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.

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

Counselling, Madness, Mindfullness, Psychosis, The Inner World, Ways of Being

Not Giving Advice

Not giving adviceI was teaching a set of my students last week and we spoke about suicide. One of my students said that it was the task of a nurse to persuade someone not to kill themselves. I said, forcibly, that I did not think this was part of a nurses’ role. Nor the role of anyone involved in therapeutic work. I believe we  have a responsibility to listen to our patients. To help them think about their choices. To allow them room to breathe. Ultimately, however, if a person is going to kill themselves, they will do so. No matter how painful this might be for all involved. Professionally, I have only had one of “my” patients kill themselves. And one “shared” patient who left our Therapeutic Community to kill himself. The young man who was “my” patient was both too well and too ill for psychiatric services. He was too ill in that his psychotic material was deeply embedded and intractable and not susceptible to any talking therapy.  (He would not take medication.) He was too well because he appeared to function very well despite his psychotic thinking. I was his Community Psychiatric Nurse and took the decision after quite a time that I would discharge him from my caseload. Some months after this he killed himself. Whilst I do  not hold myself directly to blame, I often wonder what would have happened if I had not discharged him. His mother very generously thanked me for being one of the good things in his life. I was. But not good enough to balance the bad objects inside him.

I was talking to another counsellor the other day about being given advice. I had said that there are some people whom I find impossible to listen to. They have a way of talking to me that touches something deeply primeval in me. I cease being an intelligent, thinking adult and revert to a primitive inarticulate Neanderthal who is gripping his club with all his might just waiting for the opportunity to swing it. Hard. On their head. At which point I shall beat my chest and do a victory dance!  (I have to point out that so far I have never acted out this fantasy! I go away and plot, connive, dream etc. But all in my head!)

Suicide contains this rage. There was a Twitter storm recently following the death of a man who had jumped from a motorway bridge and been hit by a vehicle. The Twitter storm was because some comments had been made  about how bloody selfish this man had  been. Many, many people were unable to get home. Get to appointments. Leave the motorway and the like as a consequence elf the huge delay caused by this incident. They tweeted their frustration. This lead to a counter blast from many more people castigating the former group for being so heartless. How dare they not be sympathetic that this poor man had been so needy that he killed himself. Various Mental health professionals posted their sympathies. Added links to Depression Self Help groups and the like. And were very, very angry at those who only had thoughts for their own inconvenience.

I try very hard as a counsellor not to give advice. Experience has taught me that unsolicited advice is usually ignored. I will sit with my patient and listen. And reflect. And comment on what is happening in the session. I will not give advice. Occasionally I am asked to give advice by my patients “What do you think I should do?” I try to respond by wondering what they would like me to say-not always a popular response! But a true one. I am interested in why my patients think I have answers that are better than their own. It sets the counsellor up to be a “better” human being than their pateint. My task is to allow my patient to find their answers. They, after all, have to live with their choices. Not me.

There are times when I wish I could allow myself to advise. The appeal of Cognitive Behavioural Therapy is that it is very directive. One can do CBT at home on the computer with a pre-packaged programme. Follow these steps and there will, in all probability, be this outcome. My professional life would be simpler. I could have confidence in the manual that lay behind my interventions. No more uncertain sessions sitting with my patient wondering “What is happening here today? Why am I feeling as I do in this session? What is my patient putting into me that they don’t want?” With a manualised therapy I could put my affective focus to one side and not constantly attend to our shared inner world. But I can’t do this! Or won’t. I believe deeply in the value of self determination. Freud said that the purpose of psychoanalysis was to make the unconscious conscious.Thus I learn about why I do the things that I do. Why I feel a sense of primeval rage at some people.(Yes. I do understand its origins. That way I can prevent myself acting out that rage!) When the unconscious comes into our consciousness, We can make choices. We cease to be driven my forces we do not comprehend or know.

Perhaps if the man who jumped from the motorway bridge had been able to understand his murderous rage, his life might have  been different. Sadly this was not the case.


Labyrinths Part 2

ImageIn my last piece I wrote about the Milton Keynes labyrinth and made reference to the original labyrinth designed to keep the monstrous Minotaur imprisoned. A friend sent me a note saying that the Minotaur was more the result of some monstrous behaviour by his mother, Pasiphae. Some research showed that she was right. The Minotaur was the visible sign of his parents failures to behave well-or at least keep their promises to the gods.

The Minotaur was the result of his mother Pasiphae’s mating with a rather handsome white bull. (Her desire seems to have been difficult to contain, according to myth, since she had sex frequently with this  bull.) The other problem was that the bull was meant to be sacrificed to the gods as a thanksgiving for his father Minos’ support from Poseidon. The end result of this was that the Minotaur was born. Half bull, half human. (Wikipedia has this poignant comment about him “… he has no natural source of nourishment and thus devours men for sustenance”) To protect both the Minotaur and society his father has a giant labyrinth built to hold him. Eventually the Minotaur is killed by Theseus. (But in typical Greek myth style this is not a simple act of triumph.His father kills himself because Theseus forgets to send him  the proper signal to tell him that he is alive.)

There are enough themes in this story to write a library of commentaries. We could wonder about not keeping promises-particularly to our gods, whatever they might be. We could wonder about the cost of beauty. About the price of power and how one gains it and keeps it. (At some cost to oneself and others seems to be the message from this story.) We could wonder about the power of sexual desire-and how women may and may not express  their desire. The list of topics is long. But for this piece I wanted to think about the Minotaur himself.

