November 2008

It was the 22nd  of February 1782. The war was not going well.  General Cornwallis had surrendered to George Washington at Yorktown the previous October.  King George III had been determined to fight on, but now parliament was clamouring for an immediate withdrawal.  The Whigs, sensing how vulnerable the government was, tabled a motion ‘that the war on the continent of North America may no longer be pursued for the impractical purpose of reducing the inhabitants of that country to obedience by force’. 


The Tory prime minister,  Lord North, who felt obliged to support the King, was in trouble.  The motion was essentially a vote of no confidence in him.  Many of his own party had crossed the floor to vote with the Whigs.  The outcome was going to be close.  If he lost, the government would fall and America would be abandoned.  He looked around desperately for the few members he knew he could count on to garner support.  Prominent among these was Sir Richard Worsley bt,  privy counsellor and accountant to the government.  But Sir Richard was absent. He was hiding.


The previous day, Lord Justice Mansfield, presiding on the King’s Bench in Westminster Hall, had delivered his verdict on the lawsuit for criminal conversation that Worsley had brought against his erstwhile friend and fellow officer, Captain Maurice Bisset of the Royal Hampshire Militia.  The reason for Sir Richard’s grievance was that Bisset had eloped with his wife and they were now living together as man and wife in London.  Not only had Captain Bisset committed adultery with his wife, but he had most flagrantly breached his gentleman’s code of honour.  Sir Richard wanted satisfaction and claimed damages of £20,000,  a huge sum that would be worth £25 million today and would have condemned Bisset to debtor’s prison for the rest of his life. 


The circumstances of the case were unusual.  Lady Worsley was the lively and attractive stepdaughter of the Edwin Lascelles, Earl of Harewood, and had brought a dowry of £70,000 into the marriage.  Sir Richard was a member of the government. While many titled ladies enjoyed adulterous liaisons with other gentlemen, there was a tacit agreement that these affairs should be conducted with discretion. Bisset and Lady Worsley had not only flouted these conventions, but Bisset had also abused his friendship with Worsley.  The wounded baronet was out for revenge.   


The facts of the elopement were clear. The couple had been living in the Royal Hotel in Pall Mall. Servants had been interviewed, the bed linen examined and witnesses had contrived to see them in bed together. There was no doubt of culpability. Seymour, Lady Worsley was Sir Richard’s chattel and Captain Bisset had made off with her. How was the aggrieved husband to be compensated?  What value could be placed on a privy councillor’s matrimonial honour? 


The defence adopted a unique strategy.  They attempted, with Lady Worsley’s assistance, to prove that she had not only behaved in a manner that was inappropriate for the wife of a nobleman, but she had done this with the active collusion of her husband.  A procession of aristocratic lovers were brought before the bench to testify that Sir Richard had contrived to display his unclothed wife before them and encouraged sexual liaisons which he had  observed from the concealment of her dressing room.  


Sir Richard, it would appear, was inhibited with the practical aspects of sex.  The lampoonists of the time certainly believed so. Perhaps witnessing the murder of a client in the Parisian brothel opposite his hotel window when he was just 18 had impressed him with the dangers of sex.  Perhaps he was homosexual.  Whatever, his interest in Seymour was more a possession than a wife.  He admired her beauty and he liked his well connected acquaintances to admire her as well.  Sir Richard was a collector of fine art and Seymour was the chief exhibit.  He even had a darkened cabinet constructed so she could be displayed.


Bisset had lodged with the Worsley’s when the militia were on manoeuvres at Coxheath in Kent.  He had free access to Seymour and they had fallen in love. She had even borne his child, which Sir Richard accepted as his own.  Sir Richard was fond of Bisset and seemed to enjoy their open triangular relationship his wife. But it was the events at the Maidstone Bathhouse that had clinched the case for the defence and the downfall of the baronet.


The day was unusually hot.  Sir Richard suggested that the three of them go to the bathhouse on the edge of the town.  This consisted of two private rooms, one for men and the other for women each equipped with a simple pool that they could wash in and a dressing area.  Worsley and Bisset finished their ablutions before Seymour when Sir Richard proposed they go round to the ladies side and take a peek at her while she was dressing.  According to the testimony of he attendant,  Sir Richard knocked at the door and cried, ‘Seymour, Seymour, Bisset is going to look at you.’ He then hoisted Bisset onto his shoulders so he could look through the window above the door. Bisset remained there for a full five minutes while Seymour exhibited her charms. 


The jury awarded damages of one shilling, the price of a pound of soap, a muslin neckcloth or a roast beef dinner.  Sir Richard had been totally humiliated.  He had been complicit in his wife’s degredation.  She was spoiled goods.  This was a public hearing and the next day pamphlets containing the more lurid details of the case were available on the streets.  Subject to such public humiliation, how could he take his seat in the House?


In the event that didn’t matter.  The motion was defeated by a single vote and the government limped on for just five more days until a further division on February 27th., when not even Sir Richard’s presence could have saved the prime minister. North tendered his resignation, but the King refused it.  He finally left office on March 20th  and the British came to recognise the United States of America, signing the first Anglo-American trade agreement the following year. 



