It takes the form of an interview between the part of me who created it – Fox – and another part – James. If you haven’t read one of my plural blog-posts before and aren’t sure who these people are, feel free to check out our Plural Selves zine, and our free book about Plurality. But hopefully you don’t need to get that part in order to find the content here interesting.

Location: Fox’s favourite cafe.
Food: Halloumi tomato pesto sandwich, OJ.

James: It’s my great pleasure, today, to be conducting an interview with the artist behind the new zine Welcome Monster Feelings. Thankyou for taking the time to speak with me today Fox.

Fox: You’re welcome.

James: Would you like to begin by telling the readers a little bit about who you are?

Fox: Nope.

James: Well this is getting off to a great start.

Fox: I think it’d be more fun if you say who I am and I’ll say who you are.

James: Oh go on then. How best to describe you?

Fox: It better be good.

James: No pressure then.

Fox: *giggle*

James: I would say that you’re the youngest child part of our plural system. Or rather we tend to think of you as who we might have been without all the rules we learnt about who it was okay and not okay to be in the world – without our developmental trauma. You are the most able of all of us to just be in the moment, to find delight and wonder in things, to move through the feelings you have rather than getting stuck in them. How am I doing?

Fox: Why do we call me Fox?

James: Because you often feel more like a creature than a human: a wild little thing.

Fox: Heh I like that. Okay I’ll do you.

James: I’m not sure it’s regular to introduce the interviewer.

Fox: I’m gonna anyway. You’re our James. We call you lots of other names like Old Man and Saint James and Captain Admin and ruder ones.

James: Captain Admin is pretty rude. I don’t just do admin.

Fox: That’s why it’s funny. You are the one of us who does most of the everyday life stuff, particular the bits that the rest of us find boring or scary like emails *shudder* But you’re also the main one who looks after the child parts of us: me, Morgan (aka Beastie), and Robin (aka Tony). You’re really good at that.

James: I’m not sure how Morgan would feel about being called a child part.

Fox: She’s not here!

James: I mean technically, given that we share a body…

Fox: If she was properly here we wouldn’t be doing this interview coz it’s not easy for her to do this kind of thing. But we’ll get to that.

James: Is that enough introductions then? Am I allowed to start the interview proper?

Fox: It’s about time!

The aims of the zine

James: *shakes head* Okay then. First question. What were you hoping to achieve with this work Welcome Monster Feelings?

Fox: Two things I think. The main one was I wanted to help the other members of our system – particularly Robin and Morgan who carry most of our trauma – to find a way to be with their most painful feelings. We’ve been in this big trauma period for the last few years, so our feelings can be very overwhelming at times, especially for those two. 

The other thing I wanted to do was to find a way back to drawing. We made quite a few zines and comics a few years back, but it was something we found much harder to do during the trauma time.

James: Why d’you think that is?

Fox: Well Morgan’s trauma often comes out as being an inner critic – so it’s very hard for her to let us draw without feeling it’s not good enough, or comparing it to what other people do, even though she also really wants us to be creative. Robin’s trauma comes out as fear and shame so it’s scary for him to put stuff out there in the world, in case people are mean about it. Also it’s just generally pretty hard to sit down and draw – or do anything much – when you’re feeling that bad. 

James: I think it was a genius move to find a project that we could do even when we felt rotten, in fact tough feelings were kind of a bonus.

Fox: I know right? And – as we say in the companion zine Welcoming Your Monster Feelings – the practice of making the monsters often helps overwhelming feelings to calm down a bit. So you gradually get this knowing in your body that making a monster will make you feel better, which makes it easier to do it the next time you feel rough.

James: Positive reinforcement.

Fox: Right, and I love that it showed Robin and Morgan that they were vital – to the project and to us. They can both so easily feel that they are ‘bad parts’, or ruin things for the rest of us, and that they should be cast out again – as they both were for so much of our lives. But I couldn’t have done this project without them. It was their feelings I was drawing most of the time. 

Also when we showed our friends, and they found it helpful and said they felt similar things, that helped Robin and Morgan to feel seen, and less alone, and like they were being helpful to others.

A plural project

James: Just brilliant! So it sounds like you see this as a plural collaboration, even though you were definitely the one leading on it.

Fox: Absolutely. Robin and Morgan mostly had the feelings, and told me about them, and then I found the way to draw them that felt most right. But we also got everyone else’s feelings in there somewhere.

James: I particularly like the holding and hearing monster towards the end…

Fox: That’s you! And he looks a bit like Sully from Monsters Inc because that character reminds us of you, and his full name is James P. Sullivan.

James: I also helped as Captain Admin right?

Fox: Yes! You did all the scanning and the making it a pdf, and learning how to make a pdf small so people can download it, and putting it on our website, and all kinds of things that I find an-noy-ing!

James: And conducting this interview of course.

Fox: Of course. Next question.

Feelings, art and monsters

James: Well I was interested in exploring with you the links in our life between feelings, art, and monsters. I know you’ve been reflecting on that.

Fox: I have. It feels like we’ve been trying to do this project our whole life, and it involves going back towards these three things that were all kind of crushed in us.

James: Do go on.

Fox: Well we’ve written before about how we weren’t allowed ‘difficult’ feelings as a kid. People at home and school tried to train us out of them with punishments for unacceptable emotions, and rewards when we made it through the day or week without crying. That’s part of the reason that Robin and Morgan got disowned. They held all the least acceptable feelings: fear and anger, but also loneliness, sadness, jealousy, pride. All sorts.

James: Right. Our feelings get so unbearable during the years in our life when PTSD hits because we’re feeling all the things that were locked inside Robin and Morgan.

Fox: Feeling the feelings they held for us our whole life. That’s it. 

Another thing that got pushed out of us in a similar way when we were small was art. We LOVED drawing. We drew all of the time. Our bedroom wall was full of our pictures.  But gradually people around us tried to make us draw the kinds of things they wanted, and to draw in the ways they wanted us to.

James: For example?

Fox: Like being asked to draw pictures as a present for people’s birthdays. And they generally wanted things like landscapes or still lifes or whatever, which isn’t what we enjoyed drawing. Also when we did art at high school we were shocked because we had to draw things from real life rather than out of our imagination – as we’d always done before.

James: What did we enjoy drawing?

Fox: Mostly people and imaginary creatures. And we drew to tell stories from our fantasy life, or to get down feelings that we couldn’t talk about or express in other ways. But eventually we learnt that wasn’t how you were meant to do art.

James: So, not only were both feelings and artistic pursuits suppressed, but those two suppressions were also related. Losing the ability to draw from our imagination and feelings denied us an important outlet for emotions we weren’t supposed to have. How do monsters fit in?

Fox: Monsters feel like the third leg of the stool somehow. 

We were always fascinated by monsters. Our favourite TV shows as a kid were Rentaghost and Dramarama. Our favourite books were pop up ghost books. Later we read true haunting books over and over and over. We were addicted to Ghostbusters – one of the first movies we saw at the cinema. When we got to choose our own topic to do a project on at school we did dinosaurs every time.

James: We had a huge collection of plastic dinos too didn’t we?

