Snap out of it!! How Depression gets Misunderstood.

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‘It Hit Me’ Claudia Unsplash.

I felt a Funeral, in my Brain
I felt a Funeral, in my Brain,
And Mourners to and fro
Kept treading – treading – till it seemed
That Sense was breaking through –
And when they all were seated,
A Service, like a Drum –
Kept beating – beating – till I thought
My mind was going numb –

 

(Extract of poem by Emily Dickinson)

 

The whole of this poem above was recited during a brilliant Ted Talk on depression by the writer and Professor of Psychology, Andrew Solomon. Do watch this; it is both personal and professional and highly informative.

2015 PEN World Voices Festival of International Literature: On Africa © Beowulf Sheehan/PEN American Center

Andrew Solomon (Wikimedia Commons)

‘Anxiety is ‘being afraid all the time but not even knowing what you’re afraid of.’

‘The opposite of depression is not happiness, but vitality.’

(Solomons.)

What Some People Say……..

Often, people with depression say that others around them do not recognise their symptoms and feelings as indications of a ‘real’ illness. By ‘real,’ they often mean physical.

Physical illness might appear more tangible; there may be a rash, a temperature, a visible lesion or wound. People may develop physical symptoms (somatisation) if their depression is not recognised or if they cannot allow the depression to become known, even to themselves.

In his powerful, complex and highly analytical book, ‘Conversion Disorder’, Webster regards such bodily symptoms as a way of ‘not wanting to know.’ His role as analyst is to respond to this, somehow. Not by knowing, but by containing and processing:

‘I prefer to think of my vocation as a psychoanalyst as a quiet liturgy to the power of the symptom, to this intimate world where very little information can be given, even when there is so much to say. Inside this multitude, I see one of the greatest intimacies on offer- one I know daily in the demand turned upon me  by a patient who needs me to know something. Needs me to. With urgency. With great shame, I return this demand to them, even if I supply a placeholder, a stopgap, given to ease the anxiety that hurtles through their flesh….’

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Somatic symptoms can be just as painful  as any other illness. Again, such symptoms may be easily dismissed, seen as ‘imagined,’ rather than as real and genuinely distressing indicators of inner mental pain. If we find a sensitive doctor or therapist, such symptoms should be recognised as the body giving vital clues to psychological ills.

The ‘wounds’ of depression are visible in the depressed person’s weepiness, inactivity, frozen expression or general misery; however these may be downplayed or ignored by others around.

Thus there have developed the expressions snap out of it, pull yourself together, stop being so miserable, you have everything to be happy about.

Many people find depression in others difficult to cope with and they may react impatiently and unsympathetically. Perhaps witnessing depression in another person unconsciously stirs something hidden or repressed inside themselves.

Such unempathic comments will pile guilt on top of the depression. The depression may then be masked.

Masks….

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The term ‘smiling depressive ‘ may refer to someone who is reacting to what they perceive as society’s lack of understanding, or to their own shame; the smile is a cover- up. The depressed person may appear happy and functional in daily life, but the smile hides desperation.

The smiling depressive may feel that their symptoms are weak, that ‘no-one loves a moaner’ and that talking about it will upset others. They may feel that no-one will understand or be able to cope anyway.  So they smile and say ‘I’m fine.’

What are some of the terms popularly used to describe depression?

We hear them often, the expressions used to describe this excruciating illness:

Blues, black dog, black cloud, low, down in the dumps, slough of despond, the doldrums,

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Image:Creative Commons Zero – CCO.

How have sufferers described their Illness?

Clinical depression is a serious and debilitating illness. It is more than feeling sad. The depressed person cannot ‘pull themselves together.’ If they could, they surely would. Do not underestimate how despairing a depressed person might feel.

Those who suffer it have described themselves as ‘Floating helplessly in the middle of a vessel , groping for the sides,’ ‘In a dark tunnel, with no light at the end of it,’ ‘Trapped,’ ‘In a dead end,’ ‘Utterly hopeless,’ ‘Paralysed, static, unable to move or do anything,’ ‘Desperate, isolated and unable to ask for help,’ ‘As if I’m nobody, rubbish, stupid,’ ‘Not interested in anything .’

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Image:Creative Commons Zero – CCO.

