Nick Read » Family

How you make me feel; projection and its identification.

Nick Read — Sat, 09 Apr 2011 21:06:44 +0000

Why do we trust some people and not others? Why do we admire some people? Why do some people make us uncomfortable? Is it because they remind us of significant figures in our lives; our mother, our father, a brother or sister, a lover, a husband, wife, a teacher? Are they suitable objects for our projections?

Projection is a ubiquitous feature of human nature. It is the cornerstone of evolution; what makes us human; the effect of an opposable thumb. As soon as we could throw, we could make things happen; we could control the future (see Projection, the missile of evolution. December 24^th, 2010), but this required us to perform the mental trick of imagination; to think the way things might be, to make believe.

Psychological projection performs that same mental trick, it transfers what we feel onto somebody else, to imagine it is they who have those some feelings and attitudes. So we protect ourselves from psychic damage by projecting the bad stuff onto those we recognise already possess some of the characteristics we want to get rid of. ‘She’s just so selfish.’ ‘I can’t trust him’. He’s so lazy, careless, unreliable, fussy, messy. This happens all the time. Just listen to how ‘a gossip of girls’ on the train criticise absent ‘friends’. Look at how politicians try to achieve a semblance of dominance and control by rubbishing their competitors; how newspapers take hold of that and amplify it. But it’s not just bad stuff. Idealisation is a kind of projection. When we admire somebody, respect somebody, fall in love with somebody, we transfer our wishes for how would like to be onto that person. They become a mentor, a role model, an object of desire.

Projection starts, like everything else, in childhood. Children deal with uncomfortable feelings like fear and anger by externalising them. First identify your enemy, locate all the bad stuff into them and then you can justify an attack. Or identify the one you admire, locate all your wishes in that person and make them your best friend. Projection is a mental trick. There are goodies and baddies; in my childhood these were cowboys and Indians; the English and the Germans. How differently you see things as you grow up. Maturity is a state of recognising the bad feelings, taking them back and containing them, realising that what we criticise in other people is also part of us, accepting our essential humanity.

Groups, organisations, institutions, governments, states, do it all the time. They are pathologically split; they operate at a very childlike manner and project all their own concealed characteristics, especially the bad ones like unreliability, inadequacy, lack of sophistication, to say nothing of selfishness and ruthlessness onto their competitors. Colonel Gadaffi is currently the embodiment of all evil though only a few years ago, he was our special friend. But the only thing that’s changed is our own projections. Members of an exclusive culture, music critics, art enthusiasts, historians, theatre buffs, vintage car collectors, can tend to puff themselves up by broadcasting their lacunae of esoterica to an audience they assume knows nothing and can be diminished by their ignorance.

But projection can only really work in society if others identify with it. This is what the psycholanalysts (another in- group) call projective identification or to put it in everyday speak, ‘how others make us feel’. In voodoo, pointing the bone can cause others to feel so guilty by inference whether they are or not, that they slink away and die. They have been ostracised from the tribe; they are not worthy to belong anymore and they cannot therefore survive. Social exclusion is a powerful force; guilt and shame, powerful identifications. People who have done something shameful to attract the projections of others, who use it as a shield for their own shame. And it’s always the ones with most to be ashamed of that seek out those they can offload on to. Those who feel unhappy make those who are close to them unhappy too

Projective identification operates in so many aspects of human behaviour. Bullies can’t contain their own fear, so they make others frightened of them. Suspicious people are secretive and engender mistrust and lies. Needy people cannot give and induce need in others. Those who are envious put on airs and graces to try to make others envy them. Lovers who feel insecure may do something to make their partners feel jealous. Unhappy and lonely people make those who are close to them unhappy too because at least they are toegether in their misery. Teachers, who are not confident, can make their students feel stupid, but equally the over-confident student can make a teacher defensive. ‘You make me feel sick, you make me so angry, you just make me depressed.’ These are all common identifications within relationships.

Those who carry a grudge are attracted to political groups, but can be very dangerous because they can cause others to feel bad and act out. So did Ian Brady make Myra Hindley do it. Projective identification is never a justification in law but it happens.

War is mutual projection as each side used propaganda to unsettle the other. Sport is the same. Winning the mental battle wins the war or the tennis match. Do not flinch; maintain the upper hand. And we the observers so want the underdog, the good guy to win, we will do all we can to inspire him with our enthusiasm. It almost worked with Tim and we’re trying our best with Andy, the nearly men of British tennis.

Some doctors are so anxious they can make their patients terrified. Michael Balint, the author of ‘The Doctor, the Patient and the Illness’ recognised this. Patients pass the anxiety of not knowing what’s wrong with them on to the doctor, so that he orders more tests in order not to appear a failure. Or their attitude may make their doctors feel angry, depressed, tired. Emotional transference is such a powerful phenomenon. As a therapist, I had always marvelled at how one client could make me feel so wound up and energetic; the next so tired I could fall asleep and have actually done so, but they were lying on the couch and I was sitting behind them and they never noticed.

Actors are masters of projection. They tune into their audience and can make us all identify with the emotions they project. I have had two actors in therapy. One made me feel so angry, I actually had chest pain and needed to ask him to leave. The other made me feel such surges of desire and compassion, it was all I could do not to take her in my arms and love her right there and then.

But it’s not all negative. We can also use projection to bring out the best in people. Look at the way babies project their hunger onto their mother, who identifies with it and feeds them. Falling in love feeds upon itself. We project our beliefs and feelings into those whom we love and if they love us too and are a suitable object for our projection, they identify our desire and act in a way that intensifies it.

Lovers give each other those feelings of security, excitement, togetherness, they’ve been looking for all their life, but what then happens to the bad feelings? Well, if they can never let this love become as imperfect as the rest of life, then these feelings are projected out onto others, and the exclusive couple clings together united against the world, unable to trust anybody else. But most marriages are not like that. They are states of mutual projection and identification, and partners try to look after their own well being by making their partners shoulder the blame and feel bad. You never think! You’re totally selfish! I just can’t rely on you. In a way they need the other to get rid of the bad feelings. When it works well, it’s a trade off. One may make the other feel alive while the other projects a feeling of safety. It works. The problems come when one of them changes the dynamic; meets somebody else, suffers a setback that destroys their confidence, accepts a job that satisfies their needs.

