Saturday, January 16, 2010

Of Dreams - Good and Bad

For all of us human animals the unconscious is a source of inspiration. Freud, the great founder of Psychoanalysis, stated that dreams were nothing short of "the royal road to the Unconscious." He was the first great scholar to give considerable attention and pride of place to the unconscious in the psychic make-up of the human person. That is not to say that the world of the unconscious was unknown to many generations of writers and artists before him. No, indeed, that is to say, that he was the first to study it more "scientifically." As I have pointed out many times in these posts, Freud considered himself a scientist, and indeed, considered Psychoanalysis essentially a science. There have been those who contested this statement, but be that as it may, we owe the founder of psychoanalysis much as he is essentially the great pioneer of all talk-therapy and of all psychotherapy.

Likewise, we owe a lot to his great masterpiece called The Interpretation of Dreams which I have written about many times in this blog - see the following link: Freud's Interpretation. This masterpiece along with Einstein's discoveries between them formed much of the cultural revolution that went to make up modernity as we understand it in the twentieth and twenty-first centuries.

My title alludes to good and bad dreams. We need both, and indeed we do have both. In this regard, I wish to juxtapose two recent films which I went to see, and to contrast them as good visual representations of both these essential categories of dreams. How often have we heard, and indeed used any of the following phrases: "my worst dream came true," "it was a nightmare," "I thought I was in heaven," "you are the woman (man) of my dreams" etc. ? Now I wish to discuss human dreams as represented in two recent films I viewed. The two films I wish to compare and contrast are showing currently nationwide, viz., Avatar and The Road.

I first came across the word "avatar" years ago when studying comparative religion in the late 1970s - avatar in Hinduism refers to the many representations, appearances or manifestations of a particular god. We in the Christian West often use the term incarnation and this term quite closely approximates to what is meant by avatar. However, for the Christian West there was just one incarnation of the Godhead and that was Jesus Christ, but for the Hindu Religion, the most synchretistic of religions, there could and can be multiple incarnations of any god and therefore many avatars. In more modern culture I see avatars refer to some kind of three-dimensional representation of pictures of individuals and, for one's profile picture on different sites and discussion boards, one can upload one's chosen avatar, having got such an image made of your favourite profile picture.

The official site for Avatar is very good too, and gives one a tempting taste of the real thing: Avatar Official Site. This is a film of mythic proportions, and indeed we human animals need our myths - those greatest and most wondrous of dreams, those mythic dreams that tap into our very sense of who we think we are or can possible be, into our sense of what the very universe is about and what our very role in it is or can be. It is no surprise that such a film of epic and mythic proportions should be made by James Cameron, the Canadian film director, producer, screenwriter, editor, and inventor. He wrote and directed The Terminator (1984), Aliens (1986), The Abyss (1989), Terminator 2: Judgment Day (1991), True Lies (1994), and that epic of epics Titanic (1997), and now he comes along with the wondrous, wonderful, epic and mythic Avatar (2009). Having made several feature films, Cameron turned his focus to documentary film making, and to co-developing the digital 3-D Fusion Camera System. Described by a biographer as part-scientist and part-artist, our man Cameron has also contributed to underwater filming and remote vehicle technologies. He returns to feature film making with Avatar which made use of the Fusion Camera System technology.

This was my first time experiencing the 3-D effects at the cinema, and I found it simply mind-blowingly brilliant. As one reviewer lyrically puts it:
Avatar is an astonishing feast for the eyes and ears, with shots and sequences that boggle the mind, from the epic – a floating mountain range in the sky, waterfalls cascading into nothingness – to the tiny details, such as a paraplegic sinking his new, blue and fully operational toes into the sand. The level of immersive detail here is simply amazing. See Review.
Ans so, to my mind, this film Avatar combines all the best in technology with the deepest of human dreams and desires, thereby raising this film to epic and mythic proportions never before witnessed in the cinema. It is a cross between science-fiction at its best and the Utopian dreams of the likes of Gandhi, Martin Luther King, JFK and the cinema experience is consequently like Gandhi/The Mission meeting Star Wars/The Matrix. This film touches one deeply at the level of the soul as well as superficially on the level of the senses. It's a must see film!

