Independence or autonomy?

The problems of funding, supporting and adequately organising social care are in the news, and with luck will form part of the current UK general election campaign. At the moment the issues are seen almost entirely as a matter of funding. It's all a lot more complicated than that, though funding is a significant issue. Carers UK estimates that 1 in 8 adults in the population has some kind of caring role. It estimates that 6.5 million people are involved, in some capacity, in caring. This does not include those whose caring is an incidental but vital aspect of their role - teachers, social workers, police, prison officers, home workers etc. If people directly involved in caring are on benefits, they get paid £1.77 per hour, thus saving the exchequer £132 billion per year. If employed, carers are likely to earn at or below the level of the current minimum wage, £7.50 per hour (this is only since April - it has been less than that.) 

And caring is a demanding occupation.  Those providing high levels of care are twice as likely to be permanently sick or disabled, compared with the rest of the population. (Survey by Carers UK 2016)  625,000 people suffer mental and physical ill health as a direct consequence of the stress and physical demands of caring. (op.cit) Over 1.3 million people provide over 50 hours of care per week!

This is just the political aspect of the problem. From an organisational point of view, caring (at the agency level) is a badly managed occupation, where staff are increasingly being asked to cover impossible amounts of work and geographical territory in less and less time, by people who do not understand the complex human nature of the work. Training in adult care has become the province of an organisation called Skills for Care, which offers vocational qualifications at a range of different levels and with differing specialisms. This framework (a term beloved of civil servants) is the end product of a generation of tinkering with the vocational qualifications system by successive governments who have completely failed to understand the needs of vocational education, and who have led us like the Gadarene swine down the road of reductive tick box training, with minimal associated education or personal development. Such organisations have an Orwellian capacity to talk endlessly about 'the regulation of quality' and 'the achievement of standards', with lots of fine sounding bodies to back up this newspeak, but who, it would seem to an observer like myself, would not know quality in a learning experience if it got up and bit their bums.

And to add to the general chaos of the situation, Skills for Care estimates that there is a need for more than a million additional workers, while the ones who already do the job are leaving in droves. The prognosis for what effect leaving the European Union will have, I leave to your imagination . . . . And does it follow, even if we could get these numbers of people into the occupation, that we have a million people with the right qualities to do the job well? Real (not fictional) quality in training and development could be a critical factor in this situation. 

I am not qualified to address all these contextual problems. I can only draw attention to them, but I am very interested in the actual business of being a carer, in what it means to be a carer, indeed what 'care' is - and I notice that almost nothing is said about this when the subject comes up. Being 'cared for' for some time recently after a major operation was an eye-opening experience. One thing that struck me pretty quickly was the way in which the interests of carer and cared-for could diverge quite markedly. My carer (who did an excellent job of looking after me, by the way) was often interested in discouraging me from doing things for myself - things which made her anxious. I suppose she didn't want to be held responsible if something went wrong and my physical health got worse. Put it another way: her estimate of what I could manage, shall we say, seemed lower than mine. And if your pay depends on the client remaining sick . . . . you can easily see how possible it is to hope that the patient will not be able to do certain jobs, perhaps for quite a long time!

I, on the other hand, was keen to start doing as much as I could for myself - I wanted to recover, not over-hastily, but as quickly as seemed reasonable to me. It might have been tempting to lie back and allow someone else to hand me the paper to read, but, actually, it was good for me to make the necessary stretch. At my age, I need to keep as mobile and active as possible in order to preserve my ability to live alone in a house I love, rather than becoming a charge on the state in a nursing home. And I was well aware of how a period of ill health can dramatically affect that ability - sometimes a capacity for independent living, once lost, is never recovered. From talking to many older people, including many with similar health problems, I'm pretty sure that the general wish of all of us is to remain as independent and capable as possible.

But to do that we do need to be active - not becoming marathon runners, not going to expensive exercise clubs, just keeping generally active around the house and in the garden. We need to do the shopping as long as we can, to go out for walks and coffees in town, to be able to enjoy local entertainments and sporting events, and to keep driving for as long as possible. Driving is a particularly interesting issue, where carers can have a lot of anxiety about older drivers. The majority of accidents, we are often told, involve young people, though older drivers come in for a lot of stick in the press and among the busy and irate middle-aged. But let us not pit the young against the old. How about driving under the influence of alcohol, which is no respecter of age? In a survey conducted by the charity Brake, 20% of drivers of all ages responded as having risked driving while over the limit by driving the morning after a night of heavy drinking. Risk is not a factor peculiar to the old!

In my desire to return to active living, I found the hospital and the consultant who did the medical care were at one with me in this - they had me out of bed and moving about with a zimmer frame as rapidly as possible, both to reduce the risk of thrombosis and also to kick-start the movements that would enable me to begin to return to a normal ability to walk as soon as possible. Sometimes they overdid it and it became rather a brutal process, but on the whole, it worked well. When I got home from hospital, however, I found that I had to educate my carer in the idea that I wanted to continue in this vein - did not want to spend my days being waited on hand and foot. If you are a carer you may want to say, yes, but not everyone is like that. Some people overestimate what they can manage, some are quite hard to get moving after a period of ill health. Yes, indeed, but the client knows much more about what they want and can do than the carer - they have lived with this person for much longer! I still think the majority of us are pretty keen to get back to independent living as soon as we can reasonably manage. One's being revolts against the idea of being permanently unable to look after oneself. The carer's anxiety may get in the way of this goal, rather than the client's. Over-caring can be a mixed blessing. And while caring should be adequately funded and supported, there is clearly a 'too much' side to some caring which shows in the amount of ill health experienced by carers. 