Fox: Yes! Dimetrodon was my favourite dinosaur, but they don’t think Dimetrodon was a dinosaur any more!

James: This may be a tangent.

Fox: Heh. 

James: How did monsters relate to art and to feelings?

Fox: Well they relate to art because a lot of what we wanted to draw was mythical creatures like dragons. 

They relate to feelings because, when we reached double figures and things got really bad, we started reading authors like Stephen King, Dean Koontz and James Herbert. We thought that reading horror books would help us to be less scared in our real life – like maybe we could get used to facing frightening things by reading those books, and become braver.

James: And did our monster love get suppressed too?

Fox: I think so. We once tried to do a book review of a horror book in school and they didn’t like that. It wasn’t a proper book like the ones you were meant to read. When we studied psychology at university – and afterwards – we were always drawn to monster-y topics, like the paranormal, and why people do evil things, and the meaning of fairy tales. But those things were always looked down on as not proper, so we wound up doing our projects on other stuff – somehow making it acceptable.

James: And yet our PhD was on loneliness, our first paper was about goths and Pagans, and the first conference we organised was about vampires. We kept finding our way back to feelings and monsters didn’t we?

Fox: All the way through. Like we did the A levels that people said we should do, instead of the ones we really wanted to do (drawing and stories!) But we spent the whole summer after we finished those exams painting our room with a giant dragon, even though we were just about to move out of there. Then after our PhD we started writing fiction. We were going to do a whole collection of alternative fairy tales and take a creative writing course, but we didn’t get accepted. For a long time we’ve had an idea for a book called Everyday Horrors: a mash up of horror fic and self-help.

James: It seems like we’ve been trying to make Welcome Monster Feelings our whole life, and finally, we’re making it, now that we’re nearly fifty.

Fox: Speak for yourself old man!

James: *Grin* 

Reclaiming lost things

Fox: It’s like reclaiming isn’t it? By reclaiming art, and reclaiming monsters, we’re also reclaiming those feelings and the parts who hold them. No part gets left behind.

James: Absolutely. I couldn’t agree more. And I suspect that many people have a similar history – at least with feelings and with art. The world, and the people around them, tell them that they mustn’t show their feelings, and that they ‘can’t draw’.

Fox: That’s why we love Lynda Barry, who we mention in the zines. She says that most kids just naturally tell stories with pictures, but then they get taught proper writing and proper drawing, and they lose all that. Her books and resources are all about getting it back, by playing with it, using wax crayons, drawing quickly, colouring in, that kind of thing. And lots of drawing from the imagination!

James: I notice that when we can allow you – Fox – to just draw from the feeling (with the odd bit of help from Google images to see what certain things look like) it just comes out looking right.

Fox: It’s amazing. Morgan is often sure there’s no way it’ll come out looking like we feel it, but it really does. It’s all about keeping it simple, not trying too hard, just getting the feeling down.

James: I think Lynda Barry is helping people get back to the child part of themselves who can draw that way, and tell stories too. The part like you that perhaps everyone has somewhere inside.

An early attempt to welcome monster feelings?

Fox: More questions please!

Inspirations

James: Well you’ve mentioned Lynda Barry. Can you say something about your other inspirations for this project?

Fox: I guess there are two kinds of inspirations: other people who’ve used monsters as a way of exploring feelings, and other people who have come up with practices for welcoming feelings. 

For the first one we’re super inspired by Pixar movies. They are something we watch a lot of because they are so gentle, and we generally need that in the evenings. Inside Out and Monsters Inc are the obvious ones, but lots of the Pixar shorts explore trauma and plurality too. Far From the Tree and Twenty Something are great examples.

We also recently watched the movie A Monster Calls, which is all about monsters and fairy tales as ways of dealing with huge tough feelings. Hannah Eaton’s graphic novel, Naming Monsters, is about that too.

We really love this Zen Pencils comic version of Rumi’s poem, The Guest House, by Gavin Aung Than. That poem captures the whole idea of welcoming feelings better than anything else, which is why we included it at the start of the zine.

James: What about the practices for welcoming feelings?

Fox: We wrote about focusing and Pema’s F.E.A.R. practices in our Staying With Feelings zine. Those are about feeling feelings in the body. Our therapist helped us towards the idea of visualising feelings. She suggested imagining the feeling you’re having as just one cell of the body, and picturing it outside of yourself, describing what it looks like: its colour, texture, that kind of thing. That helps it be more manageable – it’s not all of you, just one cell, and it’s outside of you so you can approach it curiously.

James: Externalising the feeling, so it doesn’t feel like all that you are and all that you’ll ever be, as traumatic feelings often feel.

Fox: Right. But cells aren’t much fun. I think that imagining feelings as monsters makes it more playful. And you can do with a bit of lightness and humour when you’re dealing with something that hard.

James: Agreed. And that makes it a bit more like the Tibetan demon feeding practice that we’ve written about before.

Fox: Except in that practice you don’t tend to draw the feelings. Lynda Barry adapts a Zen practice where you draw your demons in her comic One! Hundred! Demons!

James: It’s so cool that you’re now part of this group of comic and animation creators who’ve explored monsters in this kind of way.

Fox: I know, I love that. It’s what I’ve always wanted.

James: We found our long, slow way towards art, monsters, and feelings, didn’t we?

Fox: We sure did!

Monster feeling practice

James: I know that you’ve also made a companion zine called Welcoming Your Monster Feelings. Do you want to say something about that?

Fox: Yes. We wanted to find a way to share our practice with people, in case they might find making monsters about their feelings helpful too. We were going to finish the Welcome Monster Feelings zine with a few pages about how to do it. But our friend H said they thought we shouldn’t do that, because it should stand on its own as art!

James: What did you think about that?

Fox: I think they were right. Because we still struggle to see ourselves as someone who can legitimately draw pictures or tell stories, we often want to wrap those things up in a kind of self-help project, like we used to do with academic projects. Publishing Welcome Monster Feelings as a standalone book of our art felt really important. But we did still want to share the practice, so I made an extra little zine about that.

James: And do you describe your process in that zine?

Fox: Not exactly, because I know that not everybody will work the way that we do. The zine explores all kinds of different ways people might access their feelings and turn them into monsters, and the different reasons they might find that helpful.

James: Can you share a bit more about your process here then. That’s something people often want to know about artists.

Fox: Heh that still sounds funny – artist. What I do is I sit down, usually with Robin or Morgan. That means that we’re… what is it?

James: Co-conscious. That’s the word for when two parts of a plural system are foregrounded at the same time, like you and I are right now.

Fox: Cool. So the other part really tunes into their feeling, and kind of shows me and tells me what it’s like. Sometimes we feel it inside our body, and sometimes we have an image. Like that last feeling in the book from Morgan – we got a strong image of that classic Peanuts comic where Lucy pulls the ball away from Charlie Brown.

After they’ve shared the feeling, I find a way to turn it into a monster picture. And I draw, with a mechanical pencil, whatever comes out. I like to draw in this sketch book we got from WHSmiths, it has a hard cover so it looks like a proper book. And that means you can’t just rip out pages if you don’t like it. It feels important that we keep them all – however they come out. That’s part of the welcoming.

