Archive | Psychotherapy

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Self Help Summitry and Class

Posted on 09 February 2011 by JamesHamilton

Norman Vincent Peale

In January, London’s School of Life held what it called “The Self Help Summit.” The Summit, culmination of years of psychotherapists’ frustration at what they call the Self Help Industry, brought together a remarkable range of (tongue very much in cheek) the usual suspects: Philippa Perry, Alain de Botton, Richard Wiseman, Mark Vernon, Frank Furedi, Robert Rowland Smith, Oliver Burkeman (who has recently published a new book, Help!). Vernon, on the School of Life’s blog here, summarized the Summit’s questions thus: “Can self help make you happy, develop your power, save your life? Or are it’s (sic) advocates peddlers of snake oil? Or again: given the genre is hugely diverse, is it possible to separate the dross from the gold?”

I wasn’t able to attend, but if the various reports of the event are anything to go by, it went well and did better than just avoid becoming the kind of sneerathon that might have anticipated. But I want to add a thought of my own.

I’ve read a lot of self help books in my time. I met my first as a teenager. I’d fallen in love for the first time, only weeks after fastening onto my first real-world ambition. This wasn’t a situation for which my upbringing had prepared me. I knew no one in my world to whom I could ask advice from, or turn to, or trust. It was a lonely and frightening time.

I came across a copy of Norman Vincent Peale’s Power of Positive Thinking – in WHSmiths, probably, because this was the pre-Waterstones era. Scenting that this wasn’t a book that you wanted to be seen with in public, I read it in my room – and, for the first time, ran across concepts like goal setting, perseverance, and setting your own standards. All that and more, set in an go-getting, early-century America that was far removed from the knackered, cynical world I’d been brought up in. Throw your heart over the bar and your body will follow.. Advice! Tips! Guidance! Real life examples! What to do if things go wrong! I grabbed it and hung on hard.

(The religio-social background and history to NVP and positive thinking is fascinating – start with Barbara Ehrenreich’s Smile or Die: How Positive Thinking Fooled America and the World which is, incidentally, far harder on the self help industry in toto than the Summit appears to have been).

Over the next decade, self help played a huge part in stimulating my interest in psychotherapy as a career. I quickly found myself exploring thinkers like Aaron Beck, Irvin Yalom and Anthony Storr besides. But helpful as those great names would prove in guiding my work and practice, none of them would have been any help whatsoever to my stuck and somewhat lonely 16 year old self.

I’ve found little over the years from the official mental health industry that would have been. Even the sainted David Burns, whose Feeling Good is the favourite book of Metafilter, would have proved beside the point. Later, perhaps, but not then. Self help is not always, or not even principally, opposed to or in competition with professional therapy writing or services.

Because, with so many self-help books as with certain moments in life, mental health is not the principle issue.  Direction, purpose, and recovering some sense of control over life are central themes, alongside ideas of change and transformation. There are times along the way when that – something you are doing – not the emphasis on the style of your thinking found in some schools of psychotherapy – is what you really need. There’s room and a time for both – no one’s explicitly denying that, and ultimately they boil down to the same thing – but sometimes you need one so much more than the other, or you need one before it can become time for the other.

You might have noticed without my mentioning it that these are longstanding working class themes. The dream of breaking out into a different, better world: it’s the tale of every local lad done good, it’s the story behind Educating Rita and John Major’s autobiography, it’s the legend behind all those Carnegie libraries and Tesco and Amstrad and, and, and, and. Direction and purpose: they are not easy things to find, and they get harder to find, and use, with every rung down the ladder.

It is one of the classic “insults of class” – having to win for yourself the right to believe that you are entitled to form and follow your own ambitions. At the summit, Robert Kelsey attributed to self help his recognition that his sense of failure in life was in fact a fear of failure. That’s a hugely important point and he made it well. It’s also a middle class one. It’s easier to have a fear of failure when you know how and where to start, indeed, when you know you are allowed to start at all.

The need to change, to be different succeed is a familiar idea to anyone from a working class background. That, to put it bluntly, is because it’s true. It’s an easy thing for middle class journalists and writers to mock, who already have security, who already own the idea that you can achieve what you set out to do, who started life already halfway into the world most people must hustle and scramble to reach. It’s easy to mock when you’ve grown up knowing lawyers, poets, artists, bankers and academics and so assume that those fine careers are options for you. (I am lower middle class in origin and made it to 18 without having known personally any adults in any of those fields – I saw only computing, and not much of that. What about families where no one works at all?)

