Tag: Psychotherapy

Melancholia

The term melancholia has served many uses in literature and poetry. It is perhaps particularly useful as a semantic device in English language writing, where few nouns exist to describe a state of mind which is at once calm, fearful, despairing, restless, hollow, and longing for something inexpressible. In Von Trier’s film Melancholia (2011) he attempts to capture this set of emotions. In the film, Melancholia is the name of a rogue planet that crashes into earth, causing its destruction. The story depicts the lives and relationships of a handful of people in the lead-up to this Armageddon. It centres upon the sisters Justine and Claire, who are portrayed as each other’s conceptual opposites. We see Justine sink further and further into the throes depression whilst Claire tries harder and harder to care for her.

The three terms melancholy, melancholia, and depression have overlapped throughout history, and in a broad, general sense the use of the latter has grown increasingly popular as the former two have declined. This does not mean, however, that ‘depression’ has simply replaced melancholy and/or melancholia. That there exist such a vast number of different historical narratives about melancholia, melancholy, and depression is not simply a result of different perspectives among today’s historians. Rather, it is a testament to the vast and shifting meanings that these terms have possessed over time. When it comes to melancholia in particular, the word has been used at least since antiquity to describe illness, but not one uniform disease. Thus, rather than speaking about melancholia as a single concept, the word is best understood as corresponding to a number of different – though often overlapping concepts.

In psychoanalysis, Hanna Seagal describes melancholic depression as a defence mechanism devised by the body to fight the depressive state of the mind. This defence is known as manic-schizoid. Freud went further and was the first person to use melancholic to describe depression.

Freud compares the phenomenon of mourning after the loss and death of a close loved one to the idea of melancholia. Freud explains, they both share a similar outward affect on the subject and are both due to similar environmental influences. The inhibition, “absorbedness” of the ego, and the disinterest in the external world is evident in both, mourning and melancholia equally.

Despite their similarities, Freud states, there are some fundamental differences; mourning is recognized as a healthy and normal process that is necessary for the recovery of the loss and would not be seen as a pathology nor a need for medical intervention. However, melancholia, is an abnormal pathology, and a dangerous illness due to its suicidal tendency. In ‘healthy’ mourning we slowly detach ourselves from our loss whether that be through death or heartache, in melancholia we attach ourselves to it, creating the empty space within our psyches. Crucially with melancholia, it is the impasse that is created in the impossibility of expressing the true extent of the feeling that overwhelms. In melancholia the capacity to link the thoughts with words that provide catharsis has been lost. The purpose and rituals that we adopt to find meaning lose significance and no longer provide a symbolic capacity to hold our mental and physical selves together. We can see the depiction of this in the film ‘Melancholia’ as the lead characters depression stems from her inability to seek comfort and relevance in the ritualistic behaviours that humans engage in. She becomes more and more absorbed by the meaningless and insincerity of life, loosing the capacity to find the words to connect her feelings to those around her, there is an absence of inherent value both in her self and in living. However, as Justine begins to accept the inevitability of utter sorrow and unhappiness, the sense of longing melancholia produces is so great that it is concurrently painful and sweet as it provides the possibility of escape.

While many of us will have never experienced melancholia to the depth that Justine exhibits it, we can understand her emotions in part by drawing on what we may have experienced of sadness and longing. The film demonstrates that emotion doesn’t have to be rational to be true. In fact, it speaks to the idea that emotion is never rational, but, in contrast to the cultural view, it is not necessarily bad for emotion to be irrational. We can find a kind of optimism in the peace that Justine is ultimately able to find in her melancholia. In the words of the philosopher Slavoj Žižek:

‘If you really want to do something good for society, if you want to avoid all totalitarian threats and so on… accepting that at some day everything will finish, that at any point the end may be near. I think that, quite on the contrary of what may appear, this can be a deep experience which pushes you to strengthen ethical activity.” The result is not fatalistic hedonism, but a kind of profound engagement with the meaning and significance of life’.

On being “Good Enough’

We might consider that at the core of therapy is the idea of self-awareness. At times of vulnerability – whether that be heartbreak, stress at home or work or generally feeling unable to cope we may find ourselves suffering from unbearable feelings and want to block these out. However, avoiding the sensations we feel can increase our vulnerability to being overwhelmed by them.