Once it feels like I’ve got the sketch right I go over the pencil lines with drawing pens. I like the ones that have several different sizes. Then I rub out the pencil lines, and we do the colouring in. That’s very soothing and often we do it together. I like these felt-tips which have a brush end and a fibre tip end. It feels good to use felt-tips because that’s more child-like than pastels or pencil crayons or paints I think. And I like the bright colours.

James: We might need to get you some more of those felt tips for your birthday. We’re close to using some of them up.

Fox: I’d like a bigger set because there’s only one grey and it doesn’t come out great on the scanner. There is a really big set you can get, just saying.

James: Heh, that is a whole lot of felt-tips. 

Trauma, shame and monster feeling practice

Fox: Can I ask you a question?

James: Unconventional, but fire ahead.

Fox: Well you’ve written a graphic guide about trauma and mental health, which goes pretty well with my zine, right?

James: I guess I was the main author of that one – on behalf of the whole system and what we’ve just been through. It’s like the grown up version of your zine in some ways – except not that grown up because it’s still a comic with lots of superhero references. Hopefully Jules will be illustrating that one this year and it’ll be out in 2023.

Fox: Grown up books take a lot longer it seems.

James: *grin* I do think they go well together though, you’re right. What was the question?

Fox: I wondered why you think monster feeling practice is so helpful, given all the stuff you’ve learnt about trauma.

James: Ah yes, I do have a few thoughts about that. One thing that we explore in the graphic guide is how trauma is often the result of violence combined with silence: painful things that happen to someone which aren’t heard or held by anyone around them. We realised that many of the things that help with mental health struggles – like meditation, therapy, or activism around social injustice – are about the opposite of violence and silence – they are about kindness and honesty. Make sense?

Fox: Kindness is the opposite of violence, and honesty is the opposite of silence.

James: Right. And drawing monster feelings is all about being more honest with ourselves about what our feelings actually are, and more kind around them – that gentle process of drawing them and colouring them in, and the whole idea of welcoming them rather than trying to eradicate them. 

Sharing those feelings with ourselves is also a great way to connect more with the different parts of us – to really hear what it’s like for them and to hold them in their tough places. 

Fox: The holding and hearing monster! Kind holding and hearing the truth.

James: Yes! The zine also helps us to connect with other people when they resonate with your drawings. That’s a way of healing the disconnection (with self, others, and the world) which lies at the heart of so much trauma.

Fox: But why is it so important for us to be able to feel the monster feelings? 

James: Ara and I explored this a bit last year in our Staying with the Big Feels blog post. One reason is that it’s hard for a person to be authentic – to be real about who and how they are – without all of their feelings. And it’s hard to have real intimacy – or good relationships – with other people too if you’re still hiding some of your feelings from yourself and/or from them. Being able to be yourself, and having good relationships, are both vital for mental and physical health.

Another thing is that the feelings that many people, including us, most often avoid or repress are the most vital for self-protection and for caring for others. Robin has held much of our fear, and Morgan much of our anger. We’ve realised recently how those feelings are so important for keeping ourselves safe-enough and for acting with integrity.

Fox: The integri-tree!

James: That’s right, you drew a few pictures relating to this. Robin’s fear of shame – when it isn’t unbearably intense – helps to guide us in what we take on, and what we don’t, recognising when other people are trying to pull us or push us into things, or when it’s coming from a dodgy motivation inside us. Morgan’s anger – when it isn’t twisted into confusion – helps us to state our needs and boundaries, as well as seeing other people more clearly. Your anger sunshine picture captured this beautifully.

Fox: Thank-you.

James: There’s lots more I could say about this, but the point is that without access to some of the supposedly ‘negative’ feelings, it’s very hard to empathise with others, to recognise danger, and to value ourselves equally with other people, rather than seeing ourselves as worse-than, or better-than.

Fox: For us it’s often worse-than. That’s why a lot of our pictures are about shame.

James: Mm, and it’s very common for shame to be at the heart of people’s tough feelings as Brené Brown has pointed out. We’ve been reading a lot about shame since we did a workshop on the topic last year, linked to the shame and medicine project. 

The book we’re reading right now says that it’s very hard to express shame verbally because it’s often non-conscious and not available to the language parts of the brain. So perhaps you’ve really hit on something with these drawings – giving us a way to communicate feelings that would be impossible to express in any other way.

Fox: Wow.

James: I know right? And it’s vital because so much of what people do that hurts them and others is an attempt to avoid painful feelings – particularly shame and the fear of shame. If we were able to get to a point where we were okay with all those feelings – where we could weather them, if not actively welcome them – then potentially we wouldn’t do those hurtful things. It’s a lifelong journey though, as Pema would say.

Fox: Life long, and many books of monster feelings!

Where next?

James: That’s a great segue to the final question I have for you. Where are you hoping to go next in your creative pursuits, now that you’ve got us here.

Fox: Well I’ve already started Welcome More Monster Feelings, so that we’ll keep going. Most of the monsters in the first book were Robin’s ones, partly because he was foregrounded for a lot of the time we were making it, and partly because Morgan initially didn’t want to do her feelings because she struggles so much not to be critical of them.

James: She really didn’t like the volcano drawing you made of her rage.

Fox: I knew that would happen! It’s the only one where the colours ran, and you can’t see the face very well. But then I did the one of her snake-eating-its-tail, and the sunshine anger, and she loved those, so I think she’s on board now. She has quite a few more monsters to share.

James: Anything else you want to do, or is it all monsters all of the time?

Fox: I would like to make more plural zines now that we all know each other better. I’ve started one about how people can learn to love their different parts, and there’s another one to do about how they can communicate better between them. 

But I also want to listen to H and do some more stuff that’s just about our own experiences – not trying to be a self-help thing. Maybe I could do more plural comics like the Chalk Board one. Also I think Morgan would love to write about our journey of embracing our inner critic, perhaps with fairy tales!

James: It would be great if she could feel free enough to create herself. She has such a powerful and tender voice when she can find it through all the horrors she’s experienced.

Fox: Totally.

James: Okay. Well thank-you very much for sharing some of your precious time with me today Fox, and for joining me at the keyboard instead of the sketchpad for once.

Fox: You are very welcome. I expect extra cuddles later.

James: You got it. And I hear there’s a new Ghostbusters movie…

Find out more

• For more on this topic check out our monsters and feelings zines, and our workbook with Alex Iantaffi, Hell Yeah Self Care.
• Patreon link: If you enjoyed this please feel free to support our Patreon.
• Plural tag: This post was by Fox and James.

The post On monsters, emotions, and drawing: An interview with the artist behind the zine ‘Welcome Monster Feelings’ appeared first on Rewriting The Rules.

I’ve experienced mental health struggles for most of my life. For me, like many of us, that means that I’ve had a high level of self-critical background noise a lot of the time: thoughts that I’ve done something terribly wrong, or that I will do, or that there’s something wrong with me. It often manifests as a low, heavy mood: a kind of grey fog over everything that makes it difficult to see things clearly, to make decisions, or to appreciate the beauty of the world around me. At its worst, it has tipped into extreme self-loathing and the urgent wish to eradicate the ‘bad’ parts of me in order to make myself acceptable.