Projective identification requires us to think. When somebody behaves angrily or badly to us, we need to reflect on our own attitude and behaviour and the reason for it. How did it all start? What was the trigger, the fear? We all have responsibility in our functioning society to bring out the best in people, the most constructive response, but in a narcissistic, self seeking society, people all too often have to have their own way, because ‘we’re worth it’. It may be unfashionable to say, but I do believe that we have the friends, the colleagues, the children and the relationships we deserve because we help to make them the way they are for us

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King George, the stammerer.

Nick Read — Sat, 09 Apr 2011 18:40:57 +0000

Bertie was never expected to become King. David, his elder brother, appeared a far more charismatic leader. People turned a blind eye to his dalliances with actresses and socialites as they had with his grandfather and nobody thought he would give up the throne for Mrs Simpson. But he did. So with war with Germany looming and the country needing strong and effective symbols of leadership, Bertie was reluctantly propelled into the spotlight. But Bertie had a speech impediment; he stammered. His voice became paralysed with fear whenever he had to speak in public.

The King’s Speech, which was released on Saturday and stars Colin Firth as King George and Helena Bonham Carter as Queen Elizabeth, is a moving and humorous account of Bertie’s relationship with his Australian speech therapist, Lionel Logue, who helps him overcome his fears and deliver wartime speeches that rally the nation.

The Royal Family have always been conscious of their role and their distance from the rest of society. Some of the best bits of the film show how the King struggles to deal with Lionel Logue’s down to earth familiarity. He is propelled to an apoplectic eloquence by the sight of Lionel lounging in the Coronation chair in the Abbey.

Bertie is stuck between his instinctive desire for human affection and contact and his overwhelming sense of duty and obligation. He is a fully paid up member of the firm, but he is also a loving father and husband and needs Lionel as a friend as well as a therapist. During the war, he had a close and understanding relationship with Churchill, who had also suffered with a speech impediment when he was younger and was also frightened of his father.

Bertie, like many Royals, was brought up, not by his parents, who were always on duty, but by a nurse. But the nurse preferred his older brother and was callous and cruel to Bertie, pinching him and depriving him of food so he lost weight. David also used to tease him and his father, King George V, had no patience with his stammering. Queen Mary, his mother was stiff and distant, embarrassed by expressions of intimacy. So Bertie, despite being second in line to the throne, had a lonely and abusive childhood.

Bertie was also naturally left handed, but compelled to use his right hand. This experience is not uncommon in people who stammer. He had knock knees and suffered the pain of splints for years.

The film revealed how stammering is not so much a fixed mechanical defect of speech but more an emotional disorder; the overwhelming effect of fear, fear of humiliation and with the loss of an effective means of communication with other human beings, of loneliness.

Bertie did not stammer if he sang the words, or when music was played into his ears at the same time. When Lionel encouraged him to swear, utter the rudest words he could think of, it threw Bertie into conflict; he was brought up to repress any expression that was improper. But once he had permission, he swore with gusto and no hesitation. All these techniques facilitated emotional expression and eliminated his self consciousness. He could communicate with his wife and daughters quite confidently, but his brother, David and his father could readily reduce him to a state of paralysis.

Lionel and Bertie remained friends for the rest of the latter’s life. He was there to inspire confidence during all the King’s wartime speeches. This was the Royal Family’s finest hour. The audible and visible presence of the King and Queen in London during the blitz, their refusal to emigrate to Canada, the bombing of Buckingham Palace, the young Princess Elizabeth driving ambulances endeared them to the British people. But the King’s nervousness caught up with him. Always needing cigarettes to relax him, the King died of bronchial carcinoma in 1952.

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Ghosts in the Nursery

Nick Read — Sat, 23 Oct 2010 12:06:11 +0000

Henry James leaves his stories open to his readers interpretations. That is the source of their intrigue. The ‘Turn of the Screw’ is his most famous and most chilling novel, but why? Is it because it explores, albeit obliquely, that most horrific of topics, the loss of innocence.

The governess is both an unreliable and uninformed narrator and as such gives the tale its edgy somewhat hysterical character. She has been employed by their uncle to look after Flora and Miles’, in effect to become their parent. We assume their real parents have died. On the day of her departure for Bly, the large country house, where they live, she is given a letter saying that Miles has been expelled from school for some undisclosed misdemeanour.

She meets the children and is instantly charmed. They are polite, intelligent and kind, but there is something a little too knowing about them. She leans from the housekeeper, Miss Grose, that both Miss Jessel, her predecessor and Peter Quint the butler, died shortly after leaving Bly, but she sees what Miss Grose identifies as apparitions of them in the grounds and the house. Jessel and Quint seem to have some malign hold over the children, and the governess fears for their safety. What on earth has been going on? There are dark hints of sexual abuse. The apparitions increase and the children appear to collude in the deception but by the end we begin to wonder whether they are just creations of the governess’s overheated imagination. Flora is taken away for her own safety by Miss Grose. Miles remains with the governess but dies in her arms while she is trying to prevent him from looking at Quint.

The Victorians were very interested in ghosts and long exposures required to take contemporary photographic images reated ‘evidence’ of all kinds of ephemera and phantasms; lost objects. The children, we assume, had already experienced loss, first of their parents, then of their uncle and the servants he employed to look after them. The governess, we learn, has also experienced loss and perhaps her neediness creates strong attachments first with the absent uncle and with the children, but does she also create ghosts? Are not only Peter Quint and Miss Jessel but also Ms Grose and even the children projections of her fearful imagination?

If what happens cannot be processed (with the aid of a parental figure), then they become very frightening. Is this fear what the governess experiences and transfers to the children? Benjamin Britten, who wrote an opera of the same name, had a deep empathy with the character, Miles. He was sent away by his beloved mother to boarding school where he was abused. But did he later abuse his choir boys, as suggested by Alan Bennett’s new play, A Habit of Art?

The richness of James’s story lies in the gaps, which create space for the authors interpretations. There are links with mourning and melancholia, for example. Mourning is a process of working through memories until they wear away, but in melancholia, the aggrieved identifies with the lost object (the ghost) and blames himself. ‘The shadow of the object falls on the ego’. The tendency for the melancholic to identify with the person who has let them down is known in psychoanalytical terminology as projective identification. This process defends against the realities of separation by assuming the absent identity; in other words, becoming the ghost. We sense the horror of this in the two innocents.

Melancholia may be thought of as a condition of too much empathy, too much forgiveness. It’s a disease of therapists; too much ruth; ruthful instead of ruthless. The one who is lost remains as a ghost inside us and because we can’t evict them, we have to suffer. Natasha Kampusch was kidnapped as a child and held in a cellar for 8 years but felt protective towards her kidnapper and guilty about escaping and telling. Children often think its their fault when parents split up. Lovers frequently blame themselves when they are rejected because they can’t bear to lose their beloved.