The material for this blog was taken from Hallie Rubenhold’s fascinating new book,  ‘Lady Worsley’s Whim; an eighteenth century tale of sex, scandal and divorce.’    

As director of a research group,  I used to tell my graduate students that the most important quality they needed in order to be a scientist was imagination.  I might have added persistence, the ability to delay gratification, forever if necessary.  For if their curiosity were ever gratified, they would cease to strive.  And science is more about the process than the results. 


At the time my students were more concerned about the homogeneity of the population they were studying, the appropriateness of the statistics.  I tried to tell them that scientific rigour without imagination is intellectual death, but equally imagination without scientific rigour leads to delusion and chaos. You need the right balance to be good scientist. Experiments are easy if the question is right.  And to ask the right question, you need the imagination.


Imagination allows you to see things, not as they are, but how they might be.  It’s about the image, not the object.  It’s make believe, delusion even.  But without imagination, we cannot plan, we cannot work things out, we cannot explore, investigate or deduce. 


Imagination is perhaps the greatest characteristic of the human mind – the single feature that has made us so dominant and successful.  It is the apogee of consciousness, but yet it is informed by the unconscious.  How often have we had the experience of going to sleep on a problem and coming up with the solution?


Imagination allows us to reach out from the mundane, the familiar, the quotidian and dare to see things not as others see them but from a completely different perspective.  ‘Dare to be a Jonah.  Dare to stand alone,’ was the message that Viscount Stansgate used to exhort his son, the young Anthony Wedgewood-Benn with.   Tony Benn had political imagination.  It was in the eyes – the cartoonists saw it – that hint of madness.  Margaret Thatcher had it too. Even Tony Blair.   


This week, Einstein and Eddington has been screened on BBC1.  Two images capture the essence of scientific imagination to me.  One was of the young Albert, having just been rejected by Elsa, standing in the middle of the street in Berlin in the pouring rain with the traffic swerving either side of him. He is desolate.  Life holds no meaning for him, but gradually a smile dawns on his face as he realises that light, like the cars passing either side of him, does not travel in a straight line but is bent by the gravitational force of large masses. 


The second was of Arthur Eddington, clearing the table and asking his sister and his friend to hold the cloth out while he places a loaf of bread in the middle of it. In so doing he demonstrates how the tablecloth representing space is distorted by the gravity of the loaf, which represents the sun. He then takes an apple and rolls it round the contours.  ‘And this is the orbit of the planets,’ he concludes with a flourish.  Brilliant!   


Eddington was much more of a pragmatist than Einstein. He was reputedly ‘the best measuring man in England’.  By comparison,  Einstein, a theoretical physicist who invented his own mathematical symbols and absolutely refused to conform, could seem quite mad.  Einstein needed the more controlled imagination of Eddington to come up with the experiment to prove his theories, but what an imagination.  Who but Eddington would have thought of setting up a campsite laboratory on a hill top on the island of Principe off West Africa to photograph the eclipse of the sun and prove that the light from the stars lying behind the sun is bent by its gravity?    


‘Discovery favours the prepared mind.’  To be effective, imagination has to be contained by method and the exponent needs sufficient immersion in their subject to invent the theory, devise the experiment, make the observation – about ten thousand hours of it according to author, Malcolm Gladwell.  Alexander Fleming would not have realised the significance of his contaminated petri dishes if he hadn’t spent half a lifetime staring at bacterial cultures.     


Gladwell’s new book is called ‘Outliers’.  It is about the ecology of success and makes the point that genius is not born but created.  The computer geniuses that work in Silicon Valley have a disproportionate tendency to have been born in 1955 because they would have been 21 in 1976 when the computer revolution started and therefore best placed to realise its potential.  Asians are so good at mathematics because, according to Gladwell, growing rice in paddy fields is so complex and labour intensive with so many variables to factor in, that it is an excellent training for the mathematical mind.  To be really good at anything, you have to ‘live it’.  Top class gymnasts, tennis players, ballet dancers, musicians do little else but practice.  As Eddington commented, ‘This is what I was made for.’  The particular drift of a person’s imagination is determined more by culture than by inheritance.   


As a young researcher, my boss used to accuse me of trying to reinvent the wheel.  ‘There’s nothing new under the sun,’ he would comment as I showed him my latest set of results.  He was right.  Any field of intellectual endeavour, whether in the arts or the sciences is not so much about making brand new discoveries, but of seeing things in a different way that makes more sense to the changing culture.  The great orator and debater, Edmund Burke, realised it, ‘This power of the imagination is incapable of producing anything absolutely new; it can only vary the disposition of those ideas which it has received from the senses.’  But nevertheless, seeing things in a different way can lead to progress.  ‘Imagination is the engine of change.’   