I found, also, that giving over one's home and way of life to another, though s/he may have the best of intentions, could be a depressing and even risky business. Quite a lot of elderly people are now victims of fraud and theft by so-called 'carers' who in fact see them as a soft touch. The carer is normally unsupervised to an unusually high degree in their day to day work. It matters what kind of person they are. In passing, have we learned the lessons of the appalling level of abuse of children in so-called care that has been uncovered in recent years? That positions of 'care' tend to attract those with a malign agenda of their own? The power relations are less than equal, sometimes considerably so. Abuse of the elderly and disabled is now a growing social problem. And while I am not in the business of blaming victims, is it our fault as clients as well as that of the perpetrators? How come the population is so financially gullible, is what I ask myself? Is it that the joy of being 'looked after' - perhaps for the first time in their lives - causes them to drop their usual alertness for signs that some people are untrustworthy? It is too easy to assume, in my opinion, that older people are mentally less able in some way, and therefore become easy victims. They have donkeys' years of experience of life behind them, after all, and not every older person has dementia or even a poor memory. I think there is more to it than that.

Where I'm leading up to is the idea that psychology is a key aspect of the caring business, and that is discussed hardly at all. It cannot be measured by ticking boxes - it has little to do with whether the carer can perform certain tasks like changing a dressing (helpful though this may be). The psychologies of both carer and cared-for are both engaged in the process of caring, often in a closely intimate, one-to-one relationship, which parallels to a degree the relationships among families - which are by the way notoriously unbalanced! - and does not anywhere nearly resemble the carefully trained, tutored and supported relationships which develop in counselling and psychotherapy.  

All this led me to think more about what good quality care actually is. The word comes from Old English carian, cearian "to be anxious, to grieve; to feel concern or interest," and beyond that from proto-Germanic ‘karo’ meaning “to lament.”  Caring is closely related to sadness, and also to the anxiety that goes with having a concern about another person. Caring is about feeling the needs or the suffering of another person, and perhaps implies being able to respond to those needs. Doing the washing up because you want your kitchen to be clean is not in itself a caring activity. Doing it because you can see that another human being is struggling with it is the caring part. In other words, it's in the motivation of feeling the needs of another and responding to them that something becomes a caring activity. I very much doubt whether you can tick-box the existence of such a response. It is in the same ball park as concepts like ‘empathy’ and ‘relatedness’, which enable us to be alongside another human being and go beyond our own immediate needs in response to theirs. If you question this, think about the opposite of caring - i.e. not caring a bit. At that extreme, we place psychopathic behaviour as that which is unable to feel or respond to the needs of another, and we see this as sick and sometimes inhuman behaviour. It gets into the Diagnostic and Statistical Manual of Mental Disorders (DSM) with very little argument. 

Of course this type of 'caring' response - feeling the other's needs - has not always been fashionable. There was quite a long period when it was regarded as 'unmanly' or at best sentimental 'fussiness', and to be discouraged. It is easy to make the mistake of imagining that people of another generation, whose lives were nasty, brutish and short, could not have had the feeling responses that we have today. However, brain studies strongly contradict the idea that caring is somehow a ‘modern’ state, and that those of another generation did not have to feel as we do.  Professor Mark Solms (Professor of Neuropsychonalyis in Cape Town University) comments:

There are several classifications of the basic emotions [found in the brain].The best-known taxonomy is that of Jaak Panksepp(1998), which recognizes (1) appetitive foraging,(2) consummatory reward, (3) freezing and flight, (4)angry attack, (5) nurturant care, (6) separation distress, and (7) rough-and-tumble play. The basic-emotion systems are given capitalized names—SEEKING, LUST, FEAR, RAGE, CARE, GRIEF, PLAY—to distinguish them from the equivalent colloquial usages. It is important to note that each of these circuits generates not only stereotyped actions, but also specific feelings and motivations, such as curiosity, sensuality, trepidation, anger, affection, sorrow, and joy. The brain circuits for the basic emotions are conserved across the mammalian series, and they admit of considerable chemical specificity.
(The Conscious Id   Mark Solms   Neuropsychoanalysis Vol. 15 , Iss. 1,2013   Bolds are mine.)

In other words:  1. these are the oldest emotion systems in the human neurobiology, belonging to the mammalian brain (we are talking millions of years old here), and 2. CARE is definitely one of them! We share these systems with all other mammals. ‘Basic emotions’ are in fact what we sometimes call ‘instincts’ or drives. They are systems because they involve both actions and feelings,  generated by the activation of these systems, which are triggered chemically, with specific chemistry attaching to each of the systems.

It is not hard to speculate why care is so deeply embedded in human psychology, given its obvious importance for our survival. Nurturance (caring) is what parents have done for their offspring for millions of years. If they had not, if they could not respond with feeling to their offspring's needs, we would not have survived as a species. Modern infant studies have shown how vitally important mother love and care is for the thriving of infants, and how they can fail to thrive – can indeed die - without it. It is not the food deprivation alone which causes death, but the care that goes with it. And we can see from Panksepp’s classification how equally deeply embedded are grief, separation distress and loss. All seven systems are best thought of as functioning at the same time – they are not to be envisaged as separate packages, though the chemistry that associates to each system is probably specific to that system. We can lose what we care for, and the grief of loss can be extreme. Observe a dog or a horse grieving over a dead offspring, and you will appreciate how profound these feelings can be – and how physical and active they are. The basic emotion of CARE generates ‘stereotyped actions’ as well as feelings and motivations. We show caring in specific and recognisable ways.

It is nice to note that play is also deeply embedded in the human psychology – which explains why we can joke, even at a moment of intense sadness or suffering. And that play is conceived as physical and not merely mental. Hence, art is a form of play and goes back to the very beginning of human culture. It could be that the activation of these touchstones of feeling in others from time to time gives us assurance that we are in fact dealing with another human being. People who do not display these touchstones are harder to relate to. In extreme cases, they are the province of our most famous serial killers, and we call these 'inhuman.' There is nothing so scary as an emotionless android in the movies!

