Nick Read » narcissism

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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There, but for the grace of God; a perspective on psychosis.

Nick Read — Sat, 23 Oct 2010 12:17:03 +0000

You’re driving me mad, I’m going crazy, I’m losing my mind, he’s just daft, it just doesn’t make sense! How many times a day do you hear such sentiments? How often do you express them yourself? Our lives are so complex, so pressurised that we have to work very hard to keep things together. And yet, we don’t see too many overtly mad people these days; most are medicated; a few locked up in institutions. But we can all show pockets of paranoia when our buttons are pressed. We can all go mad, especially if deprived of social contact and support. There is, however, a distinction between being mad and going mad and some people are just nearer the edge than others.

The medical term for madness is psychosis, which essentially implies having beliefs, attitudes and behaviour that are antithetic to social convention. Psychosis is not the only category of mental illness; there is also neurosis. The old adage captures the distinction nicely. A neurotic thinks that 2 and 2 equals 4 and is worried about it. A psychotic just knows that 2 and 2 equals five. So neurosis is a disturbance of doubt while psychosis is a condition of certainty and conviction. They are styles of being, different but not immiscible. Although people may try to evade the torment of neurosis by developing delusions , they can still be tortured by convictions of victimisation, devastated by fears of fragmentation. Life for somebody who is psychotic, can literally be hell! Even when things are calm, there is no peace from their internal thoughts and voices. No wonder so many people who have a psychotic breakdown, chose to end their own lives.

The problem is not so much how we can distinguish between neurosis and psychosis but how we can we distinguish each from so called ‘normality’. ‘Normal’ is a social construct, defined by reference to the culture a person comes from. The Christian notion of God, his reincarnation as Jesus Christ, the virgin birth and the resurrection, is considered quite normal in the United States of America and much of the western world. But as Richard Dawkins has emphasised, what is God but a massive delusion? The only reason a religious conviction is not considered mad is that the same delusion is shared by others. Falling in love is another delusion that is widely encouraged by society even though it has such massive potential to shatter a person’s private web of meaning.

Psychosis is a distortion of meaning and as such, a logical consequence of being human. We can all go a bit mad at times. Human beings are creatures of meaning, compelled to find reasons for their existance and what happens. They have a big brains that can see into the future, and a deep seated fear of what might exist in that void. They have the imagination to invent stories and can be both comforted or tortured by the delusions they create.

Meaning develops through relationship with others, initially our mother, father, brothers, sisters, grandparents and later, a wider circle of family and friends , teachers, mentors, books and television. It is conditioned by society, represents society and maintains us within that society. Therefore, if we regard psychosis as an alternative or distorted state of meaning, it is a social disease. It stands to reason that those who grow up isolated, conditioned by perceptions that are incompletely normalised by others, develop their own fragile belief structure that can set them apart from others. Alone in a black and white world, where people are either idealised or denigrated, they can tend to be suspicious and blame others. All the good stuff is located in themselves while the bad stuff is projected out though the opposite may attain.

But there are shades of isolation. People who live on the cognitive borders of society are able to function quite normally for much of the time, but may exhibit uncompromising and paranoid ways of thinking when their meaning is challenged. Mental illness might be regarded as a defence against the loss of meaning induced by change.

As creatures whose identity is created from meaning, we are all vulnerable to change. Any of us can be overwhelmed and devastated by an event that is completely outside our experience, and most of us, especially the more solitary, adopt strategies to prevent the devastation caused by a breakdown of meaning. Some may assume an idealised persona, a special identity that offers a role and purpose. This may be reinforced by special musical, literary or artistic talents perfected through the years of isolation. Others may mould themselves to their environment, sensing what others want and adapting to it. Women are said to be better at this, readily adapting their personality to the needs of a new partner. And finally some keep it all together by encapsulating themselves in an all consuming interest, an obession for work, a dedication, a faith.

