A fair number of clients describe very similar problems. They’re constantly tired, or very edgy and unable to rest; teary, stressed and not coping. What used to be small problems have become insurmountable. They’re irritable, panicky and can sometimes behave in ways that seem beyond their control leaving them feeling ashamed, stupid, defensive and angry.
 
As well as taking these symptoms seriously in a psychological sense I’ll also ask them to visit their GP to request some blood tests.
 
Full Blood Count (FBC)
This measures your general health, including how much iron you have in your blood. Anaemia – a lack of iron – can make you feel exhausted, short of breath and cause palpitations. Shortness of breath and palpitations are also symptoms of panic attacks.
 
Low levels of magnesium and calcium can cause panic attacks.
 
An FBC will show if you have any underlying infections which will make you feel tired and less able to get through the day.
 
Thyroid Function Test
The symptoms of an over- or under-active thyroid are very close to the symptoms of anxiety or depression. An overactive thyroid can also result in mood swings, insomnia, persistent tiredness and weakness, and the classic symptoms of a panic attack, palpitations, nervousness and irritability. 
 
A Blood Glucose Test
GP’s generally offer 2 types of blood glucose (sugar) test for people who are not showing overt signs of diabetes: the fasting glucose which shows what is happening to your glucose levels after 8 hours of not eating, and the HbA1C which shows what your average glucose levels have been over the past three months.
 
Type 2 diabetes is increasingly common and can lurk for years before it’s diagnosed. Some of the symptoms of it are tiredness, depression, and the classic symptoms of a panic attack: anxiety, sweating, palpitations, trembling. If your blood sugar suddenly drops, as it can do in diabetes, you can also feel irritable and bad tempered.
 
These tests are performed at the same time with just one needle and take about 20ml of blood in total.
 
Once you and your doctor get the results you will both have a much better idea of what may be causing you to feel psychologically unwell. Even if you have a clinical diagnosis of depression, anxiety or panic disorder, get these tests done. Physical causes of symptoms are notoriously ignored in people with a mental health diagnosis. And as with any medical issue if your GP is unhelpful get a new GP.
 
There’s an intimate link between the body and the mind and just by attending to what the body needs, whether that’s more or less thyroxin, iron or just water, we can improve and sometimes even cure what seem to be emotional problems. If you have an underlying physical problem that you don’t know about therapy can help you be more motivated to attend to your health so that you eat better food, exercise and drink water more regularly, but this will not address a problem thyroid gland, low iron or diabetes.
 
You never know, you may be able to avoid therapy altogether!
 

#mondaymotivation is a twitter routine where people and organisations get all whoop whoop about how GREAT the beginning of the working week is. I work with small organisations to help create their social media strategy and know it can be useful to schedule a guaranteed-to-trend hashtag but unless it's truthful it's more than wasteful, it invites criticism.

My local college has been serving the community for a century offering excellent education in a Ward that is the joint first most deprived in London. It was recently sold to the Council in fairly strange circumstances - who are now going to demolish it to build houses. We have been promised that the College is simply relocating - and no doubt it will.

Many locals have been incensed by this and their detailed research has uncovered some alarming information about what looks like financial mismanagement of some description.  

All this is happening at a very high level and the day to day running of the College continues. Banners have been put up outside telling us to prepare for something wonderful and the social media is always good. But their #mondaymotivation post this morning was too revealing.

Another local organisation picked up on it and, to my joy, referenced an article debunking positive psychology. Then they referenced a blog that has been digging into the Colleges finances. 

“The Management Accounts up to 31 December 2016 indicate that the College will fall significantly short of its income target for the current year. The overall shortfall is expected to be in the region of £1.7 million.

Governors expressed concern at the dramatic change in financial forecasts compared to what was reported to the Board in October, where the then Management Accounts forecast a year-end surplus of £256k.”​ 

Oh dear.

I have no idea about what's really going on at the College but, from a psychological stance, this tweet exposes rather too much about the uncertainty and anxiety that college staff may be feeling.

The image seems based on purposefully alarming carnival entrances designed to let you know that you're entering a world where the usual rules don't apply. It's menacing and sinister and if you walk through the gaping mouth you are consenting to enter a world that you have been blatantly warned about. You give your consent for anything to occur, especially things that are frightening and disturbing, like being eaten up. The features are based on something that is human but horrifically distorted. Clowns are ambiguous: they're supposed to be hilarious and they're notoriously creepy. They say one thing and mean the opposite. The origin of clowning is in satire, where the Fool was able to tell hard truths to powerful people as long as he kept entertaining them. And everyone knows the narrative of the deeply unhappy clown.

I'm not going to say much about the nose on the gif other than that Freud would have a field day with it, and that my more analytical colleagues would have something to say about an unconscious reference to being conned. 

Positive thinking is clearly linked to denial. (Do a search for 'positive thinking denial'. The second image is of a clown with his fingers in his ears and his eyes tight shut.) Denial is a coping mechanism that allows us breathing space in which to adapt to new, unpleasant information, but refusing to accept that something is very wrong means that the world slips out of your control - like entering into a sinister carnival world. Cognitive dissonance makes the world seem confusing and threatening and, as any recovering addict will tell you, denial traps and isolates you, preventing change.

