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Talking Cure

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What makes the mind develop? What helps children grow up? When can we think of ourselves as adults? Why do we fall in love? Why do our feelings sometimes 'get in the way'? How do families affect us? What is mental illness and what is normal? These are just some of the questions discussed in this new reissue of the classic Talking Cure: Mind and Method of the Tavistock Clinic.It has long been known that having someone listening carefully to what we say can help us make sense of life and cope better with its difficulties. In a unique synthesis of modern human relations, psychology, and science, experienced psychotherapists from the renowned Tavistock Clinic explore the power of the mind and the importance of therapy.Talking Cure shows how the mind operates through all stages of life. Drawing on Tavistock Clinic research and case studies, it demonstrates just how much "the heart has its reasons the reason knows not of". Providing insights into many areas of contemporary life and into the challenges of the future, this book provides a valuable insight into one of Britain's foremost psychotherapeutical traditions.Contributors from the Tavistock Clinic include Robin Anderson, Jenny Altschuler, Caroline Garland and Margaret Rustin, who also contributed to the accompanying six-part BBC series on the Tavistock Clinic.

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1. Beginning of the Mind

ePub

In the Creation story of the Book of Genesis, God laboured for six days followed by a day of rest to observe his work. This myth, where God divides the light from the dark, the sea from the land, the physical from the spiritual, is a powerful pre-scientific account of the creation of the world and of man. We know now that it took several million years for man to evolve from his primate ancestors. Likewise, the belief in the tabula rasa, the blank slate of the new-born’s mind, which originates from philosophers of earlier generations, is no longer compatible with what we know. It has given way to the idea that a new-born baby brings a mind with him. In the same way that an antelope calf staggers to its feet immediately after birth, this mind is capable of communicating as well as many other mental activities.

If the mind is not a blank slate at birth, when does our mind begin? What is going on when the baby is growing in the womb, at a level beyond the physical changes? Does the baby in the womb have a way of registering its experience? How does a mind begin to take shape before birth?

 

2. Play

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And the streets of the city shall be full of boys and girls playing in the streets thereof. (Zechariah Viii. 5).

Introduction

Even tiny babies know how to play. The mother copies and elaborates the baby’s more disorganised movements and gives them some order; the baby then copies these copies and alters them, and this in turn is further copied by the mother. Is this a game? It certainly seems to have playful qualities. Later when babies throw things out of their chairs and invite a parent to pick them up, only to repeat the action often with a smile or a gurgle, we can certainly think of this as a game.

Although playing is most intensive in childhood and adolescence it remains part of our activity throughout life. Indeed, we usually think of those who can remain playful in their adult lives as being those most full of life. The word play used in the sense of drama suggests that culturally we have made a connection between children’s play and adult activities, especially art. These activities which form the fabric of human civilisation and culture and are deeply important to large sections of society can be thought of as adult derivatives of children’s play. The notion of play is also associated with fun. But although pleasure and laughter are often associated with play, adult playing can also be a very committed activity. Likewise children’s play can be very serious.

 

3. Are Children Innocent?

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Adults have powerful longings to believe that babies are good. When we look at a newborn baby it seems natural that the idea of purity comes to mind. The beginning of a new life, as yet untouched by all that can impinge on human beings both from within and from without, evokes in us a desire to protect and idealise the baby and our own responses to the baby. This has something to do with the way in which a new baby in a family, or small children in general, can be invested with our hopes of something better emerging in the future. The new chance represented by new life - not yet spoilt in the ways that we may feel our own lives have been - is a source of hope.

In particular, the baby born within a loving sexual partnership contains the hope of the couple that their relationship is creative. Each member of the couple feels that a part of themselves is within the baby and longs to see in the developing child good aspects of their own character and talents. Such parental idealism, too, contributes to our desire to believe in childhood innocence. We tend to look at our children as if into a mirror, like Narcissus in Greek mythology, seeing the beauty and not the blemishes. These deep longings for perfection soon come into contact with all the mixed reality of life, and both parents and babies discover that negative feelings as well as love have a place in their lives together.

 

4. How Does Growing up Happen?

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Introduction

From the moment we come into existence as a single cell to the moment our last breath leaves us, we are in a process of constant biological change. For human beings, growing up physically takes more than a quarter of our life-span. It takes place in a predetermined way under strong genetic influences whether we like it or not.

Emotional growth, on the other hand, seems to take place - at least in humans - in a different way, with huge personal influence. Successful emotional growth leads to yet more personal development whilst hold-ups inhibit further emotional development. The broad direction of mental development is also predetermined, and yet how we mature emotionally, and where we get to is variable and difficult to sort out. The personalities of identical twins, for example, can have remarkable similarities but, equally remarkably, there will be many differences: what different people they become. Emotional and physical growth go hand in hand during childhood and youth, but emotional growth can continue throughout our lives whereas physical decline in some form commences surprisingly early in adult life.

