Clinical Notes

This came up in a workshop I was running for people helping refugees today. What do you do if you know someone's being treated badly, as though there's a policy at work; or some kind of thing playing out that targets them? It depends on the context, as usual, but I'd always be looking to corroborate what they are saying.

You can only do that if you stay in touch with the realities of legislation and policy making; which will be disputed, almost certainly by the people doing whatever it is unless they are acting out some kind of explicit public role or law enforcement.

You need to decide where you stand because that will affect how you read the situation. Remaining 'neutral' can be like asking someone to stay where they are because what looks like a giant boot descending from the sky above them may not be that. In fact, if they think differently it may actually be a feather.

Logic has a relationship with common sense; reasoning is sometimes very unreasonable because it leaves out what many still dispute as not a thing to discuss, say racism, which you think you'd know if you saw it. But how can you know something you can't know because it will never come to you?

Describing what you see and saying what you know can be helpful. But only if you see it or know it. Don't create an imaginary enemy, even if you believe one is there. Find another way.

Now, think about what that does to the drama triangle (Karpman's, 1968): P: Persecutor, V, Victim and R, Rescuer. Normally we're told to 'get off the triangle' by remaining neutral. The feeling driving the 'rescue' belongs to the rescuer, not to what is happening to the person in front of him, and it leaves the victim where he was; you create the enemy that 'rescue' needs. The letter comes from the Home Office. The man at the desk hands it over. It's the man at the desk you go after. Getting off the triangle is to say it as you think it is ... which, as we know, is rarely the easy thing to do.

Somebody told me that Derrida had written about a certain writer - but that Derrida had then thought this was a mistake. The implication was that to bother reading the thing Derrida had mistakenly written would be a waste of time. No. Following anybody in their mistakes, which is very different from making the same mistake, is the only way you can understand the force of what that writer goes on to write. The force of Derrida; which as he writes, is there before anything means something.

... which reminds me of something I drew attention to at the talk I gave in New York last year.

During a ‘magical’ evening in Stockholm in 1967, at the peak of Davis’ solo during a performance of one of his most well-known tunes, Hancock played a chord that was

‘one hundred per cent, completely, entirely, wrong … I believed I had destroyed the evening … time stood still and I felt totally shattered … you know what happened next? Miles took a breath and played this phrase that made my chord right … how could he turn a wrong chord into a right chord? … Miles didn’t hear it as a wrong chord, he merely heard it as an unexpected chord. He didn’t judge It. I did.’ (2014)

I photographed a group of people on the heath in Southwold, preparing, I thought, to watch the eclipse. They were, in fact, already watching the eclipse as my photo showed; an effect of the light flaring on the lens being the clear form of the moon slipping over the face of the sun. I didn't realise as I had no colander or special glasses, welding mask or pinhole camera. Maybe it grew a shade darker. I'd been on the beach and was still mainly there, my mind lost to any special visual preparations.

I've just returned from a holiday by the beach, in Southwold. Some friends hired a beach hut and for three days I was able to read, write, swim and other times lose myself in the blur of the sound of the waves, children playing and grown-ups doing much of the same.

This is bliss to me. You want to relax? Find somewhere shady near the sea and involve yourself with whatever comes to you. I watched children doing this; the younger they were, the less they seemed to be doing something against anything. Maybe against time, as they ran in circles or to and fro from the breaking little waves; or drew shapes in the sand, or followed other children around, or adults. There seemed to be just one aim: to get on with something that felt good, until it stopped feeling good.

The same happened with grown-ups, even older ones like me, walking, or lunging, eventually maybe swimming into the waves; jumping as waves reared up and broke; keeping going in the water in ways we would never imagine ourselves keeping going in life unless we took into account our thoughts, which would be where our minds were up to the same kinds of gymnastics. But here, at the beach, in the sea, a mind gets lost in the rolling of the tide, or the sparkle of light on the surface of the water, or held aloft on the gorgeous sound of children's shrieks of joy.

We keep going until we grow cold, or tired, or the sky clouds over.

