Clinical Notes

The prefix ‘para’ means alongside. It is a useful beginning to a word or phrase to keep in mind now, when so many informal, private, or secret organisations exist alongside official ones. Their presence often points to convergent groups, ones in which predictability replaces accountability.

These are not always organisations in the ordinary sense. They are closer to ecologies. People gravitate together out of self-interest, joining with those they anticipate, predict, will most likely give them what they want, and roles emerge that function less as positions than as elements in a shared environment.

Jeffrey Epstein, for example, appears less as a solitary figure than as a node within a para-political ecology that included figures such as Peter Mandelson. Information circulates through such ecologies informally, sometimes illegally, detached from formal responsibility. It is gathered, traded, and distributed according to need rather than rule.

At least, that's what I've noticed.

There are all kinds of things we can say about evidence. Evidence always has to be presented, for example — or ‘produced’. It’s then usually reproduced, as we can see in the case of the shooting of Alex Pretti in Minneapolis.

Psychotherapists are used to having facts presented to them in the manner in which the American public — at the same time, in 2026, as the rest of the world — is by the current administration: with determination, moral force, justification, and often efforts to locate them in a broader context. More production that Spielberg, Kubrick, or Cameron could ever handle.

What else can we say? The broader context also includes a scepticism about news, a belief that any image can be changed or created from scratch artificially (artificial intelligence arrives shortly after we grow used to CGI). It includes the regurgitation of phrases like “fake news” by a television personality now a president.  A hell of a production.

And we can see that if we don’t allow ourselves to be caught up in this production by, let’s say, forces unknown (which I find it helpful to call whatever seems to be motivating a client to do all they can to convince me of something — without that client realising it — as well as what they are aware they are doing), we see things we are told are not the case, were not the case, and never were the case. Dorothy does this at the end of the Wizard of Oz.  If we think carefully, we recall that whatever is being denied might be what we saw before all the things we saw and heard trying to convince us otherwise.

So, a thought to kick off 2026; a kind of New Year’s resolution. Can we resolve to identify, with all the ruthlessness of the Trump administration, everything that might erode our confidence in what we perceive? What produces that erosion?

Let’s begin here, by focusing our attention for a moment on artificial intelligence. AI is perfectly suited to post-confidence life. An answer for everything. ‘Because that matters’, as its various incarnations are keen to say in answer to any question.

What matters is not a matter for software derivatives of Peter Thiel, clever man though he is, or wheoever else has the money to bankroll AI.

What matters is that each of us does all we can to enhance our capacity to judge, by learning from sources that seem to conflict, fight and aim to cancel each other - or themselves - out. No single source or person. Make sense of that. This used to be called getting an education, which obtaining an answer from ChatGPT is certainly not.

Mindfulness is not a relaxation technique. It is a practice that can lead to a deeper awareness of what is happening to you and how you are responding to it. Its aim is not to calm the nervous system but to notice experience as it happens.

For some people, practices involving stillness and sustained attention reliably feel awful.

This is not paradoxical, and feeling like this does not mean you need to persist with them. If heightened alertness has become your familiar route to feeling safe, then reducing external demand or stimulation can be disregulating. You may feel more activated in order to feel more stable.

Mindfulness also removes you from the effects of external structure. Your attention is no longer occupied in doing something. Internal sensations, thoughts, and affects that are usually managed through activity or distraction become more noticeable. Anxiety increases not because mindfulness is being done incorrectly, but because it exposes material that has not yet been integrated.

Mindfulness often intensifies interoception. Awareness of breathing, muscle tone, or visceral sensation can be activating if you have grown used to bodily states signalling danger, pain, or loss of control. Imagine a very frightened child trying to keep as still as possible, trying to make no noise, even to avoid being heard breathing, and you may be able to imagine where this response comes from.

None of this means mindfulness does not work, nor does it mean you should persist with it. Instead, you need to find the best possible ways of slowing down and feeling stable through engagement, movement, rhythm, structure, and relationship. If somebody tells you that you need to stop doing things because you are avoiding feeling what is happening to you, or thinking about it, they may have a point. But a certain level of dissociation is actually desirable unless you lead a life without unreasonable demands.

If you want to live a better life, begin by working out what makes you feel safe without exhausting you. Listening to the sound of the wind in the trees or the rain on the pavement may feel very different from focusing on your breath. How you do these things matters. Staying with a sound you are focusing on, without getting lost in a story generated by it, creates a context in which the body can slowly relax. This is different from the undecided switching off that can happen when you zone out.

