Month: May 2023

I love popping into borough market on Friday. Tas is super quiet and the preferred cosy place for a catch up with fellow therapists. Monmouth coffee, with its ceiling fans, exquisite coffee and pastries is a delight. Soak up the conversation, cute dogs, and cool bikes. I’m looking forward to trying Rambutan the new south Indian on stoney street.

I always have a conversation with my friend “Hercules” as he is known in the market. He has the best cheese toasties and he sometimes looks after my dog. In recent days he has been super busy and there is always a twenty deep queue.

The hub bub of the market makes a wonderful antidote to the hush and seclusion of the consulting room. It’s useful to know that even after the most intense private conversation we can melt into the big group experience of a market.

I was driving along this morning. The sun was shining, but the breeze was cool. I put on the electrical heating on the steering wheel and the seat. Ah an in car sauna on a summery day. This was all that was both good and bad about living in late capitalist tech. The polluting car, creating public squalor, whilst shrouding the driver in a temporary cocoon. Psychotherapists might call such an experience a “psychic retreat.” Reality is too hard to bear, so we all need to retreat from time to time. That’s why we have room service! That’s why we can draw the curtains in the day. But for some people they can’t emerge from such a psychic retreat. For some people post COVID it is hard to throw oneself back into the painful world where there are no heated seats or steering wheels!

I was reminded of this as the radio 4 presenter reported on runners in Scotland being attacked by buzzards. Clawed no less with great violence. That was more real. They are being advised to wear helmets when running outdoors! Momentarily, I was in awe of the tough runners of Scotland ! I imagined them running around with bits if their ears missing ! A talon shaped gap in the scalp ! What a contrast they formed with my heat saturated body encased in an aluminium carbuncle-coffin! At least they were dancing with the gods. They were living, painfully, in the real world. What legendary stories of heroic deeds they could share with their friends!

The attack buzzard made me think of the world’s most perfect couple. Is it Beyonce and Jay z? No. I was thinking more along the lines of Nancy Sorrell and Jim Moir. It was love at first sight when they met over twenty years ago. What we would call a very powerful projection in our trade. But one that propelled the couple together and helped them create a family, and a fruitful artistic and professional union.

Often projections wear off, but in this case it appears to have stuck. He is still besotted with her and can’t quite believe that she still hangs out with him. Her bright plumage and red lipstick play on her position as his siren, his artistic muse. Even though he has a benign brain tumour and is totally deaf in one ear he can miraculously hear everything she says. He is tuned into her. Has he swallowed a John Gottman manual ? Every time she makes a bid for his attention he responds in kind. He doesn’t stonewall, act sarcastically or shoe contempt. He shows love and kindness and she shows energy, humour and curiousity.

Perhaps it’s a business deal and he’s just trying to get on TV and she wants to promote her make up range. Maybe they are a fabrication like Trump and Mrs Trump. Maybe. But I’d like to think not. They seem to exhibit what Mary Morgan calls the “couple state of mind”. Guggenbuhl-Craig might say they help each other “individuate” and become more of who they really are.

In any case I would strongly recommend their new TV show Jim and Nancy Painting with Birds on Sky Arts. They travel around the country painting British birds, meeting bird focussed artists and catching up with friends. A wonderful scene is the conceptual artist Cornelia Parker making an architectural sculpture out of chips. The art work has an inbuilt obsolence as the sea gulls destroy the work chip by chip.

In another scene in they paint each other without sight of the paper. These blind portraits capture the subjective truth of the other. They truly see one another.

Look. I would really urge you to run without a helmet in Scotland and brave the buzzard filled skies. But if that is just to much reality to bear, make a cup of tea and settle into this soothing show. It’s like a heated seat but better. A psychic retreat with fluttering, cavorting, ever changing birds.

There is an arresting scene in this episode when on off couple Tom and Shiv are at a party. Suddenly, everyone fades into the background. Shiv tells Tom that he never really got beyond the surface. That he never really had any tangible impact on her. That her true love was the one before him. All of this back and forth feels charged. She teases him about his attraction and desire to other women in the room.

Shiv then introduces a game. “Bitey”. The rules are that you have bite the other person. The one who says stop first loses. This game plays on aggression. How much can pain can we inflict on another ? How much aggression can we display? How much can we use another for our gratification? What are our limits ? How much do we experience pain? How much do we empathise with the pain of the other?

The psychoanalyst Robert Stoller said

“In the absence of special physiological factors and putting aside the obvious effects from the direct stimulation of erotic body parts, it is hostility – the desire, overt or hidden, to harm another person – that enhances sexual excitement. The absence of hostility leads to sexual indifference and hostility. (1979)”

There is no lack of aggression between Shiv and Tom. Shiv initiates this aggressive game and finds to her surprise that Tom is able to both tolerate pain (her bite on his arm) and inflict pain that tips her over what she can bear (his bite on her arm).

