Tuesday, December 20, 2011

Life and Death in Ireland

By Kevin Murphy MSc,
Psychoanalytic Psychotherapist,
Dublin, Ireland.

There’s been a great deal in the media recently about suicide and depression. In terms of the former, we have an alarmingly high incidence compared to our European partners. And the latter seems to be universally accepted as the root cause of the situation. Depression and suicide; they sit oddly with our reputation, and indeed our perception of ourselves, as a happy-go-lucky country that likes a drink and a laugh. So which are we: the country with an alarmingly high rate of suicide or the happy nation?
I ask that question not to confuse but to tease out something that has been a striking feature of some suicides according to reports in the mainstream media. Again and again you read the testimony of the people close to those who died in which they say that there was no sign that anything was wrong. They may even have been speaking to the person only hours before their final act and everything seemed ok. It is, on the face of it, an unnerving and puzzling aspect. What, if anything, are we to understand from it?
Well, let’s work our way back from the unavoidable fact of successful suicide. It begins with the painful truth that someone ends their own life. We can reasonably assume that this is not an easy thing to do. We can also reasonably assume that in order to do it one has to be consumed with a weight of negativity that is directed purely and solely towards oneself. Yes, there are cases where revenge against others can be a strong element but there is no getting away from the fact that the final act of ending life is directed against one’s own being, against the self. And when you further consider how instinctual it is to avoid danger and stay alive, we must also include a strong motivation to do it as being a key feature.
If we take these ideas and go back to my first point, then we have a picture of two contrary realities being lived out. One is an outward facing display of everything being alright, not giving a hint of any intention to end one’s life. And the other is an inner lived experience, and presumably a lonely one at that, characterised by a growing negativity towards oneself that will eventually end in death by one’s own hand. As an aside, it is interesting how this double positioning at the level of the individual matches a similar duality in terms of how we present as a nation: happy out but with a seemingly dark inner core. So why, in the case of those individuals who succeed in ending their own lives, is there no bridge between these two realities? Why does the inner come eventually to dominate and put an end to the outer? And why is there no route that might let human support, comfort and healing have a chance at creating some positive and far less drastic outcomes?
You don’t need a university degree in psychotherapy to understand that two realities being lived at the same time represent an enormous strain on any individual. It is a conflict, pure and simple. And this is happening at a time when there is great work being done to bring about awareness of depression and of the harsh reality of suicide for those left behind. There are free helplines, doctors, counsellors, psychiatrists, psychologists, psychotherapists, self help groups, as well as public campaigns and media debate of these issues. It seems there is one other feature we have to add to our picture so far. The people who give no hint of their anguish and who succeed in ending their own lives do not appear to reach out for these options.
What is it about depression, particularly depression that gets intolerably bad, that makes this action impossible for some? Is it simply the stigma of having it? We certainly have heard a lot about that in recent times. Is the admission that speaking about depression requires a step too far? It would certainly seem to be the case. The choice of constantly pretending that everything is fine is the choice that eventually leads to death for some. It gives us some idea of the grip this idea can have. The choice not to speak, to portray an acceptable, presentable face to the outside world, is so important in some people’s minds that it, in effect, accompanies them to the grave. What are we to make of that?
The person with suicidal depression is a person deep in sadness yet also deep in fear. This fear is twofold: firstly the depth of their depression must never be discovered by anyone else and, secondly, as a result it can never be fully accepted by the individual themselves. The sadness, on the other hand, is seen as a form of un-shiftable truth that cannot be undone, by anyone. It is a profound fatalism, if you like. They wonder how could it be fixed when it’s a problem of the mind and probably the very soul. ‘Who is qualified or able to get inside my mind and fix it? No one can do that. My situation will continue for as long as I can bear it.’ And that’s ultimately what life becomes, an endurance until it cannot be endured anymore.
You often hear people use the bits of information they have picked up from scientific circles or from the internet, or both. Depression is a case of chemicals in the brain; ‘my chemicals are out of balance’. But if that’s the case couldn’t a discreet prescription from a doctor solve that? Using the same logic, a supply of pills, which are essentially chemicals, could reinstall the missing chemicals and the problem should be solved?
Equally, you will often hear people say ‘Oh it’s genetic, my grandfather had it, and my own father, so it’s no surprise I have it too. No one can fix something that is hereditary.’ Here we see again how a seemingly reasonable explanation of an ailment, always a reassuring thing, can bring with it a hopeless fatalism at the same time. If something is in the DNA, that’s nice to know but it also implies it can’t be fixed. And in this way the depressive cycle is re-energised once again. If you are prone to profound sadness then this approach is guaranteed to get you there fast.

