Summoned for Christmas.

Getting a summons for driving without due care and attention just added insult to injury,  I had been knocked unconscious, fractured ribs, vertebrae, punctured my lung and my left kidney. But my letter advised me that it would go better for me if I admitted culpability.  I felt hurt and not a little grievous.         

So when the magistrate, a pleasant enough lady about my age, asked ‘Do you plead Guilty or Not Guilty?’, I looked at her with what I thought was an innocent smile and replied ‘Can I plead Don’t know?’  She stared at me, heavy lidded.  Undeterred, I went on to explain that I could not remember anything about the accident.  The time from filling up with petrol in Fulwood and coming to in the ambulance has been erased.  It still is.  How wonderful it would be if everything else could be erased like that.

Warming to my theme with a degree of righteous indignation, I indicated that that particular road junction was difficult.  The independent witness had drawn attention to the tall grasses that obscured vision, the junction is at an angle and at the top of a hill, so you had to look over your left shoulder to see anybody coming up from Sheffield while cars coming the other way could disappear into dead ground. Besides I hadn’t received the prosecution witness statement.      

I was clearly perceived as being awkward.  Moi?  A doctor and therapist; a model of compliance and understanding – the very idea!  Heads edged together as the bench  decided what to do. Then with anxiety glinting in her eyes and a calm politeness that indicated caution, the good lady advised that I get a solicitor to represent me and return on the 18^th, just a week before Christmas. I bowed to the court and departed with dignity.   

Mr Johnson was about my age, somewhat overweight with bluff, friendly manner;  Rumpole of The Wicker.  He looked me in the eyes, ‘Well, doctor, there’s no point in trying to defend this.  They will screw you for every penny they can.  You can’t win.  You’re a professional, you are perceived as rich and relatively privileged.  It’s not fair, but who said society was fair?  Best to plead guilty, explain the mitigation and accept three more points on your licence. I can come and do that for you if you like. It’ll cost you seventy pounds.’  

That agreed, he expounded on how much the law bends over backwards to protect the criminal.  ‘You can stamp on somebody’s head on a Saturday night in the Wicker, spend a night in the cells, and they’ll fine you a hundred quid.  I received a parking fine of £70 for leaving my car in the road round the back. I asked the officer if I could pay him an extra ten pounds and go in and rob ASDA, because that would only incur a fine of £80. But the law doesn’t treat decent, honest middle class people very well. And you won’t get legal aid.  You’ll have to pay for everything.’  

He picked up his blackberry, stubbed at the keys with pudgy fingers but couldn’t get through.  He held it at arms length and stared at it cross eyed as if trying to hypnotise it into submission. He looked at me, sighed, jabbed at the object in his hand.   ‘And this is the magistrates court.  They’ll play me music in a minute!’   

‘But don’t these things drive you mad.  I was at my doctor’s the other day.  As soon as I came in, he started typing away on his computer.  ‘Nigel, I said, look at me, look at me!’  I could have had a heart attack while he was typing away and he wouldn’t have noticed.  And if eventually he did, he would have written his report first and only then called the ambulance!’

‘The world has changed, doctor, changed beyond recognition.  And we’re seen as dinosaurs.  Nobody seems to understand any more.  And nobody knows anything!  None of my staff know their times table.  Do you believe it?  What are seven sixes – I ask and they look at me blankly and say ‘Dunno.’  He raised his eyes to the ceiling.  

We laughed!  It was ridiculous; no point in being too serious about it.  It was fun being grumpy for a bit. I’d found a kindred spirit, a friendly ghost of Christmas past – right out of Dickens. It was going to be a good Christmas after all.

 

Dr Haggard’s Disease

It was 1937; and there was trouble on the horizon.  They recognized each other at a funeral. There was a spark.  Then they found they were sitting next to each other at the Cushing’s dinner party.  He was Dr Edward Haggard, house surgeon at St Basil’s and a bit of a loner; she, Fanny Vaughan, a delicate dark beauty; older, more sophisticated than he and married to the Senior Pathologist.  They conversed easily.  She made him feel confident and clever.  She laughed a lot. She insisted they talk about pleasure, not medicine.  Wickedly, she asked him if surgeons made good lovers.  Amazed at his temerity, he replied ‘try me’.  

She did. Their affair started a few weeks after. It was she who made the running and set the limits. They would meet, make love in his room, and then part without agreeing further assignations.  He would be in an agony of anxiety until she reappeared.  But slowly, a pattern emerged.  She bought stuff for his room; rugs, lamps, bed cover, flowers unguents, transforming it from a monastic cell to a boudoir.  Then she got careless.  On a whim, she came to meet him in the hospital.  They made love on a bench in the hospital lobby.  She was spotted and word got back to her husband.

When next Edward met the senior pathologist, they argued.  Dr Vaughan hit him and he fell down the stairs, breaking the neck of his right femur.  It was a double blow.  Fanny broke off their relationship and refused to see him again. 

Edward’s recovery was slow.  It was as if the pain of his grief was transferred to the pin in his hip.  Whenever he thought of her, it attacked him.  He became addicted to morphia. 

He was sacked from St Basil’s and left to take over a remote single handed general practice on the south coast.  He thought of Fanny constantly and was determined to keep their relationship alive n his mind. At times, her presence was so strong, he could smell her perfume, hear her voice, feel her softness of her skin. He even took to wearing her fur coat.

Then James, Fanny’s son, came to visit him, a slim delicate dark haired boy, much like the mother. He was stationed at the nearly RAF base. They became friends. He learnt that Fanny had died of nephritis, but he felt he had regained her through the son.  One day, while treating James for a shrapnel wound, he noticed that James did not only have his mother’s soft skin, he had ambiguous genitalia and some breast development. It was like he was transforming into her. James was killed when his Spitfire crash landed.  Edward cradled his head in his arms, kissed her for the last time. 