But imagination is more than that.  Imagination makes sense of our experience.  It generates our life script, the narrative which sustains us, the purpose that motivates us.  Our fear of the unknown is so great that we use our imagination to fill in the gaps and invent a convincing story that we can believe.  This is part of the learning process – to find out about something – to imagine what might be so and then to test whether our ideas conform to our observations, whether we can dare to put our faith in them – for a while.    But the world is always changing.  What seems like a good idea this year may seem stale and unhelpful next.  Knowledge is not written in stone; it’s scrawled on the sand and the tide keeps coming in. 


In fact we might say, as John Lennon did, that nothing is real (and nothing to get hung about).  Everything is perceived by a brain that is conditioned by experience and given meaning by our imagination.


Imagination is the engine of creation.  It what drives artists, writers and composers to create symbols that represent the meaning of things. Even science is directed by the rules we have invented out of our imagination.  Indeed, at its furthest outreach, theoretical physics can more like a religion than a science.  We cannot see quarks and bosons.  We can only use our imagination to derive the concepts that infer their presence from what we can measure and observe.  Science is like a shark, it has to keep moving forwards, otherwise it dies. And imagination is the bosun that drives it forwards.


The big questions, like the purpose of life, the shape of the universe, the nature of consciousness, the meaning of love, are so far beyond our comprehension that we have to make extensive use of imagination to create a virtual reality. 


Living is easy with eyes closed
Misunderstanding all you see
It’s getting hard to be someone
but it all works out
It doesn’t matter much to me
Strawberry Fields Forever 1967


It would be such a dull world if we could explain everything by scientific observation and measurement.  There has to be some mystery in life and we still have to strive to make sense of it.. Our gods are fantasies, but are none the less, potent symbols of comfort and security in an uncertain world.   ‘We console ourselves with our imaginings and our delusions.’  We need something to put our faith in, even if we know it is fallible, but that can co-exist alongside the measurable, the concrete. 


‘Aboriginals believe in two forms of time; two parallel streams of activity. One is the daily objective activity, the other is an infinite spiritual cycle called the “dreamtime”, more real than reality itself.  Whatever happens in the dreamtime establishes the values, symbols, and laws of Aboriginal society. (In ‘The Last Wave’,  a film by Peter Wier)


When I was working at a mission hospital in Uganda in 1967,  the people would only come into the mission for serious illness that only western medicine could cure – often by surgery – gonococcal strictures, obstructed labour, massive tumours.  Most other illness they took to their local medicine man, who made them better by a combination of herbs and narrative. 


Science can live alongside religion.  It has to. Science can provide a structure for our imagination.  In fact if we broaden the vision, we might say that both science and religion are different aspects of philosophy.   



Imagination plays such a crucial role in human relations. Empathy binds us to others by imagining what it is like to be in their skin, but that is a projection conditioned by our own needs and experience.  We all need to believe that the one we love most in the world, loves us.  There’s no proof and we may well be deluded, but our imagination protects us from the insecurity of doubt.


But imagination can also create doubt.  Indeed some are so damaged by the vicissitudes of life that they see threat everywhere.  The world is a fearful place. Imagination can make us ill. Fears that cannot be resolved may be held in the body as symptoms, but these all too readily capture the imagination and become the source of our fears.  But although this is a delusion, it is a palpable and tangible delusion that offers the hope of medical resolution.  (See ‘Not all in the Body; when trauma goes into the body’-  30th September, 2008 and ‘The Eloquence of the Body – 23rd November, 2008.)


If we live too much in our imagination, we can lose touch with reality. Imagination that is not grounded in reality is the route to madness.  Beliefs that have no concrete basis are delusions.  Psychosis is a cultural phenomenon, when a persons beliefs and behaviour are no longer syntonic with the society they live in and threaten its integrity.  Imagination must be grounded, contained within the culture.  If it loses its cultural roots, it becomes a symptom of madness.  (See ‘Why traumatic life events can make people mad’ – 1st October, 2008).


Scientists and artists can be so dedicated to their beliefs that they exist in a hinterland of madness.  The stereotype of the mad scientist is a familiar one and so many artists have suffered from mental illness that it can almost seem a pre-requisite.  Isolated in a landscape of abstraction, if they don’t have normal human relationships to keep them on track, they can easily get lost.     


When Einstein was developing his theory of gravity, he was in serious risk of madness.  Separated from his wife and children, abandoned by his mistress, debarred from the university, he lived in a world of the symbols he had invented.  He didn’t eat, couldn’t sleep, couldn’t look after himself.  His appearance became increasingly dishevelled and his behaviour excitable and bizarre.  He was rescued through his contact with Arthur Eddington, who recognised his genius and set out to prove it. This led to a reconciliation with Elsa and with the university and an identity in the wider world.  Without Eddington, Einstein could have been dismissed as another crazy jew and died in a concentration camp.  

Self-help Groups are the bedrock of The Gut Trust.  It’s previous incarnation, The IBS Network started as a collection of self-help groups at different locations throughout the country.  Some were very successful.  Others less so.  I used to talk to the group in Sheffield, but was somewhat dismayed and embarrassed when the discussion seemed to turn to how doctors didn’t recognise or care about IBS.  It seemed that all the grievances that the members had in their lives were being projected on their overworked GPs. 


