I’m writing this listening to Tallis’s  Spem In Alium while the growing spring light and warmth is bringing my garden to budding life.     

Terry Pratchett intended to die listening to this - “That’s the one where every single part of it comes together at once, where God picks you up and drops you on your head,” - in his garden drinking an excellent brandy. Apparently he died in his own bed with his family and his cat with him, and I hope he was listening to this music.

Many of my friends and acquaintances are texting, emailing and talking on Facebook about the loss of this good man, all of us feeling a bit stupid about the terrible sadness we’re experiencing. But we’ve shared a world, landscapes, lineages, lives, adventures and histories with him and with each other, and that world has now come to an end. The characters we love can now only repeat their stories, they can’t develop or mature any more. Discworld has suddenly become preserved rather than living on in a kind of real time.

The most common element on Discworld was Narrativium, which caused people to act and events to play out as they are meant to in a story. Heroes were guaranteed to win if the chances were a million to one. If a little girl walked alone through the woods she had to meet a wolf, who was forced to try and eat her. But Pratchett’s most complex characters fought the pressures of storylines that cast them as the Evil Witch, the Killer Cop, a Farmers Wife or an Unwilling Reaper and in doing so became more fully themselves and infinitely more interesting people.   

Mistress Weatherwax, Sam Vimes, Susan Sto Helit, Tiffany Aching and Death himself exerted self control, experienced pain and unhappiness in order to learn and grow and become who they were truly meant to be. None of them were interested in being nice or even particularly liked, and paradoxically became loved.   

Please take the time to listen to Spem In Alium and raise a glass to Terry Pratchett who brought good philosophy to millions of children and adults, and whose legacy is fierce, funny and full of wisdom.

The media is buzzing with commentary and opinion on Robin Williams’ suicide some of it fairly shocking. “Williams was selfish,” “What a stupid thing to do,” “Didn’t he know how much people loved him?”

People who haven’t experienced clinical depression can have no idea what depression is like. When it’s bad it’s a life sentence in an underground cell with no door or window. When depression is just ticking over you know that life is a sea of endless pain and loss and sorrow and that whilst there are little shallow islands of not-misery you know that continuing to live means having to continue swimming through pain and loss and sorrow.

Williams suffered bipolar disorder and had a long relationship with addiction. Other people have suffered bereavements, traumas, illnesses and disappointments that they just can’t recover from. Some people go through the world with one less layer of protective psychological skin than other people, that’s just the way they’re made. Anti-depressants can definitely help some people and other people are not helped by them. The same can be said for therapy: drugs and therapy can work well to begin with and then their efficacy wears off.

Imagine having an illness that isn’t visible, that can’t be seen on an x-ray or CAT scan or be identified in a blood sample. You can understand feeling miserable if you’re made redundant or a relationship ends or someone close to you dies but when those feelings spiral downward into depression that’s less easy to understand. You’ve read about exercise and diet being really good for depression, so why can’t they come out for a run or even a walk for goodness sake? Why can’t they just eat better?

Being around someone who is depressed can be tough. It’s difficult to understand why a depressed person just can’t clear their head, take a deep breath and see that life isn’t so awful – there is sunlight and beauty, joy and pleasure in the world there for the taking. What makes it particularly difficult is that to a great extent this is true, it’s just that for someone who is depressed it’s not. People who don’t have depression can aim to leave this painful place they’ve found themselves in, people with depression can do all the exercise and healthy eating and find god and all the rest of it, and some of it may help but for a significant number it won’t make much of a difference.

You might be surprised to know how many people seem completely fine but think about death every day.

Therapists have a duty to break confidentiality when someone discloses that they are acutely suicidal. That means that if someone says, “Thanks Clare, it’s been great but this is our last session. I’ll be killing myself later today,” or “I’ve taken an overdose,” I am obliged to call the clients GP and possibly an ambulance. That seems sensible to me. And there are some people who have become exhausted from trying to keep their head above the sea of misery. They’ve taken the drugs, had all the therapy, made the lifestyle changes, love their family and friends, feel guilty about the trauma they know they’ll leave behind them and the sheer weight of having to bear life is greater than everything else.

That’s what happens to a lot of people who get cancer, MS, Motor Neurone Disease, osteo- or rheumatoid arthritis or any other chronic condition. Many of us can understand why some of those people make their way to Dignitas because we can see how their illness has reduced their enjoyment of life to nil. That’s what many people with chronic depression feel and not all the love, care or sense of duty can make a difference.



RIP Robin Williams



A link to helpful resources for people who are suicidal is on my homepage, including the Maytree Sanctuary for the Suicidal. If you want to commemorate Williams, consider donating to them.

Psychiatry has often been used as a tool of state control. People who have been inconvenient or low status or cost too much to care for have been brutalised for centuries, so last weeks 'kite flying' announcement that people who are unemployed and mentally ill may be forced to attend some kind of therapy or have their benefits stopped has precedent.

Throwing an idea out without a formed policy behind it is called 'kite flying' because the people proposing it want to see how such an idea might fly. Will we rejoice that unemployed people are being further required to perform more hoop jumping or will we boggle at what a ludicrous bit of nonsense this is?

Ethically, it's a non-starter. When we begin compelling adults to have medical procedures we enter the world of ethical committees and High Courts: particularly because psychiatry has been used to abuse people compulsion in it is treated with enormous caution. This is not to say that it doesn't occur but when it's used it's almost always in a situation that is considered life threatening. People who are not sectioned but who are so depressed or anxious that they cannot work are not a threat to themselves or others.

