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Overcoming Emotional Trauma

 

There are moments in life when things happen to us that we don’t know how to handle. It could be an accident, the loss of a loved one, a natural disaster, a mugging, being the victim of sexual abuse, or suffering an extremely humiliating experience. These events usually generate very intense emotions and can cause psychological or emotional trauma.

What is a psychological trauma?

The definition of trauma is: An emotional shock that produces lasting damage to the unconscious or a strong and lasting negative emotion or impression.

Trauma is an emotional shock that produces lasting damage in the unconscious, although it can also be a strong and constant negative emotion or impression. It usually appears when we are exposed to a potentially traumatic situation, that is, a stressful and threatening situation that has overwhelmed our coping mechanisms. It arises when we have suffered a very intense fear and we have felt incapable of managing it.

However, all traumas are not the result of a specific episode. Sometimes a “cumulative trauma” occurs, the result of having been exposed for a long period of time to situations that we have not been able to accept or manage.

In both cases, the basic mechanism is the same: emotions overwhelm us and traumatic experiences are not integrated into our “self,” but rather remain active, usually at an unconscious level, manifesting itself through psychosomatic problems, worries, or dysfunctional behaviors.

How to know if you are suffering from emotional trauma

After experiencing a traumatic episode, the brain goes into shock and most often you remember everything that happened to you over and over again in a never ending loop. Your conscious mind deletes it, which will make you feel like it has not left sequels. This occurs when the trauma is too painful, so a dissociation mechanism kicks in to prevent you from suffering too much, although that doesn’t mean trauma hasn’t occurred.

There are different symptoms that may indicate the existence of these traumas:

• Insomnia and nightmares at night. It is likely that you remember the traumatic event during the night. You can remember isolated details or relive the whole experience again.
• Greater irritability. You show yourself to be more sensitive to any circumstance, mainly to those that resemble the situation that has caused the emotional trauma.
• Anxiety and nervousness. In recent times you feel nervous, anxious and apprehensive about almost anything. It is likely that you are always alert, in a state of tension, as if something bad were going to happen at any moment.
• Fear. You have developed a fear of different situations, even the most normal day-to-day ones. You are also likely to startle easily and overrespond to stimuli.
• Confusion and difficulty concentrating. You have problems finding your daily rhythm, you feel confused and it is difficult for you to concentrate.
• Feeling of guilt and shame. Sometimes victims feel a deep sense of shame because they believe that the traumatic event was their fault.
• Or you could be very angry and blame others for what happened. emotional indifference. Perhaps you have begun to feel that nothing matters to you, the activities that you were passionate about before have ceased to interest you and you feel disconnected from your emotions

Causes of emotional trauma

Traumatic experiences overwhelm us, to such an extent that they break our psychological balance. This means that what may be traumatic for some may not be for others.

Obviously, there are some traumatic situations that have a great emotional impact on most people, such as physical or psychological abuse, a particularly dangerous accident, abuse, the death of a very close person, and illnesses that leave serious consequences.

Even so, it is estimated that 64% of people who are exposed to traumatic episodes will not develop a psychological disorder. There are some factors that increase the chances of suffering a trauma:

• Existence of psychological problems prior to the traumatic situation, such as suffering from chronic stress, anxiety or depression.

• Experiential avoidance, which involves an effort to avoid memories, feelings, or thoughts related to the traumatic event, in such a way that it only perpetuates the suffering

How a trauma is recorded in the brain

Traumatic experiences are sustained by a kind of emotional short circuit. When we experience a traumatic episode and we don’t have the necessary psychological tools to deal with the problem, the emotional part of our brain sounds the alarm and disconnects the rational part. In some cases, this disconnection is so great that the memory is erased from conscious memory. However, that doesn’t mean the emotional trauma goes away.

Neuroscientists from Harvard University found that painful traces remain etched in the brain, but in the wrong area. In practice, people who cannot leave behind their traumatic past, relive painful experiences as if they were a real situation. That is why, in order to overcome a trauma, it is necessary to turn it into a narrative experience, which means that you must process what happened, reduce its emotional impact and store it in the part of the brain destined for autobiographical memories.

The consequences of emotional trauma

The origin of many psychological problems is found in emotional traumas. When we fail to overcome a trauma, different disorders can appear that will affect our performance and quality of life.

Anxiety. Anxiety is a disorder linked to fear, so it is usual that after a traumatic episode you develop a hypervigilant and apprehensive attitude that gives way to anxiety.

• Depression. When the trauma is very great, you can experience a deep feeling of helplessness and hopelessness. You can lose joy and the reasons to live, so you could develop depression and even have suicidal ideas.

• Post-traumatic stress disorder. The trauma is relived in the form of recurring and involuntary distressing memories that cause great discomfort. In some cases, dissociative reactions may appear in which you lose contact with reality and believe that the traumatic events are really happening.

• Social isolation. Out of fear of a similar event happening again, you may gradually limit your social activities and isolate yourself.

