February 2009

Human existence is nothing is not meaningful.  The brain works in metaphor and meaning.  We surround ourselves with symbols that represent aspects of our identity.   We use mental imagery to make sense of our experience through the creation of internal objects, psychological representations that flesh out our thoughts.


And we project those thoughts, those representations, onto other people, experiences, and objects that inhabit our subjective world, influencing what we see in them, how we interpret what happens.  The person we fall in love with embodies the qualities of an idealised parent.  They have to. We all need our delusions and imaginings. They comfort us. When we discover the reality, that they are themselves after all and some of their personal habits are – well, not as we would like, it can be quite devastating.        


Inhabiting a world of meanings is like carrying our own personal television in our heads, a theatre of the mind seen through the camera of our mind and created in our own image from everything that has ever happened to us.    


The arts give voice and form to our representations.  Music can be heroic, stirring, happy, loving, sad.  It encourages personal association and can amplify it and come to represent it.  It is such a powerful emotional amplifier. 


And look at the painting and sculpture; the comforting interiors of Wilhelm Hammershoi,  the womb like reds of Mark Rothko, the painful ruminations of Louis Bourgeois.  These are all representations of the issues that preoccupied the artists.    


Language is an abstraction, a way of conveying meaning through an understood code, a metaphorical communication.  This reaches its most sophisticated and eloquent in poetry.     


But if this is all part of the theatre of our mind,  it is an interactive theatre.  If we are to remain healthy, our interpretations have to change, to adapt, when events shatter the image. If they don’t, then we cannot live with ourselves.  Instead we exist in a state of dissonance and may only find meaning in illness.  The story has to change and adapt if we are to remain healthy in mind, body and spirit.  This is what is meant by Narrative Therapy (see my blog on Narrative based therapy; changing morbid life scripts, 19th September 2008).  


But what are these representations there for?  Why do we need them?  TS Eliot once remarked that ‘mankind cannot tolerate too much reality.’   So do we use symbols to distance ourselves from intolerable realities, that we really are all alone in the world and there are forces out there that want to destroy us? 


Dr Kenneth Wright, psychoanalyst and author, who spoke at The Eye and Mind Society last week, thought so. ‘Our symbols exist to help us cope with separation and live an independant life. We cannot do that unless we can build a representation of what it is we separate from’.  This allows us to remain connected to the objects that give us security even if they are in mental cyberspace. As I explained in last week’s blog, Lean on Me (18th February), the ability to be independent and go it alone depends on the presence of a supportive partner. It is really a state of mature interdependence. This can still be the case even though they are thousands of miles away, if we have not seen them for years and even if they are dead.  As long as we know that somebody loves us, then we can do anything.  But how do we learn to be without the one we need but still have them? 


Infants use substitutes, bits of blanket, smiling teddy bears, their thumbs – transitional objects that represent a continued connection with their mother’s face and body and are used as comforters.  Transitional objects are a step on the way to internal or mental objects. 


Toddlers learn to play quite happily as long as they know their mother is there or will return very soon.  They carry the image of the consistent mother who will always be there if they need her and that gives them the confidence to play, to explore their environment.  As they grow and the distance and time of separation increase, they carry a mental resonance of the soothing sound of her voice, an image of her smiling face in our mind’s eye.  The face is particularly important.  Humans have the most expressive face of any animal.  It conveys feeling through a visual connection.  A smile makes all of us feel good .  It is immensely reassuring.  A frown is frightening.  

The older child learns to work in metaphor.  They move from a world of real things to abstract images, soothing music, soft contours, comforting colours and images, that may still represent aspects of their mother. These are all ways of creating a reassuring world.  And when adolescents leave home, they may carry an impression of home and mother which they then project into their chosen partner with whom they re-establish a much earlier intimacy.   


But symbols do not just represent home and security, they represent other aspects of our lives as well; the things we are afraid of, that make us angry.   They recreate our good objects, bad objects, guilty objects and objects we feel ambivalent about.  Good representations reassure us that we are loved.  They are a way of possessing but not possessing.  Bad representations provides the means of taming the dangers of life.  They separate us from a reality we can’t control and give us a virtual mastery, which can take away the fear. ‘You’re never alone with a bad object.’   


Symbols are rather like spirits.  We see them in our minds eye and they bother us.  


‘As I was going up the stairs,

I met a man who wasn’t there.

He wasn’t there again today.

I wish that man would go away.’ 


