Today is World Mental Health Day. It seemed a good time to start publishing a series of posts related to mental health issues.
Some years ago I posted a series of attempts to describe my work in the NHS as I experienced it. Since then I have been also attempting to use poems to approach the same experiences from a different angle. Because my poems tend to come from a darker place than my prose it seemed only right to publish the poems alongside the more positive feel of the republished mind-work posts. It felt as though that would be more balanced, more true to the experience as a whole. So, what I am planning to do is follow up a prose post with a poem after a day or two. They need to be read together to get a more complete picture of what was involved in the work I did. Above all else I would hope to convey the reality of this area of experience more completely by tackling it this way, and do more justice to the courage of those who suffered. They are stronger than we realise for bearing the unbearable so bravely.
Some Background Thinking
I thought it was about time I tried to do a post on the work I did for most of my professional life. It could be tricky and might not work out at all.
I have been struggling for ages — at least ten years — to capture in words the work I used to do. Words like therapist and therapy make me uncomfortable. Even the word counseling implies unequal distributions of wisdom. She who gives counsel is somehow superior to him who receives!
I have come to believe that what I did is best called mind-work. It includes mood-work, belief work and will-work: it should have included ‘soul-care’ but that would have been a step too far for a clinical psychologist’s job description even though ‘psyche’ means ‘soul’ to the Greeks.
Everyone does mind-work up to a point. It’s a bit like cooking though. Almost everyone prepares food at some point in his life but not everyone’s a chef. As a professional mind-worker I was a bit like the chef. I was an expert at the work at the same time as the people who worked with me as clients were experts about their own minds.
Because, to do mind-work, I drew on lots of other disciplines and traditions, including philosophy, psychology, biology, religion (especially Buddhism and the Bahá’í Faith) and the arts, I could sometimes feel like giving myself a fancy title such as psy-culturalist. This captures the richness of the traditions I could draw on and also captures the essential purpose of mind-work which is growth. It also meant I didn’t have to label myself a psychologist with its one-sided implication that I study the mind but don’t work with it, nor did I have to call myself a Clinical Psychologist with its implications of illness and therapy, which are insulting to the client.
Psy-culturalist, as a term, has a similar problem to Clinical Psychology. If we think about gardening, it’s a one-way street. Plants, as a general rule, don’t grow people. Mind-work, though, is both reciprocal and reflexive. I grow you and you grow me and we grow ourselves as well!
In the end then mind-work is a perfectly good description.
Mind-work for the most part involves forming a relationship (much more on that later) that allows words to be used in a process of collaborative conversation (the title of a book chapter I contributed to This Is Madness) to enhance meanings in a way that enables all participants to grow. As I see it every human interaction is an opportunity for mind-work and as many interactions as possible should be used as such. Even the groups of people who traditionally have been seen as experiencing meaningless lives, such as those with a diagnosis of schizophrenia or dementia, are not to be excluded from this meaning-making growth process. My work has mostly been with the former group and what follows discusses some implications of that. For me though, everybody means something and to deny that is to dehumanize us.
Perhaps it is important to clarify something. I use the word mind to cover a wide variety of possibilities. Consciousness is only one of them. Many important processes take place outside the circle of light shed by conscious attention. Mind is also where the body is experienced and shares a two-way relationship with the brain, so the realms of the physical are not excluded. The mind is a node in a sociocultural network and is affected by many wider systems which it maps and responds to in a variety of ways. No mind is an island! There is also strong evidence that the mind can operate independently of the body/brain (See Jenny Wade’s Changes of Mind, Ken Ring’s Lessons from the Light and David Fontana’s Is There an Afterlife? as well as posts on this site about the afterlife hypothesis for more detail about that.)
There are differences that should not be obscured. A psychologist is paid for her mind-work: her client is not. That is one difference which can create an undesirable power-differential if great care is not taken to counteract that tendency. Another difference lies in the fact that the client is the expert, as I have said, in his own mind: the psychologist is the expert when it comes to the nature of the work in some of its aspects. That is the only other difference. Both can grow as a result of the mind-work they do together.
That should be enough to set the scene for the exploration of my way of working that follows.
The Client’s Perspective
In 1996 I interviewed someone who had gone through a series of conversations with me about his voices. He was a former miner and an ex-army man from the Welsh valleys. He was articulate but down-to-earth. What he told me enriched my way of doing things considerably and shed a great deal of light into previously dark places. We made a video together, from which the photo below is extracted but without showing his face, and he was very keen that it be used to help others understand this kind of problem better. At the time of the videoed interview we had been working together for about six months. There was still a long way to go but much of interest had happened. I will call him Ian to protect his identity.