I’ve a friend, the child of a famous man, who has never read any self help, but knows it’s all crap. The family are wealthy: the chosen career is in a field with formidable entry costs. But I know this about my friend too: they’ve always had written goals. They’ve always used social “tricks” like mirroring and pacing in order to get on. They have a deliberate strategy to overcome failure when it occurs. They have another strategy for networking. They visualize their ideal outcomes.

So much of what they do is pure Tony Robbins. But they don’t know that, because actually, it’s just what people at their level in society do. Not overtly, or even knowingly: there’s no need. They’ll never be as self-conscious about it as people like me who have had to get it all out of a book (if not that one) because there was nowhere else for it to come from.

And I wonder if my friend, or anyone who has ever pitched an article for the hell of it, or just thought they might just – what the heck! – put in for that (interesting) job, or been called on to consult or whatever – I wonder if they have quite realized how unusual they are in British life. That their luck and fortune might lie – not in the results of their decisions, but in their assumption that they can make their decisions at all.

So I’m glad that the Self Help Summit left room for the genre to live and breathe. Without it, there’s really very little to fill the gap (the series of which this book is part is quite good) and beyond that, nothing but guides to gardening, cooking and cars, on into the distance. Even in England, that’s not going to be enough. And as for weeding out the dross – I think people might be sensible enough, resilient enough, to do that on their own.

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World Cup 2018: Remembering My Russian

Posted on 03 December 2010 by JamesHamilton

When I heard the news that the Russian Federation would host the 2018 World Cup despite a near-perfect bid from England, I remembered my Russian.

My Russian was one of the very few great men I consider myself to have met. You won’t have heard of him, and I won’t give you his name.

Our paths crossed when I was working in a public library in an impoverished area of north London. A huge, bearded man with a voice deeper than a Volga boatman’s sat down in front of me at my enquiry desk, and we got to talking. He had been a university professor in the Soviet Union, but had abandoned his home and career so that his teenaged son could have the chance to grow up in the West. His son was now tearing through his comprehensive school whilst the father kept their council flat clean and did what scraps of work he could find.

Like so many new immigrants, he did not consider what he saw around him as economic poverty. His ramshackle pad was worlds better than what his old status in the USSR had afforded him, and the Golborne Road market stalls kept him in what he considered to be the style of kings and presidents.

What did shock him were the drugs. Now, it’s not as though my colleagues and I were unexposed to this: it was around about this time that the mother-daughter prostitute team would come screaming into our building provoked by their failure to score, and we had our share of poor souls with ravaged arms amongst our regular clientele. But for my Russian, all this was new.

So it started to happen that, one by one, local street junkies would find themselves being swept up by a great Russian bear, emerging some weeks later clean, happily bewildered, full of soup and stew, the colour back in their cheeks, their clothes washed and their appetite for life mysteriously restored.

I don’t know how he did it: something about not having been told he shouldn’t, I imagine. Perhaps he felt the strength of his own new freedom in London, and wanted to share it with those who had lost theirs to a different kind of unelected power. Or just force of personality. At any rate,  he sat in front of me one day months into our acquaintance and said,

James – in my country we have beautiful laws. In your country – not so beautiful. But in your country, people obey the laws. And that is the difference.

Aye, aye, that is indeed the difference, which is why even mild displays of corruption in the UK lead usually to extended or indeed permanent banishment from public life.

So it really couldn’t have been other for me, that when FIFA handed 2018 to Russia, a decision as demanding of Kremlinology as any from Kosygin or Brezhnev,  I remembered my Russian.

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Talk Therapy, Sympathy and Meaning

Posted on 30 March 2010 by JamesHamilton

Metatone raised three questions in comments on my earlier post here :

1. Is the common factor in talk therapies that work the regular contact with a relatively non-judgemental/sympathetic person who seems to be paying attention?

2. Is the common feature of all the talking therapies that they represent a process (thinking of process over outcome) and that largely any process is an improvement on no process?

3. Is it true of, a benefit of, talk therapy that it provides a language for things, a way of talking about them, that was otherwise lacking?