Ghosts in the Nursery was an event organised by the Harry Guntrip Psychotherapy Trust on October 9^th to coincide with a performance of Britten’s ‘A Turn of the Screw’ by Opera North.

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Beauty with Balls; an appreciation of Ingrid Bergman

Nick Read — Sun, 11 Apr 2010 07:30:53 +0000

I think I was in love with her from the start as she gazed steadily at me with moist lips and knowing eyes from the flickering monochrome screens of such classics as Casablanca, Notorious, Spellbound, The Bells of St Mary’s, and For whom the bell tolls. Her face expressed vulnerability and innocence, yet also courage; a lonely, shy girl next door trying to survive in a dangerous world. That was her appeal. Clearly, she needed me and only me to love and look after her. Aa-ah! But that was before the brisker virtues of Julie Andrews and the smouldering hot house appeal of Julie Christie.

Ingrid Bergman was for my sixpence, the greatest film actress there ever was. She was a natural, right from the start. She loved the camera; it held no fears for her. Maybe it was because she enjoyed posing for her photographer father, Julius, so much. He once commented that one of the children he photographed would some day become famous. Little did he know that this would be his beloved Ingrid.

It was perhaps the tragedies of her early life that gave Ingrid that look in the eyes, that orphan appeal for love, that came straight through the camera and said ‘Hold me, look after me. I love only you and I need you so badly! It was irresistable!

Ingrid was deeply affected by the story of her parents romance. Her beautiful mother, Friedel, had fallen in love with Julius at the age of 15 when she saw him sketching in the park but had to wait seven years before her parents considered his prospects sufficient to look after daughter. The marriage was blissfully happy, tinged only with a wistful sadness when Frieda’s first two children died in infancy. Then Ingrid arrived and was adored by both her parents, but just two years later Freida died. Ingrid had little recollection of her mother, and was loved and cherished by her father, but when she was just 12, her beloved father died of stomach cancer. At the time she consoled herself by reading Friedel’s love letters to Julius during their long period of waiting. This may well have implanted the longing for romantic love that shines through the eyes in all her screen parts.

The eyes have it. Ingrid was not an iconic beauty, she was tall, had slightly prominent teeth , refused to pluck her full eyebrows, but she looked healthy, had flawless skin and that look. Always the look! And she was a chum, the girl next door you could lark about with. She had a mischievous penchant for practical jokes.

After her father died, Ingrid was looked after by aunts and uncles, who deeply opposed her ambitions to be an actress, but relented after exacting a promise that if she failed the auditions for the Royal Stockholm Theatre at her first attempt she would abandon all notions of the stage as a career. She didn’t. She was a natural. Film roles followed and by the age of 21 she was a celebrity.

Over the next ten years she moved to Hollywood and made a sequence of films. She was an instant box office success. People loved her natural beauty, her innocence, her girlishness, her intelligence, her sense of fun. But Ingrid was a young woman who knew what she wanted and how to get it. She was a bird with balls. She would deliberately take on the difficult roles which didn’t always cast her in the best light. She loved acting. She loved the challenge and the celebrity. She loved being loved.

But in real life she was always looking for that special romance, that perfect bond of intimacy, that constant warmth of feeling; the man who would adore her, cherish her and keep her safe enough to pursue her ambitions. She wanted the consistency of a deeply intimate relationship to give her the confidence to risk the excitement of the challenge of a new part. The two were not always compatible and her men did not necessarily want to play the house husband to the famous actress.

She married Petter Lindstrom, who was a dentist, when she was just 22. He was her first long term relationship and was somewhat older – maybe that was part of the attraction for her; Petter could look after her. But he was a bit cool and distant and tried to curb her exuberance, control her behaviour, watch her weight. He didn’t like the way she frowned and somewhat jealous of her relationships with her leading men, although she took her responsibities as wife and mother very seriously and was not unfaithful. By 1943, at the height of her fame, she suggested to Petter they might get divorced. There was nobody else but the marriage had rigidified and her career had left it behind.

Then she met the mercurial maverick director, Roberto Rossellini. It was love at first sight. He was married with two children, she with one. There were difficulties getting divorces. People were scandalised when she moved to Rome and began living openly with Rossellini and so soon obviously pregnant. She got terrible letters. Offers of parts in America dried up overnight. Besides, Rosselini made it clear that he wouldn’t allow her to go back to America or to work for any other director but him. Their professional association arrested both their careers. Their affair turned her from goddess to whore overnight. She needed to draw on great reserves of courage to live through the scandal of her affair and marriage to Rosellini, and the separation from her daughter, Pia and from Petter, whom she still needed as a friend and helpmate. But she was in love and at times of her greatest loneliness and fear, she could always escape into her role in the play.

She had three children very quickly by Rosselini, Robin and the twins, Isabella and Ingrid Isotto, but her relationship with Rosselino was becoming difficult. He worked like an artist, he wasn’t disciplined. He used amateurs and never knew the script in advance, expecting the actors to improvise. He would suddenly leave the set and retire to his bed for days. Ingrid was a professional, she needed consistency. He gave her the kind of controlling inconsistency where only he knew the answers, which came to him in a flash of inspiration. She longed to work with other directors, but Ingrid was his property. Eventually after seven years, he went on an extended project to India. He was away a year and returned with his own Indian family.

Ingrid’s subsequent marriage with the Swedish producer, Lars Schmidt went much the same way. She was working again, rebuilding her career and may have neglected the marriage a bit, taken Lars for granted. There was an element of self destruct in Ingrid. When she had the love she craved, the consistency she needed, she became insecure and bored and needed to escape into another role. She couldn’t hang on to the marriage. It sort of drifted away. Ingrid was always comfortable with acting. It was life that made her nervous.

‘The greatest loneliness’, she once said, ‘was the loss of intimacy with someone you had once been close to, of being with them and finding you have lost the ability to connect.’

Ingrid ignored the lump in her breast at first because she was in a play and about to start a new film. By the time she got it treated, it had spread, but she carried on acting, often in great pain. Her last project was a portrayal of Golda Meir; she kept her grossly swollen arm elevated all night so she could do the scene where she was required to lift both arms up in a typical Golda Meir gesture – she was that professional. As she got older she became more forthright, if she didn’t want to do something, she didn’t. She had no need of pretences any more.