Perhaps most importantly, he emphasised the role of trust.
P.: And it was in November that we first met, wasn’t it?
I.: Yeh. Jenny [his residential social worker not the author of the book recommended above!] had started talking about you, you know? And it was coming up to the meeting with you. And I can remember going to the meeting with you that first time. And I can remember thinking who’s this bloke asking me all these questions, you know? And I didn’t trust you. But Jen was persistent that I could trust you, so I decided to trust Jenny and to talk to you.
P.: And you actually asked if Jenny could come to sessions, didn’t you?
I.: Yeh, I asked if Jenny could come, yeh.
P.: Right. And I think she came about the second or third time you came.
I.: Yeh.
P.: And did you feel more comfortable with her there?
I.: I did, yeh.
P.: And did that make you feel more able to begin to trust me at least personally if not what I was doing?
I.: It took about a month to start to trust you. And that was with Jenny backing you up.
This cannot be stressed too much. Trust takes a long time to build and is easily lost. In Ian’s case Jenny who had worked with him for years and vouched for me assisted the development of trust. In a “delusion” exercise I use in workshops we can see how a period of unsympathetic and confrontational treatment at the hands of other people makes it harder for someone to believe we are not going to be the same. We need to prove our trustworthiness over a period of time. We need to be prepared for hostility at worst and the cold shoulder or evasion at best in the early stages of our relationship. We would be wise not to assume that such behaviour is the result of “paranoia.” It is at least as likely, if not more so, to be a natural reaction to months if not years of other people’s outspoken incredulity.
What also was important to the success of my work with Ian was all the effort Jenny put in in-between times.
I.: It took about a month to start to trust you. And that was with Jenny backing you up.
P.: And that was by being there in the sessions and by talking to you between whiles wasn’t it? You used to have meetings and discussions with her between times.
I.: Inbetweentimes, yeh. And we’d talk about what we’d talked about, you know? And she supported you in what she said.
She helped him remember what I had said or correct his distortions of it. She encouraged him to make use of the suggestions we had come up with. She helped him make sense of what was happening to him in the terms I had described it. Isolated mind-work sessions will achieve little if they are not reinforced and supported by a lot of work in-between.
We will hear much more from Ian in the next post.
The subject of ‘trust’ in human relationships is a fascinating one. An area of interest of mine too. Thank you for sharing, Pete. I look forward to reading more.
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Good to read about your work, Pete. It reminded me how fascinating I found it. In the dark time I am experiencing at the moment it shines a light on the path forward. Thank you, both for the post and reminding me of those interesting times.
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It’s good to hear from you, Jenny, though it saddens me to learn that you are going through such a dark time. I was enriched by our working together – they were interesting times indeed, but not in the sense of the Chinese curse.
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Just wanted to say I thoroughly enjoy reading your blog. In recent years I have become interested in the Baha’i Faith whilst simultaneously experiencing a decline in mental functioning and a diagnosis of psychosis. What has been of great help for me in healing has been affirming my own inner belief that my experience of mental illness was more a process of growth than a futile illness. There were many doubts along the way and internalised stigma to move past but two things that have encouraged me to see the mental suffering as growth have been developing a deeper spirituality, and learning about a theory of personal growth developed by Kazimierz Dabrowski, a Polish psychiatrist/psychologist, known as the “Theory of Positive Disintegration”. I wonder if you have heard of this theory and would be interested based on your knowledge and experience if you have any comment on it in relation to mental health and spiritual or personal growth.
Many thanks for sharing your insights. I look forward to reading more.
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It’s hard to express how much I value positive feedback from someone who has direct experience of psychosis. Though I have experienced trauma and emotional pain directly, my only experience of psychosis is indirect and it’s always a risk commenting on such a profound experience from the outside as it were. I’m also very glad you have pointed me in the direction of Dabrowski. I hadn’t heard of him (no surprise there – I’m always discovering how much I’ve still got left to learn) and have just looked at the Wikipedia piece on him. So much that he says resonates with my own experience of life that I will be buying one of his books. Which would you recommend?
In the Wiki article, among the points that struck home were these:
“The lower animal instincts and the forces of peer groups and socialization are inferior to the autonomous self (personality) constructed by the conscious person.
“To break down the initial integration, crises and disintegrations are needed, usually provided by life experience.