I’ve paraphrased the questions to some extent and might have gotten away from what was actually being discussed. I hope not too far away. In turn:

1. Common factors between effective forms of talk therapy.

It turns out, as I mentioned in the previous post, that it’s hard to establish through testing ANY features of ANY talk therapy that are definitively useful. That might be because we just haven’t been able to define a series of tests that we are currently capable of delivering that would establish such a thing. Or, it might be that talk therapy doesn’t work, at all, and that any improvement experienced by the client is down to reversion to the mean, outside factors, changing circumstances or the wisdom of age. Heaven forfend.

Each therapy has its own rough idea of how things might be expected to proceed, all being well. In CBT, the client counters the thoughts and beliefs that underlay negative emotions. As they get better at this, over a period of weeks, they feel better bit by bit. In psychodynamic counselling, which can last years, the building client-therapist relationship creates a safe testbed for all of the client’s beliefs and assumptions about his relationships with other people – the therapist becomes a confidante, a mirror and a source of advice and commentary. The client finds their own better way through all of this.

So go the manuals. But if the manuals were always right, there’d be none of those heaving shelves of case studies.

My own experience of this was pretty stark. I had only one case in ten years go by the book. In every single other case, things went differently. Over time, I came to notice patterns in what was happening. Common factors did exist. They just weren’t where training told me to look for them.

I’m probably not the person to ask about whether it’s about sympathetic attention of someone appearing to take interest. At any rate, I find it a hard question to answer. What made my therapeutic relationships work or not work were intangibles – who in their life did I remind them of? Did they instinctively like me, or did I turn them off from the outset? Sometimes, the relationship would start off well, and then get closer as the sessions passed, and this, if there was anything, seemed to matter. Some that had started well stalled, and once stalled, never recovered.

Moreover, even when the relationship was going well, there would always be the question at the back of the client’s mind of money. Did I really care, or was I an actor, pretending interest in order to earn a living? Some vocalised this, some, I’m guessing, kept it to themselves. Frankly, the money was never good enough to be any kind of motivation, but any monetary exchange suffices to raise the issue.

2. Is any process is an improvement on no process?

Yes, I think so. It’s not an answer in itself, but it’s important nonetheless.

By process, I mean (1) a structure by which I as a therapist believe things operate, and (2) a procedure one can present to a client as a roadmap and route to a solution to problems they can see no way past on their own.

I came to suspect that most of the problems that were presented to me were the result of people not accepting some of their own feelings.

Imagine a Great War trench under bombardment. In it, imagine an officer whose father and grandfather were both career soldiers and war heroes. Now his own war is underway, and he wants desperately to live up to them. Like them, he must be brave, a leader, an example. Down come the shells. One over there, another – damn! that was close! He can’t believe how scared he is. He wants to turn and run. Get to the coast, get a ship..  But all around him are resolute faces. How much braver these common men are! What a coward he is! I must be brave.. but he’s frightened, frightened through.

Sixty miles away, upstairs in a moonlit nursery, his daughter, not yet six, stands at the open window. The air carries the bombardment to her, distant thunder. Her Daddy is very much on her mind: childish instinct tells her that what she can hear is bad news for him. In her imagination, she feels him hurting, and his hurt makes her cry as she listens. Her mother isn’t sleeping either, and comes in, gathers her, rocking: there now, there now…

Both the officer and his daughter were scared. But the officer didn’t think it was OK for him to be scared. For him, courage meant lack of fear. He felt fear: he was wrong to feel fear. He was wrong, there was something wrong with him: he was less the man than his forefathers who’d neglected to tell him only a fool doesn’t feel fear. Instead, as he stood, a small child, at the top of the stairs, they’d urged him to jump down: come on.. you’re not scared! You’re not scared, a big brave boy like you!

The officer took a lesson from his fear: that he was an inferior man. His fear was prima facie evidence of his flawed status, of his failure to continue a line of heroes.

Whatever the CBT he didn’t live long enough to undergo might have told him – e.g. challenge the belief that you are inferior because you are afraid – the bottom line was his regressive questioning of his own emotions.

I’d give that officer some chance of undergoing the experiences we label together as PTSD. At any rate, the cases of PTSD I saw all had a common theme: not just traumatic events, but a rejection of the feelings experienced during those events or a negative reevaluating of those feelings later on. I’d give him some chance of developing depression. But I’d have few fears for his daughter as a direct result of her experience that night.