Watched Elisabeth Leonskaja play a recital last night. Comes to the piano, sits down and plays as one movement. Crazy, like she’s pulling out a gun, the Sundance Kid, shooting the trousers off the piano.

Context for this: a surrounding set of precedents; and nobody knows where she’s at, or what she’s in.

Look back forty years. My family circumstances: nobody tells me much more than what a plate’s for. I play cricket and play the trumpet. I bowl extremely fast, dangerously so. I love how that feels. I love how the trumpet feels in my hands. The middle notes like an animal I let run out around my wrists, or maybe smoke. I watch people smoke and get why they think it’s worth it.

My music teacher calls me aside. Tells me I should take this seriously. You have a talent. Fine, but what’s that? I am eleven. I listen to Jesus Christ Superstar, The Police, Chopin records from Poland and Mantovani because I have to. I watch cricket with my grandmother in her little room in the middle of nowhere, in her cottage in the mountains. A Sony portable TV run off a car battery.

I do the trumpet like it feels right; like the bowling. Five years after chat with music teacher I go from Friday night trumpet performance to adult cricket match next day, take nine wickets. Have no idea why the two things feel like I’m doing the same thing.

Fast forward to: I begin a psychoanalysis with Kleinian. Ultra-interested in interpreting how I keep falling asleep on the couch. Points out all resistance. Says nothing of me doing five or six jobs at the same time; and me thinking I can cope like that. Falling asleep all over the place: at home, lunch hours, on her couch. (Supine, low light, no eye contact, no need to respond: Adenosine, Noradrenaline, Histamine, Acetylcholine, Orexin, etc.)

Now, a thought I share with Frances Badelow and Louise Trodd when I am eight, one year before I end up in Moorfields Eye Hospital. Nobody knows why.

What if I try to include everything?

Context for this: complex relationship between a body’s internal physiological conditions, its perception of ongoing events, and its prediction of action to maintain homeostasis. Conditions: internal and external as continuous event (psychoanalysis is an event, so a movement), temporally complex, involving recollection and deferral. Deferred effect, deferred attempt. Deferred reaction.

Imagine this. In psychotherapy, transference provides conditions to work out where we are at. Or what we are in. Improvisations as wild as John Coltrane to inventively supplement unconscious predictions more than following by rote. New possibilities for consciousness. Learning from experience to include talent and effects of smoking.

At Moorfields the condition gets better. A doctor holds my hand and tells me what is wrong. He says my eyes are painful, and I cannot see, and it does not matter. He will see to it that I am looked after.

A psychoanalyst stalking her patient's family becomes an occasion to trace plot back to a sheet of instructions pinned backstage, and to argue that clinical formulation is the novel's habit practised on clients, best given up in favour of listening without knowing where on earth you are going. Or, more notes on psychotherapy.

I went to see Private Life, the film with Jodie Foster and Daniel Auteuil. Part of the plot involves Lilian Steiner, the character played by Foster, wondering what one of her clients actually meant in a session not long before the woman's death; and when I say actually I'm pointing in a way that the film also does to the unreliability of any record. Recently I also read Ben Lerner's Transcription, which makes a few of the same moves in a very different way. If you do this job, this psychoanalytic version of it in particular, I recommend both. Fair warning: I give away a good deal of the film in what follows.

Most of us take notes. Some of us record our sessions. None of this really helps with what counts most, at least to me. That is whatever someone's breath is carrying, words or no words, at any moment of appreciation: listening to someone, feeling their presence in their movements, watching them. The last of these might be more important, you'd think, if you work on Zoom a lot. I do, but I don't think so. The tenuous nature of the Zoom relationship is everything, if you let it be. Presence in a room is much easier on us all, but not necessarily best for the work.

Anyway, I digress. But digressions are so crucial to us being alive. We skip here and there instinctively depending on where we believe we are heading, not only as speakers or writers but as listeners, as readers. We have in mind, often without realising it, a kind of plot of where we believe we are heading, and this coerces us into all manner of intellectual gymnastics.