Despite these experiences I’ve always been reluctant to label myself with the terms that might seem obvious when you read this description. I’ve probably ticked the boxes for several of the recognised ‘psychiatric disorders’ in my time, but I don’t feel comfortable identifying as a person with depression, as mentally ill, or as having a psychological problem. Equally I don’t feel comfortable identifying as sane, mentally well, or psychologically healthy. As with so much in life, I feel that the binary – in this case between ‘mad’ and ‘sane’ – is actually part of the problem.

The mad/sane binary

The mad/sane binary is present in all of the mainstream messages that we receive about mental health. For example, high profile campaigns to end mental health discrimination have often centred around one, apparently game-changing, statistic: 1 in 4 people have a mental health problem. Celebrities like Stephen Fry and Ruby Wax have used the figure to speak bravely and openly about their experience of mental ill health, but the danger of that statistic is that it suggests that 75% of the population do not experience any mental health problems at all. Rather than seeing mental health as a continuum which we might all move up and down over the course of our lives, we’re forced to stake our identity on one or other side of a strict dividing line:

‘Either … I have a mental health problem – I need help – it’s not my fault
Or … I don’t have a mental health problem – I don’t get help – it is my fault’

In this way we’re placed in a double bind, because accepting one side inevitably involves denying the other, and neither side promises a great outcome. If we’re seen as having a mental health problem we may well feel utterly disempowered, as if there’s nothing that we can do to improve our situation. If we’re seen as not having a mental health problem we might feel like we can’t admit to having any problems or get any support because we’re completely responsible for our own happiness and well being. The responsibility either rests entirely with other people, or entirely with ourselves, and either way that puts us in an untenable position.

Linked to this is the fact that both sides of the binary internalise suffering, seeing it as a purely individual thing, rather than a symptom of wider social issues. We are forced to view mental health problems as inborn, either caused by illness (perhaps a genetic vulnerability and/or brain chemistry issue) or by a personal deficiency (such as bad habits, faulty thinking, or lack of moral fibre). This can be very damaging because there’s strong evidence that all our human experiences are biopsychosocial: a complex interaction between the world around us, our personal experiences of it, and our bodies and brains, with all of those aspects influencing the others. We risk doing further damage to ourselves when we attempt to change our individual experience without recognising the role of social injustice or cultural messages in our suffering.

Social suffering

For example, it’s clear that structural oppression and social inequalities have a major role in mental health struggles because we see far higher rates of such difficulties in groups who are socially marginalised. One recent UK study found that women were 40% more likely to develop anxiety and depression than men, for example, another found that LGB people are twice as likely to be suicidal as straight people, and a further one that BAME people are six times more likely than white people to be admitted as in patients in mental health services. We need to recognise the role of intersecting marginalisations in mental health struggles, and the ways in which social experiences such as poverty, discrimination, and the experience of trauma are highly related to psychological distress.

We also live in a culture, which encourages the very kind of self-critical thinking that’s a feature of all the most common mental health problems. The French philosopher Michel Foucault famously used the analogy of the panopticon prison for our culture. In this prison there’s a single guard sitting at the top of a central tower in the middle who is able to see into all of the prison cells. Prisoners end up monitoring their own behaviour all of the time, just in case they might currently be being watched.

Foucault argued that our culture works in this way through all of the pressure we’re under to self-improve, and to present a positive, successful self to the world. We’re made to feel fear that we might be lacking or failing in some way, and we’re sold products which claim to help us to allay those fears. Makeover shows, self-help books, and beauty products are some of the more obvious examples. Social media also encourages us to maintain the illusion of perfection online, leading to endless rounds of self-evaluation and comparison.

In a world where so many of us are struggling with very real social problems, it’s vitally important to acknowledge the cultural context we’re in and to resist individualising our suffering. The mad/sane binary is very effective in preventing challenges to toxic policies and practices because people are not aware of the social context of their struggles, and because there is a fear that if you do speak out you will be dismissed as ‘insane’.

We can see this at play in the recent moves to regard unemployment as a psychological problem and the insistence that those claiming benefits undergo cognitive behavioural therapy. The responsibility is placed on the individual rather than on wider societal problems, and resources are focused on psychological change rather than addressing economic inequalities. There’s a high risk that people are left in the same damaging situation, but with an even greater tendency to blame themselves for it.

A sane response to a mad world?

The psychotherapist Winnicott famously said, of depression: “The capacity to become depressed […] 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 healthy or mature persons”. Perhaps we would do well to view the depression, anxiety, and other mental health struggles that most of us grapple with at some point as a sane response to an insane world. This would shift the emphasis for change away from the individual and towards the wider societal structures and cultural messages around us.

I know that what has helped me the most in this area has been to recognise the social and cultural aspects of my struggles. It’s a huge relief to allow the weight of total responsibility to lift, and to recognise the role of internalised self-criticism and social power dynamics in my experiences. This acknowledgement also allows me to engage critically with the mad/sane binary: resisting the sense that I’m completely responsible for my difficulties and the sense that I have no capacity at all to help myself. In this way I can cultivate a kinder relationship with myself, on the one hand, and feel more of a sense of kinship with all of the others who are in the same cultural boat. Such connections enable the possibility for collective resistance and for social activism, which feel like a much better focus for my energy than continually trying to change myself.

Find out more

My zine on social mindfulness covers these ideas in more detail. My zines on Staying With Feelings, Self-Care, and Plural Selves are also relevant to mental health.

My other blog posts on mental health include:

• Mental health: Beyond the 1 in 4
• Mental health: Beyond a health focus
• Mental health interview 1
• Mental health interview 2
• Supporting each other through mental health crises
• Mental health and relationships

For more on LGBT and GSRD mental health,  check out:

• New Resource on Gender, Sexual & Relationship Diversity (GSRD) and Mental Health
• LGBT+ mental health video
• Bisexual mental health

The post Mental health beyond binaries appeared first on Rewriting The Rules.

When I saw that the main characters in Inside Out were a person’s emotions I knew that I absolutely had to go see it. I wasn’t disappointed. In fact several times I was moved to tears by how familiar the experiences were, and by this hugely important, complex, and rarely-expressed message being communicated so simply and profoundly in a ‘kid’s film’.

If you’d rather not be spoilered for the movie then please do go see it before reading the rest of this post. Also do be aware that it may well tap into lots of different emotions as you’re watching it – if you’re anything like me – not just the joyful ones. As we’ll go on to see that may not be a bad thing!

The rest of this post is divided into three sections:

• Experiencing all of our emotions
• Shutting down our emotions
• How to sit with our emotions: A practical guide

Experiencing all of our emotions

Inside Out follows an eleven-year-old, Riley, and her emotions – Joy, Sadness, Disgust, Anger and Fear – as her family moves from Minnesota to San Francisco. Previously her inner world has been dominated by Joy. Joy has made it her business to ensure that Riley remains as happy as possible, building up a store of mostly joyful memories which have, in turn, shaped her personality. However, following the house-move, many of these memories become tainted by Sadness – who can’t seem to stop herself from touching them and turning them blue.

