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Video May 1993

In the main video interview transcript, an extract from which features at the beginning of the first post in this sequence, there is a very important passage focusing on one aspect of the impact of consultation on a key aspect of Ian’s difficulty with the voices. It concerns his memories of what he had done that made him feel so guilty.

I.: Well, when I was ill, it didn’t seem real. You know what I mean? My memory didn’t seem real. It was like a dream. And it was as if I’d never done anything. But talking to you reminded me that I’d actually done these things, you know? And that it was memory. And that I’d actually done the things.

P.: It was memory not imagination?

I.: That’s right. It was reality.

P.: And how did knowing that it was reality prove so helpful? What did it do?

I.: Well, it proved the voices wrong for a start.

P.: Ah. Why? Were they saying that they were real and your memories weren’t?

I.: Yeh. It proved the voices were wrong. And that my memory was right. And talking to you fetched it out into the open.

In a later video interview in September the following year, Ian explained that he felt as though talking helped get the feelings he had repressed ‘out into the open.’ He was in effect able to consult about them. Reflection had paved the way towards his being able to think about the feelings and begin to feel them. Talking about them brought them more fully into the open and enabled him to make better sense of them. The voices on the other hand fed on his habit of suppressing his feelings.

The September interview also explained how we had refined our understanding of his pattern of suppression. If he began to feel low, slightly depressed, he’d switch off his feelings which then brought the voices back.

But I must not make this process sound too simple. Yes, it is true that learning to reflect can pave the way both to a better understanding of our own mind and heart as well as potentially enabling us to share our discoveries with someone else and compare notes in a consultative fashion. But the transition is not necessarily automatic.

Video September 1994

The Importance of Trust

Take this extract from the May 1993 video. Jenny was his care worker.

P.: And it was in November that we first met, wasn’t it?

I.: Yeh. Jenny 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 . . .

P.: Right.

I.: . . . 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.

P.: And that was by being there in the sessions and by talking to you between whiles . . .

I.: With Jenny.

P.: . . . betweentimes.

I.: Inbetweentimes, yeh. And we’d talk about what we’d talked about, you know? And she supported you in what she said.

This extract testifies to how hard Ian found it to trust me. If it had not been for the fact that he had been living for some time, since his discharge from hospital, in a social services home specialising in the care of people with serious mental health problems, and if he had not had the time to build up a trust relationship with his care worker, Jenny, over that period, on an almost daily basis, who knows how long it would have taken him to trust me enough to work with me, or whether he would ever have been able to trust me enough at all, given we met only once a week. A sense of trust is not easy for someone who has been abused and a sense of safety is not easy for someone who has been traumatised. Ian had experienced both abuse and trauma.

After the May interview, the field of consultation had expanded beyond his Thursday meetings with me and his regular conversations with Jenny to include a Voicework Group, which had been set up at his instigation. He felt strongly that these opportunities for consultation were as important for him as his medication. Without Jenny, though, building sufficient trust to do effective work it would have taken far longer to reach this point, though he felt it would have happened in the end even so. I’m not so sure on that as he was.

Detachment

There is one quality that has been implicit in much that I’ve said so far. It is both the fruit of even the early stages of reflection and the soil from which a further ability to reflect more deeply springs. It is also an essential prerequisite of consultation. Those who are too attached to their own perspective will always find it hard to consult. I am speaking of the quality of detachment. Its power goes even further than this. Bahá’u’lláh, the Founder of the Bahá’í Faith, wrote (Arabic Hidden Words No 68 – my emphases):

Know ye not why We created you all from the same dust? That no one should exalt himself over the other. Ponder at all times in your hearts how ye were created. Since We have created you all from one same substance it is incumbent on you to be even as one soul, to walk with the same feet, eat with the same mouth and dwell in the same land, that from your inmost being, by your deeds and actions, the signs of oneness and the essence of detachment may be made manifest.’

If we are divided against ourselves we are also going to be in conflict with others. If we can, by a process of reflection, become both more detached and more integrated, we can transcend both our inner conflicts and our conflicts with others.

‘Abdu’l-Bahá describes this possibility in the following words (Selections from the Writings of ‘Abdu’l-Bahá 1978 – page 76):

. . . .all souls [must] become as one soul, and all hearts as one heart. Let all be set free from the multiple identities that were born of passion and desire, and in the oneness of their love for God find a new way of life.