As in his other novels, Spider and Asylum, Patrick McGrath has written a dark gothic suspense on a background theme of mental illness. What was Dr Haggard’s illness?  He had fallen in love with Fanny, and whereas she was much more realistic and in control,  he had imbued her with all the virtues and attributes.  He made up stories.  She was the victim bride of a bully. He had to rescue her. She would run away with him. She was the  missing half that would make him whole. But for Fanny, it was an affair, a thrill, a bit of excitement in an otherwise dull life. It had a beginning, a climax and an end.

The ending was cruel, she was ruthless.  He was devastated. But even after she rejected him, Edward still continued to worship her idea. He suffered agonies in his hip from his broken heart but he would not, could not, let go. Without her, there was no meaning in life. 

Meeting her son restored the connection, but that was when reality and fantasy entwined.  The body was transforming into hers’.  He became his angel, a high flyer, who would die consumed by fire. His love had been returned to him.  And Edward was transforming too into a small figure in a black fur.  He was merging with her.

So as the story limped its painful path to a catastrophic conclusion, we realize that Edward is not only deluded but hallucinating.  With penetrating insight and consummate skill, McGrath has once again demonstrated the power of infatuation to instigate the decline of a lonely personality into obsessive psychosis.

Edward Haggard was always at risk.  He was intensely solitary, much preoccupied with metaphysics and passionately fond of poetry.  His father was a rector and Edward ‘had all the makings of a certain type of priest’.  It was predictable that he would imbue their affair with so much more meaning than she. He would create a phantasy (Melanie Klein’s spelling) out of it and would continue to inhabit that phantasy even though the reality had long gone.  His disease was an excess of meaning, a toxic imagination.  What started as the sort of identification that all lovers experience, descended by degrees to fixation, obsession, delusion and hallucination.  There is a point in the story when we realize that things are not right,  perhaps the embodiment of Fanny in James.  After that we begin to question the whole fabric of the story.  How much of it was delusion and when did it take hold?  There was probably an affair – some crisis had to propel Edward out of Earth’s orbit – but did he ever meet James, did James ever exist, did Fanny become frightened by his obsession with her and was Ratcliffe really the boorish bully he described? 

The passionate phantasy of love cannot last.  It has to be transformed into the fond reality of everyday life or shatter and be rationalized as a mistake.  Edward could do neither.  He preserved his meaning, fed it, allowed it to grow until it took over his whole personality, disconnecting him from the conventions of society and ultimately defining him as mad.  In selfishly seeking out the sensitive man who would provide some meaning to her life,  Fanny never considered the possible consequences.

 

 

Tempus Fugit

Time flies, the old man cried, as the alarm clock struck him on the back of the head.  For the elderly, time does indeed fly; not just the clock but the days, the weeks, the years.  Time seems to shorten, to press in on itself, as we get older.

But for the young, a week can last forever.  Remember how we measured our age in fractions of years.  ‘I’m seven and a quarter’, I’d reply if asked.  And that 13 weeks I boarded at school felt like 13 years.  Mathematicians have suggested that our perception of time is relative to the duration of life.  A year is 10% of our life when we are 10, but only 1% when we are 100. 

Personal time is perceived according to what new happens.  For children, the milestones are much closer. Their days are so packed with novelty, life is a constant stream of stimulation; their attention span so short that expectation seems endless.  As we get older, and accumulate responsibilities, the thrill of anticipation is replaced by the burden of obligation. There is little novelty, just more associations to work through, organise and file away. Too much to do; too little time!  With the end on the horizon, there is neither time nor inclination to look forward, so we tend to look back, reminisce, regret a bit and try to put it right. Events and thoughts collapse in on each other until time itself is confused. 

Although our perception of time passing can alter through life, our body has a remarkable ability to mark time. It knows exactly when it’s time to go to sleep, time to eat and time to defaecate, and when we change time zones, it is some time before this body clock can be reset.  So.do we have some kind of accumulator in our brain that records the oscillations of temporal neurones, or the beats of the heart?  Probably not!  Nobody has identified a cerebral clock, but neuronal and hormonal activity is responsive to environmental cues or zietgebers like day/night cycle, day length and temperature.  So while real time is relatively static in our bodies, our perception of time is elastic.  When I am running, the same route goes much more rapidly if I am in a relaxed meditative state than if I aware of my performance, even though my pulse rate is much the same.  Time is like a river; the flow may be constant, but the calms, rapids and waterfalls of our thoughts can make seem to slow it down or speed it up.   

It has been suggested that our perception of time depends on our degree of arousal.    During extreme arousal, time slows down and intensity of experience is magnified, our memory expanded.  The more energy the brain spends in representing an event, the longer it lasts.  We can get more done in the morning when our level of arousal is at its optimum.

Think of how slowly time goes during a crisis. If we are going to crash, everything seems to go into slow motion. You have an argument with your lover and then part; you remember every word, every gesture, every look. Time dilates  Psychologists call this amydala memory.  When the panic button is pressed, the brains cine film speeds up.  If you’re laying down a lot of memory, time goes by a lot more slowly, but does it just seem that way in retrospect because there’s more to play back? 

Generally time passes much more slowly if you are waiting for something, but that too depends on your perspective. Take two men at a football match. The score is 1-0. There are ten minutes to go.  To the one whose team is ahead, that ten minutes is an eternity of dread, but to the others desperation to score accelerates the final whistle.

It would seem that our perception of time is an emotional quality.  Time is suspended when you are in the thrall of love, but if you know you must part, then it speeds up alarmingly.  Samuel Johnson said that there is nothing like a hanging to concentrate the mind, but he could have equally transposed ‘time’ for ‘mind’. 