Symptoms

There are several different kinds of depression and  it has many symptoms, which might last for any months or perhaps years. Often a depressed person may appear antisocial, cancelling social dates, unable to get up to go to work in the morning, or to get dressed, washed etc. Such is the feeling of utter inactivity, numbness, lack of energy and helplessness.

There may be irritability, low self-esteem, feelings of guilt and shame. Sometimes, people experience low libido, bodily aches and pains, loss of appetite (or perhaps the opposite), inability to think or concentrate, early waking. They might feel the need for more cigarettes, drugs or alcohol in an attempt to numb the pain.

Other symptoms can be sleep difficulties, ruminative and dark and suicidal thoughts, self harm, loss of interest and a lack of motivation. Often there is much anxiety and a sense of impending doom.

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Andrew Solomon said ‘we know depression through metaphor.’ This is an important statement.

Art is a way of expressing such feelings, through metaphor and symbol. Artists like Rothko, Pollock, Van Gogh and Munch all experienced mental illness and various kinds of depression.

These states of mind were expressed through painting and I will end this post with a look at a the work of some of the greatest artists who were able to graphically express their depression in paint:

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Van Gogh. Sorrowing Old Man.

 

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Munch. Melancholy.

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Pollock. Greyed Rainbow. . (Image:Mark Mauno, Flickr.)

Next week’s post is about How Therapy May Help Your Depression.

If you have had depression and feel able to share something of your experience, do please comment below.

The Real Truth About Mindfulness

‘Many benefits and fruits of Zen practice are real, but they are not to be gained, nor pursued. Just sit, regularly, for a sustained period, and see what is here right now.’

Rosenbaum and Magid

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Mindfulness and Psychotherapy

Many psychotherapists find that mindfulness is of value in terms of their practice. There is a considerable evidence base that it can be an effective therapeutic tool. (Also see Baer, R. A.  and  The Lancet,)

Psychotherapists using mindfulness techniques help patients to understand, for example, that ‘thoughts are not facts’ (Christine Dunkley & Del Loewenthal) Self- awareness is vital, and such therapy can help people understand how they might be contributing to their own distress. For example, we might learn to accept the impermanence of life, instead of denying it:

“It is not impermanence that makes us suffer. What makes us suffer is wanting things to be permanent when they are not. We need to learn to appreciate the value of impermanence. If we are in good health and are aware of impermanence, we will take good care of ourselves. When we know that the person we love is impermanent, we will cherish our beloved all the more. Impermanence teaches us to respect and value every moment and all the precious things around us and inside of us. When we practice mindfulness of impermanence, we become fresher and more loving.” Thich Nhat Hanh

There are three main ways in which mindfulness is used in therapy: (Barker)

  •   Teaching mindfulness to clients
  •   Practising mindfulness themselves in order to cultivate therapeutic qualities
  •   Attempting to create a mindful encounter in therapy itself

The techniques of mindfulness are used in several different therapies. For example, Mindfulness-Based Cognitive Therapy blends mindfulness with Cognitive-Behavioural therapy.

Mindfulness Based Stress-Reduction Therapy, developed byDr Jon Kabat-Zinn, aims to help alleviate some of the anxieties of daily life.

It is often used in the treatment of chronic diseases, with some beneficial outcomes. It is frequently offered as a group therapy, focussing on such aspects as staying in the present moment and the importance of the individual taking regular time out for meditation.

Critique of Mindfulness 

‘The commodification of mindfulness and meditation is increasingly prevalent and problematic’ Rosenbaum and Magid

 

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Whilst there is no doubt that mindfulness can be helpful and therapeutic, it has limitations. It is not for everyone, and needs to be used professionally.

Whilst there is considerable value in using mindfulness to reduce stress and increase self-awareness, it must be emphasised that it is not a panacea for all ills.

‘There is a contemporary shift in its use and meaning, which actually distorts mindfulness, taking it far from the original Buddhist emphasis on ethics and consideration of others. The danger is that it will be diluted into a corporate, self-serving and over-secularised commodity.’ Rosenbaum and Magid

An increasing backlash against this popular trend is occurring, in that it is becoming fashionable and commercial. It is often promoted as a kind of designer cure-all, another ‘one size fits all’ solution to life’s ills. Another criticism is that it encourages a narcissistic focus on the self.