Becoming aware of the ebb and flow of emotions within our bodies can put us in touch with our inner world. In noticing our feelings of anger, irritation, nervousness or desperation we become able to shift our perspective and open up new options other than our automatic, habitual reactions. Mindfulness puts us in touch with the transitory nature of our feelings and perceptions. When we pay focused attention to our bodily sensations we can recognise that our emotions are not set in stone and hopefully increase control of them.

The paediatrician and psychoanalyst Donald Winnicott, observation of mothers and children focused amongst other things on how the mothers held their babies. He proposed that these physical interactions lay the groundwork for a baby’s sense of self, and with that their capacity for self-regulation. ‘The ability to feel the body as the place where the psyche lives.’ In the majority of cases Winicott believed that mothers were able to be ‘good enough’, but in cases where the mother cannot meet her babies needs and impulses ‘the baby learns to become the mother’s idea of what the baby is’. Children who lack physical attunement are vulnerable to shutting down the direct feedback from their bodies.

As adults in order to learn how to become available to our bodies feedback we need to change how we deal with difficult feelings and increase our awareness of inner experiences. Allowing our minds to focus on sensations and notice how in contrast to feelings that might feel overwhelming our physical sensations are transient and respond to slight shifts in bodies, such as how we hold ourselves, our breathing and even our thinking.

The next step might be to label our physical sensations. Practising mindfulness calms down our sympathetic nervous system, so we are less likely to be thrown into a flight or flight response. Learning to observe and tolerate what we are feeling in the moment, is a prerequisite for safely being able to revisit the past. It is possible to tolerate a great deal of discomfort if we are able to remain conscious that our bodies’ reactions are constantly shifting. Mindfulness has been shown to have a positive effect on a number of psychosomatic and psychological issues. It has also been shown to activate the brain regions involved in emotional regulation and lead to changes in the regions related to body awareness and fear.

Our need for meaning.

From its conception, psychoanalysis has been as much about a therapeutic method for treating neuroses as a theory of the mind. In this way it considers some of the major questions around our continued search for meaning expressed through literature, music and art.

‘How to live in a world in which justice and power, right and might, often seem to have nothing to do with each other? How to deal with the fear that my own aggression and violence will overflow and violate all that I care about? How to confront my own death, and the deaths of those I love? How to act responsibly in the absence of freedom? How to make this inhumane world a more humane place and so comfort myself, and offer comfort to others.’

Alford 1992 The Psychoanalytic Theory of Greek Tragedy

Viktor Frankl, a psychotherapist and contemporary of Sigmund Freud, developed his therapeutic skills in an impossible setting. He was among those sent to the concentration camps by the Nazis, and he used his skills to inspire prisoners to fight for their survival by finding meaning in their suffering.

He states “As a professor in two fields, neurology and psychiatry, I am fully aware of the extent to which man is subject to biological, psychological and sociological conditions. But in addition to being a professor in two fields I am a survivor of four camps — concentration camps, that is — and as such I also bear witness to the unexpected extent to which man is capable of defying and braving even the worst conditions conceivable.”

In the clip below Frankl speaks to young people on how he came to formulate his ideas. And states – “Between stimulus and response, there is a space. In that space is our power to choose our response. In our response lies our growth and our freedom.

Frankl’s book ‘ Mans search for Meaning’ provides an extraordinary example of how humans are able to survive through some of the darkest hours and the most crushing situations imaginable and provides inspiration to us all.

Yeatsian Geometry

Turning and turning in the widening gyre
The falcon cannot hear the falconer
Things fall apart; the centre cannot hold;
Mere anarchy is loosened upon the world.
Yeats.

“We need to open our eyes. There are over two million illegal immigrants bedding down in this state tonight! This state spent three billion dollars last year, on services for those people who have no right to be here in the first place. Three billion dollars! 400 million dollars just to lock up a bunch of illegal immigrant criminals… Our border policy’s a joke! So, is anybody surprised that south of the border, they’re laughing at us? Laughing at our laws?”

These are originally the words of Derek Vinyard, the Neo-Nazi protagonist of Tony Kaye’s cinematic masterpiece, American History X. The film tells the story of Derek Vinyard’s gradual realisation that the bigoted beliefs he has held for most of his adult life are mistaken. He then tries to prevent his little brother Danny from following in his footsteps and becoming embroiled in the race-related gang-violence that was rife in parts of the US in the 1990s. These words were terrifyingly more recently used by Donald Trump at one of his election rallies.