So is our perception of time a factor of the emotional energy of our thoughts?  The more energy we devote to things, the more we are conscious of time. Take boredom, for example, or depression.  Boredom is not passive or boring. Far from it, boredom is an active state of anticipation and frustration; an urgent need for something to happen, a  desire to kill time and attack your situation. Similarly most depression is a highly aroused state of anxiety and despair.  Driving my car down the motorway is the most boring thing I do. A journey to London is like a trip to the moon.  But if I listen to an audio-book at the same time, then I hardly notice it.  Children (of any age) who can lose themselves in creative play are rarely bored.  Boredom more usually applies to administrative tasks that I resent, like writing a grant application, filing a report or completing the tax return. Such a waste of time! But if I am preoccupied by some concern, that anything that takes me away from it, becomes boring. Perhaps time passes so slowly for the young because their lives are so occupied by the anxious frisson of change, that for nothing to happen is intolerable.       

Time races by if we’re absorbed in a task.  It’s a form of meditation. I have spent two hours writing this article and yet it seems I have only just started. The same phenomenon occurs if we watch a good film or when we’re relaxed at a dinner party, talking to friends.  This acceleration of time is enhanced by alcohol and recreational drugs.  I can lose time having a good time. During therapy, the 50 minute hour goes very quickly when the client is engaged and relaxed, but if he’s defensive and resistant, it drags.  We can spend seven hours asleep completely unaware of time yet if anxiety keeps us awake all night,  the slow blind slither of night-time is exquisite torture.  

So how should we spend time?  Should we seek solace in creative activity and allow time to speed by unnoticed?  Or should we seek to extend it with stimulus and novelty in an accelerating desperation to avoid the end?   What is the bigger waste of time?

 

Time and Tide.

Time is the measure of things moving.  It’s like history; one bloody thing after another, but if nothing happens there is no time, ho history, nothing.  We know by determining the rate of decay of radioactivity in rocks that the earth came into being 4,558 million years ago.  This sounds a bit like Archbishop Usher, who calculated that the world was created 4,404 years ago. 

 Time cannot be thought about with considering space as well.  Time is the fourth dimension.  We only need to go out and look at the night sky to see it happening.   The light that reaches us tonight set out from the nearest star 5 years ago and from the most distant galaxy, many thousand years ago.    

Isaac Newton thought time was always there; a God given fact, space was the constant stage upon which things happened, and light always travelled in straight lines. It was not until Albert Einstein that anyone dared to question these ‘facts’.  Einstein deduced that things that seemed to take place at the same time from an observer on earth, would occur at a different time if you were passing in a rocket. Events are perceived at the speed of light and if we were to pass through space near or at the speed of light, time would slow and stop.  Both time and space are relative to the observer.  Moreover light could ‘bend’.  The sun, 8 light minutes away probably did not exert an attraction on the earth but it warped space so that objects had to move in a fixed trajectory around the sun and light had a trajectory too. But it was Arthur Eddington that came up with the ‘proof’ by studying the light from stars behind a solar eclipse that light could appear to bend around massive objects  Eddington illustrated this by throwing a melon into the middle of a tautly held tablecloth and then rolling a walnut around the depression created.  Eureka!

If things are completely inert and nothing changes, then there is no time.  As soon as things change, there is time. So time and space are a continuum.  The approved wisdom states that time started with The Big Bang some 5000 billion years ago.  Since then matter, galaxies, stars, planets are speeding apart and getting colder and colder.  At one time, it was thought there would be a limit to the expansion and as mass  decelerated, gravitational forces would cause it to start to implode and then time would run backwards.  That’s what the equations would predict.  And how can we begin to understand what caused the big bang originally is it wasn’t some coalescence of mass and energy.  Nevertheless, physicists now seem convinced that there was a big bang and everything sped apart and is still accelerating and must eventually disappear.  Then nothing will change and time will cease again. Part of the evidence of the big bang came from the analysis of interference or white noise on television monitors.  I maybe an old cynic, but in astronomical physics as with everything else, what value evidence?              

So do we move through time or does time move through us?  We may be able to see time past, both in cosmological terms and what is fixed in memory, but we cannot see what is to come.  And there’s a problem, if time passes through us, then everything is preordained.  There is no free will.  To a certain extent that is true.  After the first few years of life, we create for ourselves a template for the way we will react, the choices we are likely to make, how our future is likely to be.  As the Jesuits said, give me the child at 7 years of age and I will show you the man.      

But doesn’t this all depend on the assumptions we make.  How do we know?  Physicists talk confidently about the distance of stars, how far galaxies are away, but how do they know?  Is there any independent measure of this that doesn’t depend on assumptions about time and space?   If space is curved like a doughnut,  could we not be looking at ourselves coming back?   Does Einsteinian geometry predict astronomical observations or does it just explain them?  Just as the design of a camera, the curvature of the lens, the shape of the aperture, determines our perception of the object, so image we have of our universe depends on the instruments by which we observe it, the assumptions of our  computers and the conceptual limits of our frontal cortices. The ancient Egyptians believed that the sun travelled across the sky every day and the moon did the same every night.  How much more satisfying life must have been then.

 

Of families, fathers, failures and forgiveness in the whimsical world of Wes.

What kind of person are you?  Since when have you been so perfect?  When did you last fuck up?  What are you going to do about it?

Royal Tennenbaum has been evicted from his family by his wife, Etheline, for playing around. He is casual, careless even as he explains it to his three genius children,  Chas, the financial whizz, Richie, the tennis star and Margot, the playwrite.  17 years later he wants to be reconciled with his family; he wants to make amends; he is seeking redemption. Besides, he has lost his money and has nowhere to live. 

But by that time, his children are pretty messed up. Chas is neurotic; he has lost his wife in an air crash and is bringing up his two boys (all three of them dressed in identical red shell suits) in a rigorous health and safety regime. Richie is depressed; he broke down during a grand slam final and now travels the world alone on his private yacht. Margot is bored, married to a neurologist, but spends most of her days locked in the bathroom, secretly smoking and watching television.  They are all regressed. Gratification is either oral, as in Margot’s cigarettes, or anal, as in Chas’s schedules and lists. There is not a lot of sex and what there is, does not seem much fun. Their lives are fantasy; the real world is anaesthetized. They are bored and aggrieved. In their own ways, they all feel their father has betrayed and failed them. They are stuck.     