In her attempts to prevent Sadness from causing any more damage, Joy manages to get both of them ejected from the control room to the outer reaches of Riley’s inner world. This leaves Anger, Fear and Disgust in charge while Joy and Sadness try everything they can to get back before Riley runs away from her new home.

The message of the movie is that we require all of our emotions: not just the so-called positive ones. We soon realise that Joy’s tendency to ignore and suppress Sadness is actually getting in the way of them finding their way home. It seems like things work pretty badly when just one of the emotions takes charge, and much better when they all work together through being equally valued.

One of the most poignant moments in the movie is when Riley’s old imaginary friend is devastated to realise he’s lost his last chance ever to be with Riley. Joy’s attempts to cheer him up or force him to keep going fail. However, when Sadness sits with him and shows that she understands how hard it is for him, he’s able to experience his own sadness, to cry, and eventually he’s ready to move again.

The theory that kept coming back to me as I watched the movie was Emmy Van Deurzen’s compass of emotions. In this, Van Deurzen imagines the emotions on a wheel which we travel round all of the time, moving from ‘high’ feelings like joy and pride, through anger and fear to low feelings like sadness, and then up the other side through envy and hope, to joy again.

Critically, Van Deurzen argues that we need to be able to experience all of the emotions to go around the compass like this. If there are emotions which we shut down or avoid then we’re likely to get stuck in certain places. Paradoxically, as in Inside Out, if we disallow one emotion – like sadness – we’re likely to become stuck and find that we stop experiencing joy much too. If we lose the capacity to experience some of the emotions entirely – as when Sadness and Joy are lost in the film – we risk falling into depression and all of our emotions becoming shut off. This is rightly depicted as the darkest moment in Inside Out.

It may not be that we always move in the same direction on the compass, or that certain emotions always follow others. Indeed, as Inside Out shows, we can often experience seemingly opposing emotions at the same time (e.g. joy and sadness, anger and hope, fear and determination). Indeed, when the first memory comes in that reflects these kinds of mixed feelings we see that it is perhaps even more beautiful and valuable than some of the ones which reflected only one of the basic emotions on its own.

Shutting down our emotions

The problem is that, through our lives, most of us learn that certain emotions are not acceptable: either to express or – often – even to experience.

This is what moved me to tears several times during the film as I remembered moments in my own childhood and adolescence when – like Riley – I learnt that certain feelings were unacceptable. It made it even more powerful that – for me like Riley – a critical time was the sudden experience of starting a new school with strange and different rules. However, of course, these moments are different things for different people, they happen at different points in life, and they can be gradual, or sudden, or both.

The film underlines what a terrible impact such messages can have as elements of Riley’s personality – that we’ve previously enjoyed watching – turn grey and gradually disintegrate entirely when her emotions are lost. Most devastating for me was the moment when Goofball Island disappeared. Now that it wasn’t safe for Riley to experience all of her feelings there was no way that she could goof about in the way she used to as a child.

Where does this shutting down come from? We can see it on multiple levels like those I wrote about in the recent zine that I posted about here.

On the outer level our wider culture gives us strong messages about which emotions it’s okay to feel and which it isn’t. Generally in western cultures we’re encouraged to have happiness and ‘positive’ emotions and not ‘negative’ ones. The British ‘stiff upper lip’ also discourages expressions of fear. And messages also differ depending on our individual identities, with certain emotions being seen as more or less acceptable for people of certain genders, classes, ages, or nationalities, for example.

On the next level in, our communities and institutions also reinforce many of these messages. In the movie we see how, in her new school, it isn’t acceptable either for Riley either to show too much enthusiasm for the things she’s passionate about, or to show sadness about what she’s lost. The cool girls will judge her for it. It’s easy to find ourselves joining in this kind of tone-policing in our communities – of whatever kind – whereby certain emotions are deemed unacceptable to admit to or express – for certain people or across the board. It’s worth being mindful of this whenever we find ourselves judging how somebody ‘should’ or ‘shouldn’t’ feel about something.

At the interpersonal level we learn a great deal about acceptable and unacceptable feelings from our close relationships, particularly from the family and friends who are around us growing up. In Inside Out Riley’s parents inadvertently give her the strong sense that they appreciate her being happy and strong during the house move. She takes this as a message that it isn’t okay to be struggling in any way about it. Riley is even described as their ‘happy girl’: fixing her in this way. We then see how Riley’s – and Joy’s – attempts to keep her joyful tragically have the opposite effect. By trying to sustain her joyful persona in the face of great pain she actually becomes angry, anxious and cut-off, and risks losing the love of her parents as they don’t recognise her any more. In another key moment Riley’s old friend doesn’t seem to realise how envious Riley will be of her new friendship. When envy doesn’t feel acceptable, Riley goes straight to anger, and ends the friendship.

How to sit with our emotions: A practical guide

Fortunately for Riley, Sadness and Joy are able to make it back to the control room – once Joy recognises the value of Sadness. Then Riley is able to take the risk and show her parents how sad and frightened she is. Even more fortunately, perhaps, her parents are able to accept her emotions, to share some of their own, and to let her see that they love her as much when she’s sad as they do when she’s happy.

Most of us are not so lucky. Our parents – and the other close people in our lives – live in the same wider culture as we do with all of its crappy messages about unacceptable feelings. They’re also part of institutions and communities that have done a number on them. And they’re in their own family systems wherein certain emotions have been deemed too dangerous or threatening. So they may well have responded to moments like Riley’s by giving us a clear message that our fear, sadness, anger, joy, disgust, or other feelings, were not something that they could be around, or even that they couldn’t love us if we expressed them.

We will have internalised this. Either we’ll have managed to find a way of shutting down those emotions entirely, or – perhaps – in trying to shut them down we’ll have managed to make them shout even more loudly so we’ve become defined by them. Or a bit of both. There are so many ways that this can go.

The urgent question is what we can do now. Here we are, as adults, with all these imbalances, exaggerations, and silences in our emotional states. What can we do about it?

The answer that many different therapies, meditation practices, and belief systems have come up with is the idea of ‘sitting with’ our emotions. I’ll briefly describe one of these practices – a person-centred therapy technique called focusing – here, but there are several similar practices in other therapeutic and spiritual approaches if this one doesn’t work for you.

Focusing reveals perhaps the main flaw which I found in Inside Out which is the fact that the emotions are located in Riley’s brain and not in her body. It’s good that Inside Out doesn’t buy into the popular idea that emotions and rationality are separate things. Instead it expresses the existential view that we’re always in emotion: propelled towards things or away from things by our feeling states. However, the film does buy into another ‘dualistic’ split: that of separating the mind and the body, and seeing the mind as the most important bit. Actually, this kind of focus on the mind can be part of how we lose touch with our emotions: We stop being able to tune into our bodily sensations and the important things we can learn from these about our feelings, and instead try to figure things out, or fix things, on a purely intellectual level.

