Category: Uncategorized

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.

If only….

The word envy comes from the Latin invidere: to look upon maliciously. It is to look at another’s good fortune grudgingly, the feeling of horror when we contemplate a colleagues advantages or the need to spitefully denigrate when we fear that others are getting more than their fair share and certainly more than us.

Melanie Klein’s view of envy highlights its destructive assault on anything that is admirable. ‘Envy is the angry feeling that another person possesses and enjoys something desirable – the envious impulse being to take it away or to spoil it’ (Klein, 1957: 181).

In psychological terms envy is a feeling or impulse, which in its destructive and spoiling qualities can be disastrous to the personality. Envy can inhibit development when deeply entrenched in the psyche and exerts a powerful influence on the whole personality.
The more we examine our own envy, the more we understand it, the less likely will be our need to use it against others. In therapy we might find a way to transform our envy into a vehicle that allows us to look deeper into ourselves. When we feel the raw force of envy we know that we are not settled in our minds and bodies and not fully accepting of who we are in both our beautiful and flawed ways.

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.