Monday, October 27, 2008

Coming to Terms with Grief

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

As a culture, we don’t have much room for death. By that I mean we don’t have anything in the way of preparatory rituals or public discussions on the subject. Certainly there is a process once we die, of funeral arrangements and so on, but that’s about it. In this regard the late author Nuala O’Faolain’s radio interview with RTE’s Marian Finucane on April 12 of this year was both brave and ground-breaking and worth a listen for anyone who can access it. It is the voice of woman talking about her own impending death.
Death is hard for everyone. For those who are about to die and for those who will be left behind. But what is probably hardest of all is the lack of guidance that our culture gives us in terms of how we should prepare for, deal with and cope afterwards with the death of loved ones. It is an interesting concept considering that death is the final stage for each and every one of us.
In the western world we have technologies that can put people into the farthest reaches of space. We can see inside the human cell. But we have no technology to help us deal with the reality of death. Instead we shy away from death and everything to do with it. It is as though we want to ignore that it has happened as quickly as possible and get on with our lives.
You could say we have evolved a culture that doesn’t so much promote living as shun the notion of dying. For a very long time we even took it further and treated old age, the stage before death if you like, as something decidedly unattractive and unworthy of our attention. As a cultural attitude, it was a curious way to live considering that sooner or later we would experience the death of someone close to us.
I had a client recently who was coping with the sudden death of their partner. A major burden in this client’s grief was the attitude of those in the outside community. After the burial, it was as if things should get back to normal as quickly as possible. But that is not the way it is with death. There is no set time in which someone should ‘get over’ the death of a loved one. Often it can take a long time, particularly if the death has been unexpected.
You find the famous five-stage grief model of Elizabeth Kubler-Ross and the four-stage model of John Bowlby misinterpreted again and again in this respect. In Kubler-Ross’s case, the Swiss doctor was actually describing the stages the dying person went through, not the bereaved who is left behind. But yet you find people coming to therapy with a knowledge that they are in the ‘denial’ stage or the ‘anger’ stage. That is a useful model if you have been diagnosed with terminal illness but not so much if you are the one left behind.
Certainly there is shock, denial, anger and eventually acceptance when we lose someone. And yes the Bowlby model does offer an insight with its ‘phase of numbing’ or its ‘phase of yearning and searching’ for the lost person that can last several years. But it would be a mistake to assume that grieving is like moving through a check list. We don’t pass through phases like an automaton, ticking boxes and then arriving at acceptance when all the pain is over. Grief is messy and confusing and because our culture has no room for it or no idea how to alleviate the burden of it, it has to be done in private, away from the public gaze. So it is isolating as well as everything else. And despite people’s best intentions, it is only when you are ‘better’ that are you welcome back in society again.
But the bereaved person needs an opportunity to fully honour the one who is lost to them, to relive their life in stories and memories, to feel they are beside them once more, to let them ‘live’ again in whatever way they can. Grief is worked through not by forgetting or ‘getting over’. It is worked through by re-experiencing, by remembering, by re-telling the stories of the dead person’s life again and again, by admitting the loss that their death represents and by celebrating their lives and their contribution to the lives of others. This would be in line with Sigmund Freud’s concept that he outlined in his famous 1917 paper ‘On Mourning and Melancholia’.
And yet it is this very place that our developed western culture lets us down. We have chosen to embrace life while at the same time ignoring the place of death in all our lives. While good friends and family provide a vital role in making up for this lack, therapy too takes up where society leaves off. Grieving is the process whereby someone we love is lost to us. It is a painful and sometimes lengthy way of coming to terms with that loss. Our culture’s desire for it to be quick and unobtrusive is unhelpful.
Sometimes the loss comes at the end of a long and painful illness. Sometimes it comes out of the blue. Whatever way it comes, it leaves us searching for meaning, for a way of understanding what has taken place and for a way of coping with it in order to move forward. In our increasingly secular world religion offers fewer people comfort in the face of death and so the business of making sense of it becomes even harder. But patience, openness, a listening ear and the recognition that grief is not some form of illness to be hidden away can all help it reach a natural end and allow something new to grow in its place.