Grievance never makes anybody better.  A relationship involves at least two people and, like a marriage, if you want it to work, you have to put something into it.  ‘My doctor’s useless,’  gets you nowhere.  It’s much better to take responsibility for the relationship and ask the question, ‘What can I do to get the most out of my doctor?’  This may then lead you into trying to find out more about your condition so you can have an informed dialogue. 


So if you can present your doctor with specific questions about diet, stress, drugs instead of overwhelming him with ‘the pain is dreadful and I just can’t cope any more’, you are likely to be able to work in a constructive partnership to manage your Irritable Bowel Syndrome (IBS).


The same applies to groups.  Don’t expect your group leader to come up with solutions.  Take a more active approach and try to get the most out of the group. 


Self help groups need to be structured.  I think they work better when there are held each week and there is a curriculum.  I designed the web-based IBS Self Management Programme to be run in groups as well as for individual study.  It not only contains a wealth of information, it has case histories and exercises that lend themselves to group interaction and reading that be prepared for the next meeting.  The leader should either be a health professional (with IBS?) or somebody with experience of managing groups.  They should facilitate and steer discussion rather then lead it.  The emphasis is to enable people to have the confidence to manage their own condition.


IBS is an individual condition.  There is no typical presentation.  The range of symptoms, the pattern of occurrence and what brings them on or takes them off is idiosyncratic.  There is no prescriptive solution.  Every IBS story has to be assessed on its own merit and requires an individual solution.  One useful exercise is for one group member each week to talk about their condition while the other members work with the facilitator to try to understand what it means and how best to manage it.  Perhaps 40 minutes each week should be devoted to that.  This not only helps the group to bond and communicate, it provides a safe place where problems can be talked about openly among friends.


Another important aspect of each group meeting is guided relaxation or hypnotherapy,  which trains people to relax the tension that is causing their symptoms and facilitate communication.  Tapes can be useful for this and can be purchased.


The focus of any self help group must be on management of the symptoms, but this requires an understanding of the condition and what causes it.  Instead of devoting valuable time to a formal lecture,  it is probably most useful for members to read prepared educational material on topics such as ‘What is IBS?’, ‘What are the causes of IBS?’ and ‘The Place of Complementary Therapies.’  before the meeting and to allocate time for questions and clarification.  This would allow en more focus can be placed to important skills like how to manage your diet, how to decode what your symptoms represent in terms of what has happened, how to recognise and manage the stresses in your life, how to manage anger, anxiety, depression,  how to get the most out  of your doctor,  how to manage IBS in the workplace, at home with the family, on public transport, abroad.  All of these topics are covered in detail in The IBS Self Management Programme.  Keeping a diary that documents the symptoms and relates them to diet or what is happening in your life can be a very useful aid to self discovery and group work. 


As time goes by and people become confident at working in the group, then they learn what helps them and can feed it back so that group members can suggest further modifications and learn from the experience of each other. 


Time should be allocated for extracurricular activities.  The hypnotherapist, Elizabeth Taylor in her original Therapeutic Group Programme used to invite group members to go on walks around Rossendale with her.  This proved very popular. Social activities can be arranged.  Insight into cooking for IBS can be encouraged by demonstrations or bringing in foods that have been prepared previously. 


The possiblities for recovery are legion, but one principle is crucial.  You will only get out of your group what you put into it.  Getting over IBS represents a challenge to engrained thinking and requires a change in attitude and behaviour.  So use your group constructively.  Engage with the other members and help each other find your own pathway to recovery.  

Compared to the mind, the body is more visceral, more explicit.  It’s the flesh, blood and guts of life.  But I’m not wanting to write so much about what the body is, but more about what it represents.  If the brain controls the way the body works, the mind is concerned with what it means. Every thought, every wish, every dread, every worry, everything that happens to us is played us in our physiology.   Physiology is the embodiment of mind.        


Look at the way we stand, the way we sit, how we walk, the gestures we make with our hands.  Our bodies reveal so much about the way we feel.  The open posture of joy is in marked contrast to the hunched up, head down, shuffling posture of sadness.  Body language is universal.  The balled fists and  jutting chin of anger or the cowering of fear are the same, no matter which culture we are from. The arms folded across the chest indicate a defensiveness in any country.  Clumsiness can reveal a mind out of control. Attitudes of mind are held in attitudes of body.  It is impossible to feel joy while simulating the posture of sadness.  Pilates improves mood and well being through the adoption of a confident posture. 


Listen to how we speak.  The high pitch of tension, the muffled consonants of guilt,  the lack of confidence expressed in the hesitancy, the inability to find the right word.  We don’t have to see a person to know how they are feeling.  We can discern that by the sound of their voice.  A nervous voice can make us feel nervous too. 


