Wednesday, 30 November 2011
Saturday, 26 November 2011
The Heroic Client is wonderfully polemical – a fearless examination of contemporary medical approaches to mental illness and its treatment. The book targets the pharmaceutical industry and the psychoactive drugs it produces. It attacks the medical model and its tendency to define mental illness reductively in terms of ‘biochemical imbalance”. The authors are sceptical of approaches that stigmatise individuals and reify the causes of mental illness by applying biological models and questionable diagnoses - an approach that turns clients into passive recipients of behavioural treatments and tablets. The authors ask for clients to be cast in a different light - competent, resourceful, and resilient – with the agency and self-efficacy to find solutions and make positive changes.
The book begins with a chapter entitled, “Therapy at the Crossroads”, in which the authors warn of a situation developing in which counsellors and psychotherapists exclusively work for medical practitioners. In these circumstances the medical model becomes the only way of explaining mental illness, with the therapist as an adjunct to medication, a fixer of broken people. In chapter two the authors challenge the supremacy of the medical model, calling into question the evidence base on which it rests and suggesting other constructions of mental health and mental illness that include the social context and the personal history of the client.
At the heart of the book are three chapters that provide an alternative to the established diagnostic approach. In examining the client’s story for signs of pathology the medical model misses an alternative interpretation of the client’s experience, one in which the client endures or overcomes trauma and loss through the discovery and use of social networks and inner resources. The ‘heroic client’ has a different tale to tell once he or she is freed from the template imposed on them by pathologising and medicating mental health professionals.
To support the heroic client practitioners ensure their therapy is client directed (chapter three) and outcome informed (chapter four). In my favourite chapter, rich with case material, the book highlights the importance of identifying and exploring the client’s theory of change (chapter four). The authors refer to research carried out on the innovative hypnotherapist Milton Erickson in the 1980s. Nobody could quite understand how he worked out which intervention his clients needed for recovery to take place. Eventually the researchers realised that Erickson didn’t know either, but that his clients did. Erickson listened to his clients and from them he discovered what they needed in order for therapeutic change to take place.
The book contains a critical examination of psychoactive medication. The fact that so many children are being prescribed stimulants and anti-depressants ought to concern us all. The authors explain just how flimsy the evidence is supporting anti-depressants, with many proving hardly more effective than placebos. So, this book is a cri de coeur – urging therapists to stand against the drug companies and the medical model and to listen instead to clients and their heroic stories. A very good read!
Thursday, 24 November 2011
Wednesday, 23 November 2011
Monday, 21 November 2011
I’ve just finished reading Darian Leader’s latest book, What is Madness? It’s an absorbing read – sometimes difficult – but ultimately, fascinating and humane. Leader explains the roots of psychosis using the psychoanalytic theories of Jacques Lacan and at times the explanations seem rather more complex that the phenomena being explained. The discussion of Lacan’s client, “Aimee”, for example, is labyrinthine in its use of competing psychoanalytic explanations for her psychosis and behaviour. That's why I appreciated Leader's comment that, "A psychoanalytic theory of psychosis does not imply a psychoanalysis of psychotic subjects" (294). Indeed Leader points out that individuals experiencing psychosis are suffering from too much meaning and do not benefit from the interpretations of therapists.
The book opens with a chapter entitled, “Quiet Madness” in which Leader draws our attention to a mistake commonly made in conversations about psychosis. According to Leader it is wrongly assumed that madness and the visible symptoms of madness are the same thing. For Leader the symptoms of madness - hallucinations, paranoia, delusions - are the individual’s attempt to make sense of the horror that has befallen him or her: ‘responses to madness, attempts at self-cure’ (17). This is a fascinating insight and extends my own belief that emotional disorders such as depression or anxiety are perfectly functional when seen in the context of the individual's history and current experience. This realisation ought to guide the therapists approach. Attempts to remove the symptoms of psychosis without helping the patient to explore their condition may well interfere in the process of self-healing. As Leader says, medication is useful because it tempers the intensity of psychotic symptoms but should also serve as a 'platform for dialogue'.
Leader emphasises the importance of symbolism and language when explaining madness. He sees madness as a breakdown in these structures, resulting in a terrifying loss of meaning and a disconnection from reality. In response to this the individual cobbles together what he can to make sense of his experience. This may show itself as paranoia or other delusions. The individual may believe he or she has been abducted by aliens if this restores meaning and makes sense of a catastrophic event. Psychotic individuals (and psychoanalysts?) cling to the most unlikely ideas in their attempt to make sense of the world.
In what Leader calls, “Quiet Madness”, the individual may appear balanced, keeping his delusional world under wraps and thereby achieving the semblance of normality. In an interesting chapter, Leader suggests that the serial killer, Harold Shipman, is an example of “Quiet Madness”. To his patients and colleagues he appeared to be a professional, kind and diligent doctor; but it was this role that enabled Shipman to stabilise his madness, part of which involved the murder of hundreds of patients.
