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!
 

I loathe this kind of Inspirational Quote. The cliché of a Wise Exotic Person, in this case that acme of wisdom, a Native American; the shrewd observation of nature; the comparison between something ordinary and ubiquitous against something noble and clever; and the requirement to change your attitude, you weak, stupid fool.

Clearly, this person has never seen a raptor in the rain. This kind of ‘inspiration’ is too often built on fantasy, ignorance and the desire not to encourage but to load blame on to vulnerable people. It has the added benefit that it makes us feel better about ourselves.

Viktor Frankl and his selectively quoted book, "Man's Search For Meaning" is often used to punish people: "When we are no longer able to change a situation - we are challenged to change ourselves." "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."


Can we be clear? Frankl was writing about his experience in a Nazi concentration camp. Although he hypothesised about what signs individuals gave of despair as a prelude to their death these are not research results, they are the desperate observations of a dying man. Using Frankl’s words in this way suggests that if only those spineless failures in concentration camps who gave up had just changed their attitude a lot more of them would have survived. Frankl turned the memory of his wife into a kind of religious mania, an act he credited with keeping him alive, but I’m not aware of any inspirational quotes suggesting we all do the same. 

There’s a great deal to be said about altering our attitude towards events. It’s absolutely true that if we can gather ourselves after a failure, loss or catastrophe and keep moving forward then we are more likely to achieve more and perhaps be happier. This can be very important for people who’ve experienced bereavement, at some point they need to drag themselves away from misery and shock if they’re not to remain out of the world. But some people will remain in that state. Do they have terrible attitude? Are they stupidly refusing to be helped?

Or has no one offered them the kind of help that they can accept?

There’s always a reason for a ‘bad attitude.’ Sometimes it’s a personality habit and it’s no use saying that this can be dealt with by snapping out of it: in every situation people do what they believe is best. When we say they should just try harder or be nicer their perception of the world as a place full of cruel people who have no empathy is compounded.

Happily, an increasing number of people are beginning to speak out about their failures and anxieties, their inability to buzz through the world like a chainsaw, the mental illness that floors them and the shock and humiliation of collapse. Less dramatically, we’re recognising the existence of introverts who make up around half of the population and who are quickly exhausted by having to do things that extroverts are energised by. Like go to meetings. Or talk to people.

By the time that most people come to therapy they’ve moved past the possibility of changing their attitude into miserable paralysis. Thank goodness. That’s the place where change happens, not in denial of reality.

Let’s look at another Viktor Frankl quote – one that’s longer, more complex, requiring more reflection than those chosen by other people who want us to get a grip:

“Love is the only way to grasp another human being in the innermost core of his personality. No one can become fully aware of the very essence of another human being unless he loves him. By his love he is enabled to see the essential traits and features in the beloved person; and even more, he sees that which is potential in him, which is not yet actualized but yet ought to be actualized. Furthermore, by his love, the loving person enables the beloved person to actualize these potentialities. By making him aware of what he can be and of what he could become, he makes these potentialities come true.” 
― Viktor E. Frankl, Man's Search for Meaning

When we tell people to change their attitude we shut them down. When we acknowledge the reality of their situation - that they are unique, that they are not us - when we give each other compassionate space, then genuine, individual growth becomes possible. Not growth to satisfy anyone else’s idea of success but growth that leads to their own concept of accomplishment.

I am entranced by this video

The song is about the singers relationship with her father, but it elegantly describes some of the processes that some people – by no means a particularly damaged or miniscule proportion – go through in order to discover more about their problems.

Michael * came to therapy with acute symptoms of stress. His workplace was stultifying, his boss out of his depth and another member of the team was a bully. The workload was too heavy for everyone and Michael had become the earthing rod for the offices collective unhappiness. We worked together to identify the shock and shame of being stressed, addressed the office dynamics and considered why Michael might have become a scapegoat. Michael felt much better prepared to deal with the complexities of his toxic work environment and decided to remain in therapy to explore the other matters that had begun to unfold during our time together.

Most of us have lost the innate power of our imaginations by our mid teens. Our heads are stuffed with factoids that will help us become hard working taxpayers and tremendous machine parts. You don’t have to write poetry or wear a rainbow jumper to be something other than a component: part of being a whole human being is about knowing what you feel and why you feel it, and therapy is a good way of kick-starting that process.

Michael found it straightforward to remember his past but realised that he couldn’t recall how he felt about events. His memory had become almost entirely cognitive. I wondered what his younger self looked like and we began thinking about Michael as a child of around 9 – how did he dress, what did he eat, did he have a nickname, what he liked and disliked, and so on. In a short period of time this younger Michael regained his own voice and began speaking with older Michael reminding him how he felt in some detail.