• Dissociative disorders. Dissociation is a clear symptom of having suffered an emotional trauma, because it is an automatic response from our brain to disconnect from pain

How to overcome a trauma. Psychological treatment

Since traumas are related to emotions, reasoning and language are usually not very effective. That is why it is necessary to resort to techniques that work directly on the unconscious and the emotional part of the brain, where the traumatic shock occurs.

Although exposure therapy is the trauma treatment par excellence, it is fundamental that before embarking on exposure to trauma-enducing stimuli, that a safe space is created, where empathetic listening and validation can help to forge a space where the person experiencing trauma feels in control and prepared to embark on the healing process.

Cognitive processing therapy

Cognitive processing therapy (CPT) is based on the idea that immediately following a trauma, you were probably not able to fully process what happened to you.

In trying to understand the event and how it affected you, you might later come to conclusions that are not healthy.

You might, for example, decide that it’s not safe to trust anyone, or you might believe that you’re to blame for what happened.

CPT aims to identify those incorrect conclusions and restructure them in healthier ways. This kind of therapy usually takes place in around 12 sessions, during which you and your therapist work together to process what happened through talking or writing about the experience.

Prolonged exposure therapy

Like CPT, prolonged exposure therapy addresses the tendency to adopt unhealthy thinking patterns in the aftermath of a traumatic event.

For example, as a result of trauma, you may have developed a fear response that’s out of proportion to the dangers you face.

To change your fear response, prolonged exposure therapy begins with some education about PTSD symptoms. Your therapist will equip you with skills to calm down and cope when you face something frightening.

Once you’ve learned self-calming techniques you and your therapist will create a hierarchy of fears.

You’ll start with things you find slightly scary and progress to more intense fears — possibly those related to the trauma you experienced. You will not progress to the next level on your hierarchy until you and your therapist are satisfied you can handle each one.

Over several months of treatment, you and your therapist will work together to help you face your fears, allowing you to practice new coping skills.

You’ll learn that your thoughts and memories related to the trauma are not actually dangerous and do not need to be avoided.

Neurological therapies

Many of the long-term effects of PTSD are neurological. For that reason, treatments that focus on the brain and nervous system have been found to be particularly effective at restoring function and reducing symptoms.

Eye movement desensitization and reprocessing (EMDR)

Eye movement and desensitization processing is a therapy that uses repetitive eye movements to interrupt and re-pattern some of the trauma-related memories you have.

After talking about your history, you and your therapist will select a memory that you find particularly difficult.

While you bring the details of that memory to mind, your therapist will guide you through a series of side-to-side eye movements. As you learn to process the memory and related feelings it brings up, you’ll gradually be able to reframe that memory in a more positive light.

Research found that when provided by an experienced therapist, EMDR can help reduce many symptoms of PTSD, including anxiety, depression, fatigue, and paranoid thought patterns.

It’s a low-cost therapy, has few if any side effects, and is recommended by the World Health Organization (WHO) for treatment of PTSD.

Medication

The American Psychological Association (APA) recommends certain antidepressants for the treatment of PTSD symptoms.

The APA notes that the most common medications used for PTSD treatment are selective seratonin reuptake inhibitors such as:

• paroxetine (Paxil)
• fluoxetine (Prozac)
• sertraline (Zoloft)

It’s important to note that paroxetine and sertraline are the only FDA approved SSRIs to treat PTSD.

What you can do to help yourself

• Journaling: Research has shown that writing about traumatic events is short sessions can significantly reduce the symptoms of PTSD and when combined with other therapies can reduce the length of the therapy. Writing has also shown improvements in depression, anxiety and help lower blood pressure.

• Yoga or meditation: Studies have shown that Yoga and meditation work well as complimentary therapies along with more conventional psychological therapies. They both help in regulating bodily functions such as breathing, create awareness to mood states and increase resilience to uncomfortable emotions

If you feel you would like some professional help with emotional trauma, you can contact me here https://counsellingtherapistmadrid.com/https://counsellingtherapistmadrid.com/

How many COVID-19 epidemiologists does it take to change a lightbulb?

 

We have found 24 strains of light bulbs each with its’ own peculiarities, some are activated by this switch here and other are activated by that switch there. Important factors to be taken into consideration when studying a switch-light correlation are finger pressure and the social context in which the switch flick is entrenched. Existing wiring in the building may be problematic, some wiring is more adequate that other wiring where rust and bad usage can complicate a free flow of electricity. Of course, many people just lie about their light bulbs which can become a major confounding variable when searching for the optimum bulb-changing moment. Correlation is not causal, so lack of light from a light bulb doesn’t necessarily mean that it needs changing. More research needs to be done in the field of light bulb changing before we can come up with an exact figure, so while we may be able to help you change a lightbulb, you’re on your own with COVID.

Based on an idea by Ben Goldacre

The Suicide of Veronica Forqué

The recent death of Spanish actor Veronica Forqué, shines the focal spotlight on suicide and the difficulty of living

Death by suicide is the primary cause of unnatural death in Spain and causes more deaths than traffic accidents. In 2020 3,941 people gave up living and took their own lives. What is surprising is the mediatic impact that her tragic death has had. Suicide is very rarely reported in the press in response to what is known as the Werther effect. A term coined by sociologist David Phillips based on the book by Goethe, The Sorrows of Young Werther, where the protagonist commits suicide. Phillips claimed that after the New York Times published an article on suicide, the number of suicides in the city increased and since then a pact by news companies has kept suicide out of the press.