Even if we do not believe in a God but at least have faith in the essential oneness of all humanity, this will help remedy our current conflicted state, wherein we are at war with ourselves as well as with others. This is Bahá’u’lláh’s description of the challenge we face compared with the reality most of us are blind to (Gleanings from the Writings of Bahá’u’lláh = CXII):

No two men can be found who may be said to be outwardly and inwardly united. The evidences of discord and malice are apparent everywhere, though all were made for harmony and union. The Great Being saith: O well-beloved ones! The tabernacle of unity hath been raised; regard ye not one another as strangers. Ye are the fruits of one tree, and the leaves of one branch.

This is another two way street. As individuals in harmony with ourselves we become more able to love and care for others, and as communities in harmony with one another we become more able to support and care for our fellow human beings.

Such levels of detachment, reflection and consultation are not easy to reach and are even harder to sustain, but the effort of attempting to do so is amply rewarded. Usually the effort is more than compensated for by the benefits gained.

Crucial Caveats

However, it would be too simplistic to suggest that people struggling with challenges as monumental as those Ian had to battle with can always achieve these benefits in a sustainable way. I am not arguing that reflection and consultation are always possible for people in such extreme distress.

Many of the contexts in which a person struggling with psychosis is placed seem neither safe not trustworthy. Sometimes the contents of a client’s consciousness prove so terrifying or distressing they cannot feel safe dealing with them nor trust their ability to manage them.

There came a point where the lady with the history of abuse chose mind-numbing medication rather than deal with the worst of her experiences.

After almost a year of our work together things seemed to be going well. Then came the unexpected. She found herself in a building that closely resembled the building strongly connected with the worst episode of abuse she had experienced at the hands of her father. Just being there was more than she could cope with. She became retraumatised in a way we none of us could have anticipated or prevented. The next time we met she could not stop sobbing.

We discussed what she might do. There were two main options.

She could, if she wished, continue on her current low levels of medication and move into a social services hostel where she would be well supported while we continued our work together, or she could be admitted onto the ward and given higher levels of medication in order to tranquillise her out of all awareness of her pain.

She chose the second option and I could not blame her in any way for doing so. It would be a betrayal of the word’s meaning to suppose she had any real choice at that point but to remain psychotic while the medication kicked in rather than deal with the toxic emotions in which she felt herself to be drowning.

Ian did the same when it came to his memories of slaughter from his army days. It was in June that he experienced a devastating return of the voices that led to his hospitalisation. Further exploration discovered a link between a traumatic army experience, which had occurred at that time of year, and an overwhelming reactivation of the voice-inducing guilt – far stronger than anything he had experienced in connection with his breach with his alcoholic partner. Each year after that he preferred to allow himself to become psychotic rather than attempt to process the intolerable guilt. He chose increased medication and admission to hospital till the anniversary effect was over, when he would be discharged to resume a relatively normal life until the next anniversary.

Graph of the Model that states Psychosis is on a continuum with Normal Functioning (Source: The route to psychosis by Dr Emmanuelle Peters)

A Genuine Help

What I am contending from my decades working with ‘psychosis’ in the NHS is that my CBT training was made more effective by my spiritual practice and the facilitation of those twin skills: reflection and consultation. The meanings achieved as a result facilitated flexibility and personal integration, as against the distressing rigidity and disturbing inner and outer conflict of the psychotic experience.

Hopefully one day these conclusions from personal practice will be validated in systematic studies.

An additional point to mention is that this is not just a model for psychosis. Take Laura for example, with her diagnosis of endogenous depression, ie one that her doctor felt was not explicable in terms of her life situation. She used to believe that her parents were more or less perfect. The work we were doing became very stuck and seemed to be going nowhere.

We had plateaued on bleak and distressing terrain, more tolerable than her previous habitat but too unwelcoming to live on comfortably for the rest of her life, and yet with no detectable path towards more hospitable ground.

Frustrated by the protracted lack of movement, I began to see discharge as a very attractive option. I discussed this with my peer supervision group.

Effective group supervision provides a context where fruitful consultation can take place and better decisions about the most fruitful line of action can be made. We decided that I should continue with the processes of exploration but make sure that I did not continue my habit of stepping in relatively early to rescue her in sessions from her frequent experiences of intense distress.

