psychology


stressed-student80% of Sheffield students self report disturbances in mental health.  This was the shocking statistic presented by Anna Mullaney, welfare officer for the students union, speaking at a debate, organised by Sheffield’s University Counselling Service.  More objective studies have shown that  1 in 4 students have a mental health problem.  Around  50% of people attending doctors surgeries or specialist clinics have illness that defies medical explanation, such as eating disorders, Irritable Bowel Syndrome or Chronic Fatigue Syndrome, all of which often start during a period of adolescent dependency extending into the mid twenties or beyond.

Why might this be so?  Is it because children are so overprotected they are ill equipped to cope with the stresses and pressures of independent life at university?  Or is it that modern Universities are particularly toxic for students?  Or are we just over-medicalising everyday experience?

 

Are Universities dangerous?

When I went to University in the nineteen sixties, I was among a privileged 30%.  I knew I had a job waiting for me as soon as I left.  The government funded my tuition fees and I had local authority support for my accommodation and sustenance.  As the Prime Minister of the day proclaimed, ‘we had never had it so good!’   It was true.  We were very fortunate.  We were also eager to make our way in a world that seemed more secure than it does now.

Nowadays, most young people expect to go to University.  It is a rite of passage into adulthood but there is not a guarantee of a job at the end of it. Many university leavers start life on benefits.  The bar has been raised.  Employers are often looking for students with Masters degrees or Doctorates and these are only awarded to the most competitive students.

The pressure to succeed, claimed Ms Mullaney, often means extra courses, assignments and ‘character-developing’ involvement in student politics, administration and sport.  Universities were always a preparation for life, but that life has become much harder. Most students have to take casual employment in bars or restaurants just to earn enough for the necessities of food, shelter and entertainment.  Many find it more economic  to live in a house together with other students, but this gives them no privacy and little time for thought and study.  They may fall out with their housemates or feel coerced into drinking too much, taking drugs or casual  sex.  The stereotype is that students work all day, finish their shift in the restaurant late a night, then hang out with their friends until the early hours and then get up for lectures again the following morning, but that may not be the norm.  Nevertheless, loneliness, poverty, the stress of assignments and exams, alcohol, drugs and sex make for such a toxic mix, it is amazing that so many students get through it.  But many don’t and what happens during what should be  ‘the time of their lives’  may leave them increasingly susceptible to illness and stress.   So is university that dangerous or does it just seem so?  Is this why more students are living at home these days?

 

The Pathologising of Everyday Life

The other speakers in the debate went to University in ‘the golden age’.  Sir Simon Wessley, now President of the Royal College of Psychiatrists, acknowledged the results of mental health surveys of young people and the stresses of university life, but questioned whether such stress should be considered abnormal or just part of growing up.  Change is always stressful and leaving home and going to university has always been a challenging transition.  It is way we deal with stress and the experience and resolution of anxiety that helps people learn and grow in confidence and enjoy life.  Enjoyment and self confidence always comes with overcoming risk.

Wessley questioned whether we were not in danger of pathologising everyday experience?’   Might, for example, everyday sadness and disappointment now be regarded as depression; life stress, anxiety disorder; a robust exchange of views, bullying;  focus and hard work, autism or obsessive/compulsive disorder; or the boredom of an intelligent child,  attention/deficit hyperactivity disorder?  There is obviously something in that but such assumptions may condemn many to accusations of malingering, rejection and stigmatisation.

Quoting from a study of those soldiers deemed at risk from battle trauma, Wessley noted that the greater proportion of those at risk showed resilience under fire and grew from the experience.  The same applies to assessments of vulnerable students.  Fitness to study assessments could rule people, who otherwise might do brilliantly, out of university.

 

Does Awareness make people ill?

Ken  McLaughlin, Professor of Social Care & Social Work at Manchester Metropolitan University questioned the benefits of awareness campaigns for mental illness. He wondered whether this might focus too much attention on vulnerability instead of celebrating the risk and the excitement of life.  Awareness creates labels, which makes people more conscious of being sick and justifies illness behaviour?  Have we become so Health and Safety conscious that we worry ourselves sick about the risks of everyday life than just accepting them and enjoying the challenge?   Moreover, he added, by labelling people as mentally ill, are we producing a stigma, that isolates the individual, causing rejection and more tension and illness.