Given the important risk factors, as well as the delicacy required to cover suicides, suicide-related news is only published when the processing of the information can have a preventive effect on suicidal behavior. The theory of the 'Papageno Effect' indicates that exposure to information about people who have faced crisis in a positive way and without suicidal behavior exerts a protective effect.

The dimension of the health problem posed by the suicide data in Spain has caused the trend in the media to report news that addresses this problem from a preventive perspective. The great taboo has been collapsing in recent months, perhaps due to the magnitude of the figures, but also because of a society increasingly concerned that mental health should have the same importance as physical health in Spain.

Requests from various platforms to political parties to address this problem has increased notably in the last legislature. According to the EFE agency, the proportion of clinical psychologists is 6 per 100,000 current inhabitants, compared to the 18 on average in the European Union. There are 9.6 psychiatrists in Spain for every 100,000 inhabitants, far behind countries such as Poland, Finland and Belgium with 24; 23 and 20 respectively.

The social debate on suicide is neither easy nor straightforward. Mental health involves multiple variables that can lead to suicidal thoughts and behaviours. There are also many false myths that surround suicide and relate it to cries for attention. This summer, within the framework of the conference of regional presidents, the head of the Consell, Ximo Puig, showed a clear concern for mental health and called for "a shared strategy between the autonomies." "We are very concerned about the suicide rate," said the head of the Consell. Last year, 82 Valencians between the ages of 20 and 39 took their own lives, 30% more than the year before the start of the pandemic. The young population is precisely the age group most affected by this problem.

Teacher Burnout

 

Many of my friends are teachers and they often tell me how they feel less and less motivated by the teaching sector and would suggest the seriousness of a situation where teachers are struggling to find personal meaning in what they are doing. This is especially relevant in an education sector that relies heavily on standardized tests where teachers feel a conflict between what they feel as “good teaching” and the pressure to perform. If this includes a lack of social support from the school, it can leave teachers feeling isolated, anxious, and facing inevitable burnout.

According to educational psychologists Cristina Maslash and Michael Leiter (1997), burnout has been described as ‘a prolonged response to chronic emotional and interpersonal stressors on the job’, and is defined by the three dimensions:

• Exhaustion: a state in which the teacher feels they cannot offer any more of themselves
• Cynicism: a distant attitude toward work, colleagues, students and other aspects of the job
• Inefficacy: a feeling of becoming incompetent and ineffective at the job

 Recent studies report that between 10 and 20% of teachers could be suffering from high burnout levels, and between 20 and 40% from moderate levels. In the United States 17% of all teachers leave the profession within the first 5 years. Some of the factors associated with teacher burnout are students’ challenging behavior, work overload and lack of time, and role conflict and ambiguity.

Research into teacher burnout has also revealed an important link between perceived working environment and individual burnout levels, that is to say the higher burnout is perceived collectively, the higher the chances that individual teachers will become burnt out. Several studies have also reported the relation between teacher burnout and harmful effects on physical and psychological health, how it negatively affects work performance as well as professional and family relationships. In addition, burnout can influence the way teachers perform their work as well as curriculum-specific contents. In an era where student Social and Emotional Learning is high on the agenda and schools are incorporating it into the academic curricula, Ransford et al. (2009) found that teacher burnout was negatively associated with the promotion of alternative thinking strategies linked to socioemotional curriculum.

Research into prosocial classrooms has focused mainly on the academic outcomes of students and interaction between teachers and students. The development of rapport between the teacher and the student is seen as fundamental as they both enter the classroom with inter-related goals where both rapport and a prosocial climate is co-constructed that actively encourages student participation (Sidelinger & Booth-Butterfield, 2010). According to Schrodt, Turman, & Soliz (2006), participating in rapport-building behaviors has been shown to positively influence students’ opinions of instructor credibility and students’ evaluations of instruction.

This may be where theory and practice clash when we consider that already overworked teachers are now burdened with the added pressure of having to provide warm and emotionally responsive support to all children with the aim of building a rapport. Just take a minute to reflect on what it might mean to you as a teacher to always be emotionally available to all your students. Would you feel extra pressure knowing that students’ opinions of your credibility were linked to your capacity to develop rapport?

With no, or very little training, teachers are expected to cultivate a warm and nurturing classroom climate, coach students through conflict with thoughtfulness and display Zen-like emotional regulation, often in the midst of chaos. Whilst at the same time attending to the demands from parents, school boards and an ever-increasing amount of standardized testing. Very little professional development is spent on acquiring these emotional competencies and it is easy to see how teachers can find attending to students emotional and behavioral needs overwhelming, which if we are to believe the academic literature, will lead to lower academic performance by the students. In this situation a teacher may be tempted to over-compensate and revert to authoritative and punishment styles just to keep a grip on the class and any sense of emotional regulation is lost as the class deteriorates into a self-sustaining environment of disruption. This is what Jennings & Greenberg (2009) refer to a “burnout cascade”.