In focusing practice the attention is right on these bodily states. It’s most basic form goes like this:

• Sit comfortably and quietly and bring your attention slowly to your body and how it’s feeling.
• Ask what wants your attention. Focus in on any sensation that you notice in your body (a tightness of the throat, a clenched stomach, or a sense of emptiness, for example).
• Say ‘hello’ to that sensation: welcome it warmly, like Sadness sitting down with Riley’s imaginary friend.
• Really listen to the sensation, try to find the best way to describe it (e.g. it’s like a dense ball stuck in my throat).
• Check back in with the sensation to see whether that description fits well enough, or whether you need to change it or add to it (e.g. it’s not just stuck, it’s like it’s rammed in there, like a cork in a bottle).
• Sit with the feeling, with interested curiosity, not trying to change it, or to force it to communicate: just being with it gently and curiously. Try to understand it from it’s point of view. Notice any words, images, or metaphors that come to mind. In focusing books and websites you can read about different questions that you could ask it at this point, if it feels okay to do so.
• When it feels ready to finish you can express gratitude to the feeling, and to your body, and reassure it that you’ll keep coming back to listen to it – and other feelings – in this friendly way.

Going back to Inside Out this is a lot like Riley actually giving kind attention to each of the emotions inside her whenever any of them want her attention, instead of putting one of them in charge, or trying to get rid of others. However, when we do this practice what we often find is that the feelings we become aware of are the ones that are preventing us from feeling other feelings (like Joy in the movie). You might start feeling a sensation of fear or sadness, for example, and then a strong feeling of anger or disgust at yourself for having that feeling. When we have these feelings-about-feelings the thing to do is to sit with them just as gently and curiously as with the original feeling. It can help to remind ourselves that – like Joy in Inside Out –  these feelings are trying to keep us safe, even if what they are actually doing is the opposite.

Of course, given how many years most of us have spent suppressing and avoiding certain emotions, it can take a while to open up this kind of line of communication. Practices like focusing can feel very unfamiliar at first and can take a while to get the hang of. There are ways of doing them with a friend, or with a therapist, if that feels easier and more supported than doing them alone.

However I am convinced of the power of these kinds of practices. Elsewhere I wrote about what happened last year when I sat and noticed a couple of feelings that usually felt too overwhelming, or too insignificant, to sit with.

Earlier this year I went to a focusing workshop. In the first practice I found it fascinating to see how my own throat tightness shifted and opened up when I finally gave it some gentle attention. In the second practice I used focusing to go back to a specific memory when I hadn’t treated myself very kindly. sitting with the memory I suddenly became aware of a side of myself that I hadn’t seen there before: A playful side of myself that wanted to do something silly and outrageous to cut through the situation. I got a strong image of Mr. Tickle from the Mr. Men books. So much so that I went out a bought myself a Mr. Tickle mug the following week. Perhaps my own Goofball Island hasn’t been completely destroyed after all!

Find out more

The ideas in the post are also presented in my Staying with Feelings zine.

You can find out more about the compass of emotions in this book and video by Emmy Van Deurzen.

A great book about the messages we receive about emotions is Transforming Emotion by Glenda Fredman.

If you want to find out more about focusing practising, The Power of Focusing by Ann Weiser Cornell is an excellent introduction to it (and nowhere near as wacky as it looks from the cover!) There are also lots of resources on The Focusing Institute and British Focusing Association websites.

Note: Some of the images in this post are Copyright (c) 2015 The Walt Disney Company and Pixar Animation Studios, to whom I express my grateful thanks.

The post Inside Out: Getting in Touch with Our Emotions appeared first on Rewriting The Rules.

For the last few months I’ve been thinking a whole lot about the social side of mental distress. It feels really important to me to recognise how our suffering is embedded within our relationship dynamics; our workplaces, communities and other institutional systems; and our wider society.

I often notice what a relief it is for me – and my friends and clients – when we realise this social element to our suffering: particularly how the self-criticism that we do so constantly is something that everybody else does as well, because we’re all in this self-critical culture. It’s not that there’s anything wrong with us. It’s understandable.

This week I’m speaking at a few conferences which touch on themes of inequalities, individualising and intersectionality, and on mental health and mindfulness. So I thought – instead of the usual stand-up presentation – I’d make a zine that captures my experiences of these things, and makes some suggestions about how we might creatively engage with them.

It was also a good opportunity – for me – to get back into making comics: something I’d love to do more of, especially now I’m working on a comic introduction to queer theory with a professional artist. Here’s one of the comics I made for the zine. You can download the whole zine at the end of this post if you’d like to read it more clearly.

For my zine, the comics really helped me to understand how intertwined all these social levels are – as are the inequalities that we suffer from, and benefit from, and the ways in which we are individualised and individualise others.

You can download the zine as a pdf by clicking on the link below. I’d suggest printing it out as a booklet to get the full zine experience – or just reading it online. There’s also a whole book on mindful therapy by me here (including more comics!) if you’re interested in reading further on the topic.

SocialMindfulnessZine

The post New Zine! Social suffering and social mindfulness appeared first on Rewriting The Rules.

They asked me to submit something that particularly addressed mental health in the context of relationships, so I wrote this article on supporting people in our lives when they’re struggling.

Most of us will experience a mental health difficulty like depression, anxiety or addiction during our lives. And at some point, most of us will have a friend or family member who is mentally unwell.

Our culture tends to view people with mental health problems in one of two ways. Either they have brought it on themselves and need to ‘pull their socks up’, or they have a ‘disorder’ and need help because they’re incapable of helping themselves.

When faced with a friend who is suffering it is tempting either to blame them for their problems and try to shake them out of it, or to leap into ‘rescuer’ mode and try to fix them.

Neither extreme is a good solution. We can end up angry and resentful if we hold them responsible for their problems, or burnt out from all our attempts to help. They can end up more defeated and self-critical than ever if they feel culpable, or kept in a guilty and powerless state if they can’t respond to our efforts.

As a therapist and psychology academic I am often asked to give advice on supporting friends when they’re in difficulty. Here are seven thoughts on how you can help without either rescuing or blaming.

1. Listen.

If we’ve had a particular difficulty ourselves, or know somebody else who has, it’s easy to assume we know what it’s all about. But these things can be very different for different people, so it is vital to start with listening to what it’s like for your friend. Some people experience depression as a flat low feeling, whereas for others it feels more desperate and frightening. Some people harm themselves for a release of tension, whereas for others it is a punishment, or a kind of soothing.

Similarly we might have thoughts about what will help our friends based on our own experiences or assumptions, but it is better to check in with them. If they are struggling they may not know for sure what’s best, but they might know what to avoid because it makes things worse. You could make a list together of some possibly helpful things to experiment with.

2. Be present with them.

Once somebody has a label like ‘depression’, ‘PTSD’ or ‘personality disorder’, people around them often start to treat them very differently. If somebody was distressed, or quiet, or acting strangely last time we saw them, it is easy to expect that they’ll be the same the next time. Often one of the best things we can offer, as a friend, is to be present with them however they are on this particular occasion, instead of treating them as their label, or as how they were last time.

It can be useful to have some time out ourselves, before seeing them, in order to put ourselves in a good place to be with them as they are today. We may have to scale down the kinds of things we normally do together, but doing an activity that isn’t all about their mental health can really help.

3. Get support yourself.

If somebody we care about is suffering it can take a big toll on us too, for all kinds of reasons. We may feel guilty or hopeless, we might give a lot of our time and energy to supporting them, or we might find ourselves picking up on their feelings and finding that we’re also low or anxious after seeing them. It’s important that supporters get support too. Think about who you could lean on a little more. There are helplines and counsellors available for carers and others in supporting roles.