Positive thinking can result in the polar opposite of what we're told it's supposed to do, as it did today for the College. Their maniacally upbeat, ambivalently simple tweet has drawn some very serious attention that is way beyond what a social media team can be expected to deal with.

Organisationally, we always have to spin things to our advantage but this is a skilled and delicate job, one that requires complete awareness of reality and the avoidance of being seen to be misleading. Individually, attempting this kind of spin is more often than not denial at best, narcissism at worst. One way or another the truth shows itself, whether we know it or not. 




*I've not addressed the spelling mistake because it may be that the person who wrote the tweet doesn't speak English as a first language. And it adds to the post's incongruence.

There comes a point when you  have to take stock and say, “Things are bad.”
 
The beginning of the economic downturn saw a tedious increase in ‘experts’ telling us that positivity would make everything better. Thinking about what is good rather than bad and focusing on the good stuff really can build new neural pathways and change your attitude for the better. But it won't help if you want to walk across the road with your eyes shut.
 
Very quickly the suggestion that positivity can be helpful has turned into a demand. We live in a country where therapists are working with the DWP to make unemployed people go back to paid employment and where paid employment is suddenly perceived as a ‘positive health outcome.’  If you think that’s wonderful then you don’t care about evidence.
 
It is unethical, counterproductive and has no basis in fact. It speaks volumes about the desperation that many therapists are feeling.
 
Because you’re reading this it’s probable that you’re all too aware that things have been falling apart for some time. Many businesses can’t afford the materials and staff they need and so existing staff are working at the edges of their ability and capacity. Public services - the services we all use when we travel, get ill, expect an educated population or want our elderly relatives to have some kind of dignity – have been amputated. Things are falling apart. The most vulnerable amongst us have been telling us this for years. And now ordinary people who are not vulnerable are feeling it.
 

• Workplace bullying is at an all time high.  
• France is 30% more productive than we are.
• The suicide rate has gone stratospheric.
• Mental illness has increased significantly – and not just because of better awareness.
• Hate crimes are commonplace.

 
Cognitive dissonance is
 
 “the mental stress experienced by a person who simultaneously holds two or more contradictory beliefs, ideas, or values; when performing an action that contradicts existing beliefs, ideas, or values; or when confronted with new information that contradicts existing beliefs, ideas, and values.”
 
We all experience it from time to time but many of us are finding a home in this unbearable environment.
 
Demands for positivity have become authoritarian, insisting that we cut a smile into our face and do little dances of joy to demonstrate team spirit or something. Anyone saying, “My life is hard” is a shirker.  Anyone suggesting that motivational speeches don’t put food on the table is dismissed as unenthusiastic. People who want to care for a sick child are told that they must ‘arrange alternative childcare.’
 
How do you discern whether positivity indicates confidence or stupidity? Intelligence, good business strategy and the ability to avoid danger involves knowing when to cut our losses. The alternative is to continue staring at the sun, borrow unsustainable amounts of money, time and good will and crash disastrously.
 
Things are bad for most of us right now and, as adults, we need to look at facts rather than allow our prejudices and desires to rule us. Sterling is falling and the trend is downward. A 60-hour week is no longer unusual. (If you don’t work a 60 hour week that’s a good thing not an indication that you’re lazy.) Anxiety is twice as prevalent as depression. Our children are becoming more and more distressed.

If you’ve read my blog for a while you know I don’t like inspirational quotes and the pretence that everything will improve if we all just pull together and think happy thoughts. Now I’m saying that if you’re an ordinary person and you’re not feeling a bit crap that it’s likely that you’re ignoring something.
 
 

Think about Russian Dolls: one large figure contains another who contains another and another and another. We too have many parts to our personality: we show one aspect to our parents, another to our friends another to our colleagues and so on. And there are parts of our personalities that tend to make us act in certain ways when we become stressed.

Many of us will have experienced some kind of intense event or events, perhaps falling over hurting ourselves more than usual and being told not to cry, to toughen up.  Or spending too long alone too often. Or feeling very frightened and being told that we’re being stupid or silly. It doesn’t have to be horrific abuse or a life-threatening incident: not being heard and seen properly, not being met where we were in those moments when we really needed to be, not being told, “Yes, you’re right, what you’re experiencing is real,” means that we learn that it’s more acceptable to hide those parts of ourselves away.

Very few of us are able to access these dismissed and hidden parts of ourselves with ease. We don’t like it when we become angry or sullen or overexcited and so it seems better to squash those repressed feelings down too. Some people begin to feel out of control, even if it’s just raising their voice at a friend or co-worker or having to go to the loo rather than cry in public. Some people find they begin to need the light on at night, or to check if they’ve switched off the gas, or become fearful of travelling on the underground. Very gently, things start moving further out of control, not in any huge way.

But the feelings begin to impact daily life. They might feel enraged at small things or panicky if a routine has to change. Stress? Absolutely, and there’s lots of ordinary stuff we can do to reduce stress. Some people come to therapy. All of us bring our past with us wherever we go, and it’s often appropriate to gently and at the clients pace begin to explore that.

