I heard the other day about a story of a road rage incident that I found very interesting, not because I am unaware of these incidents but because it involved a medic. Somehow one always imagines that someone in the medical profession to be above such things, after all when we go to see the Dr, they ask after us and not us them. But medics just like all of us suffer from emotions and stress, none of us are immune.

We are after all only human; we suffer the same feelings and thoughts, but express them differently. If feelings have not been allowed expression they seek an outlet in another way, for men this is often in anger. For women it is often about tears. Neither resolves the issue, we have to at some point learn to understand what we are feeling, and find a way of communicating that.

The road rage story must be very familiar to us all. This medic having been cut up on a country road, then chased the driver for several miles at breakneck speed. You may have done it, I confess whilst I have never chased anyone I have been chased and can vouch for the fact it is extremely frightening.

So what does road rage mean? Clearly it is easier for someone to chase down an unknown on the country roads rather than confront a known person. And that in my opinion is what this is all about. We call it displacement. The person who has done the cutting up has clearly triggered something in the drivers head. It could be something like ‘you will never do that to me again,’ or ‘this is (mine) my stretch of the road’. Whatever it is it is certainly not about the unknown person, but that the driver is venting his or her anger onto the world. They may well be very angry people at home too, or they may, like the medic have to always be on their best behaviour, and vent their frustration onto someone or something unknown. The point being that unless they learn to express what they feel in little amounts throughout their day and week and months, things build up until there is an almighty explosion. People behaving entirely uncharacteristically.

Anger, rage and hatred are all part of being human; they are emotions just as love and sadness, kindness and forgiveness. It is when they are not allowed to be expressed or expressed in a way that has no containment that it becomes dangerous. How often have I heard a mother say to a child ‘Don’t say you hate me’, whereas at that moment that is exactly what the child feels. But thinking something and doing something about it are two entirely different things. To think something does not mean you will act upon it.

Anger is nearly always about fear, and when we can recognise that and truly understand that, and find someone to help us work through it, then something can be let go of, and the road rager inside of us will slowly disappear.

When I was in training one of my very first patients was a woman in her late 60’s. She had been an evacuee during the war and recognised that for as long as she could remember she felt afraid.

We worked together for a long while and I was extremely fond of her. She was almost child like in many ways, tiny and fragile, but also somehow diminished. I remember her for may reasons, and notably found that she was never able to attend the last session before any holiday breaks, but instead, would always would send me something, usually a bouquet of flowers. Something I later found out that she always did to her mother.

There is something called transference and was clearly at play here. This means that at some level the enforced separation which happened when I had any holiday felt like the same sort of thing to that which she had experienced as an evacuee, and so she needed to remind me to keep her in mind, and so she would send me a gift, as if I was the mother who might forget her, and stop loving her.

And even after all these years I have never forgotten her. Being forgotten or not thought about was her major fear, and to defend against her pain she had taught herself never to show any feelings. She told me very early on, in a fiercely defiant voice, ‘can’t cry, and won’t cry.’ As if she was still that vulnerable little girl being sent away all those years ago. She had learned that she appeared less vulnerable if she never showed how upset she really was.

However, the problem with not expressing your feelings whether it is sadness at loss, or anger or frustration, means that even after many years the feelings get lodged, they are stuck , they do not simply disappear. Therefore, sometimes people feel them (pain), in their bodies, they get headaches or migraines, for example. Or one of my supervisees was telling me about a boy she sees at a school, he had been kicked out of home, and complained of pains in his chest, he had pains in his heart he told her, his heart was literally aching.

Sometimes however, as with this patient, if affected her ability to relate.
No one ever knew what she was feeling, because after all these years, she didn’t know what she felt either.

So slowly week by week we would unravel some part of her early life to help her begin to feel again, and to begin to bear the fear and pain of loss. Losing her mother and father, and also her sister, who had been allowed to come home after 2 years of being away. The loss of her child hood and the loss of innocence, coupled with the fear of the woman who had looked after her, and the memory of the broom in the corner.

Once in the room she was telling me a very painful story, and I found the tears slowly trickling down my face, I said to her ‘I cry the tears you are unable to’.

She was never able to cry in the room, but I do believe she learned to trust that she could be more vulnerable with those she loved, and not fear the pain of being rejected.

I realise as I write this that there is so much here, psycho –somatic issues, projective identification, the receiving of gifts, these are all issues I will tackle, but for today I am staying with being able to feel your feelings. It is as important emotionally as it is physically, as it allows us to move on. As one of my other patients said when the feelings began to surface, ‘When I know I really don’t want to come here, that is exactly what I must do.’

