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The research on trauma and mental health suggests that a huge part of the way we generally got into them was non-consensual treatment at the hands of other people and/or the world around us. So whatever we do to recover, heal, or otherwise address our issues, it has to be done differently: from a place of consent, care and friendliness for ourselves instead of a place of fear, shame, and harshness.

The master’s tools

Audre Lorde famously wrote that ‘the master’s tools will never dismantle the master’s house’. This means that we can’t dismantle systems and structures of oppression using the same kinds of mechanisms and tools that were used to put them there in the first place. If we try to do it that way we generally re/create corrupt systems rather than finding our way to some genuine alternative. 

We can see many mental health struggles as a set of inner systems and structures which were put in place when we were treated non-consensually during our lives, often in childhood, but also through traumatic experiences which happened later on. Most of the main therapeutic approaches agree that when we’re taught that we have to be a certain way in order to receive care and protection – or to avoid punishment or rejection – we develop survival strategies in order to cope.

Trauma and survival strategies

It’s these survival strategies – in the form of habits and patterns like addictions and compulsions, fear and anxiety, depression and distancing, anger and acting out – which we end up addressing as adults, when we realise that they’ve become a problem. They may be rooted, for example, in physical, sexual or emotional abuse or neglect at home, in particular traumatic events that happened to us, in the discrimination and hatred we experienced due to being part of any marginalised group, and/or in being repeatedly sent back into unsafe situations such as bullying or otherwise hostile school environments.

In our current culture few of us escape such experiences entirely. Few girls reach adulthood without experiences of sexual harassment and assualt and without learning the ways they will be denied agency and regarded as second class citizens throughout their lives. If you are part of an oppressed group you will soon come to realise how differently you are treated: how your body, labour and life are valued less. School is a pretty non-consensual situation for even those who escape the more obvious forms of trauma there, much of which is normalised. Most families pass on messages that children should override their self-consent in order to conform to normality, hide their feelings and/or meet others’ expectations. 

All of this occurs within a wider culture which rests on teaching people that they are lacking and should be different to how they are in order to ensure docile and productive citizens, and in order to sell everything from drugs to diets, fast food to fashion, soft drinks to spirituality.

Treating ourselves non-consensually in the name of recovery

The problem is that – once we become aware of our mental health struggles, our habitual patterns, or our unhelpful survival strategies – the way we go about trying to address them often mirrors the very way they were put there in the first place. We try to fix ourselves, we push ourselves too far too fast, and we force ourselves to do all the things we’ve been told will help, punishing ourselves we don’t find ourselves improving as quickly as we felt that we should.

This has been brought home to me recently in a few ways. I’ll share my own experiences here and then give a few further examples where this might apply.

Trauma work

First I’ve been struggling particularly in the last year or so with what I’ve learnt are called emotional flashbacks: quick plummets into fear and shame which result in feeling very small, fragile and incapable of anything. I realise I’ve experienced these at greater or lesser intensity throughout my life, but the literature on cPTSD has helped me put a label to them. After reading a few books on trauma I fixed onto an idea – also common to many schools of therapy – that it could be useful to use current triggering experiences to connect back to earlier memories of traumatic events, and to revisit those in some way to loosen their grip.

Being somebody whose survival strategy tends towards the overfunctioning end of the spectrum, I grasped this idea and ran with it. One day, for example, I decided to write down all the traumatic memories I could think of in order to start revisiting them as a regular practice. Needless to say the result of this was not in any way pretty. I’m learning that the only way to do this kind of work is slowly and gently. If you try to push through, or force it, you end up retraumatising yourself and doing nothing to loosen the grip of the habits you’ve developed in order to survive.

Mindfulness

Another example is mindfulness. As regular readers will be aware, I’ve always been skeptical of the mindfulness movement from a social justice perspective, and a lot of my work involves attempting to weave Buddhist thinking and practices together with social understanding and engagement. 

However, I definitely bought the Buddhist mindfulness idea that it was generally a good idea to put time aside every day to sit, to notice your thoughts, and to keep bringing yourself back to the present. I figured that should be helpful to enable me to become more present to everyday life, to learn how not to get carried away into reactivity when hard stuff happens, and to notice forms of oppression acting through me and working to dismantle those as much as is possible.

What I actually found was that my fifteen minute meditation at the start of every day ranged from – at best – sitting with my noisy mind carrying me away for fifteen minutes and feeling a bit bad that I hadn’t come back to the present at all by the end to – at worst – taking a fifteen minute journey into precisely how bad I felt about myself.

I’m now reading an awesome book by David A. Treleavan called Trauma-Sensitive Mindfulness which brings mindfulness into dialogue with trauma-informed therapy and social justice. It’s helped me to make sense of these meditation experiences. As someone with regularly recurring cPTSD symptoms, meditation like this can be counterproductive unless engaged with in a trauma-informed way. In fact many – if not most – people experience some mild to major re-traumatising when they try to just sit with themselves without having any awareness of how trauma works. In pushing myself to meditate every day like this, with the idea that it must be good for me, I think I’ve been making things worse, and certainly not better.

Staying with feelings

A final example is staying with feelings: something that I’ve always been a big advocate of, as you can tell from my zine of this name. But engaging with the work of blogger and trauma-informed counsellor Love Uncommon showed me a vital missing piece of these practices. It’s only a good idea to stay with your feelings when they are in the manageable range. When they have reached a high intensity – or tipped into reactivity – then it is far more helpful to soothe yourself until they are manageable again. As with the other points, trying to stay with feelings when they are overwhelming is often retraumatising and unhelpful, making the feelings more scary and harder to stay with, rather than less so.

A similar thing is true for conflict and staying with each other’s feelings. A lot of people have the sense that the best thing to do in conflict is to stay and hash it out. But if any of the people involved has tipped into high intensity reactivity – or a trauma response – then that is a really bad idea. Far better to take time out, self-soothe, and cool down, perhaps making a time to return to whatever the conflict was about when everyone is in a good place to do so. Staying when one or more of you is in a place of trauma is again a recipe for retraumatising yourselves, acting out your survival strategies in ways that tighten rather than loosening them, and making further painful conflict between you more, rather than less, likely over time.

Other examples

Other examples where people often take a non-self-consensual approach to addressing their mental health struggles would include forcing yourself to go to a form of therapy or support that doesn’t feel right for you, staying with a therapist who doesn’t feel good, insisting to yourself that you must ‘be better’ by a certain point, anything which rests on the idea of ‘pulling your socks up’ or ‘getting over it’, and engaging in any form of self-help which is based on the idea that you are broken and need fixing rather than that you are okay as you are and deserve support. 

I’ve also had some interesting conversations with people recently who’re moving away from abstinence and restriction approaches to addressing addiction, self-harm and self-soothing to models where you allow yourself all the things you want, but engage with them consciously and intentionally with curiosity. One person said that any habit that harms us is oppression acting through us, so we cannot and must not respond with further self-harm and oppression.

It may seem paradoxical that some people experience way more radical shifts when they move towards the latter model, but it makes sense from the perspective that progress is only possible when we stop treating ourselves in the way that put the survival strategies or unhelpful habits there in the first place.

The role of fear and shame

Another part of this clicked for me after reading Pete Walker’s book on cPTSD (yes I am becoming a trauma nerd). He puts a lot of emphasis on the fear/shame feeling combo as being the key feature of emotional flashback and also – I realise now – a low level everyday backdrop to life for most of us with these kinds of past experiences.

Related to the idea that we can’t help ourselves using the same non-consensual approaches that hurt is in the first place, is the idea that fear and shame will not get us out of fear and shame. When we’re struggling we often try this kind of approach. We feel that we are bad people for struggling in these ways so we try to shame ourselves into addressing them or sorting ourselves out. We try to frighten ourselves into action by pointing out all the terrible things that might happen if we continue to employ our survival strategies.

There’s a whole additional post to be written about how fear and shame-based strategies don’t work for changing other people’s behaviour in a world where these seem to be the go-to strategies everywhere. Justin and I recently podcasted about this in relation to the fearmongering and shaming responses we’re seeing in response to the Covid-19 pandemic.

Fear and shame tend to make people frightened and defensive, and therefore more – rather than less – likely keep right on doing the things you don’t want them to do. The same is true with ourselves when we’re struggling. Like what could be a worse strategy for trying to cure ourselves from fear and shame than giving ourselves a load of fear and shame about our fear and shame. Think about it.

So what can we do?

So what I’m saying here is that if we treat ourselves in the ways that put our survival strategies, habits, or stuck patterns there in the first place this will solidify and tighten them, rather than dissolving or loosening them. 

What is the alternative? Well it is a massive challenge within our current cultural context because it involves us treating ourselves – and each other – in the radically different ways which intersectional feminists from Audre Lorde onwards have been encouraging us to do: valuing ourselves and others equally, practicing self-care, sitting with the places in which we are oppressed and victimised and the places where we oppress or hurt others. 

Such thinkers also point out that individual and systemic shifts need to happen alongside each other, given our interdependence. It’s hard – if not impossible – for individuals to change their inner landscape if the non-consensual outer landscape remains the same, and the idea that we should be able to do so harms us more. Engaging with others to share our experiences and work collectively is vital if possible.

For me a key starting point is self-consent. I’m trying to slow down my everyday life sufficiently to notice every time I’m drawn to override my self-consent. This is proving easier to notice now that many attempts to do so result in an emotional flashback plummet into fear/shame (trauma humour). But I’m also trying to notice the micro-moments of overriding my consent, the flickers of fear/shame that come up when I do that. I try to pay attention to what happened to elicit that response, to bring self-compassion to the situation to understand why that was my response, and to consider ways in which I might engage with whatever happened differently, in ways that don’t override my self-consent.

Slowness is another key here. This just can’t be done fast. Speeding up inevitably involves pushing through and getting overwhelmed. It’s helpful to tune into when I’m stepping out of my comfort zone into my stretch zone, and ensuring that I pull back into the comfort zone before I hit overwhelm. I was having a lot of quiet nights in before they became the default.

If fear and shame are a big part of the problem, then the solution is the opposite: cultivating protection and care to counter the fear and shame. Pete Walker talks about reparenting yourself and reparenting by committee. Other authors talk about cultivating a compassionate witness within yourself or befriending yourself, often alongside receiving a safe-enough and kind-enough therapeutic relationship to model what this might be like. 

I’ll be writing more about how I’ve gone about this from a plural perspective, but basically it’s anything you can do to be kind and protective towards yourself rather than shaming or frightening yourself, and to treat yourself consensually instead of non-consensually. 

Useful questions to ask yourself are: ‘what do I usually/habitually do under these circumstances?’ and ‘what would the opposite of that look like?’ You may find that there are several different ‘opposite’ options to play with. They may also be the ‘opposite’ of the experiences that resulted in your stuck patterns or survival strategies.

At this point you can bring those other practices back in. For me it’s not about stopping addressing traumatic memories, meditating, or trying to stay with my feelings. All those practices are immensely valuable, but only if done consensually, gently, gradually, and in ways that feel good rather than bad, and stretching rather than overwhelming.