 

5. What Causes the Mind?

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‘Of course history is an art - just like all the other sciences.’ It is in the sense of science as an art that most psychoanalysts and psychotherapists, like the historian author of this quip, would think of themselves as researchers. They are materialists. If asked the question, ‘What causes the mind?’ one of their first answers would be, ‘The brain’. We think of the brain as being more fundamental than the mind. In states such as deep unconsciousness, anaesthesia or death, the brain can exist without there being a mind but there are no states - at least that we know of - where mind can exist without brain. Most of us would accept this and all the evidence points in this direction.

However, as we repeatedly learn, human beings cannot bear too much reality. Correct scientific ideas are often irrationally denied. Or scientists can over-use rationalism in a defensive way. They can promote the scientific method of investigation as the only way, ruling out other facts or bodies of knowledge which are difficult to face. Neuroscience and its advances are sometimes used to make the fact that people are persons redundant. Persons have passions. They experience the difficulties that personal relationships often entail. They can carry troubling thoughts, feelings and wishes in their minds. Over the course of life, from being a baby in the womb to infant, from infant to child, from child to adult these relationships and these wishes influence powerfully how the mind - and brain - develops.

 

6. Love

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There is a bawdy poem by Pushkin telling the story of Tsar Nikita, all of whose forty daughters were born without genitalia. Wishing to put this sorry state of affairs right, the Tsar sent a messenger to the local witch to ask for help. Obligingly, the witch packed up forty sets of female parts in a box, and sent the messenger off with them. He was filled with curiosity. What was in this mysterious box? He shook it but there was no noise. He sniffed at it - and detected a deeply familiar and irresistible smell. Overcome, he opened the box

- and to his dismay out flew the forty little female parts, up into the trees like so many birds. He sat gloomily down by the side of the road, aware of what would befall him if he returned to the Tsar empty-handed. He was in despair until an old peasant woman came down the road and asked him what the trouble was. Simple, she said: all you have to do is get out your penis… and at once the forty female parts fluttered back down to him and were easily caught.

 

7. Dreaming

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How do we know we are dreaming? We usually don’t, at any rate not until we wake up. Dreams in which one says to oneself ‘This is only a dream’ are relatively rare. How we know that we are awake is a harder question. We believe that we are awake and not dreaming, but we cannot prove it. Bertrand Russell, the philosopher, wrote dryly, ‘It is obviously possible that what we call waking life may be only an unusual and persistent nightmare’. Young children may know that ‘dreams’ are the name for the life that takes place when they are in bed with their eyes closed, but they can be confused about the reality of these events.

A small boy awoke crying, frightened by a nightmare in which he was being pursued by a crocodile. His mother came to his bedside to comfort him, but he remained inconsolable. She said to him, ‘Tell me about the crocodile, what did he look like?’ With a fresh burst of tears at her obtuseness, he said, ‘Well, you should know what he was like, you were there too!’

Once awake, most adults can recognise the physical laws of space and time that govern waking life. These Newtonian laws do not hold good in dreams, where strange alterations in space-time excite no comment. Most of the time we think that we keep these two worlds apart. Yet a powerful dream can affect one’s mood throughout the day. Getting out of bed on the wrong side, unreasonably picking a quarrel, or alternatively being surprisingly buoyant, in a good mood, can sometimes be linked to the events of a forgotten dream (see Plate 8).

 

8. What is a Family?

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The term family has different meanings for people of different ages and cultures. Family forms are changing rapidly, and more and more children are likely to spend some of their lives in families that do not fit the norm of a two parent -two child family. At the same time, British society has changed in other ways, becoming increasingly multicultural, with diverse family patterns and cultural traditions, even though the image of the ‘nuclear family’ continues to dominate ideas about the family. When a National Children’s Bureau survey asked children to define what a family is and what families are for, it found their definitions were about love, care, mutual respect and support, regardless of gender, ethnic background and location.

How then do these comments reflect the reality of families today? Is what these children define as a family realistic or are they holding on to dreams?

These are important questions. What is it that families share and what makes each and every family unique? This chapter highlights how details of family interaction affect relationships both inside and outside of the family. In families, we are constantly trying to understand what is happening and work out what others are thinking. Some of the ‘stories’ or ideas we have about one another may be shared, but others are not, and it is the tension of negotiating which story will dominate that forms the core of family life.

 

9. Groups

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In this chapter we widen our perspective and consider the nature of the group: the setting in which human beings join with each other in units of varying size and complexity, each greater than the sum of its parts. These social structures -many-bodied, yet in many respects functioning like a single organism - have their own dynamics, both internal and in relation to each other, which can be studied in their own right.