The film is over 19 years old yet its themes couldn’t be more relevant to our current political climate. We only have to look at the Brexit’s rabble-rousing rhetoric to see how closely related these sentiments are to the type of white supremacist vitriol that Vinyard preaches during the film.

We are now witnessing the highest levels of movement on record. About 258 million people, or one in every 30, were living outside their country of birth in 2017. A 2003 projection anticipated that by 2050, there would be up to 230 million international migrants. The latest revised projection is that there will be 405 million international migrants by 2050.

The experience of moving from one country to another tends to increase the likelihood of the use of primitive defence mechanisms as a protection against the difficulties of everyday life and in relationships in the new country. The danger of this social development is an increase in the use of splitting and in the use of ‘psychic retreats’ in an attempt to uphold an idealised inner and outer world without pain or conflict.

Today, we live in an age of anxiety about ‘post-truth’ politics. ‘Fake news’, targeted messaging and seductive persuasion are rife. Digital technologies have created extraordinary new possibilities But many of our contemporary concerns about the new dark arts of political persuasion have a longer history. In the mid-20th century, psychologists’ curiosity and dismay about our susceptibility to manipulation and control crystallised. Their work offer us food for thought in a new age of economic development, population movement and populist fervour. In the 1940s, the psychotherapist Money-Kyrle was worried about the power of radio and other mass media to reveal and provoke our worst selves. In his essay, ‘A Psychological Analysis of the Causes of War’, he explores the roots of conflict

‘The study of cases of melancholia, paranoia, and homicidal mania helps us to recognize psychological mechanisms which are present, to some slight extent, in all of us. These mechanisms may not greatly influence us as individuals; but they sometimes have a great influence on us as members of a state.’

In the 21st century, he would have been looking at our use and the incredible power of the Internet.

Vinyard-esque remarks are now a part of the mainstream. Hostile, political rhetoric that’s used all too often as a part of our normal political process and so it seems the important message of American History X, that “hate is baggage” and that “life’s too short to be pissed off all the time”, has been forgotten by many. The politics of division are thriving across the world, and we will all suffer for it.

‘In the space between chaos and shape there was another chance’.

Jeanette Winterson, The World and Other Places:

Life transitions are challenging because they force us to let go of the familiar and face the future with a feeling of vulnerability. Whether positive or negative, a transitional space can force us to adjust to new ways of living, being and working. How we deal with these changes can feel quite challenging to our sense of well-being and our emotional health.

Many significant changes are triggered by regrets about unfulfilled dreams, a discontent or dissatisfaction with how life has turned out or a feeling that you are not at peace with the passing of time.

When we consider change in our lives, we might think about the work of the psychoanalyst Donald winnicott, who wrote about the important transitions an infant experiences in separating from her mother.

He believed that our sense of self emerged through our interpersonal relations, especially through early interactions between the main carer and her infant. In order for the infant to develop, the caregiver must gradually allow disillusionment so that the infant feels she is a separate individual but also feels safe and empowered. As this process occurs she begins to sense that her needs and emotions are not immediately met because her mother is not an extension of herself.

Healthy separation happens when the infant’s emotions are reflected back to her and adequately held without crisis occurring. This mirroring and holding creates what Winnicott called a transitional space, a container where the infant feels safe enough and powerful enough to navigate and integrate her needs and emotions allowing her to develop a stable sense of self that can develop authentic emotional connections in everyday interactions with others while still feeling some sense of control.

At some point we all have to deal with times of major life transition, which require adjusting to new identities and new perspectives. These changes are not always smooth, but it is helpful to appreciate that they happen for an purpose and can be important to allow us to grow as individuals developing resilience and self belief.

They perhaps attempt to signpost us in the direction of being closer to who and what we want to be and hopefully allow life to feel more meaningful and authentic.

Using Winnicott’s concept of a transitional space is helpful in navigating these times of change. The strength in these situations is knowing when we need to ask for support from those around us. – Whether that be family, friends or seeking the help of a professional. As I have gone through my own transitions in life, I have decided where I am going to focus my attention and what support I need. I know that I cannot manage significant change myself and I am open to help. Being proactive, aware and vulnerable are important characteristics to successfully negotiating the significant changes that life has a habit of throwing up.