Care and grief as actions persisted for centuries in standard human behaviour. Grief and rage had to be a public display, as in the Old Testament, when mourners rent their garments to display their sorrow or rage. Jesus Christ questioned whether such display was always rooted in 'real' feeling - a sophisticated thought for his time. Christantiy absorbed much older philosophies such as stoicism, and one way and another, for a long time, feelings were not for public display. Our Anglo-Saxon ancestors prided themselves on suffering in silence. This tradition obviously had some strength in it, judging by the length of time it endured as a philosophy of life, punctuated by intermezzos of display and self-ornamentation such as happened during the Elizabethan period. The silence of the sufferer became associated with the 'manly' or 'saintly' virtues such as courage and endurance, and probably had an important function to play when much of life was nasty, brutish and short. After all, there was a lot you could not do much about. Nowadays, because we can do more, we tend to think that what we can do we should do. We like to see ourselves as fixers – that, indeed, there ‘should be’ something we can do about almost anything. Anything that could have been done that has not been done is therefore viewed as unpardonable neglect. It does not, of course, follow that this is the case. For us, post two devastating world wars, the preservation of life has become so sacred a philosophy that we are becoming over-concerned to preserve it, even in those who would in fact like the choice of ending it.

The mammalian emotion systems we have been discussing gave way quite recently (in the perspective of human history) to the development of the pre-frontal cortex – that which probably distinguishes us from most other mammals. Among its many sophistications, this part of the brain enables thinking to become an adequate substitute for action, allowing us to pause and reflect, in situations where, at one time, action would have been the only option. Nowadays we have the option of thinking about whether care is the right way to proceed: and if so what kind of care? As opposed to jumping into the middle of a problem, with action governed by an ancient imperative that drives us to do something! At such moments, we are sure we know what the other person wants/needs. And indeed, if they don't want it, we still know better what is good for them!

This is where I came in, I think, when I began to sense the complexities and conflicts of interest in being cared for. And it is where the tick box approach to training of care workers is so inadequate. It seems to bypass the whole question of how to proceed, whether to proceed at all, and, if so, what is the right kind of care. Thinking, shall we say, is to be discouraged, in favour of learned procedures. What needs to be thought about, I suggest, as a first base, is whether it is independence that the client/patient needs, or more personal autonomy.

The two terms are not synonymous, though they are used as though they were. 'Independence' is rooted in the doings and claims of states and populations - French 'independence' being typical. It is closely connected with having enough money to live - i.e. not being a dependent relative or one supported by the state. And it often shades into 'not influenced by others in one's opinions or conduct - thinking for oneself' (OED) As such independence has had a good innings as a quality to be admired. We all like to think we are not influenced by others. We will vote as we think fit, won't we, in the forthcoming general election? (though it is hard to see what the point is of having a political debate if we are not going to be open to being influenced!) The problem with independence as a life goal is that it isn't always a practical possibility. But also, it ignores the fact that close relating involves dependence by definition. If we are to be able to love, we need to place ourselves in a position of some vulnerability - including that of (potentially) being hurt. Trauma prevents some people from being able to tolerate this risk. But until they can find a way to do so, the traumatised find it hard to make close relationships. 'Feeling the other's needs' and responding appropriately is central to our idea of a good relationship. You cannot really have intimacy without a basic empathy like this. If you are never going to be influenced by your partner, you can quickly end up in a pathological relationship where all the power is on one side. Good parenting involves seeing the difference in one's children and trying to respond - rather than trying to get the children to conform more closely to us.

Autonomy, on the other hand, is Greek in origin, meaning 'having its own laws'. In Kantian thinking, it is all about having an inner law - a state or capacity to consult inwardly, that we can and do invoke when it is needed - something that Kant identified as a serious moral virtue. It is about being able to act in accord with one's moral sense, rather than one's desires (one's instincts or basic emotions?) In a word, it is about having a mind of one's own. Here is where the mammalian brain response is not enough. We also need the capacity to pause and think conferred by the pre-frontal cortex. We may or may not be entirely independent, in this sense - we all have to depend on others to a greater or lesser extent - but even in the closest relationship, we can still retain a sense of doing what we think is best or right for us, whatever our circumstances. 'Doing the right thing'  has had a poor press, compared with 'independence' - it seems we feel we can demand that people get things right, and not just 'try to do the right thing'! I am doubtful about this. But that's another argument.

So 'independence' can make us feel good and strong and unbending before others - an independence which may be more fictional than actual - as evidenced by the way in which instant hysteria breaks out, should there be a petrol shortage or a concern about the safety of food. Meanwhile, we may not actually have much personal autonomy - because the fact is we do what is expected of us most of the time! We become fixers - we rely in actuality on the mammalian brain's belief that CARE requires automatic action and feelings - stereotyped action/feelings for the most part. Instinctive care is a knee-jerk response: there is the need, and I am required to respond. In this situation, one quickly becomes a compulsive carer.

I wonder whether the option of pausing for thought is less readily available to some people? I notice that for some people, the knee-jerk response to meeting a need is ‘I must respond’ at once. As opposed to, “I must think about what is the best way to go here.” Do we really need more publicly provided care is a question worth asking? Should we restructure the whole of our public finances to do greater justice to the work these many careers do? Surely there is a cost benefit, and not just a cost, to the work of caring? Without doubt, when it is well done, quality caring enhances lives and saves us a lot of public money. More importantly, it enables that stage of a person’s life to demand less of the allied services than they would otherwise.  And there are knock-on consequences of a lack of care – as we know too well, now that we see how hospital beds can become unavailable for the next unwell persons who could use them. There is always a price on what we don’t do or provide, as well as what we do. On the other hand, are we becoming hooked on the whole idea that somebody ought to be caring for us? Are there, in other words, expectations which have been raised in the modern world which simply cannot be met? The fact that we pay for care so poorly suggests we value it at the most basic level, if at all. Or has it been consigned to that type of work which is held to be vocational? The sort where the workers should be content with getting very little pay since their reward is the joy of doing the work?