Patreon link: If you liked this, feel free to support my Patreon, it will certainly help this self-employed person to maintain some income during these uncertain times.

Plural tag: This post was written by Beastie.

The post The master’s tools and mental health: We can’t get out of our struggles the same way we got into them appeared first on Rewriting The Rules.

Gratitude for mental health and well-being?

We probably assume that gratitude will be a positive thing for the person being thanked, but recent research in ‘positive psychology’ has found that it also has a very positive impact on the person doing the thanking.

The pioneer of positive psychology, Martin Seligman, studied all kinds of techniques for making people happier. The three he found to be the most effective were: remembering three positive experiences at the end of every day, finding a main strength that you have and applying it in a different arena, and writing a letter of gratitude to somebody and delivering it personally.

We might also consider the fact that most common mental health problems include a major component of criticism. In depression people frequently struggle with self-critical thoughts, in anxiety fear of failure is often bound up with self-criticism, and self-criticism often also has a key role in body image issues, self-harm, psychotic experiences, and addictions. For this reason, therapies and practices involving kindness and compassion have become increasingly popular in recent years. The tendency to evaluate, judge and criticise ourselves harshly is often related to a similar approach to other people. Therefore expressing gratitude and appreciation might be a useful counter to this tendency. Perhaps we can cultivate self-compassion to counter self-criticism, and appreciation to counter our criticism of others?

Finally, Open University research on relationships – the ‘Enduring Love?’ project – has found that ‘saying thank you’ was the most highly valued way in which people in couples showed their appreciation for each other. It is common, in long term relationships like those studied, for people to start to take each other for granted. Also it is very easy for people who live alongside each other for long periods of time, and who have high expectations of love relationships, to become judgemental of each other in ways that they probably wouldn’t be of other people in their lives, leading to conflict.

The act of saying thank you for small –and big –things that we do for each other, is a good way to demonstrate that you still appreciate somebody rather than assuming that helping you is their duty or obligation, for example. It is also a good counter to the kinds of criticisms that happen in conflict situations. Researchers at the Gottman institute found that unhappy couples engaged in a great deal of criticism, whereas happy couples had five times as many positive interactions to negative ones, and expressions of gratitude and appreciation are a good example of such ‘positive interactions’.

Individual or social?

However, there are some limitations to this approach to gratitude which focuses on the potential impact on individual mental health and well-being, or on satisfaction in individual couple relationships.

As I’ve discussed elsewhere, the criticism that so many of us struggle with is not just an individual thing that we happen to do (because of faulty brains, for example). Rather we are embedded in a culture which encourages high levels of criticism and comparison. Products are advertised on the basis that we are lacking and need to improve ourselves in some way, or that having such things could make us better than other people. Make-over TV shows, the red-rings round ‘problem’ body parts in women’s magazines, and self-help books also often encourage ourselves to compare ourselves to others, to self-monitor, and to criticise ourselves and other people.

From this perspective, expressing gratitude towards other individual people would be a starting point for a wider project of countering this culture of criticism, rather than an end-point that is reached once it has resulted in improved individual happiness or decreased relationship conflict.

With a more cultural understanding we might try not to stop with gratitude visits to those close friends and inspirational teachers who have helped with our individual journeys. We might expand out to also consider the strangers who have a positive impact on us every day: the people whose work keeps our streets clean, for example, or all the many people whose collective work goes into our morning cup of coffee.

Such an approach might lead us to more social considerations of how to ensure that all people are valued – particularly those whose contribution is often undervalued in the current national and international situation. This points us towards a recognition of our interconnectedness and interdependence. It may not stop with human beings but rather it could enable us also to appreciate the other species who enable us to live the lives of comfort that we currently enjoy.

Thus expressions of gratitude in such situations may come with a call for further action. They might also help us to be more present to our lives: to appreciate things as they occur instead of only in reflection afterwards. In this way such gratitude is a component of engaging more mindfully with the world.

Gratitude or appreciation?

Another more social issue here is around the power dynamics of thanking people. I once offered a workshop at a community event to encourage people to express gratitude to those who’d helped them in their lives. A disability activist pointed out to me that ‘gratitude’ wasn’t a great word as it implies a power imbalance between the people involved. She said that disabled people are often expected to express gratitude and seldom expected to be the people who others are grateful to. For these reasons we re-titled the workshop ‘appreciation’ rather than ‘gratitude’.

I thought that this might be a useful reframing for other situations as well. For example, when it comes to mental health issues the focus could easily be on those who have struggled to thank those who helped them, but it is often so much more complicated than that. We get a lot from being the ‘helper’ as well as the ‘helped’, and situations of gratitude can set up an unrealistic ‘us and them’ distinction between mentally healthy and unhealthy. It is important to demonstrate that all people are valued and appreciated, and that can be particularly powerful in the case of those who are rarely thanked.

Bringing this back to the Open University campaign we explored the possibility of all OU people expressing their appreciation, not just the students. For example, as a lecturer I am so often struck by how much I have learnt from students: at least as much, over the years, as they have learnt from me, I am certain. A similar thing is true for the clients I have seen as a therapist. It is hard to put into words what a huge deal it is to have somebody open up their vulnerability to another person like that, and how much I have learnt – personally and professionally – from their courage. I like the idea of appreciation as a mutual endeavour rather than a one way street across the power dynamic.

Doing appreciation: Why, what, when, where and how

To end on a practical note I want to consider some of the pragmatics involved in ensuring that a thank you is ethical and consensual.

Encouragement to make grand gestures of thanks can, ironically, miss the other person entirely and become all about us, the thanker. So we need to think about the why, what, when, where and how of appreciation.

First we need to consider why we’re doing it. Personally I don’t believe that improving our own happiness is a great motivation for saying thank you! Similarly it is easy to say thank you because we feel it is expected of us, because it’s just what people do in the situation we’re in, or because we hope to get something in return (their thanks, or sense of obligation to us, for example). So we might reflect on whether we are genuinely appreciative of somebody and what they have done, as well as whether our thank you is freely given rather than in expectation of a certain response.

Secondly it’s worth considering the what, where and when of appreciation. There are many different ways of expressing appreciation and thanks. Do we make a grand gesture or just a simple message? Should we provide a detailed explanation of the impact somebody has had on us, or just say that we appreciate them and leave it at that? Is it important to meet in person or can it be better communicated over phone, email or message? Should it include some kind of gift or not?

This all relates to the question of how our appreciation will be received. We need to consider what we know about the person. For some people a public declaration would mean the world, for others it would be excruciatingly embarrassing. Receiving a thank you letter might be so moving that a person would want to be alone, and with enough time to process it, rather than feeling that an immediate reaction was required. If the person we’re expressing appreciation for is somebody we have drifted away from, or had problems with, they might resent our intrusion into their lives.

There are similar issues, of course, with other kinds of declaration such as the ‘making amends’ encouraged by twelve step addiction programmes, or expressing our congratulations to somebody when we don’t really know whether the thing that’s happened (birthday, promotion, pregnancy) is really a cause for celebration for them.

A couple of recent examples spring to mind for me. I’ve read several books lately where the writer has thanked their partner in the acknowledgements section to the point of saying that the book would never have been written without them, and that they actually did much of the work of writing or researching it. Sometimes I wonder whether that public thank you might feel somewhat undermining to someone who – from the sound of it – might more appropriately have been listed as a co-author.

On the other hand, I recently experienced something that meant a great deal to me: somebody thanking me for my writing which had connected with them. The respectful way in which they did that, acknowledging the potential overwhelmingness of the situation for me, and allowing me time to take it in, was really appreciated.

In closing I’d like express my own appreciation to the OU campaign people for getting me thinking so much about this topic and to you for staying with me to the end of another long blog post: Thank you!

If you like, you can read the pdf of the original article here: MetroThankYou

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Collaborative relationship therapy

The approach is the ‘collaborative couple therapy’ of Daniel B. Wile, a US therapist. You can read all about it on Dan’s website here. Personally I prefer the term ‘relationship therapy’ to ‘couple therapy’ as it recognises that not all relationships are couple relationships.

Dan’s first idea is that the aim, in relationship therapy, should be to ‘solve the moment, not the problem’. This takes the pressure off trying to fix the whole – often seemingly overwhelming – difficulty that people are having. Instead, the emphasis is placed on addressing each interaction that comes up as something that can be ‘solved’, or engaged with more helpfully. Dan shares my view that conflict isn’t a problem in relationships: it is inevitable, and it can be helpful depending on how we engage with it.

Practicing this ‘solving the moment’ approach again and again means that another way of addressing issues becomes more and more available to the people in the relationship. They will also come to understand each other better in ways that will no doubt be helpful in addressing whatever they are struggling with.

The ‘moment’ is solved in the following ways:

• The therapist regains empathy
• The relationship regains connection
• The individuals in the relationship regain their voices

Dan’s idea is that, when we have a conflict, we generally do not voice our real feelings about the matter. These often feel too vulnerable and exposing to express; and perhaps they are too difficult to identify in the heat of the moment; and we have deeply embedded habits which lead us to respond in ways other than opening up.

Instead we retreat to fallback measures which save us from voicing our feelings. The two most common are blame and withdrawal. Either we lash out and attack the other person for causing the problem, or we withdraw into ourselves and close off. Dan lists a further fallback measure where people rush to fix the situation in ways that don’t address the feelings involved.

So, for example, if we’re having an argument with a partner or housemate about who does the washing up, our underlying feeling might be of being taken for granted and devalued each time they ignore the pile of washing up: maybe they really don’t care about us. However, rather than voicing this we are likely either to blame them (lashing out at them for being lazy), to withdraw (retreating from the painful conversation and just not saying anything in future despite being upset about it), and/or rush to fix (apologising for arguing with them and suggesting we watch a movie together or something). Similarly they may well not voice the feeling they have of guilt and embarrassment at being called on their, rather entitled, behaviour. Instead they respond with blame (attacking us for making a big deal out of something so trivial), withdrawal (going quiet or leaving the room), and/or rushing to fix (giving us a bunch of flowers the next day).

In these ways we tend to get into adversarial cycles (where we blame each other, and this escalates), or withdrawn cycles (where we avoid conflicts and resentment festers). Dan’s idea is to shift such cycles into collaborative cycles through enabling people to recover from fallback measures and voice their real feelings: confiding in each other.

This is the point at which I think it gets profound. Dan notices that, as a therapist, his empathy for one or other person tends to drop when they retreat into fallback measures. At the moment when somebody starts blaming, going quiet, or trying to placate their partner, for example, he often finds himself judging them for how stupid or unhelpful they’re being. His experience as a relationship therapist has taught him that it is in those very moments that he needs to find his empathy for that person – by recognising that they are falling back on those measures in order to defend their vulnerability. His method then is to go alongside the partner for whom he has lost empathy and to voice his hunch about what their real feeling might be, to help them to voice it themselves.