Etheline holds the balance between love and hate. She is the controller, the Jewish mother who single-mindedly created the three gifted prodigies. Narcissistically embroiled in her own sacrifice, she maintains the split between the good mother and the bad father. She wants retribution. Her children are her agents, but at the expense of their own freedom.  They have never been able to separate from her. They need a third point of view provided by a redeemed father in order to leave the family jungle and explore the savannah.  . 

To gain entry to the family home, Royal pretends he is dying of cancer. The children return too, bearing their grievances and sorrows.  Margot was always treated as the adopted child by Royal, who dismissed her first play as ‘a lot of kids running around in animal costumes’.  Richie is still in love with Margot since their teenage escape camping out in the Africa section of the Natural History Museum.  Chas retains the BB lodged between his fingers after being treacherously shot by his father during a game at the summer house. ‘But you’re meant to be on my team!’  Perpetual grievance is a failure to thrive. The world is not composed of perpetrators and victims; it is much more complex and messy than that.   

Royal’s deception is discovered.  He is sent away again, though not before he has made contact with his family by subverting his grandsons to the excitement of risk.  Slowly, the family come to enjoy the vital intention of his comic duplicity, but reconciliation is only complete after he has really died.  

As long as their parents are unable to behave as adults, the children cannot grow up either. It takes Royal’s return and his sincere expression of remorse for Etheline, Margot, Richie and Chas to risk forgiveness and feel pity.  Royal is an agent of remembering. The  acknowledgement of his failure as a father and his desire to make amends awakens the  children from their symbolic death. He has given them the greatest gift any father can give their children; his humanity. Their lives can now be realized through forgiveness. 

To err is human, to forgive divine. To grow in wisdom, we all need to forgive the bad and  bring out the good, but that can be so hard to do.  It is said that you can only forgive others if you forgive yourself, but some just accept all the blame; they forgive everybody else but never forgive themselves. The hardest thing of all is to acknowledge your own faults and sins, to be open about them and to forgive them. Yet that way is life.

So, express remorse  without qualifications. Hold up your hands.  Say, ‘Yes, I’ve behaved like a shit!’  Royal Tennenbaum has had to come to terms with his own selfishness and the abandonment of his children.  Gestation, even late gestation, is the parental act of becoming oneself.  That way is life, because it accepts the essential human failings without condoning the misdemeanors that have ensued.   

But what does it take to forgive or be forgiven?  Royal could only be forgiven if he threatened death. In a curious Christian re-enactment, the father had to die so that the children might live, if not in reality, in meaning.  The mythic father has to be killed off and redeemed by a different kind of dad, less yet so much more; a dad that can be forgiven and eventually forgotten. 

This article was inspired by and in part plagiarised from a talk, entitled Failing Better, which was presented by Dr Alan Lidmila to The Hallam Institute of Psychotherapy on Saturday 28^th November at the Showroom, Sheffield,  following a showing of The Royal Tennenbaums, directed by Wes Andersen.   

 

Of daughters, damage and destruction; is that the legacy of Mrs Klein?

Melanie Klein might be said to have founded the British School of Psychoanalysis, though it was never as formal as that. There was a never a ‘concrete school’ more a movement dominated by the ideas and interpretations of Mrs Klein. 

 Psychoanalysis was (and still is) very incestuous.  There were not many psychoanalysts and most of these lived and practiced in NW5, near Maresfield Gardens where Freud lived and worked.  They still do. They were all in supervision or analysis with each other.  They reinforced the ideas of their ideological leader, but at the same time were intensely jealous of each other.  Given the Jewish origins of psychoanalysis, it is surprising to encounter how much psychoanalysts cling defensively to ideological dogma, despite evidence that it may damage some people and how suspicious, dismissive and paranoid, they can be to those who do not share the same beliefs.

Although Mrs Klein was not as profilic, wide ranging or eloquent as Professeur Docteur Sigmund  Freud, her work has been very influential.  She was the first to appreciate that the child, even a child as young as two or three, inhabits a symbolic world of meanings, phantasies (her spelling)  and needs the agency of the ‘mother’ to understand and work through them.   In particular, Klein postulates, young children find it difficult to reconcile  contradictory elements in their mothers’ behaviour.  They split them apart.  There is the loving mother and the disapproving mother; the good breast and the bad breast.  She called this the paranoid – schizoid position.  We all know it well. The suspicious and defensive  remain locked into it all their lives.  The media encourage such splitting;  the government is either good or bad, wrong or right.  And all us can return to such polarized attitudes at times of stress.  Anger, envy, resentment, grievance, condemnation and lack of compromise are, if not everyday, at least frequent examples of this. 

 The project of Kleinian analysis might be said to be the reconciliation of the polarities of human behaviour to achieve what she called the depressive position.  This doesn’t sound much fun and it’s not, but the concept is crucially important.  It is only by healing the split in our thought and behaviour,  that we gain understanding, empathy, concern, forgiveness and reconciliation; we learn to accommodate and integrate our own behaviour and that of others; and we find ways of working with other people.  But we have to experience the depressive position time and time again.  Every time we experience a loss, we have a choice, either withdraw and cut off or engage and find a way through.  The depressive position is a state of mourning.  Klein would say that we mourn the loss of the idealized ‘mother’ and discover the reality of   ‘Is that all there is?’ (sic Peggy Lee).  Working through The Depressive Position,  leads to personal growth.  Loss is associated with change and often a burst of creativity. 

Klein drew on her own family extensively for her ideas; her archetypical Jewish mother, her unhappy marriage and her children.  The children were her first analysands. Melitta, her daughter, has 370 hours of analysis with her mother before the age of 9.  The idea seems repellant.  It is a wonder she survived it.      

Nicholas Wright’s powerful and disturbing play is about mothers and daughters.  It is 1933. Mrs Klein, powerfully depicted by Clare Higgins, has just learnt of her son’s death in a climbing accident.  Paula, a refugee analyst, fleeing from Germany, has offered to be her secretary.  Melitta (little Melanie) her daughter, also an analyst, arrives with a letter that she has written, informing her mother that Hans has committed suicide, but this is her latest and most powerful act of vengeance on the hated mother. 