We can see examples of such behaviours in our colleagues, friends, family and in ourselves, but some people are more fragile, more susceptible to change and more clearly defended against it. But fragility is no reason for segregation. Society needs to achieve a democratisation of belief and thought. People with conviction and creativity can be exciting and inspiring. Most effective politicians have some spark of madness in them. They can be dangerous unless reined in by their civil servants. Society advances, not by the most stable, healthy members of society, but by those independent thinkers, who may at times be considered mad by their colleagues. Darwin, Einstein, Newton, and many of the great writers, artists and composers have all been considered mad at times. Ignaz Semelweis, whose hygeinic principles saved the lives of millions of women from puerperal fever, spent much of his life incarcerated in mental institutions.

Some of the ideas in this article were inspired by a talk on psychotherapy and the psychoses given by Darian Leader at the Biennial Conference of the Hallam Institute of Psychotherapy on October 2nd.

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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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Bush and Blair; a hubristic ‘folie a deux’.

Nick Read — Sat, 01 May 2010 17:47:24 +0000

They were made for each other, weren’t they? Not so much a marriage made in heaven as an accident waiting to happen.

There was George W. Bush, the rich privileged son of a previous senator and president, the playboy, the drunkard, the ne’er-do-well, who went into politics by default. He was governor of Texas for a time but really didn’t have to do very much. He went into the presidential race with no experience in national government whatsoever. He might have been a quiet reflective president who slipped into the job and worked well with people, but I doubt it. He was too much of a maverick, too much of a loner; he wanted to be a hero too much. He was dangerously out of his depth, reliant on the same hawkish advisers that his father had when he was in power.

Then there was Blair. Again, not a committed politician. As a student, he was an actor. He performed in a rock band, he enjoyed the limelight. The law initially gave him his theatre; he could master a brief quickly and deliver the essence of it with skill and eloquence. When Blair entered politics, he found his true vocation. He had great appeal. He could dress something up as if it was brand new and exciting. He introduced the concept of New Labour. He was the man of action and change, a complete contrast to John Major’s grey man.

Then there was God. George W. had found God during a visit to Billy Graham in the 1980s. From that moment he realised that God had singled him out to be President. It was God who suggested he send troops into Afghanistan. It was God who commanded him to send troops into Iraq. But this was introjection; George W had assumed messianic qualities. “It wasn’t me Guv, it was God. He commanded me to do it”.

Tony Blair was more reserved about his religious convictions. But like Bush, he was born again. He was an Anglican who became a Catholic. He was convinced of the moral righteousness of war in Iraq. It was his duty to get rid of evil dictators whenever he met them. Again, one wonders why he didn’t attempt to do anything against Robert Mugabe in Zimbabwe. But with God on his side, how could his troops fail?

Then there was 9/11. The sense of outrage was felt throughout the American continent and around the world; George W. had to do something. So he declared war – war against terror! Blair was much better with words than Bush was. He became Bush’s PR manager. They convinced each other they could conquer the world. They were a hubristic duo, both convinced of their moral rectitude. They didn’t listen to counter arguments. They disparaged those who opposed them, even those in their own governments. Blair disbanded the cabinet government and set up his own foreign affairs and defence departments within Number 10. His foreign minister, Jack Straw, was side lined. Blair wanted his place in history and so did Bush. So they ignored international law and opinion.

The war went as predicted. It was over in about 6 days. Saddam Hussein went into hiding, but was eventually caught and assassinated. Bush went on an aircraft carrier in the Gulf of California wearing a flying jacket and was photographed with the words ‘Mission Accomplished’ emblazoned on the bulkhead behind him. But they both failed to plan for the peace.

There was widespread looting and destruction. The lawlessness went on for several years and engaged hundreds of thousands of troops at great expense to both countries. But the American provisional governor had disbanded the Iraqi army and police force and isolated the more reasonable elements that might form a new government. The Americans and their British allies knew best.

The Hubris Syndrome; Bush, Blair and the Intoxication of Power was written by David Owen, the former British foreign secretary in 2007 and published by Politico’s.

They were made for each other, weren’t they? Not so much a marriage made in heaven as an accident waiting to happen.

