Friday, July 31, 2009

The Fear in All of Us - 1

By Kevin Murphy M.Sc.,
Psychoanalytical Psychotherapist,
Dublin, Ireland.

A client was telling me recently about their experience of an anxiety attack. It happened in the workplace and involved panic, sweating, a rising sense of fear along with racing, negative thoughts. Coupled with this was a twofold additional response. One was an unmistakable sense that the anxiety was out of all proportion to the event that triggered it – being asked to take on a new project. And second was a recoiling at the idea that it should have been happening to them and that it was a particular failing on their part to be reacting in this way. This latter being almost a fear of the fear itself.
So, this had all the signs of the classic anxiety attack. An unpleasant sense of fear, increasing rapidly in intensity, seemingly out of nowhere, that threatened to overwhelm this client and over which they had no sense of control
For a ‘disorder’ that is probably embedded in the widest range of psychical disturbances and emotional issues, there is still very little public understanding, or even medical understanding, of what really causes it.
Certainly there are plenty of descriptions of the symptoms of anxiety and many diagnostic categories that include the heading of anxiety. But when it comes to actual explanations of where it comes from they are pretty thin on the ground.
The official definition is that it is a psychological and physiological state characterized by cognitive (thoughts), somatic (bodily), emotional, and behavioural components. These components combine to create an unpleasant feeling that is typically associated with uneasiness, fear, or worry.
The same definition considers anxiety to be a generalized mood condition that occurs without an identifiable triggering stimulus. As such, it is distinguished from fear, which occurs in the presence of an observed threat. Additionally, fear is related to the specific behaviours of escape and avoidance, whereas anxiety is the result of threats that are perceived to be uncontrollable or unavoidable.
A degree of anxiety is considered to be a normal reaction to stress but when it becomes excessive or insistent, it falls under the classification of an anxiety disorder.
That is the official position on anxiety. Against this backdrop I thought it might be interesting to consider the psychoanalytic understanding of anxiety, in particular the Freudian/Lacanian approach (the Freudian position reinterpreted by French teacher, author, psychiatrist and psychoanalyst Dr Jacques Lacan), which in my view offers the richest theory available.
A good starting point might be to differentiate the rather obvious point about the beginnings of anxiety. Often you find that people come to therapy when anxiety becomes unbearable and unmanageable in their lives. By that stage, usually, they have lived with a reduced level of anxiety without any overt knowledge of its existence for many years. When it does emerge in a problematic way, a common description of the experience is that it simply cropped up, triggered by nothing they can point to as the cause, but that it has been having a debilitating influence ever since.
The most common request is to return people to the point in their lives when there was 'no anxiety'. And, equally, to act quickly in bringing about such a change.
But anxiety is not something that simply arises in someone’s life unannounced. In most cases you will, on deeper examination, find traces of it stretching back through their history. And, while it is possible for people to feel the benefit of beginning therapy almost immediately, ‘fixing’ anxiety is not something that can be done without an investment of time and patience.
Freud, as far back as 1894 in his paper 'Anxiety' first pointed to the link between anxiety and desire, an odd coupling you might think. And, incidentally, while you may often hear people say that Freud is old hat, like so many of his discoveries this link has been making its way down through psychoanalytic thinking and theorising ever since. Why is the link between desire and anxiety such a discovery?
Because desire is one of our earliest and most persistent drivers towards pleasure, comfort, security, happiness and everything positive. Its opposite is the thing we experience when all these positives are absent: anxiety. No-one before this had noticed that the striving for pleasure, well being, comfort, happiness, confidence, wholeness, peace of mind and even love was the opposite side of the same coin which included anxiety.
Anxiety is the lack of all these things. And in its adult form, it is the painful awareness, the uncomfortable truth, the frightening disappearance of our subjective autonomy, and even sometimes the disempowering realisation that we might lack these things.
So where does this ability to experience a lack of this kind come from? In my next blog I am going to look at how this happens. Far from emerging as a result of no known cause or triggered by small, ad hoc occurrences of daily life, psychoanalytic theory proposes that anxiety is an intrinsic part of human experience and is present from our earliest stages of life.