Melanie found Melitta interesting as a child, but could not show her the love she needed.  It seems that she suffered post-natal depression after the birth of her daughter and went away for an extended period leaving Melitta to be brought up by her baba (her grandmother).  And when her mother returned, she didn’t so much love and care for her daughter; she analysed her. Klein inaugurated the British School of ‘object relations’   Melitta is an object, not a love object, more an object of interest and curiosity. There is interpretation but no human warmth.  

As she later complained, Melitta had no life of her own.  Her mother has appropriated it; her marriage, her career, everything.  Wright’s play shows her locked into an unresolved rebellion with herself, caught between the mother she idealises and the mother whom she hates.  She cannot reach the depressive position.  She has to attack the mother she hates while craving the affection of the one she loves.  The letter about Hans suicide is a murderous attempt to rid herself of the mother who dominates her life.  Melanie, for her part, is also split, she wants her daughters love, but hates her betrayal.  In the  transference, Melitta assumes the symbolic impact of Melanie’s own mother.  As the situation builds to a crisis,  provoked by the disclosure that Melitta has gone into analysis with a competitor, consorted with the enemy as it were, Mrs Klein throws a glass of wine at her and rubs the torn up letter in her hair. As Paula notes, she makes a symbolic attempt to drown her daughter in urine and rub faeces in her hair.  The awful irony is that we can only understand this because of the writings of the mother.  There was no father to rescue either of them, to find the third position, to make sense and space of the pernicious diad, to lead them out of the claustrophobic forest onto the savannah.     

And what of Paula?  She plays the role of the good daughter with Melitta locked out of the house as the bad daughter. She selects Melanie as the idealized mother she never had.  The play ends with Paula in her first session of analysis with Melanie, which cannot be interrupted while Melitta frantically rings the door bell.             

So should we think any less of Melanie Klein because of the way she damaged her daughter?. Theory is all very well but a child still needs to know she is loved. And doesn’t the analysand, the symbolic daughter, also need containment and support to gain the confidence to grow.  Surely to withhold that can lead a fragile person into a unhealthy state of dependence.

Or should we think more of Mrs Klein because she had worked through her own  depressive position and offered her insights so that the rest of us might understand. 

Or should we just accept and make a balanced appraisal? Understanding  doesn’t mean we have to follow the teacher.  That must be a reconciliation of our depressive position.    

Mrs Klein has been playing at the Almeida Theatre in Islington, with Clare Higgins, Nicola Walker and Zoe Waites and brilliantly directed by Thea Sharrock.  

 

In praise of uncertainty

The Archbishop of York, John Hapgood, once famously declared that ‘the lust for certainty was a sin.’  This statement was surprising, shocking even, coming from the second most important churchman in the country; a man who engaged with the ‘certainty’ of God. 

We live in an uncertain world.  We can never be sure of anything, truth, fact, reality, faith; they are all illusion.  Nothing is absolute; there are contexts, conditions, caveats and excuses.   Alter the perspective and the conclusion changes. We can never know the right course of action; all we can do is weigh things up and make a decision, that seems best at the time. 

From the dawn of civilization, people have needed to invent myths to explain the things they didn’t understand; day and night, the weather, the changing seasons, the migration of animals, the growth of crops, family relationships, love, anger, grief, madness. These ‘certainties’ were ascribed to the deities, who alone understood the ways of the world and  required appeasement.      

But man is restless and curious.  There have always been the neurotic ones, those who would challenge the elders and question the collective wisdom; the ones who noticed the missing stair in the double helix.

Man’s neurosis has made him successful. Curiosity has generated the knowledge that has turned men into Gods; Gods who knew how to grow their own food, create their own shelter, and migrate to every corner of the globe. The first revolution in human society, agriculture and the settled community, was followed some thousands of years later by the industrial revolution and the growth of massive cities, but now we have been taken over by the third wave; the electronic revolution, further disconnecting us from the tangible traditions of home and tribe. This new artificial world is based on belief and expectation.  Money, property, occupation, marriage, family can no longer be relied on. There is no absolute security.  What we regard as our wealth, our security, is more a matter of collective trust than any real commodity.  What sustains us as family and home is the faith that it is so. We are consoled by our illusions, up to a point.  

But there is a paradox; the more illusory and insecure our existence, the more we demand absolute certainties.  Our need for security permeates all aspects of our existence.  Daily administrative concerns domesticate an existential insecurity by providing the illusion of control. This is not so much a lust as a fundamental human need for shelter; what psychotherapists would term containment.  We need to know that our savings will be secure, that we will get effective treatment, that our children will get the best education, that we will be promoted, that our wife will love us forever.  These are our certainties. But all too often we worry about whether it will rain tomorrow, whether the rubbish will be collected, the mail delivered, the roads gritted.   We are panicked by a glitch on our computer,  enraged  by transport delays,  devastated by the loss of our mobile and tyrannized by regulation.   

To provide the reassurance to calm our fears, we demand more information.  We need to know what we can never know.  So we build glass and concrete temples dedicated to science, create multinational corporations to look after our money and service our existence and construct whole cities dedicated to treating the incurable, unexplained malaise of a society, that is sick with worry about being worried.  These are all illusions.  The reality, as we have seen all too clearly, is that our money can never be safe, the basic services, energy supplies, water, food, are finite, our shelter can be destroyed and life is an incurable illness.  But how desperately we need those illusions,         

In our uncertain, artificial world, try as we will to distinguish reality from fiction, truth from lies, right from wrong, the good from the bad, we fail. And this failure leads to regulation, because regulation provides the structural illusion of certainty. So we regulate every aspect of our existence – banks, hospitals, schools, transport and food.  So just as our ancestors never questioned their deities, so we put our trust in the God of  Science, the mysterious divination of evidence, the Rule of Law, the Oracle of Psychology, the Security of the Bank and The Power of Government.  Not to do so invites chaos or so we fear.  And our collective psyche abhors tension and chaos.    

