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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Counselling, Madness, Psychotherapy, Reflective Practice, The Inner World, Ways of Being

All change?

bullyingI have recently left the world of academia to return to front line nursing. After seven years teaching in a university I’ve decided it’s time to move on. I’ve spent much of this week wondering how I feel about this move. I was sad to leave friends and colleagues behind .I was sad to leave classroom work behind. I am a good teacher and enjoy the buzz of classroom work. But…as I carried on thinking about my reaction to leaving, it dawned on me that I was rather numb. I wasn’t clear about my feelings. As this week has gone on the numbness has given way to relief. From this comes a feeling of freedom. I can breathe! (This was apparent in my singing lesson. I had breath to hit the high notes. To be able to move from a low note to a high one and back down again. Without too much effort. I could breath.My lungs had room to expand.)

As I was musing about these feelings it dawned on me that this was what is described by women who come out of an abusive relationship. Many of my patients describe a pattern. At first their partner is very loving and attentive towards them. They feel loved and wanted. As the relationship develops things change. Slowly and imperceptibly. He becomes more controlling .He wants to know where she  has been. Who she has been seeing. He goes through her mobile and looks at her text messages. (But gets very angry if she does the same thing.) Little by little the power is taken from the weaker one who continually adapts herself to her partner’s demands. There seems to be no end to her compliance and his dominance. At the end there is a truly MAD relationship- Mutually Assured Destruction.

My relationship with my university fits this pattern .When I first got the job I was delighted and excited. Oh! The wonderful conversations I was going to have! The heady atmosphere of living and working with academics! (Yes. I know! But one has to dream a little!) In truth, the early days of our relationship were fun. We laughed a lot. We enjoyed each other’s company. Slowly, however, things began to change. My dream partner became more demanding and less helpful. I was left to write and run a course by myself. (I had no idea how to do this. I’d spent 20 years as a clinician.) The person given me to help simply returned my poor attempts with red lines everywhere. “Wrong! Wrong! Wrong!” No proper help was given.I was left, literally, in the cold. (My office was a small, cold, damp room in what had been the servant’s quarters.An apt image.)

As with any abusive relationship, there were good times. Friends who supported me and shared their experiences. Both good and bad. Once or twice I complained about my treatment to “the authorities” .Support was mixed. I had to follow appropriate procedures. Fill in the proper forms. Go through the right channels. So I carried on because I had invested a lot in this relationship. I was proud of my status as their partner.

There is a story told about frogs. Put one in a pan of boiling water and it will do its best to jump out. Take the same frog. Put it in a pan of cold water. Slowly increase the temperature of the water. The frog will adjust to each increase in temperature. Eventually it will boil. But never have tried to escape, not realising its danger. The end result is the same.Death.

My turning point came after one particularly painful episode where I felt bullied, humiliated and threatened one time too many. There was, as always, a power imbalance. I was, structurally, the more vulnerable partner. Following a bout of depression I handed in my notice.I left this week. Hopefully I will be missed. Friends are sad that I’m going.My students will miss me and my funny ideas! The university has lost a gifted teacher. But nothing much will change. It rarely does…

There are many more things I want to explore in future blogs.General issues about power and abuse. Bullying and victimhood. Where and how we should train future nurses, therapists and counsellors. About the ways in which an organisation chooses to ignore its shadow side. But seven hundred words is enough for today.

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

War wounds

war woundsI filled in a job application recently. As always I had to list all my illnesses and disabilities from birth to now. I listed what I could recall. I’m not good at these sort of questions. I tend to have an illness, live with it for a time and then forget about it. Occasionally I’ll need to know about it- in which case I usually ask my wife! I came to the section on Mental Health problems. And paused. The question was phrased quite precisely. Are you currently receiving treatment for any Mental Health problems? I could answer, honestly, “No. I am not under treatment for any mental health problems.” (I have had time of work recently due to a short-lived episode of depression. This has now been resolved. I received no treatment-although I was prescribed a course of anti depressants, which I chose not to take.) But my reaction surprised me. I had no problem saying that I had mumps when I was a child. Why should I view depression any differently?

I began to wonder about this and discovered that there is a sense of shame around emotional problems. I dislike the terms mental illness and mental health problems. They medicalise distress.  If I am depressed, I want to know why. If I am psychotic, I want to know the meaning of my psychosis. What might I be defending against that needs such a drastic response? I have spent a number of years in therapy. I found it helpful and healing. Many of my friends shake their heads and say something g like “I don’t want to know what’s in my cellar.” Or attic. Or shed. (Choose your locked room.) I find this strange. If I know what is in my cellar, I have nothing to fear from it. It’s there because I haven’t got round to throwing it away. Or I think I might want it some day. It’s not there as a prisoner. Or a forgotten orphan. So why would I have a sense of unease about declaring any emotional problems I might have encountered?

I live near Stoke Mandeville hospital which has its spinal injuries unit. It is not uncommon to see people in wheel chairs around town. There appears to be no sense of shame attached to them. Getting aground is more complicated than if one is able-bodied. But that’s an issue for town planners. Not a destigmatisng campaign. We now have the Paralympics where  athletes with some kind of disability compete. One sees all manner of physical injury on display. Artificial limbs abound. The key message seems to be one of “Look at what we can do. Not what we can’t do.” Soldiers come back from wars with their wounds. Frequently they are given medals for their bravery. This  seems to be less prevalent in the realm of mental health. I have yet to see anyone given an MBE for their bravery in combat with schizophrenia. Or depression. Or mania.

The dictionary definition of shame is interesting and revealing. The OED gives this as part of its entry “The painful emotion arising from the consciousness of something dishonouring, ridiculous, or indecorous in one’s own conduct… fear of offence against propriety or decency…” It also has roots in a sense of guilt or disgrace. How sad! Rather like blaming someone for walking on a hidden mine and losing their legs. In what way are they to blame?

in my thinking about this blog, one image that came constantly to mind was that of Christ’s stigmata. These wounds were displayed when it was helpful to others to so do. When they gave hope reassurance, comfort. (John 20:27)  There seems no sense that he was ashamed of his wounds. Rather the contrary if one takes a view that Christ’s death was redemptive. So, maybe it’s time that we can allow our emotional battle scars to be displayed. “Wear your poppy with pride” was the slogan for supporting survivors of armed conflict. It was a successful slogan. I wonder what a Mental Health flower might be? A rose because it is impossible to  separate the thorns from the flower? A Lenten Rose because it will grow and flower in seemingly inhospitable times?  Perhaps we should commission the RHS to create a Mental Health flower. What would you ask them to create?

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