Thus, there are mindfulness colouring books, mindfulness apps and books like Mindfulness for Dummies, The Mindfulness Diet, Mindfulness for Dogs, Mindfulness is Better than Chocolate, Mindfulness on The Go, Mindful Birthing and so on.

‘…this new corporatised McMindfulness – which in the long term will do as much as a McDonald’s Happy Meal to sate a person’s gnawing hunger for a richer life.’

 Daily Telegraph

 

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Incredibly, a Chicago burger bar sells ‘a more mindful burger.’ Joiner.

I wonder how they might advertise this product? Your ideas are welcome in the comments box below. Please contribute whatever comes to mind!

Here’s my take on it:

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One American headline asks:

‘Does L.A.’s Absurd, Narcissistic, and Pricey Mindfulness Trend Have Its Benefits? 

In Los Angeles, mindfulness has become a hot commodity (Los Angeles Magazine)

The writer’s conclusion is that it does: ‘Bring on the chakra exorcism and $24 hemp smoothies,’  she adds, entranced by her experiences. One of these ‘experiences’ is lead by a woman ‘spending the full 15 minutes with a hand over her heart, head tilted dreamily to the side, whispering, “May I forgive myself” over and over again.’

There is criticism of mindfulness as a process that prevents thinking, that it can be used as an avoidance of considering difficult situations, merely by an unquestioning acceptance of them.

Although the NHS supports mindfulness, an Oxford academic claims it stops people thinking deeply:

‘I think mindfulness and meditation are bad for people, I absolutely think that. People should be thinking.’ ( Theodore Zeldin)

This misuse of the concept surely constitutes another form of mindlessness; there is  criticism that corporate organisations use mindfulness in order to stop employees thinking about problematic work issues. (Hackspirit.com)

In similar vein, some schools and universities have used mindfulness to reduce student stress. However, there has been criticism that, as in the corporate setting, such use masks institutional flaws by focussing the problem on the students’ mental health.(Harriet Swain)

Another criticism resides in the ‘infantilising’ nature of this approach, in that it implies that students are going to be troubled emotionally if they do not engage in mindfulness.

Of course, some children are troubled emotionally; at this present time, the evidence of this in terms of child suicides is painfully apparent.

Offering mindfulness exercises is not going to help such children:

Pooky Knightsmith, vice-chair of the Children and Young People’s Mental Health Coalition, said such exercises could be actively harmful for those who are particularly vulnerable or have a history of trauma.

“If a child is suffering abuse at home, being given space and time for thoughts to drift through your head isn’t necessarily good,” she said. “Schools need to be aware of the potential risks, even with the most seemingly nice of interventions.”

(Independent,2017)

Have you had experience of mindfulness? What do you think of it? DWill you let me know in the comment box below?

Metacognition and Mindfulness: Do You Know What You Don’t Know? Part 1

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Image: Denise Krebs: Metacognition, Flickr.

Contemporary Approaches to Metacognition

‘That which has been is what will be; that which is done is what will be done. And there is nothing new under the sun.’ Ecclesiastes. 1:9

The extensive range of contemporary approaches to thinking have roots stretching far into the past; the origins of the concept of metacognition can be found in the work of the great Greek philosophers such as Socrates and Aristotle.

When Socrates stated that ‘I only know that I know nothing’ (a somewhat roughly translated but succinct version of lines 21 a-e in Plato’s Apology), he was using metacognitive skills to acknowledge his lack of knowledge.

The wise Confucius said:

‘Real knowledge is to know the extent of one’s ignorance.’

He, too, was using metacognition to asses and monitor his own mental abilities.

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Image: Lentina_x.  Socrates. Flickr.

 

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Image: Confucius the Scholar. Qing Dynasty. Wikimedia Commons.

Whilst the term metacognition has its etymological origins in Greek (meta = above) and Latin (cognitio= thought), the concept was not termed metacognition until 1979, when American developmental psychologist, John Flavell, described it as ‘knowledge and cognition about cognitive phenomena.’ (Flavell)

This new – and ancient – concept has many dimensions and many applications. Metacognition, is popularly defined as ‘thinking about thinking,’ or, more technically,

‘a ‘recursive sense of consciousness…..the capacity to think about one’s own mind.’  Dehaene

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This ‘recursive’ aspect of metacognition is interesting, in that it signifies the ability to be self-reflective, self-referential, to have thoughts about one’s own thoughts and beliefs and, in so doing, to function as both subject and object.

