Race in the consulting room

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.

Mental Health support contact details

Mental health helplines
Whether you’re concerned about yourself or a loved one, these helplines and support groups can offer expert advice.

Anxiety UK
Charity providing support if you have been diagnosed with an anxiety condition.

Phone: 03444 775 774 (Monday to Friday, 9.30am to 10pm; Saturday to Sunday, 10am to 8pm)

Website: www.anxietyuk.org.uk

Bipolar UK
A charity helping people living with manic depression or bipolar disorder.

Website: www.bipolaruk.org.uk

CALM
CALM is the Campaign Against Living Miserably, for men aged 15 to 35.

Phone: 0800 58 58 58 (daily, 5pm to midnight)

Website: www.thecalmzone.net

Men’s Health Forum
24/7 stress support for men by text, chat and email.

Website: www.menshealthforum.org.uk

Mental Health Foundation
Provides information and support for anyone with mental health problems or learning disabilities.

Website: www.mentalhealth.org.uk

Mind
Promotes the views and needs of people with mental health problems.

Phone: 0300 123 3393 (Monday to Friday, 9am to 6pm)

Website: www.mind.org.uk

No Panic
Voluntary charity offering support for sufferers of panic attacks and obsessive compulsive disorder (OCD). Offers a course to help overcome your phobia or OCD.

Phone: 0844 967 4848 (daily, 10am to 10pm). Calls cost 5p per minute plus your phone provider’s Access Charge

Website: www.nopanic.org.uk

OCD Action
Support for people with OCD. Includes information on treatment and online resources.

Phone: 0845 390 6232 (Monday to Friday, 9.30am to 5pm). Calls cost 5p per minute plus your phone provider’s Access Charge

Website: www.ocdaction.org.uk

OCD UK
A charity run by people with OCD, for people with OCD. Includes facts, news and treatments.

Phone: 0333 212 7890 (Monday to Friday, 9am to 5pm)

Website: www.ocduk.org

PAPYRUS
Young suicide prevention society.

Phone: HOPELINEUK 0800 068 4141 (Monday to Friday, 10am to 10pm, and 2pm to 10pm on weekends and bank holidays)

Website: www.papyrus-uk.org

Rethink Mental Illness
Support and advice for people living with mental illness.

Phone: 0300 5000 927 (Monday to Friday, 9.30am to 4pm)

Website: www.rethink.org

Samaritans
Confidential support for people experiencing feelings of distress or despair.

Phone: 116 123 (free 24-hour helpline)

Website: www.samaritans.org.uk

SANE
Emotional support, information and guidance for people affected by mental illness, their families and carers.

SANEline: 0300 304 7000 (daily, 4.30pm to 10.30pm)

Textcare: comfort and care via text message, sent when the person needs it most: www.sane.org.uk/textcare

Peer support forum: www.sane.org.uk/supportforum

Website: www.sane.org.uk/support

YoungMinds
Information on child and adolescent mental health. Services for parents and professionals.

Phone: Parents’ helpline 0808 802 5544 (Monday to Friday, 9.30am to 4pm)

Website: www.youngminds.org.uk

Abuse (child, sexual, domestic violence)
NSPCC
Children’s charity dedicated to ending child abuse and child cruelty.

Phone: 0800 1111 for Childline for children (24-hour helpline)

0808 800 5000 for adults concerned about a child (24-hour helpline)

Website: www.nspcc.org.uk

Refuge
Advice on dealing with domestic violence.

Phone: 0808 2000 247 (24-hour helpline)

Website: www.refuge.org.uk

Addiction (drugs, alcohol, gambling)
Alcoholics Anonymous
Phone: 0800 917 7650 (24-hour helpline)

Website: www.alcoholics-anonymous.org.uk

National Gambling Helpline
Phone: 0808 8020 133 (daily, 8am to midnight)

Website: www.begambleaware.org

Narcotics Anonymous
Phone: 0300 999 1212 (daily, 10am to midnight)

Website: www.ukna.org

Alzheimer’s
Alzheimer’s Society
Provides information on dementia, including factsheets and helplines.