What we don’t hear said often enough is that growing up with people who have a sadness within them, and even the jolliest of people do, can make you sad as well. Outwardly it’s going to look exactly the same as a hereditary issue or a chemical imbalance, but in reality it’s not. Nor is it permanent.
A psychoanalytic understanding of how this profound sadness takes root is that it is based on an unshakeable sense of loss. Something has been lost to the person, something they can’t put their finger on or name or describe. The person suffering is conscious only of a profound loss at the very centre of their being.
Freud in a famous paper, written in 1915 and published two years later, compared melancholia (profound and potentially harmful sadness) with mourning, the first time anyone had done so, and argued convincingly that in mourning the person knows who has been lost to them but in melancholia, which is similar to a grieving process, they are unaware of what is lost. They are unaware usually because it happens at such an early age or because it has been worked on by our powers of repression. In his paper Freud makes a number of interesting points, essentially insights he gained from his clinical work, which are just as relevant today. But before I mention these let us consider seven important assumptions that are needed to make it easier to understand what he is saying. Firstly, and most obviously, we invest emotionally in those we love. This means part of us goes into our relationships and we suffer real pain when they are ended. Secondly, we identify, become ‘like’ the people we love. The verb ‘Identify’ comes from the Latin ‘to be the same as’. Thirdly, these connections can be sometimes broken and easily so. Fourthly, when we ‘lose’ a connection with someone as an object of our love, there is a painful internal surge of emotional energy as we pull back into ourselves and retreat from outer reality to our inner reality. Fifth, our human life is full of moments of loss – from birth, through weaning, through puberty, through broken or unhealthy relationships, through bereavement and so on – and to lessen the impact on us we incorporate into ourselves something of the lost object of our love. Sixth, this loss can happen for real or imagined reasons at any age of our life. Seven, we can start to quietly attack ourselves for being responsible for this painful loss.
So, what Freud pointed out was that in severe depression very often we don’t know what or who has been lost to us. But even if we know who has been lost to us, we are not sure exactly ‘what’ we have lost in losing them as love objects. Think of the number of people with complex or troubled relationships with family members or loved ones, for example, and how their thinking remains fixed on trying to solve it. We lose interest in reality around us because we are completely absorbed in trying to figure out this puzzle.
Unlike actual mourning, the person suffering profound sadness has an extra characteristic – ‘an extraordinary’ reduction in their confidence, self regard, self belief and self respect. When we mourn the loss of a loved one, the world becomes a ‘poor and empty’ place. When we are in profound depression, it is we ourselves who become ‘poor and empty’, no matter what outward trappings we have acquired. The person sees themselves as worthless, morally despicable and expects to be punished. In believing that a love object has been lost to them, a transformation has taken place whereby the person becomes something of the thing that was lost and becomes, in turn, the target for their own anger and negativity. The picture Freud paints of this kind of sadness is completed, he says, by a capacity for life threatening behaviour or, as he puts it, by ‘an overcoming of the instinct which compels every living thing to cling to life’. (Freud, S., Mourning and Melancholia, 1915, Standard Edition, Vol XIV, p.246.)
When all else has failed we try to return to the place where we began as infants, to a self-sufficient inner world that promises comfort. But in contrast to our first experience of it as infants, this time something of the disappointments we have encountered in reality return with us. Now it is not a nirvana but a more claustrophobic internal life plagued by guilt and condemnation and a puzzling sense of loss. It is interesting in Freud’s paper how he says this profound and potentially harmful sadness can arise not only as a result of real events but also from all those situations where we might feel slighted or neglected or disappointed. (p.251) Put another way, in profound depression the loss can be based on something real or imagined.
At an age before we even realise it, we build up a sense of ourselves through our interaction with others. This gives us an internal anchoring point, if you will. This is our ego ideal, the sense we carry within ourselves of who we believe we are and can be, not only in relation to significant others in our lives but also in the larger context of the world we live in. Whether there is trauma or not, but greater damage is done if there is trauma, it is astonishingly easy for us to pick up the message, ‘I have lost something important and so I will never be good enough to fix the sadness and unhappiness in me or others’. This simple message is very hard to shift once it becomes part of our self-belief system. It then becomes the template for all our other relationships, which is why people with profound depression get so little from their relationships and why, ultimately, their key relationships are not enough to help them fight the urge to end their own lives.
Because the person has difficulty forming a positive image of who they are, the business of engaging with others becomes problematic and consistently unsatisfying. It’s not about vanity either, more about survival. A positive ideal about ourselves is the thing that sustains us through difficult times. This ideal is created not in isolation but in the interplay with those around us whom we have loved, who have loved us and with whom we have been able to identify strongly and positively.