Working through and letting go finally allows us to find some peace, and even after many years or however old we are, it is never too late.

A life well Lived

What does that mean?

I think for me it is something I might like on my headstone when I leave this world and for me it is about living a life with as much integrity as I can. To be honest it is not something I always manage, even yesterday in the high winds my car door was slammed into the car next to me. It was an accident, but to my shame I looked at the car door and thought it was OK, and would have walked away had the owner not confronted me. I like to think had I thought there was damage I would immediately have done something about it, but at the time I thought no more about it.

One is confronted by death on a regular basis, and dying is to the forefront of my mind currently due to a good friend dying last week and another 2 friends with brain tumours, someone told me last week about a daughter of a friend who died from CJD. From diagnosis to death took just 4 weeks. All of these women were/are in their 40’s and 50’s too young, far too young.

And if I were in their place would I think having integrity is enough?

A life well lived, must mean different things to different people. Jung talked about the purpose of life being to fulfil one’s potential, how many of us do that? We have all known people who have died, do we at the end, even think about the question, was my life well lived?

The Headmaster at a local school has raised thousands of pounds for charity, the marathon runner who broke new records, the owner of the horse who won the Grand National; the rider, and the trainer, who was the most happy, who had achieved the most, and do these achievements make our lives our well lived? Or is it more fundamental than that? Is it enough to love and to find that you are loveable?

That burning desire to keep achieving, the frustration I see in the Professor I meet on occasions when he finds he can no longer write as he used to, where does that come from? Without doubt he has loved and been loved and raised a wonderful family with 3 children who have all remained married to their original partner. What a success, but is it enough? To have our name in lights albeit briefly in this day of celebrity culture does that make our lives well lived, is it more than just being known? Or is fame something about being recognised, by someone, anyone, not being rejected. In the end, are we all seeking acceptance and love just for being who we are.

I don’t know the answers all I know is that if you are lucky enough to find that you are loved and have someone to love that is more than part of it, and if you fulfil your potential whatever that is, whether it is achieving fame through an achievement or just satisfaction from trying to write a blog each week perhaps at the end it is enough, providing for me, at least, I do it with integrity.

What do you think? Please let me know your thoughts.

I saw a patient, not one of mine, but at the centre where I work part time. This patient had had to be told that they were not able to continue counselling because their attendance had been too erratic, and despite numerous attempts to help the patient remember to turn up, the patient had not done so on many occasions. So a decision was made to say to the patient that counselling would have to cease.

This was a hard decision to make because this patient had suffered terrible trauma and abuse of power from what should have been a trusted parent during their childhood and additionally had also suffered incredible losses and further abuse during adult hood. Counselling was their lifeline. However the decision was made albeit, not lightly, to stop further sessions in order that at some level hopefully the patient would understand that they have to learn to take responsibility for what happens to them in their life once they are an adult.

Now this client then suffered a further loss and contacted the counsellor who had been seeing them. The counsellor then referred the patient to me. I said to ask the patient to come into see me.

I worried and fretted about what I would say, but had decided that I would say to this patient that they could come back providing that some of the debt was paid and that the boundaries could become tighter and that a new contract could be drawn up and agreed to.

The patient duly came, on time and sat down. I looked at this patient and found something in them that touched me deeply. Their whole demeanour was of absence of power, their was a shakiness and fragility that shook me. I asked what they wanted and they said to come back to their old counsellor. At that moment I realised that the position I was in, was one of absolute powerover this person, if I had wanted I could have used my position to continue to abuse this patient as they had been abused all of their life. You see they gave me power over them, their request was not a demand but an appeal, for me to turn down or not …. as I chose.

The outcome is of course that they are coming back and the boundaries are being tightened, so all in all a good outcome, but I found the whole experience deeply disturbing, I recognised how many people do that to others, how often power is given to people who choose to abuse it.Something carried over from childhood into adulthood, a compulsion to repeat a previous experienceor experiences.

Afterwards I shed some tears, and my over riding feeling was one of humility and a hope that I behave with good judgement, humility, kindness, and awareness that there are always others far more vulnerable than they need be and poeple always prepared to abuse others, power needs to be used with thought, intelligence and wisdom, and should never be used in the pursuit of making money or furthering the self interest of any one or any one group of individuals.

He makes me feel so mad, or she makes me want to scream? How many times have we all heard these expressions?

The answer is probably quite a lot, in fact most of us are told every day that we made someone do this, or that.

However the truth is that no one has the power to make you do anything you don’t want to, ……. unless that is you give that person permission consciously or unconsciously to do so.