The Hubris Syndrome; Bush, Blair and the Intoxication of Power was written by David Owen, the former British foreign secretary in 2007 and published by Politico’s.

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Visionary or Disaster; a perspective on William Sargant

Nick Read — Sun, 21 Mar 2010 18:55:37 +0000

We don’t hear very much about William Sargant now, but in his day, he was the most eminent figure in British psychiatry, a large man with a leonine profile and convictions as strong as his character; somebody you obeyed and never argued with. David Owen, one time British foreign secretary, worked under Sargant at St Thomas’ in the 1960s and recalled him as “a dominating personality with the therapeutic courage of a lion” and as “the sort of person of whom legends are made”. But others, who preferred to remain anonymous, described him as “autocratic, a danger and a disaster” He was a man who could excite strong opinions.

Although he was part of the listening profession, Sargant wasn’t a great listener. Describing himself as “a physician in psychological medicine”, he abhorred psychotherapy and dedicated his life to leading the biological revolution in psychiatry, promoting such treatments as psychosurgery, deep sleep treatment, electroconvulsive therapy, insulin shock therapy and the development of mind altering drugs. He had the courage of his convictions, but his reliance on dogma rather than evidence have made him a controversial figure. His book, Battle for the mind, a physiology of conversion and brainwashing, written with the help of Robert Graves, emphasises the apparent need for evangelists and politicians who would change people’s minds to excite them first.

William Walters Sargant was born in 1907 into a ‘larger than life’ Methodist family in North London. Five of his uncles were Methodist preachers, one brother was a bishop; another, Thomas Sargant, a human rights campaigner.

He got a place at St John’s College, Cambridge and became President of The Cambridge University Medical Society. He did his clinical training at St Mary’s, where he excelled in the Hospitals Rugby Competition. Too impulsive and sure of himself to be a great academic, his one foray into medical research, a paper on the use of large amounts of iron to treat pernicious anaemia was criticised and this may have led to his mental and physical breakdown and his subsequent shift to psychiatry, where the absence of validated treatments gave him free rein to develop his convictions.

It was at the Maudsley under Edward Mapother that Sargant became convinced that ‘the future of psychiatric treatment lay in the discovery of simple physiological treatments which could be as widely applied as in general medicine‘. During the war, Sargant worked at the Sutton Emergency Medical Service but was frustrated when London County Council medical advisors tried to curb his experimentation with new treatments but, as he said “we generally got our own way in the end”.

While at Sutton, Sargant treated veterans with battle trauma by abreaction, deliberately getting them to relive their experience on the premise that it would eventually wear away. He described a man who was shot at by German pilots as he swam out to the boats at Dunkirk, experienced all over again the terror of drowning but then walked away from the session without a care in the world. Sargant never really validated or controlled his studies or even analysed the results of his treatments. He was no scientist; he just did what he considered right.

In 1948 he was appointed director of the department of psychological medicine at St Thomas’s Hospital, London, and remained there until the 1980s. There he developed his procedures for ‘brainwashing’ . He created a 22 bed sleep ward on the top floor of the adjacent Royal Waterloo Hospital,, in which he would keep his traumatised patients in a continuous state of heavy sedation for periods of up to three months and subject them to insulin coma therapy and frequent electroconvulsive treatment. This brainwashing, he claimed, re-patterned the brain, wiping it clean of the traumatic experience so that when they woke up they couldn’t remember what had happened .

Sargant also advocated increasing the frequency of ECT sessions for those he describes as “resistant, obsessional patients” in order to produce “therapeutic confusion” and so remove their power of refusal. “All sorts of treatment can be given while the patient is kept sleeping, including a variety of drugs and ECT [which] together generally induce considerable memory loss for the period under narcosis. We may be seeing here a new exciting beginning in psychiatry and the possibility of a treatment era such as followed the introduction of anaesthesia in surgery”.

