A Matter of Death and Life

My friend, Linda, bought me a book of this title. It was jointly written by Irvin D Yalom and Marilyn Yalom. Linda had read several of Irvin Yalom’s books whereas I had never heard of him although he is, according to the back cover, ‘an internationally renowned psychiatrist’. Because they have the same surname, I refer to them here as Irvin and Marilyn as if I know them. I don’t.

Marilyn had been diagnosed with multiple myeloma (a cancer) and the idea was to write alternate chapters concerning how this diagnosis affected them both. At a certain point about two thirds of the way through the book, Marilyn was unable to continue and Irvine had to finish it himself. They had been married for sixty-five years so this was never going to be easy.

I found this book unnerving since I had recently lost my wife, Audrey, to cancer of the throat and it turned out that both Irvin and myself had a problem in common with atrial fibrillation and were on the same anticoagulant drug, apixaban, not a drug to be taken lightly.

Though both knew that her cancer was terminal, Marilyn tried two different approaches to fending it off. Neither of them worked but both of them left her feeling dreadful. And this led to a desire on her part to take a medical way out of life – something which is possible in California if two medical practitioners agree. Irvin was reluctant to accept that she felt this way since it would involve losing her entirely but, to put a stop to her suffering, he had to agree with her in the end that her life was no longer worth living.

The book struck a chord or two. The first was the similarity in our situations. The second was another point in common. Both Irvin and myself have been subject to irrational responses and thoughts. The one which struck me most was a constant desire to talk to my wife, knowing full well she was dead. In part, this was because in the later stages of the disease she was house-bound and I reported back to her even more than usual. But I continued to talk with her anyway. Which also brings up the subject of photographs, and here I note a difference. Irvin had a photograph of Marilyn printed, but found it too painful to look at and turned it to the wall. I had three made and look at them all the time.

This desire to talk to my wife, which I often give way to, is plainly irrational, yet Audrey had told me often in the past that I relied too much on logic so, who knows, she might approve of this development. Can these conflicting aspects of character be reconciled? Irvin believes they can and quotes the views of a professional contact (unnamed).

Memory is no longer believed to be a unitary phenomenon, rather, memory is comprised of distinct systems that can work independently, have different neuroanatomic loci, and can even work at odds with each other. He describes the dichotomy between “explicit”  (or “declarative”) memory versus “implicit” (or “procedural”) memory.

Explicit memory is conscious and is dependent on medial temporal lobe structures as well as the cortex of the brain.

Implicit memory is largely unconscious and often underlies skills, habits, and other automatic behaviors. It is processed in different parts of the brain: the basal ganglia for skills, the amygdala for emotional responses.

These two kinds of memory can operate independently, almost unaware of each other, and can even be in conflict with each other. (P 178)

This would explain, for example, why I keep on wanting to tell Audrey things, and often do, despite the fact that I am only too well aware that she has died. It would also give each one of us an out if we were embarrassed by our irrationality. It’s not me, doc, it’s my brain!

A third point of contact is that both Marilyn and Audrey were looked after by their husbands for many months, both wished to die at home, and both did. But that leaves Irvin and I on our own. If we develop a terminal illness there are no wives left to look after us as we looked after them. Personally, I would hope to pop my clogs by going to bed one night and not waking up the next morning. What I would want to avoid is a lengthy illness during which I would have to be looked after. Who would fulfill this role? There is no one I would wish to inflict this on, so how to leave the departure lounge if the need arises? Well, fortunately for people like me, Irvin has given us a detailed account of how this might be achieved. This is part of it.

Dr.  P first gives her some medication to prevent vomiting and then prepares the lethal drugs in two glasses. The first glass contains 100 milligrams of digoxin, enough to stop the heart. The second glass contains morphine 15 grams, amitriptyline 8 grams, and diazepam 1 gram. (P140)

Digoxin is available here in the UK by prescription only. It is derived from digitalis, so those of us wishing to use this method may have to grow our own foxgloves.