Phone: 0333 150 3456 (Monday to Friday, 9am to 5pm and 10am to 4pm on weekends)

Website: www.alzheimers.org.uk

Bereavement
Cruse Bereavement Care
Phone: 0808 808 1677 (Monday to Friday, 9am to 5pm)

Website: www.cruse.org.uk

Crime victims
Rape Crisis
To find your local services phone: 0808 802 9999(daily, 12pm to 2.30pm and 7pm to 9.30pm)

Website: www.rapecrisis.org.uk

Victim Support
Phone: 0808 168 9111 (24-hour helpline)

Website: www.victimsupport.org

Eating disorders
Beat
Phone: 0808 801 0677 (adults) or 0808 801 0711 (for under-18s)

Website: www.b-eat.co.uk

Learning disabilities
Mencap
Charity working with people with a learning disability, their families and carers.

Phone: 0808 808 1111 (Monday to Friday, 9am to 5pm)

Website: www.mencap.org.uk

Parenting
Family Lives
Advice on all aspects of parenting, including dealing with bullying.

Phone: 0808 800 2222 (Monday to Friday, 9am to 9pm and Saturday to Sunday, 10am to 3pm)

Website: www.familylives.org.uk

Relationships
Relate
The UK’s largest provider of relationship support.

Website: www.relate.org.uk

Conflicts of Choice.

The idea of conflicts over unacceptable aspects of the self is a central part of the psychodynamic point of view. In relation to our internal worlds Freud borrowed the word ‘dynamic’ from the study of physics to convey the idea of two conflicting forces producing a resultant third force which acts in an opposing direction.

Any attempt to understand the basis of human behaviour must consider the issue of our motivation in relation to the conflicts that arise within our inner selves. Dramatists, poets and artists have explored the fields of love and hate, destructiveness and hedonism long before science turned its attention to these issues. There are many types of innate behaviour, from simple in built reflexes promoted by survival and learning to more complicated patterns built up over our childhood. In Western society our needs are generally no longer driven by our struggle for food and water, but a constant motivator is our desire to relate and for love. In our choice driven society this creates enormous conflict within our psyches.

In relation to relationships there is now a dilemma. Choice implies some conflict. When we break up with someone we might be told ‘there are plenty of fish in the sea’. However, these days these fish really are at our finger tips….on Tinder, Grindr and the many other apps and dating websites. Committing to someone with so much choice is now hard, even impossible. The conflict is always present –with one eye wandering, we want perfection and possibly the next ‘like’ may be that perfect match. Choice. We think opportunity is good. We think the more chances we have, the better. But everything becomes watered-down. Never mind actually feeling satisfied; it can now feel difficult to understand what satisfaction actually looks like, sounds like, feels like. We’re one foot out the door, because outside that door is more. We are unable to see who’s right in front of our eyes asking to be loved, because no one is asking to be loved. We long for something that we still want to believe exists. Yet, we are looking for the next thrill, the next jolt of excitement, the next instant gratification.

Is our constant need to distract ourselves to bombard ourselves with stimuli an indication of our inability to face the conflicts inside our own mind? Is that what makes us miserable? Why we feel dissatisfied? We wonder why nothing lasts and everything feels a little hopeless. Because, we have no idea how to see our lives for what they are, instead of what they aren’t. How can we be expected to stick something out, to love someone when we struggle to love ourselves?

In a world filled with tantalising options perhaps the way to true love is to put our phones down for a moment and take time to consider the people that exist in our lives already.

Food issues

At the start of 2020 many of us will turn our attention to exercise and healthy eating to shift those few extra Christmas pounds and re-energise ourselves into the New Year. However, for some there may be a much darker side to the resolution to look and feel better.

The rise of a form of disordered eating called Orthorexia is becoming increasingly mainstream, fuelled by the mania for healthy eating and our growing anxiety around obesity it lies somewhere on the blurred boundary between being health-conscious and a health obsessive. Defined as a “fixation with righteous or correct eating” – what begins as an attempt to improve one’s lifestyle can morph into an unhealthy fixation. It’s unknown how widespread the condition is because it is not currently recognised as a clinical diagnosis , however, it can be just as harmful psychologically as it possesses the same joyless preoccupation with appearance and food.

Eating disorders are a relatively common psychological illness but are not always well diagnosed. They describe illnesses characterised by irregular eating habits and severe distress or concern about body weight or shape. Eating disturbances may include inadequate or excessive food intake, ultimately damaging an individual’s well-being by both physiological damage to health and psychological illness. There are also the more hidden negative social, employment and lifestyle effects associated with eating disorders.