Our faces are even more expressive.  There are over seventy different muscles of facial expression, each controlled by twiglets of the sympathetic and parasympathetic nerves  and modulated by a seasoning of hormones.  Primates are unique in the animal kingdom in being able to advertise their feelings in their faces.  And human beings have the most expressive faces of all.  Every nuance of emotion can be expressed in the face, not only fear, joy, sadness and anger but also complex emotions like shame, guilt and envy, and even ambivalence as when the mouth grins confidence while the eyes flash fear. It’s almost impossible for facial expressions to lie; the false smiles and masks of concern all too clearly betray insincerity.    


Throughout a lifetime, emotional attitudes become etched in the face as creases develop along lines of tension. As a therapist, I make a note the themes expressed on the faces my clients sitting opposite me.  They may be smiling but the hollowness under their eyes, the parallel lines above their nose, the tightness in the cheeks tell a different story. 


Nevertheless, the adoption of a particular facial expression has a direct effect on how we ‘feel’.  Mood is a body sensation.  Smiling actually makes us feel happy – light and confident and full of energy, whereas putting on a sad expression makes us feel heavy and tired.  Facial expression is controlled by the same nerves that induce feelings in other parts of the body.  Infants learn how to feel by copying the emotional expressions of their mothers.  A smile feels good.  A frown doesn’t.  That’s the way they are wired up. An expression of disgust may actually make them feel sick. 


And if we smile, then we can make other people smile too.  Smile and the world smiles with you.  The feeling is passed on. We are social animals and as such can so readily take on the mood of the people we are with.  I can be with one patient and feel absolutely exhausted, but as soon as my next client comes in, I am wide awake and my heart is racing.  The technical term for this is counter-transference. My feelings give me insight into how they are feeling.  Comedians and politicians quickly tune in to the feeling of their audience and know how to work it.  Police on crowd control at football matches are too well aware when the mood turns ugly.       


So emotions and moods are based on physical sensations, the embodiment of what happens to us.  In most situations, we instantaneously relate how we’re feeling to what has happened and know that what we are feeling frustrated or sad or anxious about.   Emotions are feelings put into context.  There can be no emotion without a body.  People with quadriplegia can have a noticeable blunting of affect while those few tragic cases of  ‘locked-in syndrome’, in which a lesion in front of the midbrain results in a total loss of feeling throughout the body, are said to express a tranquillity quite out of keeping with their devastating condition (though how they do that is not clear).     


The word, ‘emotion’, is derived from the latin verb, emovere, to move out.  The transformation by context of our body sensations into an emotion allows resolution.  The feelings can be eliminated by dealing with the situation that caused them.  But if what happens is so unfamiliar and so awful that we don’t want to think about it or we are unable to resolve it, then the feelings remain and are consolidated as symptoms, which are taken to the doctor.


Evidence for this comes from the study of people who have persistent symptoms of infection, injury or operative trauma even though any objective signs of illness have long disappeared.  A few years ago, we showed that patients with persistent symptoms of diarrhoea following an attack of gastroenteritis had higher scores for anxiety and depression and more traumatic life events at the time of their original illness than those whose symptoms cleared up.  It appeared as if the symptoms of gastroenteritis had been recruited to express ongoing distress.  Similar observations have been made in patients with chronic fatigue syndrome following influenza, pelvic discomfort after hysterectomy, persistent back ache following back injury and ongoing dental pain following tooth extraction.  A connection between the context and  physical symptom is established in the brain and continues to be evoked whenever the person is reminded about what happened.   


Persistence is even more likely to occur with symptoms that were originally evoked by stress.  Such symptoms represent the meaning of what has happened. Thus, chronic fatigue may be generated by obligations that the patient resents, anorexia by a fear of adult responsibilities, incontinence or flatulence by feelings of humiliation and shame. But such interpretations are not prescriptive. Like dreams, unexplained symptoms express the personal experience of the patient and can only be resolved by decoding their message in the light of what has happened to them.   


So much of our personal history is apparent in the way our bodies relate.  Look at how people greet each other.   Do they make and hold eye contact and for how long?  Do they shake hands, hug or kiss – one cheek or two or even three?  Is their hand warm or cold or wet?  And their grip, is it firm, crushing or loose.  Does the hold linger too long?  Are they stiff and stand-offish?  Is their speech hesitant?  And how does the manner of their greeting make us feel?  All of these convey a meaning which we can easily detect. 


So much more is revealed in the way people make love.  All of our ambivalence about people is played out through sex.  Impotence is a sign of vulnerability and disempowerment.  Vaginal dryness implies a lack of desire; vulvodynia – sexual repression, a conflict between fear and desire.


The philosopher, Maurice Merleau-Ponty has suggested that the way we think is conditioned by our notion of the body. Our bodies and the nature and range of our perception provide the framework by which we understand the world. He called this embodiment. What happens is processed through the body, which then supplies the meaning of the situation.  No wonder we have so many visceral metaphors to describe emotional experience:  I can’t stomach that,  it pisses me off, I can’t bear it, gutted, heartache, it takes my breath away, you make me sick, it gives me the shits.  


Ancient physicians understood health and the nature of illness in terms of the balance of the four humours, black bile (melancholy), phlegm, blood and bile.  This made no sense from a physiological perspective, but since each bodily fluid represented a different mood (melancholic, phlegmatic, sanguine and choleric), it emphasised the importance of the emotional links with the body on health. 