Such reflexive thinking, is, in itself, a time-honoured concept. It involves holding up a virtual mirror to the self and then identifying one’s subjectivities, one’s personal perspectives and biases.

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Self-Monitoring: The self in the Mirror

Metacognition is thus about monitoring, control and regulation of our thoughts; it is a skill that is highly relevant to education and learning.

An example of a metacognitive thought might be ‘I know that I have a problem with science, but I am good at art.’ This is a ‘self-monitoring’ thought, which might lead us to action and strategy that could help us understand ourselves and our learning skills better.

The theory of metacognition can be applied to many different disciplines; as it relates to self-understanding, metacognition may be used in certain therapies. Over recent years, Professor Adrain Wells has developed ‘metacognitive therapy,’ which offers techniques to treat many psychological disorders.

It focusses on facilitating patients to recognise and manage their responses to their own negative and worrying thoughts. They are encouraged to explore their ways of handling, for example, ruminative thinking and a pervasive sense of threat.

Wells’ message is

‘Thoughts don’t matter, but your response to them does.’

Wells.

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The content of the thought is seen as less relevant than the way of thinking about the thought. Metacognitive therapy aims to enable people gain flexibility in the way they respond to their negative thoughts. They are helped to be less rigid in their ways of thinking and less dependent on unhelpful ways of managing such thoughts.

Metacognition and Advances in Cognitive Neuroscience

Using the tools of contemporary neuroscience, scientists are now beginning to identify the brain mechanisms that govern metacognition.
(Fleming)

Scientists at University College London (Fleming) have conducted a series of trials in which they identified that ‘the people with better metacognition had more gray matter in the anterior prefrontal cortex.’

Disorders like schizophrenia, stroke and dementia can adversely affect metacognition. Deficiencies in this area can have disastrous consequences, leaving a person unable to have ‘insight into his or her own illness.’ (Fleming)

Research has been conducted into the use of various medications to help improve metacognition. Some people do have better metacognitive skills than others; there are, however, ways to improve these self-assessment skills. It has been discovered that meditation and stopping to reflect on one’s learning can help with the process of metacognition.

METACOGNITIVE SKILLS

Mindfulness

How can we think mindfully? The process of mindfulness uses metacognitive skills; the term signifies an awareness and acceptance of one’s thoughts in the present moment, attending to them without judgement or censure.

Thinking mindfully involves acknowledging thoughts, without criticism, watching what happens to the thought in the thinking process. Although there is some overlap between metacognition and mindfulness, the former extends and develops the process further, perhaps into action.

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Theravada Buddhist Nuns Meditating

The term mindfulness originated in Buddhist meditation practice; it is now widely used, and in a variety of settings. It can be helpful in reducing stress levels and in enhancing enjoyment of life.

It can help us to become aware of what is happening both in and around ourselves, encouraging us to pause and notice sounds, smells and sensations.

Mindfulness provides a way of becoming aware of thoughts, especially intrusive and troublesome ones. These can have a powerful negative effects on our lives if they take over and appear to wield power over us. We can learn how to control them, gaining new perspectives:

A teacher walking with his students points to a very large boulder and says, “Students, do you see that boulder?” The students respond, “Yes, teacher, we see the boulder.” The teacher asks, “And is the boulder heavy?” The students respond, “Oh yes, very heavy.” And the teacher replies, “Not if you don’t pick it up.”

(Shapiro and Carlson)

This story illustrates how mindfulness can help manage fears about ‘obstacles’ that may be insurmountable only in one’s thoughts. A mindful approach would involve being aware of the boulders, but not to feel one is necessarily compelled to rearrange or shift them.

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Mindfulness teaches an approach of  acceptance, an awareness of the impermanence of life. Has this technique helped you? Let me know in the comments below.

Discover more on this subject by checking out next week’s post: Mindfulness: The Real Truth.

How Can Psychoanalysis Survive into the Twenty-first Century? (3)

Doctor:
Not so sick, my lord,
As she is troubled with thick-coming fancies
That keep her from her rest.
Macbeth:
Cure her of that.
Canst thou not minister to a mind diseased,
Pluck from the memory a rooted sorrow,
Raze out the written troubles of the brain
And with some sweet oblivious antidote
Cleanse the stuffed bosom of that perilous stuff
Which weighs upon the heart?