No informed consent was requested for what was an experimental procedure. No systematic study ever validated Sargant’s cerebral lavage, but there are patients still alive who claim never to have recovered their pre-traumatic memory and become profoundly incapacitated as a result. Sargant, himself, ascribed such failures to the patient’s lack of a “good previous personality” and discharged them to the wards of long stay mental hospitals. These patients have never been compensated. All patient records at St Thomas’s and the related health authorities relating to Sargant’s activities were destroyed.

But there was worse. When Harry Bailey, an Australian psychiatrist enthusiastically adopted Sargant’s methods with enthusiasm, 26 of his patients died. Sargant also admitted some fatalities. The fact that more had not succumbed was almost certainly due to the quality of care by the St Thomas’s ‘Nightingale’ nurses, who monitored the patients sleep every 15 minutes and woke them up every six hours for feeding and toileting.

Sargant’s ward was closed soon after his death in the 1980s; his books removed from the libraries, his influence suppressed, his opinions castigated.

One of my teachers, a surgeon, used to tell us that there were three types of doctor; the good, the bad and the downright dangerous. Sargant was the latter. Evangelism and conviction are dangerous qualities in medicine and Sargant has been roundly condemned as ‘someone of extreme views who was cruel and irresponsible and refused to listen to advice’; some suggested that he was motivated by repressed anger rather than a desire to help people. In medicine, tyranny is dressed in a white coat.

But Sargant was a man of his time. Revolutions would not occur without the extremist, the outspoken, the dogmatic and the domineering. So those who would praise modern developments in the pharmacological treatments of schizophrenia, dementia and depression, have a debt of gratitude to Sargant the prophet, who had to be condemned for his extremism.

For medicine is a profession that requires us to listen, make careful observations and assess any new definitive treatments by the most scrupulous scientific methods. Doctors have to be seen as caring and careful. I once knew a doctor who had the unfortunate surname of Reckless; he should have changed it.

But, in Sargant’s defence (which is a bit like the defence of indefensible) the effects of new psychiatric treatments are not easy to assess. There are no measureable end points like inflammation, blood pressure, blood sugar levels. There’s just patient testimony. ‘Yes, I’m feeling much better, thank you.’ Good results may be more due to the care and attention of the doctors and nurses than any effect of the treatment. It all depends how you ask the question and what statistical methods are applied. Powerful advocates and suggestible patients can still produce ‘effective’ treatments. Perhaps that’s the nature of the mind; it’s confidence and faith that heals the traumatised psyche – and there are many routes to that. In a therapeutic wilderness, the most important thing is to be mindful to select treatments that do not have the potential to damage.

Take antidepressants (or don’t take them), the most commonly prescribed drugs in the western canon. Are they effective, or do they just dull the sensibilities, sanitise the anguish and despair, and keep people in depression by suppressing the motivation for change?

Even Sargant acknowledged, albeit in typical grandiose manner, how psychiatric treatments may strip away the personality and motivation.

“What would have happened if such treatments had been available for the last five hundred years?… John Wesley who had years of depressive torment before accepting the idea of salvation by faith rather than good works, might have avoided this, and simply gone back to help his father as curate of Epworth following treatment. Wilberforce, too, might have gone back to being a man about town, and avoided his long fight to abolish slavery and his addiction to laudanum. Loyola and St Francis might also have continued with their military careers. Perhaps, even earlier, Jesus Christ might simply have returned to his carpentry following the use of modern treatments.”

A recent systematic review could not establish any efficacy for the newer antidepressants, the latest generation of Sargant’s mind altering drugs, though they all have significant adverse effects. So why are billions still taking them? What does it say about society and those who run it?

Sargant, the maverick, the charismatic loner, the one who dared but was considered out of step and downright dangerous, was as described in his autobiography, ‘A Quiet Mind’, a heavy smoker, suffered with tuberculosis and struggled with depression for most of his life. It was his karma, (the collective guilt of a family of preachers?), and he lived up to it by putting his patients and his own reputation in considerable danger. Was this some death wish, some demon of self destruction? Winston Churchill, another depressive, comes to mind; so wonderful but so dangerous – relishing the excitement of risk, rushing up to the roof of 10 Downing Street during the blitz to watch the fireworks, but suffering agonies during peacetime inactivity. No wonder Clemmie found him difficult.