Mostly we can choose whether we want to get angry and shout, or walk away, no one can make us. But if somewhere deep in our unconscious there is something that is picked up by both people then the person who might not normally behave in such a way suddenly explodes or throws something, it is as if the anger (for example) gets transferred onto the more passive person and is disowned by the more aggressive of the pair. The same thing can happen in groups, suddenly a group will become hysterical, or sad, something gets picked up collectively.

All well and good but how do we change that? Well the answer is to recognise what are your feelings and what might belong to the other. If you don’t normally get angry and suddenly feel overcome with rage see if it belongs to the other. Of course there is nothing wrong with being angry I am not saying that, but what I am saying is that whatever feeling you are now feeling may not always belong to you, and by recognising that, - you begin to have a choice, whether to react ……… or not., or whether to feel … or not.

So the next time you think he makes me feel so, - ask yourself, is it your feeling or is it theirs, because if the feeling does not belong to you he or she cannot make you feel anything you choose not to.

I am struck by the public/media adoration of Kate. The fact that you already know who I mean proves the fact that she is now clearly one of the most famous women in the world.

And yet although I understand why that is, what strikes me is that only a few years ago she was completely unknown, but by marrying someone famous she too has become famous.

So…. here we have one ordinary woman, and yet do we think that she might feel or think the same to us? Somehow I think not, it is as if by becoming famous she is imbued with superhuman powers to always know how to act, to be always willing to smile, to stifle the yawn, never to be ill or to have an off day. We seem to forget that being famous is just that, well known.

Kate will still feel what she always felt, she may be taught how to cross her legs in public, or what to wear but she will still be essentially the same person underneath the designer dress. She will still suffer from toothache the same as you and I. Yes, it struck me that as humans some of us are famous or well known, and some of us are well, just us, yes we are all uniquely different, but peel away the layers and underneath we are all paradoxically absolutely the same.

Fear leads to anger, anger leads to hatred, hatred leads to war.

I use this quote from Star Wars a lot to explain to my patients that underneath everything, underneath the front that we pose for the world, is fear. We may not recognise it, it may come out as anger or depression, but it is what lies beneath.

Inevitably when we become overwhelmed the fear eventually is allowed to surface and then we may see it as a clinical breakdown. You may have met these people or experienced it yourself. The inability to get up in the morning, the dread of the day, the churning stomach or worse not to be able to get up at all, to stay in bed , in your house, in a place you consider safe.

I have even worked with someone, a while ago now, a young person, and I was the only person she saw all week. No one else. She was driven to me and driven back again, and she never ever came out of her house for anything else. She was 19.

Yes fear can be paralysing but we defend it by becoming angry, or overtly focused, constantly busy, in an avoidance of thinking, and feeling to the point where we may become exhausted. We may avoid the feeling by not feeling at all, by becoming numb, or unable to think, or overtly hostile in an effort to keep people away. These are all tactics our unconscious brings forth to protect us from the fear of fear itself.

What do I mean by fear? Well the fear of not being good enough is the main thing patients bring, they may not understand what this means at first but eventually they understand that they fear they are not good enough to be loved. These people are often driven people, often exceptionally nice people but you do not know or see the real person. Because they fear that who they are is not good enough they keep themselves or part of themselves hidden. Because ultimately the fear is that if you knew them, if you really knew them you would not like them and then they would know that their fears are realised, it has been proven that they are not loveable.

So the next overtly hostile person you meet, or the next over nice person you speak to may not be showing you who they truly are, because underneath there is a fear. If we can understand that then perhaps we could prevent the escalation into anger, hatred and war.

I have always loved that word. Somehow it is has always felt right to accept that if you give something you could expect to get something back, after all that seems fair. Yet we all know that if we help the old lady across the road there is no way she can pay us back. We do it because we want to. Human kindness pure and simple.

However I have heard about a local village where there has been an upset with the local land owner. He apparently gave some land to the village that was his and it enabled the village to benefit.

Wonderful you might think, yes and generous, however and here comes the rub, this local land owner now wants to run a business from his several properties. Which could mean, if he gets his way, functions happening for up to 18 hours a day every day of the year.

The fact that many villagers could lose the quality of life which they have come to expect and deserve from living fairly remotely, may well now come under threat.

Yes reciprocity, I feel it is not a given and in terms of the work I do with my patients I believe to love someone absolutely without expectation for receiving something back is about finding a quality in yourself of absolute integrity.

There’s an elephant in the room.
It is large and squatting
so it is hard to get around it.
Yet we squeeze by with,
“How are you?” and “I’m fine.”
and a thousand other forms of trivial chatter.
We talk about everything else –
except the elephant in the room.
We all know it is there.
We are thinking about the elephant as we talk together.
It is constantly on our minds.
For, you see, it is a very big elephant.
It has hurt us all, but we do not talk about
the elephant in the room.

