Friday, June 20, 2008

Idling With Ivor 9

I continue here with thoughts that literally assail me from reading Ivor's marvellous memoir Music and Madness. With the possible exception of entries on Freud, I cannot think of anyone's book which has caused me to write as many entries as this wonderful work. I would highly recommend this memoir to anyone with an interest in mental health from the multiplicity of caring professions involved in that sector to anyone with an interest in helping people be they social workers, youth workers or politicians.

I have just read chapter 32, called The Frozen Present, which I can say in extremely insightful for any psychotherapist or counsellor or helper to read.  This chapter impressed me with its solid scientific base, its practical approach with some good clinical examples, with its considered assessment of Freud and the more recent history of treating Post Traumatic Stress Disorder.

Once again I was impressed, not alone with the erudition of the writer and his clearly extensive clinical experience - in short, he knows what he's writing about, and his exceptional courage and honesty.  In this regard I want to quote in full the final paragraph of this chapter.  As I have noted before Ivor is usual for a psychiatrist in Ireland as he is also a psychotherapist, whereas practical all, if not all, psychiatrists in Ireland today work from a medical/biological/pharmacological model of psychiatry.  With this in mind he was anxious as his retirement approached that his psychotherapeutic unit in St Brendan's would be continued and not allowed to fall into neglect and fade away completely:

The date of my retirement duly arrived in March 1994 but, but as nothing had been done to implement this recommendation, I decided to hang on, on a sessional basis, for a further year in the hope that there would be some positive development.  By the end of that year it was clear that the programme manager had no intention of seeing this work continue.  The simple fact that a unit of this kind causes a lot of disturbance and disruption in the smooth running of a hospital such as St Brendan's.  In my experience the administrators of a health board are not primarily interested in the therapeutic outcome and welfare of the patients.  Rather, they are concerned with running a service that is financially economical and causes them as little trouble and disruption as possible.  I apologise if this sounds somewhat cynical but it has been my experience over the years of the way such bureaucratic organisations function. (Op.cit., 309)

Let all those involved in helping people take note.  I have also noticed something similar in the educational field.  Bureaucratic organisations are often soul crushing and soul destroying. As this chapter was so interesting and also so deep and the arguments so broad scientifically that I would just like to list in no significant order some interesting insights therein:

1. I loved the title of the chapter, viz., "The Frozen Present" as it describes precisely how a person who is traumatised may freeze at the particular moment of trauma.  However, what really came home to me that while I might have previously put the emphasis on the adjectival part of this phrase, namely "frozen," Ivor insists that the emphasis be placed on the noun itself, viz., "present."  I found this really interesting and new for me.  Ivor points out that we all frequently fall into the error that we are dealing with the past.  "Actually, we are always involved in the 'now': the 'frozen present,' what is stored in our memories, in our bodies, our attitudes and behaviour." (Ibid., 284)  As he states a little later: "Whatever we are attempting to change, it is what is there now that we have to work with." (Ibid., 285)

2.  The person/client/patient/analysand is the only one who can change himself or herself; "...any change and new learning involves some pain, but if what we are attempting to change is ourselves, our deepest personality, this can involve a lot of suffering.  If the person you are dealing with is not prepared to suffer then, to put it will be absolutely helpless to do anything to help him." (Ibid., 285)

3. Traumas that have happened to us years ago are cut off into a "frozen present" and are stored somewhere in our body and mind or body-mind.  The latter part of this sentence is mine and not Ivor's - I am interpreting what Ivor is saying and drawing my own conclusions here, but I feel they are what he is on about in this chapter.

4. Ivor worked with a lot of patients who suffered from unresolved traumatic experiences in the old Protestant church in St Brendan's.  The idea behind his therapeutic sessions every two weeks with these patients was the integration of this traumatic experience.  Ivor used a modified version of Grof's holotropic method.  "For patients who were unable to get into the traumatic experience in this way, we could inject Ketamine, which, apart from being a legitimate anaesthetic, is also a powerful hallucinogenic agent." (Ibid., 286)

5.  As well as the "fight or flight" response documented by Walter Canon in 1929, Ivor refers to another ancient response to danger namely that of "playing dead" or also "freezing" which "involves the operation of a primitive, biological, adaptive response which acts at the level of the primitive brain (outside conscious awareness or control)." (Ibid., 287)  The author then goes into the physiology of the brain, locating the areas of these primitive responses.  See pages 288-291 for some very clear diagrams and a comprehensive explanation.

To be continued.

Above, a picture of a walker I took on Donabate Beach last Sunday

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