Tribes in some regions of central Africa live in the world of spirits all the time, so when somebody returns to the tribe after many years absence, they throw sand at him just to check he is real.  Some of us do something similar for the people we don’t quite trust. We test them out.  Is this person for real?  Will they be there for us?


Young children and many older ones inhabit a split world of all or nothing, good or bad, which they try to control through magic and superstition.  It takes time, training and experience before they acquire a more balanced approach and develop more ambivalent but realistic representations.   


Some people find it difficult to make mental representations.  They do not trust their mental images.  They cannot think about the meaning of things.  They have to know the facts. Perhaps for them, separation has been too sudden and they need to hold on to reality. 


But for the majority, it’s our accumulation of our memories and meanings that build up our identity.  How we cope depends on the nature of our objects. If they are good, we can go out into the world with confidence. If, however we surround ourselves with negative representations, then life is a torment, for which the only relief is the support of our friends.

‘They say you will all die!’ 


Mulu’s cries add a chill to the low afternoon sun.   


The villagers had been on the hillside opposite the ambo, the basaltic stele that we were attempting to scale, all day, laughing and shouting cries of encouragement.  But now it was late, night was imminent and they had begun to panic. If we spent the night on the mountain, the spirits would surely kill us.


We had started well.  There was a clear diagonal line up the western face that must have marked the site of the original steps.  But this soon ended and we were forced to muscle our way up a greasy chimney to a precarious ledge, occupied by bellicose baboon, who, after much lip curling and smacking,  turned, and with slow disdain, presented his rump and strolled back the way he had come.


It was too dangerous to reverse our route in the dark. We would have to bivouac on the narrow ledge. The problem was that we only had the fly sheet to shelter under if it rained and just two sleeping bags between the four of us. Mike and I wedged our legs into one and tied ourselves to the base of stunted tree, but in the middle of the night I awoke to find our ties had worked loose and the entrapped bottom halves of our conjoined bodies were suspended over a four hundred foot drop. I nudged Mike, who turned over, propelling us further out of our centre of gravity.  It looked as if the villagers prophecies were about to be realised. But no. Gently I awoke him and moving very cautiously and hooking our arms around the tree without uprooting it, we managed to pull ourselves up. Although we strengthened our ties, we had no more sleep that night. 


Mount Wehni was in the northern highlands of Ethiopia, not far from the ancient capital of Axum.  It had not been climbed for four hundred years.  Then it was a prison.  The Emperor kept any challengers to his throne incarcerated in the huts on the top.  The only way up and down the perilous pillar of rock was a wood and rock staircase, but that had collapsed.  Cut off from supplies in their inaccessible eyrie, the prisoners and their guides perished. 


In 1966, as a second year medical student with a yearning for adventure, I and a group of like-minded friends organised The Cambridge Medical Expedition to Ethiopia to carry out a survey on the prevalence of the debilitating parasitic illness, schistosomiasis, in areas of economic development.  While we in Addis, we met a climber, Dave Prentice, who was on a personal mission to climb Mount Wehni and  needed a few more foolhardy romantics to help him realise it.


We didn’t succeed.  By midday on the second day, we were still a long way from the top.  Reluctant to spend another sleepless night on the side of the mountain and concerned  about our lack of water, we abseiled down.  


The villagers welcomed us like spirits returned from the dead and prepared a banquet.    There were large black glazed jugs of tej, a kind of honey mead,  a bowl of we’t, a spicy lamb curry and plates piled high with injerra, a pancake made of the sourdough prepared from tef, a coase flour made from the seeds of a grass that grew in the highlands. We tore off pieces of injerra and used it to scoop up the we’t, sluicing it down with an infinite supply of tej.  As the night wore on the villagers entertained us with songs and dances.  We staggered back to our tent boisterous and happy at 3am.  It was a feast, I shall never forget. 



‘The Queen of Sheba’ is the one of a small number of Ethiopian restaurants in Britain.  Situated on the corner of Fortess Road in Kentish Town, it is not posh, but it has character and the food in delicious.  A strong aroma of incense greets you as you enter a  dark candlelit interior.  Plain wooden tables and chairs are placed around the small corner room.  Amharic crucifixes, spears, shields, black earthenware jugs and lamps adorn the walls. A strange, haunting Ethiopian music is playing.  This restaurant manages to recreate in Kentish Town, the atmosphere of a hut on the road to Lalibela.  Time Out calls it a funky juxtaposition of ancient and modern.   


‘The Queen of Sheba’ is is a family run business.  Mother is the chef, father runs the accounts and the daughters, beautiful dusky temptresses with wild curly hair and high boots, serve at tables.         