We need to know where we stand, what will happen. So we look to our leaders to guide us.  Our politicians have to appear certain, lawyers trustworthy, businessmen reliable, doctors omniscient and efficient.  They all trade in absolute truths. We make Gods of them.  We have to believe that when our politicians tell us they will cut taxes, improve medical services, increase the state pension for old people and get us out of recession, that this will happen. But politicians are false gods. Certainty for a politician is at best what seems to be the optimal solution at the time and at worst sheer deceit and manipulation.  To be certain is to appear to have control and control is power.  And we need to know our leaders have the power to look after us. The media, the watchdog of an insecure public, demands certainty and will destroy those whose predictions fail to happen, whose promises are unfounded.      

It’s a game of pretence, a case of keeping one step ahead of disaster. Politicians are theatrical exponents of deception. Lawyers conjure truth out of doubt.  Businessman are skilled manipulators. Doctors trade in reassurance.   But they are only giving us what we want; the semblance of certainty in an uncertain world! 

Far be it from me, a lusty sinner, to take issue with the good archbishop, but I think that lust for certainty is less a sin and more a sign of insecurity.  Lust implies the need to own, to have power and control and that makes us feel secure.  It is what this desperate need leads on to, what it justifies, that are the sins; the deception, division and conflict, war, even murder. Doesn’t religion, in preaching a doctrine of certainty generate sin as much as any other conviction.  God save us from those who have conviction!         

Certainty forecloses discussion, precludes compromise, stifles creativity and promotes division. It inhabits a world that is split; right or wrong, black or white, good or bad.  The illusion of certainty  requires deception, suppression and secrecy.  It denies the real world and leads to conflict. There must be winners and losers.   

Uncertainty is freedom and life. We need to accept uncertainty if we are to understand the nature of things and change them.  Knowledge is not written in stone, but on shifting sand and the tide keeps coming in.  We should marvel at what we don’t know, engage with the fascinating complexity and the stimulus for understanding. Curiosity is one of the greatest joys of life. 

If we are to live together in harmony, we need to acknowledge there are no absolute rights or wrongs; only what we decide is so. Everything has its contexts and conditions.  Laws are there to be broken if conditions dictate that is the greater good.     

But society has to deal in absolutes, otherwise there is no society.  And the bigger society is and the more complex, the more the individual needs to be regulated.  No man is an island … Society determines that we make decisions, obey conventions, laws, that our word is our bond.  Doubt and inconsistency could lead to chaos and disintegration.   But society is too large to trust or to understand. It is an artifice that must be accepted advisedly not absolutely.  .   

There is a third way; that is to acknowledge the necessary regulations of society while at the same time realizing and understanding the complexities and uncertainties of human existence.  (Give unto Caesar that which is Caesar’s ……….).  Decisions should not be imposed by obligation but arrived at by creative compromise.  Accept society’s necessary regulations, but retain the personal uncertainty, because it is out of uncertainty that we derive identity and meaning.   Too much regulation will breed fear and stifle life; too little threatens distintegration.  Decisiveness can lead to sin, but indecision may slide into chaos.  As ever, we need to find the golden mean

Day must follow night

and life will last forever,

but the watchman spins his coin

and the way it lands is never. 

 

The Shiver Spot.

The weather was a bit grim this morning; just off freezing and pouring in rain. I slipped on the mud and was soaked through in seconds, losing any insulation afforded by my leggings.  My hands soon felt like blocks of ice, but my back, which was covered with a winter running top and a light waterproof , remained dry and warm and I didn’t feel chilled.  I wasn’t even shivering, but this got me thinking exactley where we feel cold.  

I think we feel it at the back of our necks, across the shoulders and a few inches down the centre of our backs. I call it the shiver spot.  It’s where shivering seems to start.  Say you have washed in the open air or been for a swim in a cold river, and your teeth are chattering, if you pour hot water onto the shiver spot, or better still get somebody else to do it, then the chattering and shivering stops immediately.  The effect is still there if you pour warm water over your shoulders though less intense. 

But why is that?  What is special about that spot?  Well in animals it is the major subcutaneous site of brown fat, that particular type of metabolically active fat that generates heat in animals that live in temperate or cold zones. Brown adipose tissue (BAT for short) is well supplied with sympathetic nerves, which are activated by cold;  a   fall of temperature of the skin of the shiver spot of just a few degrees is enough to trigger an anticipatory thermogenic response that will prevent a drop in core temperature. This area has, as it were, a hot line to the brain. A drop in the temperature of the hands and the feet is not enough to cause a thermogenic response probably because this induces a local vasoconstriction that shunts blood away from the skin and returns it to the trunk via counter current heat exchange between the major arteries and veins in the centre of the limb. 

A fall in the temperature of the skin at the back of the neck is a much more immediate indicator of an imminent fall in core temperature because the back is more exposed – think of the way all mammals curl up in the cold.  Also that area at the back of the neck is close to blood vessels supplying that part of the brain stem that houses the life support systems of the body, so the temperature of this area must be maintained as a matter of necessity. 

But what about a rise in temperature? Does this area also stimulate heat loss?  I don’t think it does.  But if not, is there any sweat spot.  Might it be the mouth?  Foods that produce a sensation of heat in the mouth stimulate sweating immediately.  Does gustatory sweating have any role in temperature regulation?  Or is there another area?  Does anybody know?

 

How to keep your shape when all about are losing theirs; is there an answer to the current epidemic of obesity?

For the last twenty years, we have been getting noticeably fatter.  Rates of obesity in America and Western Europe have more than doubled since the nineteen eighties.  And the problem shows no sign of diminishing. If trends continue, it has been estimated by 2050, one in two adults and one in four children will be obese with all the health risks that entails;  coronary heart disease, strokes, high blood pressure, diabetes, cancer, arthritis, gallstones, accidents and a profound reduction in life expectancy.  Alongside loneliness and depression, obesity is one of the three major public health issues of our time. 