Warning signs of teacher burnout

True burnout is much more than simply feeling tired or overwhelmed, and can lead to serious depression. That's why it's so vital to be vigilant about the warning signs.

• Fatigue and sleep issues: A full day of teaching is enough to make anyone feel tired, but if you're experiencing fatigue before you even get to school, you may need a break. However, those experiencing burnout often struggle with insomnia, which can turn into a vicious cycle.
• Repeated periods of forgetfulness and intense trouble concentrating: Burned-out teachers may find it hard to complete normal tasks and have trouble concentrating on their work. A lack of sleep can amplify these symptoms even more.
• Appetite and weight issues: Any drastic weight loss or gain should be investigated by your doctor, as this is often a sign that you need to focus on your overall health.
• Depression and anxiety: If minimized or ignored at the early stages, teacher burnout can intensify into feelings of anxiety and depression. Always speak to your doctor if feelings of sadness or anger are affecting your daily life.

How to Avoid Burnout if you are a teacher

The theory says that to avoid teacher burnout, teachers need to build balance into their lives by setting clear work boundaries and managing to find down time at the weekends. Which sounds fantastic, but a busy schedule and a demanding head of department may not be so permitting. If you can do that then by all means go ahead, but most teachers will need to grit their teeth and continue. You may not be able to completely avoid burnout, but there are certain things that you can do to lessen its effect upon you.

1.       Focus only on your class and try not to get caught up in school politics or gossip. Stay focused on the task at hand, which is teaching kids.

2.       A change is as good as a rest. Maybe you can change age group, subject or class

3.       Build a positive community amongst your work colleagues

Burnout is a serious condition that can have grave consequences on physical and psychological wellbeing. If you or a colleague is suffering from stress, overwork or burnout and would like to speak to a psychologist then you can contact me here.  

 

References

Sidelinger, R. J., & Booth-Butterfield, M. (2010). Co-constructing student involvement: An examination of teacher confirmation and student-to-student connectedness in the college classroom. Communication Education, 59(2), 165–184.

Schrodt, P., Turman, P., & Soliz, J. (2006). Perceived understanding as a mediator of perceived teacher confirmation and students’ rating of instruction. Communication Education, 55, 370–388.

Maslach. C & Leiter. M (1997) The truth about burnout: how organizations cause personal stress and what to do about it 

Ransford. C, Greenberg. M, Domitrovich. C, Small. M & Jacobson. L (2009) The role of teachers’ psychological experiences and perceptions of curriculum supports on the implementation of a social and emotional curriculum. School psychology review 38(4):510-532

 

Wicked Witch of the West

Non-conforming women have always been ostracised

The Truth & The Lie

According to a 19th century legend, the Truth and the Lie meet one day. The Lie says to the Truth: "It's a marvellous day today"! The Truth looks up to the skies and sighs, for the day was really beautiful. They spend a lot of time together, ultimately arriving beside a well. The Lie tells the Truth: "The water is very nice, let's take a bath together!" The Truth, once again suspicious, tests the water and discovers that it indeed is very nice. They undress and start bathing. Suddenly, the Lie comes out of the water, puts on the clothes of the Truth and runs away. The furious Truth comes out of the well and runs everywhere to find the Lie and to get her clothes back. The World, seeing the Truth naked, turns its gaze away, with contempt and rage.
The poor Truth returns to the well and disappears forever, hiding therein, its shame. Since then, the Lie travels around the world, dressed as the Truth, satisfying the needs of society, because, the World, in any case, harbours no wish at all to meet the naked Truth.

The world famous painting- "The Truth coming out of the well" Jean-Léon Gérôme, 1896.

Mindfulness as the Spiritual Heroin of Capitalism

Heroin was known for its numbing anaesthetic qualities even by the Chinese back in 1839 when they realised that the Chinese population was becoming more and more docile under the influence of British- imported opium.

Capitalism is failing to provide an egalitarian society and that means real suffering for millions of human beings. Inequality is on the rise as in 2017 we reached the point where 1% of the worlds population control 50% of the wealth.

Unless you belong to that 1%, the chances are that you spend your working day in a precarious job that has the end result of making someone else rich. You may have a full-time contract, but in Spain you can be sacked pretty much anytime. You will find that if you are ill, you can no longer go to the Doctor to get your free Public Health treatment, because your boss is no longer obliged to pay for your time at the doctors. You can either take a days holiday or you can lose a days pay.

You may find yourself working in a call centre to make ends meet and your daily activity is bullying and badgering people into pension plans, telephone contracts….just fill in the dots yourself. There will at all times be someone behind you bullying and badgering you into bullying and badgering more effectively and helping you hit those bullying and badgering targets.

If you are a woman, you’re more likely to be in a precarious low paid job, where you will be expected to clean 21 hotel rooms in a day and you’re only allowed 15 minutes to clean each room. You’ll be between 51 and 56 years old and your body will be held together by elastic bandages that help you get through the day without too much pain.

We are running scared, looking back over our shoulder to see who’s coming up behind us to take what little we have away from us.