I continued to see her. Laura and I consulted carefully and jointly agreed that I would allow her to sink right into the “heart of darkness” in order to explore it more fully and understand it more clearly. The very next session, when we first put this plan into action, after I had left her alone in her silence for something like half an hour, Laura came to a powerful realisation at the heart of a very intense darkness. She said: “I think my mother threw me away even before I was born.” Thankfully consultation had helped me manage to avoid doing something similar by discharging her before we had resolved the causes of her depression.

This paved the way for deeper and more fruitful explorations of the reality of her childhood, continuing to use the same reflective and consultative process I have been describing in this sequence of posts.

Ian’s Last Word on the Matter

P.: Is there anything else that you feel that you want to say that I haven’t brought out by the questions I’ve asked you?

I.: No, except that the pain, you know, the questions you asked were painful. And I didn’t want to answer them.

P.: And you didn’t see the point of answering them either, did you?

I.: No, I didn’t see the point in answering them because I didn’t recognise myself that the problem lay there. But once I could see where the problem was I could bargain with the voices.

P.: Yeh. And you had to know where the problem lay, roughly . . .

I.: Yeh.

P.: . . . before you could bargain with them?

I.: And talking to you showed me where the problem was. So, I was able to deal with the voices in a positive way.

P.: Yeh. But before you had gone through this whole process there was no way you would have realised that the problems were what they turned out to be.

I.: No. I thought it was just schizophrenia.

P.: Yeh. And that was the end of it.

I.: And that was the end of it. I was schizophrenic and that was it. And I had nothing to look forward to except hospital and more medication. And I couldn’t stand the thought of that, you know? So that jumping under a train was looking very attractive. But it doesn’t look attractive now.

P.: Because life seems to have more to offer?

I.: Yeh.

I need to add here, though, to put all this fully into context, that I visited him in the hospice when he was dying of emphysema and other complications consequent upon what he knew was his self-damaging habit of heavy smoking. He was well aware of the implications of the injury to his lungs caused by the bomb blast that led to his being discharged from the army on health grounds.

I sat by his bed watching him breath in oxygen from the cylinder at his bedside. When he had taken in sufficient oxygen, I felt moved to ask him the question I had asked once before during our therapeutic relationship.

‘In the light of all you know now, were the gains you made worth the pain you had to go through?’

‘No,’ was the answer he gave. ‘They weren’t in the end.’

As he did not spell out exactly why not, I did not feel it right to press him for his reasons. Even so, his answer taught me a lot, not least how difficult it is to be sure you have obtained fully informed consent before embarking on any intervention.

I’ll leave it there until the New Year, and pause my posts until then as I did last year. I wish all my readers well over this festive season.

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Bani Dugal, Principal Representative of the Baha'i International Community to the United Nations

Bani Dugal, Principal Representative of the Baha’i International Community to the United Nations

A couple of friends on Facebook recently  flagged up an article on the Bahá’í International Community site that resonated particularly strongly with me, perhaps because of the way my life experiences have reinforced how important trust is as the foundation stone of any enduring relationship: it is something without which love, in any real sense of that word, does not seem to me to be possible. Below is a short extract: for the full article see link.

Many today are wondering whether the United Nations and the international system are up to the challenges of the moment.

The rise of non-state actors, the resurgence of nativism and xenophobia, the displacement and migration of populations at historic volumes – the challenges are numerous and rapidly changing.

Yet among the obstacles facing the international community, the Independent Commission on Multilateralism recently highlighted one as particularly problematic:

Repeatedly, the Commission heard reports of a deep lack of trust. There is a lack of trust both among states and between states and the UN Secretariat. There is a lack of trust between governments and their citizens….And there is a lack of trust within the UN itself among the various departments, agencies, funds and programs.

The problem, they suggest, is not that we are unable to work together effectively. Rather, it is that we frequently refuse to. Whether as individuals or members of families, communities, demographic groupings, or nation-states, we are disinclined to rely on others, to depend on them for aspects of our well-being. Humanity is faced with a deficit of trust.

The reconstruction of trust

This is one of the foremost problems facing the international community today.

If citizens and their elected institutions distrust each other, the affairs of society cannot be beneficially ordered. If governments distrust each other, meaningful progress on global challenges cannot be achieved – aspirational rhetoric notwithstanding. If ethnic, racial, or socioeconomic groups distrust each other, solidarity and social integration are little more than empty wishes.