Impulsive, amusing, needy, sentimental, though at the same time kind and generous and loyal to her friends, Ingrid was never the celebrity; she could not be aloof. She needed to connect to people too much. But there was always something of the orphan about her, clinging on to her previous emotional securities, meaningful objects, letters, photographs, friends and dreams. She was the beautiful empty princess. ‘My life was always concerned with finding and holding on to love,’ she commented towards the end. She never stopped looking for the quality of intimacy her parents had enjoyed but had never realised that their relationship too would have transformed into something more mundane had it lasted. Better for us, the millions who have fallen in love with the image that Ingrid expressed, that it didn’t.

Ingrid Bergman died of breast cancer in 1982 on her 67^th birthday. The English edition of Charlotte Chandler’s biography ‘Ingrid’ was published by Simon and Schuster in 2007.

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It’s a Dog’s Life!

Nick Read — Sat, 16 Jan 2010 15:52:12 +0000

‘A dog is a man’s best friend’, so they say. They are our companions. They are, like us, social carnivores that hunt in the daylight. We were made to collaborate. How much more effective we would have been as hunters with dogs to detect and chase our prey. And dogs would have played a crucial role in the development of civilization by protecting our crops and home and herding our animals.

But there’s more to it than that. Dogs offer us their devotion. To them we are the pack leaders – to be appeased and served. Dogs are attuned to us, they obey our commands, respond appropriately when we point; they can be trained. Chimpanzees, although they have 99% of our genetic code, tend to do their own thing, albeit intelligently. There is even a dog who has learnt 300 words and can fetch an object from another room, having only just seen a picture of it. And think of how working dogs can be trained to herd sheep, to retrieve an animal that been shot, to sniff out drugs or explosives.

Dogs make a deep emotional bond with us. Studies have shown that when dogs look at images of humans, they are drawn to the left side of the face which expresses emotion more eloquently and has a direct connection with the emotional right side of the brain. They tune into our emotions and can respond to our feelings. They know when we are upset or angry. They feel it. And dogs are good for us. We are more likely to survive a myocardial infarction if we have a dog and less likely to have another heart attack.

Dogs have evolved an elaborate vocal repertoire to communicate with us. Most dog owners can recognize at least six types of bark. These are emotional signals; excitement, anger, aggression, hurt, fear, playfulness. Brains scans have shown that the same area of orbito-frontal cortex lights up and we release the bonding hormone, oxytocin, when we look at pictures of dogs as when we look at images of children. Our need to nurture runs deep. Dogs induce the nurturing behaviour in us they need for survival, and they also release oxytocin when they look at their owners and are fondled. Dogs not only give but they induce unconditional love.

DNA data has established that our domestic dog is descended from the grey wolf and came into existence about 100,000 years. But wolves or wild dogs do not acclimatize to humans naturally. They cannot read our emotions and they don’t have the same vocal repertoire. When wolf puppies are brought up with humans, they revert to wolves at about 8 weeks and become dangerous. It takes many generations of selective breeding to get an animal that behaves like a dog. Long term experiments conducted on Silver Foxes in Eastern Siberia has shown that domesticity can only be induced after 50 generations. Only then do they behave like dogs. The strange thing is that in breeding out aggression, other characteristics change too, like the colour of their coats and the shape of their heads, their ears and their tails. In fact, they become like puppies. Selective breeding for domesticity favours juvenile characteristics.

This makes me wonder whether sexual selection in human societies over the many generations since civilization began has also succeeded in breeding out aggressive characteristics? Are we just all big babies? Have we bred domesticity in ourselves and with this passivity, laziness, neediness and a predisposition to obesity, heart attacks and diseases related to anxiety, such as Fibromyalgia and Irritable Bowel Syndrome?

Contrast our open faced, needy population with the hard bitten images of tribal chieftains, warlords who seize and impregnate their women by force. Such brutal sexual acquisition might perpetuate a much more ruthless typology until such time as civilization suppresses the behaviour that has induced it? The aggressive no longer rule the earth, at least outside the strongholds of Afghanistan, but have we become too tame, like the dogs?

This article was the topic of a Horizon documetary, shown on BBC television last week.

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Cries and Whispers

Nick Read — Sat, 02 Jan 2010 10:55:14 +0000

I first experienced Cries and Whispers in 1973. I was, even then, drawn to the deeper, darker aspects of human psychology. It was no wonder, therefore, that I was into Bergman. I rated the Seventh Seal and Persona as the greatest films I had seen. Then came Cries and Whispers. And now, after a gap of nearly 40 years, I have experienced it all over again. And I still agree with the reviewers. Cries and Whispers is probably the most intense expression of emotion it is possible to experience in a cinema. Ingmar Bergman was a truly great director and his partnership with the cinematographer, Sven Nykqvist, was one of the most creative in the history of cinema.

The opening sequences set the mood, time passing in the ticks and strikes of the clocks, the unrelenting passion of the crimson carpets, walls and drapes. We see a woman or is it a man; the angular face and lank hair obviate sexuality. She is lying in bed. Another woman, plump and beautiful with ringlets of honey blonde hair lies asleep in a chair. The invalid gets up stiffly and walks painfully across to her bureau and writes in her diary, ‘It is Monday and I am in pain.’

Agnes is dying of cancer. Her sisters, Karin and Maria, have returned to look after her, but it is the peasant Anna with her plump expressionless face and simple faith who loves and cares for her. ‘In elliptical flashbacks, intended to give us emotional information, not tell a story, we learn that the three sisters have made little of their lives.’ Karin is icily detached, married to an older husband, a calculating, sneering diplomat, whom she loathes. She cannot bear to be touched and in one awful scene lacerates her cunt with a broken glass and smears the blood over her lips to avoid her husband’s attentions. Maria is beautiful, but corrupt and heartless. She is married to a weak man, whom she despises and so she consoles herself with other liaisons. When her husband stabs himself and pleads for help, she turns away. Maria and Karin were close as children, but are now too damaged to allow any real intimacy. Agnes always felt isolated, especially from their tragic though beautiful mother.

Theirs is not a happy house, it’s a place of guilt and repression, cries and whispers. Nobody can get close enough to draw comfort from anybody else. Agnes is in agony, her back arched as she struggles to breathe, desperate for human warmth, but her sisters turn away. Only Anna can console her, pillowing her head in the living flesh of her breasts to ease her terrible transition.

