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.
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.
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,
“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.”
Part of my training as a nurse was to spend time on a mental health ward so in 1983 I was sent to what was genuinely a bin. One of the women there had arrived as a child when the building had been a Work House. There was an elderly man with Alzheimer's, a 16-year-old young woman with alcohol problems, several young people with learning difficulties and about 20 other people with diagnoses that I knew nothing about.
Young doctors practiced electro-convulsive ‘therapy’ on the elderly woman. Every couple of days the elderly man was dragged naked and shouting through the ward and made to stand in a bowl by his bed where water was poured endlessly over him as he became increasingly distraught. The 16 year old young woman was sedated every time she challenged the staff on the basis of what she was actually feeling, which was often. In retrospect she was being punished because the staff felt threatened by her obviously splendid intellect. One of the young women with a learning difficulty was offered voluntary work at London Zoo but the staff laughed at her, saying that the idea was as stupid as she was and they prevented her going. All the women were sexually assaulted by some staff and some patients.
Aged 18 and stuffed with the high moral ideals of my nursing school I imagined that this was an urgent problem. It was only because I was a gobby teenager who didn’t know better that anything got done: none of the managers and just one of the (very senior) teaching staff took me seriously. The school of nursing protected me and two members of staff were sacrificed. Nothing changed. I kept banging on about it until one of my teachers said, “What do you want? Blood?” I was flabbergasted that the alternative to dealing with grotesque abuse was perceived to be killing someone and at that point began to learn to shut up.
News that staff knew about Jimmy Savile’s abuse of patients shouldn’t come as a surprise. We know that people - often very senior, generously paid people - find it easier to punish less senior people than to take whistle-blowers seriously. We know that whistle-blowers are treated with absolute contempt and ill treatment, not just by managers but also sometimes by relatives of abusers.
DBS checks are a waste of time and a horrific waste of money. What actually protects vulnerable people is a culture, not of suspicion but of openness and transparency where every person from the most senior manager to the youngest student are expected to speak out about what they see. That culture is supported by a policy that has to be followed if someone alleges abuse: it's a statement on the poverty of where we are now, that a policy has to drive people towards transparency.
I wasn’t the only student nurse on that ward but when I spoke to my peers about what we were seeing I was told that we were only there for 6 weeks, that it wasn’t that bad, that the staff knew what they were doing, that they didn’t want to risk a good review, that they were frightened. Just a kind of non-specific, generalised fear. As if the sky might fall on their head.
Every sphere of employment is full of bullies. Often, those bullies are out of their depth and anxious because they’ve been promoted on the basis of ticking some boxes in a selection process rather than because they are actually suited to their role. How many of us would admit that, turn down the big wage and move somewhere where we might be happier? But that’s their business. What is our business – your business too – is to ensure that we safeguard people who are weaker than we are. It’s not just in healthcare; it’s in offices where you have the power to make someone’s life worse.
The energy that you will have to use to protect yourself from knowing that you have made someone live without heating, without a home, without dignity will exhaust you. The people around you need to tell you that you’re doing the right thing because they’re doing it too. If this kind of behaviour makes you feel uncomfortable, take note. Leave if you can’t change the culture. If it makes you feel powerful, if you’re just following orders, you really do need support to stop.
The majority of my clients come to me with very similar stories: “I have too much work, my boss is either very nice but doesn’t support me or is unpleasant and doesn’t support me. I’m working way over my contracted hours and achieving very little of actual value, but as long as all the boxes are ticked that’s all that matters. I like my work but the kind of stuff I’m expected to do now has really worn me down. I don’t see my family. Secretly, my children have become a burden, they get in the way of my work.”
In some cases coaching helps the client to break down what looks like an enormous pile of never ending demands into smaller, more manageable tasks and attention to relationships, and whilst this can be very valuable it is not the whole answer.
Whether we like it or not the UK is now in the grip of a fantasy approach to life where a lack of hard work is the only thing keeping you from success and the unemployed are all workshy scroungers. I read an article in Forbes yesterday that partly drove me to write this blog entry: “Mentally Strong People: The 13 Things They Avoid.” What really chilled me were the comments, 65 pages of “Thank you so much, this really made my day, this is so amazing and I can see where I need to do more work on myself.”
