”

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Counselling, Mindfullness, Psychotherapy, The Inner World, The unconscious, Uncategorized, Ways of Being

10 Miles to go

A friend and I completed a 100 mile cycle ride yesterday. It was hard work! But enjoyable-if you like that sort of  thing! We managed to achieve Gold medal standard in our age group by finishing in seven hours. We had not set out with any expectations of  doing anything more than completing the ride before sunset! The medals were a huge boost to tired legs and sore backsides. We climbed a total of 3,000 feet in those seven hours. And alternately cursed, smiled, wept depending on where we were at any given point in the ride.

The hardest part came after 90 miles. There was a sign proclaiming “10 miles to go.” We whooped with excitement. A mere 10 miles. No problem! A few minutes later my friend turned to me and said “You know what that means, don’t you?” “Yes,” I said. “It means we’ve still got another 40 minutes riding to do.” For a short time our euphoria vanished in the face of how much work was still left. We carried on pedalling and, eventually passed over Marlow bridge and in to the finishing area, got our times and medals and gave each other a High Five, grinning like a pair of Cheshire cats.

As a mental health nurse I was always taught that the most dangerous point in the recovery of someone who is depressed, is not the acute phase. Mostly they are too depressed to act out in any way at all. The crisis comes when they are getting better. I’d always taken this as axiomatic. A useful piece of clinical data when managing somebody who is depressed. That remains true.  Until yesterday, however, I had never really experienced that maxim first hand. We’d ridden 90 miles. We’d got up at six in the morning, loaded the bikes, parked the car, signed in and set off on the ride. We griped, complained smiled etc. Then we  got to the “almost there” mark and nearly threw our bikes away and called a taxi .I’m pleased we didn’t. (And  “Thank You”to all my friends who sent “Bravo” messages.They are much appreciated.

Whilst being ill is horrible, one knows where one is in a strange way. Hair falling out? Blame the chemo. Depressed. Blame the divorce. Dropping things? Blame the arthritis. One gains much justified support and sympathy an acute phase. The problems begin with recovery. One’s life is no longer in immediate danger. The expectation is that one can resume normal duties-albeit in a graded way. It is this stage that is the most demanding. Having come so far, that final 10 miles seems so near yet so far. Small wonder that this is the danger phase in so many illnesses. As it was on our ride. Hope had been kindled followed by the almost overwhelming realisation of how much effort was still required of us.

Once more I’ve had practice teach me the real meaning of theory. But on reflection, I’m still pleased they told us we only had another 10 miles left. If only because it made the 5 mile marker all the sweeter.

 

10 miles to go

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Borderline States, Counselling, Madness, Psychoanalysis, Psychosis, Psychotherapy, Reflective Practice, Religion, Schizophrenia, Spirituality, The Inner World, The unconscious, Ways of Being

Depression 1

This week I want to finish off the trilogy of Anxiety, Anger and Depression. (They are all part of the same family tree of emotions coming of the central trunk of fear of being annihilated.) Firstly, however, it will be helpful to define some terms.  The image on the left is of a mother breast feeding her baby. In psychoanalytic language the breast is known as an object and forms a central tenet in analytic thinking and writing. This gives rise to what is known as objects relations theory. The idea being that the mother’s breast stands for the whole process of nurturing, being fed, being cared about. The baby’s experience of the breast will include the smell of its mother, an awareness of her feelings, a sense of being the centre of the universe- albeit briefly! All these feelings are encapsulated in the word “object”. The theory goes on to suggest that this external breast- object- morphs into an inner representation. Thus the experience of being nurtured in real life is taken in by the infant as an inner experience. So the infant of an anxious mother will acquire a sense that the world is not a safe place. That he or she is also unsafe- that at any moment a disaster will occur which will overwhelm them. A child of a depressed mother may well acquire a sense of low self worth due, in part, to a mother who was too preoccupied with her own concerns to care about her baby.As the baby grows up it will find that it makes choices that seem to confirm their view of themselves.This can be expressed in all manner of ways .At the extreme end is suicidal depression running through to  paranoia and Manic depression. These are linked to the inner world and the individual’s relationships with its internalised objects.