It is only to be expected that this book will deal with grief, and it does. Technically, I know what this word means but I have no feeling for it; if a word must be used at all, I am happier with the word ‘anguish’. However that may be, there are two occasions at least when it is suggested that we who are left behind can get over it in one, maybe two years. Inhabiting the irrational end of the spectrum as I now do, I find it surprising that anyone would want to get over it. I regard grief as my friend, keeping my wife’s memory fully alive. I realise, though, that if the person left behind is much younger than I am, they might want to marry again, or whatever it is people do these days, in which case getting over it might be a desired outcome, allowing them to ‘move on’.

Is this a good book? On one level it is; it is a well written account of two people facing the end of their relationship, how each of them deals with it, and how the survivor, Irvin, copes with his loss. Does it help others in the same or a similar situation? I can only speak for myself here, but the answer is no. How could it?

The Power of Negative Thinking

It is always assumed that negative thoughts are bad for mental health and there are clearly times when they are. For example, being unable to rid the mind of a specific negative thought for days, hours or weeks is likely to be harmful. The longer it takes up residence the harder it may be, like an unwanted lodger, to show it the door. Or it might, as it were, create a well-trodden path which it refuses to abandon. A phrase like neural pathway comes to mind, though how medically accurate this is I don’t know.

As a consequence of this, there are many authors out there (life coaches, persons of faith, shrinks, gurus, swamis and the like) who advocate positive thinking and extol methods by which this may be encouraged. I note that these books are often categorized as to whether they are aimed at men or women and suspect (I’m too indolent to count) that more are aimed at women than men. Why might that be? As a rule, women give more thought to such things, and those of them who live with men will sometimes have a stronger incentive.

Meanwhile, here are a couple of positive thoughts to help us through this vale of tears. Firstly, Abraham Lincoln:

“Whatever you are, be a good one.”  

Nice one, Abraham. So how would a rapist, swindler or a Vladimir Putin live up to that? It doesn’t bear thinking about. Moving quickly on to Tupac:

“Reality is wrong, dreams are for real.”

If reality is wrong and dreams are real, then dreams are wrong, right Tupac?

It would not only be possible but easy to expose many such statements of the positive to a negative critique, but we would not want to remove their crutches from people who really need them to get along. What would be the point?

But it seems that ridding the brain of negative thoughts is to be encouraged. Take Eliminate Negative Thinking by Derek Howell, for example, a book which specifically targets negative thoughts. An obvious question arises. How effective are such books for those who read them? I don’t believe that social scientists have applied themselves to answering this question, and it would a very difficult task to attempt, but a certain person I know well has an impressive library of self-help books yet has confined himself/herself to the bedroom for the last several years. I already hear the reply, Ah, yes, but I’d even worse off without them. And there is no way to test this, so life goes on.

Yet we should at least ask whether all negative thoughts are bad. Veronika sits in the graveyard thinking I am totally worthless because her friends have dropped her from seventeen social media platforms. It is theoretically possible that she is totally worthless but highly unlikely. Snap out of it, Veronica! Meanwhile her sister, Verity, interrogating her newsfeed on the subject of Ukraine, comes to the view that there is no level of base behaviour to which some will not sink. Since there is ample evidence of this over thousands of years, Verity is entitled to subscribe to this negative view on the grounds that negative though it may be it is also realistic.

A phrase that struck me many moons ago was penned by Thucydides – Human nature being what it is. Say no more, mate, we get the message.

Though given to negative thoughts, I tend to keep them to myself. However realistic they may be, they don’t go down well. And that’s OK, I can live with that. The fact that I can also die with that is neither here nor there.

Fear of Failure

The word ‘mind-games’ is often taken to mean attempts by one person to influence another. It is well known in sporting circles where Coach A will falsely claim that his opponents in the forthcoming match are the favourites when everyone knows fine well that they are not. By this transparent stratagem, he aims to pile the pressure of expectation on Coach B and his team. But the games am I stealing up on here are those played by the mind against itself. I will start with a small, insignificant example and end with devastation.

My wife and I are partial to coffee and keep the necessary ingredients in a cupboard which contains the usual coffee, percolators and mugs. But notice also the clock on the wall.

So, to access these essentials of our addiction, I open the cupboard door.

No surprise there. But guess what? When I open this door, I obscure the clock on the wall.