Now to the second film, The Road. If Avatar represents essentially the best of human dreams, then this film represents the worst of our nightmares, the end of planet earth and the end of its human animal inhabitants. In Avatar we have a glimpse of Utopia with the deep belief that it could possibly be true. In The Road we have an on-screen representation of our worst nightmare, that we human beings will eventually destroy ourselves and prey one upon another as we have reduced our planet to a lifeless and crumbling uninhabitable desert. It is a nightmare of equally mythic proportions - the death and dying of the few humans that are left on planet Earth is almost inconsequential and insignificant and almost unmoving against the sheer greyness and depression of a planet which itself is almost dead. The tragedy is not so much of human proportions, but much greater, the end of all earthly life, human, animal and inanimate. This is a Dystopic film of infinitely depressing proportions. It is your worst nightmare come true. The world is in ruins after some apocalyptic event.

A father and his son are walking towards the coast in an attempt to head south to escape the increasingly cold, endless winter. Along the way they have to avoid gangs forced into cannibalism. The father has dreams about his wife, who committed suicide before the story begins. At one point they find an intact bomb shelter filled with food and supplies. Rather than remain in this sanctuary, they continue on because they have not yet reached the coast. The only named character they encounter in the entire book is an old man who says his name is Ely. They eventually part ways. The whole journey is a struggle to survive in a world no longer capable of sustaining life. They almost lose this struggle when a thief makes off with all their worldly possessions, and the Father nearly loses his struggle to hold on to his humanity in taking those possessions back. The boy is all that keeps him barely human. The boy is his warrant, in his own words. In the end, they reach the coast but find it is no different, no better than the place they left behind. The father finally succumbs to the illness that has plagued him from the beginning, dying and leaving the boy alone.

Then at the end another man who has a wife and two children finds him and invites the young boy to join their family. There is a hint of possible survival for a little longer in the bosom of this warm family, but given the bleakness of the whole apocalyptic Armageddon nature of the film, we can indeed hold out little hope. In this film, we have the ultimate nightmare of the death of all life as we know it, the end of the world, the end of life, the end of consciousness. All through the film one gets the sense of the boy and his father literally crawling back to the sea, that ancient cauldron of slime from which we crawled aeons back at the very beginning of evolutionary life.

Both films are worth seeing from the point of view of the contrasts of Utopia versus Dystopia, of the best of all possible dreams and the worst of all possible nightmares. However, it is important to note that Avatar does deal with the struggle of Good versus Evil and that evil features a lot in it, but in keeping with all traditional epics and myths Good does win out. In The Road, we have the sense of the end of things, that Good is a useless little emotion at best against the all-embracing final extinction of all life. Evil wins the day.

Choose your vision or choose your dream. Maybe the truth lies somewhere in the middle!

Tuesday, January 12, 2010

To Medicate or not to Medicate, that is the Question 3

I should like briefly to return to this question of medication versus talk therapy for the "cure" or at least alleviation of the pain of Depression, that most misinterpreted ailment - it is as much misinterpreted as one of its polar opposites, namely love. Well, what brought me back to this topic at all? Quite simply, the other day I chanced to visit my mum, who is in a nursing home. I had called at an earlier time than usual, and as she was being changed, I sat down at the communal table just at the nurses' station. On the table lay a copy of the daily Irish Independent. I refer to the issue of this paper for Friday 8th opf January, 2010. As I leafed through this paper my eyes caught the photograph of beautiful lady sitting in the lotus position on her sumptuous and comfortable double bed. The beautiful and beguiling smile belonged to that of the popular Irish writer of "chic lit," namely Marian Keyes.

As I have a keen interest in this subject, I read this article with great attention. Indeed, it was written by one of my favourite Irish psychiatrists, Professor Patricia Casey. (I have many favourite psychiatrists as those of you who read these rather eccentric and "sui generis" postings will note. I am quite taken with the quip made about C.P. Snow - I'm not so sure who made it - that "all his geese were swans," - I believe it is the same with me, I find it quite impossible not to praise, and, indeed, I possible do over-praise and over-estimate what is just good as being very good and excellent. However much I admit to this fault, Professor Casey's article was riveting for me. She had a rather long title to the piece, but nonetheless quite effective, viz., "Sometimes words are not enough to lift depression." You can read this article here:

Patricia Casey

Casey makes very well the points that I was attempting to make in my other two posts. This most important point is: There are two distinct versions of Depression, namely (i) Endogenous Depression and (ii) Reactive Depression. These terms, Casey informs us, are the more tradition terms for demarcating two very different realities one from the other. The first category may be termed variously, but they all mean the one thing, namely a CHEMICAL IMBALANCE in the brain. Hence we may designate this form of depression as being: Endogenous, Chemical, Biological or Clinical Depression - you may choose your own preferred term. The second form of depression may be called by various names too, viz., Reactive Depression or Situational Depression. Hereunder are the words of Professor Casey in describing the first and worse kind namely Clinical Depression:
[it is a]depressive illness, so incapacitating that physical functions cease; eating, reading, moving, washing, talking all seize-up in a state of almost frozen emotional and physical paralysis. In psychiatric jargon, this is called psychomotor retardation. For some, life itself may end when the emotional pain and hopelessness become too engulfing and no light is visible, no joy foreseen and no love apparent.
I found one very helpful book on this form of depression, the clinical or endogenous variety and it really appealed to me. It was called Malignant Sadness by the atheistic biologist and a wonderful scholar, Lewis Wolpert. I cannot remember if I reviewed that book in these pages as I read it some ten or more years ago. It is full of science and explains the whole psychiatry thing in a biochemical fashion. I loved it, because Lewis Wolpert writes with scientific knowledge and a passion and a certainty I did not find in other books. He also describes therein my own peculiar symptoms, which I share with him, in precise detail. I also learned that many patients spend years trying to get a proper diagnosis because, while there are many common early symptoms, there are also ones peculiar to the personal chemistry of this or that individual. Anyway, psychopharmacological intervention helped me and continues to do so. It's at my peril that I discontinue my medication...

As a sufferer from this type of depression and having gone through two severe bouts of it, I totally and completely concur with Professor Casey, and indeed with Marian Keyes whose blog Brofessor Casey quotes. Needless to say I found Marian's webpage and found some quotations therefrom. Let's listen to her words too:
My dear amigos, happy new year to you all and I hope your festive season was not too unpleasant. I’m very sorry but this is going to be a very short piece because I am laid low with crippling depression. Regular readers know that I’ve been prone to depression on and off over the years but this is in a totally different league. This is much much worse. I know I’m leaving myself open to stinky journalists saying ‘What has she got to be depressed about, the self-indulgent whiner, when there are people out there with real troubles?’ so I won’t go on about it.

All I will say is that I’m aware that these are terrible times and that there are people out there who have been so ruined by the current economic climate that they’ve lost the roof over their heads and every day is a battle for basic survival and I wish I could make their pain go away. But although I’m blessed enough to have a roof over my head, I still feel like I’m living in hell. I can’t eat, I can’t sleep, I can’t write, I can’t read, I can’t talk to people. The worst thing is that I feel it will never end. I know lots of people don’t believe it, but depression is an illness, but unlike say, a broken leg, you don’t know when it’ll get better
See this link here, and do read the wonderful pieces of wisdom she writes there at the end of her entry for that day: they are nuggets of gold garnered from different authors from a range of traditions and places: Marian Keyes

Reactive Depression or Situational Depression as Professor Casey terms it is indeed a far different creature which does not share the depth of distress exhibited by the clinical or chemical variety of the complaint. Now I am going to copy here probably too much of Professor Casey's wonderful words. However, I advise you, if you have an interest to read her article in full and follow all the links given on the page. Also reading Marian Keyes' contribution is also recommended - I have given both links above. Now I'll quote Professor Casey once again and leave this gripping topic there:
...the same word, 'depression', is used to describe two different phenomena. One is a mood state that arises in response to life circumstances, which I will refer to as situational depression, while the second describes an illness that can arise spontaneously due to changes in brain chemistry that are independent of life events. This is often termed clinical depression or depressive illness. Formerly, these different emotional states were called reactive and endogenous depression. Interestingly, those who suffer with clinical depression rather than situational depression can distinguish the two mood states as being very different.

With one there is a total lack of joy, a feeling of flatness, an inability to respond to or to experience love. With the situational variety, the person can be distracted from their low mood and tearfulness, they can interact and react to their surroundings and be responsive to those in their lives.

Changes to the way depressive illness is diagnosed have resulted in the two being conflated -- with those who are unhappy due to life circumstances being misdiagnosed as having a clinical depression and receiving antidepressants. The appropriate criticism of the use of medication in these circumstances has caused many with clinical depression to refuse lifesaving antidepressants.

Those with depressive illness find it difficult to engage with talking therapies due to their physical inability to even concentrate, let alone act, on advice. Engaging in pleasurable activities is physically impossible as the whole psyche seems to shut down.