In the absence of indentifications with people like this – not unreachable idols but ordinary people subject to the ordinary imperfections of being human – those prone to severe depression substitute in a different kind of ideal, one without flaws that is based on perfection or infallibility. This is the dangerous one because a) it is impossible to attain and b) every failure in attaining it brings self punishment. The end result is a person for whom sadness and the unattainability of certain standards become central components in their lives, along with ever increasing self-punishment. How often do we hear of successful people die by suicide? It would seem that no amount of success can ward off the self punishment. In fact the person who dies by suicide is essentially carrying out the final act of punishment on themselves after a life, however long or short, of consistent internal punishment that they mistakenly believed they deserved.
These are weighty issues that do not often get an airing in public discourse. There is no easy cure and there is no quick cure. Medication can help and so too can psychotherapy. But psychotherapy requires people not just to talk but to give themselves permission to engage in a relationship, albeit a professional one. This second part is often the trickiest bit of the operation. Profound depression tells the sufferer that they are never going to re-find what they have lost and that they don’t deserve to re-find it. The need for another person in this context, especially a trained other, can often be seen as a further example of their own imperfection. Some prefer to remain suffering rather than see themselves in that light. But that is the very place where all humanity resides, in imperfection, in the potential to make mistakes and very often fall short of ideals. If someone suffering from profound depression can manage to allow themselves a leap of faith, to believe that going back through the route of a connection with another human being – the place where it all started – might help them re-find something of what was lost, then there is real hope that something positive can be achieved.