‘I love you, mind, body and soul’, lovers declare while staring deeply into each others eyes.  What they mean is ‘I love you with all of me’.  Mind, body and soul are the three indivisible components of self, but what do each of these actually represent?


Mind is often regarded as some strange entity, an unknown force that governs the working of the brain; the ghost in the machine, but if that is the case, where is it, what is it?  We can’t do an operation and remove the mind, but we do recognise what happens when the mind is deficient.  Patients with dementia, or an absence of mind, cannot learn or remember, they cannot reason things out, they cannot think clearly.  So is the mind the thinking apparatus of brain?  If so, why can’t neurosurgeons operate to remove that part of the brain in people with schizophrenia; why can’t they transplant a better mind – one they’ve removed from an accident victim and kept in deep freeze? 


The answer is that the mind is not part of the brain.  It is the brain, but not the firm greyish blancmange we would see in an open skull.  Mind is not a structure.  It is a function.  And as such it involves the whole of the brain.  It is not centred in one location; it involves the whole network of neuronal interconnections.  The mind is the brain in action!  The distinction is much the same as that between the lungs and respiration, or the heart and circulation.  


Most philosophers perceive mind in terms of thinking, planning, reasoning, remembering, learning and feeling; the conscious expression of who we are.  But very little of what the brain does is conscious.  The control of our guts, our lungs, our kidneys and our circulation is quite automatic and unconscious.  Similarly our motor functions; walking, swimming, riding a bike, playing the piano, are carried out quite automatically.  By that I mean that we don’t have to think about it; it’s entrained into us by experience and practice.  Indeed, if we start to think too much about it, we make mistakes. 


Tennis players on ‘the tour’ have honed their skills to such an edge of perfection that their brain automatically computes the trajectory of the ball and the position, strength and action of the racquet as an extension of their arm.  When we think about that, the complexity, the achievement is quite incredible.  We couldn’t build a machine to do it.  We could never think it out consciously.  In fact, we shouldn’t try to think it out.  In The Inner Game of Tennis, W.Timothy Gallway describes how, to be at the top of their game, competitive sportsmen have to learn to relax and trust their unconscious mind and not tighten up and try to control it.  Andy Murray is a more successful tennis player than Tim Henman was because he doesn’t lets doubts constrict his game with anxiety and control.  As an indication of just how much these functions are incorporated in the unconscious mind, when researchers described a tennis serve to a player, who was in a profound coma, all the appropriate parts of his motor cortex lit up as if he were making the shot. 


The same principle applies to musicians, writers, cooks, surgeons,  any complex role or set of actions that demands a high degree of dexterity.  Although years of training requires conscious application and practice to establish the circuitry in the brain, once it is there, it is best to have confidence and let the unconscious mind take control ( although practice is still important to keep the skills fresh and to make minor adjustments and adaptation).  I am typing this piece quickly, but as soon as I start to think about what I am doing and try to override my unconscious mind, I make too many mistakes.    


We not only act automatically for most off the time, we see what we expect to see.  For the most part we don’t actually notice what happens.  Psychologists carried out an experiment in which they asked to watch the video of a football game and count the passes that the white team made.  They all did it accurately.  Then the psychologist asked, ‘And did you see the dog that crossed the pitch?’  None of them had.  The unconscious mind had eliminated it.  


There is a condition known as cortical blindness, where a stroke, injury or tumour in the visual cortex at the back of the brain deprives people of conscious vision.  They can’t see a thing, but when a cup of tea is placed in front of them, they pick it up and drink.  The eyes and their nervous connections to the base of the brain are quite intact.  Their unconscious mind ‘sees’ the cup and performs the action. 


And we hear what we expect to hear.  This is a major source of dispute between couples.  Over years, people who live together come to know each other so well, that they longer listen, they just know what they will say, and their unconscious mind provides the script.    Most of the time this works well.  There is comfort in predictability. Conflict only arises when one partner makes a change in the directions and the mind of the other ignores it. 


Brain scans have shown that when schizophrenics hear voices, the auditory cortex lights up.  There are no voices,  they are created by a troubled unconscious mind, which gives them meaning and brings them to consciousness.    


And we understand what we been conditioned through learning and experience to understand. Have a debate about politics with anybody and they will come up with the same arguments.  It’s so predictable.  We understand character and personality by its predictability.  It’s sobering to think that what I value so much as my intellect, my  individuality, is really nothing more than a highly programmed and conditioned neuronal machine.  And the more I struggle against predictability, the more I recognise that the manner of my unpredictability is so predictable.  When I was a teenager, my friends and I learnt how to strip down the engine of a three ton lorry at Norton army camp outside Taunton.  The corporal instructor taught by rote.  If we interrupted him with a question, as we frequently did – out of pure devilment, he would have to go right back to the beginning and start again.  He was on automatic pilot.  Perhaps we all get like that as we approach the vanishing point.