 

Blaming the individual for society’s ills.

McLaughlin was was concerned that societal and political problems were so often reconfigured as psychological issues for the individual.  People who are unemployed may not so much need counselling or CBT; they just need help to find a job. Trades Unions seem more concerned with helping people cope with inequalities than fighting them.  The same might apply to student union initiatives. It’s often when people feel entrapped in a situation where they feel ignored or unfairly treated that they get ill.  Expressions of frustration and anger can be quite rational responses to the injustices of life.  CBT may help the individual deal stay with their troublesome feelings, but positive action may be more effective.

Situations that induce feelings of entrapment, impingement, rejection, isolation, loneliness, inequality, poverty and hopelessness often underpin distress and illness and should not just be seen as a failure on the part of the individual. We need to address what it is about society that makes people feel bad.

 

Are interventions exacerbating the problem? 

Professor Kathryn Ecclestone, from The University of Sheffield’s School of Education said that the university has trebled its expenditure on psychological support of students, but questioned the evidence base of such interventions.  Mindfulness courses, resilience training, trigger warnings on upsetting lecture material and provision of ‘safe spaces’ for vulnerable students have become commonplace. She questioned how helpful these were.   ‘Are we offering much needed support and recovery facilities or are we in danger of fostering dependency?  Do self help groups keep people in illness?

Simon Wessley quoted from research showing that psychological debriefing after trauma  doubled the rate of breakdown.  It was better to talk about normal things with family and friends, he claimed.

 

At the age of 19 to 21, young people are still trying to find who they are.  Students are very suggestible; they take on many worries about the way they feel they should be. Experience gains at University lasts throughout life.  Instead of creating a space to talk about a perceived problem or seeking escape through sex and drugs and loud music,  universities might help students to work together, face life and experience that frisson of risk and resolution that will them grow into responsible and confident adults.

 

 

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Don Juan, the ambivalent one, the wild man women love to hate or hate to love, the one they want to tame or not, the libertine who liberates sexuality from the everyday shackles of marriage, the maverick who rejects the mores of society to please himself, the nomad who promises freedom but delivers loneliness.  Don Juan epitomises the essential conflict of masculinity, excitement or commitment; constantly on the move, he comes in through the window late at night but does not stay for breakfast. 

But who is Don Juan?  Is he a melancholic, searching for something he can never find and does not wish to?   Inasmuch as we all model future relationships on our first love with our mother, do we imagine little Juan’s mother as a tease, unavailable, the joy of possession snatched away from him leaving the unremitting quest but no trust.  So is the Don predestined to a perpetual  struggle between life and death; does he yearn for the love that will kill him, yet fear it?  His promiscuity embraces death but flees the pain.  Is he Peter Pan, forever in search the Wendy he must reject in place of Lilith, la femme fatale, who will seduce and kill him?  Or can we imagine him unfulfilled, getting old;  a wine soaked depressive regaling all who will listen with of tales of conquest,  sans teeth, his flirtations rendered impotent by repetition?    

Don Juan is complicated; he disturbs us.  On the one hand he represents excitement, power, liberty, joy, orgasm.  On the other he is a coward; fearful that relationships weaken him.  He will never  commit or belong.  He does not wish to possess.  He needs to explore, seek out, live the adventure, continue the quest. 

So what of Don Juan in the 21st century?   In an age when technology has uncoupled sexual urge from reproduction and given women control of their own sexuality, has he been rendered redundant by a tipping of the scales of sexual power?  Is there less risk in seduction and less meaning?  Disconnected from social responsibility, coupling is ruled by the thrill of the moment, the sensation.  So is everybody Don Juan?  Is it a case of every man and every woman for themselves?   We read that community and family are being eroded, less people are entering the commitment of marriage,  more children are raised by single parents who are less available as role models or guides,  young people are exposed to sex and pornography at a precocious age and are more likely to experiment with variations in sexuality.  There’s no mystery any more.   So has the Don not so much disappeared as become normalised, familiar and tamed and well, boring?  Is he just as likely to be gay these days?   Has our sexualised society become lost in adolescent fantasy?   Psychiatrists tell us that more males are phobic of commitment.  Sociologists report that career women cannot find partners to father their children.  At a time when loneliness and depression are the common ailments among the young, has romantic love lost some of its passion?