Tuesday, October 21, 2008

How to be a Resistance Fighter

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

I was talking to a woman some time ago who told me that she had been to a psychiatrist. She had been suffering from depression and had gone to see if she could get some help. She described the experience as useful but then, for a reason she didn’t quite understand, she decided to break off the treatment and didn’t go back. When I asked her why she did this she said she ‘had just felt stupid lying there not knowing what to say’.
That was that, she moved on and, as it turned out, someone else joined our conversation so I didn’t get the chance to discuss it further. But something about what she said has stayed with me since.
Psychoanalytic psychotherapy tends to focus on what people say, the words they use, in order to probe for a deeper understanding of what is going on ‘behind the scenes’. The reason this woman gave for breaking off her treatment was, on the one hand, short and seemingly straightforward. But looking a little further it has an underlying richness that illuminates a central element in the therapeutic process.
She said she had felt stupid lying there not knowing what to say. What she was actually describing, without realising it, was a moment that has a fundamental role in analysis. It was the moment of resistance. Sigmund Freud made this a central element of his classical psychoanalytic theory. It is the moment when forces within us fight against our competing desire to get something out. It is the irresistible force meeting an immoveable object that physics likes to speak about. The result is inertia, a dumbing silence in which nothing is said and nothing can be said. The experience from the client’s perspective is one of not having anything to say.
We repress thoughts and ideas that give rise to unpleasure. It happens in all of us and it happens often without us having to consciously think about it. It’s not all bad either, sometimes repression is necessary in order to allow us survive certain experiences and situations. But once something is repressed it has a tendency to return either as a direct memory or in other more diverse routes. And since it was usually unpleasurable to begin with, our automatic reaction is to keep it repressed. This activity of keeping something repressed is called resistance.
So how do we know this ‘resistance’ when it occurs? Well, as I said, it is when a client reaches a point in their story where there are no more words, when they fall into silence, when they become acutely aware of the therapist's presence and when they see a picture in their mind and tell themselves ‘no I will not talk about that’. A great many people come to therapy and censor out what they will and will not talk about. At least at first they do, until they get comfortable with the process, trust their therapist and realise they are wasting their money if they are not going to be honest with themselves.
I don’t mean to be puritanical about this. Every one of us experiences resistance in the consulting room at various times when we are the client. Sometimes we win over it, and sometimes it wins over us. But that is part of the challenge of therapy, returning again and again to see if we can overcome this inherent desire to keep things buried, if we can get to new things, throw new light into our dark corners.
Resistance also surfaces in the way some people tell themselves why things should remain hidden and out of sight: it will upset us, it will bring back bad memories, there is no need to go into all that old stuff again in order to move forward. All of these are very reasonable reasons. Modern psychoanalytic practice, particularly Lacanian theory, believes that each session should follow the path that the client decides to speak about with only minimal interruption or direction from the therapist. It does not dictate that a client’s history should always be forensically sifted in every session. It does not demand that the scene of trauma or unpleasant experience be revisited relentlessly. The pace is set by the client and each session grows out of those things the client wishes to speak about. The rationale is that if something repressed is trying to find expression it will eventually makes itself known either directly or indirectly.
Resistance also makes itself heard in the inner voice that tells us not to enter into or continue with therapy, as my example above showed. Resistance emanates from within and is designed to stop us doing the work of therapy, of asking questions of ourselves, of sorting through the experiences of our lives, of undertaking any kind of work that will question the very things which resistance is trying keep hidden. In short, it has succeeded when it brings therapy to a halt before it has reached its goal.
The woman mentioned above said she felt stupid lying there with nothing to say. Not only had resistance brought her to a stop in what she wanted to say, it then heaped a sense of embarrassment and humiliation on top for good measure. It didn’t really matter what ploys she unwittingly used against herself, the end result was exactly what the unconscious part of her wanted. She walked away from therapy with her questions unanswered and her dark corners comfortably unperturbed.

