My family history was never meant to feature so much in this blog, but once again I turn to a memory that involves my father. Actually, my recollection involves both my parents and goes back to when he died of a heart attack in 1989. I happened to be visiting them on the night of his death and I will always retain the vivid memory of being awakened from a deep sleep by my mother as she burst into my room and cried, "Wake up! Come quickly! Dad is having a heart attack!" It took me a moment to come to awareness and realise what was happening. But once I did I quickly followed her into their bedroom where I found my father gasping loudly and rapidly, with a curiously blank and impassive expression on his face. Immediately, I phoned EMS which said that a crew would be with us within a half hour, which seemed far too long to save him. Unfortunately, neither my mother nor I had CPR training, but I knew that standing by helplessly watching him die would be almost as agonising for us as dying was for him. So I made a pretence of exercising a skill that I didn't actually possess and urged my mother to join me in trying to save my father. It didn't work. By the time the ambulance arrived my father had crossed a threshold into irreversible brain damage as the medics sensitively explained to me soon after they tried to revive him. They could save him, they advised me away from my mother, but if they did he would be brain dead and on life support for the rest of his life. My decision, I am tempted to joke, was a no-brainer. But in truth I knew that my father would have dreaded the thought that he would spend the rest of his life languishing in a non-conscious state, his body sustained artificially by technology. Sparing my mother any part in the decision that I knew she would later approve, I told them to let him die.  

The story does not end there, however. My mother was devastated by my father's entirely unexpected death, especially as they both had been looking forward to their fiftieth wedding anniversary which was just two years away. Their marriage was as close as it was enduring and neither could have imagined living without the other. But my mother was forced to confront the unthinkable reality of living alone as soon as the ambulance crew left my parents' home. Suddenly looking like a lost little girl, she asked me "How can I possibly live without him?". In fact, life did become very difficult for her, especially in the immediate aftermath of my father's death. Staying at her house a few weeks after his funeral, I woke up in the middle of the night to hear her sobbing and crying out my father's name. I wanted to go into her bedroom and console her, but something told me that she didn't want that. As much as I loved my mother and father, I knew I couldn't be with her in the depths of her sorrow. I also knew that her sorrow was something that she needed to feel, no matter how painful her experience of it was. So I lay in bed listening to her weep, staying awake in case she wanted me to be with her. But her call for me never came.

Later, though, I heard an extraordinary story from my sister about what my mother had experienced sometime in the period of her deep mourning. She had been alone one night--perhaps she had been calling out my father's name just as she had done on the night that I heard her--when an apparent miracle happened. My father actually appeared in their bedroom. Sitting down on the bed he had shared with her when he was alive, he assured her that he was fine and told her not to worry about him. He also told her that she too was going to be fine, for he knew that she would be well taken care of in his absence. My mother was not particularly superstitious, but nor did she possess a notably sceptical mind. In fact, it occurred to me that in her grief she might have been highly suggestible as sleight of hand artists refer to people who are easily tricked. Yet, in my sister's account of what my mother had told her, the exchange between my mother and deceased father was exactly what he would have said, for he had always been the wise and protective husband to her. Moreover, the vividness of her experience seemed to be far beyond what she might have simply imagined. I myself never questioned my mother about the visitation, mostly because I didn't want to cast doubt on an experience that had consoled her in a way that I never could. But I have always wondered if the spirit of my father actually did make a posthumous appearance to her.

In his book on hallucinations, Oliver Sacks (who himself recently died) wrote that hallucinating the presence of a recently deceased loved one--especially a parent, child or spouse--is actually quite common among people who are in bereavement. Losing someone who is very close can actually feel like losing a part of oneself, just as the well worn cliche claims. Sacks even goes so far as to compare such a loss to losing a body part and experiencing a so called phantom limb from which physical sensations arise from an apparently absent source. It as if the brain feels forced to conjure what is assumed to be essential to self experience. Sacks does not, however, consider the idea that such hallucinations could be the means by which a disembodied spirit becomes manifest. But then neuroscience must regard hallucinations as neurological events and not as potential vehicles for spiritual presences. Hallucinating the spirit of a dead loved one can be seen as nothing more than emotion overriding an intolerable objective reality. Its only mystery to neuroscience is how such wish fulfilment manages to be so convincing.   