There are few straight-forward answers to these questions, but they all matter. As a starting point I want to suggest that we need to get much straighter in our minds about what services the state should offer. When that has been cleared a little, we need to focus much more on the psychology of the caring relationship in order to improve our selection and training of carers. If we can only manage to find fewer, better paid and qualified people with some standing in the community in the same way as teachers, nurses and social workers are valued,  who can really do this job, that may be a better compromise than spending more public money on creating fresh opportunities for clients to be badly served or even defrauded or abused. A good starting point for employers looking for carers, and trainers working with them, might be to concentrate on an understanding of the value of autonomy and how to encourage it in carers and their clients. They might also in their programmes provide spaces to think on the de-merits of a false independence, in which we proudly claim that we need nobody, but actually demand all kinds of things of others without even noticing it!

Recovering from an operation

I am now back at work after major knee surgery,  and so there is a gap since the last post. It has been a thought-provoking experience. I had not felt so vulnerable for a long time - very dependent on the surrounding people to make things happen, from the trivial: "Could you bring in the post?" to the major concern like getting to the hospital on time, despite traffic, for an outpatient appointment - of which there seemed many.  The first one came so soon after discharge that I wondered why they had bothered to send me home.

I had at one level too much time on my hands - fortunately after three weeks convalescing at home I no longer felt ill - and, at another level I had no time to do what I wanted to do because there was always something intervening, like doing exercises, taking the endless pills, eating at the time convenient to the carers, etc. I had an enormous sense of relief to take back the management of my own life. But this did not seem real until around six or seven weeks after the operation, which is the longest time I can remember since childhood in which I so depended on others for basic things like help to put my shoes on.

It seemed real when I could finally decide how I would spend my time that day, when I would eat, when I would pop out to the shops. Driving was almost the last thing to return. I was advised by the medics not to drive before six weeks of recovery had elapsed, and I took this advice. But driving gives me a huge sense of freedom which I had almost forgotten because I had so taken it for granted for years and years. For a while I recaptured that delightful state in which every small thing gives pleasure - deciding what to eat for lunch, sliding into a convenient space in Sainsbury's car park. I kept wanting to behave like a kid and say, "Look, mum, I  can do it!"

A few feelings and ideas remain that came out of that period. One was the fairly obvious realisation that I am much more dependent on the surrounding community than I care to admit. Less obvious, but striking for me, was realising how much my concentration improved when I was forced into not trying to do so much. When spread-eagled on a sofa you have limited choices - can't butterfly your way through a day, doing this, that and the other, often all at the same time. It doesn't work. If a decent book is available, you had better read it, especially if the only other option is daytime TV, the last resort of the hopeless. I realised I quite often 'read' while doing two or three other things at the same time. Or 'watch TV' while keeping my eye on the laptop, etc. This has to stop! I enjoyed things so much more when I was focussing on one thing at a time. Got some nourishment from them.  In my present state of much-improved mobility and fitness, I can feel the old bad habits creeping in - and I don't like it much. Some self-discipline will be involved, but I need to get back my sense of mindfulness, as the exponents of this practice like to call it. I suspect that we all suffer from the illusion that if we 'multi-task', we will somehow get more done in a shorter space of time. The women's movement made a virtue of multi-tasking for women and did us no favours. This is pure baloney, actually, since what really happens is that we half-do everything - skim over the surface of life - leaving a task to be completed some other time, which will just take time another day, or more likely be abandoned. Or we get used to being sloppy with everything, and thus quietly lower our standards and do nothing that gives us real satisfaction. Worst of all, we decide it takes too much time to think in any depth, and have no opinion about anything at all - which we are then obliged to rationalise as the virtue of a peace-loving mind. Which brings me to a more subtle point: what is the point of doing anything anyway? If it is not to achieve the pleasure and self-nourishment that comes from doing it. 

And if there is no reward involved, why am I doing it? "It has to be done by somebody," is a common response. Well, maybe - but does it have to be done by you? This comes up, frequently,
in psychotherapy sessions. Women especially seem to feel that they cannot possibly leave a job alone that a partner refuses to notice. If the partner has reneged on 'their job', they feel they have no choice but to do it for them.  This is simply untrue. You can leave the bins unemptied until somebody complains! And then refer the complainant to your partner! It's hard at first, but it gets easier with time, trust me.  "I get paid for doing it" seems to me to be an alibi for a doing a job you hate, rather than a reason. You have two options which are being discounted: one is to get another job, and the other is to find out what is likeable about the job you are doing. Getting another job may involve upheaval and sacrifice. Jobs may be thin on the ground in your field. But sometimes life requires you to take a risk, take the hit and move on. If that's impossible, then it is possible to find something interesting or at least tolerable about the job you are doing. My sister once told me that early in married life she realised that she would have to do a lot of washing up, which was not her favourite chore, but she decided that this being the case, she would learn to enjoy washing up. I thought this heroic at the time - have never achieved it myself - but it makes good sense if you can do it. Even then there are options - save up for a dishwasher, hire your partner for the task, or the kids. I notice my sister eventually took the second option - and good luck to her.

What mindfulness has taught me, though, is that there is magic in every moment, if I can bear to pause and consider it. And this is what I miss when I lose my concentration and start butterflying my way through life - trying desperately to do everything my brain tells me to do and failing to pause and reflect on what I really want to do, or how I really want to do it. 

How do people change their minds?

The New Year has blown in bursting with more contributions to the 'post-truth' debate. It seems as though the liberal intellectual world has finally discovered Freud! And his fellow founders of depth psychology. A very long time ago we learned from these thinkers that people engage in varieties of rationalisation, projection and denial all the time. And this means all of us! Sadly, it is not a characteristic confined to a few muddle headed types, and nothing to do with us. It is the way in which a human being functions. And these characteristics have now found a label, which is 'post-truth.' It does not make us bad people, just people. So let's start by trying to get the value judgements at least temporarily postponed.