4. Know the limits of what you can offer.

When somebody is suffering we often want to do anything we can to help, and it is easy to offer more than we’re able to give. The experience of offering something and then having to pull it away again can be rough on both of you. If your friend asks for a particular kind of support it is okay to ask for some time to think about it before responding. Think about the other demands in your life, what your limitations are, and how long you might be able to offer it for.

5. Be part of a wider support network.

Linked to point 4, everyone has different skills and none of us can be everything to somebody. You might be great at practical support but not very good at sitting with somebody who is crying. You might be a wonderful person in a crisis, but need a lot of space if you’re around somebody else day in day out. For these reasons the ideal situation is to have a network of support rather than just you. Think about whether there are others – friends, family, professionals – who could offer support too.

6. Maintain your boundaries.

Most people who are suffering will be kind to those around them, but some people can become quite insular when they are struggling. It is definitely important to give them a break on this, but it is also important that you know your boundaries. For example, it’s not okay for your friend to ask you to keep the fact that you’re supporting them a secret; or to expect you to be their only means of support or their therapist; or for you to be the recipient of threats or other behaviours which would be considered abusive under other circumstances. It is okay for you to change what you can offer if these things happen, or if your situation changes.

7. Be flexible.

Finally, it is easy to get stuck in your role as your friend’s supporter. Over time this can actually make it more difficult for them to shift out of their role as the one needing support. Don’t treat your friend as somebody who only gets help and never gives it. When we’re suffering it can feel incredibly powerful to realise that we are valued and still capable of supporting others – even in small ways.

Also, there will certainly be times in your lives when your positions are reversed and you are the one needing help. After what they’ve been through your friend may well have just the expertise and experience you need, so be prepared for your roles in each other’s lives to shift over time.

More information.

Mind has an extensive section on supporting people with mental health problems, and lists of further contacts.

Rethink provides information and a helpline for carers, friends and family.

There are also support groups and helplines available for those offering ongoing support through www.carersuk.org and www.carers.org.

The post Supporting each other through mental health struggles appeared first on Rewriting The Rules.

My own position on mental health is that we all struggle, sometimes, with experiences of fear, sadness, anger, loss, shame, etc. which make life very difficult. Perhaps one of the most challenging times is when everyone in a relationship is struggling at the same time.  That is what I will mostly focus on here.

I went to a very interesting workshop on this topic at the weekend which helped me to think through some of these issues. The workshop highlighted the fact that many people had shared experiences and had developed similar, very helpful, strategies for dealing with them. Of course I won’t write anything here about specific examples given because the workshop was confidential, but I do want to thank the other people there for helping me to clarify my ideas as well as for giving me the confidence to write this post.

Pressure to seem fine

The backdrop to why struggling is hard in relationships is the pressure that we are under to prove that our relationship is ‘fine’ at all times. People are often very fearful that if they admit that they have any difficulties, friends and others will say that it is the relationship that is at fault. Given that relationships are inevitably challenging, this can reinforce concerns that most of us have that perhaps there is a problem with our relationship.

For people in less conventional relationships, this issue may be exacerbated because any acknowledgement that things are not perfect could be taken, by others, as proof of what they always suspected: that this kind of relationship can’t work.

Such fears often mean that, when we are struggling, we don’t let anybody else in besides our partners. This can put strain on the relationship in multiple ways. We might feel that we are entirely responsible for our partners’ struggles (and for making them better) and that they are entirely responsible for us in return. Also, if everybody is presenting a perfect relationship and a struggle-free self to the world, then we can feel very alone knowing that we don’t really fit that.

Wanting to stop partners from struggling

One result of all this is that we can end up constantly monitoring our partners for any sign that they are starting to struggle, and then – if they do show signs – trying to cheer them up or prove that they are being irrational. This, of course, is rarely helpful and often makes it more, rather than less, likely that they will feel anxious, self-critical, or hopeless.

Perhaps part of this aim to stop partners from stuggling is the fear that we too will be drawn down into the suffering that they are experiencing. If we have had really difficult times ourselves in the past then this fear makes a lot of sense, but unfortunately the reaction to it (trying to stop anyone from feeling bad ever) is pretty unhelpful!

Instead of trying to prevent ourselves, and our partners, from ever struggling, we can try to acknowledge that we will all go through easier and harder times, and that it is okay to be sad, anxious or angry. Paradoxically, accepting such feelings often makes them less debilitating than if we layer extra difficult emotions on top of them (feeling sad about feeling sad, fearful about feeling angry, etc.) In relationships, one great thing we can offer our partners is acceptance that however they are feeling is acceptable and sensible given the situation they find themselves in.

Another part of this is recognising that just because a partner is feeling something, doesn’t mean that we have to feel it too. We might feel guilty if we are having a great time in life, whilst a partner is going through a difficult period. However, we are often of more use to them, and to ourselves, if we can hold both those things simultaneously (rather than trying to make them feel as good as us, or sinking down because they are struggling).

Different things work for different people at different times

What about those times when everyone in a relationship is having a hard time at the same time? Perhaps the most important answer is that different things work for different people at different times. For some people, at some times, it may be better to separate off and/or get support elsewhere, whilst others, at other times, find it good to get together for some mutual kindness.

An important part of this is recognising that, even in relationships where people have a lot in common, they might need quite different things when they are having a tough time. For example, some people long for physical contact whilst others find any kind of touch difficult. Some need to talk it all through till they feel better and some find words difficult. Some really want to be alone, whilst others find isolation incredibly hard at such times. And some like others to try to fix things whilst others just want to feel understood. Mutually respectful conversations about what different people find useful when things are difficult can be extremely useful, especially because it can be very hard to articulate these things in the moment when we are suffering.

Here are just a few ideas which might be helpful, and it can also be helpful to remember that all these options are available.

Stepping up

A great example that came up in the workshop, which I’ve experienced myself, was of spider phobia. I used to be somewhat scared of spiders myself, always asking somebody else to get rid of them. But I noticed that when I was with a partner who was very scared of spiders, I became much braver and actually rather enjoyed being the one to wield the glass and postcard.

Something similar often happens when more than one person is struggling. One person somehow realises that they do have a bit more strength or energy than they thought, and steps up to do some looking after, supporting, or problem-solving (whatever is necessary). It can be empowering to realise how much more we often have than we think we have, even when we’ve had a rough day or things are hard and we thought that we had nothing left.

The important caveat to this is that it can become problematic if it is always one person who becomes the ‘stepper upper’ in such situations. Getting stuck in roles (such as the emotional one and the rational one, or the victim and the rescuer) often leads to problems. So it is worth, when you are not struggling, having a conversation about how you might ensure that that doesn’t happen.

Getting space

When more than one person is struggling and the struggles seem to be spiralling everyone into even worse places, it can be a very good idea to recognise this and get some time apart. This can happen, for example, when everyone feels that the difficulties they are having right now are much bigger than those that the other person/people are having, and keeps trying to show how much more desperate a place they are in. It can also happen when needs are very incompatible at that time (e.g. one person wanting silence and one wanting to talk).