Once such feelings are voiced, the other person often softens and as able to connect with them better, and perhaps to voice their own feelings. However, as we all know, the exchange easily drops back into fallback measures of blame or withdrawal. This is where Dan returns to the idea of ‘solving the moment’. One moment has been solved, now we’re onto the next moment and a new challenge to solve.

Implications

For me there is so much of use in this approach, not only as a therapist but in my own conflicts in all kinds of relationships, and in the wider conflicts that often bubble up in groups or communities.

First the idea of aiming to ‘solve the moment’ rather than ‘solving the problem’ is useful. We can get so tangled up and overwhelmed by all of the history and complexity in play when we conflict, especially with people or groups which we have had long relationships with. The idea that each moment ‘solved’ has cultivated our capacity to engage with each other a little more helpfully next time is a good way of taking the pressure off. Also I like the redefining of the word ‘solved’ as meaning finding a connection and hearing each other, rather than resolving our differences or getting rid of the conflict. That seems a lot more respectful of the inevitable differences and tensions that exist between people and groups.

Secondly, the idea that we fall back into patterns of blame and/or withdrawal when we feel vulnerable resonates with me. So many times a day I notice that I start to become bothered and my reflex reaction is to find someone or something to pin it on, or to find ways to avoid the difficult feelings (for example, by trying to distract myself or by rushing to some kind of quick fix). Dan’s approach reminds me of how useful it can be to notice those patterns kicking in and, instead, to try to stay with the difficult feeling. I can aim to refrain from acting, or withdrawing, until I have a better understanding, and then to try to voice that understanding (to myself and/or to others concerned). Obviously this is extremely difficult and we are likely to fall back into habitual measures time and time again, but we can try not to beat ourselves up for this, and to regard each time that we manage the different approach as cultivating it in a way which will make it slightly easier the next time.

Finally, Dan’s approach alerts me to the possibility that the very moments when I find it hardest to empathise with others are the very moments in which empathy is most required, and most helpful. When somebody attacks me, or withdraws from me, I generally want to blame them or to withdraw from them myself. And such responses are easy because I have good justification. Everyone agrees with me that the other person was out of line, so I am supported in lashing out or complaining about them, or in deciding to cease engaging with somebody so painful, or in trying to insist on that the situation which is hurting me so badly gets fixed immediately.

But all those responses exacerbate the situation, hurting both me and them in the process. As Dan so wisely puts it ‘if you can’t turn your partner into an ally, you are stuck with turning your partner into an enemy or a stranger’. The approaches of blame and withdrawal just leave us – and them – with more and more enemies and strangers in our lives.

So perhaps – again probably only occasionally at first – we can start to notice those moments when somebody attacks us or withdraws from us as moments requiring of empathy, assuming that it has tapped into something so vulnerable for that person that they’ve had to reach for a fallback measure. Dan repeats the famous quote from Philo of Alexandria here: ‘be kind, for everyone you meet is fighting a great battle’.

Instead of rushing to defend ourselves, perhaps we can attempt to at least imagine what might have been triggered in the other person, using our own desire to defend, withdraw, or fix, as a way into connecting with them rather than disconnecting. Again the aim here is not to smooth over conflict, to deny difference, or to get rid of difficult feelings that may be present. Rather it is to ‘solve the moment’ by turning it into a moment of potential connection and empathy where we have voiced our own vulnerability, and have opened up space – if possible – for the other to voice their’s (if they are in a place where it is possible for them to do so).

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For anybody who hasn’t read it, the story goes that the plane was delayed and one woman – Diane – made a big fuss about needing to get home for Thanksgiving, causing the cabin crew some stress. Another passenger – Elan – livetweeted the exchanges. During the flight he continued to tweet as he sent Diane messages about her lack of compassion. She responded defensively, his messages became increasingly offensive, and when they landed she slapped him in the face. People following Elan on twitter retweeted his story and many deemed him a hero for calling Diane out on her lack of compassion.

You can read Elan’s whole livetweet commentary here.

I read this with amusement to begin with, sharing some of Elan’s glee at pointing out the selfishness of a privileged plane passenger and her tunnel vision at not realising how everyone around her was probably in the same boat. However, my amusement gradually became discomfort as I got through to the end. Another post helped me to realise why. Here, Dan Solomon points out Elan’s lack of compassion in not attempting to imagine why Diane might have been so upset at being delayed. Perhaps she did have reasons beyond those of other passengers for needing to get home. Certainly Elan’s responses did not help the situation, either for Elan or for the flight attendants (who are the people who we arguably should be most concerned with in this situation given how easy it is to treat such people as things – just their job roles – in such situations rather than as human beings).

Reading Dan Solomon’s post got me thinking further though about the ways in which compassion seems to be understood in all these commentaries: First Elan, and a lot of others, judge Diane for her lack of compassion and attempt to point it out. Then other people judge Elan for his lack of compassion and attempt to point that out.

It got me wondering about writing a post where we try to imagine all of the reasons why Elan might have done the things he did: background, the everyday language he is familiar with, the cultural pressures to crave celebrity. Perhaps he had such important reasons to want to get home for thanksgiving that Diane made him see red, and then there is the spiral of conflict that is so hard to step out of, and all of the people egging him on over twitter.

So then I could maybe judge Dan Solomon for his lack of compassion towards Elan and attempt to point that out? And then somebody else could judge me for my lack of compassion for Dan Solomon and point that out too? Where does this end?

It almost seems like there is only one piece of compassion available and we have to give it to one person at another’s expense. Also we are pulled into this polarised thinking where one person has to be the bad guy and the other the good guy, and we struggle to figure out which is which.

This all seems important to me because I become pulled into these kinds of everyday conflicts often, and they generally play out in precisely these ways: offence and defense, right and wrong, good and bad, compassion entirely for one person or entirely for the other. I recently heard a story about a conflict in a local town over the ownership of a bar which escalated in just this way and ended up in attempted murder. It doesn’t take a great leap to see the resonances between these kinds of interpersonal conflicts and the much larger scale ones that play out on our TV screens.

My own view is that if our goal is to prevent, or stop, the escalating conflict then compassion is definitely key. All of the commentators on this story are, I think, right to focus on compassion. But the compassion needs to be extended to all of the players here: to the flight attendants at having to deal with this situation, to the others on the plane, to Diane with her stress and tunnel vision and – now – her despair at being the target of so much hatred, to Elan and his joy/fear/excitement at being the person to do something, to the retweeters and their thrill at what Elan did.

Our compassion might involve remembering times when we have been in similar situations to all of these people, and – perhaps – behaved in even worse ways than them. It might involve – as Dan Solomon did – imagining all the possible reasons behind each person’s behaviour (and imagining that there are some we can’t even imagine, and asking whether we even need to deem them ‘good reasons’). It might involve thinking about how we would treat our friends differently if it was them involved and not these strangers. It might involve calling ourselves on our own tendencies to judge before understanding, and to treat people as things, and having compassion for that as well.

We can’t put a limit on compassion. Rather, in letting it circulate freely through the whole situation we can – perhaps – create an endpoint in this spiral of aggression.

Hoax:

Following this story playing out, it seems that the whole thing was a hoax by Elan – a reality TV producer – including a supposed letter from a family member of Diane’s claiming that she was terminally ill. This doesn’t really change the argument above given that situations like this do unfold all the time. And we might also ask ourselves whether we can have compassion for such a hoaxer, for those who are taken in by a hoax…

The post Compassion all round? A little story about Elan & Diane appeared first on Rewriting The Rules.

The political project of learning to recognise and name patterns of oppression has been, and continues to be, an important one. It has helped us to recognise that our own experiences of pain are not just personal; they are also political. And so we have become involved in social movements responding to these patterns and creating new ones. In this way, learning to name oppression can help to create a sense of connection among those who experience it.

At the same time, we notice that an idea (or ideology) of connection can substitute for the more complex experience of direct connection, of listening to another’s stories and of empathising with another’s pain. Political identity based on oppression can assume that experiences are identical: that all LGBT folk, all workers, all women, or all people of colour will have experienced the same oppression and should have the same politics. Of course, this all falls apart when we notice that everyone is characterised in different ways at different times in different contexts. No one is simply LGBT or a worker, or only a woman or a person of colour. Assumed, rather than directly experienced, connections rapidly fall apart when those who are assumed to be identical point out that they are not. Queer, working-class women and transfolk of colour experience all four of these patterns of oppression in particular ways (and, quite possibly others around ability, age, appearance, education and more). No politics of identity can incorporate so many differences.

Tensions around naming oppressions and recognising such complexities have formed the backdrop of a number of recent conflicts which we have been aware of due to living in the UK and being involved in LGBTQ politics. Some have played themselves out publicly, some more privately via emails and social networking sites. All of these cases have involved members of two marginalised groups, one attempting to name the oppression which the other is (unwittingly?) perpetuating due to their (perceived) privilege. Examples include complaints about trans-exclusion and cisgenderism in lesbian, gay and bisexual spaces (due to labeling of toilets, mono-gender workshops, etc.); criticisms of perceived biphobia in the work of lesbian and gay academics; pointing out the ignorance of structural power relations and imperialist narratives in the polyamory and kink scenes and associated literature; and many concerns about the perceived racism and/or ethnocentrism of gay and queer activists and journalists such as Peter Tatchell, Johann Hari and the organisers of ‘East End Pride’. On a personal level we have found ourselves saddened by the divisions and rifts often resulting from such conflicts. At the same time we recognise the echoes of earlier vital interventions, such as 1960s and 70s black and lesbian feminists pointing out the vastly different experiences within womanhood.

Naming Oppression

In one of the most publicised of the recent cases that we are aware of, Jin Haritaworn with Tamsila Tauqir and Esra Erdem (2008) published an essay entitled ‘Gay Imperialism’ critiquing Peter Tatchell as ‘the central figure’ in conflating Islam and homophobia. Here, Tatchell’s version of naming sexual oppression conflicted with Haritaworn’s (among many others’) naming of intersections of gender, sexual, racial, ethnic and religious oppressions. Tatchell’s response to the critique was defensive. He wrote to the publishers complaining that the book contained lies about him, and stating that he was not racist but anti-racist. The independent feminist publisher responded by publicly apologising and taking the book out of circulation (Raw Nerve Books, 2009). Johanna Rothe (2009) wrote a response to this, calling the act ‘censorship’ and noted the authoritatively defensive tone of the ‘apology and correction’: ‘the statement denounces that the article contains “untruths,” and it proclaims Tatchell “not Islamophobic” and not racist. It quotes brief phrases from “Gay Imperialism” and intersperses them with averments that it is “not” so, or that Tatchell has “never” done this.’

Professors joined the debate. Sara Ahmed (2011) responded to Tatchell’s request to point to the racism in his activism by noting that racism can be subtle and that she saw much to concerns her in his statements and in the letter of apology from Raw Nerve.