Now, it seems to me, we are socially in a place to consider whether people in fact truly base their opinions on fact, whether they really, really engage brain before opening mouth (as all those mugs used to say.) Psychologists of all persuasions have suggested that unbiased weighing of fact and opinion is a rare activity. The problem is that the psyche is so full of stuff already - as I like to say, it got there before we had a chance to form a mind of our own at all! It had a head start in the hundred metre dash - where even a split second can make all the difference between winning and losing. By the time we wake up to ourselves - the self we discover we possess, usually with some glee - our psyche is well formed with material. Trauma studies suggest that psychological wounds can derive from the earliest experience of birth and before birth. There is now a whole field called transgenerational trauma which harks back to generations ago, and what we may or may not have brought away from those experiences. Epigenetics is showing us just how the brain adapts and doesn't, to all kinds of tiny shifts in our biochemistry. So let's pause in our long-held convictions, to wonder, at least, whether our openness is as great as we imagine it to be.

If the question of 'truth' is on the table at length, at least enough to put it in quotation marks, what attitude ought we to adopt to this discovery? BBC Radio 4 is floating a new series of programmes for the new year called 'The New World' (http://bbc.in/2hx950T) and is worth listening to. I recommend it. Listening this morning my attention was caught by the word 'bubble' - the way we all live, it seems, in bubbles of our own making or choosing. There was anger among Brexiteers about the supposed liberal 'bubble' or the 'Westminster bubble' which they felt had left them outside of the debate. But it turns out that we all live in bubbles - it's just that we don't know about the bubble we actually live in. We spot others' bubbles easier than our own. The bubble is a neat image of the surrounding networks in which we function, within which we get mirroring feedback of the type which helps us to feel that we are the ones in the 'right.'  This is true politically and helps to reinforced our political beliefs. Some researchers even suggested that we tend to move geographically into areas where people of like political mind tend to live - this is called psychological geography.

It struck me that it had been common at one time to disparage the way in which immigrants tend to collect in particular areas of the country, as though this were a uniquely negative characteristic of our friends from Pakistan or the Caribbean. Of course, it is a human tendency all over the world, where groups of ex-patriots commonly collect in specific areas of like individuals. The British Raj was a classic example of the expatriate British living in India and doing everything they could to make it as much like home as possible. Racism is not being able to recognise this tendency without reference to ethnic origin, it seems to me. It isn't 'them', it's all of us! Whether it is right or wrong is a separate matter. The wrong, I think, may well be that of the Westminster bubble, who did not think intelligently enough about this human tendency, and its consequences for the differing impacts of large groups of immigrants in areas that once experienced themselves as a typical British 'bubble.'

But the question that we now need to address much more forcefully, I think, is this: given our tendency to congregate in bubbles, whether geographical, intellectual, spiritual or whatever, how can people be brought to change their minds? How do you get out of the bubble you are in? Is it possible to get out of it? Or are we all, Matrix-like, stuck in a virtual programme world where there is no escape? This is a far more difficult question to answer. The radio programme above suggested various ways - one professor thought that ten minutes a day of pausing for doubt would help, for example. I liked the suggestion that we need to seek out opinions contrary to our own - and actually listen to them! The listening part is really hard. I like to read the London Times when I can manage it, not because it is my favourite newspaper, but because a) it still holds claim to some measure of reason and objectivity (this I know is also open to question, but at least news and opinion are kept separate to a degree), and b) because it keeps me in touch with how the 'Establishment Bubble' thinks!  The contribution however that I liked the most came from a Southern Senator in the United States, who had changed his highly conservative mind on the subject of the environment. He comes from a place where climate scepticism is the norm, and 'expert' opinion is automatically wrong. He said, speaking about trying to persuade others of his change of attitude, "It's very important to use the language of the tribe in reaching the tribe."

This seems to me a powerful observation from an experienced political campaigner. The Senator was saying, as he elaborated, that in trying to reach climate change conservatives, it was useless to talk in terms of 'scientific opinion' (the dreaded expert) or the need to save the planet for future generations (the liberal conviction of responsibility for others, which seems to leave out 'us' - those who suffer now!). What the sceptics needed to know was how business could benefit from dealing with climate change, how the free market could be engaged to rally to the cause, and so on. And perhaps (remembering the God-fearing nature of some of those constituencies) how God had gifted the world to us to use but not to destroy?  These points are not 'wrong', it seems to me, simply viewing the issue from another perspective. This practice used to be called 'rhetoric', and was taught in schools and higher education, with no idea that it was a disgraceful or unethical practice. The brief those generations started from was that persuasion was an art and a skill that everyone needed at their finger-tips - because the world consisted of other people who did not think as we did. The bubble mentality is quite the reverse, it seems to me: it believes that persuasion is beneath one's dignity, that conversations with the undead (namely all those who disagree with me) are not at all desirable but a waste of time. Persuasion, indeed, may be a source of angst - fear that hearing the other's opinion may show me that I am not always right. In the recent EU referendum, the campaigns on both sides seemed to me to be based on failures to grasp these important lessons of rhetoric. They were full of expert opinion, which only revealed how conflicted so-called expert opinion can be. Neither party seemed to have given much thought to what language the opposing tribe could hear. It seems that the 'gut instinct' approach to politics is the norm among the populists, and certainly the gut instinct seemed to prevail on this occasion. I must say I am in favour of gut instincts - they have often led me to a better more sane place than a dozen learned books. But the gut is not the only seat of wisdom in the human body. The gut - the solar plexus chakra - is often the seat of anxiety, of neurotic doubts and depressions. Which is why we get so much indigestion when we are worried. J.R.R. Tolkien liked to use the phrase, "What does your heart tell you?" which seems even better to me than the gut. For the heart chakra contains our broader feelings, making space for our finer feelings of hope, trust and the desire to do right by all our people. Too often the heart has been cut out of our politics - as though we think political questions can be decided by numbers alone. I think I wanted somebody to tell me that being a European meant espousing a set of values and a way of life that suited me. That it represented hope for peaceful co-operation and the healing virtues of community, of sharing, of communal solving of problems, of noticing what we had in common, instead of what divided us. Sceptics will of course scoff that the EU could never deliver such high ideals, and they may be right. But the anti-EU bubble contained its own improbabilities too - of more money in the national coffers which we would personally feel the benefit of, of the limiting of the population to those who looked more like us, of rolling back the tides of globalisation and the restoration of national power and glory. On these ideals too, the jury is still out. Let us wait and see.