Like most people who come to therapy there was nothing poisonous or horrific in Michael's past. Part of growing up is, as well has having good times, experiencing disappointments, shocks, fears, loss, unhappiness, the usual stuff of an ordinary childhood and dealing with them. For all of us there are events that stand out usually because the adults around us behaved in ways that were unhelpful.

In therapy this work is never about blame. Circumstances make people behave in certain ways, no one is perfect, and it’s useful just to consider how things happened so that we, as adults, can make better sense of them.

Remembering the difficult feelings – betrayal, abandonment, shock, bereavement, resentment, terror – can be much more difficult and so we tend to say, “Well, that happened, it’s over. Let’s move on.” In fact, those feelings remain, unacknowledged and hidden away. 

But they’re alive. And if we ignore them they begin to run us. 




I'll be writing more on this subject in my next post.

A woman caught me as I stumbled on the bus yesterday. I sat next to her and she said, “We’ve all got to be kind to each other now,” and something extraordinary happened between us.

I held her hands. If you don’t live in London you may not know how utterly bizarre it is to hold a strangers hand on a bus. It’s unusual to make eye contact! But this woman was radiating something powerful that compelled me to take hold of her hands.

“What did you vote?” she asked. I’m old enough to remember when it was considered incredibly rude to ask how a person voted, but I answered her anyway.

“I voted UKIP,” she said and turned to look me straight in the eye. All I could think of to say was, “Why did you do that?”

“My next door neighbours are on benefits and they work cash in hand,” she said, clearly wanting my response. It’s not the most insightful or professional thing I’ve ever said but what came out was,
 “So what?”

“Don’t you think that’s wrong?” she asked, and I said that they probably had very good reasons for taking the terrible risk of being caught. “But they’re from Iran or Iraq or somewhere, and I’ve had cancer and I work. Don’t you care that they’re on benefits?”

I told her I couldn’t care less and asked her where she came from - English wasn’t her first language. She said her mother and father were from different nations and that she was from yet another. “My boys tell me the same,” she said, “They say that what my neighbours do is none of my business.” We looked at each other, holding hands very tightly, and then she got off the bus.

I was dumbfounded. The whole interaction had taken about 3 minutes.

It would be foolish to extrapolate an entire theory from that short connection, but isn’t there something about her anxiety, her desperate need to understand, that’s reflected in the national response to the election? She won’t be the only person to have voted against her own interests – a non-White, not-affluent woman who has had cancer – because her need to punish, to punch down, to harm people who are more vulnerable than she is, is greater than self preservation.

An accumulation of other stresses would have preceded this outpouring and perhaps the election was the final straw. I have no idea. But it seems to me that the single most important thing that this woman said, that goes beyond politics and ideology, beyond feeling gleeful or shocked or devastated at the outcome of this election, is the very first thing she did and the very first thing she said to me:

She caught me when I stumbled.

She said, “We’ve all got to be kind to each other now.”

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.

A good part of my working week is spent in other people’s offices where I've noticed that there are little signs telling people how to use a microwave, what the fridge policy (a fridge policy!) is, reminders not to steal and that in the event of a fire they must leave the building to avoid being burned to death. In one office there were 14 full colour, laminated notices telling people to come to work on time, not to pour boiling water on toddlers, to avoid spreading infectious diseases, the sink policy – yes, really - that time in the kitchen was being monitored, and that staff attendance was under review.

This in an organisation that "doesn't have the money" for a box of tissues.

I'm a big fan of Health and Safety legislation, it really is necessary to tell people that hot water is hot, but Health and Safety is not the issue in an organisation that feels it necessary to watch how long individuals are spending in a kitchen.

The private sector doesn’t seem to have the same issues. People there somehow know how to use a fridge without needing a policy. It's not that people who work in the private sector are any brighter than people who serve the public, far from it. It’s more that initiative is more likely to be nurtured rather than treated with suspicion and organisational vision tends to be wider than what’s happening in a microwave.

Work in the public and voluntary sectors is too often reduced to a Kafkaesque model of not-work where flair and imagination are perceived as suspect and personally threatening. In the private sector innovation, ideas and positive critique are more likely to be welcomed.

I've worked in places where little children bellow and cry too much while stressed workers scream nursery rhymes at them. The staff have obviously gone through training and got appropriate qualifications. The staff ratios are legal and the toilet-cleaning rota is managed very well, everything is fine on paper and that's all that matters. Sickness rates and staff turnover are costing an arm and a leg but the funders are content with the reports sent to them. Funders tell organisations what they expect to hear and then organisations repeat it back to them including, incredibly, sending them ‘case studies’ instead of saying, “No, we will not send you a case study because that would be entirely inappropriate.” Instead, organisations make case studies up.