Put simply, societies can neither endure nor advance without trust.

This is nothing new or revolutionary, of course. Nevertheless, numerous aspects of the multilateral system are shaped by the dictates of power politics and expediency – constraining or motivating actors ranging from nations and UN departments to civil society organizations and individual activists.

What becomes clear is that while the importance of trust is generally recognized, its construction is rarely prioritized. Whether the work is too long-term or its mechanisms insufficiently understood, its results too diffuse or not flashy enough, too few tangible resources are committed to this objective.

A central focus of civil society, United Nations agencies, and Members States alike in the coming years will therefore need to be addressing and reversing deficits of trust at all levels of the multilateral system. An explicit commitment, universal and resolute, must be made to the global reconstruction of trust.

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Griefwork v2

In 1995 I apparently gave a long talk to some meeting or other, after which the content of my talk was published by the BPS Psychotherapy Section. I have no memory whatsoever of giving any talk but I do remember writing the article. It seems worth publishing on this blog, with some updates in terms of one of the practical examples, a much shorter version of the original article as it complements with useful background the Approach to Psychosis sequence I republished some time back: I’ve also tried to reduce the psychobabble, though maybe not enough for everyone’s taste!  I’ve in addition included references to later research that sheds further light on, for example, neuroplasticity and the relationship between trauma and psychotic experiences. This is the third of five instalments.

In the last post, I started to explore the next interpretation of thinking through others described by Shweder in his book Thinking through Cultures(b) `getting the other straight, of proving a systematic account of the internal logic of the intentional world constructed by the other’ for `strong and persistent’ feelings `must after all be based on something real, which it may perhaps be possible to discover.’

Talking to Ian

Talking to Ian

It needs a long illustration to convey its relevance so this is why I began to share Ian’s experience last time.

At first he found it difficult to trust me. Within the psychiatric system, trust is an issue which, with people who hear voices, frequently slows down the piecing together of the picture. He asked if he could bring his key-worker from social services with him and I agreed. Even then he found the going very rough. `The questions you asked were painful. And I didn’t want to answer them. I didn’t see the point in answering them.’ Gradually over a period of three or four sessions he became more able to disclose some of what was in his mind both about the voices and about his past.

For him there seemed to be two breakthroughs. One was early on.

I knew there was something wrong with me. But I didn’t know what it was. And it seemed so simple when it was explained to me that it seemed too simple, if you know what I mean. But it worked. I bargained with the voices. I kept my promise to them and talked to you, and things got gradually better.’ It wasn’t a question of shouting them down: `I just talked to them quietly. I told them I knew they were unhappy and that I would do something about it. I said “I know that you’re unhappy. But I don’t know why you’re unhappy, but I’ll talk to Peter about it and see if we can’t get to the bottom of it. And I’ll try to make you happy.” I asked them if they could let me sleep. It took a coupla nights. Then they give me a break.

We wrote him a letter at about this point to help him hold on, in between sessions, to what he was beginning to grasp during the session itself. We said, in part:

We felt there was a pattern in what you were telling us. It looks as though, when life is interesting and/or enjoyable, the voices are either not there or quite friendly. For example, this seemed to be the case most of the time when you were in the army and was true for several years after you were discharged on medical grounds. When things get difficult and lonely however the voices seem to turn nasty.

It doesn’t look as though your feeling that you must have done something to upset them is not correct. It’s more as though they feed off your unhappiness, uncertainty and distrust of other people to cut you off even more from the outside world and tempt you into dangerous courses of action. In fact, they may sometimes even simply be the expressions of those feelings, arising from within you as a result of your emotional state.

Certainly, they often play on your fears and your feelings, and what they say may seem to reflect the way you feel so well that you come to believe it’s true. But it’s only true to your emotional state rather than true to the world as it is. If you can learn to build on the ways you cope with the world so that you deal with your feelings better, the voices may not turn nasty so often: they may even not turn nasty at all.

Remember how we described the way the army teaches people not to be aware of their feelings? When life goes badly wrong and you have no powerful distractions, like parachute jumping, and no close companions to help you pretend you don’t feel bad, then you have only the voices to rely on and they turn very sour. In fact, they turn into tempters and tormentors.

Although it will be hard to unlearn the lessons of the army about how not to feel and about how to look `macho’, as you put it, it is possible to do so over time and with support. In the meantime, it may help to remind yourself, when the voices are at their worst, that they are feeding off your pain and loneliness to make you believe what feels true but is not.