The question has been raised, 'what happens when the high ideals with which we vote are disappointed?' There is a fear here that something very dark enters the national psyche. My news is that it was already there, from long ago, and only surges to the surface at certain times and places for complex reasons. I have a worse fear still, which is that evidence has little effect on the 'bubble.' On the contrary, it tends to reinforce the attitudes and beliefs of those in the bubble. Almost any opinion, idea, concept, experience can be dragged into the service of 'what I believe.' What I believe then becomes 'truth.' Jerome Bruner, the American educational psychologist, once said, "The fish will be the last to discover water.' Which I think sums up the bubble mentality only too well. What is always there cannot be seen.

I don't exempt psychology from this truism, by the way. It has its own bubble, a wondrous work of mutual self-mirroring at times, where great work on the human psyche can only be described and explained in the most obscure language, full of the kind of technical language that cannot ever be shared with the population at large. A few years of embedding, and like the fish, we totally lose sight of the water. I personally have not much time for obfuscation in any field, still less in my own. Bruner also said, " . . .  any subject can be taught effectively in some intellectually honest form to any child at any stage of development." This seems to me to be the most important truth about communication in any field, and does not just apply to children. Only it poses a major challenge, because we have to find the right language in which to achieve this, and that is not easy - requires serious effort and thought, and may well be misunderstood or be castigated as the dreaded 'dumbing down.' The question arises, moreover, as to how far we want to be understood? Or to understand others? Openness does not come easy. Being right is critically part of our self-image.

Yet good minds through the centuries have been able to acknowledge they were wrong. Easy to say, "Einstein could do it, but I'm not Einstein." No, but it was not at all easy for Einstein either! When you have become the possessor a fearsome international reputation, then is the worst possible time to find out you are wrong. The point is, I think, that if the truth you aver seems of overarching importance - more important than your personal pride or self-worth - then and only then can you be openly wrong. Then, maybe, you can find out where your true values lie.

Divided we stand

The air seems thick with argument post-referendum. We are told we are a divided nation. Listened to Labour's John McDonnell this morning on radio telling us that we need to come together, and that Labour will lead the way. He is not the first and won't be the last. As someone remarked, the sentiment can begin to sound downright threatening! You will do as you're told and come together, or else . . .

First of all, I notice that we remain standing despite it all. Yes, a few individuals have resorted to violence, and some to inflammatory racist dialogue, but it was ever thus. Some people cannot settle an argument without shouting or fisticuffs. I sympathise with the shouting (though don't advocate it) but haven't much time for the fisticuffs. We have laws, rightly, to deal with that sort of approach to public discourse, and I just hope it is being taken seriously by those whose task it is to enforce them. Mainly, however, we are arguing heatedly, at times furiously, but within the bounds of civilised behaviour. The nation has not fallen apart, my neighbours are still talking to me, and politics has become interesting again, if somewhat hectic.

Underneath the debate about whether we remain in the single market, whether we jettison the free movement of labour, what our prospects are in a World Trade context, is perhaps a deeper debate, to which many analysts are struggling to give a name. What I am hearing is a strange mixture of anxiety, sometimes paranoid, shed-loads of mistrust, a lot of anger, plus a certain kind of exhilaration about being let off the leash at last!

The latter element is interesting me quite a lot. Could it be that the British, whose culture has been buttoned up for a century in the eyes of the rest of the world, have finally shrugged off the inhibitions that have told us, time and time again, to say nothing - to be polite at all costs - and never to talk about controversial things? I declare an interest - it's the part of being British that I have always disliked the most. Not being able to say what you are feeling or thinking in a genuine, honest way, has not played well with the health of our society in my opinion. Ultimately, remaining buttoned up has made it hard for us to achieve real intimacy in our relationships. To be close involves us, of necessity, in being frank. I am not talking about sex, as some people seem to think as soon as the word 'intimacy' is uttered, though, of course, our sexual relationships are very much involved in our ability to be intimate. I'm speaking about the business of being emotionally open - being able to say, "I'm sad, I'm angry, I'm depressed, I'm furious" et al. In a word, just to say, "This is how I feel." That we don't do this easily in this country has led to the cinderella status of the mental health services, to the lack of firm public support for psychotherapy and counselling services, and, worse, to the time it has taken for abused and mistreated people to feel able to complain about what they have suffered. The sight of other people saying just how they feel can evoke an astonishing amount of feeling. Years of being buttoned up can quickly lead to a splurge of ventilated feelings. For some, the feeling it evokes is rage. Feelings are coruscated as 'mushy', 'sentimental', 'inappropriate in a public place' and so on. It is quite intolerable, isn't it?

Well, not really. It is misguided sometimes, and misplaced in others. But just as we can get it wrong in regard to a whole hosts of behaviours from time to time, it is only a mistake, after all - not a hanging offence. Perhaps you opened your mouth too hastily when moved by a sense of fury about what someone said in a meeting. And afterwards regretted it. Or possibly you told your spouse a couple of home truths that you had been harbouring for too long. And wish you hadn't said it. I think we all need to get over this kind of guilt and sometimes shame. These are toxic responses, and far worse for us than what we actually said in the end. It can be sufficiently hard to get over it to warrant some professional help. But that's fine too. Nothing to hang your head in abject horror about! Do what you need to do for you, is my best advice. And worry not to so much about what other people may think!