Tuesday, April 19, 2011

The Unconscious in Our Everyday Lives

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

You’ll often hear people say that talking about things makes no difference, that it has nothing to do with real life, with the real world. Leaving aside how curious that sounds to a therapy practitioner, the comment is worth examining. What people are really saying is that therapy can have no relevance for them in their daily lives. How can it? How can an activity that takes place in a private consulting room, for one hour a week, have relevance for someone’s life? How can talking about oneself to a total stranger make any difference whatsoever?
I was reminded of this question when I visited the London Science Museum recently. It had an exhibition called ‘Psychoanalysis – the unconscious in everyday life’. The very point of this exhibition, in among all the other exhibitions on medical science, space flight and so on, was that psychoanalysis is about the everyday. It is about the small things that go to make up a life. The minor details, the trivial occurrence, the forgotten name, the misplaced phone, the favourite toy, the strange look that someone gave you, the half-glimpsed wishes that surface in day dreams and in night dreams. These are the often overlooked building blocks on which a life is built. They are also the external representatives of inner drives that we never get to see otherwise.
And that’s why talking to someone in a private consulting room has relevance to the outside world, to the everyday reality that we occupy. Because talking about the small details, the overlooked and often forgotten stuff, is the place where we find something of our true selves. The big choices, where to live, what to work at, who to marry, are all very important too. But when we ignore the smaller details, we are discarding a great deal of richness. Or put another way, if life is a great tapestry then we are ignoring the fine needle work that goes into it.
The Psychoanalysis exhibition in London, now unfortunately finished I might add, was divided into a number of sections: Play, Neuroscience, Wish-Fulfillment, The Everyday and The Uncanny. The Play section was an exhibition of how psychoanalysis is used to work with children. It looked at the work of famous child analysts Donald Winnicott and Melanie Klein both of whom drew their ideas from the work of the founder of psychoanalsysis Sigmund Freud and applied them to the area of children.
The section on Neuroscience showed the increasingly ‘fertile’ collaboration between this scientific field and psychoanalysis in recent years. The most active part of neuroscience today is the focus on explaining non-conscious thought processes to explain emotional experiences. In Wish-Fulfillment they showed ancient Roman offerings to the gods that helped them achieve their wishes for good fortune, good health and so on. The point was being made that people today engage in similar activities regarding wishes and dreams even if they do so in different ways. In fact, one of the main areas of focus of contemporary psychoanalysis is on trying to identify what exactly is the wish, the true wish, of the person who comes for therapy.
There was also a Cabinet of the Everyday which had ordinary objects that we use – cars, fashion, kitchen utensils – each of which has the power to become emotionally endowed through our unconscious projections onto them. These items all have a practical use but psychoanalysis is interested in the symbolic and unconscious meanings that are part of them also.
The last section was The Uncanny which was a concept Freud used to describe how we can often feel deeply disorientated even when we are in familiar surroundings. In fact, Uncanny in German, as Freud used it , means Unheimlich which is literally translated as ‘unhomely’. We are usually in vaguely familiar surroundings when this feeling hits us. Our perceptions of the world around us become destabilised, something knocks us off our usual perch and everything begins to seem unreal.
As well as these sections in the exhibition there were numerous works of art, two of which were specially commissioned, and the others which were done by artists inspired in one way or another by psychoanalysis. It was an interesting tie-up of art and psychoanalysis because not only has the latter been used to interpret human behaviour but it has also been traditionally used to interpret literature and the arts. In short, it has been used to interpret nearly every human activity that we find in our everyday lives because it is a therapy of the everyday.

Thursday, February 17, 2011

Time To Switch Off For A While

By Kevin Murphy MSc.,
Psychoanalytic Psychotherapist,
Dublin, Ireland.

In my most recent blog* I was writing about what to expect in therapy and what to talk about. In the course of it I happened to mention how difficult the act of talking and speaking can be. Speaking sounds like a simple thing to do, but sometimes it is far from it. I went on to mention how, because the act of speaking can be difficult, it brings with it built-in resistances and some people will go to great lengths to avoid it. And I mentioned how we can see this going on all around us all the time, not just in terms of therapy. The most popular advances in human communication over the past decade have offered us new ways to avoid speaking. Texting and internet social sites were two new media I singled out, but you could also add Twitter and computer games and so on. It all adds up to the same thing: the reduction in actual speaking face to face between human beings.
Imagine my surprise then when I spotted an article in a Sunday newspaper recently*, entitled ‘Too Wired to Talk Like a Human’. It was about US technology guru Sherry Turkle’s new book on how technology shapes our lives. This is her third book but it is arguably bleaker, less gung-ho and less technology supportive than her first two. The new book is entitled ‘Alone Together: Why We Expect More from Technology and Less from Each Other.
Turkle, a professor of social studies and science at the prestigious Massachusetts Institute of Technology (MIT), got the idea at a dinner party of friends when the guests fell momentarily silent. It was her Pauline moment when she realised that the people around her were texting, flitting in and out of the ‘now’, so to speak, with dreamy smiles on their faces.
According to the Sunday Times article Turkle is worried that massive numbers of people are surrendering to internet compulsions that may be hollowing them out and leaving them more jittery and insecure than any previous generation. Strong stuff, indeed.
The real danger, she says, is 24 hour immersion in this techno-world because thanks to innovations in broadband, it is always on, never off. We are no longer drinking, to use the term of the article’s author, from the waters of intimacy but are engaged in a tsunami of violently loud web chatter.
Turkle is quoted as saying: “Thirty years ago I envisaged this technology as playful, something we would turn on at the end of the day, but now there is no escape. It owns us.”
She is particularly non-plussed by Facebook founder Mark Zuckerberg’s famous comment that privacy is dead. This means that every teenage indiscretion, and indeed every adult one too, lives on forever in cyber space. There might well be ‘forgiving’ but, it appears, there won’t be any ‘forgetting’.
She also fears we are putting our faith in false gods such as techo-toys and the uncertain nature of friendship on social networks. “We are investing in these relationships because they offer more instant gratification than friendships in the ‘real’ which take time and generosity,” she said.
But she isn’t calling for radical measures. She likes Skype and the way it connects people across the world. She does, however, fear that many will end up friendless and isolated, vulnerable to mental illnesses such as compulsions, obsessions and phobias. Her solution? We need to switch off the phone or the computer and hear the silence every now and then. And we need to do it in a way that we believe in. Then we can begin to think about communicating and connecting again in the real world, with real people.
“Right now we are too busy communicating to think, to create and truly connect. It is about finding a new balance,” she said.