Anneka is only one year old, but she is bonding with me.  She stares hard at my face, makes eye contact, holds it, then reaches out, touches my nose, my eyes, my ears, scanning each of my features, fixing them in her memory.   Then later when she hears my voice she looks round until she finds the face and smiles.   It seems to me she is not just recognising, she is bonding. 

In the fusiform gyrus, deep in the inferior temporal lobe of the brain, there is a collection of neurones that respond to specific faces.  Damage to this area by a tumour or a stroke leads to the neurological condition, known as proposagnosia – absence of face recognition.  The same region also serves place recognition.  It responds to the features of particular cars in car enthusiasts like Rowan Atkinson, and to characteristics of birds in bird watchers like Simon Barnes.  Indeed Barnes writes about having a giss for a bird, a facility for identification from minimal cues.   If Anneka is played a recording of birdsong, she immediately looks out of the window to see the bird.  Is this the beginnings of giss? 

So is the fusiform gyrus, the site for pattern recognition?  And do people develop a facility for better recognition of patterns that are familiar and interest them, like cars, bird or traction engines?   That would make sense.  After all, Chinese people are better at recognising Chinese faces and find Europeans look very similar.  

But recognition is not the same as familiarity.  The latter is more a function of the amygdala and its emotional connections to the orbitofrontal cortex.   You don’t need recognition in order to form an emotional connection. People with proposagnosia are not autistic.  Some with proposagnosia greet everybody with great familiarity as if every face was a friend.   So do minor forms of proposagnosia lead to indiscriminate affection and intimacy, like the potion poured into Titania’s ear.  Almost anyone will do, even one with the head of a donkey.  Is promiscuity based on a neurological deficit of character recognition? 

Bonding is more enduring than emotional connection.  It requires a specificity, a recognition that is  consolidated by repetition.  Every time you see that person, go to that place, hear that song, a charge of emotion fixes the connection deeper into the memory, like paths through the forest.  It takes time to get to know a person, to trust the consistency of the interaction, to establish that  emotional railroad that makes relationships meaningful.   And once that bond has been produced, it is impossible to sever.  Reinforced by contact, it only declines by degrees when lack of contact and/or disillusion no longer sparks the memory.

 

Life is a constant process of modification and adaptation,   The basis of our identity is forged early on through the interaction with our parents.  Our whole world is our family, our home.  But then as we grow, become more independent, explore our environment, other people and situations influence us;  extended family, friends, school, holidays, university, marriage, job; they all accrete to our personality to form a distinct, recognisable identity.  But it doesn’t stop there.  We continue to remodel our personality throughout our life.  This usually occurs by a gradual process of evolution, but it sometimes occurs more dramatically by crisis and revolution. 

So what is it that changes us?  The simple answer is experience; the things that happen.  If the environment changes, then we either adapt and grow or we stay put, stuck in the past. Not all events change us, of course; most of what happens can be accommodated within the confines of our experience and serve only to reinforce our view of the world.  But occasionally, we encounter someone or live through some situation that so outside our experience that we are forced to adjust our whole way of thinking to incorporate it.   

Change is an emotional interaction.  Things that are different challenge, excite, shock, frighten and even depress us.  If we engage with them, we may feel envious, guilty, ashamed or angry.  Sometimes we may be able to change the situation, but more often than not, we can’t; the only thing we can change is ourselves.  Working through, coming to terms with, are the processes of change;  the reconstruction of the personality that develops out of emotional crisis.   So if something affects us, makes us think and feel, then we are changed by it.  Change is instigated by emotion.   We fall out with somebody, argue, disengage, fume, but then later, sometimes much later, we pause, start to see it from their point of view, and reconcile our differences.  We are changed by what has happened.    