The Americans have unfortunately given us a dubious example of emotional openness for years. Many of them take the opposite view to us, it seems - the more you lay your feelings on the line, the more popular you are. The backlash from a British audience to this kind of public display can reinforce our conviction that it is better and safer to stay buttoned up. But both of us are in the wrong, it seems to me. We are far too buttoned up for our mental good, and the Americans are too all hung out about everything for theirs. There is no particular virtue in failing to be able to express an honest feeling. And equally, there is no cosmic brownie point to be awarded for transparently wallowing in insincere feelings - what a friend of mine calls 'cosmic wanking.' What really matters is the genuineness of the feeling. Feeling something in itself is neither virtue nor vice. It's normal and human, like eating and sleeping. It's what we do as members of the race. The hard part is being able to distinguish the phoney from the true, in what we hear and what we speak. Artists have helped us, I think, in being able to spot the phoney, and the better the artist the more helpful they have been. But wherever the help comes from, we need all the help we can get in this area.

I have noticed that men who often find it particularly hard to express feeling can be emotionally galvanised by football. It seems there is something about eleven men kicking a ball around that arouses passion - and passion is not my word, but the word frequently chosen by football supporters and commentators when they want to confer the highest admiration they can imagine. Equally, the worst criticism you can make of a footballer is that s/he lacks passion. In sport, generally, I suspect, we of the buttoned up culture have found an outlet for our suppressed and often repressed feelings. It cannot be accidental that the national game, football, has struggled hardest with the kind of behaviour that is pretty much outlawed elsewhere in society.

So has the EU exit changed the national culture is my question? I think we need to calm down a bit and remember that change is a process, not an event! I think something has begun, indeed. For many people, feelings have spilled over their usual confined spaces deep within psyches, and come out yelling and furious, sad, depressed, triumphant, excited, badly shaken. When this happens, a process begins but is not concluded. Not yet, by a long chalk. The important thing about having said whatever you said, is that you don't then retreat into a sulk or walk away to tend to the cabbages and refuse to open the topic ever again! This is really tantalising behaviour, sometimes downright tyrannical. It seems to say, "I have said what's important, and I have no intention of listening to your reply!" If you want to say something difficult and possibly destabilising to a relationship (and 'I'm for leaving' qualifies, believe me!) then you had better say it. But equally, do not expect to the person thus told to say, "Ok, then," and walk away likewise and never refer to it again! Some of those who desperately want to exit the EU seem to regard what they said when they voted as the final word of God on all things. Sorry, but there is no such thing. Once you open a dialogue ('dialogue = a conversation between two or more people'), you have some responsibility to expect that dialogue to continue. To facilitate a space, indeed, where that dialogue can continue. And have the patience to listen, as you are being listened to.

Refusal to take part in an ongoing dialogue often has a lot to do with sheer fear. Fear that one may still lose the argument. That somehow the other party will get the better of you. That you may not be articulate enough to find the words you need to defend your case. That the power balance will turn out to be as unequal as you always imagined. Well, these are all risks of dialogue, all right. The same risks that any kind of relationship poses. But they have a chance, at least, of leading to some kind of resolution of conflict. At worst, they offer relief from living a buttoned-up kind of existence, which is painful. And a not unimportant consideration is that if you want to get better at expressing yourself, you need practice! Which means accepting that part of your learning will sometimes be getting it wrong, going over the top or even on occasion making a fool of yourself. Why is it that we would expect to be told to practice if we wanted to learn golf, but never seem to imagine that we need to practice talking to others? That we might need practice in expressing feelings, especially difficult ones. That choosing the right words is not a gift divinely conferred, but one that comes out of years of making an effort?

Being able to listen is often the heart of a psychotherapy exchange. Among other things, it helps us to orient ourselves towards the task of simply talking about ourselves, that hasn't had much chance to flourish earlier in life. If you had buttoned up parents, you are very likely to grow up a buttoned up kid. A lot of earlier behaviour and thinking needs unlearning. But also we need experience of actually listening to ourselves talking. Hearing my own voice at work is powerful - it can make me feel different, like a person of some importance with a mind of her own. It helps me to feel that what I mind about is worth saying.

So it seems that one part of the country has a lot to say to the other part. And we haven't really been listening well to each other, perhaps for a long time. So if the time is now, then let the dialogue continue, by all means, and let's not get too worked up about it. I suggest a moratorium on the demand that we come together. This seems to me to be like the voice of the teacher in the playground, demanding that this battle cease at once! I don't think we need to tell anybody what to do, really. Perhaps just allow a period of unusually heated discussion! From such dialogues something emerges, in my experience, eventually. Which will probably turn out to be surprising.  

 

Sacred truth

The word 'truth' is unusually around in our cyber- and other spaces. The word 'post-truth' has been declared word of the year by those who write dictionaries. A Times correspondent described 'post-truth' as lying - it's that simple. My generation can call a spade a spade, he declares. There is much generalised anxiety around about the idea that perhaps we are increasingly being fooled into misperceptions, to the extent that we are no longer in touch with reality. Do we all live in a Matrix, or a Truman Show kind of world in which we are 'normalised' into believing that what is real is not in fact real at all?

This idea is not new - what is? I recall a great sci-fi writer of another generation (E F Russell) who wrote about our planet as in fact a scientific experimental laboratory, run by aliens of far greater advancement than us in knowledge. Little did we know that they might call a halt to the experiment at any time . . . .

All such perspectives seem to be grounded in huge anxieties, which we don't care to admit to often, that we are in fact unimportant little creatures, dots upon dots upon dots, frequently way off beam, who take ourselves fantastically seriously without just cause. Are we Hamlet's 'the beauty of the world, the paragon of animals,' or are we 'this quintessence of dust?'