• Tuesday, January 11, 2011, ‘The Only Way Out Is In’.
• The Sunday Times, January 30, 2011., News Review Section, p.6.

Tuesday, January 11, 2011

The Only Way Out Is In

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

It’s that time of year when new resolutions are decided on. For many people the idea to enter therapy, an idea that might have been on their minds for a long time, will finally become a reality. It is a big step, and it is one that should not be taken lightly. Be prepared to commit to however long it takes to reach your objectives. Don’t let anyone tell you that therapy is short or that its objectives can be achieved easily. It is work, and sometimes difficult work, depending on the nature of the issues.
What is that old saying about a free lunch? There’s no such thing. You’ll hear the same sentiment bandied about in other terms – no pain, no gain, or that other old saying ‘nothing worthwhile comes easily’. Yes there is always the allure of things magically falling into place with the minimum of effort. And there are plently of people out there willing to promote that message. But things that are truly beneficial are usually the product of focus and determination and time. So when it comes to choosing which you want, another old hackneyed saying comes to mind: ‘you pays your money and takes your choice’.
Of more concern, however, is the question people have about what they should do once they begin therapy. It seems a curious question when you consider how familiar people are with the process of therapy now. So many movies and so many books include examples of what therapy is and what it does. Yet many people ask the same question. What should I do? What should I talk about?
The question, when you think about it, is a demand for an answer to something very obvious. In therapy you talk. And it is a demand for someone else, in this case the therapist, to put words on something they already know themselves. The answer is as simple as it is profound: speak. Speak about all the things you want to speak about. And speak about all the things you don’t want to speak about. The only way out is to put our experiences into words. The act of doing so brings out new meanings about them, dispels old fears, reduces their emotional effect on us and brings greater understanding and acceptance.
Yet speaking out who we are and what we have experienced, simple as it sounds, is not easy. The act of speaking brings with it built-in resistances and people will go to great lengths to avoid it. You can see this going on all around us all the time, not just in terms of therapy. Look at the most popular advances in human communication over the past decade and notice how they have offered us new ways to avoid speaking. Texting has allowed us avoid speaking. Internet social sites have allowed us avoid speaking. You can also see signs of this trend in the large number of changes within society and communities generally and you can trace the same trend; the reduction in actual speaking. And yet, this is the very reason why people end up needing therapy. Therapy is not a ‘cure’ for the absence of parents or friends or priests or neighbours or success or good looks or good fortune. It is a cure for not speaking. When we don’t put ourselves into language and define ourselves by speaking, the quintessential act that designates us as human beings, we run the risk of ceasing to fully exist. Equally, when we put ourselves into therapy by asking the therapist to do all the talking for us (What do I do? What do I talk about?) then we are also avoiding speaking and so it becomes a form of therapy owned by the therapist, not the client.
There is no way of avoiding the obvious. Therapy is about speaking. And often it requires us to speak about the very things we would rather not speak about, things that portray us in a way that we would rather not know about. As such, as French psychoanalyst and teacher Jacques Lacan once said of his own challenging theories, the only way out is in.
Perhaps it might be useful to hear what the man who discovered this simple technique has to say on the subject. Sigmund Freud discovered the talking cure back in the mid-1890s. Well, actually his colleague Josef Breuer did when he was working with a patient he disguised with the name Anna O. Anna was being treated with hypnosis for an array of physical and hallucinatory symptoms when she suggested (not the therapist) that it would be better if she was allowed simply talk about the things she was experiencing. And so began psychoanalysis. What Freud did was take this powerful innovation and then offer a technique called free association which allowed the person follow the chain of their speaking wherever it might lead.