The menu features traditional Ethiopian classics, spicy meat or vegetarian we’ts, served on injerra, which has been cooked over steam and has the appearance and texture of a damp dish cloth but a delicious slightly acidic taste that complements the salty richness of the we’ts.  There is also Kitfo, the Ethiopian equivalent of steak tartare, a delicious beetroot salad,  spicy spinach and cottage cheese, and Kantegna, injerra toasted in butter and hot spices. 


Ethiopian meals are rich in ceremony.  The main course, which is often shared by 2 to 4 guests, is served on a large metal tray covered with a mesob, a conical rush cover, which is removed with a flourish to reveal a large flat disc of injerra covered in a variety of meat and vegetarian we’ts.   More rolls of injerra are stacked up on the side.  You eat with your hands, just as we did  40 years ago at the feast at Wehni.   It is a pity they do not serve tej in Kentish Town, but the strong Ethiopian lager, Castle, has a good back of the mouth bitterness that works well with the acidic injerra. 


There is no dessert, but it is essential to experience Ethiopian coffee. 


Coffee is highly prized in Ethiopia.  It was, according to legend, discovered in the highlands (see my blog, Frisky goats and dirty cats; the serendipity of coffee, 8th August, 2008).   It is served with elaborate ritual.  First the waitress arrives with freshly roasted coffee beans smoking on a metal spatula and presents it to each of us to smell.  These are then taken away to be ground with cardamom seeds and a small piece of cinnamon bark and put in a glazed black coffee pot.  Boiling water is added and the pot is placed on a rush ring on a metal tray together with two small cups without handles, a bowl of sugar and a small clay pedestal surmounted by a tablet of glowing charcoal upon which is smoking three small pieces of frankincense. 


I sip my spicy coffee, waft the incense into my nose, close my eyes, hear again the haunting melody of the flute, the rhythm of the tabor, the excited chuckle of conversation and I am transported from north London to a balabat’s tukul on a ridge in the remote highlands of Ethiopia, where I celebrate with friends our miraculous deliverance from the spirits of Mount Wehni.


No-one ever died for lack of music, but nevertheless for many people a life without music would hardly be worth living.  No human culture is without music. Bone flutes have even been found in neolithic burial mounds. But what is music?  What is it for?


These were the questions posed by Dr Jason Warren, Consultant Neurologist at Queen Square, at last Monday’s meeting on Music and the Mind at The Royal College of Physicians at Regent’s Park.  


So is music a language, a mating display, a cultural artefact necessary for social cohesion or is it, or is it as the psychologist, Steven Pinker, proposes just auditory cheesecake, there for entertainment and serving no useful function? 


Musical sounds may well be a kind of proto-language, but music doesn’t tell a story, convey facts or help us to understand things more clearly. Jason Warren proposed that music and language might have separated very early in human evolution and ontogeny.  Call sounds are both semantic and emotional; the semantic aspects developed into the symbolic code we call language (which nevertheless has a musical cadence), while the emotional elements became music, which has its unique facility to encode feeling. 


So music, as musicologist, Daniel Leech-Wilson suggested, is perhaps best understood as emotional experience.  It changes our mood.  It becomes our mood.  Music can be exciting, depressing, angry, sad, frightening, heroic, stirring.  And yet it leaves a significant minority of the population, the tone deaf, stone cold.  This begs the question as to whether tone deafness is associated with a deficiency of emotional experience.   


When Catrin Finch played her new arrangement of The Goldberg Variations for the harp at the Royal Academy of Music last Sunday, the tumbling notes, the plangent chords, left me heartbroken.  I sat with my eyes closed throughout the performance, tears coursing down my cheeks.  No tone deafness there, I guess.     


Others would have experienced it very differently.  But that’s the thing about music. Although it can enable social cohesion – think of hymns, anthems, folk music, it nevertheless provides an intensely personal fulfilment. It affords people their own emotional experience without interference from each another. We all attach our own individual meaning to music. We all have special tunes, songs of particular emotional significance.  Perhaps it was the song that was playing when we met our beloved for the first time. Or perhaps it was just the popular music of our youth that rekindles nostalgia.  


Recent discoveries in neuroscience underscore the relationship between music and emotion. Brain scans have shown that the more primitive emotional areas of the brain, the amygdala, insula, hippocampus, cingulate gyrus, become active when music is played.  And in his new book, Musicophilia, Oliver Sacks described a patient who was struck by lightning and some 7 weeks later developed an obsession with music that was accompanied by an increased spirituality and emotionality.  Music and an altered emotional state can be part of temporal lobe epilepsy; often it is the emotional association with the music that seems to be important in bringing on the seizure.  