 

Macbeth. William Shakespeare.

 

 

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Lady Macbeth

(image: detail of John Singer Sargent’s “Ellen Tarry as Lady Macbeth”, via freeparking/Flickr)

A desperate Macbeth urge his doctors to magically erase unpleasant thoughts and memories from his troubled wife’s mind.

Is this the stuff of dreams? Of science fiction? Perhaps. But just maybe such magic is becoming a little closer to reality.

We might not be able to remove a memory, as Macbeth asks, but we can certainly see some mind- blowing developments in the area of brain imaging.

Metacognition, consciousness of self, can now be measured; our perception of the world around ourselves as it registers in our brain can actually be witnessed on screen:

‘We can quantify your introspection. We can measure the amount of brain activity anywhere in the brain…..Through the use of MRI and ERG we can make the invisible visible…. we can see which areas of the brain are used in different tasks like smelling, sensing, thinking …..’ (Dehaene- video)

Conscious and unconscious activity in the brain is determined and evaluated through the use of such tools, together with an intricate series of experiments. Thus it is that our ways of thinking, to some extent, are becoming observable. It is certainly an exciting time for neuroscience. What was once a futuristic fantasy, is now becoming a reality.

“ By about 2040, there will be a backup of our brains in a computer somewhere, so that when you die it won’t be a major career problem.” (Ian Pearson, quoted in Robinson)

How does all this relate to Freud? Well, what has recently emerged in the field of neuroscience is exciting for adherents of Freud. It is called Neuropsychoanalysis. Research into this new area was pioneered by the neuropsychologist and psychoanalyst, Mark Solms, at the University of Capetown.

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Solms underlines the fact that Freud was aware that neuroscience in his time was not sufficiently developed to support psychoanalytic theory. Freud began his career as a neurobiologist, attempting to find science to back up his psychological findings; however, he dropped this, as neuroscience was so undeveloped, and he focussed on the  practice of psychoanalysis.

Freud predicted in 1920 that advances would be made in neuroscience  ‘in a few dozen years.’ As we have seen above, new discoveries and inventions now mean that ‘introspection can be quantified.’

Psychoanalysis is built on the belief that introspection is a powerful force: that thinking has power(M.M.Owen.)

To be able to scientifically measure such brain activity and functioning is wondrous; how Freud would have rejoiced at this new and important knowledge.  For many years, psychoanalytic theory and science followed divergent paths, with little connection.

Freudian theory was on the decline, as we have seen in the previous post. Now, the advent of neurospsychoanalysis means that some aspects of psychoanalysis can be revivified.

Neuropsychoanalysis may be explained as an exploration of the connection between psychoanalysis and neuroscience:

Now, with advances in technology that give us a window on an active brain, we can link brain processes with psychoanalytic concepts – ideas that emphasize the deep unconscious layers of the mind, the central role of emotions and interpersonal relations in mental life, and the importance of fantasy and mental representations.  Neuroscience is rapidly expanding our understanding of the neural circuits involved with conscious and unconscious processes, motivation, emotion, self-regulation, memory, interpersonal relations, and more.  As we bring these domains together, neuropsychoanalysis illuminates how the mind is organized at the deepest levels can inform and enrich brain exploration – and vice versa. NPSA

 

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Image: P. Denker. Prd Brain Scan Flickr.

What is the Psychoanalytic Way of Thinking? Can it Help Us in This Short Term World? Part 2.

……Or Is The Therapy Couch destined for the Scrapheap?

In this short-term, throwaway, bargain-basement culture, we may wonder whether an approach that inclines towards the long-term, and the more expensive, can be helpful to us. Or will it fall by the wayside?

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Image: Brandon Giesbrecht. Flickr.

What IS Psychoanalytic Thinking?

This way of thinking involves a focus on the unconscious, the part of the mind that is not immediately available to our conscious awareness. The unconscious is a repository for hidden fantasies, thoughts, feelings and memories, which may motivate us in our daily lives.

Psychoanalysis aims to help us access such concealed aspects of ourselves, to bring the unconscious into the conscious, in order that we can learn to live more fully and be less afraid of what might lie within.

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Psychoanalysis also uses the relationship between therapist and patient as an arena within which to explore sometimes self-defeating ways of being in relationships. These may have developed in childhood.

