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

Riding the waves of grief

I had an aha moment this week about grief and letting go. It was the trees that led me there. Like many people, I am challenged by having to let go – of things, people, places, identities and feelings. I get attached. That enriches my life, but it can also be painful to let go. Grief for any kind of loss, whether that is a life, a relationship or a part of ourselves, can completely overwhelm us or keep us stuck for a very long time.

I don’t enjoy endings or goodbyes. Sometimes I even cry at the end of a book because it is finished and I’m not going to get to spend time with those characters any more. I once spent a day in mourning when my favourite television show finished – thank goodness for Netflix and box-set binges. I am not going to delve into the deep psychological recesses of my hoarding tendencies – that may be a blog for another day. Today, it’s all about the trees.

Autumn is my favourite time of year. The trees are glorious right now, all decked out in gold and bronze and fiery red. The other day, I slowed down and watched as the leaves effortlessly detached themselves from the branches to float down and join the growing blanket of leaves covering the ground. The leaf just lets go – when it is ready. There is no painful wrenching away. It just lets go. And when it falls, it becomes part of something else, something equally beautiful. Who can resist a pile of leaves? In time, the leaves will break up and become part of the earth, that nourishes the tree, to grow new leaves.

“You expected to be sad in the fall. Part of you died each year when the leaves fell from the trees and their branches were bare against the wind and the cold, wintery light. But you knew there would always be the spring, as you knew the river would flow again after it was frozen. When the cold rains kept on and killed the spring, it was as though a young person died for no reason.”

 Ernest Hemingway, A Moveable Feast

There is so much in this season that reminds us of cycles – that eventually everything has to die for life to continue. And yet, as human beings, we cling on to dead things, dead relationships, dead people – like a leaf’s futile efforts to cling to a branch. But I have a tentative observation – that the thing that we grieve most, is our grief. That is what we find most difficult to just let go of. There is a sense of loss when the searing pain dulls, when we realize that we got through a day or a week or a month, without feeling sad about our loss. It feels like some kind of betrayal to ourselves.

The trees outside my house are now almost completely bare and reminds me that when we do let go, we are often overwhelmed by a sense of emptiness, rawness, bareness. We are exposed to the elements. It strikes me that letting go is a process which unfolds in its own time. It won’t be rushed or forced and the best thing we can do is to show ourselves kindness, compassion and gentleness while we ride the waves of grief.

Dr Murphy - signing off

We stand alone - at the end of life

Something interesting happened to me when the news of Robin Williams taking his life hit the headlines and every internet site on the planet. I found that while everyone else was talking about suicide, I really did not want to, so I lost momentum for my blog. And I am a person who really needs momentum. So I am curious about my reaction and I think there are several facets. Like any tragedy that hits the worldwide headlines, suddenly it throws an issue into the spotlight and behold, everyone has an opinion.

Part of me remained curious. Would this elicit more empathy, more understanding, more awareness, more openness to talk? I think perhaps there were some small shifts in public perception, but generally, everyone was shocked and confused. Because, we can spout our theories, we can do our research, we can count our numbers, but really, we are mostly, still confused about suicide.

It is such a personal, individual decision. Yes, of course there are themes. Yes, of course there are things we can know that are helpful. But at the end of that dark tunnel that marks the end of our life, we stand alone. Whatever takes our life away, we stand alone. Whoever is beside us at the moment of our passing, we stand alone. It’s me and me baby, looking into the abyss, the end of my time and I am alone.

So, the decision for suicide is taken – alone. That is why on an individual level, no one can really know what was going through a person’s head or heart. And we so desperately want to know. We want answers. So we hypothesize. But we will never really know.

"We're born alone, we live alone, we die alone. Only through our love and friendship can we create the illusion for the moment that we're not alone."                                                                  Orson Welles

And so, that leads me to the other reactions to a very public death by suicide. The shaming, the criticism, the labeling, the disbelief that someone would end their own life. They are selfish, gutless, faithless, hopeless, worthless better off dead. Yes, that is actually what some people think and that is what they say (or type) out loud, in public. The diatribe became louder and louder and I had to literally switch off – my computer. I guess it did give me a chance to reflect on my own lack of tolerance of people with a lack of tolerance. Yes, I’m aware of the irony.

It also highlights to me, that sometimes talking about, working with suicide, all the time can become overwhelming. It is difficult work and sometimes we need to do something else for a while, no matter how passionate we are. Even very productive work can be avoidance – of something.

Dr Murphy - signing out.