As Ian found pictures easier to absorb than words we captured the core point in the letter in a diagram.

Voices Flowchart

 

As later understanding revealed, our view of his army life was coloured by his rosy presentation of it at this stage. None the less, the letter eased things forwards somewhat. Our idea that acceptance and integration of difficult feelings would be a possible solution only worked for more manageable negative feelings. As we found later, there were feelings that were too dark for him to contain and so he reverted to repression and hallucinations as preferable ways of coping.

Negotiating with Voices

At first he used a pattern of negotiation with the voices which took a vague form: it became more precise and specific as time went on. He told the voices that if they left him alone for a time in the day, he would give them all his attention in the evening. It worked. They gave him a break.

. . . not having the voices talking to me so much enabled me to think. And I could think for periods of time. And I could think about what I was going to say to the voices because they’d give me time to think about it. And it also give me time to think about exactly what I was going to talk to you about. Once I could see where the problem was I could bargain with the voices. And talking to you showed me where the problem was. So, I was able to deal with the voices in a positive way.’ He felt that earlier advice from staff had not been helpful: `They kept discouraging me and said I shouldn’t talk to the voices. I should ignore ’em. And I kept saying “Well, I should talk to them because I can get in touch with them” I’d felt that all along.

He had not felt though that it would turn out to be as easy as it was:

I didn’t think I could get in contact with the voices so easily. I thought it would take a lot longer. But I found that it happened pretty quickly.

In Memory of Lance Sergeant Dan Collins v2

The Effect of Emotional Pain

The other breakthrough, built upon early work to get him more in touch with his emotions, came a dozen sessions later. This is the one which relates most strongly to the issue of creating a `systematic account of the internal logic of the intentional world constructed by the other’

I knew something was bothering the voices. And I think it was over the split up with my partner. And the pain that that caused which I hadn’t dealt with. I just pushed it to one side. I hadn’t come to terms with it. I still loved my partner. And I was still hoping that somehow we could get together. But I’ve give up that idea now. And I’ve put her in the past. Because I was sad inside and because I was still hanging on, really, the voices kept plaguing me. They were feeding on my unhappiness.

This was not an easy process. At the beginning, he explained:

I hurt so much that I thought it wasn’t worth being well. I didn’t want to go on with it at first because I thought it hurt too much but I knew that I had to go on with it, if I wanted to have peace of mind.’

Later it seemed `a price worth paying. Getting your feelings back is a painful thing and it really hurts. Makes you cry. But once you done your crying and you’ve realised that that’s real, then you come to terms with it. You can put it in the past without worrying about it.’

In fact there was still a great deal of work to do at this stage. None the less he was able to describe very clearly the way emotionally-loaded events or actions were related to the voices for him:

I had to deal with the feelings. Feelings were something I’ve always suppressed. [The voices] kept feeding on my suppression. I kept saying `No. I didn’t do that’ or `No. This hasn’t happened’ and they kept getting worse and worse until it got unreal.’

And even though a painful process of emotional re-education still lay before him, the voices had almost completely gone:

I haven’t had ’em for eight weeks. I’ve had ’em for a short period, calling my name. But they soon went.

He summarised his progress in the following way:

I didn’t recognise myself that the problem lay there [i.e. in the way he was dealing or failing to deal with his emotions]. I thought it was just schizophrenia. Jumping under a train was looking very attractive. But it doesn’t look attractive now. I haven’t got any voices at all. I’m not taking any medication for the voices. And I’m sleeping better. I’m eating better.

At the time of my talk Ian had been voice-free for up to three months at a time, only had relapses for a day or so at a time and was on reducing levels of medication. He had bought a car and was driving again. He had not had a hospital admission for almost a year, in contrast to the previous pattern of four or so per year. A voicework group, which was set up largely at his instigation, had been instrumental in facilitating and consolidating his gains. The group exemplified the characteristics I am describing to an even greater degree than the individual work.

We later discovered that there were two anniversary effects that triggered a resurgence of the hostile voices: these related to two traumatic army experiences whose pain he was never able re-experience and integrate, preferring instead for the voices to get worse at that time of year. It was the lesser of two evils for him, even though it risked relapse and consequent hospitalisation sometimes.