 I find myself feeling very sorry for the Minotaur. The vision of him being trapped in a labyrinth with no means of escape I find a lonely one. (I have always had a fear of solitary confinement. My hope is that I would sink into a benign psychosis and hide there until I died.) His isolation- imprisonment- leaves him as much a victim as the seven young men and women who were sacrificed to him every seven years. He is punished for his parents mistakes. (His seven yearly victims are chosen by lots, which is both more and less kind.) 

As a psychiatric nurse and a counsellor I often see patients who are trapped in their own labyrinth. Sometimes it is a labyrinth of their own making, sometimes of others’ making. Invariably my patients are not the only ones who are in pain. Parents, husbands, wives are all affected. Sometimes it seems that the only way out of the labyrinth is through death. Sometimes a literal death.Sometimes a psychic death. Sometimes  physical death is seen as an answer to psychic death.

I remember one patient whom I looked after. He was in his mid twenties and had had two or three serious psychotic episodes. I used to visit him in his home, whee he lived with his mother. I saw him weekly for about six months before discharging him from my caseload. He was both too ill and too well. His delusional material was utterly entrenched but made limited impact on his day to day living. Thus I could “do” nothing for him. Eventually i discharged him- or, possibly- discharged myself from him. Not too long after I discharged him he killed himself at home. (I cried a great deal over his death. But many fewer tears than his mother.) For him physical death was preferable to life in a labyrinth from which he saw no escape.

I recently assessed another young man who was still at school. He was having behavioural problems at school as well as having a number of problems in his family. (In many ways he represented the conflicting wants and demands of his parents who found in him a convenient “problem” that had to be solved. I enjoyed meeting him and offered to work with him. Sadly he did not return. I presume he is still wandering in his and his family’s labyrinth.

The Milton Keynes Labyrinth was easy to  navigate. The route was clearly laid out. It was not possible to get lost in it. (And if all else failed one only had to follow the light of Milton Keynes to get home.) For so many of the people whom I have seen over the years, their labyrinth is not as easy to leave. They have no one to help them find a way out. Or they feel that they only meet Theseus’ who want to kill them. (I do wonder if, in the end, the Minotaur was grateful to Theseus?)

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

Les miserables

Les Mis 2
Les Mis 3

By now it seems as though the entire world world has seen – or at least heard of- Les Miserables. The critics have written their reviews and we have gone to see either the stage play and / or the film. I have done both and thoroughly enjoyed both- and admit to wiping away several manly tears as the film came to an end. (I plan to see it at least once again , possibly more before it finishes here.) I was struck by many things about the film- the set design, the singing , the acting and the courage it portrays. In this blog, however, I want to look at the conflict between Valjean and Javert-and how this might be understood.

Javert stands for the Law. (And it helps him stand. No law, no Javert. It is his whole Being. Without it he has no life.) Valjean has a different view of  Law. It is a servant, not a master. Or it should be in his thinking. It represents a pair of crutches to provide support. not a strait jacket to paralyse and restrict. In Arthur  miller’s play, The Crucible, Javert is represented by the Rev. Hale who has come to investigate the happenings in Salem. His view of theology matches  Javert’s view of the Law. “Theology,” Hale declares, “is a fortress. No crack in a fortress my be accounted small.” (As the many who die in Salem attest, Rev Hale keeps his fortress very well protected. Small matters like justice, mercy and compassion are kept outside his fortress. Javert does much the same with his fortress of Law.)

In a moving song Javert says this to Valjean

“You know nothing of Javert

I was born inside a jail

I was born with scum like you

I am from the gutter too.”

This is the heart of Javert. He is terrified of the gutter- which is much more a place within him than it is a physical place. His fear is that the gutter can claim him at anytime. Hardly surprising then, that he persecutes anyone who he thinks might threaten his brittle security. This, of course, takes us to homophobia, sexual abuse, racism, bullying, sexism and fundamentalism in all its outfits. They all have in common a fear of the other-and of the other within them. The homophobe is terrified by his own desire for another man. The fundamentalist is terrifed that their world view migh be wrong. They will kill to defend their view-and in the process kill anything new in themselves. (Perhaps “they” should read “we”. It is too easy to join Javert in our liberal condemnation of others’ illiberalism.)

The tragedy for Javert is that the gutter  does kill him in the end. He cannot tolerate  that Valjean has escaped- both physically and emotionally. Whilst Valjean is persecuted, it comes from without- in the form of Javert- not from within. In biblical terms these two men represent Law and Grace, respectively. And Law struggles to understand Grace as Javert struggles to understand Valjean. In another piece Javert says

“How can I now  allow this man

To hold dominion over me?

I should have perished by his hand

  It was his right.

It was my right to die as well

Instead I live… but live in hell.”

This is his dying soliloquy and his obituary as the song ends with him committing suicide. The cost of  allowing Grace to help Javert leave the gutter is too high.

 Writing this piece reminded me of a patient i saw for a few sessions. He came because he feared that  he was the violent man his wife constantly accused him of being. It soon became apparent that the violence came from his alcoholic wife-violence that was both physical and emotional. He was very relieved when I pointed this out to him. He fundamentally loved her and hoped that she might change. I suggested that the course of the  rest of any counselling might be about  helping him to think  about why he chose to stay with this abusive wife. He never returned so I don’t know the outcome. My fantasy is that the cost of change was too great for him. Javert like death was preferable to life.