At which point, having just obscured it, I am overcome with a desire to look at it and find out what the time is – and this from a man who never wears a watch. Which strikes me as strange. As an example of the mind at work against itself it is clearly a small one. After all, it’s easily solved. All I need to do is move the clock or train myself to check it before opening the cupboard door.

But I have seen the mind in conflict with itself at a much more serious level. The person in question has crippled herself for decades and, unfortunately, over a period of years, a crippling of the mind has led to a crippling of the body. Although there was nothing wrong with her legs to begin with, now she can no longer walk, partly because of muscle wastage but mainly because her knees are locked. And she has done this to herself.

I am not a shrink, but as far as I can tell the underlying process goes as follows.

  • I do not want to fail.
  • If I never attempt anything then I will never fail.

And this is obviously true. You could say she has failed at nothing because she has taken the precaution of attempting nothing. Unfortunately, the corollary of this principle is also true – if we never attempt anything then we never succeed either.

So where has this led? Since she never leaves her bedroom, let alone her house, she has succeeded in making herself entirely dependent on others. And this despite an impressive array of self-help books. What will her future hold? I have no idea, but know that I won’t be here to see it.

I could document this sad state of affairs with photographs but for obvious reasons have chosen not to do so.

Wry Thoughts on Losing Control

Like many of us, I’ve had to deal with large documents, usually course submissions for an exam board.

But people like me (I ran a recording studio) are not to be trusted with such things, so the college employed a woman whose jobs was to check through our submissions on the look-out for errors, weaknesses and possible improvements.

And I can’t deny that she found them. She could have marked up the text with revisions, suggestions and so on, but preferred to slap explanatory Post-its on the sections she wanted amended.

I was not alone in thinking she went a bit over the top here. Our documents would be returned positively bristling with Post-it notes, despite the existence of other colours all yellow, and one such occasion, rather than top myself, I went for a cunning plan.

I accepted Pat’s major suggestions, but there were many others, most of a nit-picking nature. So, life being short, I artfully removed quite a few of these notes before returning the document to her. Since she couldn’t remember all the Post-its she’d placed in the document in the first place, she didn’t notice that several were missing. Sneaky, right?

Pat was so well known for her system she was referred to as Post-it Pat, no doubt based on the children’s character Postman Pat.

Another example. A certain education administrator I knew many years ago had a long, rectangular office, along one wall of which he had a long rectangular pin board. This was his pride and joy. Written on small plastic pins of various colours were the class, classroom, teacher and subject of every class in the college. In short, the timetable for the entire institution.

Yes, he had it all under control – until certain students who’d figured out the weakness in his system, snuck into his office one evening, removed every single pin from the board and left them in a heap on the floor.

The following morning, he came close to a nervous breakdown because now he had no idea which of his many pins went where. In one fell swoop, from total control to no control at all. His world had collapsed on his office floor.

So the fact that a system is physical does not make it safe. Even in the real world (the world not involving computers) backup is essential.

Of course, we all lose control in the end, but that can’t be helped. If you find the thought disturbing, take the advice of Swami Rod – just relax and have a bad time.

Opening a window on the world

Every week for many years I have collected medication for my daughter and delivered it to wherever she was staying at the time, usually a room in a lodging house. The reason for a weekly rather than a monthly collection has been the prevention of suicide by overdose. Since I am still making these collections this, at least, has worked.

Over the years I have been a visitor at pharmacies in various parts of the city and have rubbed shoulders with junkies at all of them because that is where they go for methadone, which they swallow out of the public gaze in a discreet back room or booth. That way, the pharmacist knows it is being taken and cannot be sold on to third parties.

Being an early bird by nature I have met many junkies. Due to the urgency of their need many of them are early birds too. The methadone they take is used as an alternative to heroin but is also an opiate in its own right.

If you were in the right place at the right time you would see me mingling with the gentlemen in question at a quarter to nine and, who knows, might mistake me for one of them. Why not? I am there for drugs too.

Today as I was walking up the steep footpath from my daughter’s current flat, two of them met me on the way down. I heard them coming from some way off, as anyone with ears would have done. As they passed, one of them made me an offer.

‘Want some cheap steaks, mate?’