Instead of rising up and protesting, we're meditating and becoming mindful

Capitalism’s answer to this has been a masterstroke in deception and manipulation. Relying on ancient eastern philosophies companies all over the world are helping their employees find relief through mindfulness and meditation.

When your back is breaking, or you’re being forced to break your own moral code, when you're underpaid and living in fear. Mindfulness is there to remind you that any toxic emotions you may demonstrate in the workplace are disruptive to workplace harmony, mindfulness will help you just observe your situation in a non-judgemental manner and will allow you to disattach to what is going on around you.

The passivity and individualistic nature of mindfulness makes it a perfect bedfellow for an ever more savage type of capitalism.

Mindfulness is the new opium for the masses

Non-attachment

I’ve always been attracted to the idea of non-attachment as promoted by Buddhist philosophy.

As someone who is invariably caught up in thoughts I often find myself attaching to the material world and in particular, outcomes. The very idea of being able to unattach is a very appealing one andI I can imagine a life of not suffering and being above all worldly pleasures.

Buddha, or Siddhartha as he was known as at the time of striking off to find enlightenment, came to the conclusion that the way to avoid the inevitability of human suffering was to detach from the constraints of pleasure, achievement, striving and reputation. Which he promptly did and found enlightenment.

His conclusion was reached one day when he’d managed to convince his father to let him go out for a chariot ride around the city where he was basically being kept a prisoner by his father. He had had a rather sheltered life and was surprised to encounter, first an old person, then a sick person and finally on his last chariot ride, a corpse.

It was at this moment that he realised the futility of human existence and that our ultimate destiny is old age, illness and death. The only way he could conceive of escaping from such suffering was to renounce the pleasures of life.

Of course the real pity of all this was that Siddhartha didn’t actually take the time to jump down off his chariot and have a quick chat with these suffering souls that he had encountered. He may have been surprised by the perception they had of their own existence.

He may have discovered that they may have been pretty content with their lives. You see people in general tend to adjust their expectations to their own reality, that is to say, as we get older we no longer expect to be able to do things that we could do when we were 20 and people who live in quite extreme poverty, although there are limits, tend to be just as happy and content with their lives, on a subjective level, as affluent middle aged middle management.

When Stephen Hawking was asked how he found the motivation to continue with his work given his physical condition, he replied that at the age of 21 he was diagnosed with amyotrophic lateral sclerosis and from that moment his expectations became zero, so anything above that was a plus.

Buddha would’ve probably pitied Stephen Hawking more than Stephen hawking did himself.

But our expectations can adjust up as well as down. This can be seen in millionaire lottery winners, who after an initial increase in happiness, soon return to base default level as expectations about their own happiness increase.

People tend to adjust to adversity very well and after emotional or physical suffering our levels of contentment very quickly return to our default level as we adjust to new circumstances and adjust our expectations. In fact there is not one person I know who has gone through painful and difficult times that does not feel a better person for having done so. 

Cutting ourselves off from all worldly pleasures with the aim of avoiding suffering seems pointless, especially when it seems that suffering is a fundamental part of the human experience. On top of that, moving through adversity seems to make us better people.

Here in the West, we are privileged to live in a Democratic, more or less egalitarian society, where we’ve never been so healthy or lived so long. We enjoy culture and art and can argue about politics. We feel passionate about things and surely a life of unattachment is a life that lacks passion.

We are spiritual beings that are fortunate to enjoy a brief spell of worldly pleasure. Dive in I say, indulge and drink deeply from the well. Let’s make mistakes and embrace our neurosis, enjoy every moment of pain as we do every moment of pleasure. 

Always, always, always live well

Chris and Mirella

Chris and Mirella stood together high on the cliff top with majestic views over the whole valley below. As they looked yonder they could see the slaves of the science paradigm each heaving huge blocks of stone into place, there was a multitude, each with a very specific role in the construction of the pyramids built to honour and preserve the evidence based scientific paradigm. Each slave laying the block of stone that was to become their prison, and each slave learnt to see the pyramid as they had been told to see it by the wise teachers in the schools of learning without realising that they had forgotten how to question.

“¿Why should one question?” declared Mirella and it was true, because engraved on each of the pyramids were the words p=<0,05,  thus it was written from that moment on all knowledge must be p=<0,05 as a testament to it’s objectivity and all other knowledge which does not bear this sign shall be rejected and ridiculed, and so it came to pass.

As Chris and Mirella looked on an old man Kierkegaard came to them and declared “The people still suffer!” “¿Do you not see?” “The people no longer exist, but are lost completely to objectiveness.” Kierkegaard sunk deeper into his cloak and turned mumbling “mark my words!! Objective madness is the worse type of madness because one regards oneself as just another fact. People with objective madness have no soul.”

Chris turned to Mirella and asked “maybe the time has come to be authentic and admit our incoherencies.”

“I am always coherent!!!” cried Mirella, to which Chris answered “That may be so, but isn’t it also true that when we claim to be something we shed responsibility for our actions?”

Chris paused, “we can never just be, we chose and do”.

Mirella sunk deeper into her woollen jacket, for it was beginning to get cold, her voice trembled either from the cold or because it was the first time she felt uncertainty “But if I step outside of the scientific paradigm, what shall become of me?”