What these later discoveries revealed was that the loss of his partner was triggering his awareness of an earlier pool of pain he seemed to know nothing about at that point, and couldn’t bring himself to deal with later even when he knew it was there.

I learned to respect people’s choices in this respect. He was not the only person I worked with who chose admission to hospital in preference to re-experiencing unbearable pain.

Sadly, a year or two later Ian’s continuing cigarette habit exacerbated his emphysema, the same illness as had killed his grandfather. It strangely echoed his mother’s death from tuberculosis: she died before he was two years old. (See below for a brief history of his life up to the point at which we worked together on his difficulties.)

I visited him in the hospice in his last weeks of life. As he lay on the bed with his oxygen cylinder close by, I asked him the same question again as I had asked him during our video recording.

‘Was the gain from our conversations worth the pain you had to go through during them?’ In the video he gives an unqualified affirmation. When I spoke to him in the hospice, as he was dying, he said the opposite. The gain had not in the end been worth the pain. I shall return to that issue in the last of this sequence of posts.

What remains true though is that without all this additional information it would have been impossible to make sense of Ian’s psychotic experiences.

Next time I’ll be exploring further examples of ‘thinking through others.’

Talking to Ian

Talking to Ian

For those interested in the full back ground to his psychotic experiences and how far back in his life traumatic events and situations began helping to shape his sensibility I have included at the end here a brief summary, which I helped him write, of his life up to the point I worked with him. It took a lot more time than I describe to glean all this information. It also indicates that Ian’s initial portrayal of army life was not as rosy as our letter to him suggested, based as it was on his earlier accounts of himself.

Ian’s Biography

By the time I was 14 months old my mother was dying of tuberculosis and I was failing to thrive. I was abandoned by my dad. My aunt rescued me and took me to live with her. She applied to the courts to adopt me. My dad, at the 11th hour, began to contest this. The proceedings dragged on until I’d started school. My situation with my aunt was not secure until I was six years old.

When I was seven my grandfather died suddenly. I was extremely close to him.  The pain of that still haunts me.

When I was nine I was walking to school through a farmyard, when I saw the farmer hanging in his barn. Shortly after that, the voices started, but they were nice and friendly, and kept me company as I walked the hills near home.

I went down the mines as soon as I left school. I wasn’t happy with that and joined the army. Within the first couple of years, I think, I was stationed in Hong Kong. A bullying sergeant major triggered a psychotic episode. The voices turned nasty. I heard the voice of the sergeant major mocking and insulting me all the time. I faked my way out the army hospital by denying I was hearing voices any longer.

The army didn’t know what to do with me. As they reckoned people with schizophrenia were antisocial, they decided a solitary job within the army would be the best thing for me. They came up with what they felt was the ideal solution: they’d train me to be a sniper. You spend long periods alone and when anyone comes along to disturb you, you kill them – a great idea in their view. There’d be none of that stressful social contact!

At least two incidents in which I was involved in the army left me with strong feelings of guilt. The pain of the deaths I caused, I know now, set up the later experiences of psychosis.

I was discharged from the army after I was seriously injured walking towards a bomb in Northern Ireland. I did this deliberately. It was part of a pattern. From time to time I felt I didn’t deserve to live so I put myself in danger. If I lived I felt I was meant to live and maybe I deserved to do so. When the feeling built up again, as it kept on doing even in civvy street because the guilt about the deaths never left me, I’d play the same kind of Russian Roulette.

Once out of the army I used to do this by lying down on a railway line in the early hours of the morning. If no train came within a certain period of time, I reckoned I deserved to continue living.

After leaving the army my marriage broke up and I ended up living with someone with a serious drink problem. I held down three jobs, working all hours, in order to make ends meet and finance her habit. Eventually, I got completely exhausted and depressed. I couldn’t cope any longer and threw her out.

That didn’t finish it though. I was so convinced that she would die on the streets, I felt like I’d killed her. I became tortured by guilt. I shut himself away in my room with my dog. I survived on frozen chips for six weeks, until my boss became so concerned he got the police to break in. They found me completely psychotic, they say. I think I was determined to die this way. They sectioned me. That began an eight year history of sections, medications, with long and frequent admissions, until I felt that life had nothing to offer me.

[At the end of this eight year period the video interview, from which I took the extracts I quote in the posts, took place. He didn’t want to be fully in shot because of the tremor the medication had caused him.]

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