The psychoanalyst Otto Kernberg could be writing about this scene when he says

“Erotic desire includes a sense that the object is both offering and withholding itself, and sexual penetration or engulfing the object is a violation of the others boundaries. In this sense, transgression involves aggression against the object as well, aggression that is exciting in its pleasurable gratification, reverberating with the capacity to experience pleasure in pain, and projecting the capacity onto the other. The aggression is also pleasurable because it is contained by a loving relationship”

Kernberg, 1995

This public foreplay leads them to the bedroom where they have sex. They both, fully clothed, report on it being very “nice.” The game of bitey has led to mutual satisfaction. Unusually, there is no irony flickering across their faces. They then talk about other taboo subjects such as love, money and ambition. They talk about jewellery, watches, suits and other objects that make them feel good about themselves. They talk about their aggressive drives, but within a loving context.

What is key here is not the bite in itself. That would be just painful. It would be a turn off and possibly an assault. What the game of “bitey” is about is how aggression and love are interwoven in the dynamic of any given couple.

Hewison says

“Where aggression is missing, erotic satisfaction is stunted or impossible. Where aggression is used in the the service of love, to get through to someone, to connect deliberately (and rapturously) breaching the boundaries of personal space and body surface in sex, relationship has the potential to deepened through mutual satisfying erotic needs. Where aggression is paramount, eroticism is curtailed and becomes routine; connection between the couple is limited to acts and roles, boundaries (emotional and physical ) are turned into objects to be used, or used by, and love dies

(Hewison, 2009)

I don’t agree that Shiv and Tom are monsters. Sure you wouldn’t find some of their lines on a valentine’s card. But in truth, perhaps these characters, and their couple relationship, is more accurate in its portrayal of love and hate in a living relationship. These fictional characters provide us a screen, a space, to explore aspects of ourselves.

I am grateful to couple psychoanalyst Mary Morgan’s : A Couple State of Mind (p 143-144) for her exploration of aggression and these quotations

When Tom gives Shiv an encased scorpion in a red jewellery box we know this is going to be a great episode. What sort of present is this? Is it an insult or a joke? Who finds it funny? Tom does. Shiv looks pained. Tom has found a perfect image to represent how he thinks of his wife. Toxic, poisonous, scaly, dangerous.

Later, in a block buster scene, they really go for each other. She calls him a snake. A good retaliation. He says she shouldn’t have children. She calls him a conservative hick. She accuses him of stealing her father. She tells him his wine smells of wet dog.

We are all narcissistic to some degree. But here it is poetically rendered. She says he only married her because he wanted to fuck her phone book. Even as they try and get close they are pushed apart.

They try and have a real conversation. They try to get beyond “projections.” But all they really do is articulate each others vulnerabilities.

Still every couple will relate to this episode. Parties throw up so much material. She wants him to stay up forty five minutes more. He wants to go to bed. He wants everyone to leave. Both are terrified of losing their jobs and status. But neither can provide solace to the other.

There is a strange love in their insults. They don’t shout or hit each other. But they know each others scar tissue and shadow areas. If marriage is “mutual confrontation until death” (Guggenbuhl Craig), then they may have a talent. The gods of marriage are Zeus and Hera, and when they argue the heavens rumble ! I feel there is so much condensed in this argument. They know each other. But whether they will combust or transform is all in play. Riveting stuff.

In couples therapy all of these snake-scorpion dynamics are at work. Under the surface each argument is often a microcosm of the psychodynamics between the couple.

This spring I dusted off my running shoes and completed my first ultra marathon. Marathons are so nineties! No one is that interested, too mainstream, honestly! If you want something to talk about with your mates go ultra, which is any distance over 26.2 miles. Full on zeitgeist. Swap tarmac for forest trails. Leave your Garmin watch at home and run by feel. Ditch the gels and eat real food. Scratch away the surface (26.2 miles) and find out what lies deep underneath. Will you find deep reserves or a hollow nothingness? Instead of running with 50,000 runners for a few hours you will be with a few hundred over the whole day. The top races eschew tat and give out discrete belt buckles and bragging rights.

I entered the worryingly named 100 hills. Flat courses are fine for personal bests but gradients, climbs, they test you in a totally different way. This race consisted of 50km of muddy trails through the Chilterns.

I’ve enjoyed running marathons but there is something different about ultras. As the starting siren went I quickly found myself at the back of the throng. I found myself alone for long stretches. Occasionally I would chat with another runner. I met a woman who said, “I once ran 91 miles but the organisers wouldn’t let me run the final 9 miles of the 100 because it had started snowing.” That has stayed with me. Sometimes we stop ourselves from completing something and other times an external force bigger than us stops us dead in our tracks.

There were some sections that were too steep to run. A fast hike is all that I could muster. Or a not so fast hike. All the normal barometers of success, such as pace per mile, go out of the window. The only metric that mattered was could I keep going until the end.

When a patient comes to therapy I dont think of it as a sprint, or even a marathon, but an ultramarathon. Speed isn’t that relevant. The biggest question is can they keep moving forward through the difficulties they encounter.