Past behaviours will inevitably be repeated symbolically in the therapy relationship. The space between therapist and patient becomes a kind of ‘theatre’ in which to reactivate and re-act aspects of one’s past experience. Feelings and behaviours towards the therapist will inevitably reflect aspects of the patient’s primary caregivers. This is called the transference.

Psychoanalytic ways of thinking emphasise the importance of early experience in contributing to personality development.

Psychoanalysis itself is a long and intensive form of therapy, aimed at discovering with the patient repressed thoughts and feelings. This is achieved through the interpretation of dreams, fantasies and memories, using the technique of free association. We all have defense mechanisms which protect us from painful thoughts, feelings and memories.

Psychoanalytic psychotherapy resembles psychoanalysis in terms of technique and approach, but it is often shorter and less intensive.

Psychoanalytic Thinking Has Changed with the Times

Freud was the founder of psychoanalysis; however, this school of thought has not remained static, but has developed and grown over the years. Whilst there may be fewer people practising ‘pure’ psychoanalysis than there were, the influence of psychoanalytic theory has been enormous. Many therapists are more eclectic in their approach, whilst valuing the learning from psychoanalysis.

Literature, literary criticism, art and film have particularly been influenced by Freud’s theories.

As W.H. Auden said in his poem In Memory of Sigmund Freud:

to us he is no more a person
   now but a whole climate of opinion

under whom we conduct our different lives: (Auden)

 

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Sigmund Freud with Stephan Gabriel, (1921-2015) his grandson and brother of Lucian and Clement.

Image: Wikimedia Commons

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Psychoanalytic Congress, 1911. Wikimedia Commons.

 

Addressing Criticisms of Psychoanalysis.

Some have criticised psychoanalysis for the fact that it takes time and is therefore expensive, especially in this throwaway and short-term culture, where thinking for oneself has been eroded.

Others regard psychoanalysis as having insufficient evidence-base for its effectiveness; they feel it is lacking in scientific credibility. Bowman sees this attack as ‘a defence against psychoanalysis.’

Indeed, it is so often the case that insights into the unconscious that emerge through the process of psychoanalysis may be experienced as threatening. Confronting one’s true feelings and motivations is not for the faint-hearted. Perhaps sometimes it is easier to criticise than to consider.

Manualised treatments, such as cognitive behavioural therapy, may be researched in a way that takes into account their ability to be predictive and generalised in approach. Psychodynamic psychotherapy, however, can never be so reduced, technique-driven or inflexible; nor can it be fitted into such mechanized and systematized methods of measuring efficacy:

‘Evidence-based demands and standardisation sought through State regulation and the NHS approach are contradictory to the psychoanalytic view of the uniqueness of the individual. What may prove therapeutic for one client may be totally inappropriate and ineffective with another. Psychotherapy is not a technique to be learnt and universally applied but is an exploring of human subjective history and experience. It cannot be ‘forced to happen’ and certainly cannot be guaranteed in the form of an ‘offer.’’

(Leader, 2008).

Research

However, despite these issues, reliable and thorough  research has been successfully carried out. It has indicated that there is definitely ample evidence for the efficacy of psychoanalytic approaches. (Peter Fonagy)

This  research revealed that, as a treatment for severe depression, psychoanalysis was much more successful than CBT. The effects lasted longer after therapy than with CBT, and the research appeared to reveal that CBT became less effective as time passed.

With this in mind, will psychoanalysis and its ideas survive in the 21st Century? To find out, read next week’s post.

Have you found psychoanalytic thinking helpful? Please leave a comment below.

 

 

 

 

 

 

 

 

Thinking Psychoanalytically: Can This Survive in the 21st Century? Part 1:The Context: Warning! Our Short-Term Society Can Seriously Damage Our Health.

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Freud’s couch.

‘In the sphere of psychotherapy, short-term, standardized treatments and contracts are becoming the norm, which greatly appeals to insurance companies.’ (Vernaeghe)

Is our twenty-first century world itself becoming short-term and standardized?

As we have seen in previous posts, ours has become a culture which frequently  demands immediate gratification and quick results. This will, inevitably, have long term deleterious effects.

Here are two important examples:

1.In the NHS

‘Fast-track counselling’ or ‘call centre therapy‘, as it has been described, has been introduced into the NHS, to cope with the increasing demand for help with depression and anxiety. The IAPT (Improving Access to Psychological Therapies) offers some 30 minute telephone and online consultations of CBT  and also individual and group therapy.