Focusing outside yourself in this way achieves a limited but important kind of control. You are doing something you have chosen to do. The context changes. Your attention is no longer directed at something you experience as threatening.

Practices of sustained inward attention in which you distance yourself from the world’s distractions are not for everybody. Unfortunately, they have come to be widely regarded as necessary. They are not. Believing they are is a repugnant kind of moralising we could all do with less of.

There are lots of ways to think about what we call transference. One simple way is this: it’s a kind of emotional persistence that can make us less attentive to what’s actually happening now.

Suppose I get into a relationship because it feels right. It feels powerful, convincing, even wonderful. That might mean I’m stepping into the best relationship of my life. But it might also mean I’m chasing a particular feeling I already know well. If that’s the case, the feeling itself starts determining a relationship. I may not slow down enough to really notice who this person is, how they relate, or where the difficulties might be. And the things I miss at the beginning are often the very things that matter later on.

There is a phase I have come to recognise in the lives of some people who have struggled with food, appetite, or bodily regulation. I did not notice it early in my work. In fact, I only began to see it after following a small number of people for many years. The time it took me to recognise it was roughly the time it took them to arrive there.

I did not hear about this phase in advance - I didn't predict it, either. I saw it happening. Addiction workers will be familiar with the broader context: difficulties that emerge in midlife are often preceded by others, sometimes displaced, sometimes socially sanctioned. But what I am describing does not quite fit the idea of substitution. It appears later, often after a long stretch that might reasonably be described as stable. People may have months or years behind them in which the original problem no longer governs daily life, and yet something persists. It is as if life continues to be lived in the shadow of what happened.

This period is often mistaken for depression. It is not that. What I have seen is something closer to a prolonged exposure: a sustained encounter with ordinary life once the earlier means of regulation has fallen away, in which feeling is no longer buffered as it once was and a sense of power is no longer reliably restored; a long stretch in which life is lived without the buffer that once held it together, and without any clear replacement for it. There is often a sense of hopelessness, but it sits alongside something else, harder to name. A faint superiority, perhaps. Or a sense of being set apart. The person does not feel well, but neither do they feel simply defeated. They appear to be waiting, without knowing quite what for.

At this point, explanations tend to proliferate. Family stories, trauma narratives, developmental accounts. None of these are necessarily wrong, but in practice they rarely help. The search for reasons can become an activity in its own right, one that never quite closes. The problem is not that meaning is irrelevant, but that explanation begins to behave like metaphysics: each answer generates another question, each cause another cause. It starts to resemble an argument about God. Not because the question is foolish, but because the form of the argument makes it impossible for anything to change.

It is more useful, I have found, to attend to how the difficulty is happening. What is being organised in the present? What is someone trying to maintain, regulate, or avoid, even if they would not put it that way? This is not a search for origins, but for function. It is a way of staying with effects rather than causes.

There are, of course, occasions when psychological symptoms turn out to be constrained or driven by biological conditions that were not initially visible. Equally, there are presentations that appear biological and are not. The point is not to deny biology, but to avoid granting it explanatory authority where it does not resolve what is at stake. In the phase I am describing, biological findings rarely settle the question.

This period matters. If it is lived through without being supplemented, something often begins to loosen. Life, oddly, starts to happen with less effort. By supplement I mean something quite specific, close to Derrida’s sense: a prosthesis that adds power or coherence at the point of absence, but in doing so also replaces it. The supplement supports, but it also stands in. It fills a gap while preventing that gap from being lived.

Alcohol is an obvious example, but there are others that are less readily named as problems. Exercise can function as a means of restoring bodily mastery. Faith can supply certainty where uncertainty has become difficult to tolerate. Marriage can stabilise identity through another person. Parenthood can confer moral authority, purpose, and direction. None of these are pathological in themselves. They become problematic when they are recruited too quickly, when they serve to restore a sense of power before the underlying organisation has shifted.

When that happens, the supplement begins to organise life. It has to be protected. Others are drawn into it. What looked like recovery hardens into a structure. A life may function well enough, but something in it does not quite move. The consequences are rarely limited to the person alone.

This is why the phase is so exposed. It offers little in the way of consolation or mastery. It does not feel powerful. But it is also the point at which something else becomes possible: not explanation, not resolution, but a reorganisation of how power, dependence, and vitality are lived. Whether that happens depends, in large part, on whether the space is tolerated, or whether it is filled too quickly with something that looks like a solution.