We have evidence of what happens when we put a government agency - ATOS - between a patient and their GP. The suicide rate increases and the financial cost of appeals outweighs any savings made. The emotional cost to patients and their families is often catastrophic. There's no reason to believe this new scheme will be any different.

Therapeutically, counsellors know that a person who has been sent to therapy by a spouse, employer or parent is unlikely to do well. Therapy should never be a punishment or way of controlling someone, it has to be freely chosen. Yes, offenders are often compelled to attend therapy and what happens is that a majority learn the language of contrition rather than positively learning much about their motivations and their effect on victims.

So we know that compelled therapy is ineffective. We can also add that if this dreadful idea was ever to be implemented it would be limited to six or so sessions, which is barely enough for someone who is mildly unhappy let alone someone with a mental health diagnosis. The waiting list - already enormous for NHS and most agency therapy - would make it unmanageable and we can guess that, just as with CBT, many of the people trained for this project would not actually be therapists at all, but technicians on a budget and under pressure.

So what might the purpose of this dreadful scheme be? Would people compelled to have therapy be removed from the official numbers of the unemployed? This is what happens to people who are compelled to join other unemployment schemes so that the numbers of unemployed and particularly long term unemployed fall, on paper. If ministers wanted to help people with mental illness back to work they need to give appropriate funding to existing mental health services and reopen the services that closed because of reduced funding.

But we live in a period of time when it's not quite acceptable to throw stones at the mentally ill, yet we are encouraged to pour scorn on them if they are also unemployed. If the public mood likes the idea of punishing people who are so profoundly unwell that they have resigned themselves to living on around £100 a week then this will no doubt happen. At the very best, it will offer therapy to people who have not been able to access it. At worst it will offer dreadful non-therapy from ill-trained, ill-motivated non-therapists.

This idea slunk off in shame in 2009: there's no good reason why, 5 years later, it shouldn't slink off to die.

Here’s a terribly sad piece from a woman who wishes she’d died at the same time as her husband. 14 years after his death her life, she feels, remains pointless without him.

Grief is a complicated, difficult process that we all will have to go through at least once in our lives. Elizabeth Kubler Ross proposed a model of grief that has been misunderstood as a linear journey, from one stage to another to another until we come out refreshed and sorted out in ‘Acceptance’. If you’ve been though grief you’ll know that a more accurate model, and one that Kubler Ross herself advocated, was more of a spiral where over a matter of years we revisit the stages of grief experiencing them as more or less painful depending on the circumstances. An anniversary is bound to be more poignant that most other days, and if that anniversary falls during a time when you’ve lost your home you may experience it as catastrophic. Alternatively, being under urgent stress, you may forget entirely about it.

There’s been some controversy over the DSM understanding of grief, whether it’s a mental illness or a normal human experience, and people from both sides of the argument have interesting, useful things to say. I wonder how it is, though, for this woman who still feels that her life is wasted because her husband isn’t with her? I don’t have any answers for her in particular, not least because she’s not asked me for any, but I think it’s likely that a person in a fugue of loss might be experiencing complicated grief, something absolutely as debilitating as a chronic physical illness.

Counselling can help and there are a number of specialist agencies that can help with specific kinds of loss. It may be that a person who experiences, say, bereavement because of suicide would see a counsellor who specialised in being with people bereaved by suicide and then a few years later a general bereavement counsellor and some time later still a body psychotherapist and then want to return to a suicide specialist. Like the stages of grief, we will revisit our bereavements over the years. But we’re not doomed to live there.

On Sunday I attended the regular professional development interview with Online Events, free and open to anyone, therapist or otherwise, to learn about a specialist area of counseling. Last nights interview was with Felicity Biggart and Martin Weaver on the theory and teaching of Trauma Resilience.

It is possible to successfully work ones way through trauma with the use of some fairly straightforward techniques and with the support of a diffusion group, that is, a number of people chosen by the traumatized person who will listen with care to whatever the traumatized person needs to say. You can read more about this work here.

The interview took place on the same day that the atrocity in Heula came to light, one amongst many atrocities in Syria and indeed all over the world. What made this news particularly awful are images of a large room filled with shrouded bodies including 46 children. The bodies were not available for forensic examination because they had to be buried within 24 hours but reports are that most of these people weren’t killed by artillery but murdered at close quarters. Some of the children are reported to have had their throats cut.

We all know that some humans can be savage and monstrous but to hear a very current report of savagery can (perhaps should) shock us anew. This is a very healthy, proper response demonstrating that we’re not shut down, blasé or uncaring; we absorb the news and then life takes over again allowing us to function – if we were to empathise with all the barbarism in the world we’d become mentally ill. And still, for a great many people the story of Heula will remain with them and be part of a small traumatisation, which is healthy and normal. If we make no connection between Heula and our own children having their throats cut, their terror and agony, then we have lost the basis for our own humanity.

The Heula massacre was mentioned in the Trauma Resilience interview and Martin suggested that a way of dealing with this trauma-at-a-distance was to find a diffusion group, perhaps even from the people in the chat room, and in sharing ones upset and sadness with a group of people prepared to hear it, reduce it.

It strikes me that we have lost this very human response not just to shock and trauma but also to sharing joy and delight. News media have taken over the storytelling and we suck up detail at-one-remove. Telling stories, hearing and seeing other people respond empathically, reminds us that we are actually alive in the world, and matter. A large number of my clients don't have this kind of support system, not because they're isolated, elderly or mad but because it's part of normal life now. Coming to counselling is almost all about telling your story and having it really heard. Perhaps for the first time.