Research conducted in 2018 resulted in some criticism of this service:

‘The results suggest that only the tip of the iceberg fully recovers from their disorder (9.2%) whether or not they were treated before or after a personal injury claim. There is a pressing need to re-examine the modus operandi of the service.’

Journal of Health Psychology

Dr Elizabeth Cotton(2018) laments the poor quality of this service according to her research, with too few sessions offered and a rigid model of CBT used.

2. Regarding Our Planet

Crucially, our planet may also suffer from this short-term -and short-sighted- approach:

‘While short-term thinking is not surprising, it can be problematic. In his 2004 book A Short History of Progress, Ronald Wright describes human beings in today’s world as running 21st century software on 50,000-year-old hardware. The results can be catastrophic. For example, our inability to properly consider long-term risks or opportunities in combination with our short-term focus explains the four decades of inaction in dealing with climate change. We did not respond to the proverbial hand moving in slow-motion towards our face before it was nearly too late.’

Feike Sybesma,

Future generations will inevitably have to endure the results of this lack of consideration and forward thinking in terms of the risks of climate change.

3. Consumerism and This Throwaway Culture.

In 2018, we live in a society that is led by materialism and  consumerism. Influences which shape contemporary life are, for example, the celebrity culture, with its ‘must-have’ fashions, image-consciousness and status symbols and the huge shopping centres that are everywhere and often resemble places of worship.

In terms of beauty, the fake and the false is prized over the natural (nails, hair extensions, eyelashes, breasts etc.)

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Image: The  Trafford Centre.  Wikimedia Commons

Ours is a society which regards the disposable, the throwaway, as the norm. Rather than wash items, we use disposables, such as paper cups, face-wipes, paper towels, tissues. Rather than repair, we discard and replace, without thinking.

Food is packed in layers of plastic and cardboard which create more rubbish. The oceans are polluted with waste plastic and microfibres, harming animals and the environment.

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  ‘Trash Mountain.’ Woodley Wonderworks. Flickr.

Goods are deliberately not made to be durable, so that they will have to be discarded and new ones purchased. Often repair costs exceed that of buying new. Repair shops are disappearing from the high street.

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‘e-Waste.’ Curtis Palmer. Flickr.

Cheap and poorly made fashions can be changed quickly, so that people will buy new clothes regularly. Imported plastic shoes replace leather ones. Obsolescence and future failure are built in to many digital and electrical goods. Furniture is seldom passed down through the generations, as it used to be. Younger generations mostly seem to prefer IKEA to antiques.

All these factors- fast- track therapy, short-term thinking about climate change, fast food, the throwaway culture, all these embody the current lack of long term thinking, which is reflected in so many aspects of contemporary society.

In Freud’s Day…..

How were Freud’s ways of thinking different? In total contrast, Sigmund Freud collected treasured antiquities, objects to keep and value, full of meaning and history. He was passionate about archaeology. Such artefacts are the opposite of disposable; they are to keep, to cherish and preserve, for centuries.

They represent connectivity with the past, things that have been entombed and retrieved, that can, like buried memories, give us clues as to how the past affects the present. This is long-term thinking.

Frued’s choice of such artefacts  reflected his approach to his life and work:

‘Like archaeology, psychoanalysis is an exercise in sifting through the fragments of the past.’ (Freud Museum)

When people lay on his couch, they knew they were mostly in this for the long term, perhaps several years. This was no quick fix, but a deep, meaningful exploration and analysis of a person’s internal world.

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    Some of Freud’s artefacts

Next week’s post asks: Can Psychoanalytic thinking fit into today’s short term culture?

What do you think of today’s short-term and throwaway culture? Let me know in the comments below!

Thinking and Acting

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Are thinking and acting separate facilities and can they function independently? Does the one precede the other or are they interlinked, even blended? Should we think or act first?

Is thought in itself an action?

Some might say it is, for when we think, our minds are often described as ‘active.’ Asimov said ‘Writing, to me, is thinking with my fingers.’ Similarly, Michelangelo stated that ‘A man paints with his brains, not with his hands.’

However, some people, such as Goethe, regard thought and action as separate entities. He felt that ‘thinking is easy, acting is difficult and to put one’s thoughts into action is the most difficult thing in the world.’ He obviously did not regard the two as part of a smooth continuum.