So, when Lilian Steiner listens to a recording of a session, and then when she looks at her notes of that session, her opinion of what is going on changes dramatically. Fortunately, my own changes of opinion have not led me to go stalking my clients' family members, believing they may be murderers. I have not accused my son of being, in another life, a Nazi sympathiser in the 1940s who arrested my lover and rendered our current situation unspeakably painful. No. Lilian does, but I have only, perhaps, those joys to come.

These kinds of thing may be the most baroque magnifications of a psychoanalyst's mistaken assumptions, self-justifying of course, and maybe a good way for someone to teach about counter-transference, listening and what 'doing something' to your clients might actually look like; they are also, and this is what made me love the film, a most drastic examination of plot.

Plot. For some reason the 1990s saw two surprising things occur, rather like twists in a novel. First of all many young writers found jobs as creative writing lecturers. Simultaneously a science of fiction writing appeared, based loosely it seemed on Aristotle's thoughts about what makes a perfect whole: a beginning, a middle and an end. A teleological drive, then, from one through the next to the last, with all that this involved in terms of cliff-hangers, showing not teleologicalling, and so on. I found this something of a shock, living as I was on the edge of it; since my idea of writing was rather looser than that. Even the novels people called thrillers or blockbusters that I enjoyed seemed to bounce around less determinedly than the new art of writing dictated. More in the way Stephen King's The Shining is written clashes with what a creative writing model of successful narrative demands than agrees with it. Ghosts and madness are very hard to hem into an 'Aristotelian' frame, carrying with them all that sense of something of the past.

Plot, the synopsis of which is something any writer will be told they need to come up with if they are to have their writing commercially published, is a funny thing. I am, as it happens, writing one myself at the moment. Imagine a time before the novel. Plott (as it was sometimes spelled) referred to what was written on a sheet of paper and pinned up backstage of a theatre production. It reflected what needed to be blocked out for a play: all of the movement, the dynamics, that performers would act out of an evening. It signified challenges for the actors and stage crew, and somehow it survived the transition from play to novel as a series of instructions for understanding the progress of what goes on, but without any real thing involved. Plot, in a novel, became a self-enclosed imaginary space that fought with the imagination rather than rain, mud, acoustics, lighting issues, noisy audiences and so on. Instead of a drunken crowd the writer of a novel had to contend with a reader's distracted mind.

Minds, if we return to my first thoughts here, are given to wilfully plough on to their own ends. Give me something to think about and I am already predicting what to do with it without knowing, only feeling something that will take me there without me realising what I have done (until, for example, someone like Lilian Steiner finds herself hypnotising a child after impulsively deciding to ransack his home in search of a session recording and recognises she may have acted a little unwisely). If there is a point to this piece, which is of course straining at the un-Aristotelian, as I generally do to the bafflement of many, it is to say don't blame Aristotle.

Look instead at something you could call transmission, the odd effects of what happens when something passes between one and another, like Ian Curtis on a record singing, shouting about dancing to the radio. Aristotle didn't write about plot. He did seem to write about a self-enclosed space, mythos in his Greek, which translated into Latin for most of the medieval period as fabula; and then, in English, became plot. Plot after the movement from drama to novel that I mentioned; and there's a thing I wrote, Another Approach to History Taking, where I mention Walter Benjamin's objection to novelistic psychologising: the interior movements one might describe as movements of the mind. I was getting at something serious, I hope, rather than simply (as I have been told) difficult. The movements of minds attuned to the character of the novel, which seems to have now infiltrated every form of representation, leaves an awful lot of room for each of us to end up creeping around wondering about our clients' motives. We generally call this kind of thing formulation, aetiology, or something of that sort.

If we simply listen, however, and follow what we hear without diving into our sense of meaning, what might that enable a client to do? Find their way, which is what they will inevitably do, as Freud seemed to believe and Shapiro made explicit in her AIP (Adaptive Information Processing) model, which is cranky and crude. Whatever we believe we are doing in relation to what we are experiencing, we are more likely doing something in relation to all the prior instances of events in our lives that seem similar to the context we imagine we are in. But let's say that I am wary of sophistication these days. It seems to mean doing some very strange things to fit in. Sophistication, of course, is a form of productivity. Hence botox; hence influencers, more accurately the sorry victims of their own policing of desire.