Indeed, therapists who attempt to carry out these therapies with those who are severely depressed will often speak of their clients as not being 'reachable' or emotionally accessible. Those who, when well, are capable and decisive become needy and indecisive.

(These comments are accessible at the above given link)
Above, a picture of the sky in the Phoenix Park. I took this photo in June 2009.

Monday, January 11, 2010

Sometimes the Centre Cannot Hold 5

Searching for the Elusive Centre:
I return again to R.D. Laing's little classic The Divided Self. What impresses me is Laing's sheer humanity and impressive humility. In commenting in some detail on one of Kraepelin's descriptions of one of his patients (a young man) way back in 1905, he mentions the fact that very little has changed really with respect to doctor-patient interviews. Notice the humanity and humaneness of Laing's commentary in the following:
One may see his behaviour as 'signs' of a 'disease'; one may see his behaviour as expressive of his existence. The existential-phenomenological construction is an inference about the way the other is feeling acting. What is the boy's experience of Kraepelin? He seems to be tormented and desperate. What is he about in speaking and acting in this way? He is objecting to being measured and tested. He wants to be heard. (Op.cit., p. 31)
Bring your attention to the last two sentences because they are at the heart of what Laing as an existential therapist is all about - listening to the patient in the concreteness of his existence, listening to his pain and torment, not attempting to measure or test, but being a trained and empathetic ear.

The Therapist as Interpreter:
Laing bows his knee to the founder of psychoanalysis - Dr Sigmund Freud - at this point in the text. According to Laing the great man used the metaphor of the expositor or reader of hieroglyphics as a rough approximation of what the therapist or analyst seeks to do - to interpret what the patient said OR says. He also mentions the metaphor of the interpretation of historical texts as expounded by Dilthey (see ibid., pp. 31-32) While commending this interpretative approach, Laing does issue a timely warning:
To look and to listen to a patient and to see signs of schizophrenia (as a 'disease')and to look and to listen to him simply as a human being are to see and to hear in as radically different ways as when one sees, first the vase, then the faces in the ambiguous picture. [Laing is here referring to the traditional visual perception puzzle where one can see faces looking at one another on one glance or a vase or candle stick when looked at with another glance.] (Ibid., p. 33)
Then, Dr Laing, quotes Dr Harry Stack Sullivan's important remark, on the surface of it very obvious, that the psychotic patient is, after all, 'simply human.' In this way, the therapist can understand the patient's existential position. He then loses no time to disabuse the reader's mind of a narrow cognitive understanding of what is meant by 'understanding.' By this term, he tells us, he means something akin to 'love' which he admits is a very debased and over-used term. Then he expresses by a real example what he means by 'understanding' or 'love.'
No one has schizophrenia, like having a cold. The patient has not got schizophrenia. He is schizophrenic. The schizophrenic has got to be known without being destroyed... the therapist's hate as well as his love is, therefore, in the highest degree relevant. (Ibid., p. 34)
Insights into Schizophrenia:
I was quite taken with Ronald Laing's use of the glass metaphor with respect to schizophrenia. I had also come across the use of this image by a woman with whom I had a short relationship. She described her schizophrenia as similar to being in a glasshouse. Our sense of our own privacy is very important to each of us and it is the very basis of genuine relationships. However, schizophrenics often see themselves as totally transparent to others. Here are the words of Ronald Laing once again:
... but the person whom we call schizoid feels both more exposed, more vulnerable to others than we do, and more isolated. Thus a schizophrenic may say that he is made of glass, of such transparency and fragility that a look directed at him splinters him to bits and penetrates right through him.. We may suppose that precisely as such he experiences himself. (Ibid., p. 37)

Sunday, January 10, 2010

Sometimes the Centre Cannot Hold 4

When words get in the way:

It would seem that some people who are essentially power brokers e.g., politicians, senior civil servants, senior lawyers, the clerical hierarchy, senior consultants and bankers and others in the higher echelons of their professions can be nothing if not mental gymnasts. By this, I mean that they can use and abuse language for their own purposes. When I was studying theology well over 30 years ago we discussed such "mental gymnastics" by the name of casuistry. It is a form of argumentation that is specious or excessively subtle and intended to be misleading. Cardinal Desmond Connell is one of its leading exponents in the Roman Catholic Church in Ireland. Mike Roddy, a Reuters journalist and blogger neatly sums up Connell's specious argumentation:
Cardinal Desmond Connell said that while a priest could not tell a lie, he could knowingly leave a false impression, under what Connell said was the concept of “mental reservation.” “There may be circumstances in which you can use an ambiguous expression realising that the person who you are talking to will accept an untrue version of whatever it may be,” Connell said by way of explaining this cleverly nuanced take on St. Augustine’s treatises proving it is never lawful to tell a lie. Mike Roddy: See this link here: Reuters Blogs
It's not only the Catholic Hierarchy that uses specious argumentation - all other power brokers do too, viz., politicians (recall for a moment Brian Lenihan Snr's (RIP) quip "on mature recollection," or bankers who can use such euphemistic and oxymoronic terms as: "downgrowth" for hardship, repression or depression; "negative profit" for loss; "write downs" for write offs and the term "underbanked" instead of poor or broke.

Of course, business people can use euphemisms too e.g., "pre-owned" for used or second-hand. I've even read the term "enhanced interrogation" for "torture" and "convenience fee" for surcharge. I remember way back in 1979 when we went to see the famous film Apocalypse Now with our then English lecturer John Devitt he gave us the task of writing a brief comparison between the film and Joseph Conrad's Heart of Darkness. It was then that we heard the extraordinary term "exterminate with extreme prejudice" for "kill." This is a language use that tends to sanitize the unacceptable "stink" caused by the appropriate word. To do such to language is not too short of lying, in a sense. We are somehow afraid to tell the truth, to present things as they really are.

However, what I am getting at here is that the use, misuse and abuse of language is all about power and control, all about protecting vested interests whether that be monetary or professional, and even cultural (I'm alluded cultural prejudices against outsiders etc).

And so now, I wish to return to The Divided Self by Dr. R.D. Laing. Laing set himself the task as a young man of 28 when he wrote this classic in psychiatry to make madness and the process of going mad comprehensible. However, to do so he looked to the language of existentialism and phenomenology to make his arguments more comprehensible and clear to the general reader. He starts by quoting Wittgenstein who averred that "the thought is the language." and that a "technical language is a language within a language." (Op. cit., 19) Let me quote Laing more fully:
The words of the current technical vocabulary either refer to man in isolation from the other or the world, that is as an entity not essentially in relation to the other and in the world or they refer to falsely substantialized aspects of this isolated entity. Such words are: mind and body, psyche and soma, psychological and physical, personality, the self, the organism. All these terms are abstracta. Instead of the original bond of I and You, we take a single man in isolation and conceptualize his various aspects into the 'ego', 'the superego' and the 'id.' The other becomes either an internal or external object or a fusion of both. How can we speak in any way adequately of the relation between me and you in terms of one mental apparatus with another? This difficulty not only faces classical Freudian metapsychology but equally any theory that begins with man or a part of man abstracted from his relation with the other in his world. We all know from our personal experience that we can be ourselves only in and through our world... only existential thought has attempted to match the original experience of oneself in relationship to others in one's world by a term that adequately reflects this totality. (Ibid., p. 19)
In short, then, Dr Laing avoids all the above terms which he sees as separating out and dividing the existing human being into "things" and "its" and what he terms as mere "abstracta." There is not a little truth in his contentions. The 'I' and 'You' which Laing mentions above is very much what the Jewish philosopher/theologian, Martin Buber had in mind when he wrote his brilliant classic Ich und Du. (1923) Laing then tells us that he will use the term "being" to denote all that man is. The person, for Laing, can never be reified or made into a collection of things or processes - can never be 'thingified' or 'it-ified' (my neologism). He refers to "it-processes" and "the inveterate tendency to depersonalize or reify persons." (Ibid., 23). He then insists that the relationship of the Doctor or Psychoanalyst is one of person-to-person not professional-to-client or scientist-to-it. He argues passionately that each one of us can only exist as entities in relation to others, never in total isolation. Let me return to Laing's passionate words once again:

There is another aspect of man's being which is the crucial one in psychotherapy as contrasted with other treatments. This is that each and every man is at the same time separate from his fellows and related to them. Such separateness and relatedness are mutually necessary postulates. Personal relatedness can only exist between beings who are separate but who are not isolates...

Psychotherapy is an activity in which that aspect of the patient's being, his relatednessz to others is used for therapeutic ends... (Ibid., p. 26)