Racism in speech, she notes, does not simply depend on the explicit articulation of ideas of racial superiority but often works in ways which mean that such associations do not need to be made explicit. So, for example, politicians might use a qualifier “this is not a war against Islam” and then use repeatedly terms like “Islamic terrorists” which work to associate Islam with terror through the mere proximity of the words: the repetition of that proximity makes the association ‘essential’.

Meanwhile, Jeffrey Weeks (2010:16) defended Tatchell, while also acknowledging the complex challenge of addressing sexuality and religion in our conflicted world.

Peter Tatchell has himself recently been vehemently attacked for precisely those sins – imperialism, racism and Islamophobia – that he has fought against, in a polemical critique of his own recent campaigns against fundamentalist hostility towards homosexuality both in the West and the global South. He has been accused of imposing western standards of sexual rights on an infinitely complex world. And when he sought an apology from the publishers – which they readily gave – for what he saw as a distortion of his views and his record, he was attacked in a fierce cyber-controversy for using his white privilege to censor alternative perspectives.

Now, most of our friends and colleagues have chosen to side with Jin Haritaworn in this conflict and with other critics of racial hierarchies within LGBT politics in other similar conflicts. We can understand why. A great deal of violence by states, corporations and individuals is justified by a belief in the superiority of certain versions of whiteness and masculinity over their Others. This includes, but is not limited to, war, environmental racism, sexual violence and economic exploitation. It also includes prioritising the intellectual over at the emotional. We wish to address this last point with a call for mutual compassion.

This is complex and emotive territory. In this brief article we want to consider our own preferred strategy for addressing such conflicts (‘compassionate communication’), and to interrogate its strengths and limitations, as well as the strengths and limitations of an alternative strategy (‘naming oppression’). Our aim is to raise questions and to chart where we are currently at in our own – often uncertain and uncomfortable – journeys in relation to these issues. Clearly these strategies are not mutually exclusive, but rather there is much to be learned from bringing them into an ongoing dialogue.

Compassionate Communication

Our preference in these kinds of conflicts, in general, has been to ask how such conflicts grow and how they might be resolved. We appreciate the strategy of naming oppression for reminding us that the personal is also political. Our intention is to remember that the political is also personal.

We come to this as people who have practised, thought, and written about conflict, and who have some ideas, informed mainly by social constructionism, Buddhist philosophy (Barker & Stanley, forthcoming 2012), queer/anarchism (Heckert, 2010a, 2010b) & nonviolent communication (NVC) (Rosenberg, 2003), about what we regard as an ethical and effective way of approaching conflict. Also, we have engaged with issues of identity and the cultural histories of marginalisation and oppression for non-normativity, with which we can find ourselves identifying.

Our position on conflict resolution has, thus far, been as follows: that pretty much whatever the conflict, it is likely that both (or all) parties involved believe (more or less) that they are right and that the other party is wrong. Also, they may well be exaggerating their rightness and the other’s wrongness in order to defend against their own frightening self-judgments (i.e., labelling themselves as wrong, stupid, cruel, or abusive). Each statement that one party has made to the other – feeling it to be balanced and reasonable – has been understood by the other as being an over-reaction and aggressive, generally because it has evoked in them past and/or recent experiences of hurt or poor treatment. They have responded in a way that they believe to be measured, given the perceived attack, but again the other party has perceived this response as over-the-top and deliberately provocative. Thus the conflict has escalated. We certainly notice this pattern in the conflict mentioned previously.

In terms of conflict resolution, on the basis of this we would generally suggest the following strategy:

Each person or group goes away from the conflict and:

1. Listens to themselves with empathy. (How do I feel? What emotions pass through? How does my body react? What tightens? Can I let it release? What do I think I need that I’m not getting in this situation? Do I really need that right now? Could I be okay without getting it?)
2. Honestly and kindly reflects on memories and experiences that they bring to the situation which may be affecting their appraisal of it. (Ah, this situation does remind me of other situations which means my buttons are being pushed even harder!)
3. Imagines the various possible reasons for the other person/group’s behaviour – in a similarly compassionate way – so that they recognise the multitude of possibilities instead of assuming that it is because the other person/group just is bad, wrong, or stupid.

Each person/group then returns to the other and:

1. Takes some time to get to know each other as full human beings – what they are all about, separate to this particular issue.
2. Really listens to them when they explain why the issue is important to them, what they think about it, and what their uncertainties are.
3. Is courageous enough to also honestly explain why it is important to them, what they think about it, and what their uncertainties are.
4. Works together to find a way forward which acknowledges both people’s humanity and ability to get attached to a certain version of how things really are. This could be anything from realising they are on the same page after all, to one person shifting, to finding a compromise position, to realising that they do hold on to different beliefs and values on this point (in which case some degree of separation, agreeing to differ, and living with the tension is probably necessary).

Limitations of, and questions for, compassionate communication:

The real danger in this approach, as highlighted by many of those putting forward a more ‘naming oppression’ position, is that it may serve to diminish, erase, or silence experiences of oppression or marginalisation (in which people’s voices are already diminished, erased or silenced). If the initial conflict involved discrimination, X-phobia or X-normativity, then does the equalising ‘we are all human and prone to managing conflict badly’ approach dismiss the existence of such power hierarchies and oppressive acts?

Is giving each person an equal platform to listen, and be listened to, insufficient when one person or group has had so much less of a voice in the past than the other? If we start from a position of unequal power, do we have to further empower one party rather than assuming mutual humanness and any kind of level playing field? And if one party was seemingly discriminatory – from a position of greater privilege – then can’t it simply be stated that they were more in the wrong, however much the process of escalation, miscommunication and faulty appraisals may have been in play?

(Of course, we might question these questions. Is power something that someone has or doesn’t have? Or is it a way of moving, of relating, of doing that can be done in different ways in each moment? How attached to abstractions of identity or hierarchy do we want to be? How might we help ourselves and each other let go of abstractions and habits of power?)

There is also the extremely difficult question of where we position ourselves when the conflict is between other people or groups and we are called upon – or feel we would like to act as – mediators or advisers about potential ways of engaging. It is possible that – perhaps particularly if we are seen to share the privileged position of the ‘more powerful’ party – any attempt by us to help resolve the conflict can act as a further act of dismissal, rejection, or oppression of the ‘wronged’ party. And it is possible that it may stem from our own discomforts, and function to deny a very real experience of marginalisation and oppression. Instead perhaps we might sit with the uncomfortable fact of discrimination and prejudice and potentially also support the person who feels mistreated in this way, and/or call the other person on their discriminatory practices (which they are most likely denying), or even make other people aware of them.

‘Compassion’ or ‘conflict resolution’ can be used as a cover story. Are we drawn to resolution in order to avoid acknowledging (and to maintain) our own (for example, white) privilege? Do we simply find it painful to watch potential allies fighting and want peace? When does desire to resolve conflict stems from compassion and an ethical hope to decrease discrimination and conflict through mutual understanding, and when does it stems from cowardice and a defensiveness about our own possible privileges and problematic prejudices?

Potentials of critical compassionate communication: Reflecting upon being marginalised and upon being accused of marginalising others

Perhaps one way forward lies through further self-reflective practices which focus explicitly on such matters. It could be helpful for all people, in all positions in such situations, to spend some time describing and interrogating their experiences both when they feel marginalised and excluded and when they, themselves, are accused of marginalising and excluding others. Again, this is part of a compassionate opening to how it might be for those on the other ‘side’ of the conflict, and – more pragmatically – to consideration of what might work best in terms of changing the behaviours which we find so problematic.

This is an uncomfortable practice. It requires recognising that we all have the capacity to be victim and perpetrator, to be hurt by – and to hurt – others, to open up and to close down. But in recognising these capacities in ourselves it can become easier to understand that they are also present in others.

The people we are accusing of marginalisation or prejudice are neither singular nor fixed, and they will resist being fixed by us, just as we are resisting being fixed ourselves. The way that they are behaving now is not all that they are, nor all that they will ever be. We can see that if we look to their actions in the past, many of which we may have applauded. Their defensiveness and lashing out is likely very similar to our own response when we are accused of things that run counter to our self-presentation (but which we may well fear may be lurking underneath). We can ask ourselves what enabled us to shift and move when we ourselves felt trapped and stuck in the horror that what we were being accused of might be true. We can catch ourselves when tempted to use strategies that will shut others down or make communication more difficult, such as drawing on theories they are unfamiliar with, intellectualising, or requiring them to read materials we know that they will find inaccessible.

Similarly, when we are the ones being accused, or called upon to mediate, we can notice in ourselves perhaps our aversion to conflict, the attraction to quickly close it down in ways which may leave important things unsaid or shift the blame, our defensiveness and fears that some problematic inner truth about ourselves may be laid bare if we continue to engage. We can encourage ourselves to remember the last such conflict when we ourselves were feeling excluded, marginalised and oppressed, and how important it was then for us to have a voice, to have our rage recognised, and to be listened to. We can also recognise the tendency to present a veneer of X-blindness as a strategy for covering up any X-ism or X-normativity that is inevitably a part of us, given the difficulty letting go of the cultural norms we’ve been raised to believe are simply truth.

Conclusions

Perhaps the greatest opportunity afforded by conflicts within marginalised groups is that fact that we will all have occupied different positions at different times. At these intersections we all benefit from certain privileges and we all can be excluded and silenced by certain oppressions, many of which may not be visible or even very well understood to ourselves. We may also sometimes find that our privileges are the things we feel vulnerable, raw and uncertain about, or that our oppressions are the things about which feel stronger and more sure.

Exploring our own experiences of marginalisation can help us to connect with what we, ourselves are likely to be doing when we are dealing with others who are marginalised in ways which are less familiar to us (e.g. not noticing their experiences, not seeing our own identities because they are ‘the norm’, assuming these are just individual struggles and issues, wishing to flatten out differences and focus on connections, fearing the loss of friends if we speak of our own X-normativity or X-ism).

Exploring our own experiences of marginalising others can help us to connect with how others feel when they are accused of such things (e.g. dreading the truth in what has been said, feeling unrecognised for all the work we do in other areas, feeling overwhelmed by the time and energy it would take to properly learn about yet another thing and to put anti-discriminatory practices in place, feeling anxiety over engaging at all due to fear of saying or doing ‘the wrong thing’ and being revealed in this way).

Such strategies involve taking the risk of learning to speak more openly, to listen more gently, so hopefully the danger of further silencing and exclusion is reduced. Also we are required to recognise the uncertainties and complexities of such situations, and this runs counter to simplistic attempts to wrap things up neatly and to close them down. Finally, as we learn to slow down and to observe the ways in which societal discourses flow through us in the quick response that springs to our lips, or our tight resistance to yet another X-phobic remark, we may find ourselves turning less to the current embodiment of the discourse in this individual or group, but to the wider forces at play and flowing through them. We may be able to be more forgiving of ourselves and others, rather than tightening in guilt and/or self-righteousness, and to find ways towards unexpected alliances and collective action (Okun, 2009/10).

