Sunday, 23 November 2014

Buried but not dead - putting ourselves back together again

Does psychological suicide exist? This is the question I have been mulling over this week. As human beings we are constantly evolving and changing and it is as natural as the transformation of the cells in our bodies that parts of our psyche will also transform. But what happens when we actively try to kill off parts of ourselves?

I believe that interaction with other people can attempt to kill off parts of us. The gentle, trusting, open-hearted soul can be mutilated by the cruelty and humiliation of others. Any therapist who has ever worked with a victim of bullying or abuse can testify to the damage that can human beings can inflict upon each other. Hearts can be broken and shattered by hurtful actions and words. I think that we can take these vulnerable parts of ourselves and try to kill them off, suffocate them, bury them – so that we never have to feel them again.

"Man is the only animal that laughs and weeps; for he is the only animal that is struck with the difference between what things are and what they ought to be."    William Hazlitt, The English Comic Writers, 1819

It seems though, that these parts never really stay dead. We bury them so deep that we cannot access them, but they keep popping back up, like zombies in a video game – ever being activated by our conversations, by our relationships and often by our relationship with ourselves. Suicide – physical ending of life, is a strategy for easing human pain. And it works, doesn’t it? You die, you don’t feel anything. Suicide of a part of ourselves is an attempt to do the same, to ease pain and suffering. But it only works temporarily or this dividing of the self can become extreme or psychotic.

This is why so many forms of therapy work towards integration of the self and have a focus on working with the different parts that we find difficult. Two chair work Gestalt processes actively encourage people to face and talk to those parts of themselves that are buried and still hurting. Psychodynamic processes aim to access the unconscious parts that heavily influence our behaviour and choices. Cognitive Behaviour processes dig deep to access the core beliefs that we have developed to make them less rigid and unforgiving.

Yet somehow, throughout history, we humans have believed that we can somehow simplify ourselves and to eliminate uncomfortable emotions and experiences. I am reminded of the numerous utopian and dystopian novels and films like the Stepford Wives or the contrast in Huxley’s Brave New World between the factory-produced beings and the savage, untamed, real humans. Sure, no one wants to feel hurt and pain but would we ever really want to be like a machine?

"Man — a being in search of meaning."  Plato

No way! Say I. I celebrate and embrace being a flawed, complex, feeling being – capable of love and hate, kindness and revenge, elation and despair, pride and guilt, joy and pain, contentment and restlessness, hope and regret, safeness and fear, passion and rage. For all that means I am alive. I am not dead. Not yet. And until I am, I will live every moment, breathe it all in. And that is all I hope for anyone I am working with. Not that they be “fixed” but to help them find kindness and compassion towards themselves, to live with themselves with less judgment and harshness. There is enough of that in the world without it being inside our own heads too.

Dr Murphy – signing off

Monday, 17 November 2014

Death by loneliness - a silent killer

So I read recently that loneliness can reduce your life expectancy by up to 14 years, as much as smoking. Feeling lonely is a hugely underestimated continuing traumatic event. It can often get confused with our ability to be alone and to sit with ourselves. For some people being alone is unbearable because they genuinely cannot stand their own company. They are tortured by the thoughts in their head and the constant commentary of abusive self-criticism. So they need other people to distract them. That is very different from feeling lonely – to the point of feeling cut off from the rest of the human race.

When we lived in tribes, our very survival depended on being able to rely on other people and in turn them relying on us. It was literally life and death. If you were ostracized from the group, you perished. You died. Attachment to others was survival. Indeed for every infant attachment is survival. If our primary caregivers are not attached to us, if they do not meet our basic needs for food and comfort, then we don’t survive. So for those who may have had difficult primary attachments, then contact with others feels as though it is about survival, even into adulthood. It's why groups trigger so much of our difficult emotions - groups like families, school, workplace or other social groupings.

"Who knows what true loneliness is - not the conventional word but the naked terror? To the lonely themselves it wears a mask. The most miserable outcast hugs some memory or some illusion"         Joseph Conrad

So, if you feel like you are dying because you do not have contact or connection with other people, then it is not surprising that suicide can become an option. Loneliness leaves you physically cold, raw, exposed, unprotected. Being alive can become unbearable. Human beings need other human beings. Even more problematic is our response to being rejected and cut off – that is to isolate ourselves even further, because it seems less painful. If I reject them first, then I can somehow protect myself from the hurt. If I shut them out, then they cannot shut me out. And so the cycle of isolation continues.