Again, it can be useful to have agreed plans for what will happen at such times (how to ask for time out, where to go, how to know when to approach each other again, etc.)

Support from outside

It is wonderful if there are people in your lives who recognise that acknowledging difficulties doesn’t mean there is anything wrong with you or with the relationship (often quite the opposite). If we can cultivate friendships like this then it can often be good to go to those people at times when people in the relationship don’t have much to offer each other because they are struggling so much. Often an outside perspective can be a breath of fresh air, and taking the weight off a partner can allow them time to get to a stronger place.

Again, it can be helpful to lift our sense of responsibility that we should always be in a position to be able to help our partners, and to recognise that we can’t always offer that, and that sometimes being alone, or with other people, might be more useful.

Kindness and calmness

When we are weathering storms together with partners (whether the same storm, or different ones), it can often be helpful to focus on very calm, kind activities rather than trying – for example – to fix everything or to carry on with our plans as normal. For example, we might retreat to bed, cuddle up in front of the television, read each other stories, or go out for a walk together somewhere that feels safe. It’s good to acknowledge that we don’t have much to offer and to think what we have got available, and what activities might be helpful all round. Making sure that we get the basics (food, rest, and some physical activity) can also be very important at such times.

When we are being kind and calm to each other we can often stop the tough stuff from spiralling any deeper and create the right conditions for a gradual improvement. Instead of flailing around desperately trying to fix things immediately, we can find some safety and comfort where we are now, remembering that things will inevitably lift, and will be more likely to do so if we don’t force it.

I hope that some of these ideas will be helpful, and that Mental Health Day enables all of us to reflect on how we are all able to contribute to each others’ mental health: We can add to others’ sense of pressure and alienation, or we can ameliorate it by being open about our own struggles and by offering what we have available.

The post Mental health and relationships appeared first on Rewriting The Rules.

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.

The post Mental health: beyond a health focus appeared first on Rewriting The Rules.

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.

The study itself linked living alone to poor housing in women and low social support in men (something that has long been found to be a risk factor for single men). However they are understood, the findings clearly point to the vital social role in depression: a condition which is commonly understood to be both internally caused, and in need of only internal treatments (such as drugs and therapies). We need to move to more biopsychosocial (or even sociopsychobio) understandings of this experience.

The bounded self

Social psychologist Kenneth Gergen points towards one idea which may help to make sense of findings like these. In his book, Relational Being, he argues that in the past few centuries we have come, in the west, to see ourselves as ‘bounded beings’: as singular and separate from others. This is a culturally peculiar belief, according to Clifford Geertz, but one which we generally take for granted as a ‘fact of life’.

Gergen argues that if I accept this view of myself:

‘I must always be on guard, lest others see the faults in my thinking, the cesspools of my emotions, and the embarrassing motives behind my actions … I must worry about how I compare to others, and whether I will be judged inferior.’ (xiii-xiv)

He argues that this view underlies our education and organisational systems which evaluate us individually and encourage constant competition from the start.

Importantly, for our explorations here, Gergen suggests that depression can be located in this way of viewing ourselves The inner critics and overwhelming fears of failure which are so familiar to us are part and parcel of this view of the human being. As well as the relentless self-evaluation, toxic comparison and defensive withdrawal of depression, the familiar sense of meaninglessness and pointlessness can also be linked to disconnection from others since meaning, for most people, is associated with their relations with others.

Speaking specifically about living alone, Gergen proposes that this is something which only really makes sense under this view of ourselves as fundamentally isolated. Alongside statistics on the numbers of people choosing to live by themselves, he cites evidence for decreases in close friendships and increases in loneliness in recent years.

Gergen proposes that an alternative way of seeing things is to regard ourselves as fundamentally relational rather than bounded. This is a view which is common to Buddhist and existential philosophies (which question the separation between self and others and stress interconnection), and constructionist and constructivist approaches (which point out that we become different ‘selves’ in our relationships with different people, and that our self is something that we construct in interaction).

Bounded selves and living alone/together

Returning to the issue of living alone, we could see this as a situation in which the sense of ourselves as bounded and separated is exacerbated, especially in situations where we are also out of work or retired and have very little human contact day-to-day. It is possible to become very inward focused: listening to the loops of self-judgement and critical commentaries that go on within our heads. A vicious cycle is easily set in motion where our negative view of ourselves makes contact with others a frightening prospect, due to fear that they will confirm our self-perceptions, and we withdraw further into ourselves.

Such challenges are not absent for those of us who live with others. The bounded self view is pervasive and we also relate to other people accordingly: looking to our partners, children or parents to affirm and validate a positive view of ourselves, and fearing that they will do the opposite: seeing us negatively in a way that confirms what we dread is the real truth of who we are. This is what Sartre was talking about when he said that ‘hell is other people‘.

However, given the findings on living alone, it seems that – for many of us – contact with others goes some way towards loosening the tight grip on the self. Perhaps when we live up alongside others we have times when the self-and-other distinctions are blurred: as we share a moment, or physical contact breaks down the barriers, or we recognise our own pain or joy in the eyes of another, for example. Maybe we realise how much our own projects in life are bound up with other people, and how much they need us for their own projects, and a kind of mutuality and reciprocation comes from that.

Also, as we relate to different people in our lives we may notice that they, and we, have different sides in different situations, and also that they, and we, change over time. The recognition of our plurality and fluidity both provide relief from the grip of the bounded self. It makes far less sense to judge and evaluate ourselves (or others) when we know that we are multifaceted, and less sense to compare ourselves against others who are constantly shifting just as we are. If we can find the courage together, intimacy with others may even enable of us to reveal our vulnerability and recognise it as something that connects us rather than being something we have to defend so desperately.

Implications

So what are the implications of such findings on living alone and depression, and this way of understanding them? Clearly they point to the importance of human contact – but importantly contact which encourages a softening of the bounded self rather than further judgement and competition. We should be cautious, as a society, of policies and practices which leave people even more isolated and withdrawn. Such research should feed into current discussions, for example, of benefit systems and of how we treat older people.

Also it would be good to provide more real alternatives to living alone. At the moment, for many people, the decision is between living as a couple/nuclear family and living by yourself (if you are single or separated from such a unit). We need to expand the options and make it both socially and economically viable to live in other arrangements.

It is not that being alone inevitably reinforces the sense of the self as bounded. We can all probably point to moments of solitude in which we felt connected to others and the wider world, and this is something that can be cultivated in meditation and other solitary practices. It is quite possible to respond to the pain of the bounded self by surrounding ourselves with busyness, people and distraction in ways that become equally problematic. It is useful to consider the ways that we all relate to solitude, to being with others, and to wider community. At all levels we can operate as bounded, separate, units, or shift into a more relational, interconnected, mode.

Find out more:

For another perspective on living alone, based on a qualitative research project on those who live by themselves, see I want to be alone: The rise and rise of solo living (The Guardian, March 30th 2012)

The post Living alone and depression appeared first on Rewriting The Rules.

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.

The post Mental Health – Beyond the 1 in 4 appeared first on Rewriting The Rules.