Indeed, I might suggest that music is so much a part of emotional experience that in a culture that suppresses strong emotion, music has been adopted as an acceptable vehicle for emotional release. Think of its important role in religious ceremonies, the passions released at pop concerts, even the importance of music as a promoter of love making.  At the college conference, one elderly member was so inspired by the topic as to shock his dignified and eminent colleagues with the pieces of music he and his wife, who was looking distinctly embarrassed, liked to make love to.  I had not witnessed such enthusiasm since a very senior professor demonstrated the action of the prototype of Viagra to the council of the Edinburgh College and their ladies.        


But I am digressing.  What is it that moves us with music?   Is it its basic physical properties; the loudness, rhythm, pitch, timbre, the mathematical relations between the notes, or their combination that produces certain chords or melodies?  It is probably all of these.  Loud music stirs and excites.  Soft music makes us reflective.  It is probably no coincidence that the beat of our music matches the rate of our heart or the rhythm of our walking.  Speed it up and it is more exciting.  Slow it down and it is sad or restful.  Music played in a major key tends to be perceived as cheerful whereas when played in a minor key, it tends to be melancholic, but there are numerous exceptions.  The observation that people from musical cultures with different notations don’t perceive that distinction suggests that it is learned.  Melodies stir memories, they ‘amp’ up the hippocampus, a key brain structure for processing emotional memory.  Music has emotional associations.   Isabelle Peretz claims that emotional tension and release flow from the way our learned expectations of patterns of music are manipulated, violated  and postponed. In other words, much depends on the performance.  


Music enhances the meaning and impact of poetry.  Two years ago,  I went to hear Carol Ann Duffy read poems from her collection called Rapture.  They were then put to music and sung by the jazz singer, Eliana Tomkin.  Duffy’s flat poetic reading did not engage my emotions, but Tomkin made the words soar.  Duffy writes such excellent poetry – the combination was magic.  It is a pity that so many bad lyrics have been rendered  memorable by setting them to wonderful tunes.


Music is also therapy.  It encourages movement and thinking.  It can bring the institutionalised elderly back to life. It gives the sick hope, the mentally impaired meaning.  Indeed people with learning difficulties can have unusual musical appreciation and talent.       


Derek Paravacini was just over a pound in weight when he was born premature.  He was not expected to survive.  He did, but with severe learning difficulties.  Not only that treatment with oxygen had destroyed his retina and he was completely blind.  Nevertheless by chance, he was found to have a prodigious musical talent, which has been enabled through his long relationship with his friend and mentor, Professor Adam Ockleford. 


At last Saturday’s recital, given to the Eye and Mind Society, Derek demonstrated not only his amazing virtuosity on the keyboard but also his incredible memory for music.  He only needs to hear a piece once and he will reproduce it, note perfect.  He can also perform complex pieces that he has not played for years. 


Derek is a musical savant.  It is as if, deprived of other effective means, it is music that allows him to communicate, to link emotionally with others, to have a meaningful life. 


Auditory cheesecake?  Are you tone deaf, Mr Pinker?  Music is not just an additional dessert in the meal of life, it is the flavours, the textures that enrich our repast and make a veritable banquet out of breakfast.    

Dimpled by invisible ties,

The quilted duvet recites

the narrative of the night;

the hop and step of a tentative rabbit,

the curved cloves of the dancing deer   

the direct purpose of the dangerous fox

the fork of a foraging pheasant.


Stippled by the sudden breeze that  

shook the midnight tree.

Iced on a wedding cake of gable, arch and turret

in the huddled village under the wood.

Converted skeletal oaks into blooms of frost,

Curdled on pines hard against the gritstone cline.  .  


Ploughed up by the flock behind the copse,

the sheep-shaped patches of grass

anointed by their dung

as they rose to the frozen dawn

and trod their criss cross confusion of cold-drunk tracks,  

down the slope towards the black river.


The next day it froze,  a thousand points of light,

resounding to the crunch of meringue, the crack of a puddle.

It stuck to twigs, turning trees to wedding gowns,

grass to prayer flags,

echoing to the laughter of jackdaws,

the wounded refrain of the robin.  

The smoke uncurls, stretches

and spreads above the village,

making a mystery of the morning,

romancing valley and crag.     


And on the stump of an ancient oak,

a solitary rook clicks and croons

like Crosby, his tail a fan

on The Road to Singapore.    


Sparrows chirp by the wall

and tittlemice scold from the eaves

where martins, vagrant potters,

will build their summer trust.     