I’m placing weight here on the meaning people give to their feelings, not the feelings themselves or their strength. I’d look for that in a client. What did their feelings mean to them?

The very fact that they were there indicated that they were having feelings that they didn’t want to have. Help me, I ‘m experiencing panic and proper people don’t experience panic… Some people experience panic but don’t think any worse of themselves for it – but it’s unlikely that they’ll be experiencing panic attacks in the horrible, often random way that we refer to when we discuss panic in clinical terms.

So there’s process in terms of a therapist having an idea of what’s going on, where a client sometimes won’t – why am I panicking? because I’ve really no idea and I’ve tried everything. There’s also process in terms of a comforting programme to undergo. I’m talking to an expert now: I can – to some extent – relax and hand the problem across. Trust and first impressions on the client’s part matter here – many of my clients thought that what I was telling them sounded unlikely, but were willing, having met me, to give me the benefit of the doubt.

I don’t, for instance, think that phobias are about the focus of the phobia and some sort of traumatic experience involving it. I don’t think phobia is about extreme fear. Fear’s in the mix, sure – but it’s only one of a number of emotions at full pitch that are involved. What I think doesn’t matter: every phobic client did think it was about fear of the phobia’s object(s). They expected to prove me wrong, but, for now, I had a plan for them, I sounded at least halfway intelligent, and they were here now: I was better than nothing.. It’s a relief for people to be doing something, anything, about a longstanding problem that has resisted all their own efforts.

3. Providing a language for things

When you’re a stranger to something, an expert’s familiarity with the territory is hugely comforting, if occasionally humiliating: the RAC man doesn’t take his eyes off you as he reaches an empty hand behind him into the engine, tweaks something, and the car roars into life..

The therapeutic equivalent might be to shine meaning on what had looked random and malicious. Showing that there is a way of looking at it, rationally, sensibly.  Giving evidence that it can come to an end, can be overcome or outmanouvered. Showing that there is a way in which it fits into the grander scheme of things.

But meaning can be elusive. A client once came to me shining at the start of our tenth session, saying that “everything had fallen into place” about their life in the intervening days. And your panic attacks? Oh, those.. (thinks) no, no panic attacks. None for a while. Doesn’t matter, really. I’m just never going to let myself be treated like that again. It’s not on. I didn’t see that before, but it’s not on.

What’s that about? Well, it’s not about training yourself to relax, learning to recognize your triggers and cutting down on coffee, is it? If I’m right, and some symptoms are a consequence of interplay between a person’s core personality and their own rejection of their own feelings, then that client had come to accept and affirm their feelings, on their own, when I wasn’t there, thus breaking an ugly cycle.

But there are other instances when finding a form of words to describe someone’s experience provides them with a new and – at last, useful – way of looking at it. My therapeutic supervisor would talk about a type of client who had in essence grown up being their family’s scapegoat. All of the family’s faults and shortcomings would be projected onto that individual who, in order to cope and to maintain a belief in their family’s good and loving nature, absorbed the lot. All the client would know would be an enduring guilt and tiredness, a lack of trust in their own feelings and a sense that it was unsafe to express themselves.

So often, working with depressed people, I found myself thinking this is all about pecking order, and you’ve been trained all the way to the bottom. But “pecking order” had little appeal for people: my supervisor’s “scapegoat” rang many more bells. It introduced the thought into tired minds that perhaps I’m not as bad as I think I am. Once that thought’s there, the rest often follows.

Not always, though. When we change our view of ourselves, the people we live among don’t, not necessarily, and may indeed have a lot invested in our staying as we always were. It can feel safer to go along as we always have than make a break for light and freedom. Alice Miller has written a host of books, but I’ve always felt one paragraph from one of her earliest was sufficient to sum up the whole dilemma. From The Drama of Being a Child:

It is one of the turning points in therapy when the patient comes to the emotional insight that all the love she has captured with so much effort and self-denial was not meant for her as she really was, that the admiration for her beauty and achievements was aimed at this beauty and these achievements and not at the child herself. In therapy, the small and lonely child that is hidden behind her achievements wakes up and asks: ‘What would have happened if I had appeared before you sad, needy, angry, furious? Where would your love have been then? And I was all those things as well. Does this mean that it was not really me you loved, but only what I pretended to be? The well-behaved, reliable, empathic, understanding and convenient child, who in fact was never a child at all?