Cries and Whispers is a disturbing film, a film about life and death. It’s not only Agnes who is dying. Karin and Maria are too, and in a way, we all are. Their lives have no hope, no meaning. Karin works while Maria plays, but these are evasions. Theirs is a simalcrum. Without human warmth, without love, there can be no life. Paradoxically, it is Agnes, who finds life in simple pleasures, the garden, a drink of water and the comfort of being held. So Bergman presents us with a contrast, a counterpoint between the hopelessness, defensiveness and meaninglessness of Karin and Maria’s lives with their compromises, pretences and terror of real contact and the dreadful void of death that confronts Agnes.

Bergman does not spare us the shock and horror. Harriet Andersson is not beautiful in death; sweat glistens on her angular face, her hair is lank, her skin pale and grey, her eyes terrified; she arches her back, she drags air into her damaged lungs with long, tortured stridor, she retches, she beats her fists on her barren, wasted chest.

The cinematography is superb. As the critic, Roger Ebert, wrote, ‘The camera is as uneasy as we are. It stays at rest mostly, but when it moves it doesn’t always follow smooth, symmetrical progressions. It darts, it falls back, is stunned. It lingers on close-ups of faces with the impassivity of God. It continues to look when we want to turn away; it is not moved. Agnes lies thrown on her death bed, her body shuddered by horrible, deep, gasping breaths, as she fights for air. The sisters turn away, and we want to, too.’ We know things are this bad, but we don’t want to have to feel it. The scene of Anna embracing the decomposing Agnes has all the soul searching depth of a Rembrandt, the horror of embracing death but at the same time a moving and familiar reminder of the pieta. So the death of Agnes represents the corruption of humanity. And here again we have the dialectic; life in death and death in life. This film gets as close as any film can get to the crimson membrane of passion and sexual disquiet that for Bergman is the soul.

Cries and Whispers has little narrative. We don’t know how the major characters arrived there; we are left to fill in the gaps from the darkness of our own experience. This is the power of Bergman. He does not attempt to explain; he just shows us what its like. He communicates on a level of human feeling so deep that defies description – but how well he communicates.

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Of families, fathers and forgiveness in the whimsical world of Wes

Nick Read — Sat, 12 Dec 2009 19:47:23 +0000

What kind of person are you? Since when have you been so perfect? When did you last fuck up? What are you going to do about it?

Royale Tennenbaum has been evicted from his family by his wife, Etheline, for playing around. He is casual, careless even as he explains it to his three genius children, Chas, the financial whizz, Richie, the tennis star and Margot, the playwrite. 17 years later he wants to be reconciled with his family; he wants to make amends; he is seeking redemption. Besides, he has lost his money and has nowhere to live.

But by that time, his children are pretty messed up. Chas is neurotic; he has lost his wife in an air crash and is bringing up his two boys (all three of them dressed in identical red shell suits) in a rigorous health and safety regime. Richie is depressed; he broke down during a grand slam final and now travels the world alone on his private yacht. Margot is bored, married to a neurologist, but spends most of her days locked in the bathroom, secretly smoking and watching television. They are all regressed. Gratification is either oral, as in Margot’s cigarettes, or anal, as in Chas’s schedules and lists. There is not a lot of sex and what there is, does not seem much fun. Their lives are fantasy; the real world is anaesthetized. They are bored and aggrieved. In their own ways, they all feel their father has betrayed and failed them. They are stuck.

Etheline holds the balance between love and hate. She is the controller, the Jewish mother who single-mindedly created the three gifted prodigies. Narcissistically embroiled in her own sacrifice, she maintains the split between the good mother and the bad father. She wants retribution. Her children are her agents, but at the expense of their own freedom. They have never been able to separate from her. They need a third point of view provided by a redeemed father in order to leave the family jungle and explore the savannah. .

To gain entry to the family home, Royale pretends he is dying of cancer. The children return too, bearing their grievances and sorrows. Margot was always treated as the adopted child by Royal, who dismissed her first play as ‘a lot of kids running around in animal costumes’. Richie is still in love with Margot since their teenage escape camping out in the Africa section of the Natural History Museum. Chas retains the BB lodged between his fingers after being treacherously shot by his father during a game at the summer house. ‘But you’re meant to be on my team!’ Perpetual grievance is a failure to thrive. The world is not composed of perpetrators and victims; it is much more complex and messy than that.

Royale’s deception is discovered. He is sent away again, though not before he has made contact with his family by subverting his grandsons to the excitement of risk. Slowly, the family come to enjoy the vital intention of his comic duplicity, but reconciliation is only complete after he has really died.

As long as their parents are unable to behave as adults, the children cannot grow up either. It takes Royal’s return and his sincere expression of remorse for Etheline, Margot, Richie and Chas to risk forgiveness and feel pity. Royale is an agent of remembering. The acknowledgement of his failure as a father and his desire to make amends awakens the children from their symbolic death. He has given them the greatest gift any father can give their children; his humanity. Their lives can now be realized through forgiveness.

To err is human, to forgive divine. To grow in wisdom, we all need to forgive the bad and bring out the good, but that can be so hard to do. It is said that you can only forgive others if you forgive yourself, but some just accept all the blame; they forgive everybody else but never forgive themselves. The hardest thing of all is to acknowledge your own faults and sins, to be open about them and to forgive them. Yet that way is life.

So, express remorse without qualifications. Hold up your hands. Say, ‘Yes, I’ve behaved like a shit!’ Royale Tennenbaum has had to come to terms with his own selfishness and the abandonment of his children. Gestation, even late gestation, is the parental act of becoming oneself. That way is life, because it accepts the essential human failings without condoning the misdemeanors that have ensued.

But what does it take to forgive or be forgiven. Royal could only be forgiven if he threatened death. In a curious Christian re-enactment, the father had to die so that the children might live, if not in reality, in meaning. The mythic father has to be killed off and redeemed by a different kind of dad, less yet so much more; a dad that can be forgiven and eventually forgotten.

This article was inspired by and in part plagiarised from a talk, entitled Failing Better, which was presented by Dr Alan Lidmila to The Hallam Institute of Psychotherapy on Saturday 28^th November at the Showroom, Sheffield, following a showing of Royale Tennenbaums, directed by Wes Anderson.

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Of daughters, damage and destruction; is that the legacy of Mrs Klein?

Nick Read — Sat, 12 Dec 2009 19:41:00 +0000

Melanie Klein might be said to have founded the British School of Psychoanalysis, though it was never as formal as that. There was a never a ‘concrete school’ more a movement dominated by the ideas and interpretations of Mrs Klein.