“These disintegrations are positive if the person can achieve positive and developmental solutions to the situation.”
It reminded me of Charles Tart’s point in ‘Waking Up’ that we are all socialised from birth into a kind of trance, which is not a true sense of reality. Pain is one of the most important ‘trance breakers.’
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What’s your “delusion” exercise, Pete?
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I used to do workshops for Clinical Psychology trainees. One of the key exercises was designed to give them a sense of what it was like to have your beliefs subjected to constant mockery, attack and disbelief. So, I broke them down (probably the right expression) into groups of three. Each in turn had to think of a belief they held that was somewhat outside the mainstream. They then shared it with the other two who were to treat it with scorn and derision.
My own work strongly suggested that the ‘experiencers’ of psychosis I worked with had had years of such treatment and that one of my first tasks was to demonstrate that I would not do the same. This is what made trust such an important and difficult issue. I tried as far as I could to show that I was convinced that all our cherished beliefs are created in an effort to make sense of our own experience. My first task was often to understand how these beliefs made sense, not to prove how ‘mad’ they were. The next stage of the ‘delusion’ exercise was for the group members to treat these ideas with that kind of respect.
The debrief generally indicated that the point had got across!
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Oh, I see, Pete. No doubt the exercise worked as intended.
It reminds me of two things:
1. An exercise with Dan Siegel of Mindsight. He asked his audience to close their eyes and pay attention to what happened to them/their bodies as he repeated two words — first “yes,” and then, in a separate segment, “no.”
Try it with yourself, if you want.
You can feel the instant integrating — melting and soothing and opening — force of acceptance with a “yes;” and you can also feel instantly how your body and mind close off on a “no.”
There is a very distinct (and universal, in that it’s experienced by every human — and possibly every living — being) energy shift, up or down, depending on the word, taking place, and one can feel it whether one wants to or not.
Acceptance is powerful. Love even more so. To exist and grow, we need to belong — and within loving kindness. As a species, especially in the Western world, we don’t do so well on that.
2. Henry Murray’s evil psychology experiments, the subject of which was, among many, very young and vulnerable Ted Kaczynski (a.k.a future “Unabomber”). You can read about them here: https://www.psychologytoday.com/blog/impromptu-man/201205/harvards-experiment-the-unabomber-class-62
http://mentalfloss.com/article/62564/how-extreme-psychological-study-may-have-affected-young-ted-kaczynski
http://www.theatlantic.com/magazine/archive/2000/06/harvard-and-the-making-of-the-unabomber/378239/
The last link is especially informative.
Learning about this made me wonder (not the first time) just how many psychologists (and psychiatrists, and other mental health professionals), including “the greats,” were/are actually psychopathic.
And of course none of the public, mainstream media profiles of Kaczynski The Dangerous (and likely psychotic) Criminal, ever mentioned that episode from his life.
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Sadly the divorce that eventually became absolute in the 20th century, at least in too many people’s minds, between ethics and science, has left many victims in its wake. Apart from complicity in torture, one of psychology’s worst abdications of moral responsibility in recent history came to my attention via a TV programme about how psychologists assisted the British army in helping soldiers overcome their reluctance to kill people. I quoted it in a piece on Mindfulness:
‘. . . . a programme I saw some years ago, similar to this archive one from 1990 but going into far more detail about the preparations for the Falklands War: because it is well recorded that significant numbers, maybe even the majority of soldiers are unwilling to shoot to kill at least to begin with, according to the documentary I saw the Army called in psychologists to create a training programme that made firing to kill an almost automatic reaction. I felt ashamed of my professional colleagues for what they were complicit in.
‘This lethal facility was drilled in by repeated practice in carefully designed and vivid scenarios. What the trainers, and those higher up the chain of command, failed to take into account was that many of the soldiers who went to the Falklands and killed effectively as a result of this pre-programming would be traumatised by what resulted from their actions. Ex-soldiers are still paying the price of that miscalculation.’
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Yes. The psychologists’ (and psychiatrists’) complicity in war, mass murder, and torture chills and enrages me. It is unthinkable and unimaginable. Alas.
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P.S. Please do not think I’m comparing you to Murray, Pete! (oof)
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It never crossed my mind for one moment, Emma. Once I settle back at my desk I hope to catch some of the ideas your comments have sent spinning round my head and send them in your direction.
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Oh, good! Especially since I’m making myself at home on your blog. (Some people are that unmannered, indeed.)
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