‘Love changes everything’, wrote Andrew Lloyd Webber.  Such a deep emotional identification with another human being results in coalescence, a  blending of experience that changes both.  Change requires an interaction, an exchange.  We are social beings; other people change us.   Conflict and love; we are changed by sharing of intense emotional experience. 

 But it’s not just direct emotional experience that changes us.  We can be adjusted by culture.  Art, literature, science, technology, religion, politics are all agents of cultural change.   They facilitate change in ourselves by altering the emotional environment.  They can rearrange the way societies perceive their existence and influence the choices they make.  Somebody proves that God no longer exists or that world is finite, and suddenly the restrictions of people’s behaviour are lifted and they change.  The ability to communicate instantly with somebody at the other side of the world, the way we experience war, earthquakes and tsunamis in the comfort of our living room as they are happening, the way we can shop, pay bills, book holidays, conduct our jobs without leaving home; all off this has altered the way we are. 

Governments, yes even Conservative governments, are agents of social change; they change the social environment by legislature and the people have to move into it.  

Architects also change the social environment.  Geoff Cohen said on Radio 4 last week that good architecture must not only be functional, it has to create hope and space for emotional development.   Jaume Plensa (currently at The Yorkshire Sculpture Park) creates  environments for peace and meditation as well as exciting spaces where change can happen.  His sets for opera create such dramatic possibilities.   

Change the environment, change the meaning.   If we move away, get another job, we mix with a whole new social group and we are changed.  If we separate from our partner,  move on, marry someone else, we become a different person.  Relationships change people, probably more than anything else. Parents and teachers create the environment/space in which children can grow, but eventually the child has to separate.  A good teacher or parent equips the child to take advantage of the opportunity. By the same token, psychotherapy can expands perception and creates possibilities for change, but only the individual can change.  You not only need space to change, you need courage to take advantage of the opportunity.  And the good enough parent, teacher or therapist, must facilitate a safe environment for the person to develop with confidence and not seek to overprotect and confine through selfishness and fear.

So why do we help each other?  It defies logic.  According to Dr Samuel Okashi, who was speaking at the Cafe Scientifique last night, if we were the rational, logical creatures we claim to be, then there would always be an advantage not to.  The Prisoner Game, invented by the ‘autistic’ mathematician John Nash (depicted in the film by Russell Crowe),  demonstrated that when you cannot trust your partner what to do, it is always better to defect, because the risk of collaborating when they don’t, could mean you end up with nothing and even if you both defect, you could at least end up with something.  This makes logical sense to prisoners and psychopaths, who cannot trust.  It also makes sense for governments.  Look how difficult it is for states to agree on cutting carbon emissions.  Powerful states with more to lose, defect, because if everybody else cuts emissions they will gain, even though the world will lose.  How could you ever get them to collaborate?

Why should people who are inherently narcissistic and self interested, engage in co-operative altruistic behaviour?   Is it just that we are social animals and as such have an inbuilt need to collaborate?   Such behaviour is built into us from the beginning; it’s instinctive; the baby clings to the mother, the mother’s instinct is to care for her infant.  Families stay together not just because there are distinct advantages for them to do so, but because there is a powerful emotional bond.  People group themselves in tribes.  There’s strength in numbers, but there’s also comfort, creativity and meaning.  In a social unit, the whole is greater than the sum of its parts.  No one person can do everything.  By adopting different roles, they can work as a unit to achieve much more as long as they see advantage in doing so and there is discipline.  And for that you need trust and leadership.  Difficulties arise when you have too many chiefs and not enough Indians.  Our survival as a species is based on collaboration.        

But we don’t collaborate with others just because we discern long term gains from such behaviour or because we avoid long term losses; we avoid being punished.   No, I think it’s deeper than that.  Our lives are built on meaning, the meaning that can only come from social interaction.  Our brains are wired by making emotional connections; neuroscience shows that the more we engage with the people and world around us, the more our brains adapt to cope; the more we grow as individuals.  It’s the way we form our identity.  Defection leads to autism, depression, exclusion and in an evolutionary sense, extinction.  Comparative research among primates indicate that the bigger the social group, the larger the size of the brain.  The implication is that you need big brains to hold in mind the dynamics of so many relationships. 