‘The real issue with speed is not just how fast can you go, but where are you going so fast? It doesn’t help to arrive quickly if you wind up in the wrong place’. Walter Murch

Peace, Love and Ahimsa.

“Ahimsa,” the Sanskrit word for non-violence asks us to be kind to others and the Earth, but most especially to ourselves. For how we treat ourselves reflects how we treat others.

In order to practice ahimsa, we must attempt to lay down our preconceptions, ignorance and stereotype’s. It is, in many ways, easier to navigate the modern world in a haze, to become oblivious or even numb to the long-term effects of our actions, to consider the real cost of our behaviours and relationships. Yoga asks us to put this tendency aside and look clearly at who we are and what we do. From a place of simplicity, we can focus on our desires and the nature of our attachments, our consumer habits, and our need for excess and ask ourselves whether the benefits outweigh the harm to others.

Ahimsa asks us to be mindful of thoughts and feelings. Thoughts naturally move in and out of our minds. Whilst these don’t necessarily cause harm, excessive rumination, negative beliefs and toxic dynamics can translate into acts of ‘violence’ in how we engage in the world and with people.

We can live our lives in an outwardly healthy way, eating well and exercising and whilst these are, vital to our wellbeing, if we are engaged in a space that feels negative from within this can still impact on our mental health. Negative thinking sends out messages to the body that trigger the fight or flight response. Thoughts do this even if there’s no real outside threat.
The fight or flight response secretes cortisol, often referred to as the stress hormone. This, in turn, lowers the immune system, and makes us more likely to experience physical and emotional difficulties, ill health and exhaustion.

The purity of ahimsa is three-fold. It asks of us to express no harm in thought, word, or deed. Speech is perhaps the hardest aspect to consider. The modern lexicon has come to include a specific phrase to describe the many ‘insignificant’ ways that we infuse our speech with violence, often very subtle violence, termed micro-aggressions. When we are caught up in our ego, in the delusion of our special self, in order to protect this idea we may we fall back on ways of speaking and engaging, which belittle or diminish others in order to provide ourselves with a sense of importance or omnipotence.

A little known practice; a precursor to mindfulness, I imagine we could all do with a little Ahimsa in our lives.

A Nameless Dread.

 

 

 

 

 

It is difficult to understand why people suffer from traumatic events to such varying degrees. While there is no complete explanation for this, psychologists and therapists suggest that everyone’s psyche is made up a little differently by a combination of both nature and nurture creating subtle differences in the way we experience and process life.

Trauma is more prevalent than one might think. We tend to think of it in terms of the extremes such as war, disasters, major accidents and abuse. However, day to day emotional difficulties, which are harder to identify and aren’t’ validated or even acknowledged  by the person who experienced them can ultimately have a defining influence over our personality, relationships, and everyday lives.

To consider the impact of trauma we need to start from the most difficult moment of life – birth. From that point onward, everything in theory becomes easier to deal with as we become less helpless by accruing resources from our environment to help us cope with the harsh realities of the world. A carer nurtures her baby and provides food, safety and love. Eventually language is learned, equipping the toddler to request more specifically, with words, what it needs. Toys are imbued with meaning and coveted as belonging to the individual and are felt as part of the self, enabling play in the world. This is both a real and imaginary world that can be returned to and played in time after time. These real and imaginary objects are the threads that comprise the fabric of the psyche, giving it integrity to support experiences. We cannot control what is encountered in our lives. Experiences of terror, the unexpected, the unfortunate and the unthinkable are ineluctable aspects of reality. When traumatic events take place however, the moment itself seems to stand apart from daily life. Some say that time “stands still.” These moments are beyond comprehension. Emotions and the words that represent them such as terror, anger, and fear may be present in these moments but are not consciously felt or experienced. – or as Bion stated experienced as the “nameless dread.”

Theorists such as Freud and Klein focused on love and hate as central components to our developmental self.  The World War One veteran, and influential psychoanalyst, Wilfred Bion added knowledge, particularly the inability to know. The inability to know results from the failure to have found someone, generally in early life, willing and able to contain unbearable feelings, feelings that cannot be put into words, but have more the quality of fragments of feelings. It is only by encountering another mind willing and able to hold these unbearable pieces of feeling that one can learn to put them together for oneself.