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Seligman & Layard: Positive Psychology in Politics

Posted on 30 March 2010 by JamesHamilton

This post is in response to part of Metatone’s comment on my earlier post here

Sport got there first, of course, and got there many decades earlier. Even before Freud and Kraepelin had begun constructing their contrasting disease models of mental illness, athletes and footballers had come to a basic conception of positive psychology. It was an Arnoldian model, even in America. Meaning, significance and life satisfaction could be found in a context of team, in the refusal to give up, and in the deliberate exercise of courage.

The three core traits of optimism identified by Martin Seligman – belief in misfortune’s temporary, local and impersonal status (it’s not forever, it’s not everywhere, and it’s not me) permeate Tom Brown’s Schooldays and underpin Arthur’s famous conversation about cricket. It’s more than a game. It’s an institution..

A Window in Stirling, Scotland 1929

From whence, ultimately, sport psychology. And sport psychology’s shadow science, which says, crush your opponent. Grind him into the dust, and then take his women.

Clearly, Martin Seligman and his team are not responsible for sport psychology or Thomas Arnold.  The comparison is in taking a visible, positive outcome, and trying to understand it. Where psychotherapy concentrates on putting the roof back on where it’s been blown off by depression, anxiety, panic or phobia, positive psychology sits the carpenters, tilers and thatchers down and asks them what they know.

What do I think? I think, about time, and well done.  I’ve benefitted directly and personally from reading Seligman and his team. I see no reason at all why people who seem to deal with life’s ups and downs with resilience should be studied less than endlessly depressive pains in the neck like myself. Surely there’s value in beginning a conversation about what human strengths are, now that we’ve come so far in describing the pitfalls and weaknesses. Martin Seligman and his team are doing the job properly, and making the effort to share their results in intelligent layman’s terms.

The trouble is, of course, that sooner or later, the idea crosses the Atlantic. Good American thinking doesn’t always get across intact: some ghost squadron of U-boats surfaces halfway and torpedoes the balls, brain and spirit out of it. That, or it’s met at Fishguard by a particular sort of unrestrained English middle class enthusiast. The kind Richard Dawkins describes. The ones who have had some expensive education, and reckon from that that they know how to think…

So Seligman’s sober positive psychology, with its endless analytical questionnaires,  its slowly emerging studies, its quiet determination to establish, incontrovertibly, what there is to establish, lands on British soil and becomes Inspiration! and Happiness Now! and breakfast TV interviews with the kind of men who wax.

And then we come to Richard Layard, who wrote yesterday:

..happiness is good for you — yet it still eludes all too many of us. As Samuel Beckett once said, the tears of the world are a constant quantity. But what if he were wrong; what if it were actually possible for individuals and whole societies to boost their happiness?This is the simple idea behind the Movement for Happiness, which is being launched in September by Anthony Seldon, the master of Wellington college, Geoff Mulgan, the former head of policy at No 10, and myself. We hope it will become a mass movement, extending far beyond our borders, with members who are committed to trying to produce more happiness in all spheres of life. Underpinning the movement is the burgeoning new science of happiness, which is currently unravelling why some people and some societies are happier than others.

It’s currently unravelling that, is it? I see…

There is plenty of advice around about how to live if you want to be happy. The New Economics Foundation, for example, prescribes the spiritual equivalent of the five fruits and vegetables a day required for peak physical health. All you need to remember is “Great” — giving, relating to other people, exercising the body, attending to the world around and teaching yourself something fresh.

Quite apart from the sheer mawkishness – this is where David and Mr E do things so much better than I do – and I admit that I’m having trouble finishing the sentence: the incredible bloody cheek and nerve of it leave me lost for words. Britain is full of existing mass movements – scouting, the RSPB, the National Trust, Amnesty, the bleeding Football Association even – that implicitly promote all of these goals and give people a wider context than their own lives. And how many local clubs and associations?

I’ll be frank: I don’t trust the happiness surveys Layard cites. Too subjective, too many competing meanings. I don’t think the British trust the concept very much either. And whilst I agree with Layard that resilience can be taught – to some degree – I warn him against saying things like:

We know from scientific trials that resilience can be taught in schools to reduce teenage depression and anxiety. We know that an optimistic frame of mind can help people recover faster from illnesses.