My guess is they had stolen the steaks with a view to selling them on to impoverished souls like me – an easy mistake to make since I am only well turned out on state occasions, which in my case never seem to arise.

What they would do with the money I can safely leave you to guess, but judging from the route they were taking they had liberated the steaks in question from Farmfoods or Lidl. How they did it I don’t know.

When I got up this morning I had no intention of dealing with life on the streets, but we are all at the mercy of events. Certain images stick in the mind whether we like it or not.

Life imitating art

1
I recently published a novel called Time to Talk and today I find an article under the heading ‘Talking literally saved my life’. The story is about Jonny Benjamin, a mental health campaigner who has had ‘schizoaffective disorder’ – defined in the article as a combination of schizophrenia and depression.

A panel within the article is headed ‘It’s Time to Talk’. In it we learn that Time to Change is an anti-stigma programme run by leading mental health charities Mind and Rethink. Time to Change ‘is holding the first national Time To Talk Day’ with the aim of starting ‘a million conversations about mental health’. Good luck with that.

2
Last week I discovered that my narrator, Max, has found his way into a dissertation. In the likely event you think I’m making this up, the subject was resilience considered from a transactional analysis point of view and the method of questioning used with respondents was interpretative phenomenological analysis. (Don’t ask me, I just live here!)

3
According to several sources, one being the BBC News website, scientists from Sydney University have come to the view that shivering for 10-15 minutes a day could be equivalent to doing an hour of exercise. ‘They found that the process triggered hormonal changes producing brown fat – which burns energy to keep warm.’

In my forthcoming book, A Serious Business, one of the characters is already using this technique. ‘Ah yes,’ I hear you say, ‘but your book’s not out yet. Maybe art is copying life here?’ At this point I have to reveal that I finished the first draft in November  2006. Right, so what on earth have I been doing since then?

Revising. It’s a long story, but it’s shorter now.

Alice looked bemused. ‘And who came up with this one?’
‘Jefferson P Dangerfield, an America vet. You’ll find his recent best-seller in June’s drawer beside the biscuits: The Keep Cool Weight Loss Program, Homeostasis and Health.’

4
And finally, as they used to say introducing a ‘human interest’ story to round off the news, and finally I have to report that my character, Max Frei, has had a geranium named after him. It doesn’t get better than that.  Where’s your Nobel prize for literature now?

Therapy and the lightbulb

1
How many psychotherapists does it take to change a lightbulb?
Only one, but the lightbulb has to want to change.

2
How many group therapists does it take to change a lightbulb?
None. Group therapy doesn’t change anything.

3
How many psychiatrists does it take to change a light bulb?
One, provided the lightbulb is fully compliant with all components of treatment. Otherwise, it’s the lightbulb’s fault that it doesn’t get changed.

4
How many clinical psychologists does it take to change a lightbulb?
Well, they’ll be able to change it quickly and efficiently, once they’ve figured out the correct DSM-V diagnosis. Until then, how do we know it needs changing?
(The DSM is the diagnostic ‘bible’ of the American Psychiatric Association)

5
How many depressed psych patients does it take to change a lightbulb?
Who cares?
____________________________________________________________________________

These are my favourites from a longer list of psychiatric lightbulb jokes posted by Dysthymia Bree. This is a link to her blog.

dysthhttp://tinyurl.com/pnpx4zl

The lure of hypnosis

Shortly after I published Time to Talk, which features a fictional therapist and several equally fictional examples of therapy, the offers arrived in my in-box. How could this be, I wondered, were the marketing people on to me already? Did the NSA have a hand in this, or GCHQ?

The first encouraged me to undertake an on-line course in CBT (Cognitive Behavioural Therapy) at a greatly reduced cost.

The second encouraged me to undertake an on-line course in hypnotherapy, also at a greatly reduced cost. I really wondered about the second. I was tempted. According to a therapist whose course I recently attended, I might have some talent in that direction, evidenced by an ability to put myself to sleep while waiting for dental treatment. (She called it ‘dissociation’ but I prefer to think I was hypnotising myself out of pain’s way.)