This form of treatment is remarkably free of rules. In fact there is only one and it is called 'the fundamental rule'. It states that we, as clients, must speak about whatever comes to mind without criticizing it. That last part is worth repeating: without criticizing it. This is intended to allow us overcome the natural resistances to choosing what it is we will and will not say. As the same time it requires us take an objective stance to our own ideas and thoughts by not criticizing them. As a matter of course, we tend to pick what we think are the most important things and exclude what we think are trivial ideas or notions that portray us in a bad light. Paying money to go for therapy is wasted if we do not follow this fundamental rule. It sounds simple but it can also be challenging. You must never give in to self criticism, as Freud says, and must say the things you object to saying precisely 'because' you don’t want to. (Freud, p.135.)* Nothing must be left out just because it is unpleasant. That is probably what makes psychoanalysis one of the most challenging, innovative and powerful therapeutic treatments available.
In terms of where to begin, Freud said that the client begins the session by starting wherever they want to. The therapist does not begin the session, the client does. This is to ensure that it begins on something the client wants to talk about, not the therapist. If I as therapist say, ‘Tell me about…’ I have immediately prejudiced the course of the session by making it go in the direction that I desire. That is not the way of analytic therapy.
Freud also said that the place where the client begins speaking in each session is irrelevant. Curious as it might seem the thing that you, the client, choose to start speaking about does not matter. It can be anywhere, about anything. The important thing is to simply start speaking, again with the fundamental rule in mind, speaking about the first thing that comes to mind without criticizing it. The place you start might not be earth shattering in itself, it usually never is, but it is where it leads to that is important. Inevitably it leads to ideas that are central to the speaker’s life.
Now the other interesting thing about analytic therapy is this. It is different to an ordinary conversation. In fact, it is not an ordinary conversation. Some people like to say they have come for a chat but it is never a chat in the ordinary sense of the word. Usually, with a chat, we keep a connecting thread running through our remarks and we keep side issues that are not relevant out of the way. (Freud, p.134.)* But these side issues are just as important so speak them out in the same spirit as saying whatever comes to mind. As Freud put it, act as if you are in a train that is travelling through the countryside and you are describing everything you see to someone in the carriage with you.
Another feature of this therapy is that a systematic narrative with a sensible beginning, middle and end is neither encouraged nor expected. Often you will hear people say, 'I've been wandering all over the place' as if it was some sort of flaw. In this therapy it is not a flaw, it is actually the process being properly carried out. Equally, similar details are often repeated at later times but with a fresh twist. In this form of treatment, there is no question of talking about the same things over and over. Even if issues get repeated, they are being changed slightly in the repetition so that new meanings are attaching to them all the time.
And finally, what else is the fundamental rule asking of all of us when it requires us to say whatever comes to mind? It is asking us to be honest. And it is asking us to be honest not with the therapist but with ourselves. You will often find some people asking how can talking about oneself change anything? There are two answers to that question: the first is, it can change pretty much anything you want it to change, if you are honest in your approach to the treatment. Secondly, the act of asking that question is usually a diversionary tactic to avoid speaking. The requirement to say everything that comes to mind, and to do so as honestly as possible, is not an easy one. Some people, but not all, will do everything they can to avoid it. Even though it is an incredibly simple requirement, in practice it very clearly marks the difference between those who benefit from this form of therapy and those who don’t.
• Freud, S., (1913) Standard Edition, Vol 12.