So many clients are being told that they have ‘the wrong attitude’. Almost always what this means is “You’re not doing what you’re told to do fast enough and you ask too many questions.”
Our concept of success makes us all feel like failures. It may be that a person has to be single-minded to increase their income but the actual facts show us, again and again, that being male, remaining in full time employment and the income of the family you're born into are better determinants of not living in poverty than either hard work or ‘attitude’.
While some of the points in the first article are valid and good advice, for a moment let's turn the rhetoric on its head. Emotionally Damaged People: 5 ways to understand them.
1. Emotionally Damaged People don’t seek insight. They have learned that their feelings – and the feelings of others – are unimportant and they're disinterested in concepts of fairness or integrity. They have been trained to ignore their feelings and to treat harsh life lessons as something to be grateful for, as a matter of personal survival in an incredibly brutal environment. When a situation turns out badly they cannot bear to examine why, or who may have been affected.
2. Emotionally Damaged People don’t care about people who are less powerful than them. They couldn’t care less about criticism or advice from people they perceive to be beneath them. If the criticism comes from people they believe to be more important than them they are trained to be grateful, even if that criticism is persecutory. They can only function in a hierarchy. And they strive to be as high up as possible in that hierarchy, whatever the cost to their family or to themselves.
3. Emotionally Damaged People ignore the costs that instability have on them and on others. Emotionally Damaged people are not interested in how bereavement, low pay, illness, children, elderly parents or anything else affects anyone. They perceive themselves and especially other people as things.
4. Emotionally Damaged People are not interested in the causes of problems or how to alter anything for the better, other than the manner in which their betters perceive them.
5. Emotionally Damaged people are desperately lonely. They've been told from childhood that they are entirely alone in the world. They know that they will not be supported by anyone and they’re not interested in supporting anyone else. If their culture includes being seen to be supporting others via charity or mentoring they will become involved in these activities in order to be seen to be compliant. They have learned that human nature punishes failure and non-compliance, even if that’s the failure to be born in a prosperous family, and the emotionally damaged person is resigned to this situation. They have learned that it is better to stand on other people than to be trodden on.
Genuinely successful people know that relationships are what matter, not status or income. Having enough money to remain healthy, pay the bills, eat and sleep well, spend time outdoors for pleasure and relaxation and with people who contribute positively to their wellbeing is important – having more is nice but not necessary.
Here’s another piece of research: 1 in 5 British workers have taken time off due to stress.
“According to the study difficult deadlines, management pressure and a lack of support are the main reasons for workplace stress and 6% and 3% of stressed workers resort to unhealthy practices to cope, smoking and drinking alcohol respectively.”
Look at your attitude. See who you're trying to please, and why, and what you genuinely want from life.
Imagine if hundreds of thousands of people were wandering our streets dragging a badly broken, untreated leg behind them for years on end or bearing a ghastly wound that was prescribed sticking plasters. We’d expect the person with the untreated leg to be permanently crippled and the person with the wound to get infections, be further damaged and perhaps to die. We’d also be shocked and outraged that such a huge number of people were being treated with contempt and cruelty by the NHS.
That’s the situation we’re in with mental illness.
These are just some of the findings of the LSE research into UK mental health which actually makes good reading. It’s about time that people in power spoke robustly about ‘broken spirits’ and ‘troubled souls’, because this is precisely the issue. Organic mental illness caused by a head injury or chemical imbalance is quite rare, whereas the expectation that you can function like a machine for 80 years has a huge impact on mental wellbeing. Anxiety and depression are perfectly reasonable responses to being expected to do just that, and increasingly high-pressure circumstances only add to the problem. Poverty is a causal link to many illnesses, including mental illness (no one’s getting richer) while the stress that far too many families are under causes children to go mad, and who can blame them?
An enormous amount of the time I spend with clients is spent in discovering what they actually value. People arrive saying they’re not doing as well as they want to at work, can’t sleep or drink too much and very quickly discover that they’re being bullied at work, hate everyone around them or feel destroyed by disappointment. Soon, from feeling defensive or personally disgusted with themselves, they move to feeling terribly sad and helpless in the face of apparently overwhelming circumstances.
Then they realise that they have more options than they knew. It is perfectly acceptable to go off sick. You are allowed to rest if you’re exhausted, just as you would be if you’d been in a car accident. You are allowed to go onto sickness benefits – it doesn’t make you a scrounging work-dodger: the existence of sickness benefits recognises and respects that if the State pays the interest on your mortgage or your rent for a period of time you are more likely to return to productivity.