Blame and accusation lie down that road. If only you’d attended more to your resilence lessons, you wouldn’t feel low.. and that’s all too close to saying, don’t feel low, it’s not allowed.. And as for the optimistic frame of mind and illnesses, come walk a cancer ward with me, and see just what material these people get sent by cranks in their time of extremis and see how it makes them feel. If only I’d eaten better.. if only I’d gone jogging.. if only I could raise my spirits.. if only, if only.

There are consequences for an individual when they have a feeling, and emotion, and have a secondary layer of feelings, beliefs and emotions that tell them that the first feeling is wrong. That they are wrong for having it. Unforseen consequences of happiness lessons: the unhappy, already underground, dig further. I wonder if this isn’t why Seligman chose “authentic happiness” instead of “happiness” on its own: it says, there is fake, surface happiness, and there is authentic unhappiness.

Layard has said elsewhere that he wants “the burgeoning science of happiness” to influence government policy. Fortunately, I think the recession has kicked that ball into the deepest, longest, thickest outfield. Someone will rediscover it one day, perished, deflated and with quaintly old-fashioned markings, the veteran of fifty summers sitting in the sun with only the birds and adders for company.

Because if it were not so, the idea is bloody dangerous.

Whenever government gets ideas beyond the crudely economic, the unforseen consequences start queuing up. That’s under normal circumstances, and goes with politics. But if Layard gets his way, the unforseen consequences of it will do more than queue: they’ll rush the gates.

I know a lot of psychotherapists. The crank and creep factors are high. But so are barriers to entry. Layard’s suggestion that we lower them – by training, as a high priority,  thousands more – has one good side to it: the NHS psychotherapy bottleneck might widen a little. But the downside – a dramatic increase in the proportion of inexperienced therapists in the system – speaks for itself.

On the other hand:

Dr. Seligman is now turning his attention to training Positive Psychologists, individuals whose practice will make the world a happier place, in a way that parallels clinical psychologists having made the world a less unhappy place. (Here).

Even here, I can feel the hairs on the back of my neck come awake, and not in a good way. But done slowly, with care, with attention to the changing research news, that might be change I can believe in.

What if we believe the happiness surveys? Even then.. the surveys plot rising happiness until a plateau is reached in about 1975. For the first time in human history, it’s possible to see what happens to a society without serious material want. That should be extremely interesting. But at the moment, it’s a case of studies being used to confirm and promote the pre-existing political beliefs of the people using them. I’m a mixed-economy leftist myself, who thinks we should have toughed it out in ’79 instead of panicking our way into Thatcher. Politically, I should support Layard, but I don’t.

As a former therapist,  I find the idea of my field extending its political influence and clout sinister and frightening. I want it stopped.

And so, for this reason and on this occasion only, please, charge your glasses: the toast is Recession!

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Deisler, Football and Depression

Posted on 14 August 2009 by JamesHamilton

Deisler

I’d like to thank Rob Marrs for putting me onto this particular story. I don’t follow European football particularly well, and the Deisler situation had completely passed me by. I doubt very much I can do more with it than rehearse the usual things, but here’s what I make of it nonetheless.

Depression is “my” problem, in that in the company of (my off-the-cuff estimate) one in three of the kind of people who’ll find themselves reading this, I’ve put up with periodic bouts of dysthymic disorder every so often since my late teens. It’s a common mistake for people in my position – those who’ve experienced the problem AND practiced psychotherapy – to consider ourselves as having an unusual insight on it or some similar reflection. For what it’s worth, I’ve read the same autobiographical accounts, textbooks and analyses of the experiences of the famous depressed as you have. And all I can say having done so is that, in terms of communicating the experience of depression to those who haven’t had the pleasure, it isn’t so much that we can’t provide the right sort of metaphor, but that we lack the kind of syntax for the job.

People talk about “pain” in depression for instance (usually after telling you that it’s different from sadness on page 1.01) but then admit that they don’t mean it: the pain in question lacks the narrative, temporal quality of pain from injury or grief. And the desires for self-harm and suicide can come at the same time but drive in quite different directions: the self-harm can feel a bit like, but altogether unlike, a signal to the outside world that one has cottoned on to one’s dragging uselessness. Suicide can be a bit like, but not like – I really apologise for this – not “ending it all”, but “ending specifically this” , this nameless, faceless ongoing way of living.