Michael and I had built up enough trust for him to feel comfortable enough to experiment with what it was like to try speaking with his younger self. Using a spare chair I asked him to imagine that his younger self was sitting there. I said hello and spoke towards the chair as if younger Michael was sitting there and in time began asking him questions. Of course, the person who knew the answer to these questions was Michael himself who was astonished and suddenly much less sceptical.

Michael began speaking to his younger self – it always feels embarrassing the first time you talk to an empty chair - and discovered that a whole new part of his awareness was opening up. He asked questions, got answers and remembered all kinds of things many of them very pleasurable and fun. I was able to observe and note when Michael shut his younger self down by saying things like, “Oh don’t worry about that, don’t be silly” or something similar, and together we were able to think about how useful these kinds of responses were both in real life and in Michaels past.

Michael continued talking with his younger self, then found himself responding to that part; he was able to recognise a feeling of deep sadness that arose before more obvious feelings of feeling stupid or vulnerable or unworthy. He asked his younger self about that sadness and learned that if he was able to do the imaginary equivalent of holding his 9 year old self's hand and say that it was OK to be sad, the sadness quickly diminished and more shameful feelings didn't arise with such intensity and in time, much at all. Which meant that he became very much less likely to be bullied at work.

Conceptualising this process in this way made it more easy to grasp: younger Michael needed empathy, comfort, love – basically positive attention – and in providing it for him(self) adult Michael was healing some old wounds.

I had to stagger in to work today, feeling like hell and dosed up on Lemsip. If you’re self employed, as I am, you’ll be aware of the pressure to choose between staying in bed and paying some bills, and today I just had to get on with it.

That said, I was also able to come home two hours later and sleep, then continue to do a little bit of work from the comfort of my sofa. That’s a blessing. For the previous two days I’ve done nothing at all even though there’s a never ending ‘must do’ list. There always is. A few days away from it won’t kill anyone.

One of the questions I ask most of my clients is, “What’s the worst that will happen if you don’t go in to work?” Their response is usually to smile, look sheepish and say something along the lines of “Nothing much.” The pressure to keep attending work is astonishing. Just having your body in the office seems to be the single most important aspect of employment, rather than any work you might do. One of my clients* left his employer after a review where he was told his work was, ‘Exceptional, we can’t fault it,’ but he mustn’t listen to the radio on headphones. Why? Because his employers need for control was poisonous.

For this client, after finally realising that he was being bullied every day handing in his notice a couple of days later was the right thing to do. He had the backing of his family and enough savings to see him through 6 weeks of job seeking. For him, it was worth visiting his GP to get signed off, taking a week or so to rest and recover from an absurd work environment, and then get on with finding a new job.

The ideal way of dealing with a job you hate is to find a new one while letting your current employer pay your wage. What makes that difficult for many people is that they won’t admit that their employer is toxic. We tend to bitch and moan about work without doing anything about it, whether that’s looking for new employment or talking to a Union, and wait until something so preposterous happens that things begin to spiral out of control. I’ve had a number of clients who’ve denied anything was wrong until they’ve been assaulted at work. Denial is not just a river in Africa.





*Identifying details have been changed.

Some years ago I worked for two different counselling agencies, one British the other American.  They both offered their clients the same number of free sessions, paying the counsellors a set fee per session.

One had a webpage of counsellors that clients could chose from, gave the authorisation code to the client; the client chose a counsellor and gave the code to them. Client and counsellor met for the allocated number of sessions and at the end of the contract the counsellor invoiced and the organisation paid up within 10 days or so.

The other took a lengthy history and allocated a counsellor – the client had very little choice about who they met. Paperwork became part of every session - one form at the beginning of the session one at the end - which far from offering any kind of meaningful data gathering was used simplistically to demonstrate whether the client was getting better or refusing to take this generous and important opportunity to address their problems. I had to speak with the agency half way through the sessions so that they could determine if their money was being spent well. There was always pressure to break client confidentiality. The agency routinely took 5 months to pay invoices, often significantly longer.

These are difficult days for most organisations and everyone wants to maximise efficiency. It can be tempting to want to control every and anything that moves but, as the examples show, that is likely to add whole new – and expensive – layers of management.

The American company is getting rid of a layer of specialist management by computerising their processes. Now a programme will decide whether a client can be allowed to continue receiving counselling. This still involves huge cost and disruption and still involves paying specialists – this time techies to deal with the inevitable problems – and reduces vulnerable people to computer code.

There’s a real difference between having a tight set of procedures so that everything works efficiently, and teetering on the verge of panic all day long. Nothing is foolproof and it’s very well worth remembering that vital adage:

                                                   Hard Cases Make Bad Law.

Put simply: Stuff Happens: React Proportionately.

Of course, where you are dealing with situations where lives can be put at risk then attending to minute detail is important but proportionately few of us are in that bracket. Most management changes are made to save money and, paradoxically, it almost always results in greater expenditure. In the case of the American counselling organisation, they’re already swiftly losing trust from staff and clients. What price do you put on that?