* The next blog will appear on Friday August 21,2009.

Friday, July 24, 2009

Aspects of Love

By Kevin Murphy, M.Sc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.

When we speak of romantic love we are talking about the most positive of human emotions, the one to which we are all drawn. Being able to love is our highest attribute and being loved our most treasured experience.
Yet, despite our inner capacity to love, we usually think of it as something that exists outside of ourselves. In one respect this is true. It can only be found in that inter-space between us and another person. And when we do fall in love, it again comes from from this place.
Love attacks us from the outside. We talk of being struck by love, of falling into love, of cupid’s arrow hitting us, of being smitten, and so on.
I was at a psychoanalytic conference in Paris in June and it was interesting to hear leading US author and psychoanalyst Bruce Fink give a talk on this very subject. He had been speaking of the mini-trauma that being ‘struck’ by love represents, a trauma that can lead to repetition compulsion such as repeatedly falling in love with the wrong person or unconsciously destroying our love relationships or never quite recognising it as love even with the right person.
Love by its very nature is not a solitary experience unless you are talking about mysticism. Rather, human love, as the title of the 1955 William Holden movie said, is ‘a many splendored thing’. Quite simply, the experience of love is dependent on our ability to engage at a very fundamental level with another human being. And, as a result, the experience of love is not the same for everyone.
For some it is salvation and the springboard to a wonderfully, happy and fulfilled life. For others, it is the precursor of misery and domination. Still others seem only to recognise it when it has left their lives completely and the most famous example of this is Shakespeare’s Hamlet. It is only after his true love Ophelia is dead that he can truly understand what it is he has lost.
I suppose I came to this topic because a number of people have been talking to me recently about love in one aspect or another. It occurred to me how varied people’s experiences of this one human emotion can be.
The first person described a magnificent love for another person in which they were transfixed, obsessed, helpless. And yet the other person did nothing but abuse this love, ending the relationship cruelly and creating emotional turmoil all along the way.
The second person left their partner because they were ‘bored’ and had a series of affairs afterwards, none of which seemed to satisfy their requirements. Yet when the original partner found someone new, suddenly this was the one true love that had been lost.
The third person fell madly in love with someone despite a history of previous relationships in which they never lost emotional control. Being in love was a new and wonderful thing for them until it ended when the love partner broke it off leaving the person who had been used to so much emotional control both devastated and disorientated.
The last person fell in love with the right person, a kind, considerate, caring partner, but they brought the relationship to an abrupt end with incessant demands for attention, for proclamations of undying love and for continuous reassurances.
We assume when we talk about love and about the search for it, that we are talking as if love is out there, simply waiting, and that when we find it we will be enveloped in its healing arms.
But clinical experience shows that this is far from the case. The reality is that love is not guaranteed. There is nothing written anywhere that says everyone will find love. At the same conference I mentioned above, one of the speakers made the comment that ‘Love is not contingent in any relationship, it may happen or it may not’.
If you look up the dictionary on the word contingent you will find it means: likely but not certain to happen. There is a second meaning of the word though, and it is, ‘dependent on or conditioned by something else as in ‘payment is contingent on fulfillment of certain conditions.
Now, in the realm of love just what these conditions are is difficult to define. But one of them is the ability I mentioned earlier to engage at a fundamental level with another human being. This condition in turn requires us to be able to trust another person, be relaxed in their presence, be confident enough to convey an essential part of who we are to them, to understand if our love is being reciprocated, and to intuit whether we are engaging with someone who is capable of loving and being loved.
This, along with the flood of positive emotions that we associate with the experience, is what allows us to recognise love when we find it. But it is not as simple as it sounds. Some recognise love only when it is an obsession with the wrong person. Others do not see love when the right person is standing in front of them. Some look all their lives and never find it because a 'better' love is just around the corner. Others bring a destructiveness because, paradoxically, they fear the relationship ending.
There is no end to the range of human responses to love. Its very power emanates from the unpredictability of its effects.
The game of love is the most unpredictable of them all. But we can test what we are experiencing by asking a very simple question. Is it enriching me or is it impoverishing me? If we can give ourselves an honest answer to this question, bearing in mind that love moves us out of the realm of logic, then we have created an important foundation to understand the kind of love we are experiencing.