So what is going on?  Weight gain is not a mystery.  Fat does not materialise out of nowhere. Obesity can only be explained in terms of an imbalance of energy consumption over energy expenditure. Fat people are eating too much and not exercising enough.  It’s all down, so cynics assert, to a combination of gluttony and sloth, a gross demonstration of moral failure.  But is that a fair indictment?  Some people may have a genetic tendency to put on weight; after all, the biggest risk factor for obesity is having parents who are overweight or obese.  The idea that a pre-history of starvation might have selected a thrifty gene was currency until very recently, through we now know that the way we conserve energy is under the control of several different genes.  

And there is also an environmental issue. The Foresight Report, published in 2007, declared that obesity is a normal response to an abnormal social environment. The watchword is convenience. People in the west are money rich and time poor.  There is always too much to do.  Time must not be wasted.  We eat fast food and get around in fast cars, trains and planes. Time spent on cooking, the cost of food, buying local food, growing our own food have all decreased.  Fewer people grow their own vegetables or buy local produce. We have become disconnected from food.production and preparation in the same way as we are uncoupled from the use of our own legs to get around. Fewer people are walking or cycling to work.  Children are taken to school by car. And fewer people engage in energetic sports or activities.  On the other hand, the availability of fast food outlets, low cost bistros and restaurants, food variety, food promotion and portion sizes have all increased alongside the ownership of cars and improvement in public transport.  In fact, less and less people need to go to work any more. They can just plug into their virtual Microsoft office and stay at home. We are rather like the cafeteria rats, who, when confined to their cages and fed a varied, appetizing diet in abundance, grow enormously fat.    

This fast food, car based revolution has given licence for passive overconsumption and immobility. With too many opportunities to eat and less requirement for physical activity, people cannot help but gain weight, or so it seems.  Fast, convenience food is cheap and rich in fat.  Restaurants tend to serve big portions of high fat foods. And people tend to eat what is put on their plates. One experiment showed that when soup was presented in a bottomless, refillable bowl, people just kept eating.   Time that might be spent in physical activity is all too readily plundered by the computer and television.  The exhausted boredom, induced by the tedious combination of overstimulation and inertia can tend to cause people to seek solace in comfort eating. 

But if it was just the environment that was responsible for the obesity epidemic, then why aren’t we all fat.  80% of adults living in an obesogenic social environment are not obese and 40% are not even overweight. 

Take the French, for example; they traditionally eat a diet that is so high in cholesterol and fat and yet have less heart disease and obesity.  The most obvious explanation is  portion size.  Dr Paul Rozin in a recent article entitled ‘The Ecology of Eating’ showed that portion sizes for the same meals were 25% per cent larger in the United States than in France. Barbara Rolls showed that increasing portion sizes over the course of a week increased energy intake by 4,500 Cals, equivalent to 1.5 Kg of fat.  Increasing the consumption of fat resets physiological satiety mechanisms, so that more fat can be accommodated and people want to eat the same high fat meal again. People often notice a marked increase in appetite and weight after the annual Christmas blow-out.  The opposite works after starvation; fat receptors can be up or down-regulated. Exercise is good because it blunts this desensitisation and hunger.

The way food is served, the availability, variety, portion size and even the shape of plates all have a role in increasing intake.  We eat more when food is prepared by someone else. If we are eating with others, we tend to conform to the norm.  Food outlets tend to serve the most enormous portions.  They give too much choice and choice is inimicable to regulation.  When people are presented with a meal containing a variety of foods, they will eat much more than if they are given limitless quantities of the same food. 

So the answer to preventing obesity seems so easy.  If it is just a matter of the environment, then all you have to do is alter your personal environment.  Eat less,  cut down on portion sizes, choose low fat foods, don’t have seconds, don’t eat between meals, ration chocolate and alcohol, cook at home, only eat meat twice a week, cut down on butter, pastry, don’t rely on public transport so much, walk, cycle, take regular exercise. Take control of your life. Go on a diet.  Put yourself on an exercise regime.  About 70% of women and 30% of men claim to be on weight reducing diet. So why for most, doesn’t it work? 

Twenty years ago, the journalist, Geoffrey Cannon, published his eye catching title, ‘Dieting makes you fat’.  His thesis might be explained in part by the facts that it is fat people who tend to diet and it is very difficult to lose weight by dieting.  But there is another factor; if you deprive somebody of something you will increase the desire for it, and when they are let off the hook, they will rapidly eat more. Dieters tend to crave food and the foods they crave the most are those that they are trying to resist. 

Disinhibited eating is enhanced by the last supper effect (I’ll just have one more chocolate, then I’ll stop) and the what the hell effect, (oh, now I’ve had sticky toffee pudding, I may as well have another portion),  as well as by alcohol consumption,  eating alone, the behaviour of co-diner, and negative mood.  Dieting is more difficult when people are under an increased emotional load and feel brittle. The hedonic tendency to eat between meals might indicate an insecurity that demands satisfaction through the most basic source. Walking on the moors in late spring, I notice how lambs rush to their ewes to suckle as soon as I approach. Is that an example of the same insecurity?   

The overwhelming temptation to break one’s diet is an illustration of what psychologists call, ‘Wegeners White Bear Effect’.  The more you try to suppress any thoughts about something, the more you will tend to think about it, which results in a rebound in the behaviour you are trying to suppress.  Suppression can make people exquisitely sensitive to environmental cues.  The eponymous heroine in the novel,  Leila’s Feast, illustrates how starvation can make somebody very aware of food.  Leila wrote her cookery book while she was starving in a Japanese prisoner of war camp. A recent UK survey showed that people tended to think about eating 200 times a day.  This might suggest that they were exerting a tight control on their eating behaviour, which would just enhance the craving for food. 