It's true that many people are put into positions of responsibility that they are not worthy of and they can have a profound effect on the people working under them. It's an irony that those people who don't feel anxious about being competent at their job, who believe they're indispensable to the organisation, are more likely to be so comfortable at work that they feel no need for personal development. Similar problems arise when a leader isn't confident enough to lead but just keeps doing what they're told rather than saying, "Why do we need to be told not to scald children? What's going on here?"

Writing a fridge policy is not a good use of anyone's time. Any organisation that needs a fridge policy has far, far greater problems than manky yoghurt.

A few evenings ago I was with a group of business managers who wanted to talk about how domestic violence affects their work. I spoke with any number of individuals and every single one of them said something along the lines of “It’s such a shame that you have to frame the subject around profits and losses. Shareholders don’t care about human suffering, and the moral aspect of people you know being assaulted has become redundant. In this room it’s only you and I who think about anything beyond money.”

People said they felt isolated, paralysed, disgusted with their employers and themselves. I was able to say, “You’re not as alone as you think. I’ve had this conversation with lots of other people in your situation,” and was pleased to see their surprise, but then a veil of caution came down and the conversation took a turn towards inaction.

Being responsible for other people’s wellbeing is a big deal. Many professionals enjoy the human contact and problem solving that HR and line management can bring, particularly when good polices and attitudes exist to support and contain that helping instinct. But austerity has brought with it cynicism, hopelessness, fear and a disturbing insularity. Increasingly we – particularly people in their late teens and twenties - are looking for someone to blame, whether that’s recent immigrants, asylum seekers or people who are unemployed, basically anyone that we perceive is costing us money.  Even if it’s not our money at all.

A person who is assaulted by a stranger gets a huge amount of support compared to someone who has to take time off work because their partner has attacked them. We blame them for staying. We blame them for putting up with it. We blame them for leaving and depriving the kids of their father. We blame them for making us take up the slack when they can’t work. We blame them for not coming out with us after work. We blame them for being hospitalised. We ask how they contributed to their own death.

Feeling powerless and hopeless at work is debilitating: sometimes you can do something about it and sometimes that’s only going to cause you grief. But if you feel strongly about something ethical at your workplace the likelihood is that you’re not alone, and if you feel it’s dubious to seek connection with peers who might feel the same there is likely to be an organisation that will support you.

Here’s CAADV, the Corporate Alliance Against Domestic Violence, with membership that includes BP, KPMG, the Corporation of London and Diageo amongst many others. They recognise the monetary loss to business of domestic violence. What really motivates them is the human cost.

If you live in London the start of the working day can be absolutely dismal. There is another way! And as long as employers don't subvert this life-enhancing concept by making staff wrap their ties round their head and jump up and down, this kind of event could alter the way we approach work.

 "The [wildly successful] nerds who run IT businesses are much less interested in the "suit and tie" approach to business and much more willing to experiment with any idea which they think will keep their staff enthusiastic and creative."

Watch the Channel 4 News report here. Watching this 3 minute video will set you up for the day!

Mindfulness works. Its venerable parent, meditation, works. Exercise works and most of us find dancing a damn site more enjoyable than running in the rain. Add human connection, no matter how fleeting, and you've got a recipe for joy. 

Let me know if you go to one!

4 senior bankers have killed themselves in the last week. 

As a Bloomberg article says,



Though the reasons are not clear in either case, the coincident deaths will feed the discussion of excessive stress levels in the financial industry, not just for the young interns working 100-hour weeks but also for accomplished executives. Stress-related resignations, heart attacks and suicides may be par for the course in a high-octane, risky businesses, but the public does not really want finance to be one of these: Its money is at stake.

That sounds callous but it’s what all employers, including yours, are ultimately concerned about. If you are self-employed then you are likely to be even less caring about your own wellbeing than the average money-focused, gimlet-eyed employer.

Enough now. These men were amongst the most high-status, intelligent and wealthy people in society and they killed themselves. If they can find themselves locked into a despairing panic state then any of us can.

I don’t think it’s possible to say these 6 things too often:

• You want something to change as long as everything stays the same? Can you see why that’s not going to work?
• Your employer is not going to change. It’s going to have to be you.
• It’s very likely that to make your life better you’ll have to work fewer hours.
• If working to your contract and no more isn't possible then you may have to reduce your income.
• Even in a recession – and there is no recession in London – this is possible.
• You need to decide what’s more important to you: your status, your income or your health.
  

There are a great many techniques that will help you manage your time and your attitude towards work but working a consistent 50 hour week is just not sustainable. Don’t swallow the rhetoric about Hard Working Taxpayers. With unemployment down, why is productivity also down? Economists are baffled but for a small fee I'll tell them why this is: Everyone is outrageously hacked off, largely for excellent reasons. Don’t wait until you want to jump out of a window before you address it.