When I run or see a patient for a long time it makes me think of the poem by Antonio Machado

Traveller, the path is your tracks
And nothing more.
Traveller, there is no path
The path is made by walking.
By walking you make a path
And turning, you look back
At a way you will never tread again
Traveller, there is no road
Only wakes in the sea.
Antonio Machado, Border of a Dream: Selected Poem

In a world where we are awash with thousands of psychiatric diagnoses and knee deep in medicines that promise to do this and that how does a patient make their own path? More and more rigid and orthodox protocol therapies are arriving in our market driven culture. But isn’t therapy some what of a gamble? The patient and therapist co-create the path. The path is made by running, walking on trails. You have to leave the tarmac behind. The path is made by talking, the next word, the next breath.

After mile twenty, covered in mud, my ego battered and depleted I recalled Mike Tyson’s line, “Everyone has a plan until they get punched in the mouth.” Plan A,B,C and D had all evaporated. With a healthy dose of delusion and denial I had underestimated how hard I would find this challenge. After recently recovering from a broken arm, I was keen not to fall on the slippery muddy trails.

Still I had enough in me to get to the finish. I was fuelled by sugar water and sandwiches. But I took more sustenance from supporters who had a word for me. That was the biggest fuel. The care of friends, the care of strangers who refilled my water bottles.

Reader, I did finish before the cut off. A nice volunteers brought me a small plate of hot food and a cup of tea. I was pleased.

A week later I reported back to my running coach and asked her about her understanding of resilience. She said

“For me resilience isn’t about surviving that one big thing it’s about the daily effort to build your mental and physical strength. It absolutely is a muscle that can be developed much like our fear receptors. Having small doses of hard things builds a bank of knowledge that you’ll be ok. I like to think of my resilience bank as a filing cabinet. Every time I have a new experience or overcome a doubt that gets filed away for the next time. As runners I think we actively seek out these experiences in our sport but we all go through periods in our lives that build resilience. Often when things are tough the only way is through and that may end in a positive outcome or a negative one but regardless the world keeps spinning and we move on.”

Sophie Grant professional ultra runner

My coach is a very resilient person. She runs top races over 100 miles fast ! I am not a resilient person. It has taken me a month to recover fully from my single race. Still, I now have an experience to put in my filing cabinet for next time. I can’t really say I enjoyed the race. More like I endured it! To be honest I am still digesting the experience. In terms of parallels with long term psychotherapy I found many parallels. The terrain is always changing, energy levels go up and down, and sometimes you feel like packing it in. However the experience of sticking with it is truly precious.

What to wear to a book about fashion book launch. I don’t know but found myself wearing a yellow jumper from the ubiquitous Uniqlo. Hardly cutting edge fashion! Was I a perpetrator of fast fashion? A drab – despite the blaring yellow – conformist?

The psychoanalyst Anouchka Grose implores us to channel a punk DIY ethos into fashion. If a high end fashion boutique can re-engineer a man’s shirt into an amazing hat, what is to stop us, she asks. Dig out your safety pins.

In the picture above I’m standing with two men who seemed to have imbibed this view. I don’t know the man to my right but his hair and make up made me marvel at his imagination. To my left is Martin Creed, the artist, and most of his clothing appears to be home made, from simple materials, like paper and card (such as his handkerchief and hat). He wears a green dart as a broach. Even Jimmy the dog is unconventional as he is a vegetarian.

I feel embarrassed at my anti punk, anti-imagination jumper. But yet I don’t have the courage or even desire to dress in cardboard and paper or paint my face. This manifesto is one I will be re-reading and digesting.

I bumped into Harry Hill on the way to a comedy evening. He was a surprise guest. He had his trade mark big white collar, thick glasses and goofy expression. When he came on stage he looked like he might trip up over the microphone cable that dangled between his legs as he pranced about the stage. I had to stop myself shouting out “be careful”. His put down to a mild mannered heckler was “your the sort of guy who buys a pack of strepsils and sandwich for lunch at boots.” It sounds innocuous but there was something caustic about its timing and delivery. The heckler-contributor was duly silenced. He seemed to put his feet up on the seat in front of him in a strop. Harry Hill also insulted an elderly couple who were audacious enough to be sitting in the front row. He made jokes about their contribution in the war, care homes and shock that they were still alive. They laughed the first time and then seemed genuinely upset. Did they not get his rudeness was part of the joke. Or was he not joking.

Therapists and comedians share much in common. We have to use words and timings to have an effect on our audience. How we deliver our lines is key. How our words are heard is unpredictable. Free association and the meandering path of psychotherapy is much like improv stand up. The unconscious and a good joke share much in common. We are both seeking to find the “mot juste”, the perfect one-liner, to help the patient.

At the end of his piece Harry Hill danced a goofy dance. He alluded to his five years training as a medic. But in truth his comedy is a form of medicine for the side of us that the doctors in white coats dont have much time for. The irrational, chaotic, messy, speaking and laughing human.