Of course, this is a different feeling from being alone. Spending time alone can be vital too, to connect with yourself, to reflect, to be still, to become grounded. When connection and contact feel like a choice that changes everything. Being abandoned or cut off is not a choice. This is one component of why young people suffering from bullying can be driven to take their own lives. They are cut off from their tribe, pushed out to the fringes, unaccepted and disconnected. It feels like their very survival is at risk. On top of that they don’t have the life experience of knowing that no feeling, however painful, will not last forever, it will change and transform into something else.

So there are some different ways of approaching this. Either we say that people are responsible for themselves, or we are responsible for each other. But this is straying into political philosophy – strange isn’t it, how our world view can vastly impact on individuals. Compassion and self-compassion are vital I think, in addressing this. If we are moved by the suffering of others, we will attempt to connect and ease their pain. If we are moved by our own suffering, we will attempt to connect with ourselves and the need to get comfort from others too.

"We are all so much together, but we are all dying of loneliness."       Albert Schweitzer 

It is hard to ask for what you need from others. We risk them saying no. We risk rejection. And yet, if we don’t risk that – we may be risking our very lives.

Dr Murphy - signing off

Saturday, 8 November 2014

Life - it's a risky business

The concept of risk is a curious thing. It has an unquenchable appetite. It will always maintain this edgy hunger – because it feeds on fear. It is endless and impossible to keep at bay or control and scratches at the back of the mind with the persistence of a buzzing fly. And yet, we throw ourselves against it, trying to measure it, counter-act it, guard against it, obliterate it. Do anything to make ourselves feel better about it.

Being alive is a risk. Waking up and getting out of bed is a risk. Getting into your car and onto the motorway is a risk. Eating is a risk. Interacting with other people is a risk, of getting hurt. Dating is a risk of rejection. Working is a risk of making a mistake. Loving is a risk of losing. Living is a risk of dying.

"It is only by risking our persons from one hour to another that we live at all."    William James

One of the fascinating dichotomies of working in mental health is how much time we spend working with anxiety. It is of course the worry of risk ramped up on the equivalent of amphetamine for your thoughts. It is a cauldron of every risk imaginable with the heat turned right up. We teach people to challenge their thoughts, to learn mindfulness to calm themselves and let their thoughts drift by, to set aside limited time to worry, to put some boundaries around thinking about risk.

But then, what do we as mental health professionals do with risk? We become obsessed with it. We assess the hell out of it. We record it on bits of paper. In triplicate. The “What if…?” thinking that we try to help our clients challenge and change is part of mental health culture, in fact, it is part of most workplace cultures. People get paid a lot of money to weigh up potential risks. Bean counters have very healthy pay checks and insurance companies have an endless source of income by tapping into our “What if…?” thinking.

So what am I saying? Just don’t bother with risk? Don’t try and keep people safe? Of course not. Of course we have a duty of care for the people we are trying to help and heal. But it shouldn't be about a piece of paper. What I am saying is that it is pretty hypocritical of organisations to be so risk aversive and risk paranoid. It is a paradox that mental health professionals have to work with extreme anxiety disorders when our workplaces have what could be diagnosed as institutional anxiety, organizational anxiety, societal anxiety. It does leave us with ethical dilemmas about balancing choice and risk, freedom and control. I think we spend a lot of time fooling ourselves. I just find it ironic that if organisations put their mindset, their thought-patterns, their decision-making processes under the same scrutiny that we encourage clients to do - the result would be interesting. I think it would show up some pretty unhelpful patterns.

Why is this important? Because to work with risk, to work with suicide, self-harm and other mental health issues, we need the right kind of support and back-up. Given the amount of burnout (that's a whole other blog post) I remain unconvinced that support is well thought-out. Supervision can become mechanistic, focusing on case presentation, techniques, outcome measures and procedures or questioning competence. What about the human beings at the heart of these interactions? How does it feel? What do we actually need from each other?

"Security is mostly a superstition. Life is either a daring adventure or nothing."    Helen Keller

I attended a lecture recently where the speaker said that around 50% of therapists will lose someone they are working with to suicide at some point in their careers. So I guess we have good reason to be antsy about risk. We have to find a way to work with it, to live with it, without it being the only focus. People need to talk about their thoughts of wanting to die and we need to find a way to listen.

Dr Murphy - signing off