Chris wished there was a way to offer certainty but the truth must be told “Life will become meaningless; this is the price one must pay for being a free thinker. To be free means to assume freedom, for it is through our choices that we really become free. Accept the unavoidable, the here and now and assume the responsibility of our choice in every situation. For if we are what we do, then we are nothing but the choices we make.

“Are you suggesting that you and I..my life are all nothing?” despaired Mirella.

“On the contrary, we can only strive to be nothing; nothingness is a state which is never permanent, even if we achieve it, it cannot be maintained; It would be false to believe we are nothing, but striving to be nothing frees us from the restraints of dogma and paradigm.. When we lean on scientific paradigm we flee from our choices and our responsibility, the same as our ancestors relied on religious doctrine to avoid choices and responsibility. Who does evidence based intervention serve? Does it help the patient or does it help free the therapist of responsibility...?”

Chris turned up his collar as the winds began to chill his spine. “In the vain hope of becoming a CBT therapist, we shed our responsibility. The moment we make our bed with any school of thought we are relieved of all choice and responsibility and thus lost”.

Just at that moment the pyramids began to tremble. “You see? A theoretical framework is a fortress that we build for security, but beware for it is built upon the moving sands of uncertainty and change; any feeling of control is at best fleeting”.

“We must embrace freedom, for as much as we try to hide behind dogma and paradigms, we can never be liberated of our responsibility. We do not take an exam, there is no certificate, we cannot become, only strive to become without becoming. Once we become we stop striving and just are, we are safe in the knowledge that never again must we make another decision”.

Mirella shook her head and muttered “But being and becoming makes me feel good, should I reject that?”

“Feeling good is only temporary, it is doing that is important. What is more important to you, to feel good or live well? It is futile to try to be at one with oneself. Anxiously holding onto our theoretical framework enables us to avoid this truth and any thoughts we may have of being “right” are just thoughts and we should abstain from attaching importance to them”.

Mirella once more shook her head and replied “Surely we owe it to our clients to follow those who have gone before and what has proved to work?”

“But if I can’t make a decision free from dogma, what right have I to make decisions for others? Surely we need a committed response to each situation, not just a manual to follow. When we create our own values, we encourage our clients to be the artists of their own lives and not just followers of what has gone before”.

“When our clients come with anxiety, we should encourage them to embrace anxiety as bearer of the ultimate truth, that life is pointless. Temporary avoidance quickly disappears like sand through our fingers and objectivity can never be obtained because to understand something is to interpret it.”

Mirella turned to go as now it was getting dark, Chris thought he heard “You’re out of your fucking mind” but the wind carried it away

Globalization of Addiction

To get the full picture on addiction we have to look, not only at the ways in which it is bad for us, but also the way that substances provide something that is lacking in our lives. Something that family or society has been unable to provide, for whatever reasons.

We can consider addiction as the act of constantly seeking something outside ourselves to curb an insatiable yearning for relief or fulfillment. The aching emptiness is perpetual because the substances, objects or pursuits we hope will soothe it are not what we really need, although they did work for a while and gave temporary relief.  

Addiction is a dysfunctional way of attempting to escape from disconnection and an overwhelming feeling of fear and despair. Manifesting in a variety of shapes and forms, shopaholics, workaholics, gambling, internet, all are to a lesser or greater degree on the same continuum of dysfunctional lifestyles and an attempt to soothe something that is inside with something from the outside. It’s a form of self-harming and a failed attempt at taking back control, not dissimilar to the way an anorexic believes that the only thing they have control over in their life is the food that they ingest.

Some people are prepared to risk their lives for a brief moment of fulfilled life and a sense of connection to something.

The basis of all addiction lies in the central nervous system and neurochemicals known as neurotransmitters and their corresponding receptors. Although the Central nervous system and neurotransmitters exist, they do not exist in isolation and it’s essential for any real, in-depth understanding of addiction that we take into account the person in their entirety, that is to say in a holistic manner. The physiology of someone’s brain does not develop in isolation of an emotional and social context. On the contrary, it is very much influenced by and influences on the social and the emotional.

The false promise that substance or behaviour will make all the planets line up and everything will somehow fall into place makes them the false prophet of a distress free life. It would be wrong to label addictive behaviours as just a bad habit or a lack of willpower and falls short of understanding that all addiction is functional.

All addiction has its origins in emotional pain, whether conscious or unconscious. Powerful narcotics such as Heroin and Cocaine are anaesthetics and are extremely good at relieving pain.

A high percentage of people who engage in addictive behaviours have suffered trauma in childhood, although not all. Trauma is not a requirement for engaging in destructive behaviours, but in my clinical experience, there has been hurt, be it through a particular parenting style that cannot be called abuse, or through a deep-rooted feeling of disconnection with loved ones or the world. One thing that advances in neuropsychology show us is that stress through adversity in childhood has an enormous effect on the physiology of the central nervous system.

But its not just childhood trauma that creates an aching hole in our soul. The way society is constructed in a Neo-liberal market is enough to make my Conservative grandfather turn in his grave.