References

• Ahmed, S. (2010). ‘Problematic Proximities: Or Why Critiques of Gay Imperialism Matter’, Race Revolt 5. http://www.racerevolt.org.uk/issues/issue%20five/7_Problematic_proximities.htm [Accessed 29 March 2011] A revised version appears in Feminist Legal Studies 19(2):119-132.
• Barker, M. & Stanley, S. (forthcoming, 2012). ‘Mindfulness: Implications for Critical Social Psychologies’, Social and Personality Psychology Compass.
• Heckert, J. (2010a). “Intimacy with Strangers/Intimacy with Self: Queer Experiences of Social Research.” In K. Browne and C. Nash (eds.) Queering Methods and Methodologies: Queer Theory and Social Science Research. Farnham: Ashgate.
• Heckert, J. (2010b) “Listening, Caring, Becoming: Anarchism As an Ethics of Direct Relationships”. In B. Franks and M. Wilson (eds.) Anarchism and Moral Philosophy. Basingstoke: Palgrave.
• Okun, T. (1009/10). From white-racist to white-anti-racist: the lifelong journey. http://curlykidz.files.wordpress.com/2009/10/from-white-racist-to-white-anti-racist.pdf [Accessed 10 April 2011]
• Raw Nerve Books (2009). ‘Peter Tatchell: Apology and Correction’ http://www.rawnervebooks.co.uk/Peter_Tatchell.pdf [Accessed 29 March 2011]
• Rosenberg, M. B. (2003). Nonviolent communication: A language of life. Encinitas, California: PuddleDancer Press.
• Rothe, Johanna (2009). ‘Out of Place, Out of Print: On the Censorship of the First Queerness/Raciality Collection in Britain ‘ http://mrzine.monthlyreview.org/2009/rothe151009.html [Accessed 29 March 2011]
• Weeks, J. Making the Human Gesture: History, Sexuality and Social Justice. History Workshop Journal 70:5-20.

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Certainly it is extremely important to make support available when people are struggling. However, these news reports seem to miss something by regarding this purely as a health issue, and by focusing only upon treatment once mental health difficulties are present rather than also considering measures which may prevent such problems or increase resilience.

The fact that so many people suffer with issues such as depression and anxiety has implications far beyond the health service, and the focus on targeting funds only at treatment for existing mental health problems seems somewhat blinkered.

As a starting point, here is a list of other arenas which could usefully attend to statistics on mental health and shift policy and practice accordingly. In all of these areas a broader biopsychosocial understanding of the experience of mental health problems would be of value:

Education

Many of the negative patterns of thinking about, and treating, ourselves when we are struggling are laid down in childhood and adolescence, and experiences such as bullying, alienation, abuse or neglect in youth certainly increase our vulnerability. For this reason we could put more resources into addressing problematic school cultures and into cultivating the kinds of emotional and social skills that we know to be helpful during the early years of life. It seems strange that we wait until people are really suffering before teaching them how to understand, and work with, painful emotions and difficult relationships.

The workplace and employment

Viewing mental health as a purely internal personal matter neglects the role that the world around us has on whether or not we find ourselves struggling. Situations of workplace bullying or harassment, and toxic cultures where everyone is expected to work long hours or where employees are not valued, are certainly implicated in suffering and could be usefully addressed by awareness raising and increased resources.

Additionally, the perception of mental health difficulties could be usefully addressed on an organisational level. Destigmatising mental health problems such that employees are able to say when they are struggling could help a great deal, as could allowing everyone a few ‘stitch’ days a year when they take time out to look after themselves (after the phrase ‘a stitch in time saves nine’).

Finally, many find that some kind of employment – whether of a more or less conventional type – acts as a buffer against mental health problems in various ways. It can provide an income, give a structure and routine to the day, enable some form of contact with others, and ideally provide a sense of meaning and purpose. As a culture we seem to have swung from a situation of encouraging those who are struggling not to work (in ways which often increases their isolation and sense of being unable to do so), to one of forcing people who have become used to not working back into work. Resources could be usefully put into finding a more balanced and supportive approach.

Media

There could be greater recognition of the role of media in encouraging a certain way of viewing and treating ourselves, which many authors have linked to problems like anxiety and depression. Research consistently links limited beauty ideals to body image anxiety, but it goes further than that. Advertising, and much other media such as magazines and self-help books, often rely on encouraging people to think that there is something wrong with them that needs fixing (in order that they will buy a product). Makeover shows, reality TV, and popular contests like X-factor promote a limited idea of what it is to be a successful person, and arguably exacerbate a sense of failure among those who don’t meet the standard. The sense that we need to monitor ourselves and compare ourselves against others is opposite to the kind of compassionate and kind treatment that many regard as the key way of avoiding/combating problems like depression.

Wider culture

News articles often neglect to report the differences in rates of diagnosis of mental health problems. All of these suggest that those in more marginalised groups are more prone to such difficulties. Again, this suggests that access to individual counselling and therapy should not be the only approach to dealing with this problem. Attending to societal inequalities and injustices is vital, not just from a human rights perspective, but also from a mental health perspective.

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I’m about to start writing a chapter for my mindfulness book on depression so I’ve been mulling over what the experience of being depressed Is like, and what things help and hinder when we’re in that place. At the same time I’m becoming fascinated and concerned by the processes of conflict between people which seem to inevitably happen in all the academic and activist groups I’m part of. I’m wondering what might be done to maintain some kind of useful dialogue, rather than people convincing themselves that the other side is wrong and bad while they are right and good, and thus ceasing all engagement. Even as I see the problems in this approach I recognise the same tendency in myself.

As these two lines of thoughts unfurled themselves yesterday I found that they began to weave together into a similar set of ideas, so I decided to write a little about the patterns that I see in how we experience depression and conflict, and in how the experience can shift. Perhaps I shouldn’t be so surprised that these ideas have come together: I deliberately started my book on relationships with a chapter on the self because of the connections that there are between how we relate to ourselves and how we relate to others.

Depression: Tuning out, turning in

When I reflect on being depressed the experience is one of being simultaneously tuned out, but turned in. What I mean by tuned out is that when we’re depressed many of us become terribly concerned with other people and the outside world. We monitor ourselves closely through the imagined gaze of others and judge what we think they are seeing very harshly. We become anxious about what others will see in us, and frightened that we will get it wrong somehow and be exposed in all our uselessness. Decisions become very difficult because we are so tuned out – trying to be okay for everyone else – that it is almost impossible to tune in to what we want and need ourselves. We might find ourselves busily rushing around trying to please everyone and not letting on how much we are struggling, or we might withdraw from contact as much as possible for fear of what others might see if we let them in close.

At the same time as being tuned out, we are also turned in. While we are hugely concerned with what other people think of us or how we are being seen out in the world, we don’t really see or hear the people around us because we are so turned in and focused on our own struggles. We often spend a great deal of time in internal conversations with ourselves about whether something is wrong with us, what it is, and how we might fix it. We view other people in terms of their danger to us (‘they might see me as I really am!’), or the possibility that they might be able to help (‘maybe they have the answer’), but it is hard for us to make the shift that is necessary to understand how they are feeling and what is going on for them. Often we assume that we are the only person who is this bad and full of problems, and we are so fixated on not showing other people that this is the case, or apologising to them for our perceived wrong-doing, that there is no space available to turn towards their experience and let go of all of our own stuff for a moment.

Depression: Turning out, tuning in

When I think about the moments of relief when that heavy tangled weight of depression has lifted, they are often moments when I have managed to ‘turn out’ in spite of all this. Perhaps somebody else’s pain has pierced my bubble, or in professional mode (as a tutor or counsellor) I’ve had to put my stuff down and turn towards another person to hear about their struggles, or I have remembered how this worked and deliberately reached out to somebody else and asked how they are doing. Sometimes the relief just takes the form of sitting on a train or walking down the street and suddenly opening up to the fact that all the people that I see have their own fears and desires, tragedies and triumphs, which are just as precious and concerning to them as mine are to me.

This turning out works on several levels. On a very basic level listening to somebody else, or imagining their world, means that our mind is occupied with something else for a moment and we have a brief relief from the clatter of noisy and critical thoughts that has been exhausting us. Then there is the way that helping somebody else (anything from flashing a kindly smile through to giving them a supportive shoulder to lean on) can leave us feeling better about ourselves: we do have something to offer after all. Perhaps most fundamentally though is the sense of connection to others which is an antidote to the sense of isolation and alienation that is a major element of depression for so many of us. If people let us in through opening up to us, or just reveal their pain on their faces, we might realise that they struggle too, often in similar ways to ourselves. We realise that they are also scrutinising themselves constantly with a stream of critical comments running through their heads. We are no longer alone. In fact that pain is the very thing that links us to everybody else.

Related to this it is often the case that in finding compassion for another person we become able to find a little of the compassion that we need for ourselves. This is an important part of what I’m calling tuning in. Instead of only being attuned to what other people think of us (whether we are normal or abnormal in society’s view, whether or not this person approves of us, etc.) we can tune into our own feelings and experiences. By turning out and really seeing and hearing the other people around us we might realise that they aren’t really that concerned with us because they are so busy worrying about themselves. Or, if they are judging us and disapproving of us, we might realise that they are doing this out of their own pain and anxieties rather than because they are seeing any true flaw in us. For example, it might be that putting us down gives them a brief reassurance that they are okay, when they secretly fear that they are not. Even if there is an element of truth in any criticisms they are making of us, we can manage to hear it and bear it because we are no longer trying to present an unreal perfect image to the world. We are turned out enough to be able to appreciate our impact on other people, and tuned in enough to own up to such things without thinking that it means that we are a terrible person in total.

When we are depressed, or otherwise suffering, it doesn’t really matter whether we start by turning out or tuning in. Either one begins to make the other easier. So it might be that we deliberately try to empathise with other people or imagine what they are going through, and that gives us the space to find a bit more compassion for ourselves. Or we might start by tuning in to ourselves – sitting with however we are feeling without judging it or criticising it – and that might enable us to open up and see the other people around us.

Conflict: Tuning out, turning in

How are similar processes involved in conflict situations? It seems to me that often when a conflict bubbles up our reflex response is to tune out but turn in. We focus entirely upon the badness and wrongness of whatever has been done to us (tuning out), while our concern with the pain and suffering that the other person has caused in us means that we turn in on ourselves and find it almost impossible to hear where the other person is actually coming from (turning in).

This pattern is what leads to the escalation of conflict. Often both people or groups regard themselves as the wronged parties (tuned out) and both are so concerned with the suffering that this has caused to them that they can’t find any empathy for the others involved (turned in). Under those circumstances each thing that one person or group does is interpreted as a slight by the other, who then try to express their pain and anger at what has been done to them which is read as an overreaction and unreasonable response by the original person or group who then responds defensively. We are all prickly and hyper-aware of everything that the other person says and does (tuned out), at the same time as being defensive and protective of the sore spots in ourselves that the other person is (often inadvertently) bashing up against (turned in). This means that we tend to interpret what ‘they’ do in narrow and simple ways, often assuming that they are acting out of malice or personal defects while we are very aware of all of the complexities of the situation that have led us to act in the ways in which we have.