Reading this account of Deisler’s experiences doesn’t provide me with anything original to say about him either, but for what it’s worth, here is what I think there is to say.

Firstly, we’re talking about Germany, not England: the attitudes towards mental illness here do not necessarily copy across to Europe. Of course, 100 years ago, they had both Kraepelin and Freud, the men who began the essential psychiatry vs psychotherapy argument that rages on in e.g. Richard Bentall‘s books. Football in Germany isn’t exactly set up for what happened to Deisler, but they are much less likely to borrow the metaphor of possession and witchcraft that we saw with Tackling My Demons. (Although Deisler has called his book Back To Life…)

..my home was not a place I could withdraw to for getting support as my parents had other problems to deal with.


That’s Deisler, and I can imagine a host of depression sufferers inside and outside sport nodding in recognition at that. In my own former practice, a majority of depressives had had the kind of experience that Alice Miller (a German-speaking Swiss)  describes in The Drama of Being A Child:

It is one of the turning points in therapy when the patient comes to the emotional insight that all the love she has captured with so much effort and self-denial was not meant for her as she really was, that the admiration for her beauty and achievements was aimed at this beauty and these achievements and not at the child herself. In therapy, the small and lonely child that is hidden behind her achievements wakes up and asks: ‘What would have happened if I had appeared before you sad, needy, angry, furious? Where would your love have been then? And I was all those things as well. Does this mean that it was not really me you loved, but only what I pretended to be? The well-behaved, reliable, empathic, understanding, and convenient child, who in fact was never a child at all?

Back of the net, there, in my opinion. And I’m also saying that there are elements in Deisler’s experience that are only circumstantially related to football. If the genetic potential is there, if the peer influence is right (and Deisler says “When I was young playing football in the streets, the other kids would mock me for being small”) then the stage is set for the situation at home to wrap things up long before the final whistle.

Are there “pressures” in the game, however, that make it a situation unto itself when it comes to depression and other mood disorders?

The article talks about “a dream of becoming professional footballers with the guarantee of fame, a full bank account and an Aston Martin in the driveway” and comments that “it does not always lead to a happy life”. Does it ever? At any rate, if you have grown up badly mirrored in the Alice Miller sense, or otherwise feeling low in the universal pecking order, invisibly flawed, then money, fame, success and “new friends” – surely this doesn’t need saying – are, far from covering over the wounds, only likely to exacerbate them.

There are balanced people in this crazy game, and consistently they are the ones who reject the Aston Martin side of things: Shearer found himself a retreat in Northumberland and a city that would regard him with affection and respect his privacy. Matt Le Tissier did the same on the south coast. Nicky Barmby went home to Hull, and is still there, loving it.

Deisler talks about fainting girls and men admiring his money and pulling power. For someone with any depressive (and while we’re here, isn’t “depression” quite the wrong word for something that internally violent?) tendencies at all, this is the nightmare. When you need to hide, where do you hide? When you need trusted people to bore silly with your talk, which of your absurd hangers-on can you trust not to run to the papers? And look, there’s Deisler: in the papers…

The top of football is not the place to be depressed. And there’s another angle: therapists can be a predatory bunch when it comes to fame. I didn’t find many familiar faces coming into my consulting room, but there were some, and believe me, you feel the tug of money and attention playing on the lapels of your jacket. The sensation is very real, and some give in to it: think how many therapists you’ve heard of simply through their famous, publicized, clients.

If you are the famous client, you can find therapists who will e.g. not ask for a public testimonial, or gush about you to their friends at conference, but you will have to tread carefully at a time when treading carefully is the hardest thing.

And it might not help you anyway. Paul Gascoigne’s two autobiographies made me feel wretched and ashamed of psychotherapy. Firstly, there was the hideous misdiagnosis of what at a distance looked (primarily) very much like a severe anxiety disorder that he was self-medicating with alcohol. Secondly, there was the treatment, well-meaning and all, but leaving one with the picture of poor Paul padding around expensive Colorado retreats looking after everyone else except himself. That warm, caring, generous man being propelled unwitting through all that 12-step stuff which his background gave him so little traction with (is there anything more essentially middle class than therapy, really?)..