Modern market culture promotes a feeling of emptiness as we all strive to be the best we can. The fabricated Facebook shopfront of other people’s lives and successes can leave us reflecting on our own failures.  We all feel emptiness; dissatisfaction and frustration in an ever-globalizing world, but many of us have found tactics for keeping them at bay through distraction, be it through professional success, riches, sex, substances or addictive behaviour. But I know through personal experience that the moment this distraction stops, a void of emptiness can open up before us producing a continual white noise of anxiety buzzing away in the background that gets louder and louder as the years go by.

Drugs can offer relief to the lost and you only have to look at the way indigenous communities have dealt with the destruction of their way of life. When the glue of society’s fabric fails, substances are always there to step up the challenge.

It is not a coincidence that drug abuse is on the rise. In 2016, 20 million Americans suffered from a substance disorder, with 2 million addicted to opiates. The social fabric that held societies together is being ripped apart. The Market demands that we are a mobile, fluid workforce, uprooted and disconnected from society and from any ideology that may interfere with the globalised market forces, such as a sense of community, patriotism or religion. Certainty in the job market no longer exists making planning for the future a source of anxiety and worry.

Modern day addiction is neither a disease or a moral failure, it is a maladaptive means of survival. One where the drug user tries to buffer himself from a feeling of complete disconnection from society. It is a form of adaption that is never going to work and one can never feel whole through drug use, which will not only affect the health of the drug user, but also leave them feeling hollow, empty and craving for more.

Traditional drug care has always been based on the individual, but without a caring, inclusive and egalitarian society, recovery will always be against the odds.

Let’s not kill Phenomenology

Phenomenology is defined as first person subjective descriptions of what it means to live in a subjective world. That is, it is more concerned with lived experience rather than objective truths. In Psychotherapy this has traditionally been a powerful tool for helping people understand and come to terms with how they perceive the world and what it means to live in their subjective world.

With the surge in neuroscience and the heavy weight of authority given to DSM V (Diagnostic and Statistical Manual of the American Psychiatric Association), the phenomenology of psychiatric and psychological clients seems to have become less important. Both Neuroscience and the DSM have revolutionised the way we think about mental health, but we run the risk of converting clients into “objects of research”.

Objective classifications as laid out by the DSM and developments in Neuroscience research enable to emphasise the external, observable, measurable and recordable features and characteristics of a mental disorder. Undoubtedly this gives clinicians a huge advantage in helping sufferers and advances in Neuroscience help understand the how and the why.

However, it is also of upmost importance, in my opinion, not to lose sight of the clients lived experience of such phenomena.

Below I’d like to present two different perspectives for the same phenomena, the first is a description of Agoraphobia reproduced from A different existence by Van de Berg. J 1972

“The houses…gave the impression of being closed up, as if all the windows were shuttered, although he could see this was not so. He had an impression of “closed citadel”. And looking up, he saw the houses leaning over towards the street, so that the strip of sky between the roofs was narrower than the street on which he walked. On the square, he was struck by the expanse that far exceeded the width of the square. He knew he would not be able to cross it. An attempt to do so would, he felt, end in so extensive realisation of emptiness, width, rareness and abandonment that his legs would fail him. He would collapse…It was the expanse, above all that frightened him.”

Secondly, I have my copy of DSM V open at page 217 and it states:

“Agoraphobia

      A.      Marked fear or anxiety about two (or more) of the following five situations

·         Using Public Transport

·         Being in open spaces

·         Being in enclosed spaces

·         Standing in line or being in a crowd

·         Being outside of the home alone

      B.      The individual fears or avoids these situations because of thoughts that escape might be difficult or help might not be available in the event of developing panic-like symptoms or other incapacitating or embarrassing symptoms.”

The second enables me to coordinate well with my support psychiatrist and helps me to plan strategies and interventions, but the first powerful description helps me to understand what it means to clients to live in “their world”. Both perspectives are of equal importance.  

Why I’m Eclectic

I’m often accused of sitting on the fence by colleagues and indeed that is a luxury that age and experience has permitted me. Apart from my Psychology degree I have post graduate training in CBT and Gestalt therapy, which for me, far from being in conflict with each other are complimentary and enable me to incorporate different focus at different moments of the therapeutic process.

 Eclectic is defined as selecting or employing individual elements from a variety of sources, systems or styles.

My experience has shown me that different levels of processing are important at all phases of any therapeutic process and different models of therapy can be useful depending on where the client is at any given moment. Of course I’m not suggesting that any process is linear, but am just using a construct to emphasize my argument.

I agree with Rollo May in that an important therapeutic aim is to “set people free”, which can be interpreted as the perceived capacity for choice within the natural and self-imposed limitations of living in “our” world.

We can understand human experience or consciousness in terms of 5 interwoven levels of freedom. The physiological, the environmental, the cognitive, the interpersonal and the experiential. Each incorporates growing levels of freedom at deeper levels of consciousness.

The physiological level relates to organic freedom and is activated and limited by, amongst other things, genes, physical disposition, diet, exercise and drug consumption. This relates directly to environmental freedom where choice and freedom to manipulate external stimuli can be explored using classical and operant conditioning of behaviourism. Here one may obtain observable and measurable results in losing weight, stopping smoking and getting healthy.