Sometimes, people come to understand that there is more to life than productivity, and that there’s a difference between productivity and contribution. Churning out endless bits of paper is, for instance, far less useful and satisfying than giving meaningful support to an elderly neighbour or unhappy child or the local cats home.
A good number of clients relearn that, as Lord Layard has suggested, who we are requires just as much care and attention as how much tax we can pay. That’s now moving from a philosophical premise to a vital economic reality.
There’s been something to write at length about every day for at least the last fortnight, whether it’s the rise in demands to be ‘positive’ or the looming realization that, if something doesn’t change, we may be seeing Greek people starving and freezing to death come winter. Watching a fascist thug belt a woman three times on television reminded many of us that the circumstances we find ourselves in today are not dissimilar to the run up to WW2.
The death of Gitta Sereny, a journalist and historian who focused on the study of evil, was announced today. Rather than just reporting facts in a pulp biography she purposefully got to know the people she researched and found that she understood them. Her understanding led many of her subjects to contemplate their lives and, in one or two cases, admit their guilt.
There’s a dreadful, mature wisdom that comes from knowing that the Nazi Commandant, Mary Bell, the children who killed Jamie Bulger are just the same as we are which is to say that we are just the same as they are. That’s a horrific pill to swallow but if we simply point and sneer and hate people who do terrible things we paradoxically become even more like them: we become individuals who are capable of destroying people who we no longer perceive as human at all.
I heard a neighbour say it last week. She is of the opinion that all homeless people should be ‘exterminated because they have bedbugs’. She said ‘exterminated’ a number of times, she knows what the word means, and she wasn’t laughing. She’s clearly thought about it. I don’t think she’d pull the trigger herself but perhaps she’d be proud to be a Hard Working Tax Payer making the uniforms for the people who would pull the trigger, or cooking their lunch in a canteen. There are increasing numbers of people like my neighbour: angry, dismissive, cynical, casually violent, displacing their fear and anxiety onto people at the bottom of the pile who cannot fight back, people that very few of us give a passing thought to.
Please listen to this brief interview on Gitta Sereny’s life.
and know that only in seeking relationship with the whole person who commits evil do we learn how close we are to it, and therefore how to avoid joining them.
A report out today suggests that, despite years of repeating the mantra “Exercise Helps Depression” it doesn’t. Unless it does: the outcome of the research is that therapy or antidepressants or exercise have the same effect on depression.
This report comes out on the 40th anniversary of an extraordinary psychiatric experiment. Healthy researchers went to several psychiatric hospitals, reported they were hearing voices, were admitted and diagnosed with schizophrenia. The medical staff spent an average of 6 minutes a day with each ‘patient’ and treated them as if they were indeed schizophrenic, while many genuinely unwell patients realized there was something very different about these people, that they were not, in fact, ill. When some researchers took notes this was diagnosed as ‘writing behaviour’ and part of their illness, and it took a surprising amount of persuasion from outside sources to get some of the researchers out of hospital. On being released, every single researcher was diagnosed as being in remission, that is, still ill but not floridly so.
The resulting paper was a bombshell to the psychiatric establishment. One hospital challenged the researchers to repeat the experiment and later reported identifying 41 researchers posing as having schizophrenic symptoms. In fact, none had been sent.
Context is everything. The context in which the depression research is being received is one of cost cutting – now the hard working tax payer can stop paying for pointless gym sessions for depressed people, even if this is not what the research demonstrates. What the research also demonstrates is that when people are given quality human contact over a sustained period, whether that attention was counselling or research-led monitoring of people on antidepressants, or 13 sessions of exercise advice over 8 months, they felt better.
We live in a context that demands simple answers but in care of the mind there are very few of those. Psychiatry, psychology, psychotherapy and counselling have more in common with philosophy than, say, diabetic or bone care. Pancreases and bones tend to do the same things whoever they’re in but the mind and heart are less fixed. That said, we do know that if we expect to hear something we tend to hear it and so it’s no bad thing to question what we believe we know, what the basis’ for our beliefs might be and, essentially, how what we believe we know informs how we live ourselves and how we treat others.
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