Friday, July 17, 2009

Letting the Ideas Flow Naturally

By Kevin Murphy, M.Sc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.

A client stopped in mid-sentence recently to apologise for hopping and jumping from one topic to the next. I replied that there was nothing wrong with doing that, the best way of speaking in therapy is by allowing the free association of ideas to carry on unhindered.
The client had worried that the ideas had not been following a logical track towards an overwhelmingly sensible point. It seemed haphazard, offbeat, random whereas instead they had wanted their speaking to be logical, sensible and of practical value.
Two things were of interest in this situation. Firstly, this client had come to therapy because their life had become unworkable as a result of a compulsion that would not go away. It had no obvious cause and no obvious solution.
The second thing was this client had begun the session by reporting that since beginning therapy this compulsion had not been as much in evidence in their life.
Where is all this going?
The fact is that we love logic and sense and science and things to follow an order. The reality for most of us, however, is that our inner lives and often our outer lives don’t follow any such pattern, no matter how much we’d like them too. Impulsivity, contradiction, illogical forces, imaginary considerations and gut feelings that defy verbalisation are just as much a part of what we do and who we are, as are their rational cousins.
We are nuanced, if that’s the right word, between a logical, observable world and an almost illogical, invisible one. The business of psychoanalytic psychotherapy, at least in one of its aspects, is to form a bridge between these two registers. And often the work of building that bridge comprises simply acknowledging that these two diametrically opposed registers exist in the first instance and also that they are intrinsically linked.
Once we have that, we can then move on to the notion that the two registers are asymmetrical in terms of their scale and influence over our lives. By this I mean that there is not an equal dividing line between them. Rather the separation is pretty much 90-10 in terms of the invisible side of things.
As you may have gathered, I am talking about the unconscious mind, the hidden, invisible part of our mental life that we never see directly and that we can only know when it ‘erupts’ in our slips of the tongue, in our dreams, in our jokes and so on. In short, a form of personal truth slips out usually when we are looking the other way.
The unconscious was Freud’s discovery, and it was a point in history after which all subsequent understanding about the human psyche was never the same again. In terms of impact it has been compared to the discovery of 15th century Polish mathematician Nicolaus Copernicus who discovered that the Sun was the centre of our universe rather than the Earth, as had previously been believed. In both cases, a much larger force was now discovered as being the driving force behind a fundamental part of our existence while the role of the original centre of activity was relegated to a more dependant role.
I mention this preamble on the unconscious because in so much of our lives we encounter examples of human experience that are not explainable by logic or science or medicine. In fact, the medical profession has its own term, Medically Unexplained Symptoms (MUS), to cater for this very thing.
Anyone who heard Paddy Doyle, author of The God Squad, speak on Liveline on RTE 1 this week, will have got a glimpse of this. He is a sufferer of from chronic dystonia, a neurological movement disorder characterised by involuntary muscle contractions which force certain parts of the body into abnormal, sometimes painful, movements or postures. If it is not caused by hereditary factors or brain injury – both absent in Paddy Doyle’s case - there is no clear medical understanding as to how it occurs.
Paddy Doyle himself quoted a psychiatrist he went to who said that the profound bodily movements he has displayed since around 10 years of age may be a replication of the bodily movements of his father dying from hanging, a scene he witnessed as a very young boy. The implication being that the trauma of the experience was written into the very contours of, and continues to re-enact itself repeatedly in, his body.
My client above faltered momentarily because of a belief that speaking in therapy should follow a sound logical path. There is a logic to the unconscious but it is not the same logic as we know in the observable, rational world. Psychoanalytic psychotherapy uses free association, the free, unfettered flow of ideas, as a tool with which to catch occasional glimpses of the vast and cavernous part of our inner lives that prefers to remain hidden. So in this context, veering off the path of the sensible and the logical is to be welcomed.