David Owen who admired Sargant’s courage and spirit, has recently written a slim volume on hubris, in which Sargant doesn’t even get a mention. Ah!

William Sargant was the subject of a Radio 4 documentary ‘The Mind Bender General’, first broadcast in 2009 and repeated last Wednesday.

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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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Duet for one; the destructive narcissism of the performer

admin — Thu, 19 Mar 2009 14:03:24 +0000

Stephanie was a virtuoso violinist until she was struck down with multiple sclerosis. Now her fingering is clumsy, her bowing uneven, her music sounds scratchy and discordant. She can’t do it anymore. She is destroyed. Music was her whole life. It was her joy and purpose. Each note joined her in mystic union with the fellow acolyte who notated it centuries before. It was her religion and her ecstacy. When she and her husband met, they made music as a preliminary to making love. Duet for One, probably Tom Kempinski’s best play, slowly strips away Stephanie’s resistances and defences to reveal to full shocking horror of the devastation she tries so hard to conceal. Juliet Stevenson plays Stephanie with the neurotic intensity only she can command. Henry Goodman gives a wonderfully nuanced performance as the beleaguered psychotherapist, complete with middle European accent. We slowly learn that Stephanie was encouraged to develop her musical talents by her mother, who was herself a concert pianist until she gave it up to help her father in his chocolate business. But, tragically, her mother died when Stephanie was just nine. Her father was distraught and took to his bed. The business failed. He told Stephanie he was not going to pay for her to have music lessons any more. She had to get a proper education, a proper job. Stephanie fought her father, refused to do any school work unless she could study her violin. The conflict was long and hard, but eventually her father capitulated. Stephanie had won. She had to. With mother gone, music had become the only meaningful thing in her life. When other girls might party, shop, visit coffee bars or night clubs, Stephanie practiced – at least three hours every day! At 18 she won a scholarship to music college and the dedication intensified to eight hours a day. Most music colleges produce one virtuoso every ten years. Stephanie was that one. But now she could no longer make music, her life had lost its meaning. The acme of musical performance, being a concert soloist, demands enormous dedication, a concentrated focus on the self and it’s achievement. It is perhaps the most extreme form of narcissism. Performers are obsessed with their capabilities for most of the day every day. They strive for perfection. They have to keep testing and retesting themselves, all too aware that a precipitous entry, a slightly flat note, a false emotional balance, could mean disaster. A performer’s life is one of continual insecurity. They are a bit like the specialist rock climber. They live on the edge. They don’t just make music, they have to own the souls of their audience. They need the next performance to reassure them, to gain a momentary respite before the pangs of self doubt creep in again. They only see the failures. This fuels the engine of addiction. Even the peerless Vladimir Horowitz left the concert platform after 12 years, feeling unable to live up to his own reputation. And Jacqueline Dupre, whose story resonates with Stephanie’s, was constantly concerned that she lacked technique. Perrformers have to live with their destructive demons. They can never be good enough and for that they must be punished. Some, perhaps most, come to hate the monster they have created and wish to destroy it. Perhaps with Stephanie, as with Jacqueline Dupre, the seeds of destruction infected her immune system, causing it to destroy the lining of her nerves. Illnesses often have a meaning and a purpose. Multiple sclerosis may seem tragic for a musician, but it may free them from the tyranny of performance and all the parental ambition that went with it. There is an irony behind why an illness affects that very function that is so essential. It exposes ambivalence. Sooner or later, performers, sportsmen, actors, celebrities of any tone, want to be what they are and not what they do. And now Stephanie doesn’t have music, she has, for the first time in her life, to learn to live with other people, to collaborate, to belong, to trust, to be ordinary. It is the most difficult thing she will ever do. Duet for One played at The Theatre Royal, Bath on 17th March.

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