Tuesday, October 14, 2008

The Lure of the Norm – 2

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

Last week I wrote about the effect that norms have on our lives. I’ve come back to the issue this week because there are a number of other important ways in which norms impinge on us, and not always in a positive way.
A client of mine has lived as a single person for many years and even though they would ideally like a partner and a companion, this client nevertheless leads a productive and fulfilled life. The group of friends this client socialises with are all in couples and any who do become single don’t remain so for very long. My client, therefore, is often the only one who is single in a more or less continuous way.
The interesting thing is that this client can sustain two very different positions at the same time. On the one hand there are moments when life can be lonely and when a companion, lover, partner, is something that would make all the difference. On the other hand, this client can lead a full and productive life, always engaging in new projects, living a financially independent lifestyle with a good circle of friends and with the freedom to do what they wish, when they wish.
The norm of being in a relationship is something that this client is aware of, particularly from the examples of friends and, indeed, from the wider society. Movies, books, TV and magazines are also brimming with the message that completeness and happiness lie within the human relationship. This is the culture in which this client, no more than the rest of us, belongs and that is something to be accepted.
Occasionally one of this client’s friends will offer a helpful suggestion as to ways that a partner could be attracted: a different style of presenting oneself, a different method of socialising, a different ‘look’ and so on. Curiously, it is times like this that my client finds most upsetting. Living as a single person; being different to the norm; the day to day realities of earning a living; socialising as a single person and dealing with life’s ups and downs without the benefit of a supportive other, are all manageable.
But when friends verbally apply the norm of the dual relationship lifestyle in the form of ‘helpful’ advice then it becomes problematic. By suggesting ways in which my client can ‘fix’ their single situation there is the implicit message that it is a wrong or flawed or unsatisfactory way to live. Now the norm is being actively applied rather than just passively accepted.
The effect is, as I mentioned last week, to create an insider-outsider way of thinking. Anyone who complies with the norm is on the inside and therefore is ‘ok’. Anyone outside the norm is made to feel as if there is something wrong with them.
An interesting question arises from this: why is it that those outside the so-called norm appear to have a greater understanding of issues such as diversity and pluralism than those inside it? We can all agree with the liberal viewpoint that there are many ways of living one’s life but in practise we can be quite conservative and prescriptive about how it should be done.
The lure of the norm can have an effect not only on the way we see others but on the way we see ourselves. When someone comes to therapy you often find that they tell their story in broad strokes. They will describe things they have done or said or thought or felt in terms of it being ‘just the way other people’ do or say or think or feel. There is a comfort in this. It makes them feel normal, just like everybody else.
But there is also a negative side to it. When we are like everybody else we stop being ourselves. And that is what psychoanalytic psychotherapy is searching for: the person behind the complex of identifications and projections that make up our social selves. For behind our social selves there is another us; the one that is not being heard, the one whose life is not being lived; the one whose needs are not being met.
The only way of finding out who this person is and what this person truly wants is to stop imagining that we are ‘just like everyone else’. In broad terms yes we are but in a particular sense we most definitely are not. And so the business of therapy is to find the vocabulary, the words, to describe this person more accurately and more precisely; to use fresh, new words that do not apply to everyone else in general or anyone else in particular.
We are looking for the words that refer only to the client’s uniquely individual life. It is what is often referred to in the text books as the search for ‘subjective truth’. It is the furthest thing from cliché or normative descriptions or hand-me-down opinions of oneself that you can get. That is the goal of therapy; that something new and unique is found where something old and general used to be.

Tuesday, October 7, 2008

The Lure of the Norm - 1

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

It’s good to feel like everyone else. The world seems so much more understandable. Things fit where they should fit and fall into their proper place. If we think and act like everyone else then we have evidence that what we think and do is ok. Why is it ok? Because everyone else does it, so it must be ok.
As circular thinking goes, the idea of a norm to which we can all aspire, and from which we can all direct our lives, is a comforting thought. Apart from giving us a sense of who we are and where we belong, norms can also give us a very useful way of judging unacceptable behaviour in ourselves and others. It is impossible to imagine murder becoming an acceptable norm. Or violence, or crime, or physical abuse, and you can probably make an even bigger list.
Norms have their uses. But there is another side to them. You often hear distressed people say,‘I just want to be normal, lead a normal life, do normal things’. It is the verbal expression of the desire to live the way others seem to live, without difficulty or fear or depression or addiction or phobias or oppression or discomfort with whatever the norm happens to be. As a desire, it makes sense. We move towards norms quite naturally. Sometimes we do it so well there is almost a homogenization of personality going on. Look at clubs or gangs or other tightly knit groupings within society.
But what if we don’t match the norms? Those who don’t are often made to feel like outcasts, sometimes bullied, or victimized or made to suffer varying forms of injustice. Those who don’t accept, or who cannot comply with the norm due to physical, emotional or intellectual limitations are judged harshly. If someone doesn’t fit that standard, then they can’t belong. Equally, those who actively choose not belong deserve what they get.
Different people can find themselves outside 'the norm' at different times in their lives. Sometimes they know why they are there but sometimes they don’t. Some cope by denying what is happening and you find this in addictions of all kinds and in some personality disorders. Others will believe they are unworthy to belong and you find this in anxiety and mood disorders. Some believe the norms are just plain wrong and continue to live as they believe they should. You see this most clearly in the area of sexuality and gender identity.
Does that mean that anyone outside the norm is wrong? No, throughout history there have been plenty of examples of norms that are not just or equitable or appropriate. Even in contemporary society you can see examples of this. Think of sub-sectors of society where physical appearance is paramount, or financial wealth, or liberal sexual values, or personal and corporate greed, or even drug or alcohol use.
If you look hard enough you can even find norms that are publicly accepted yet privately rejected. Enjoying good mental health is one such. It has a paradoxical relationship with society. Everyone agrees that it is a good idea and an essential requirement for a full life. And yet ensuring it through therapy is more often than not seen as a sign of weakness rather than strength.
New norms are continuously being devised and old ones discarded but we have yet to embrace the norm of personal enquiry into our own psychical lives. That would involve a true examination of the norms by which we live.
Next week I'm going to return to this topic in order to look at one or two other ways in which norms effect our lives, in sometimes negative ways.