Being free of any physicalist bias, Buddhism has no difficulty in accepting paranormal events. And in the Buddhist cultures of Asia, the idea that my father actually did appear to my mother would provoke little disbelief. Even many Western Buddhists would find it easy to accept that my father made a brief detour in what Tibetans refer to as the sidpa bardo, an intermediate realm between one life and another, before migrating to his next birth. Whether he did or not, there is a danger of romanticising what my mother experienced. Romantics may be tempted to believe that my father's post-death appearance to her meant that he was waiting patiently on the other side of death for them to spend eternity together. Certainly, this is what my mother (who was Catholic, not Buddhist, but also somewhat romantic) would have wanted to believe. So perhaps her ardent wish to be reunited with my father was the cause of her hallucination, just as neuroscience would aver. If so, the power of her attachment and belief in romantic love had succeeded in creating her own reality, however temporary and illusory it was. Although Buddhism is more inclined to credit the veridicality of my mother's experience, it would not agree with any romantic ideas about eternity, either. For samsara is a an eternal tribulation that never ends happily ever after. This doesn't mean that my parents love for each other was false or illusory; it was just fleeting, as all things are. I also like to think that their love brought them closer to awakening and helped me along my path, too.    

Everyone by now has seen and been moved by the images of the refugee crisis in the Middle East. Hundreds of thousands of people have been driven out of Syria and in their frantic diaspora are trying to find safety wherever they can. The photograph of Aylan Kurdi, the drowned three year old boy whose body washed up on a Turkish shore might remind us of a child sleeping peacefully, except for the fact that we know he is dead. Another photograph makes it easy to imagine the circumstances of his perishing. This is the almost equally famous picture of a Syrian man holding a child in his arms as his anguished facial expression tells of the overwhelming terrors that he must deal with in order for his family to survive. Such images are shocking and poignant, yet also necessary, for they evoke compassion and motivate people to act to alleviate the suffering of innocent victims of war. Here in Britain, it was gratifying to watch the haste with which David Cameron was forced to reverse his decision not to allow any more Syrian refugees into the country following the public outcry against his refusal to grant asylum to people who so clearly need it. The British people showed the compassion that he once claimed would be the hallmark of his government. Yet the events that caused this crisis are complex and the region in general is so highly volatile that there is little realistic hope of finding immediate peace there. The situation can be likened to a terrible blaze that shows no sign of ever being extinguished. While most people would like a counsel of peace to prevail so that civic order can be restored, the raging fire of enmity and strife almost assures that any such counsel would go unheeded. 

The horror that we now witness in the Middle East is, of course, nothing new. War and its dreadful consequences seem to be what history is made of, though we tend to forget this in times of peace. Or perhaps, rather, we repress the horror of war in order to escape the dreadful memory of it. My father fought in World War ii and participated in a number of battles that were legendary for their savagery. But he didn't like to talk about those experiences or remember the carnage that he witnessed on the battlefield. "You just don't want to think about it," he told me. My father, however, was fortunate in being able to set those terrible memories aside. Others who may be more psychologically vulnerable or suffer losses such as my father never had to endure, find it impossible to free themselves of the oppressive memory of their suffering. Abdullah Kurdi, Aylan's father, lost his wife and another son at the same time that his youngest child was drowned. He now says that his soul was buried along with his family and just by seeing the picture of the corpse of his youngest son we know that he is not exaggerating. Moreover, it is difficult to imagine that he won't always feel this way. But the fallout of war is not confined to the people who have had direct experience of it. The after-effects may be felt, if not actually remembered, later in life by those around them. Although my father suffered no lasting trauma from his experience of war, he frankly admitted that it was the closest thing to hell that he had ever witnessed. Fortunately, as children, my brothers, sisters and I had little inkling of what he had suffered as a combatant. As a therapist, however, I have often heard stories of some older clients about their parents who, as children, suffered from traumas inflicted on them during WW II. As adults, their parents could become inexplicably moody or given to sudden outbursts of anger which left their children--who would later become my clients--feeling frightened and confused. A child's small gesture of defiance could provoke a towering rage that was way out of proportion to the act that had provoked it. At other times, a gloomy silence could fill the house like a noxious cloud. Perhaps worst of all, my client's parents were emotionally unable to provide the love and support that all children need. The wartime traumas of their parents were thus contributing factors to the post-war suffering that brought my clients to therapy years later, long after their parents had died. The trauma of war survived those who actually experienced it.