You have to devote time and thought to cooking healthy meals. It takes too much work to exercise.  It’s all too hard, especially if you are doing it against such a resistance.  In the past, if we didn’t work, we would starve. Now our eating has become uncoupled from the production  and preparation of food. We don’t need to work to get our meals, so why should we?  If food is there, why not eat it?  So perhaps human nature hasn’t changed that much, we may have always tended to be lazy and greedy.

But this still doesn’t explain why we aren’t all fat.  Maybe it’s all down to the culture of eating.  The French eat less but spend more time eating.  They make more of an occasion out of eating; the ambience is different.  The French tend to eat together.  A meal serves more functions that just the supply of energy.  Eating is part of a whole sequence of social grooming.  Eating together with family and friends provides relaxation, companionship, comfort and reassurance. A family that eats together tends to stay together. One in five families in the UK sit down to eat together only once or less than once a week. Many people in the United States or in Britain eat alone and can miss out on the social benefits of mealtimes and so may consume extra large portions to compensate for a degree of social deprivation.

So is overeating related to deprivation?  It is well known that people who have been subjected to starvation tend to stockpile food, eat up every last morsel and overfeed their children. Population studies have shown a definite link between poverty and obesity, but not all poor people get fat. The historian, Peter Brears, suggested that working mothers lose the skill and the time to prepare meals and tend to rely more on convenience food, rich in fat. In the Foresight report the only group who are less likely to become obese are reasonably affluent women living in the south east of England who have the time to keep fit and choose healthy dietary options. 

But since mealtimes are a whole nurturing experience rather than just a nourishing experience, is eating a surrogate for other types of deprivation?  Does the loneliness and depression that is also so prevalent in the United States and Britain, make them more likely to turn to food for comfort and solace?  People who don’t actively engage in life get bored and eat to feed their interest and confidence rather than their body.  When I conducted psychological interviews on patients with morbid obesity, I uncovered a severe degree of loneliness, depression and emotional deprivation.  So is there a typical obese personality; insecure, needy, bored and chaotic, the sort of person who might tend to turn to drugs, alcohol, cigarettes, love and companionship as well as food to satisfy their compulsive needs?    When something happens, a person’s ability to regulate their food intake gets disturbed alongside regulation of other behaviours, sleep, mood and bowel habit, for example.  There are super-regulators, who intensify their control and tend to lose weight and others, who are perhaps more chaotic and needy, who become dysregulated and obese. So do food manufacturers and restauranteurs just supply what is needed so badly? 

A recent report suggested that the tendency of people to use food to satisfy their emotional needs may be gender specific. The psychologist, David Lewis, was recently reported as saying that when it comes to tongues, melting chocolate better than passionate kissing, at least for women. All men know that sex is better than chocolate; for women it’s the other way round..

So have psychological factors, such as life traumas, deprivation, need, loneliness and depression, which seem to have increased over the same period impacted with the environmental changes to create the current obesity epidemic?  And how much of a role  do genetic factors play?   

The current obesity epidemic is such a complex mix of mind, body and meaning with culture, history and development each playing their part. There is no easy explanation, though the interaction of the loneliness, boredom and insecurity of modern life with the abundance of cheap high energy foods and the reduced requirement for physical work seem to be essential drivers.

So how can we remain slim and healthy in an obesogenic environment?  Maybe the answer is to dare to stand out from the crowd and adopt an active, healthy and interesting life style where eating is not a predominant factor.  Children, who go on ’fat camps’  lose weight as they gain in self esteem.  So the message is don’t rely on dieting; this is almost like treating deprivation with deprivation, but get out there, do things, be active, get involved and maybe, just maybe, you can allow your weight to look after itself.    

 This article was inspired by a lecture given by Andrew Hill,  Leeds Professor of Health Psychology, to the Guild of Food Writers at Artisan, the Booth’s bistro in Kendal on Friday 13th November, 2009.       

 

A rant from the far reaches …..

Mediobogdum!  What a name!  What a place!  Eleven months perched on a mountain at the edge of the empire  with nothing to do except watch the sheep and wait for those damned Brigantes to attack the fort again.  Why?  Why don’t we leave them to get on with it?  We’ll never beat them.  We can  burn their villages, kill their warriors and still they come!  And they don’t even fight like soldiers. They just appear out of the mist, set fire to our farms, steal a few sheep, trample the fields and vanish.  

And the weather, the accursed weather!  It has been raining for three days; not just a shower, but whole sheets, curtains, blankets of it, driving up from the sea, turning the ground to mud, running off the hillside in white torrents, creating  rivers of our roads. 

Nothing can be kept dry, the grain in the horrea has gone mouldy, the bedding is damp, there are even drops coming though the roof of the principia.  But at least we have the caldarium, one slight token of civilisation, though the other day the rain was so bad, the furnace went out. How can a Roman survive without hot water?  

And those Brigantes; they always chose the worst weather to launch another attack.  It’s as if they know how much we hate the wind and rain and that awful cold that grips your heart.  So we double the guard, sent out another patrol, chase shadows into the cloud.    

Why our glorious emperor, the illustrious Hadrian (may the Gods praise him!)  bothers with this barren place, I’ll never know!  He even built a wall across the whole country to protect perfidious Albion  from the Pictish barbarians in the far north!  Protect what?  There’s nothing of any value here, just a bit of lead and tin way down in the south.  Nothing grows; no grapes, no figs, no olives, not even any spices.  What passes for food is dull and tasteless;  porridge and warm mutton every day!  We can’t even get a tasty dormouse.  And there is no wine, just sour beer!  And those Britons are impossible; nothing but trouble ever since the dreadful queen of the Iceni had the temerity to sack Camulodunum.    

And to think we came all the way from Dalmatia for this!  Oh Dalmatia!  Those warm nights, the wine, the music, the restless warm sea and the women. Ah, the women!  But how could I know she was the consul’s woman?  She didn’t say, and she was so careless; he was bound to discover us.  I thought he was going to kill me, but he had a worse fate in store.  I and my men, my brave cohort, all five centuries of them, were banished to Britannia at the very ends of the world, where we cling with freezing fingers to this cold wet mountain, waiting for another futile attack!