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, Religion, Schizophrenia, Spirituality, The Inner World, Ways of Being

Bits of myself part 2

penny farthingThis follows my earlier thoughts and takes the idea of identity a bit further. I wrote earlier how much getting back to cycling has allowed me to regain a part of  myself that I thought I had had to give up. If I saw  cyclist out on a ride I felt guilty, sad and annoyed. Why wasn’t I out there? (I even tried a session of hypnosis to overcome my anxiety. I don’t think it worked-unless it was a particularly slow release style, taking a year to achieve something.) One serious test will come tomorrow when I do a 75 mile charity ride around the Chilterns. (Hence blogging today!)

I have had several conversations with my patients about identity. How parents who divorce can mean important stories get lost. Similarly when parents die, all sorts of bits of us die with them. They are no longer here to be able to ask “What happened when…?” One patient put it that it was like having a jigsaw puzzle that would forever remain incomplete. But unlike a game, this puzzle was their life story which was incomplete. So the work of mourning the death of parents is a doubled piece of work. Part of my past is gone. As is part of my future. Both feel lost.”In my beginning is my end… in my end is my beginning” wrote Eliot.

Another patient comes into my room but feels permanently absent. I find myself puzzled about where their real life is lived. (I don’t think they know the answer.) Much of our work together seems to be about “real making”. Yeats spoke of seeing “…in all poor foolish things that only live a day, Eternal beauty wandering on her way.” My patient reminds  me of this line. So  much of what is presented in the room consists of “poor foolish things that only live a day”. Or that is how my patient regards themselves and their material. The work is, I think, to allow them to find Eternal beauty. Something robust, valued and sure.

I have spoken before of my roots in Evangelical Christianity. I remember many texts, lines and thoughts from the bible. Some helpful, some less so. A conversation with one my patients recently reminded of a comment made by Saint Paul. He is writing to the church in Collosse and tells them ” For ye are dead and your life is hid with Christ in God.” (Coll.3:3) For more years than I want to remember this was held up as a statement of True spirituality. Paul makes a similar statement in Galatians “I have been crucified with Christ; and it is no longer I who live, but Christ lives in me…” (Gal.2:20) As a good believer I tried to think myself into this position. “Not I, but Christ.” It was hard work. I kept on getting in the way! Following a session with one of my patients I found myself re-visiting these thoughts from Saint Paul. I discovered that I was annoyed with the apostle. “He’s hiding” I realised. “He doesn’t much like or know the person he is. His life is at least three times removed. There is Paul. Whose life is hidden in Christ. Who in turn is hidden in the Trinity. The most floridly psychotic schizophrenic could not be much more cut off from himself. Therapeutic with Paul around his self image and self value would be fascinating. Very hard work. Infuriating. Exasperating. But fascinating. I think the work would take a long time…

I stil have more to write and am aware that 500 words makes for comfortable reading. Much more and patience begins to wane. So, I’ll write part 3 in a little while. If anyone is still reading!

 

 

 

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Counselling, Mindfullness, Psychosis, Reflective Practice

Finding my voice

I have started singing lessons. After nearly fifty years of being told “You’re a growler”, “Terry, we don’t need you.” and other similar comments I thought it was time to see if I could learn to sing in tune. I was introduced to my singing  tutor via some mutual friends, which broke the ice somewhat. I went feeling that she was not going to humiliate me for being a “growler”. I have now had three lessons and cannot express my delight and joy in beginning to sing. I am discovering whole voices I never knew I had. (My fantasy is to sing “O sacred head surrounded..” as a solo one day. The Albert Hall seems like a suitable venue!)

Being a counsellor and a psychiatric nurse I began to play with the idea of “Voices.” Of having a voice; being denied a voice; never knowing how to use my voice, the list of associations is long. Voice hearing is, as we know, a common experience for those people who have a psychotic illness. (It is also a common experience amongst people who are not psychotic. The work of Ron Coleman and his team in the Hearing Voices Network is impressive. See http://www.hearing-voices.org for more details.) There are numerous theories about the nature and source of psychotic voices but, essentially, they come from within. They are our own thoughts expressed and experienced in a particular way. As a psychoanalytically trained counsellor I take the view that “voices” represent those thoughts which we wish to deny. (“Thoughts” here represent our whole mental life-our fantasies, desires, self image, self value, hopes, dreams, nightmares etc.) But psychotic voices often are used as ways of expressing what we cannot otherwise express. They become a kind of  naughty, persecutory imaginary friend.

Two examples come to mind. One a story I was told, one an example I witnessed. The story I heard was a man who told his female worker that he was tormented by his voices telling him to masturbate over the face of a blond woman. He was at pains to assure his blond, female worker that this was the wish of his voices. He had no such desire.