In some ways conflict is the opposite of depression because we are hard on the other person and see them in limited ways, while being much more understanding of ourselves (whereas in depression we are much more forgiving of others than we are of ourselves). However, these kinds of conflicts and depressions often have the same thing at their root: Our secret vulnerabilities and shames which we are afraid might be exposed. In both cases we are hyper aware of others who might be seeing these things (tuning out) and defending against the possibility that they will reveal something we fear is there (turned in). But in depression we defend by withdrawing and separating ourselves off, whereas in conflict we defend by lashing out and trying to make our pain all somebody else’s fault.

Conflict: Turning out, tuning in

It follows that we can also shift conflict situations in the same ways that we shift depression. We can attempt to turn out and/or to tune in. Again it doesn’t really matter which one we shift first, it will probably make shifting the other one easier as well.

For example, we might start by tuning in. Instead of allowing ourselves to react in a knee-jerk defensive way to the other person or group, we might sit down on our own for a while with the aim of listening compassionately to ourselves: Why it is that whatever is happening has hurt us so much? Each time we start trying to list whatever the other person did wrong and why they are so bad we can gently bring ourselves back to tuning into ourselves instead: What are we feeling? What does it remind us of from other times in our lives? Which of the vulnerabilities that we know that we have have been triggered by this situation?

Alternatively we might start by turning out. We might recognise how we are limiting the other person or group by imagining them as just stupid, bad, crazy or malicious, and start trying to open up to the fullness of what they are and really trying to listen to where they are coming from. We may remind ourselves of the complex and multiple reasons that have led to us responding in the way that we have, and try to assume that the same will be true of the other ‘side’ of the conflict. In Rewriting the Rules I suggest we might turn our common accusation ‘how could you do that!’ into a genuine and curious question ‘how could you do that?’ This might involve us on our own imagining all of the different reasons why the other person or group might have done what they did (given what we know about them if they are somebody we know, or just what we know about people). Alternatively, or after this, it might involve us sitting down with them with the intention of really listening to where they are coming from and trying to create a situation where they feel safer to tell us this.

The combination of turning out and tuning in will hopefully mean that during such conversations we can be more aware of what is triggered for us, so that we can respond to the situation itself rather than bringing in all our previous baggage. Tuning in also means treating ourselves kindly so we are less likely to take everything else somebody throws at us. If they are still in conflict mode then we can hear the pain behind their words, while not remaining in situations that are hurting us or taking on board criticisms that are unfair. This may involve, for example, insisting on more time apart before trying to communicate, or asking somebody else to mediate.

Conclusions

Of course every depression and conflict are unique to the people involved in various ways, and I will not have captured here all the different things that they can mean to different people at different times.

With depression there are aspects of the social situations which are involved that mean that another important element is turning out towards wider society and the ways in which it encourages that self-monitoring, critical, way of being with ourselves. I’ve written more about that here and here.

With conflict there are some important things to tease out about how we deal with very real power imbalances, oppressions, and privileges which are often in play. In my view the compassionate approach makes it more, rather than less, likely that people will be able to own up to these things and speak openly about their impact, but I also understand the fear that compassion and empathy for others could smooth over such things and lead to an acceptance of abusive and problematic situations. I write more about those tensions here and here.

I hope that the idea of shifting from tuning out and turning in to turning out and tuning in is a helpful one for thinking through your own experiences of depression and conflict, and I’d be very interested to hear other people’s reflections.

Find out more…

There’s more about how to tune in in my Staying with Feelings zine, and this post about noticing.

There’s more about depression and conflict in relationships here, here, and here.

You can find out more suggestions for practical ways of turning out and tuning in in the Rewriting the Rules chapters on self (in relation to depression) and conflict (in relation to conflict), and in my Social Mindfulness and Self-Care zines.

The post Tuning out, turning in – Turning out, tuning in: Depression and Conflict appeared first on Rewriting The Rules.

But of course I am in a bit of a strange position in relation to criticising self-help books because haven’t I recently written something which looks very much like a self-help book myself? Here I want to summarise some of the reasons why I agree, with Scott, that it is worth being very cautious about such books, and also to explore some possibilities for engaging with this genre creatively (and, as Scott emphasises, critically) rather than wishing for its total demise.

Anti-self-help

In the introduction to Rewriting the Rules I call my book an ‘anti-self-help’ book. The reason for this is that in the very title ‘self-help’ there is an implication that there is something wrong with you (the self) which requires help.

So most other relationship self-help books locate the problems that people have with relationships (either problems getting together with someone, or difficulties in relationships) in the individual who is reading the book. There is a suggestion that the reason that we have problems with relationships is due to something within us such as being too needy, not understanding the ‘opposite sex’ well enough, failing to be enticing enough, or being poor at the art of seduction. The answer, of course, is to be found within the pages of the book: we need to change ourselves in order to fix our problem.

Similarly self-help books on other topics identify a flaw in the reader which can be addressed through following the advice in the book in order to create a more successful self.

In Rewriting the Rules I take a different perspective and suggest that the reason that we (all) struggle with relationships is mostly to do with something outside our selves: the messages that we receive about the way we should do relationships. And that it is these that could do with changing.

Furthermore I locate a lot of the problems that people have, in relationships with other people and with themselves, in the very way of seeing yourself that self-help books encourage. I argue that self-help books are part of a wider culture (reality TV, celebs, advertisements and so on) which encourages us to constantly monitor ourselves, to compare ourselves to other people, and to judge ourselves, whilst trying to present a perfect image to the world.

Striving to be a perfect self and to have a perfect relationship puts a great deal of pressure on people which paradoxically makes it much harder to be kind to ourselves or to be content in our relationships. Body ideals leave us feeling miserable about our bodies, constant critical comparison to others is linked to depression, and trying to have a Hollywood romance leads to relationship distress.

So Rewriting the Rules is an anti-self-help book in that it doesn’t suggest that our problems can be located in something that is wrong with us, as individuals, and it also tries to work against the mainstream self-help industry which I perceive as generally part of the problem rather than the solution.

So can’t we help ourselves?

In one way Rewriting the Rules is arguing that culture is the thing that needs to change, not us as individuals. For example it would be good if culturally we stopped having such narrow ideals of beauty, or seeing people as to blame for their problems, or telling them that there’s only one way of having sex or doing relationships.

However, it wouldn’t be a terribly helpful book to read if it just said ‘culture is to blame, not you!’ and left it at that. For one thing we all have to operate within culture as it currently is, and for another thing culture is us, and can shift, so it’s worth thinking a bit about how we can be part of that (and who already is doing that). For that reason, in the book, I explore other ways of doing things that are out there (aside from the most prevalent messages about relationships) and ways in which we might navigate the culture we find ourselves in – resisting it, opening it up, creatively engaging with it – to find other ways of relating to ourselves, to each other, and to culture itself.

So I do offer lots of suggestions in the book which might sound a lot like conventional self-help. For example, in the chapter on relationship conflict I offer some guidelines that we might follow when we are fighting. In the chapter on attraction I suggest some ways in which we might learn to treat our bodies, and the bodies of others, more kindly. And in the chapter on sex I draw on sex therapy and sexual community ideas about how to tune into, and communicate, our desires.

Critical thinking is the key

Scott Cherry’s book is subtitled some simple steps and a dash of critical thinking. This is really the key for me. Most self-help books do not include much in the way of ‘critical thinking’ whereas that is what Rewriting the Rules is all about. I’m inviting the reader to think about what those messages are (about how to have relationships, and how to treat ourselves) and then think critically about those, and to consider what we often take-for-granted and bring that out into the open to think critically about as well.

Thinking critically might involve looking at the research evidence, or asking questions such as ‘is this useful for me?’, ‘what about the people around me?’, ‘who is excluded from this?’, ‘how might it be for them?’ and ‘what alternatives might there be and what would they be like?’

Of course once we’ve had a good critical think we might decide actually this is just fine for us and to keep on subscribing to those messages or ideas. The thing is to have them available for thinking about, rather than just believing that we have to go along with them, and to open them up to critical reflection.

Self-help books of the future?

Scott’s analysis of self-help books is very useful because it helps us to see what self-help books have tended to look like until now. Unfortunately the publishing world is quite resistant to anything that looks different to those existing books, as I found during my long search for a publisher. They know that those books sell and it is daunting to take a risk on anything different (and for this reason I will always be grateful to Routledge for taking a risk on my book).

The majority of self-help books propose individual internal causes for problems and offer the words of wisdom of the author as the solution for everyone. What if we challenged both of those ideas in books of the future?

First, we could move away from internal causes. Instead we could embrace what most academics now accept as a better way of understanding difficulties (from depression to relationship troubles to pain) which is a biopsychosocial model. We need all of those levels of understanding when making sense of our experiences, and they are inextricably interwoven in complex ways. Most self-help books neglect the latter part (the social) so we need to bring it back in.

Second, we could recognise that different things work for different people at different times. My book would have been very poor indeed if it said ‘here is the one true way of doing relationships and everyone should follow it’. Clearly people think about, and manage, their relationships in all kinds of ways. People like to live alone or with others, to combine finances or to keep them separate, to have one main person in their life or many, and all sorts of other differences.

So I would like self-help books to recognise this and to be more of a jumping off point for people’s own explorations rather than providing them with a single, universal, destination. It would be particularly useful to give examples of lots of the diverse things that people find helpful (as I’m hoping to do in a book I have in mind on all of the different things that help with depression). Also I would think that a good self-help book would be about asking questions more than it was about providing answers.

There are examples of self-help books that I would advocate, so I can’t criticise the whole lot of them. Dorothy Rowe‘s books (on depression, friendship and the like) are a great example of books which include the social aspect and question taken-for-granteds. Whilst I don’t subscribe to all the theories that Paul Gilbert draws on in The Compassionate Mind, this book is both biopsychosocial and encouraging of a more compassionate (rather than critical) way of treating ourselves. Books like Esther Perel‘s Mating in Captivity and Dossie Easton and Janet Hardy’s The Ethical Slut challenge conventional rules of relating and explore how we can manage our relationships in different ways. Both books embrace diversity rather than offering one universal way of doing things.

Every book is imperfect and limited, but it seems to me that it is possible to write a self-help book that opens things up more than it closes them down and which, rather than offering some final point of ‘self-fulfilment’ (which, as Scott points out, should mean that we no longer need any self-help books), more humbly offer itself as an invitation into critical thinking on an area: a starting point for the reader’s own continued explorations, and an encouragement to change the world rather than fixing our selves.

Find out more

Scott’s book is available here, and soon on Amazon.

There’s a helpful history of self-help books, with consideration of the ways in which they are valuable and potentially damaging by Laura Vanderkam here.

Petra Boynton asks ‘self help or self harm?’ on her blog about relationship books.

Micki McGee has a Self Help, Inc. blog on the topic.

There’s an interesting post about the possibility of scientific self-help here.