Friday, July 10, 2009

Getting Past the Trust Barrier

By Kevin Murphy M.Sc.,
Psychoanalytic Psychotherapist
Dublin, Ireland

For anyone who has difficulty finding trust in relationships, therapy must offer a daunting prospect. What, after all, is being proposed by the conditions of therapy? Well, the first requirement is that very thing, trust.
It is a professional relationship we are speaking about but in the same way that you have to trust your doctor or your dentist, the same kind of principle has to apply with your therapist. Except with one important difference.
The treatment that your doctor or your dentist offers you is not dependant on regular weekly or even twice weekly visits that build gradually into an in-depth knowledge of your inner life. No other professional is expected to go where a psychoanalytic psychotherapist is expected to go.
In short, no other relationship is quite like it. Jacques Lacan, the leading French psychoanalyst once said that the analyst 'pays with his/her being' and this is pretty much what he had in mind.
Therefore, and this might seem an obvious thing, the ease or ability or facility with which a person enters into and sustains a relationship, albeit a strictly professional one, is among the conditions required for a successful treatment.
Put it another way, someone who finds that their life experiences have led them to distrust the motives of others, to distrust the knowledge of psychoanalysis (or any other therapy for that matter), to distrust themselves or anyone else as capable of conducting fruitful, curative relationships, then they will have difficulty making a talking therapy work. Because it is not just a talking therapy; it is a relationship.
You can often find that some people are eager to make it work at first but they simply cannot get over their sense of mistrust. This can manifest itself as boredom, loss of belief in the process, dislike of the therapist, or a myriad of reasons ranging from not having the time to not having the money to not having the interest. But it is not a complete loss. Once a person has come for a few sessions, a process has been set in motion that continues for a very long time afterwards.

Be that as it may, this aversion to forming a relationship because of an inability to trust can also manifest itself in other ways. For those who find relationships difficult or troublesome, there are two aspects that represent a real risk.
The first is that the relationship will impose some form of dependency on the person seeking therapy. This is an interesting one because it leads some people to opt out of going to therapy because they believe, rightly or wrongly, that they will become dependant on it, or more importantly on the person of the therapist.
In a nutshell, they are denying themselves access to the kind of help provided by a trained other on the basis that they believe they might not be able to function without the continuous help of that trained other. It can be a difficult fear to assuage. Yet modern psychoanalytic psychotherapy has one goal; to allow the person stand on their own two feet, so to speak.
The second aspect is that, like all relationships, even the therapeutic professional relationship will come to an end. The end of a relationship (as opposed to the ‘end of analysis’ which is something both Freud and Lacan wrote extensively about) involves a separation. And while for very many people, it can represent a healthy 'leaving' to carry on with their own lives in a more positive and healthy frame of mind, for others it is not so.
They imagine, as they begin therapy, that this is something that will come to an end, that will involve separation (something that has deep roots for all of us) and that this separation will inevitably be painful and distressing.
This is a form of thinking that emanates from an imaginary position in which the person assumes reality will turn out just like it. And, paradoxically, it is the very thinking that the person opting for therapy is seeking to change. Unfortunately, it sometimes doesn't get that far and can just as easily divert them in a completely different direction away from therapy.
Psychoanalytic psychotherapy is founded on a relationship between two people, a professional relationship with very clear boundaries, but a relationship nonetheless. When it succeeds, it does so because it operates using the very tools that each and every one of us has been exposed to since birth. The human relationship is the fundamental soil out of which we all grow. The therapeutic setting is as much to do with recreating the conditions for growth as it is about anything else.