Psychoanalysis was (and still is) very incestuous. There were not many psychoanalysts and most of these lived and practiced in NW5, near Maresfield Gardens where Freud lived and worked. They still do. They were all in supervision or analysis with each other. They reinforced the ideas of their ideological leader, but at the same time were intensely jealous of each other. Given the Jewish origins of psychoanalysis, it is surprising to encounter how much psychoanalysts cling defensively to ideological dogma, despite evidence that it may damage some people and how suspicious, dismissive and paranoid, they can be to those who do not share the beliefs.

Although Mrs Klein was not as profilic, wide ranging or eloquent as Professeur Docteur Sigmund Freud, her work has been very influential. She was the first to appreciate that the child, even a child as young as two or three, inhabits a symbolic world of meanings, phantasies (her spelling) and needs the agency of the ‘mother’ to understand and work through it. In particular, Klein postulates, young children find it difficult to reconcile contradictory elements in their mothers’ behaviour. They split them apart. There is the loving mother and the disapproving mother; the good breast and the bad breast. She called this the paranoid – schizoid position. We all know it well. The suspicious and defensive, remain locked into all their lives and the media encourage such splitting; the government is either good or bad, wrong or right. Most of us return to such polarized attitudes at times of stress. Anger, envy, resentment, grievance, condemnation and lack of compromise are, if not everyday, at least frequent examples of this.

The project of Kleinian analysis might be said to be the reconciliation of the polarities of human behaviour to achieve what she called the depressive position. This doesn’t sound much fun and it’s not, but the concept is crucially important. It is only by healing the split, that we gain understanding, empathy, concern, forgiveness and reconciliation. We learn to accommodate and integrate our own behaviour and that of others. We find ways of working with other people. But we have to experience the depressive position time and time again. Every time we experience a loss, we have a choice, either withdraw and cut off or find a way through. It’s a state of mourning. Klein would say that we mourn the loss of the idealized ‘mother’ and discover the reality. ‘Is that all there is?’

But working through The Depressive Position, leads to personal growth. Loss is often associated with change and a burst of creativity.

Klein drew on her own family extensively for her ideas; her archetypical Jewish mother, her unhappy marriage and her children. The children were her first analysands. Melitta, her daughter, has 370 hours of analysis with her mother before the age of 9. The idea seems repellant. It is a wonder she survived it.

Nicholas Wright’s powerful and disturbing play is about mothers and daughters. It is 1933. Mrs Klein, powerfully depicted by Clare Higgins, has just learnt of her son’s death in a climbing accident. Paula, a refugee analyst, fleeing from Germany, has offered to be her secretary. Melitta (little Melanie) her daughter, also an analyst, arrives with a letter that she has written, informing her mother that Hans has committed suicide, but this is the latest and most powerful act of vengeance on the hated mother. .

Melanie found Melitta interesting as a child, but could not show her the love she needed. It seems that she suffered post natal depression after the birth of her daughter and went away for an extended period leaving Melitta to be brought up by her baba (her grandmother). And when her mother returned, she didn’t so much love and care for her daughter; she analysed her. Klein inaugurated the British School of ‘object relations’ The chilling aspect of the play is the realisation that Melitta is an object, an object of interest and curiosity. There is interpretation but no human warmth.

As she later complained, Melitta had no life of her own. Her mother has appropriated it; her marriage, her career, everything. Wright’s play shows her locked into an unresolved rebellion with her herself, caught between the mother she idealises and the mother whom she hates. She cannot reach the depressive position. She has to attack the mother she hates while craving the affection of the one she loves. The letter about Hans suicide is a murderous attempt to rid herself of the mother who dominates her life. Melanie, for her part, is also split, she wants her daughters love, but hates her betrayal. In the transference, Melitta assumes the symbolic impact of her baba, her mothers mother. As the situation builds to a crisis, provoked by the disclosure that Melitta has gone into analysis with a competitor, consorted with the enemy as it were, Mrs Klein throws a glass of wine at her and rubs the torn up letter in the waste paper bin in her hair. As Paula notes, she makes a symbolic attempt to drown her daughter in urine and rubs faeces in her hair. The awful irony is that we can only understand this because of the writings of the mother. There was no father to rescue either of them, to find the third position, to make sense and space off the pernicious diad, to lead them out of the claustrophobic forest onto the savannah.

And what of Paula? She plays the role of the good daughter with Melitta locked out of the house as the bad daughter. She selects Melanie as the idealized mother, she never had. The play ends with Paula in her first session of analysis with Melanie, which cannot be interrupted while Melitta rings the door bell.

So should we think any less of Melanie Klein because of the way she damaged her daughter?. Theory is all very well but a child still needs to know she is loved. And doesn’t the analysand, the symbolic daughter, also need containment and support to gain the confidence to grow. Surely to withhold that can lead a fragile person into a unhealthy state of dependence.

Or should we think more of Mrs Klein because she had worked through her own depressive position and offered her insights so that the rest of us might understand?

Or should we just accept and make a balanced appraisal? Understanding doesn’t mean we have to follow the teacher. That must be a reconciliation of our depressive position.

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Towards the vanishing point.

Nick Read — Tue, 25 Aug 2009 05:44:56 +0000

I had some pizza that I made the previous night and thought to share that and the remains of a bottle of claret with her. But she is not right. Julie has told me that she gets very emotional at the prospect of me coming round. I have recently begun to wonder whether my frequent visits were helping her.

I hear her as soon as I open the door, the regular rhythm of querulous grunts, interrupted by ‘Oh Dear, Oh Dear, Oh Dear!’ My heart sinks!

‘Hello mum!’ I say with as much dramatic enthusiasm as I can summon.

‘Oh, Hello Nick. Thank goodness you’ve come.’ She grabs hold of my hands and looks up at me. Then her face breaks down and she starts sobbing, a thin high pitched whining note.

I lift her up and hug her, stroke her hair. ‘There, there, whatever’s the matter?’

‘I don’t know’, she replies, as she lifts a tear-stained face and gazes imploringly at me, ‘I don’t know’.

I feel her desperation like a heavy band squeezing my heart; a pain like pressure that I can’t relieve. How dreadful it must feel to lose touch with your life, like being trapped in a pit with people staring in but unable to reach you.

She staggers unsteadily behind me as I put the pizza in the microwave and pour two glasses of claret. She follows me to the table and stands there, unsure of what to do. I sit down, cut up her meal and invite her to sit and join me.

The grunts recommence as she slowly cuts the pizza into still smaller pieces and raises them unsteadily to her mouth.

