Book review – The Recovering: Intoxication and its Aftermath. By Leslie Jamison.

Jamison describes addiction and particularly the dynamic of the female addict, bouncing between her own story and the tales of others who have battled alcohol and mental illness.

The mythic male drunk manages a thrilling abandon —the reckless, self-destructive pursuit of truth —his female counterpart is more often understood as guilty of abandonment, the crime of failing at care. Her drinking has violated the central commandment of her gender, Thou shalt care for others, and revealed itself as an intrinsically selfish abnegation of that duty. Her self-pity compounds the crime by directing her concern away from an implicit other —real or imagined, child or spouse —and funnelling that concern back toward herself.”
― from “The Recovering: Intoxication and its Aftermath”

She highlights and questions when an ordinary craving become pathological…suggesting perhaps this is when it becomes tyrannical enough to summon shame. When it stops constituting the self and begins to define its lack.

“For shame is its own veil,’ Denis Johnson wrote, “and veils the world as much as the face.”

When it comes to alcohol, women lose the battle of the sexes on almost every front. More and more women are struggling with heavy drinking and alcoholism, a disorder that was once believed to be primarily a man’s issue. The disease is in many ways more physically detrimental to women, who, for example get cirrhosis of the liver at twice the rate of men. Even so, they seek treatment less often. The female addict sits in a tremendous amount of guilt and shame, and is afraid to tell even those closest to her the truth about herself. She views herself as a “bad” person needing to become “good,” not as a sick person needing to become well. Many others will view her this way too and it will keep her from seeking treatment.

Addiction is a very patient disease; it lies in waiting, is stealthy and manipulative. Jamison is able to convey the struggles of being in recovery, someone haunted by her past, yet also in some way nostalgic for it.

Our sense of self is never really fixed, yet we tell ourselves one historical narrative, constantly rewritten to make sense of the changes in our lives. It can be all too easy to look back on the person that we “used to be”, with a fondness and regret that are often misplaced

The book highlights the simple truth; that stability is indeed a humble, and messy process which can feel like an immense struggle within a culture that craves simple narratives about addiction and sobriety, genius and madness.

Yes, your gut is speaking to you…..

There are many clear benefits to talking therapies in improving our wellbeing, understanding our internal selves and helping us to deal with the more difficult moments in our life.

However, there is a relatively new area of development in the field of mental health, which I have become increasingly interested in – that of Nutritional Psychiatry. Focusing on a shift in thinking around the role of diet and nutrition in mental wellbeing whilst developing a comprehensive, scientifically rigorous evidence base to support these ideas.

The use of anti-depressants has more than doubled in recent years. In England 64.7m prescriptions were issued for antidepressants in 2016. This is an increase of 3.7m on the number of items prescribed in 2015 and more than double than the 31m issued in 2006. Sadly, our approach at the moment suggests that poor mental health caused by social, environmental or personal conditions is primarily treated by dispensing drugs.

Of course, there is no doubting that drugs can be very effective and have a necessary place in the treatment of mental health. However, there are potential side effects and many people are understandably reluctant to become reliant on medication. As with all medications they may help in some situations, and not in others; shown to be effective for moderate, severe and chronic depression, but less so for mild depression.

The link between poor mental health and nutritional deficiencies has long been recognised by nutritionists working in the complementary health sector. However, psychiatrists are only now becoming increasingly aware of the benefits of using nutritional approaches to mental health,

It is now known that many mental health conditions are caused by inflammation in the brain, which ultimately causes our brain cells to die. This inflammatory response starts in our gut and is associated with a lack of nutrients from our food such as magnesium, omega-3 fatty acids, probiotics, vitamins and minerals that are all essential for the optimum functioning of our bodies.

Research has found an inverse association between healthy dietary patterns (those with high intake of fruits, vegetables, whole grains, nuts and seeds, fish, and minimal intake of processed foods) and the risk of depression.

Since the consumption of omega-3 fatty acids from fish and other sources has declined in most populations, the incidence of major depression has increased proportionally. Epidemiological data and clinical studies already show that omega-3 fatty acids can effectively treat depression.

In addition to omega-3 fatty acids, vitamin B (e.g., folate), and magnesium deficiencies have been linked to depression. Randomized, controlled trials that involve folate and B12 suggest that patients treated with 0.8 mg of folic acid/day or 0.4 mg of vitamin B12/day exhibit decreased depressive symptoms.

Serotonin is a neurotransmitter that helps regulate sleep and appetite, mediate moods, and inhibits pain. Since about 95% of your serotonin is produced in your gastrointestinal tract, and your gastrointestinal tract is lined with a hundred million nerve cells, or neurons, it makes sense that the inner workings of your digestive system don’t just help you digest food, but also guide your emotions.