This is a poem by Tony Kettering, and it was brought to my attention by a patient of mine earlier this week who had talked about his mother finding the poem in a drawer when she had been clearing things out after the death of her father. Her father had kept it after the death of his wife. It is about death, and the avoidance of speaking about something that is painful. But my patient brought it to my attention when talking about a relative of his who may or may not have had cancer. No one had talked about it as if the very word would bring the disease on, and the poem shows the problem with the difficulty we all experience in saying things which may be painful .People feel that if they show their feelings they fear that perhaps the other person can’t cope, they are protecting the other from what they consider to be unbearable feelings, the problem is however, that the fear of asking the question is often worse than the answer itself .

On the other hand people may then assume that if someone else is not showing their feelings they either don’t feel at all, or even think the same as you do. I have a patient who was worried that after their divorce and on the new partner starting a new relationship that he would want to sell their old home. When she mentioned this to her partner he went ashen, that was not what he had wanted at all, and yet the worst was thought because no one had been able to speak about it or voice their fears.

To be able to share feelings is the greatest joy. Sharing your feelings is about finding comfort in the fact that others can empathise without pity. To walk away from someone when they are suffering can in the words of another of my patients make you feel like a ‘freak’, To ask the question as one of my patients sons asked her after the suicide of his father ‘are you going to die too mum?’ means that the child can tolerate the answer, he needs to know and then he can prepare.

Avoidance of feelings is not the answer to be able to tolerate them however is. What do I mean by tolerate? I often use the analogy of hot water. If you put your hand in and immediately pull it out again you are like the person who runs away from his feelings, to put your hand in and pull it and scream or swear reminds me of the person who is not able to contain any of the feelings rather like the person who constantly loses their temper, but if you can just for a second longer resist the temptation to do either of the above you are learning to tolerate your feelings, and then amazingly you find the water is not so hot after all.

Yes, in order to face or recognise the elephant in the room we need to learn about being able to tolerate our feelings, whatever they may bring up. Only then will we learn that we are brave enough to do so and that we can survive in a more emotionally healthy state.

I have a patient who merges. What do I mean by that? Merging or enmeshment means that the person feels what the other is feeling, to the detriment of the self. In other words it is as if they lose themselves in the other, they have no identity of their own.

This often starts in early childhood, the mother or main care giver may be unable to cope. This by the way is not about blame but it is about understanding. So let us say for example the main care giver is fragile, the child picks up on this fragility and will alter their response to their mother. In other words they learn how to modify the behaviour of the mother by taking on her feelings for her, by modifying themselves. They do this at the expense of their own feelings, i.e. they no longer know what they feel but have adapted themselves to the other in order that the others feelings are now bearable for them both.

This is all of course unconscious. So for example I have a patient who came to me not knowing what she was feeling or thinking. It emerged that the father (in her case), was a very powerful force in her life. He had followed her all over the world and now had settled again as a close neighbour. This father controlled his daughter absolutely. So that the daughter did not feel she even knew what clothes to wear so absolute was the control.

Gradually over time she has begun to separate from her father, having come to me after a major clinical breakdown, she began to tell him things she was never able to before and this caused a huge rupture to start with but gradual acceptance that his daughter had changed. A new relationship was formed which was of acceptance that his daughter was an individual but it meant that the father had to learn to manage his own feelings for the first time, rather than unconsciously have them managed for him by the other.

Merging of course to start with suits both parties because it means an absence of conflict, feelings are managed which would feel unmanageable. If the parent is prone to explode the child will find a way of diffusing the situation by taking on the feelings themselves and managing them for the parent. Thus the parent is calm and the child is not agitated, but in doing so loses his or her own identity – the ability to know what to feel or what to think.

Most people come to me as adults, they have had a breakdown when the management of the other has caused an over load with the management of their own lives. You may know people like this, highly controlled, rarely showing any emotion, rarely getting cross let alone angry. In fact people will often go to them to help them resolve an issue. Often highly capable people in their own right and very very controlled.

However with the overload comes the breakdown and these people for the first time feel unable to cope, they may not know what they feel just that their feelings are overwhelming.

It takes time to gradually get them to know what they feel and what they think. It takes time for them to feel like a person in their own right and who has the right to say no, this is my life.

It is not easy being a parent, I know of a friend whose child from the age of 5 would say to his mother ‘How do you know what I am feeling, - you are not me’.

Now that is a healthy child.