Uncontained emotional experiences result not just in our inability to know these experiences, but in the attempt to destroy connections between our associations, creating isolated islands of knowledge that cannot be connected in thoughts or sentences. Attacks on linking are an attack on the associations between thoughts that make knowledge possible.

Bion’s use of the term ‘Nameless dread is simply a placeholder for an indescribable feeling that takes place during a traumatic event and plays a critical role in the development of a person. If an event cannot be woven into the fabric of the psyche, something harmful happens. Unconsciously, a promise is made with the self. You will never have to feel nameless dread ever again but in return you will give up part of yourself. This promise however, comes at a great cost. The edges of spontaneity, vulnerability, creativity, openness to explore, learn, and take in what is new will be compromised.

Therapy might offer the opportunity to safely explore our experiences, associations, fantasies and feelings. Perhaps in time, we may find a way to assimilate these cut off aspects of the self, and live a fuller more authentic life.

 

 

 

 

‘Just because you’re invited, doesn’t mean you’re wanted’

From ‘Get Out’ by Jordan Peele

 

 

My role as a psychotherapist working in Central London brings me face to face with people of many different backgrounds, ages, races, class and political and religious viewpoint. The origins of psychotherapy lie in Europe which was mostly created by middle class white men to treat mainly white women. Much has changed about the world since then and much has changed in the way we see difference and otherness in the consulting room.

At the beginning of treatment and throughout the course of therapy, both the therapist and patient can expect to be silently evaluated by each other. This process leaves us open to our vulnerabilities. Psychotherapy may activate emotional memories that relate to issues such as trust, entitlement, , authority conflicts, and the possibility of being judged. The opportunity for the person in treatment to expose her difficulties and to have these accepted and validated by the therapist, are critical components of the work. A positive therapeutic relationship is predicated on creating a safe enough space to expose our thoughts and desires and the therapist’s ability to handle these, including navigating those occasions when our differences interfere with a sense of emotional safety.

With this in mind I was struck by the relevance of the film ‘Get Out’ by Jordan Peele. The film artfully attempts to allow a white person to see the world through the eyes of a black person for an hour and half.

In the film, Missy, the therapist uses hypnosis to stir up memories of main character losing his mother and the associated pain to enter his mind. She sends him to ‘The Sunken Place’ – this is used as a metaphor for the representation of People of Colour. The “sunken place,” is where people are weighted down by lies they have internalised about their history and racial trauma. This idea refers to W.E.B Du Bois’s theory of “double consciousness” where we see ourselves through the eyes of the dominant culture. Double Consciousness is an internal struggle that affects the Black psyche. Contemplating oneself through the eyes of others, you are forced to live double lives―the life of a person of colour and as a British citizen, both of which are not liberal to you. Hence, the term ‘double consciousness’. You know what racism feels and looks like, but white people do not know what racism is. They have never experienced it after all. They have never felt what it is to be suppressed by people of their own country. They have never felt that pain or misery that many people of colour have been breathing like air since their birth.

As a psychotherapist there is much to be learnt from this experience. Our role asks us to try to understand the difficulties experienced by another human being, quite often with very different backgrounds to our own. The film ‘Get out’ uses imagery and symbolism to demonstrate both the literal meaning of the dialogue as it unfolds, but also the more subtle unconscious aspects of how we relate to each other and the world.

My experience of my difference means that on occasions I can’t quite tell if what I’m seeing has underlying bigotry, or it’s just a normal conversation and I’m being paranoid. I admit sometimes I see race and racism when its not there. That dynamic in itself is unsettling. It is this dynamic the film is able to capture. These aren’t the racists Hollywood is traditionally more comfortable calling out and posturing against. They aren’t Neo-Nazis, or White Nationalists. These are good White People, proud, well off and liberal who are very likely being completely sincere about their Obama votes and desire to connect with a multicultural society. Peele highlights a very specific subset of White racism: Liberals who are insistent of their non-racism because they admire an abstract ideal of Blackness while not actually engaging or regularly encountering any actual Black people.

Peele isn’t showing us that one race is superior to the other. He’s showing us that ideas of racial superiority are learned and passed down in families, workplaces, social groups and through the media.