When people take probiotics (supplements containing the good bacteria), their anxiety levels, perception of stress, and mental outlook have been shown to improve, compared with people who did not take probiotics.

As the days grow shorter and for many of us, the colder, darker months feel more difficult navigate, it may be worth supplementing our diets with these additional vitamins and minerals to maintain our gut health and help our minds and bodies function more effectively on both a physical and emotional level.

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.

‘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.

 

 

 

 

Where all new things are possible

A Soft-edged Reed of Light

That was the house where you asked me to remain on the eve of my planned departure. Do you remember?

The house remembers it — the deal table with the late September sun stretched on its back.

As long as you like, you said, and the chairs, the clock, the diamond leaded lights in the pine-clad alcove of that 1960s breakfast-room bore witness.

I had only meant to stay for a week but you reached out a hand, the soft white cuff of your shirt open at the wrist, and out in the yard, the walls of the house considered themselves in the murk of the lily-pond, and it was done.

Done. Whatever gods had bent to us then to whisper, Here is your remedy — take it — here, your future, either they lied or we misheard.

How changed we are now, how superior after the end of it — the unborn children, the mornings that came with a soft-edged reed of light over and over, the empty rooms we woke to.

And yet if that same dark-haired boy were to lean towards me now, with one shy hand bathed in September sun, as if to say, All things are possible — then why not this?

I’d take it still, praying it might be so.

Julia Copus

A resolution to make new friends

After the manic activity that is Christmas and New Year. My resolution for 2018 is to make more friends. Not acquaintances, or people who further my career or lifestyle, but friends. Meaningful human connections that feel comfortable, enriching and authentic. Not those that leave me feeling lonelier in company than when I am actually alone.

The psychoanalyst, Frieda Fromm-Reichmann considered the issue of loneliness in her 1959 essay “On loneliness”. She describes the feeling as a ‘need and want of intimacy’. The issue had been largely ignored by other therapists of the time. Fromm-Reichmann, who had come to the United States from Germany to escape Hitler, was known for insisting that no patient was too sick to be healed through trust and intimacy. She considered that loneliness lay at the heart of nearly all mental illness and that a lonely person was a terrifying spectacle in the world, both to themselves and to others. She was known to chastise her fellow therapists for withdrawing from emotionally unreachable patients rather than risk being contaminated by them. The uncanny spectre of loneliness “touches on our own possibility of loneliness,” she said. “We evade it and feel guilty.”

Fromm-Reichmann’s thoughts are known to be the basis for the ever developing area of scientific ‘loneliness studies’ confirming that continued feelings of loneliness, rejection or abandonment can be linked with a wide range of bodily ailments as well as mental health issues. We are also able to recognise that loneliness is not synonymous with being alone, nor does being with others guarantee protection from feelings of loneliness, if there is no sense of intimacy or belonging in the interactions. We are also aware – as the psychoanalyst Donald Winnicott was able identify, that those who hide behind a false identity are probably more sensitive than others to the pain of rejection and feelings of failure that accompany loneliness.

Our current culture demands a high degree of intentionality. A good date often won’t lead to another if you don’t follow up and express interest. A career won’t solidify if you don’t network with people who share similar passion and vision. Friendships won’t form with people who don’t reciprocate with effort and consistency, but it only takes two people’s intentionality to start a chain reaction.

Making friends outside of your teens isn’t easy. There’s no obvious way to meet different kinds of people outside of work colleagues and your former school peers. You have to keep looking for those “clicks,” taking opportunities and making them, feeling slightly uncomfortable and lonely, even desperate, throughout the entire process.
We can make intentionality seem so uncool. We love to romanticize “organic” connections, “natural” relationships and friendships. But sometimes, perhaps we have to push ourselves outside of our comfort zones. Try hard. Ask people to hang out. Follow up on invites by similarly unsure people. Chase people who carry the kind of energy you want to be around. Be as vulnerable as possible if that’s what it takes; ideally, your true, authentic self, with a heart desperate for the right kind of connection. Learn to tolerate the tension of not knowing. This is something that I hope I am able to foster over the course of this year.

Melancholia

“A world that can be explained even with bad reasons is a familiar world. But, on the other hand, in a universe suddenly divested of illusions and lights, man feels an alien, a stranger. . . . This divorce between man and his life, the actor and his setting, is properly the feeling of absurdity.”
Albert Camus’s The Myth of Sisyphus:

Melancholy, Degas 1874.

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 defense mechanism devised by the body to fight the depressive state of the mind. This defense 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’.