Human beings are profoundly social animals, ‘herd animals’, as we have been called in 1916 by Wilfred Trotter, both a distinguished surgeon and also an early observer of human beings in groups. It is not only that from the first moments of life we seek out the company of others of our own species. Just as our eyes are sensitive to light in the visible spectrum, our personalities are designed to function in relation to other human beings. The very structure of the human mind is such that we define our selves and our behaviour in relation to those others. Even the hermit is part of a social system, though it is one he chooses to shun. Like biologists, psychoanalysts see the drive for relatedness to our fellows as primary, an intrinsic part of our make-up - as fundamental to our being, to our mental functioning, and to our survival as the drive for food, warmth, shelter, sex.

 

10. Work

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The fact is that after I felt sure of myself as a welder I felt sure of myself and everything, even the way I walked.

Primo Levi.

This quotation from the novel The Wrench by Primo Levi expresses the way in which our self-esteem is intimately related to our experience of work. Why should this be so? Because we get a large part of our sense of who we are, our worth and particularly our sense of our effectiveness through work. Work provides a structure to our lives, a way of being present in the here-and-now of things, rather than being bogged down in our internal worlds of memories from the past and dreams of the future.

Yet the world of work no less than that of the family, the nursery or the school engages people only if it engages with their emotional life. People go to work for money, but not only for money. All the evidence suggests that money alone, and tinkering with arrangements over pay such as bonuses, (unless this is a very significant proportion of take-home pay) has little impact on the way people perform. Other issues are at stake. People work well in organisations where there is some degree of alignment between what they value and are committed to, what they will work to achieve, and the values and commitments of the organisation.

 

11. Food for the Mind

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The health of our bodies depends on good food and a physical environment which meets our physiological requirements. Modern scientific knowledge is giving us longer lives and better physical health than our predecessors, although these benefits are very unequally distributed in different parts of the world. Better food and housing, a proper balance of work and rest, access to open space and opportunities for healthy exercise, cleaner air and controlling pollution of the land and sea are all consequences of social policies aimed at improving the quality of life. Although all of these benefits continue to be contested, the consistent commitment to public health measures of this sort does indicate the degree of social consent and a shared agreement on their scientific basis.

We should note that sharp disputes still erupt whenever new or awkward facts need to be accommodated. For example, the recent evidence that inequalities of wealth are associated with lower levels of health generally (not only for the poorer classes in society) is likely to remain contentious, since it goes against strong political and economic trends sanctioning greater inequality. Facts never operate in a neutral universe, especially in relation to human questions because we immediately encounter our different values and interests.

 

12. Attitudes to Normality and Psychiatric Illness

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Mental illnesses are altered by the beliefs and expectations we have about them. In this they are unlike natural phenomena, such as storms or sunspots, which occur unchanged whatever human beings think or do. Although we now know that some physical illnesses can be affected by the sufferers state of mind, the agents which cause infectious diseases, for example, are oblivious to whatever is thought about them. Once an infection with the meningococcus is suspected, it is not sensible for the doctor to sit back and think about the problem. It is critically important for the right antibiotic to be given quickly.

Mental illnesses are different. In most mental illnesses, definite physical causes have not been established. At the level of society, both individuals with mental illnesses and the illnesses themselves are influenced by the attitudes held towards them. This is not to suggest that simple psychological or social factors - habits of mind, prejudices, labelling, stigma and so on - can by themselves cause major mental illnesses, although the malign effect of certain very adverse childhoods can come close to producing mentally sick children and adults. Nor is it the case that drugs do not have an important role in the treatment of mental illnesses. However there is a tendency to rely too exclusively upon drugs, or to place too exclusive a hope in long-awaited pharmaceutical cures. Most of us are uncomfortable about our own emotional balance. It is easier to put one’s faith in a cure. But perhaps as a consequence, we as a society, neglect the reluctant benefits which can come from the struggle to recognise, to understand and to modify difficult emotional factors in ourselves as individuals.

 

13. Mental Distress and Mental Illness

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Then Sinne combined with Death in a firm band To raze the building to the very floore: Which they effected, none could them withstand. But Love and Grace took Glorie by the hand And built a braver Palace than before.

From The World’ by George Herbert (1593-1633).

When, between 1980 and 1982, psychiatrists and psychologists interviewed 18,000 people as a representative sample of the populations of five different places in the USA, 2,700 of them turned out to have a psychiatric disorder. In the UK up to a half of people consulting general practitioners have symptoms which do not have any underlying physical cause. 14 per cent of all people consulting a GP have a psychiatric illness. This is slightly more than those who have diseases of the heart and circulation. Two per cent of the population will see a psychiatrist in any one year and slightly less than one percent will be admitted to a psychiatric unit. A recent report estimated that at any one time 20 per cent of children and adolescents have mental health problems.