At a cognitive level long held beliefs about oneself or the world, that may no longer be adaptive, can be challenged through questioning these belief structures and through cognitive restructuring.

These levels of freedom and restriction relating to physiology, environmental manipulation and cognitive processes could be considered as conscious measurable levels of psychophysiological liberation, but the remaining two, interpersonal and experiential levels of experience often undermine and sabotage environmental and cognitive processes.

At an interpersonal level, we are in the realms of attachment and separation fears, where often our personal uniqueness and striving comes into conflict with our need for connectedness and dependence. Here we need to experience more and think less. Psychodrama and gestalt therapy have no equal as phenomenological experiential approaches.

The last and in my opinion most profound level of freedom is at an experiential level, this in itself transcends words and cannot be talked “about” but is experienced and lived. This kind of experiential freedom can be a hugely humbling experience which can leave people in awe, not of anything in particular, but of being in contact with the wonder that is existence itself, “being” in the world and participating fully in it.

El pie fenomenológico y otras experiencias fuera de mi cuerpo

Dentro de mis círculos cercanos, 2013 fue un año destacado por pérdida, enfermedad y lesiones, incluso yo mismo estuve involucrado en un accidente de moto que ha impactado en mi vida, la vida de los que me rodean y por supuesto cómo me siento acerca de mí mismo.

Tengo un expediente médico que enumera todas las intervenciones llevadas a cabo y no tengo nada más que elogios para el equipo médico que me atendió. Pero cuando leí el expediente médico, lleno de frases como tibia, tejido, trituración, injerto de piel, me cuesta mucho relacionar estas frases con mi experiencia vivida, tanto por los lesiones como por el tiempo en el hospital.

Me explico;  antes de la lesión yo estaba felizmente ignorante de mi cuerpo, mi cuerpo era lo que mi cuerpo hizo. Es decir que yo era consciente de su esencia, pero no de su existencia. Lo mismo que la esencia de un martillo es martillar, la esencia de mi cuerpo era experimentar el mundo y lo hizo muy bien, a menudo sin siquiera que yo fuera consciente de su existencia.

Jean Paul Sartre lo llamó el cuerpo subjetivo del cual no somos conscientes y usó una analogía para describir la sensación. Imagínate caminando en las montañas solo, rodeado de la naturaleza, vivimos esta experiencia inconsciente de nuestro cuerpo y cómo existimos en el espacio y el tiempo.

Ahora imagina de repente en la distancia ves lo que parece ser otra persona que viene hacia ti, tu percepción cambia y te das cuenta de la existencia de ti mismo y de tu cuerpo, nuestro cuerpo cambia de una forma inconsciente subjetiva a una forma conscientemente objetiva cuando nos damos cuenta de nuestro cuerpo como objeto. Este es el “yo” objetivo, lo que otros ven y con el que interactúan.

En el momento que el coche me arroyó, mi conciencia sobre mi cuerpo cambió desde felizmente inconsciente a dolorosamente consciente y desde ese momento mi cuerpo se convirtió en un objeto, un cuerpo objetivo sin poder en manos de los “expertos”.

Desde este momento mi cuerpo se convirtió en algo donde hacer pruebas, sondear, examinar y juzgar. Se encontró con carencias y la vergüenza me hizo querer disociar a mí mismo de este cuerpo que no es mío. Este cuerpo existe y tiene muletas incorporadas, y cuando una enfermera casualmente las mueve, se siente como una violación a mi cuerpo. A través de la intencionalidad estoy muy consciente de sus carencias, llegando, levantándose, cagando, meando y masturbándose, son todas intenciones frustradas por un cuerpo objeto.

Mi sensación de “estar en el espacio” queda aumentada. Donde estoy en la habitación, lo que está a mi izquierda, a mi derecha, delante o detrás llega a tener una extrema importancia.

Aunque los doctores explicaron lo que estaban haciendo en todo momento, no experimento mi cuerpo como tejidos, nervios y tendones. Por suerte conozco a mi pie, ya que nos hemos presentado y esto en cierta medida me ayuda a dar sentido a mi lesión. Pero me pregunto qué sentido sacaría de un cáncer de pulmón, donde yo no conozco a mi pulmón, o la esclerosis múltiple, donde me dirían que los axones en el sistema nervioso central no tienen el aislamiento de mielina adecuado. ¿Cómo daría yo sentido a esto?

En mi opinión la medicina occidental falla en ayudarnos a dar sentido a un cambio de percepción hacia nuestro propio cuerpo y también cómo damos sentido a nuestra enfermedad.

La Medicina en general tiene una visión anatomicopatalógica y arranca la enfermedad desde el dominio del subjetivo individual  y lo ubica con firmeza en el mundo físico. Este enfoque promueve la atención aguda, el rescate y la reparación, llevando a cabo guerras contra las enfermedades y las sustancias y prolongar la vida biológica a toda costa.

¿Podría ser que la enfermedad se ha objetivado de tal manera que las “personas enfermas” se han desplazado hasta la insignificancia?