The idea of transgenerational trauma may seem too vague to be truly insightful. And if history is a recurrent nightmare of war punctuated by peace, who hasn't been affected by it? It might also be reasoned that if the nightmare of history is inevitable, what can be done about it except arm ourselves for the next conflict? Although psychotherapy may try to tend to the psychic wounds of individuals affected by war, the underlying cause is much greater than psychotherapy can ever hope to address. The endless round of violence and retribution appears to be the way the world continually reorders itself. There will, it seems, always be a fire next time. The phrase "the nightmare of history" comes from James Joyce's Ulysses, and is spoken by Stephen Daedalus in mild resistance to an anti-semitic tirade by a man who blames the Jews for the decline of England. The novel was written more than a century ago and though history has since raced forward through events that nobody in the early 20th century could have predicted, the hostilities that were alive then are no less and perhaps even more virulent now. The nightmare of history from which Stephen Daedalus wanted to escape is flourishing as strongly as ever.

But what could waking up from the nightmare of history actually mean? Many people seem to think it would mean making the world a more peaceful place in which mindless conflicts don't send millions of people into exile or expose children and other innocents to the murderous ravages of war. Although this would certainly improve the world, the unconscious urge to violence and war would still remain within us. An important goal of politics should be to keep those destructive urges safely dormant and far removed from the social sphere. Yet, a nightmare born of some festering frustration could still erupt into an unexpected crisis at any time. Buddhism, of course, advocates awakening in a more thoroughgoing sense that goes to the very roots of our dangerous, unconscious urges. Waking up would mean facing up to and letting go of all the bogus needs that give rise to our conflicted interests. Ultimately, it would mean escaping samsara, the round of birth and death, but more immediately it would mean becoming aware of the fact that the nightmare of history is our own creation. 






       

In my last post I discussed psychiatry and anti-psychiatry and argued that the latter term has been used by institutional psychiatry to defend its inordinate reliance on psychopharmaceuticals.  By favouring psychopharmocology--the use of medication in treating mental illness--over psychotherapy--aptly described by Freud as the "talking cure"-- psychiatry has neglected perhaps the most important feature of psychological healing. Still it is true that the cautious and judicious use of psychopharmaceuticals may not only be life saving, it can also complement psychotherapy. But having just recently finished reading Kay Redfield Jamison's brilliant and eloquent memoir An Unquiet Mind, which recounts her lifelong battle with manic-depression (she prefers this old term for her disease to the current one, bi-polar disorder), I now have a somewhat different perspective on how medication may work as a treatment. Jamison is uniquely qualified to discuss the matter, for not only has she suffered the illness herself, but as a clinical psychologist and professor of psychiatry she possesses a deep scientific understanding of mood disorders. Fortunately, her credentials do not prevent her from being strongly in favour of psychotherapy and she expresses her view of therapy in lyrical passages of praise. But it must be noted that her psychotherapist was also a psychiatrist who, from the first, had always insisted that medication was essential for her to maintain equilibrium. For her part, Jamison is clear that lithium was the only thing that could have saved her from madness or death. For her, at least, psychotherapy was not the primary means of her life saving treatment, it was secondary. So does Jamison's case have implications for the treatment of severe mental illness in general?