There’s a more positive take on the subject by Alain de Botton here.

Other books which critique the self help industry, listed in Scott’s book, include:

• Kaminer, W. (1992). I’m dysfunctional, you’re dysfunctional: the recovery movement and other self-help fashions. New York: Addison-Wesley.
• McGee, M. (2005). Self-help, Inc. Makeover culture in American life. Oxford: Oxford University Press.
• Pearsall, P. (2005). The last self-help book you’ll ever need: repress the anger, think negatively, be a good blamer & throttle your inner child. New York: Basic Books.
• Peele, N. V. (1995). [1989] Diseasing of America: how we allowed recovery zealots and the treatment industry to convince us we are out of control. San Franscisco: Jossey-Bass.
• Salerno, S. (2005). SHAM: Self-help and actualization movement. London: Nicholas Brealey.
• Simmonds, W. (1992). Women and self-help culture: reading between the lines. New Jersey: Rutgers.
• Tiede, T. (2001). Self-help nation: the long overdue, entirely justified, delightfully hostile guide to the snake oil peddlers who are sapping our nation’s souls. New York: Atlantic.

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Biopsychosocial Perspectives

I recently heard Saroj Datta give an update on the latest evidence regarding the interactions between genes and the environment in relation to mental health. Saroj was involved in the OU science course on mental health which takes a ‘biopsychosocial’ approach to the issue, and her talk demonstrated just how impossible it is to tease apart those elements: bio, psycho, and social (which is why they are combined into one word).

I already knew about ‘neuroplasticity‘: the fact that the way our brains connect up changes over the course of our lives depending on the experiences we have (this is the way that we learn, of course, but we often forget this and regard brains as static and unchanging). Saroj presented evidence that there is also flexibility on a genetic level. Whilst the set of genes in every cell in our body remains fixed, whether they are ‘switched on’ or ‘express themselves’ is not. Animal studies have shown, for example, that a glucocorticoid receptor gene tends to remain switched off, leading the animal to be fearful and anxious, unless the mother displays nurturing behaviours (due to not being anxious herself) in which case it is switched on, leading to pups who are calmer and less stressed. This research is in its early stages, and needs to be treated with caution when applied to humans of course.

Human research supports the genetic-envionmental interaction, finding that, for example, rates of depression are high when a particular allele of a gene is present and someone has experienced three or more stressful life events, but lower if just that allele, or just the life events, are present. It is the interaction between genes and environment that is vital. There have been similar findings in relation to childhood maltreatment. However, it is important to remember that some people were still depressed without those particular elements in the place (either that gene allele, those life events, or the two together): so this is not the whole picture. Also there is unlikely to be any one single gene involved in any element of human behaviour, but rather many.

Saroj suggested that such ‘epigenetic’ changes are potentially reversible and it has been suggested that this, and neuroplasticity, may explain why there are multiple different routes to repair and recovery.

My own interest has been mainly about the social end of the biopsychosocial composite, but it is vital to remember that this is as impossible to tease apart from the rest of it as the bio end is. The ways in which the society in which we live understands, and treats, people, is vital to the way in which we understand and treat ourselves. And one of the main things our society currently does is to split apart the biopsychosocial in a deeply problematic way when understanding issues of distress or ‘mental health’.

Why I don’t like the 1 in 4 statistic

It is important to say, before I start, that here I am absolutely not doubting the existence of severe distress, or the toll that it can take on people who are struggling and those around them. Rather I am questioning the way that we currently categorise and work with such experiences, and the role of wider culture in them (which so often gets missed).

What sparked this line of thinking, for me, was a series of adverts a few years back under the Time to Change campaign about mental health, which was put together by the Institute of Psychiatry, Mind, and several other mental health organisations, with the aim of ending mental health discrimination. The adverts featured celebrities such as Stephen Fry and Ruby Wax speaking openly about their own experiences of distress, and many quoted the ’1 in 4′ statistic. For example, the poster with Stephen Fry on it said: ’1 in 4 people, like me, have a mental health problem. Many more people have a problem with that.’ Ruby Wax’s said ’1 in 5 people have dandruff. 1 in 4 people have a mental health problem. I’ve had both.’

Clearly the statistic was intended to raise awareness of the commonality of mental health problems and to decrease the stigma of those experiencing them. However, I feared that it was in danger of doing quite the opposite.

The 1 in 4 figure is problematic anyway as it is not clear where the figure actually comes from. Of the few studies which have found something like this figure, some have been measuring families rather than individuals, mental health has been measured in various different ways, and it is unclear whether we are talking about, for example, 1 in 4 people at some point during their life, or 1 in 4 people in the last year, or 1 in 4 people at any given point in time.

However, for me, the bigger problem is the potential impact of the figure. 1 in 4 suggests that 75% of the population do not experience mental health problems. That is a substantial majority. The danger is that this situates people with mental health problems as ‘them’ (compared to ‘us’ who don’t have any such problems). As we know very well in psychology, the creation of any kind of ‘us and them‘ situation increases, rather than decreases, likelihood of discrimination.

Most of us will experience some form of abuse in childhood (if we include ‘bullying‘ by peers, which I think we definitely should); all of us will experience life events such as bereavement of a loved one in adulthood which tend to result in a period of high distress; not to mention the existential givens of life which we all struggle with. Given this, is ‘ill or well’ a useful model at all?

The common dichotomous understanding which I see amongst counselling clients, friends, and students alike when they are talking about their own – and other’s – experiences of distress and suffering is as follows:

Either

I’m ill – I need help – it’s not my fault

Or

I’m not ill – I don’t get help – it is my fault

People commonly feel, deeply and certainly, that these are the only two possible places to be: ill or not ill, and that the other aspects presented here follow from that. Not only is this a splitting up of the unsplittable biopsychosocial which I mentioned in the previous post. It also suggests that there are only two options: biology or choice (social doesn’t even come into it). Mental health problems are seen as an individual – frequently physiological – problem which requires treatment (commonly drugs, sometimes also therapy) to fix. However, if there is no evidence of such an individual problem (if no diagnostic label fits, for example, or if there is suspicion that they are not suffering enough) then the person cannot be ill and therefore any struggles must be their own fault.

This way of understandings things is problematic on all levels. It prevents many people with distress from admitting it because, if they do admit it, they will have to give up control, take on a victim/ill identity, and open themselves up to stigma and discrimination. Those who embrace diagnosis may be disempowered (due to the sense that they can’t help themselves and must require expert help). They may feel that they have to take certain treatments (often drugs) because of the common idea that mental health problems are biologically caused and must be biologically treated, despite the question marks which still exist over whether, and how, such drugs work and whether they are the most appropriate way of addressing such issues in all cases (not to mention the vested interest of ‘big pharma‘ in perpetuating this particular understanding). There is no room here for sociocultural explanations or for more complex involvement of personal agency.

Also, many people oscillate between the two positions as neither side really captures the complexities of human distress. This means that those who don’t identify as having a mental health problem are haunted by the fear that perhaps there is something terribly wrong with them which needs fixing (and hiding this fear, and any signs that they might be struggling, puts them under immense pressure). Those who do embrace a label such as ‘depression’ are often haunted by a huge sense of guilt that maybe they are not really ill and maybe this is all their fault and they are totally to blame (which massively exacerbates any suffering they were already experiencing).

This puts people in a horrendous double-bind when it comes to speaking about their own, inevitable, distress and struggles in life. If we openly disclose as ‘depressed’, for example, (as many people did on the recent ‘world mental health day‘) we run the risk of reinforcing this ill/well split such that those who do not embrace such an identity feel their struggles going unacknowledged and the pain of that invisibility. If we keep quiet about our distress, or resist such labels, then we can equally reinforce the ill/well split as we are read as ‘well’ by those around us.

We need to move to more biopsychosocial model of distress. We need to recognise that distress – in its various forms – happens for complex multiplicity of reasons, and that we can have a personal role in exacerbating and ameliorating it, but that acknowledging such a role does not mean that we are totally ‘to blame’ or ‘at fault’. We need to understand that we can all access support rather than it being something only for a certain few, and that different things work for different people at different times. We need to challenge either/or illness/wellness dichotomies and to consider other possible models and metaphors for distress.

Diagnosis

The common practice within the current mental health system when people are distressed is to diagnose them (to find the category in the DSM or ICD which best fits them) and to treat them accordingly.

Previously I said a lot about why people who are suffering might want to embrace a diagnosis of a mental health problem. After this, I will say more about why practitioners may be wedded to this way of working with distress. Here I will outline some problems with diagnosis in general.

As I mentioned, for people who are struggling, diagnosis is often seen as the only option other than seeing themselves as totally ‘to blame’ for their own distress. Also, it may be the only way to access support and community, and to be taken seriously by employers and others whose understanding they may need as they are struggling. Given that this is the world we currently live in, it is important for those who are critical of diagnosis not to impose that on others. Rather we might explore, with them, the potential losses and gains of taking on a diagnostic label (something explored in the Open University counselling module). Common losses which people express are that no label fits them perfectly, that – if they do embrace a label – they feel trapped by it (that this is all that they are are all that they’ll ever be), and that they are treated differently by other people.

Irving Yalom points out this problem with diagnosis, that it easily fixes people (the way that a kiln fixes a pot) and can prevent us from treating people as whole, complex human beings. Rather, it is easy for professionals to see people as a ‘bipolar’ for example, or as a ‘borderline personality disorder’ (assuming that that category is all that they are, and that this person will be the same as other people in that category). Actually there can be multiple diverse meanings for people who fall into the same category which it is vital to explore. Take agoraphobia, for example, which involves fear of being outside the home. This could be about a fear of social contact, a sense of shame about oneself, an oversensitivity to noise, a genuine concern around violent attack (racist or homophobic, for example), an inflated concern over the risk of crime, superstitious fear of an accident happening, worry over one’s own capacity for anger and violence with others, or many other things (and combinations of things).

The point about fixing people is supported by the famous Rosenhan study ‘on being sane in insane places‘ which was conducted in the 1970s. He got a group of people to present to psychiatrists. They didn’t wash for three days and said that they heard the word ‘thud’. All were admitted to hospital and all were diagnosed with schizophrenia (except one who presented to a private clinic who was diagnosed as manic depressive, which is telling about class and diagnosis). Once admitted, the people said that they were fine and didn’t report any further symptoms. Nonetheless they were kept in for weeks at least and their behaviours were still read as ill or disordered. For example, queuing up for lunch early because they were bored was labelled ‘oral acquisitive syndrome’ and making notes was labelled ‘compulsive writing behaviour’. Science writer, Lauren Slater, repeated the study in the early 2000s herself. She didn’t get admitted, but was diagnosed and medicated by everyone she presented to, reflecting shifts in understanding and treating mental health problems.

Clinical psychologist, Richard Bentall, has pointed out the incoherence of many diagnostic categories: It is possible for two people, categorised in the same way, to have completely different clusters of symptoms. Some symptoms which are generally seen as signs of mental illness, such as hearing voices, are experienced by many people and are not always viewed as problematic.