‘Cheers, mum.’ I lift my glass.

‘Oh, I can’t finish all this.’

‘Well, don’t worry. Just do your best.’

‘You’re eating too quickly. And then you’ll leave me.’

‘Don’t worry. I’m in no rush. Just take your time.’

More grunts, then she stops, her fork poised. She gives me a long look.

‘You do like coming to see me, don’t you?’

‘Yes, of course I do mum.’

‘You’re not going to stop coming, are you?’

‘No, mum.’

‘You don’t just do it out of a sense of duty, do you?’

‘No, mum.’

‘Come on then, let’s have a smile.’

I feel confused. Why do I feel so bad?

It is projection, of course. Mum is making me feel her fears; the same fears that have undermined her all her life. She was a lonely child. She never knew her father; he had died during the Great War. She had no brothers and sisters, no friends. Her mother worked all hours, looking after her family and running the business. Although she had all the care and later, all the opportunities and material possessions that her mother could buy, she felt lonely, deprived, in the way. She grew up without the confidence of belonging. And now at the end of her life, she is still that same lonely little girl, unable to trust anybody or anything and desperately needy of attention and reassurance. So as she regresses towards the vanishing point of pure narcissism, the essence of her being, the feelings that drive her have become ‘her’. She is deeply unhappy; the orphan girl, the abandoned lover, the lonely old lady. She has to pass on the distress to those who are closest to her.

I feel responsible for her unhappiness, though I know in reality I’m not. I feel compelled to do as much as I can to satisfy her needs, reassure her, comfort her, but it can never be enough. How many birthdays have I made that special effort only to have her find fault? I never seem to learn. She passes on a lifetime’s grievance. I experience the same pernicious blend of entrapment, compromise, irritation and guilt. So much so that I fear that it has become part of who I am. Relationships have always tended to recreate feelings of entrapment and obligation and I have found it hard to tolerate my own loneliness and find freedom.

So it is my fault that she is feeling bad. I am here under sufferance. I don’t want to see her.

The awful thing is she is right. When she is heavy, like this, I don’t want to be with her. I can feel an almost infinite compassion, but her pain and my guilt are almost impossible to bear. And the more I deny the antipathy and reassure her, the worse we both feel; me, because I cannot be honest; she, because she cannot gain a real justification for her grievance. So I try to steer a winding path through ensnaring undergrowth between understanding and care on the one hand and brutal honesty on the other.

You might say it would be better to sort things out for her in a practical sense, do my duty and leave. But that doesn’t work. No suggestion, no alteration of her circumstances is ever right. She doesn’t want practical solutions. She will always find fault with them. They are incorporated into the grudge. In fact, to help her is probably the worst thing I can do, because by gratifying her demands, I take away her remaining power, the manipulative power of the grievance. What she wants is constant attention, understanding and reassurance, but even that has to be questioned, denied. It seems so shocking to say it, but what she envies and wants is life, my life! And in refusing to devote the totality of my life to her, I feel guilty. She’s my mum, after all. Surely I owe her my life.

But I’m a psychotherapist. I recognise the manipulation and the need to maintain a boundary in order to protect myself from it. But I feel the loneliness and desperation that hides behind it. As a little girl, mum would have learnt that the only way she could soothe her distress was to get her mothers attention, even if the ways of doing it made her angry. Any attention, even angry attention, was better than no attention at all. And there was always the hope that her mother would soften, recognise her distress, calm things down, rescue her. After all, how could anybody turn away from such distress. And if they did, well she just raised the stake, became more desperate. Guilt is such a good way of manipulating people.

I feel disloyal in writing and posting this article, but it is cathartic and helps me defend myself against the other guilt. Perhaps there is some deep seated resentment, simmering away, but I do not wish to be unkind. And after all, so much of what is her is in me. Only by understanding that, can I find ways of helping us both. I feel desperately sorry for her, but also terribly trapped. Nevertheless, I have a choice. I can either bear the guilt and suffer with her or I can seek understanding and some distance. I feel the latter will help her more.

In January, I am planning to go away travelling for three months. But she is 93 and frail. What if she dies? How will I eve forgive myself?

She knows this, of course. When she is particularly aggrieved with me, she fixes me with her gimlet eye and says, ‘You’ll be sorry if I’m not here tomorrow. I shall come back and haunt you, you know!’

‘Yes mum; I think you will.’

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Doing things by the book; the flawed excellence of the new NHS.

Nick Read — Wed, 17 Jun 2009 20:28:27 +0000

I should have listened to her dentist. She cared enough to call me in London and tell me that the Xray had shown a small translucency around the root of the bottom right canine and there was a sinus pointing to the gum. ‘Your mum will need that tooth out,’ she said.

I demurred. I have an aversion to what I see as unnecessary fuss. After all I had with a discharging sinus into my gum for the last five years and it hadn’t blown up. And mum was already attending the ear clinic for deafness, the eye clinic for injections of Lucentis (costing the NHS £1000 a shot); she was attending the memory clinic for Alzheimer’s and now her teeth were playing up. It was a running joke between us.

‘Eyes, ears, teeth and memory. At least your nose is alright, mum!’

‘No it’s not. Feel it. It’s so cold!’

She still had a sense of humour. I was her feed.

Anyway, that tooth flared up. She got an abscess in it. Her temperature didn’t go up more than a degree but she became drowsy, more confused, went off her food and wasn’t drinking enough. The extremes of life are such vulnerable times. For the very young and the seriously old, an infection can set in train a sequence of events that can lead to death.

At first they tried Amoxycillin, but she became nauseous and the temperature didn’t shift. So they changed it to Augmentin. She rallied a bit, but then declined. The day she fell asleep in her porridge, I finally decided that she needed more help. I called the doctor. She would not be able to visit for three hours and suggested I dial 999.

‘Don’t give her any food or drink. Collect all her medications together. Call us immediately if she gets any chest pain. Somebody will be with you in half an hour.’ They were as good as her word.

The paramedic had a strong jaw and a decisive manner. After just ten minutes, he gave his report. ‘Pulse 72 regular, BP 110/70, Blood sugar 5.1. Temperature 37.8. She’s a bit dehydrated. Respiration good. Lungs clear. No obvious pain. Pupils equal. Responding normally but drowsy. I suspect she has an infection but we need to get her into hospital to get some fluid inside her, treat the infection and check her brain scan.’

My heart sank. To my mind, hospital is where the elderly go to die. It took three hours for her to be ‘processed’ through casualty while she sat propped up on a trolley in extreme discomfort and with nothing to drink.