Some examples:

Mike who finds it very difficult to hear anyone who does not agree with his view of things. (The fear being that everyone is intent on stopping him pursuing his dream career.)

Jane who cannot allow herself to be angry for fear that everyone will reject her if she shows he true feelings about something or someone.

Marie who is a compulsive carer who has to rescue anything or anyone in distress. Less from compassion and more from a complex mix of fear of her own anger and a terror of being unloveable.

In all these cases their actions and activity comes out of a difficult inner world. Their relationship with their inner objects is conflicted.  This makes the activity of living a  difficult one.

In part 2 of this blog I will focus on depression and one way of thinking about it.

brewast feeding mother

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Counselling, Mindfullness, Psychoanalysis, Psychosis, Psychotherapy, Religion, Spirituality, The Inner World, The unconscious, Ways of Being

Anger and anxiety

I’ve needed to do quite a lot of thinking recently about anxiety and anger, which I had always seen as discreet phenomena. My patients tell me otherwise so it seems wise to do some reading and thinking. This blog is a summary of my thoughts so far. Anxiety, angst, anguish and anger all have a common root, the Latin angere meaning to choke, dread, panic, anguish. These certainly seem to describe the feelings we associate with both anger and anxiety.

This is fine as a piece of semantics. I always like finding the root meaning of a word. It sheds light on what gave rise to the word but does it do anything more? In this case I think it does. Angere conveys the sense of destruction. Choking, panic, dread make me think of drowning or any experience that threatens to destroy me and end my life. (People who talk about having a panic attack will say they thought they were going to die.)

A psychoanalytic understanding of anxiety is given by Charles Rycroft as being to ensure that primary anxiety is never experienced. And this in turn is described as “the emotion which accompanies the dissolution of the ego.” Or psychic death. Who would not want to avoid that? (Think of how we feel when we’ve had a near miss in a car or as a pedestrian.Relief is quickly replaced with fury. Both are a reaction to near death.) In clinical terms anger and anxiety are both responses to threat – the well-known Fight or Flight reaction which is much more difficult when the threat arises from within us rather than from an external threat. Which is why those who are permanently anxious or angry can be so hard to be with for any length of time, because they project their fears into those around them. We become the enemy. So, the wife who is experienced as always critical may stand for her husband’s critical super ego (that voice in our heads that is forever running us down, telling us how stupid we are etc.) The wife who is always angry at her  family may very well be following the same path. Putting her own insecurities into others so they become someones else’s problem-not  hers. What is being projected is the internal battle raging in that individual’s psyche. Their own fear of being overwhelmed by their feelings are transformed into feelings of being attacked by outside forces. Hence racism, sexism, homophobia and the like.

The more difficult part is what to do about these thoughts and feelings. Cognitive Behavioural therapy is increasingly popular. This teaches us how to manage our thoughts and feelings. So, in the face of anxiety we might teach simple relaxation techniques. Anger might well be “managed” in a similar way. Google “Anger Management” and there will be pages of techniques, courses, exercises and the like. My own approach is to try to understand the links between anger and anxiety. To help my patient see who or what  is the source of their distress.Frequently something was missing in their experience of growing up. Parents who were preoccupied with their own concerns. Parents who, somehow, failed to pick up the messages their child was giving them about their needs. (Which is not to blame parents or criticise their parenting skills. Simply to observe that there can be a mismatch between what a child might need and what a parent is able to give.)

Medication has its place. Prozac is so popular because it works! We get relief from the misery of depression, anxiety and anger. Which in turn can give us the necessary energy to do the talking therapy that will allow us to change and grow.The actress Amanda Seyfried put it succinctly “Anxiety, it just stops your life.” (Replace “anxiety” with anger, depression, or something similar. It still works.)

Anxiety and anger

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