Also, there are issues with the cultural and historical specificity of diagnosis. The classic example of this is the fact that homosexuality was included as a disorder in the DSM until 1973 and in the ICD until 1992. Other consensual sexual behaviours which are considered ‘outside the norm’ (such as fetishes, sadomasochism and transvestism) are still listed despite lack of evidence linking them to distress and calls for them to be removed.

This raises the question of to what extent diagnosis of disorder represents individuals being in conflict with the norms of society rather than a genuine pathology. There are many other examples of this. For example, the ‘sexual dysfunctions‘ are categories for people who don’t have the amount, or type, of sex that they are expected to have by wider society. Categories of ‘premature ejaculation’ and ‘vaginismus’ suggest that ‘proper sex’ involves penile-vaginal penetration.

We might also think about what things are classified as addictions and what are not (in relation to what is socially acceptable), or what forms of self-harming are pathologised (cutting and burning oneself, but generally not smoking, drinking to excess, risky sports or driving, or cosmetic surgery).

Many have argued that the high levels of diagnosis of depression in women (and the greater likelihood that distressed men will be criminalised as ‘bad’ whilst women will be pathologised as ‘mad’) are related to cultural expectations around femininity and masculinity. Also, black and minority ethnic people are more likely than white people to be diagnosed with ‘severe’ mental health problems and to be hospitalised and treated with drugs, arguably due to the western norms inherent in the diagnostic categories, as well as experiences of racism and social injustice.

Going back to Rosenhan’s study we may regard the world that we currently live in as rather an ‘insane place’ (particularly given the current economic and ecological situation) and question what it means to respond ‘sanely’ to this.Winnicott famously said, of depression: ‘The capacity to become depressed, to have reactive depression, to mourn loss, is something that is not inborn nor is it an illness; it comes as an achievement of healthy emotional growth…the fact is that life itself is difficult…probably the greatest suffering in the human world is the suffering of normal or health or mature persons…this is not generally recognised.’ In recent goals for everybody to be ‘happy‘ there is a danger that we pathologise, even more, quite reasonable forms of distress.

Us and Them in Mental Health

Given the problems with diagnosis covered above, we might ask why practitioners continue to employ these, often without critical consideration, and to maintain a split between the ill and the well.

In her book, Users and Abusers of Psychiatry, Lucy Johnstone suggests that it is very tempting for mental health practitioners to treat clients or patients in an ‘us and them’ way because of how invested they are in the current system. There is the danger that, without such clear splits, their job security would be in danger. Also they would lose the sense of expertise and professional power that they have if, for example, there was a de-medicalising of distress or a de-professionalisation of support for people who were struggling. There is a danger, more widely, that those who have an investment in being seen as sane, in control, and professional require a comparison group of those who aren’t (and this may play out in mental health systems, in families and other groups, and in society at large).

Christina Richards presents a further reason why it may be difficult for practitioners to shift away from an ‘us and them’ approach to distress. She argues that underlying a resistance to change might be a sense of: ‘“I have been doing things this way for years and will continue to do so as this way must be right (because if I have been doing it wrong for all these years look at all the pain I’ve caused/ time I’ve wasted/ good I could have done)”. It boils down to: “I can’t act in the future, because that proves I could have done so in the past”.’

This way of thinking can keep people very stuck on both sides of the ‘us and them’. For practitioners it prevents critical exploration of their current ways of understanding and practising, and substantial revision of diagnostic manuals, etc. which have been used for so long. For clients or patients it makes it difficult to change in ways that might alleviate suffering because changing is seen as acknowledging that one could have changed previously (this is especially difficult because taking personal agency is seen as putting a person on the ‘not ill’ and ‘all my fault’ side of the dichotomy explored in my second post). The more time passes, the harder it can be to step away from the way you have been doing and seeing things. There is a kind of tyranny of consistency which would be helpfully addressed by a model which embraced the fact that people change over time and that it is okay to revise and adapt the way we used to see things or admit that we were wrong in the past.

Richards quotes the great sage, Esme Weatherwax, who said that ‘Sin … is when you treat people as things. Including yourself. That’s what sin is.’ Whilst, of course, we require some kind of language to describe, and make sense of, our experiences of distress, we need to be cautious of ways of understanding that function to trap people and to concretise things rather than enabling them to move. We also need to be alert to understandings which assume that the biopsycho can be disconnected from the social such that it is only the individual who is seen as disordered or malfunctioning, rather than wider systems, and only target treatment at the individual (rather than the family, the school, the organisation, the media, or wider culture, for example). The social aspect is something that I will explore further now.

Self-monitoring Culture and Distress

A friend of mine recently posted a cartoon on Facebook which had Sigmund Freud saying ‘before you diagnose yourself with depression or low self-esteem, first make sure that you are not, in fact, surrounded by assholes’. I responded that I thought this said something rather profound about mental health at the moment. Could it in fact be said that a key aspect of many experiences of suffering is the problem of being ‘surrounded by assholes’ or – to be more generous – being surrounded by damaging cultural messages perpetuated by those around us?

When I first started counselling I became very aware that virtually everybody I saw was convinced that there was something wrong with them that needed fixing, mostly based on the fact that – when they looked around themselves – nobody else seemed to be struggling the way they were. Conversations with close friends, and self-reflection, suggest that this is an extremely common feeling: that everybody else is managing fine so there must be something wrong with me. Of course, when I asked clients how they thought they appeared to other people they recognised that they generally put on a ‘happy, managing everything fine mask’ which probably gave off the impression that they weren’t struggling either.

It strikes me that many experiences of depression, anxiety and other common mental health problems have a strong element of self-scrutiny and comparison to others in them (whilst, of course, I am wary of proposing any universal explanation because these experiences mean many different things to different people and at different times). Michel Foucault used Jeremy Bentham’s Panopticon to explain how people self-police in contemporary society. In the Panopticon prison there is a tower in the middle and cells all around an outer circle, such that a guard in the centre could – at any time – be looking into your cell. Because of this, prisoners begin to monitor their own behaviour rather than having to have huge numbers of guards. This idea has been linked to the high degree of surveillance that we now have, meaning that we could – most of the time – be being watched or recorded.

Foucault suggested that contemporary culture worked in this way more broadly. People are encouraged to scrutinise and judge themselves at all times, with advocations to self-improve, to work on themselves, and to present a positive and successful self to the world. This is linked to consumerism which is all about seeing ourselves as lacking and needing something to fill that lack. Advertising, and many other forms of media, create fears (e.g. we might look bad, be out of date, or be a failure) and then offer products to allay those fears (e.g. beauty products, the latest fashion, recipes for success in various arenas).

Within such a culture it is no wonder that people would be particularly driven to constant self-scrutiny, comparison to others, and presentation of themselves as happy, satisfied and successful (even when they may not be any of these things). This shores up the ‘us and them’ that I wrote about in my second post. Rather than distress and suffering being an inevitable part of everyday life, it is seen as a problematic lack which must be addressed, and is probably outside of the power of the person who is suffering to address.

Perhaps the major challenge for mental health practitioners, counsellors and psychotherapists is the danger that our work can perpetuate this perception: creating new diagnoses and categories and offering an ever-increasing menu of products to fix these (at a price). Even the one-to-one therapy situation is at risk of exacerbating this sense that people are wrong and need fixing, given that one person (the client) is encouraged to express their distress to another person (the therapist) who is generally fairly quiet and certainly not expressing any of their own problems. This is not to say that therapists and counsellors should be inappropriately burdening clients with all their difficulties. But we need to find ways to challenge the idea that the client’s struggles mean that there is something wrong with them, and the perception (which most clients have, even when they are therapists themselves) that the therapist has no struggles, or deals with them all perfectly.

Existential therapy includes the idea, not only that all people will inevitably suffer, but also that all responses to this suffering are sensible so long as we properly understand the person who is responding in this way. This, to me, is a very useful counter to the common assumption of something being ‘wrong’ and the person being flawed and lacking in some way if they do not respond in ways that are deemed culturally acceptable.

Alternatives: Care and compassion for all

Above I have argued for a complex understanding of suffering and distress which is very cautious of applying diagnostic criteria and of dividing people into ‘ill and well’ ‘us and them’ boxes. Perhaps a better model of distress is of a continuum which we all go up and down during our lives, and where we are not fixed at any given point. I’ve also emphasised the importance of not splitting up the bio, psycho, and social in our understandings of distress, and suggested that we must not neglect the social aspect of the biopsychosocial because societal ways of understanding people (which we internalise and which, no doubt, are represented on a neurological level) are involved in our difficulties. This is particularly the case in the way in which we are encouraged into self-monitoring, and in the way in which individuals who are in conflict with societal norms tend to be pathologised as disordered individuals.

If we resist the temptation to ‘us and them’ thinking then perhaps we can make more of a connection with people when they are distressed (rather than attempting to distance ourselves from them in ways that maintain them as ‘them’ and protect us from any sense that we might experience similar things ourselves). Then we might be able to ask questions such as ‘what works for me when I am distressed?’ which may lead to more helpful responses when others are struggling (although, of course, we must be cautious of assuming that everybody works in the same way that we do – perhaps the question is more like ‘given everything that I know about this person, what might they be needing right now?’) We might reflect, for example, on times when we’ve been under chronic stress or when a crisis has occurred in our lives.

Broadly speaking, when we reflect on what is unhelpful when we are distressed we might come up with things like: taking away the aspects which makes the person what they are (things that they regard as central to their identity such as work or relationships), removing people’s sense of personal freedom and choice, and regarding them as inexplicable or baffling, for example questioning why they can’t just stop feeling, or responding, in the way that they are doing. On the other side, we might find that what helps when we’re distressed is not being overloaded with anything else, being treated kindly and patiently and being around those we feel safest with, being reassured that we are still free (but perhaps we don’t have to make lots of decisions right now), and feeling that we are understood and that our response is a perfectly explicable way of responding to this situation (which involves somebody taking the time to understand what it means to us).

The vital role of compassion (from others and towards oneself) has been emphasised by many recently, and is part of the reason, perhaps, why various forms of mindfulness-based therapies are suddenly so popular (as they often encourage practices of self-care and compassion). Compassionate treatment of self and others is, perhaps, an opposite to the judging-comparing-monitoring mode which is so culturally encouraged at present. Rather than fearing that we are lacking, pretending that we aren’t, and trying to prove that we are better than others, we accept that everyone is imperfect, are open about our struggles, and move away from a competitive way of relating with others.

Vitally, an alternative compassionate, or self-caring, form of working with distress does not present this as something that is necessary just for people who are struggling (reinforcing that ‘us and them’). Rather it is seen as something everybody needs to engage in to counter those omnipresent self-monitoring messages (which affect us all) and to address the struggles and distress which we all experience.

Find Out More

• Many of the ideas in these posts are explored, in more detail, in Understanding Counselling and Psychotherapy.
• A very accessible book that covers may of these areas is Richard Bentall’s Doctoring the Mind.

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