As a defence mechanism they can represent a maladaptive approach to tolerating the unbearable, and perhaps demonstrate a continued conflict of desire. Those with anorexia may refuse food in order to maintain a space to keep desire alive. Those patients who eat junk food or partake in fad diets only to then indulge in violent bodily purges attempt to feel or subvert desire. These feelings are further complicated by the influences of culture and social media.

The NHS recently revealed that the number of teenagers being admitted to hospital with eating disorders has nearly doubled in the last three years. The Royal College of Psychiatrists has laid the blame for this unprecedented rise firmly at the door of social media and particularly pro-anorexia and pro-bulimia websites offering tips on how to avoid food.

As clinicians we may also become aware of the significant percentage of those with eating disorders who also struggle with alcohol and substance use disorders. In 2003, the National Center on Addiction and Substance Abuse issued the seminal report, “Food for Thought: Substance Use and Eating Disorders,” which highlights this relationship. The report established that Individuals with eating disorders were up to 5 times as likely as those without eating disorders to abuse alcohol or illicit drugs, and those who abused alcohol or illicit drugs were up to 11 times as likely as those who did not to have had eating disorders. Specifically, up to 50% of individuals with eating disorders abused alcohol or illicit drugs, compared to 9% of the general population. Other research has offered similar findings. Struggling with an eating disorder ¬ or a substance use disorder -increases one’s chances of developing the other disorder.

There can be many underlying issues which lead to an eating disorder, these may include, difficult relationships in early life, low self-esteem, loss of a loved one or the end of a relationship. Different forms of psychotherapy, such as individual, family, or group, can be helpful in addressing the underlying causes of eating disorders. Therapy can be fundamental to treatment because it the opportunity to address and heal from traumatic life events and learn healthier coping skills and methods.

Confronting a disorder is the first step of recovery. If you are suffering, it is important to admit that you need help. Though this can be the most painful and difficult part of the process, it is essential in order for recovery to begin. By reaching out for help and confiding in others trust about your struggles, you are taking the biggest step towards overcoming your eating disorder. If you have a loved one who is suffering from an eating disorder and are worried about their eating behaviours or attitudes, it is crucial to communicate your concerns in a loving and supportive way. Confronting the person you care about is a necessary step towards getting them the help and treatment they deserve.

If you are concerned about any issue related to an eating disorder then please consult your doctor or seek advice from a reputable website such as:
https://www.b-eat.co.uk/
https://www.nationaleatingdisorders.org/
http://www.nhs.uk/Livewell/eatingdisorders/Pages/eating-disorders-advice-parents.aspx ) http://www.nhs.uk/Livewell/teengirls/Pages/treatmentforeatingdisorders.aspx)

Happy Holidays

For most of us this time of year brings us closer than usual to our family. While the holidays can be a time of celebration, and coming together, being together can also provoke feelings of anxiety for those of us whose families don’t quite live up to our hopes and expectations.

Families are the tribe from which we come from, and the desire to be with family and stay connected is deeply compelling. The other truth is that our relationships are often fraught with unresolved issues that may carry simmering tension and ambivalence. The holidays can exacerbate this built-in tension.

There are ways in which we can satisfy our need to connect and also take care of ourselves in the process. Family time cannot always be controlled or curated into a meaningful or joyful experience. Sometimes not even a peaceful one. There are always different agendas and personalities at play, knowing and respecting your limits can be critical to maintaining emotional balance. This may mean setting a boundary or stepping away if you find yourself feeling triggered.

Being Mindful is the ability to be in the present moment, without judging your experience. Mindfulness is a practice of simply observing your thoughts, feelings and sensations. It can help to free us from over-identifying with emotional reactions. Mindfulness can help you stay grounded and create space from thoughts and emotions that arise, that would otherwise derail you.

Most of us cannot be our full authentic selves in the family context. If we reduce our expectations and separate our desire for acceptance and closeness from what is actually present, we may suffer less. If we accept the inherent limitations of being with our families, we don’t have to superimpose and experience disappointment when our family doesn’t live up to our fantasy.

You cannot find peace by avoiding life.

Virginia Woolf.