If you are prone to difficulties, then football isn’t the best place to be, and fame can make finding worthwhile help all the harder and riskier (if it’s to be found at all: can I put my hand up and say that although I criticize Paul Gascoigne’s treatment, my distant/unreliable diagnosis isn’t exactly awash with optimism about what could be done for him?) .

But is there something special about sportsmen, about footballers, that sets them up for mood disorders? Or about the environment itself?

Real sporting talent is harder to miss than it used to be. In the 1940s and 1950s, improved nutrition and working conditions meant that Middlesbrough, a place with famously little to do if you were a boy who didn’t like football, was awash with playing talent. Brian Clough could remember many a man better than either himself or Len Shackleton who simply preferred factory life to being treated like a chattel by Ayresome Park. That’s all changed now: coaches can no longer rely upon chance discoveries in non-league football of the Ian Wright variety. If you are good enough to be good at sport, it’s more likely that you’ll end up like Phil Neville, with more than one sport knocking at your door when you’re still at a young age.

And if you are that good, the pressure to take the chance given you is immense. Sometimes, it will be welcome: sporting biography is full of men and women who had been able to do nothing right until they e.g. picked up a javelin… and, finding something they could do, they hung on to it as hard as they could.

But football draws into it men and women – more and more of the latter as the game grows – who are extremely gifted at it, and able to work hard enough to develop that talent, but who aren’t actually interested in it and don’t enjoy it. Fans can miss this, because we all wanted it so badly ourselves as kids (and do you find, as you get past 30, that your fantasies contemplate retirement, your fantasies hang up their boots, your fantasies start taking coaching badges?). But it’s perfectly possible to be international standard at football and not care about the game at all.

You can live the dream and find it’s your nightmare job; and then you find that no one wants to listen or sympathise. Footballers can’t complain about anything – all that money! what more could they want? except the things that we all really want and need: an honest day’s work, and then the sleep of the just. But how many footballers fetch up with the sleep of kings?

And yes, football is ultimately a male competitive environment, and no, you can’t display weakness. One of the most revealing conversations I had in this respect was with a young coach at a Premiership club. He’d been struggling, and, whilst struggling, had overheard his “colleagues” discussing with relish how they were going to take advantage of his difficulties, pile pressure on his head and steal his opportunities. One hears similar tales from business, but business people bullshit on the grand scale, and I wonder.

Thus the environment, and I know I’ve added nothing new there. As for the footballers themselves – and the sporting mentality in general – there is something that I’ve seen, that I don’t altogether understand, that might contribute. I can only describe it as a kind of teak-hardness.

I’ve come across this mostly in golfers. By teak-hardness, I mean that from my perspective, the men (all men up until now) that I’ve seen in this appear to have trouble feeling any real emotion at all. They persist in a steady, solemn, serious, strongly judgemental frame, giving little away, not laughing except at another’s humiliation or misfortune, admitting to no grief or upset of their own, and looking ahead only to opportunities to distinguish themselves from the contemptible mass of mankind. Writing it down in one go makes it sound a lot nastier than it actually looks: there’s little unpoliteness – indeed, they will tend towards old-fashioned courtesy and a surface-level protectiveness towards women and the defenceless. They aren’t rude, but neither, you realise after a while, are they paying any particular attention to anyone else, and they have, ultimately, little interest in, and no knowledge of, the feelings of others.

Sitting with people like this – they’ll usually have come complaining of some mysterious, essentially physical complaint that they suspect and fear of being psychsomatic (ever met anyone with glove anaesthesia? rare but fascinating..) – you have the sense of being in front of a thick sea wall, with powerful currents and a world of natural chaos hemmed in behind it. If that wall goes, everything goes – identity, personality, sense of place in the world, sense of being worthy of humankind – total collapse. Worse than depression, or an anxiety disorder: total, enduring, nervous breakdown.

It’s not something I fully understand, and I suspect I’ve described it badly, but it’s a type I’ve only met in full in sportsmen. I’m reminded of that wierd BBC belief that sporting success should inspire the young. Given how many top sportspeople are solipsistic egotists who enjoy putting one over on other people, I do wonder what they are trying to encourage.

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