I address this question without pretending to have any definite answers or even having the means of arriving at one. As a therapist I have no medical training and couldn't prescribe aspirin, let alone anti-psychotic medication. But both my reading and experience as a therapist incline me to be sceptical of the more extravagant claims of psychopharmacology. The evidence is both abundant and clear that the benefits of drugs therapy have been wildly oversold, in part, it seems, because medications need to be sold. It is also clear that the medical approach to mental illness has progressively moved away from trying to understand the experience of psychological distress as a means of gaining insight into madness and instead has tried to pin down symptoms in behaviour for discrete disease entities that never quite materialise. My own experience confirms what my reading has documented. Many of my clients have gone to their GP's or psychiatrists complaining of anxiety and depression and with scarcely an attempt to find out why they might be feeling that way, are given prescriptions for anti-depressants. While this has sometimes brought them short-term relief, it also had the effect of making them feel more helpless and confused about their emotional lives. The experience of such frustration is often what prompts people to turn to psychotherapy. They want to make sense of their experience, which is something that psychopharamaceuticals alone fails to do for them. But making sense has two rather different meanings which should not be conflated. Many, if not most of my clients come to therapy in order to make sense of what may be called a crisis of personal meaning. But for someone who is suffering from a severe psychosis as Jamison did, making sense of one's self experience in the throes of a psychotic breakdown means nothing less than trying to find enough emotional stability for ordinary living. In cases like hers, medication would seem indispensable for making any kind of sense at all. Yet not everybody would agree with her.

R.D. Laing once argued that by resorting to medication (usually without the patient's consent) psychiatry halted the potential for self healing that could occur naturally in psychotic breakdown. Breakdown can lead to breakthrough, as he put it. This does sometimes happen, but instances of it are surpassingly rare, even without any interference from psychiatry. Moreover, Laing made his argument in reference to schizophrenic breakdown, which though also classified as a psychosis, has much different characteristics than manic-depression (I follow Jamison's recommendation and use this term instead of bi-polar disorder). According to Laing, the schizophrenic could be regarded as almost a frustrated mystic and psychosis could be seen as a way of dealing with his frustration. Although Jamison, a psychologist who firmly believes in the biological origins of madness, has no tolerance for this line of thinking, when writing about manic-depression she makes a somewhat similar case. The manic depressive often possesses great intellectual and imaginative powers which can lead to great artistic, literary or scientific achievement. Indeed, in another book, Touched with Fire, she discusses how manic depression affected such great artists as Lord Byron, Vincent Van Gough and Virginia Woolf, both in the expression of their genius and in the torment of their emotional lives. But perhaps it is her own personal testimony that conveys even more strongly the sense of creative exaltation that arises out of a charged hypomanic state. In these high moods, she felt more intensely alive and open to the creative possibilities of being in the world. But she is equally clear about how dreadful and self nullifying her depressions felt, as well as how terrifying it was to feel possessed by wild, manic energy while feeling hopelessly doomed (it is this latter feeling that to her makes manic-depression the perfect term for the condition). Jamison admits that there are times when she misses the inspiration that her illness brought her. But she is also keenly aware that without lithium she would be either dead or insane. Unlike Laing, she finds no self healing potential in madness at all.

So who is right? Psychiatry or anti-psychiatry? The question is too misleading to be answered. Firstly, the term anti-psychiatry no longer possesses the radical, oppositional force that it once did and it now functions as an easy smear for any critic of institutional psychiatry (Jamison, to her credit, does not invoke the term). And the fact that the medical treatment of madness dates back to the earliest days of medicine tells us not only that it has always dealt with mental illness, but also that it always will. Even so, institutional psychiatry has lost trust by neglecting the human, experiential dimension of madness, perhaps the most uniquely human affliction there is, by becoming so consumed by the biology of mental illness. In treating the disease, it has lost interest in the experience of the people who suffer it. As an author of a definitive textbook on manic-depressive illness, Jamison knows all the available science on the disease. But as a non-scientist I am more impressed by her personal testimony about why she needs lithium in order to survive. I wonder who but the most rabid anti-psychiatrist would want to deny someone like her the medication? But by handing out medication indiscriminately, without concern for the experience of the patient, psychiatry is guilty of a similar dereliction of care. 

As a psychotherapist I can only observe the debate about the merits and dangers of medication without being able to participate in it. But I would still criticise any practitioner, medical or not, whose putative expertise sanctions ignoring the personal experience of the patient. Contrary to what Kraeplin said and institutional psychiatry believes, psychiatrists are not surgeons and they do need empathy in order to treat their patients. Perhaps reading An Unquiet Mind would be instructive for them.