I then began to wonder how hypnosis could be taught and learned online. Would the student have a subject on screen whom he could then hypnotise with his honeyed tones, references to balmy breezes, ocean waves, cup cakes and so on? My mind was invaded by a series of cartoon images – I really wanted to give it a try.  ‘Hi, Mildred.’  ‘Hi, Rod.’  ‘About your credit card details . . . .’

I remember a Chuck Jones cartoon where Wile E Coyote tries to hynotise the Road Runner, but the Road Runner – prescient as always – has equipped himself with a mirror and bounces his hypnotic rays back into Coyote’s eyes. Coyote, holding out his arms in front of him, duly obliges by walking off the edge of a cliff.

Seriously though, do we think an online hypnotherapy course could work?

‘Today’s deal from the Hypnotherapy Centre of Excellence will give you the tools you need to become a hypnotherapist. With training from highly skilled professionals, two certificates upon completion, scripts to help with your sessions and marketing tips. •£39 (regular price £599) for an online hypnotherapy practitioner course •Includes full course materials, a course manual, hypnotherapy scripts, e-books, free monthly practice groups and ongoing help and support •Upon completion you’ll receive 2 certificates from the Hypnotherapy Centre of Excellence and IANLPC •You can also receive a third certificate from the Institute of Leadership & Management (ILM) for an additional cost •To view the course details please click here’

[A reblog of my previous , this time with a title]

A musical way to reduce stress

At a course I was on recently, I learned that when we breathe in our heart-rate increases and when we breathe out it decreases. So a useful technique for reducing stress is to exhale slowly following a sharp intake of breath.

It is possible to do this as an exercise, but I find it requires considerable discipline. So an obvious approach would be to play a wind instrument. Since I used to play the trombone, I considered that. But I no longer have one and, besides, people tend to notice when you’re playing. The trombone isn’t the quietest of instruments. On the other hand, it does require a fair bit of air to fill it, hence my present lung capacity.

So in theory, the best way to go about stress relief using a wind instrument would be to select one which requires a lot of air. And the obvious candidate would be – yes, you’ve got it! – the Sousaphone.

Photo by TAZphotos via Flickr Creative Commons

Unfortunately I don’t have one of those either, and in any case the neighbours would notice that even more than the bone. Yet if only I had one what couldn’t I achieve? I could set up a tribute band playing old Temperance Seven numbers and call myself the Reverend Rod for purely promotional, as opposed to devotional purposes.

Leaving such fantasies aside, I think of the flute. It takes more air than you might think to play the flute since you need two flows of air – one into the instrument and the other across the mouthpiece. I used to have a flute but don’t any longer, so an alternative had to be found. I sashayed into various music shops till I located what I was looking for – a tin whistle, also known as a penny whistle. (Life being what it is, there isn’t an ounce of tin in it: it’s made of brass and costs a bit more than a penny.)

The whistle is small, but you can hold a note on it for a long time, hold several successive notes for a long time. It beats just breathing out. But – and there is always a ‘but’ – the whistle comes with a problem. A flute has keys, so closing holes as you play is fool-proof: let go of the key and the cap with its pad closes each hole and no air escapes. Perfection itself. But the whistle has no keys, so unless you cover each hole COMPLETELY with the appropriate finger it will – and does – emit horrible screeching noises. And covering each hole completely is harder than you might think, especially with the lower notes.

So now we have these ghastly noises and they have an effect – they increase your stress level. Well, that worked, didn’t it! But we learn to look on the bright side. You can’t win them all, but with practice you can surely win some.

If these are the symptoms, what is the condition?

These are not all of the symptoms, just some of them, but enough to be going on with.  And I am not making any of this up.

1) Stopping frequently in her tracks when walking along

2) Refusing to wear her glasses with the stated aim of reducing ‘sensory overload’

3) Frequently relieving herself in anything to hand despite having a toilet on the same floor (anything to hand including what you might be drinking from next)

4) Frequently thinking of suicide over a twenty year period

5) Mild self-harm

6) Often stated fear of not being able to communicate, so often with a pen and paper at the ready

7) Difficulty breathing which she attributes to panic attacks

I am asking in the hope of enlightenment, since an assessment is coming up which may result in compulsory treatment.

Right, but treatment for what?