The key factor is trust.  Relationships, societies are based on trust.  Evolution assumes collaboration, at least for time enough to exchange genes but for social species collaboration must persist for much longer.  Trust is the glue that bonds people into families, friendships and tribes.  We have to know that at the end of the day, those whom we are bonded to by trust, will not abandon, mislead, exploit or betray us.  We need to know we belong.   Without trust we are like prisoners; always suspicious, watching our backs, making sure that others do not steal the advantage leaving us with nothing.  Society disintegrates without trust.  

The Prisoner Game is not the only game. There is another game for social animals and that is what my grandmother quaintly called courtship.  Here the goal is conjunction, the creation of a lasting bond.  In the edgy dance of courtship, each partner attempts to determine the sincerity of the other in all sorts of tests and tasks. ‘if you really loved me, you would do never be late, forget, let me down.’  The object is to build and establish the share mythology of absolute trust that will sustain the sufficiently to rear confident, trusting children while at the same time consolidating their place in the tribe.  In the courtship game, there is only one win.  The philanderer and seductress may achieve a short term gain, but it doesn’t last and both are the losers, gaining only disillusion and loneliness; lust, trust and bust!    

The Prisoner Game is based on false assumptions.  It assumes that human beings are purely logical, rational animals, who have no time for trust and only see personal advantage in relationships.  It is rather similar to the corporate game in which representatives employ the skills of seduction, charm and persuasion, to gain an advantageous deal.   Trust often doesn’t come into it; the best either partner can hope for is mutual advantage, bound by a written agreement, where law replaces trust.   But in the corporate world too, aren’t the best agreements forged during a round of golf or over a drink or meal?  The enjoyment of the game, the companionship, alcohol and food are ways executives still use to break down suspicion and promote trust, but increasingly such individuals are ‘protected’ by their PR companies.  As societies have expanded, so they have developed ever more efficient systems to protect themselves from ‘messy’ emotions.   You need more than the promise of good intentions if you are going to strike the best deal. 

Are so called civilised human beings becoming more selfish and more suspicious?  Do we trust less?   And are we paying the price for this?  Isn’t loneliness the major public health risk of our time?  Hasn’t the birth rate declined  – and the divorce rate gone up?   Are we breeding a generation of mixed up, disenfranchised kids?  Are we more split, more confrontational, more keen on our individual rights than building something together?  Is it better to be right than be together?  Is this the essence of our decline as a society?  Can we do anything about it?

The driver game, in which drivers choose whether to drive on the left or the right,  only works if the players can rely on each other to make the same choice.  A partnership must be mutual, in marriage, friendship or even corporate relationships.  If one partner does everything, if one partner is ambivalent, deceives, plays away, betrays, it doesn’t work.  But collaboration requires energy (though not as much as suspicion) and as long as their basic needs are met,  human beings are lazy. 

So is this the way the world ends – not with a bang, but a whimper?

Lionel has been rector of his poor inner city London parish for a long time.  He is a compassionate man, who offers support and pastoral care to his parishioners,  visits hospitals and prisons and is a good shepherd to his flock,  but Lionel’s  faith is slipping.   This is reported to Charlie, Bishop of Southwark, who urges him to express his  true faith in the liturgy.  ‘It’s not so much what you believe’,  he asserts, ‘as what you are seen to believe’; the Christian ritual is clearly more important than pastoral care.   Lionel and his friends have quietly ignored this while paying lip service to it.  Donald ‘Streaky’ Bacon, cannot see what all the fuss is about.  He glories in God’s natural world and can’t be doing with the dogma.  Things come to a head when the newly ordained Tony, who has discovered  his evangelistic zeal and rejected his much more realistic relationship with his perceptive girl friend, persuades one of Lionel’s practitioners to leave her husband.  In the meantime, Harry’s live-in relationship with Ewan has got into the Sunday papers.  But it’s Lionel, who the Bishop, furious at the ordination of women, is after.   He may succeed in the short term, but change is inevitable.        