Leader argues that quiet madness can erupt into full blown psychosis through various trigger events, often associated with rites of passage. Marriage, divorce or having a book published, all have the potential to trigger psychosis: moving the individual from ‘being mad’ to ‘going mad’. Events have this potential because they require from the individual a new set of symbols, and if the individual cannot symbolise this transformation they are at risk of becoming psychotic. Leader spends several chapters exploring this process so my summary here is incredibly superficial.
The final chapter of this complex book suggests ways of working with psychosis. Following his hero, Jacques Lacan, the author uses the metaphor of the secretary - to quote Lacan, the therapist ought to be, “the secretary of the alienated subject” (305). Leader likes this description, likening the therapist to a secretary who faithfully records, asks for clarifications and doesn’t intrude too much (305). The therapist as secretary helps the client to build a personal history, helps the individual to explore their own frame of reference and thereby helps in the work of self-healing. Leader is honest about the amount of time, hard work and commitment required to work with clients experiencing psychosis. He is hostile to therapies that seek to return clients to “normal” and measure success by how far their clients have adapted to social and community norms. Instead Leader suggests that an “investment in dialogue and a curiosity about the logic of that person’s world can open up new therapeutic directions and offer the possibility of change. Therapy can do no more and no less here than to help the psychotic subject do what they have been trying to do all their lives: create a safe space in which to live” (330).
Monday, 14 November 2011
First of all I have a beef with 3D. There are a few moments when 3D is amazing, when objects float in mid air between the viewer and the screen. But these moments are so rare that they do not justify watching a film wearing sun glasses. What the viewer gains in depth of field he or she loses in brightness and colour. I have seen two films in 3D just recently and with both I wanted to say, 'Can someone please put the light on'.
On a positive side the Immortals has some spectacular computer generated imagery and the beefcake actors are lovely to look at. But the film is a disappointment because it presents charactures rather than characters: the evil Hyperion is covered in scars and crushes people's heads when they bring him bad news. He seeks to destroy mankind because the gods failed to save the lives of his wife and child. Thus he holds a special contempt for priests, setting fire to one after dowsing him in oil. This is all we know about Hyperion, a villain with no back story and no complexity, someone we can hate with a clean conscience.
The heroic Theseus is physically perfect but incredibly boring. We know nothing about him except he loves his mum, wants to protect poor people and has been blessed by the gods. He is naive and seems like a school boy in a man's body. When he makes a speech to raise the morale and stiffen the resolve of his army it isn't convincing. One soldier shouts, 'Who are you to lead us?' A good question! The response, 'I'm an ordinary Joe like you' didn't inspire much confidence.
At the same time as this human conflict is being acted out to it's predictable conclusion, complete with references to future conflict, in case this makes money and a sequel is needed, a conflict also rages in the heavens. The Olympians led by Zeus intervene once Hyperion unleashes the Titans. Keats' poem Hyperion has a wonderful image of a Titan led on the beach, the poet is able to communicate the vast size of the Titan in just a few sentences. In this film, and with all this technology to hand, the Titans are presented as imps, moving at Benny Hill speeds, they seem an unlikely scourge. Zeus joins the battle and at this point the stylised fight scenes, with heads and bodies hacked and smashed, tip over into silliness and a memory of the Ninja Turtles came into mind.
But more disappointing than all this was the plot. The 300 was a much better film, despite it's right wing agenda and xenophobia, because it told a simple story well. Not so The Immortals; which is a shame because the Greek Myths contain eternal truths, wonderful metaphors and great events. The Immortals captures none of this. Even Troy was better!
Wednesday, 9 November 2011
Sunday, 6 November 2011
Friday, 4 November 2011
Today @Shrink_at_Large Tweeted the link to a funny Simpsons video in which Marg sees a therapist to cure her flying phobia. In true Freudian style Marg lies on the couch and free associates. With the “help” of her therapist she’s able to trace her anxiety to a time when she caught her father working as a stewardess on a passenger jet. I say in true Freudian style because one of Freud’s most famous cases, The Wolf Man, was neurotic, according to Freud, chiefly because he’d intruded on his parents having sex. In fact Freud himself wrote about seeing his mother naked on a train, an image the young Freud found both disturbing and memorable. As with a great deal of Freud, what begins as theory turns out to be autobiography.
So the scene in which Marg intrudes on her father serving drinks has a pedigree. Interestingly Marg also remembers other train related trauma, such as the engines of her toy plane bursting into flames or being machine gunned by a crop duster whilst walking past a field of corn. These are discounted by her therapist in favour of the more significant trauma of seeing her father working his way along the aisle. Marg’s phobia only becomes apparent to us when the Simpsons are given free air tickets. These are to buy Homer’s silence after he crashes a plane whilst pretending to be a pilot (which he does to get a drink in a pilots only bar). Maybe it’s this parallel that leads to Marg’s crisis: all her life the phobia had served as a defence, enabling Marg to avoid planes and airports - and ultimately the memory of seeing her father serving cocktails on an economy airline.