When psychoanalysts talk about the unconscious mind, they are referring to way our actions, perceptions and thoughts are conditioned by our experience.  The significant events of our life are never lost.  They remain locked away as a neuronal memory, a set of connections that influences all aspects of our behaviour from the way we deport ourselves to the choices we make in life to how we react to situations. George Groddeck psychoanalyst, correspondent of Freud and author of Das Buch von Es (The Book of the It), even suggested that illness is a unique expression of personality.


Whoever sees in illness a vital expression of the personality will no longer see it as an enemy.  In the moment that I realise that the disease is a creation of the patient, it becomes the same sort of thing to me as his manner of walking, his mode of speech, his facial expression, the house he has built, the business he has settled or the way his thoughts go – significant symbol of the powers that rule him.


If we can understand the origins of our behaviour, we have the opportunity to reappraise them, decided whether they are still appropriate and make adjustments.     


Change is possible, but it requires courage to alter the reassuring patterns of a lifetime.      Imagination is the engine of change; the ability to think outside the box, to imagine how things might be.  Artists, writers have imagination in abundance, but it fades.  Too many become fixed, their style becomes typical, instantly recognisable.  Writers can tell the same story over the over again.  Actors become typecast.  Scientists keep doing the same experiment in constant reaffirmation of their one big breakthrough.  It takes too much effort, too much soul-searching to reinvent yourself.  The artist Isamu Noguchi did it.  He constantly changed his style, his medium. He had to. With a Japanese father and an American mother, his art was a fusion of cultures, a restless quest to discover his identity.         


So when your lover tells you, I love you, mind, body and soul, you hope that the mind component means that they  love you with all the imagination at their disposal and the necessary courage to face the change that loving you must bring …..  and not that they love you because you are the predictable embodiment of projections, based on their life experience of relationships – in other words, you remind them of their mother!   



‘Stella was only four when she lost her mother.  Her father struggled to bring up the family alone but when he got married, his wife had her own children and did not have the  time or patience for Stella and her brothers.  They went to live with their grandmother, but when Stella was just 12, she too became seriously ill and Stella was left to bring up her brothers by herself.  She felt isolated and overwhelmed.  She remembered it as the time when her stomach pains first started.  They were associated with a sensation which she described as blackness. 


Then she met Jed and fell in love.  He felt the same. She relaxed.  They got married and had two daughters.  7 years later, Jed had an affair with a woman at work.  Stella didn’t get annoyed.  She just became numb.  The blackness returned and with it her pain.  She no longer had any meaning in her life.’     



In the psychological literature,  the diagnosis of post traumatic stress disorder tends to be restricted to people who have had life threatening or abusive experience.  This is unfortunate.  Trauma is much more widespread and covers anything that affects or upset us.  Our responses to a particular incident are highly idiosyncratic and depend on our personal history.  Indeed most of my patients suffer from the meaning of what has happened to them or as Freud put it, people suffer mainly from reminiscences.     


When people are traumatised, they can lose themselves in what has happened (see my blogs on ‘Why falling in love can be so traumatic’, 23rd September;  ‘Not all in the mind, what happens when trauma goes into the body’, 24th September and ‘Why traumatic life events can make people mad’, 1st October).  Identity is overwhelmed,  individuality subsumed.  The self fuses with the trauma.  The intrusive thoughts, sleeplessness, ‘nightmares’, rumination, depression are all indicative of total preoccupation with what has happened. The self, in essence, becomes the trauma identity.  This might for example explain how prisoners come to identify with their captors, how people remain with those who have abused them and why there can seem to be such a perverse drive to repeat the trauma – what Freud termed ‘compulsion repetition’. 


So if the self is invaded and occupied by the trauma, the body becomes an instrument of propaganda. 


The events and situations that affect us on a daily basis are expressed in the body and mediated through subtle changes in the activities of the sympathetic and parasympathetic nerves and the endocrine glands.  If what happens is within the range of familiarity, the  bodily reactions are processed instantaneously and subconsciously by the mind; the feelings are ‘recognised’, categorised and converted into emotions by being put into context.  ‘This makes me angry.  I feel anxious about that.’  The emotion then drives resolution and the whole experience is stored for future reference. 


But if something happens that is so alien to our experience, so overwhelming that it cannot be processed, so awful it cannot be resolved, then it remains locked in the body as an illness, the symptoms of which persecute the individual as the trauma previously did.  ‘The pain is killing me.  It never lets me rest.  I cannot bear it any longer.’   


Unless the context can be accessed, emotion cannot be generated. Without emotion, the  traumatised self has no sense of  meaning. It is little wonder, therefore, that victims of trauma experience ‘annihilation’.  ‘Trauma denies the person the right to have a place in the world.’  For much of the time they are ‘numb’.  If  they do feel emotion,  it is quite indiscriminate and meaningless.  There is little difference between anger, fear, or sadness; only arousal and panic.