David Hare’s play reminds me of recent deliberations of the future of British psychoanalysis.  Are those trained in the dark arts a  loose philosophical conglomeration of curious and reflective individuals driven by a desire to understand and make sense of our collective existence in order to help their clients or are they  constitutionally bound to uphold the belief and values of a particular dogma, to practice the ritual, intone the liturgy.  Is is there any difference between the psychoanalytical institutions and certain Christian sects or even the Orwellian ‘Thought Police’?  The threat of Big  Brother is ever present.  Dare to express a different opinion and you could be excommunicated.      

The difficulty is that however much we may try to maintain the faith, however much we may fear change, we can’t stop it happening.  If we are going to survive, we have to adapt.  Psychoanalysis is very different than it was in the 1930s; beliefs, attitudes, forms of communication, the structure and even the existence of the family are all different.  We are all divided from our children by time and change. 

Psychotherapy has become more accountable, more measurable; like it or loathe it, most therapists and counsellors are practicing a modified form of cognitive behavioural therapy.  Like the tribes of Papua New Guinea, the culture of psychoanalysis is not so much dying but being assimilated into more generic forms of psychotherapy.  I don’t think this is necessarily a bad thing.   I believe that psychoanalytically inclined psychotherapists should communicate and work with the new breed of counsellors and psychotherapists and lend their considerable insight to bring about an evolution of thought and practice?   

But isn’t that what’s happening?  How many psychoanalytical psychotherapists practice a pure form of psychoanalysis?  Haven’t we all found in various ways that we have had to develop our own eclectic blend of practices?  Isn’t this what education is about?  We learn a method and then adapt it according to the environment in which we work.   Our training provides a way of thinking that we cannot ignore, but doesn’t this create opportunities to cross pollinate and produce more robust cultivars?  Shouldn’t we embrace and be as curious about the new influences as we are about the old doctrines?  The question for all refective beings is how we can create the sort of integrative, lively meeting of minds from which we can grow.  Were Sigmund Freud still alive, I don’t think he would cling to the ideas he had a century ago.  He always tried to move with the times. 

Racing Demons has been one of three plays in the recent David Hare season in Sheffield.  The Cameron government is seeking to regulate  psychotherapy as a discipline under the Health Professions Council.    

Who was Eddie Carbone?  Was he the strong leader of the longshoremen that worked between Brooklyn Bridge and the breakwater in the nineteen fifties, the kind uncle, who offered a home to his orphaned niece,  the compassionate community activist who found employment and  accommodation for illegal immigrants from the old country?   Yes all of these.  These aspects of Eddie deserved respect, but there was also a dark side; Eddie the tyrant, the bully, the weak man, so insecure of his own masculinity and power, he would terrorise his wife and niece and betray those he offered to shelter and protect. 

The trouble started when Marco and Rodolfo came to stay.  Eddie was already preoccupied by the blossoming sexuality of his niece, Catherine, and becoming over-possessive, but when it became clear that she was falling in love with Rodolfo, he had to put a stop to it.  He told his lodgers to leave, but Catherine threatened to leave too, so Eddie, desperate to keep his niece, informed the immigration authorities and Marco and Rodolfo were arrested pending deportation.  Out on bail, Marco comes looking for Eddie.  They fight, Eddie pulls a knife, but during the tussle, Marco turns the knife on Eddie and kills him. 

The View from the Bridge, probably Arthur Miller’s most powerful work, exposes the fragility of the American dream of opportunity, freedom and shelter for the dispossessed, through the complex personality of Eddie.

Eddie affects strength and demands respect, but is so insecure of his own sexuality and power.  His wife Beatrice is in charge of the home (and the bed) and Eddie is troubled by the sexual presence of Catherine and too concerned about Rodolfo’s sexuality.   He is threatened by the arrival of the cousins from Italy and feels compelled to demonstrate his dominance in demonstrations of boxing and trials of strength, which he loses.  He fears the loss of his dominant status in the community and the family, and resorts, like all weak leaders, to tyranny.   Inevitably, his entrenched attitude brings about the tragedy that shatters the world of everybody associated with him. 

And now America is trying to exert its will on Libya by bombing forces loyal to its leader.  It won’t end well for any of us.

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