 

14. Therapy

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When mental or emotional difficulties occupy the mind to the detriment of everyday life, treatment may be helpful - or indeed necessary. Just as one might go to a doctor with a bodily pain so one might consult someone experienced in mental disorders when excessively troubled in one’s thoughts or feelings. There are five categories of treatment for the emotional and mental problems of life. Each does an essential job but none of them does it perfectly, so that different kinds of treatment are sometimes best used in combination with each other. Although this chapter is primarily concerned with just one of these types of treatment - psychodynamic psychotherapy - we begin by outlining the other main types of treatment (see Plate 13).

On the whole, the major mental illnesses need to be treated with drugs and social interventions. Chemotherapy is treatment by drugs, powerful chemicals that have been discovered to have an effect on the body or upon the agents of illness. Those used to treat mental illness include anti-depressants (such as sertraline or prozac), anti-psychotics (such as chlorpromazine or clozapine), sedatives such as diazepam (Valium) or barbiturates, and stimulants (such as Ritalin or amphetamines). Physical treatment describes physical interventions such as electro-convulsive treatment or ‘shock’ treatment (ECT), or, more rarely, brain operations. In ECT, an artificial brain seizure is induced under an anaesthetic and, for reasons that are not fully understood this can sometimes bring about dramatic improvement in some forms of depression. Social treatment involves measures to improve the sufferer’s social conditions or relationships. It can include protected living arrangements - the old-fashioned meaning of the term asylum - or living in hostels or in special communities. Occupational therapy, protected work settings, or help from a community psychiatric nurse with managing the day-to-day business of life are all forms of social treatment.

 

15. Registering Time

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Typically, a young child is supposed to be innocent and curious before he grows into a bold and optimistic young adult who then proceeds to become a sagacious and serene old person. Of course, this is a gross idealisation of the reality, for there are many trials and troubles that lie upon this path of development. Not least, new and alarming experiences generally make us feel as small and vulnerable as a baby and it is difficult to tolerate this as an inevitable emotional accompaniment to change and maturation. This chapter is about man’s lifespan development. It offers no recipes or solutions and seeks only to describe some of the problems.

‘I want to grow down’, one six year old said. Birthdays to her were not markers of moving on, but demands for going forwards which she dreaded. She wanted to go backwards. She was afraid of not being able to manage becoming more independent from her mother and of the growing expectations that she should be able to share people and possessions with other children.

 

16. Age

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Many old people continue until the end of their lives to make a personal contribution that is deeply missed when they are gone. In these old people whose zest for living is undiminished the capacity to remain open to new experience is a fantastic quality. Their generosity to those who are mature but who still need occasionally the comfort of a parent is deeply reassuring. Many of these loved old people are quite able to accept that their life will have a limit and can welcome death as an event coming like a good friend, at the right time. The sculptured and lined attributes of the aged are an antidote to our modern tendency to make being forever youthful our only goal.

One much loved woman, Miss Tait, a lifelong spinster in her eighties, began to lose something of her usual vigour. She was nauseous and lost weight. After a short while a malignant, inoperable tumour was diagnosed. Over the succeeding months she gradually weakened but the inroads made by the tumour were gentle rather than nasty. Often she seemed to be denying that there was anything wrong. ‘I’ll be better next week, don’t you think?’ On other occasions her conversation seemed to indicate that she was perfectly aware of what was going on. ‘It’s been not a bad life. I’ve had my life. I’m ready now. I’m tired’, were asides which were scattered through her conversation. She said that her only worry was her younger brother whom she’d always looked after. She hoped to be re-united with her mother.

 

17. The Future

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Science and technology have given us tools that have changed the world and that would make ancient man marvel. The advances in the humanities and the arts, though no less significant, have been less spectacular. Our knowledge of the human character has changed as the humanities and the arts have changed: slowly and subtly. As a result the scientific ideas of the ancient world tend to be of historical interest only whereas the ideas of ancient literature, the Bible and Shakespeare are as relevant to man today as they were the day they were written. In science even the rate of its advance is accelerating. In marked contrast the cause - man - of this exponential growth is not. Late (very late) twentieth-century man or woman is recognisably the same as Biblical man or woman. The 400 years since Shakespeare’s time have not made his view of the human drama out of date. This contradiction of a man-made abundance of scientific and technological developments with man himself unchanging in his fundamental nature, creates some important but familiar tensions. While men and women bend the environment with their technology, they can also struggle to adapt themselves sufficiently to these discoveries.

 

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