Clinical Notes

A client with dependency or addiction problems is likely to need some immediate help arresting the relentless experience of anxiety. We can’t regulate our emotions as if we are adjusting a thermostat, but we can do certain things that will likely have helpful effects.

Try this. I’ve organised this as a series of numbered steps. As ever, however, you’ll find the format struggling to contain my thoughts, which is me refusing to struggle with the format: which is what I wish more clinicians would do. Process never occurs. Events do.

1.     Help your client to learn how to take their pulse by touch. When I learned how to take my own I found the whole business rather repulsive. However, I persisted, trying to keep in mind that overcoming my reservations at touching my own body and experiencing a feeling that in fact guaranteed I was alive might not be a bad thing. The more I did this, the more I discovered I could learn. Sometimes I was ‘hypo’ – my pulse was low when I expected it to be high. My skin tension on these occasions felt weird – and I still don’t know if that was because of something to do with a level of dissociated awareness in my touch, or a degree of extra tension in my skin. However, the point is that I noticed differences.

2.     Once they (and you) know how to take their pulse, ask them to count the beats over a minute.

3.     Do three runs of 6-6-4 breathing (breath in for 6, out for 6 through the nose and hold for four seconds).

4.     Count the pulse again. What’s different?

5.     See what happens. Whatever goes on in a highly aroused autonomic system and the states of mind associated with it – including, for example, cognitive effects relating to the experience of time – will be open to your joint investigations. What does a pulse feel like when someone feels this or that way? Explore these things yourself. That kind of curiosity overcomes a certain cut-offness which some call objectivity, which is the nemesis of all psychotherapy.

Someone I know very well was reading a book about quantum physics and they described to me their mounting frustration about the different ways the author described the positive applications of quantum thinking. What she seemed to be describing were various kinds of money-making venture that at first looked like positive forms of expropriation; but in effect seem more like a different kind of privatisation. However, the objections she wanted to make, or more, I suppose, the ones I would now want to make, were very hard to put into words.

Lyotard's différend has a way with this that very few ideas do. To object to the way this book was describing the potential effects of quantum physics was hard because of the way the book was written: that is, the form of its discourse. That form, if one looks at it as much as what happens when the form is followed (ie, read the book and think in relation to what is written), is surprising. It seems to involve writing about objects of quantum experimentation: financial schemes or medical interventions. Applications, to use that word again. But as soon as one begins to try and understand quantum physics there is a problem: quantum physics is not understandable within the terms of a discourse invested in applications. It seems to be, what? A something (a discourse?), that dispenses with the ideas of objects.

Some people, like Fred Moten, are more invested in trying to absorb that understanding than running with the forms of object-oriented discourse that the book my friend was reading had unhesitatingly committed itself to. When that happens, surprising things follow. Subjectivity, for example, or any discussion of subject-object type relationships might be less of a thing to discuss ... as what becomes of any thing?

Lyotard's différend describes how some forms of objection become impossible as they cannot operate within the terms of a particular discourse. This is unsurprising if one thinks about what objections owe to our understanding of objects: the concretisation of language that becomes necessary in order to discuss things, which is also a profound form of censorship. In concretising, what gets lost?

I think of this every day. What happens if I try to remain open to what may have become lost in what somebody is trying to say? J-F Lyotard, like a number of very interesting thinkers I try to read, often does not get read because his work is described as difficult. Difficulty is necessary, isn't it? Why would we read anything and expect it to be easy? If something is unclear that's a different matter; but easy reading, rather like easy listening will never confer much beyond the common ground of thoughts and feelings least likely to cause us difficulty. Difficulty that rewards sustained attention is different from the kind of difficulty presented by gatekeeping or badly-written obscurity. The charge of difficult gets used to dismiss both indiscriminately.

Finding a sense of freedom in difficulty might be another way of expressing something of what can happen in psychotherapy.

Well, yes. (A very compact psychoanalytic formulation often overlooked in supervision.)

What happens if you see effects rather than symptoms? Looking at symptoms ask you to consider causes, and almost inevitably results in a pathology; noticing effects leaves you examining what something does, and whatever that may be, it may very well not be pathological. In fact, the degree to which psychotherapists invent pathologies for their clients becomes clear. As does, of course and often surprisingly, the revelation that a pathological symptom may be doing something very helpful. Freud describes all of this; it's nothing new. However, it seems as if something may have beocme lost in translation - into English, and over time.

People who have had complex or difficult lives often find themselves feeling alone even when things are going well. Here are some thoughts about why, and a simple procedure that might help. Unless, that is, you like feeling alone. Some people do.

1.     At the really bad end of life you can experience extreme social, economic and emotional pressure. Your focus narrows to what you perceive as immediate threats. Thoughts of the future become unbelievable or unreal (which sometimes protects them): your sense of time contracts. The past seems to merge with the present. There is no luxury of deliberation because there can’t be. You need to be like this.

2.     At the amazing end, things are different. Your sense of time opens out. Play, care, and curiosity become more possible. Plans can be made. Relationships can be tended. Faith, hope, and trust return as ways of being in relation to a future that has not yet arrived and that feels worth moving toward.

3.     People occupy different bands of this scale. Someone who has moved from very bad conditions to generally good ones carries the full width of that range in their neurobiology. The bandwidth is wide. Someone who has lived near the good end throughout operates within a much narrower band. Neither can fully see how much the other’s range is shaping the way they respond. 

4.     Pockets of care, play, and bonding exist at every point on the scale, including the really bad end. They are not exclusive to safety and comfort. But at the bad end they are can be more compressed, harder to access, shorter, more easily disrupted and unlikely to feel predictably available. 

5.     Someone who works their way from the bad end to the good end may still, under pressure, find themselves responding from the bad end. For example, something unexpected happens, or someone you love needs help. You decide what to do quickly, without telling anyone. Your nervous system, weighted towards appreiating life as it played out many times while it was forming, when you were young, misreads the present situation as needing emergency action. There's nothing irrational going on: just something out of synch. 

6.     Fast problem-solving was necessary when life was consistently difficult. Acting quickly, deciding alone, not waiting, not consulting — all of that was crucial. Bringing tall of this into a relationship at the good end disrupts communication and bonding. The speed that once provided protection now gets in the way: it isolates and disrupts. What is needed is the capacity to slow down when the danger is not, in fact, real.

7.     Saying "I’m not sure" or "I don’t know" is your ticket out of this kind of trouble. It creates a holding pattern. It heads off the fast-response loop learned in the past and makes space to include someone else in whatever decisions get made.