Shakespeare’s Hamlet thought similarly, although he regarded thought and conscience as negative manifestations of fear. For him, thinking robs him of the courage to act, leaving him a coward:

‘Thus conscience does make cowards of us all,
And thus the native hue of resolution
Is sicklied o’er with the pale cast of thought,
And enterprises of great pith and moment
With this regard their currents turn awry,
And lose the name of action.’

(Hamlet, Act 3 scene 1 83-88)

This is not an uncommon way of seeing thinking, one which regards action as creative and heroic and thought as stultifying and weak:

‘Don’t think. Thinking is the enemy of creativity. It’s self-conscious, and anything self-conscious is lousy. You can’t try to do things. You simply must do things.’
(Ray Bradbury)

‘Dance first. Think later. It’s the natural order.’
(Samuel Beckett)

However, in an interesting paper called Creative Action in Mind, Peter Carruthers makes the point that thought may not always accompany, or indeed precede, action. For example, when a person mirrors another’s physical actions during a conversation, they often do so without conscious thought or planning.

The trumpeter Miles Davis said ‘I’ll play it first and tell you what it is later.’
Carruthers highlights ‘act-first accounts of creativity,’ such as jazz improvisations. These sometimes surprise even their musical creator; Carruthers refers to the book by Berliner entitled Thinking in Jazz:The Infinite Art of Improvisation , which highlights the fact that there is often no planning or thought preceding spontaneous acts of musical creativity:

‘So when a jazz improviser is surprised by the sequence of notes that he hears himself play, that is evidence that he didn’t have a prior expectation (whether conscious or unconscious) that he would play a sequence of notes of that sort. And that means that he had not formulated a creative thought in advance of performing the creative action. ‘

I do take issue , though, with the above statement about ‘conscious or unconscious ‘expectation.’ Surely an expectation is, by its very nature ‘conscious’? The unconscious represents the part of our mind of which we are largely unaware; therefore I do not think we can actually have an ‘unconscious expectation,’ as Berliner implies.

What we can have is unconscious brain activity. This might involve us being surprised by what suddenly surfaces into consciousness, such as memories, dreams and, yes, musical improvisations. Thus the jazz improvisor mentioned above may, in fact, to my mind, have a store of unconscious musical sequences, garnered from a multiplicity of past experiences, that might pop out and surprise him at any moment. Berliner’s above-mentioned ‘evidence’ is therefore a little shaky.

It is possible to think and act simultaneously. This is amply illustrated in Donald Schon’s book  The Reflective Practitioner: How Professionals Think in Action .

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He uses the term reflection-in-action to describe a process whereby people think and know about their work whilst they are actually doing it. He also calls it knowing-in practice. This is a considerable skill, honed through intelligence and experience.

It is something we all do, not only at work, but in our everyday lives:

Phrases like “thinking on your feet,” “keeping your wits about you,” and “learning by doing” suggest not only that we can think about doing, but we can think about doing something while doing it.

In fact, thought and action can be, and are, creative partners. Buddha said ‘with our thoughts we make the world,’ and ‘what we think, we become.’ He saw the creative power of thought as crucial to constructive action, a parts of the same process.

Many see thought as necessarily preceding action. Beethoven carried his thoughts in his head ‘ for a long time, often for a very long time, before writing them down.’ Freud said that ‘Thought is action in rehearsal.’

This ‘rehearsal’ time is regarded by others as crucial. Scientific research by Dr Stephen Fleming reveals that, often, the quick-fire decisions that are encouraged in our current society, do, in fact, mean that we might sometimes increase our chances of getting it wrong. In an article in Aeon in 2014 entitled ‘Hesitate!‘ he states:

‘The agonising feeling of conflict between two options is not necessarily a bad thing: it is the brain’s way of slowing things down….

When people do come to speedy conclusions, there is less opportunity to gather and assess the necessary evidence to form a good decision. The ‘neural flip-flopping’  between options is regarded as ‘the brain’s weighing of evidence for and against decision………..We should allow some indecision into our lives.’

It is a pity that Shakespeare’s Hamlet could not have known of these findings. Then he might have felt less cowardly in relation to his indecisiveness and he might have seen his hesitation as a constructive mechanism.

However, the play would have been far less attractive to the audience and much less of a tragedy.