The incident took place many years ago in a psychiatric ward. It is not directly about “voices” but is a similar event. A female patient was bending down to pick up something from the floor.As  she was bent down a male patient promptly kicked her on the bottom. When she remonstrated with him he simply looked down at his foot and said “Naughty foot!”

What both these incidents represent is a desire that cannot be given voice. The man whose voices were urging him to masturbate over the face of a blond woman was trying to say something about his sexual desire. Sadly there seemed to be no way in which he could voice this desire. So it became split off and denied. Had he been able to talk openly about this wish, he might have found some relief. And gained an understanding of his view of women. His view of sex. His view of his own aggression and several other areas that were clearly an issue for him. Sadly this did not seem likely to happen.

My patient with his “Bad” foot was doing something similar. (Although I suspect he knew very well what he was doing.) Nonetheless he was able to put his aggression away from himself and into his foot.

So, where do my singing lessons and psychotic voices fit together? Broadly they are both about having a voice that can be heard and valued. But i will write more about that in a following blog.

singing lessons

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Counselling, Mindfullness, Psychoanalysis, Psychotherapy, Reflective Practice, Spirituality, The Inner World

Melanie Klein goes to college

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The psychoanalyst Melanie Klein based much of her work on her time spent watching babies and their mothers- particularly babies who wee being breast fed. Form these observations she mooted the idea that the baby creates two breasts- a Good breast and a Bad breast. She argued that this split occurs in the baby’s imagination to help the infant psyche survive its responses to being fed .She suggests that the baby is torn between gratitude to a mother-breast who feeds and cares for him and his envy and hatred of the same breast. She argued that one could see from the infant’s play these two distinct attitudes. When the mother is attending to her baby, playing with him, feeding him, making him the centre of her world, then the baby feels love and gratitude. However when the same mother does not immediately attend to his every desire, the baby is filled with rage and bad feelings, with very little benevolence to mitigate this rage.

Klein argued that to allow itself to know that the mother who cares is the same mother who ignores him would be too much for the baby to manage emotionally. So he creates a Good mother and a Bad mother. One the baby loves, the other it hates. This she called the paranoid-schizoid position and saw it as representing a very primitive developmental stage in the baby’s emotional growth. When the baby is older and stronger, she argued, it is able to understand that there is only one breast-one mother. That the mother who feeds him is also the mother who ignores him. And vice versa. The implication of this realisation is that the baby learns that he can both love and hate the same object. (From this beginning comes the whole theory of Object relations- a major force in psychoanalytic thinking and practice.)

The next question then is, what has this to do with learning, teaching, and education? I want to suggest that this split between a Good breast and a Bad breast is present in the classroom-certainly at university level and very much so in the teaching of mental health nursing. There are many strands to learning. We take in new information. We have to allow ourselves to be taught. We have to find room for our new knowledge and reconcile it with what we already know. In some case this is easy. There is no emotional challenge involved in learning how to take someone’s blood pressure. It is a mechanical task. Giving an injection can be slightly more daunting because we fear hurting our patient. But with practice we learn this skill and give-mostly-painless injections! We are pleased because we have learned a new skill and are keen to practice it. (My students are always enthusiastic givers of injections whilst this is a novelty. Once qualified this enthusiasm wears off quickly. What was new is now routine.)

When it comes to psychiatric illnesses, however, we move to a different realm of knowledge. Take schizophrenia. What is it? Is it caused by too much dopamine in the system and therefore a bio-chemical disorder? Is it a statement about the relationship between the psychotic individual and a mad world? In which case it is a psychosocial problem. Is it a form of ego defence whereby the individual projects his madness into outside objects like voices, the radio, or television? So that he can deny his own madness? In which case it is a problem that requires a psychoanalytic treatment. Or is it cause by demons and evil spirits-in that case it requires a priest or holy man.

One of the exercises we use with our mental health students is Jo’s story. It is the story of Jesus put into a contemporary setting-with Jesus ending up in a secure unit! We give our students this story and invite them to comment on it. Responses run through   “Well Jo is obviously psychotic. Probably schizophrenic.” to “Possibly autistic?” to “Sounds a bit like Jesus” to “He’s not mentally ill at all. Just annoyed the wrong people.” After a while we say that this was the story of Jesus, put into a contemporary setting. The student’s responses are enlightening. For the committed Evangelical student this is anathema. How dare we suggest that Jesus was mentally ill? Our story is rubbish and has nothing about it that bears any resemblance to their Jesus. (Whenever I use this particular exercise, I make sure to have my emotional body armour on. I know how passionate some students can get!)

Other students look amused and thoughtful. Some are bored with the whole process and want to learn proper information about medication without wasting their time on idle speculation.