After an overnight stay in the noisy confusion of the Medical Assessment Unit, she was moved to the pride of the hospital, the spacious, high-tech environment of the Hadfield Unit, a state of the art intensive care facility for the elderly.

When next I visited the next day, mum lay adrift, cocooned in pillows in a bay the size of a large meeting room with enough space to wheel in Xray equipment, heavy duty cardiac resuscitators, scanners and whatever else was needed. It seemed alien, impersonal, a futuristic medical facility on a starship, staffed by holograms. It looked like she had already died and was in the departure lounge awaiting transportation to another dimension.

The doctors, a pretty young woman with long hair, flaired trousers and short top that exposed a little too much midriff and a young man in jeans, an open necked check shirt and stethoscope draped around his neck, were posing for a photo-shoot at the entrance to the bay.

Why don’t they wear white coats these days? Perhaps I am just too old fashioned, but it would convey a degree of professionalism that would inspire confidence. But they were approachable and friendly and offered their opinions with authority and tact.

It was the nursing that worried me. The woman in the bed across the bay from mum was on the commode. I had seen the orderly deliver it twenty minutes earlier. She was calling out in some distress. ‘Is there anybody there? Please help me. Oh please help. Is there anybody there?’ But the nurses strolled past and ignored her. After another five minutes, I could stand it no longer. I went up to the gossip of nurses busily sitting at their station.

‘Excuse me but the lady in bay three seems to be in trouble. She has been calling out for the last half an hour.’

They stared at me crossly. I could have used my ‘I am a doctor’ ploy, but I didn’t want to. Why shouldn’t they respond to me as a human being? One of them, the most senior, I guess, her dark blue uniform buttoned up very tight, responded tersely.

‘Oh, that’s Eileen. She’s always calling out!’

‘But I really think you should….’

‘Oh all right, then!’

Eileen had fallen off the commode on to the floor. Later the senior nurse had the decency to thank me.

But why in this intensive care environment, did nobody seem to care enough? Why did they leave meals in front of patients who couldn’t feed themselves and just return to take them away? Why did nobody help people drink? Why was mum never mobilised except when I took her to the window and back? Why did nobody just sit and talk to her? She was so terrified.

Mum’s mental state just deteriorated in hospital. Always a proud, private person, she seemed to give up all sense of dignity and self. There was an outbreak of diarrhoea on the ward. Mum got it and for the first time since infancy, suffered from incontinence. Then she got a urinary infection.

It was two weeks before her physical condition had stabilised sufficiently to get her out of hospital, but by then, she had become part of the routine; she was terrified to go.

Mum was no better after her stay in hospital. She returned just as confused as when she went in. She didn’t seem to know where she was anymore. As the days past, her agitation increased. I called her GP. He was kind and prepared to take time to assess the situation. We decided to stop the Cipramil she had been on since before she got ill and start Lorazepam, a short acting tranquilliser with sedative properties. It didn’t help. She became more drowsy and one day she didn’t wake up at all, but when we eased back on the dose, she became very agitated and confused.

I called the memory clinic. At first they couldn’t remember her. I was put through to ‘Mick the Memory’, the kindly clinical psychologist who knew mum well. He didn’t think their prescription of Cipramil was part of mum’s deterioration had suggested I bring her in for an urgent appointment. I explained again that she was too weak and confused to leave her flat. Could they come and see her?

‘Oh’, he laughed, ’We don’t do domiciliaries. Let me speak to Dr McDonald and I’ll ring you back.’

He was back within the hour with a solution. ‘Dr McDonald has referred your mother to ‘the rapid response dementia team’. They will come and see her in a few days.’

They were late! Nevertheless I was impressed. They had sent a consultant psychiatrist and a senior psychiatric nurse. Dr Patel wore a black suit, white shirt and tie and an expensive perfume. His black shoes gleamed while he stroked his smooth chin thoughtfully, pondering whether it was a good idea not to treat mum for a urinary tract infection and whether we should try to cut the Lorazepam tablets in half. But Dr Patel seemed was singularly reluctant to go into the bedroom and see mum. His nurse did, but was bothered that mum was not awake enough to collect a urine sample, but she had forgotten to bring any sample bottles. They left after ninety minutes with the recommendation we continue with the same treatment and a promise to return every day over the weekend.

That night while attempting to reach the commode, mum fell. The carer, who was due to watch her, was working in the sitting room and did not hear her try to get out of bed on the baby alarm I had bought from Lewis’s that morning. She dialled 999. It was protocol.

The paramedics checked her, decided there was no injury, and left suggesting that we fit her bed with cot sides and call ‘the urgency and incontinence team’.

The urgency and incontinence team can’t come until next Wednesday. Clearly my call wasn’t urgent enough. I went out and bought a pack of incontinence pads and three absorbent waterproof bed covers, called, somewhat curiously, Kylies. Although quite compact, they claimed to absorb 3 litres of fluid.

I don’t wish to be too critical of the NHS. Any organisation that has intensive care wards for the dying and professionally staffed rapid-response dementia service, cannot be that bad. My concern is that our much vaunted nationalised health care system seems to have misunderstood that the most sophisticated technology, the most highly trained staff do not necessarily equate with quality of care. Hospital nurses seem to have lost the ability to look after patients. The real personal care has now been devolved to orderlies and cleaners while the nurses sit behind their desk writing reports and organising treatment plans. Mum’s GP is good; he balances his scientific understanding of medicine with the art of compassion and healing. He is an exception. There are others; Mick the Memory, Liz the dentist, but too many others adhere slavishly to evidence-based practice without engaging their minds.

We hear all the time about how expensive the NHS is, but just a cursory glance will reveal how much resource is wasted for how little gain. Is it necessary to have such a high tech unit to keep the dying alive? Isn’t it better to provide a caring environment to ease the last days of life and allow people to die in dignity surrounded by their family. The Hadfield Unit only allowed visitors in for an hour in the afternoon and two hours in the early evening. Mum was lonely and frightened. in there. No wonder her mental state deteriorated. And the consultant on the dementia team may have smelt nice, but would the nurse have done the job just as well by herself?

Evidence based treatments, expensive drugs that over-treat the problem and cause too many unwanted effects, the rigid reliance of management protocols and algorithms; they all fail because they don’t take account of peoples’ individual needs. And in the gap between efficiency and compassion lies a lonely person, often abandoned by their family and reduced by the state to the status of a machine past its sell by date.

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