Since the meaning of what has happened is so unacceptable to their self construct, it  cannot be worked through and resolved.  It therefore remains split,  sometimes acceptable, sometimes not.  Thus like an argument between entrenched protagonists, it is acted out endlessly, seeking some redress, some sense of understanding or forgiveness.  Films shot in hospitals after the first world war reveal how shell-shocked soldiers re-enacted the circumstances of their trauma in brief  biopics; the endless grimacing of an infantryman  who had bayoneted his enemy in the mouth, the private who hid under the bed at the sight of a French officer’s kepi.  Similar traumatic representations are played out in our present day clinics and surgeries;  the apoplexy of situations impossible to stand,  the hunger strikes,  the intolerable shame of uncontained bowels,  the pain that tortures the soul.       


In Wednesday’s talk at The Hallam Institute of Psychotherapy, Patrick Loftus explained how the creation of images in art can  transform the trauma and so gain reconciliation by achieving emotional potential.  Art  can generate a meaningful object, an object that a person can own and use to make sense of their world.  This or the process of producing it becomes  an expression of the self, separate from the trauma, and can form a nidus of regeneration for a disintegrated identity – a nucleus of meaning, fixed in time and space, linking mind and matter.  Writing poetry or short stories can surely serve the same function; space to think, time to reflect.  Narrative makes sense of experience and facilitates integration.  In his book, Nature Cure, Richard Mabey described how being out in the country, observing wild birds and animals life created a focus of imagination, that helped to take him out of his depression.   


Music does something more.  Yesterday’s programme on Music and The Brain on Radio 3 described how music, like language, is charged with affect.  Tone, pitch and cadence integrate body and mind, releasing emotion.  As one contributor commented, ‘Without a body, there is no emotion.’    


The musical qualities of an infant’s babble – proto-speech – imparts such pleasure to the listener; their cry such alarm.  But a Beethoven quartet, a Mozart Aria or a Bach fugue, Ella Fitzgerald, Elton John even Jon Bon Jovi (You give love a bad name!) optimise the emotional stimulation. Performers often talk of surfing the emotional wave.  For trauma patients, music can awaken anaesthetised and paralysed emotions, providing a medium for thoughts to take flight,  but there is a risk of  being overwhelmed with uncontained feeling.  This is where rhythm comes in.    


Rhythm is so important in trauma management.  Rhythm entrains and organises.  It creates a structure for the music.  It contains the emotion by creating a cognitive map.  Last week at lunchtime in the Wigmore Hall, I watched how the clarinettist, Martin Frost, was so immersed in the Brahms Quintet that his body appeared to be making love, but the technicalities, the timing, the rhythm organised his brain keeping him focussed and on track. 


Our whole existence is dominated by rhythms.  Heart rate, walking, breathing, brain waves, circadian rhythms, cycles of brain activity during sleep.  It is surely no coincidence that the ‘beat’ of  most musical compositions (0.7 to 2 Hz) corresponds to the rhythm of the heart and that of walking or jogging, or that of rocking.  Both music and jogging release endorphins, calming the brain and body. 


Speed the rhythm up and the music is more exciting.  Slow it down and it becomes sad and contemplative.  Two new and effective trauma therapies also, like music, tap into these physiological rhythms.  These are Emotional Freedom Technique (EFT), which involves rhythmic tapping over acupressure points,  and Eye Movement Desensitisation and Reprocessing (EMDR), which involves  rhythmic movements of the eyes.  A century ago, hypnotists used to get their subjects to focus on a swinging fob-watch.  Now EMDR therapists move their finger back and forth in front of their subjects face.  The regular movements seem to focus the mind, distracting troubled people from their preoccupations and inducing a feeling of calm.  In the same way, the ‘musical’ mantras and breathing exercises  (pranayama) of transcendental meditation relax tension by helping people to stay in the moment.   Children with learning difficulties often soothe themselves by rocking and respond positively to music.         


The emotion and rhythm of music has a powerful capacity to bind people together.  Singing, dancing, marching, chanting, recitation are all very bonding experiences.  Along with making love, another rhythmic emotional activity, making music generates deep feelings of trust and confidence.  When people are upset, they retreat into themselves.  Isolated in their fear, traumatised people are as disconnected from other people as they are from their emotions and their bodies.            


There’s nothing new under the sun.  Slowly – too slowly it seems – we are rediscovering with the confirmation of neuroscience what was so essential to our tribal ancestors,  that rituals involving singing, dancing, legend, play acting and charismatic suggestion, can not only serve as a powerful cohesive force,  but can also help people cope with the tribulations of their lives.  Our challenge is to harness this age old feature of human society to heal the fragmentation and illness that is such a pervasive aspect of our modern existence.    

Remembrance on approach to Derby Station.


It was less than I imagined

and more, as,

with ophidian stealth,   

we slipped closer …..closer still, 


and laughter died,

conversation ceased,      

telephones suspended, 

computers stood by. 


Just the steady tumbrel

like the thump and grumble

of distant ordnance;

the drumroll of execution. 


Trackside sentries   

in Guantanamo orange

looked without seeing – while, locked

in my own capsule of remembrance,


a silent tear



and dropped.     



                                          11th November, 2008. 






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