I use this example to highlight the difficulty of learning. In this case the knowledge on offer challenges many deeply held beliefs. We are seen as a threat to the student’s existing worldview. (The truth is, that we are not explicitly challenging any worldview. We simply invite the students to consider a case history. It is they who diagnose schizophrenia or similar. But in Kleinian style, the hatred is denied and projected into us the lecturers.  It is we who are dangerous, not the student’s own thoughts. Which is, of course, one model for psychosis.)

To learn is to risk. If I learn to do this thing. I will be expected to do it next time. And the time after. And I may not want that responsibility. What happens if I fail? Or don’t want to have to know that I know something? If I allow that Jesus could be seen as being psychotic, what happens to my faith? If I allow that my psychotic patient might be like Jesus, what happens to the way in which I nurse?

I remember doing studying Theology at Teacher’s Training College, many years ago. I went to college as a Christian fundamentalist, certain in my faith. I was taught by that most dreaded species a Liberal! My lecturers did not share my worldview. They interpreted the bible and Christianity in an altogether different way to  me. Thus they were the enemy. To be engaged in battle with at every possible opportunity- in the hope that they would see the error of their ways! I spent three years with my emotional hands covering my ears, lest I become contaminated by their heresy. (Many years later and I find their view entirely reasonable and probably too conservative-but that is another story!) I could not listen their teaching because my whole world view was based on the need for certainty that fundamentalism provided. To accept their views would have meant opening myself to a world of not -knowing. And that was intolerable at that time.

So it is for our students. What does it mean to take in new knowledge? How do I decide what knowledge to take in and what knowledge to spit out? Can I trust my teachers to have my best interests at heart?  ( A Good breast) or will they feed me poison ?(A Bad breast) It seems to me that in the same way that a mother has to support her baby so that it can feed, so we as teachers have a similar responsibility to our students. How they use the feed is outside our control, but we do have a responsibility to provide the most favourable conditions in which a feed can occur.

Bibliography

Klein, M. 1988 Envy and Gratitude and other works 1946-1963 London: Virago Image

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Counselling, Psychoanalysis, Psychotherapy, Reflective Practice, Spirituality, The Inner World, Ways of Being

Tall

I discovered some time ago that my wife and I use stories in quite different ways and to serve rather different ends. For my wife and her family the main purpose of a story is to convey facts. If one of her family begins a story with “Do you remember last Tuesday when we went for a trip to the National Trust gardens in  Kent?” they had better be very confident of the facts of their story. Otherwise it will be swiftly “deconstructed”. “No. It wasn’t last tuesday, it was last Wednesday. I know that because last Tuesday we had our boiler repaired and I had to stay home all day”. “And,” someone else will chime in, “it wasn’t Kent because they had floods and we couldn’t get there.” “That’s right, ” somebody else will say ” it was last Wednesday and it was English Heritage because the National Trust property didn’t open on Wednesday.” As you can imagine in my wife’s family one learned to get one’s facts correct before risking a story!

By contrast my family used stories in a different way. The “facts” always served  secondary purpose. nobody particularly minded which day a given event took place. Nor even where. Stories were to illustrate someone’s character. Or how V.W.’s were less reliable  than Ford. The whole infrastructure of “facts” were less important than the point they were being used to make. These two different mind sets took us both a long time to get used to. I accused my wife’s family of needless pedantry whilst she accused mine of a wilful disregard for the facts!

We are, of course, both right. And both wrong. As a counsellor and a lecturer I hear many stories from my patients and my students. I remember my early days as  a lecturer talking to a class of thirty students about schizophrenia. After about ten minutes a student put up their hand and asked “Terry. Do you think schizophrenia is caused by demon possession?” I was very unsure what to say. I had a view which did not include demons. Yet I did not want to crush my student. We both had stories about the origins of schizophrenia. My task was to allow him to explore and tell his story. And to value his experience whilst finding a way of suggesting that demonic possession was not the most helpful model to use in clinical practice.

C.S. Lewis in his novel “Out of the Silent Planet” has one of the characters, Ransom, comment “It even occurred to me that the distinction between history and mythology might be  itself meaningless outside the Earth.” In my counselling work “”facts” are, of course important. Did my patient hit her husband? Was my patient drunk and was he arrested by the police? Did my patient steal from Asda? These are facts and they are important to the work. But the more important questions then follow. “Why did you hit your husband?” “Why did you get so drunk?”  “Why did you steal from the supermarket?” The back story-and a  particular kind of truth-then begin to emerge. History and mythology can join hands and support each other rather being in competition.

This distinction between history and mythology opens up many areas for discussion. That will be my next blog.Out of the Silent Planet

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