Incumbent of herbaceous border,

the grey, brown dunnock,

as furtive as a monk,

chants an insistent catechism.    


And in the night

the robin trills  

soft, like falling water,

under the light.  

Want to be strong and independent?  Well, lean on someone else.  That was the conclusion of a study of 115 couples carried out by Californian psychologist  Brooke Feeney.  She showed the greater the support they provided for each other the more independent they were. Safe in the knowledge that their partner would give them the back up they needed, individuals became braver and more willing to go it alone.
‘The support from a loving partner is like an insurance policy’, she explains.  ‘Just as a person driving a car without insurance may be reluctant to drive long distances or to take unnecessary risks’, she explains ‘so too are individuals reluctant to take independent excursions away from a partner who does not provide good cover in an emergency.’


If you have to shore up the home base all the time, then you have no time to develop your interests and becoming self confident.  Mature relationships are a triumph of interdependency.  Knowing somebody is there for you is a real gift.     


We get the same message from studies of child development.  A child who grows up safe in the knowledge that they are loved, supported and encouraged will be able to leave home and explore their world. Children of insecure parents,  over-concerned  with their own worries, may become boomerang kids who never really feel confident for very long by themselves, or suffer chronic anxiety, ill health and difficulties with their own relationships. 


The greatest gift that any parent can give their children is the confidence to take them for granted.   So why in adult relationships, do many women accuse men of taking them for granted?  Why do some need to be cherished and adored so much, that they will make their partners feel insecure by flirting or rationing their affection?  It certainly isn’t about love; it’s more about insecurity and acquisition of power.  The partner who can make the other feel jealous or inadequate holds the power.  Adoring husbands often tend to be castrated and impotent.  Love affairs are nearly always about security and power and will invariably weaken one or both partners. 


In love as in life, happiness and well being is achieved through trying to enable each other become the confident and interesting person you are.  Bring out the best in others and you will feel good.   


In Fire, set in Agra and Delhi, a beautiful young wife reacts against her selfish, womanising husband by having an affair with her sister-in-law. Earth takes place in New Delhi where the tragic events surrounding the 1947 Partition are seen through the eyes of an eight-year-old Parsee girl whose beautiful Hindu nanny is in love with a Muslim.  Water, is the concluding film of Deep Mehta’s courageous trilogy that attacks patriarchal oppression and religious bigotry in India.  It is set in 1938 in the religious city of Varanasi, Uttar Pradesh and focuses on the plight of widows, who either have to die on their husband’s funeral pyre or marry their husband’s brother or live a live of poverty and seclusion in a widows ashram.       

Chuyia’s husband dies when she is just 8 years old.  Her father has no choice but send her to the ashram.  All of the inmates are older than her, some quite elderly. They have their hair shaven and are obliged to beg in order to eat.  Only one woman is allowed to keep her hair, the beautiful Kalyani, who is forced to prostitute herself to make extra money for the ashram.  Although religion is used to justify the terrible treatment of widows, the decision to expel them from their families is more about economics.  ‘One less mouth to feed, and the cost of four saris, one bed and a corner in the family home saved.’  

Narayan, a young lawyer and a follower of Mahatma Gandhi, falls in love with Kolyani, but when he takes her across the lake to meet his family, Kolyani realises that Narayan’s  father is the elderly Brahmin she has been prostituted to.  She insists that the boat is turned around.  That night while Narayan goes to confront his father she walks into the water and drowns herself. 

Chuyia, who has angered the elderly woman who runs the ashram by her rebelliousness, is then sent across the lake to be raped by Narayan’s father.  To escape the same fate as Kolyani, one of the other women in the ashram gives her to Narayan so she can be brought up in freedom as a follower of Gandhi.  

Although the British abolished suttee, they could not intervene to end this barbaric institutional incarceration, but it is a time of change.  Gandhi’s intervention has brought about a law allowing widows to remarry, but traditionalists do not accept it. 

Water is an exquisite piece of film-making.  The scenes of water are beautiful; misty  lakes with rafts of lotus flows, the distant islands and mountains,  early morning ablutions of the faithful, the torrential rain.  But although the water looks beautiful, it is polluted and dangerous. Beneath the surface is sexual abuse and death.  “Learn to live like a lotus untouched by the filthy water it grows in,” one of the widows is told in the film.   


Water was made at the start of a new millennium.  Nevertheless, some sixty years on, the film raised such a storm of protest in India that there was a riot on the set and it had to be shot in secret in Sri Lanka.   

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