We could engage with this argument at great length - possibly arriving at very little useful conclusion.  It's narcissistic in its essence - born of the need to feel like 'the Great I Am' and the fear of not being. Equally, we could say, 'why does it matter?' The why question is what often comes up in psychotherapy.  I find that people want to know whether they are important or not - whether they are valuable, whether they are valued. And the reason they want to know is because nobody has given them much to go on in the past. The parental job, among other things, is to help your children find their own worth and feel confident in it. But often parents have too little sense of self-worth themselves, and cannot transmit to their children what they never had themselves. They themselves are confused and uncertain in this difficult world. Do they matter? Do their children matter?

The ultimate cop-out is to say, 'What is truth anyway?' as Pilate did. I can't really blame him, in the difficult world of Judean and Roman politics of the first century. But it is a cop-out in the sense that shoving aside the existence of truth is meant to relieve you of responsibility. I didn't actually lie to you - I just told you the version that suited us both at the time! It's an attempt to escape from that responsibility by shelling the very idea of truth. Deny truth and you are free to say whatever you like.

The fact is, though, that we have always been free to say whatever we like. Haven't we? What curtails our freedom, or appears to, is the world of consequences. Patients who struggle with a powerful sense of being in chains - being denied the right to their point of view, being controlled, being shut in, shut down, shut up - are sometimes demanding the impossible, namely the right to say and be whatever they want without any consequences. Yet, provided you are prepared to accept the consequences you can do and be and say anything you like. But consequences there will often be! It takes courage to accept the consequences of your behaviour, because you feel that what you have to do or say is that important. It is the essence of the struggle to be a self in a world that is over-peopled with other selves also struggling in the same way. If you want to be free to commit crimes, don't expect them not to put you in jail! If you want to stay in bed mornings, don't expect them to forgive you for being late for school! What these struggles are about, it seems to me, is the immensely difficult task of finding your place in the world, where you are not a lone wolf but one of a community. You can have your share, but you cannot have it all. Not without consequences.

But are there always consequences you may wonder? It can be a desperately unfair world where some people seem to get away with no consequences at all for their behaviour. I think the word 'seem' is important here. You may lie and cheat and not get found out, it is true - but you yourself will find you out. The idea that life is a breeze if you play by no rules and collar all the bonuses is wrong, or at least a partial truth. There is always the overhanging fear that one day . . . . someone will find you out. Justice has a long arm in a world where records are always left somewhere of everything we do. Abused children grow up and get courage to spill the beans. Investigative journalists expose fraudulent behaviour that goes back decades. You are always having to cover your tracks. Always having to make excuses, think up fresh lies and deceptions. The quality of relationships is tarnished by lying and deception. You imagine that nobody knows - that it is your dark secret. And then you find out that everybody knows! Has been treating you differently from way back as a person who cannot be trusted. All hope of real closeness, of intimacy, goes out of the window. You inhabit a phoney world where nobody is expected to be real, to be in the now. You have put yourself in the Matrix, in the Truman Show, willingly! And this is a fate worse than death.

A particular issue for a lot of people, I find, is struggling for the right to say things - find a voice and use it in people-to-people situations. If they could do that, they probably wouldn't need psychotherapy! But their fear is too great. Won't people be angry with them for disagreeing? Won't they lose their closest relationships and be abandoned? Won't they be unpopular? (This is a particularly powerful fear in teenagers - a fate they can only gasp with horror at!)  I don't dismiss such fears as trivial. Not at all. But you tend to find with experience that being disliked in one quarter gets you rather liked better in another. Also, being abandoned is actually not the worst thing that can happen to you (I exclude childhood of course in this). It may be that, having got rid of some deadwood in your life, you may have cleared the first space in your life to do something for yourself alone. Imagined consequences may turn out quite differently from what you thought. Imagination plays tricks, enables our internal worlds to speak many varieties of untruth to us - to whisper in our ears all sorts of negative stuff.

So I want to speak up on the side of truth as being psychologically healthy, if nothing else. However, there are caveats worth thinking about also. It pays to be thoughtful about what truth actually is. Very few truths are sacred and inviolable. Truth is not perception. We are creatures of perception - we tend to think that what we perceive to be happening is the only truth there is. Keep an open mind to the possibility that your perception may differ from that of other people - and that neither may be wholly wrong. Check out the facts. Do the work of a good journalist and make sure you know the event history. Social media don't seem to mind whether you have checked anything or not. Everything that is said is presumed to be the case. And a lot of people seem to be be extremely gullible. "It was in the papers" was once a common self-defense against being challenged. Not now. But 'it was on Twitter' has become an easy substitute. Time we became harder to fool. Time we came to value truth more highly. The alternative is to join the world of The Truman Show and not even know you're doing it.

Post-election reflections

Well, it's all over, and we can breath a collective sigh of relief.

The outcome of the Presidential election has obviously been a major shock and to some people has been a source of dismay and indeed profound despair. It feels all too much like what prevailed on the morning after the EU Referendum was declared. A nasty chasm opens up, in which we find that we are capable of thinking about each other quite differently from what we ever imagined. When I was a school kid, we were taught that the great virtue of the United Kingdom was its homogeneity! From one end of the islands to the other, we were all pretty much the same! Yes, honestly! We've come a long way since then, but even so we did not quite understand how utterly different we were from each other until the ground began to quiver beneath us. Difference, and how we come to terms with it, seems to me to be the great issue of our time.

I'm left with a myriad of impressions of the whole vast stretch of the election, which is so long and laborious for the Americans that I have always wondered how they can bear it. And even now, the handover process will take up unconscionable quantities of press and TV and social media discussion and analysis, and it won't be until a cold January day in Washington that the lid is finally sealed on the whole episode.  American friends say, "You don't understand. It works for us." Ok, I believe them, but I also think we understand only too well! Actually the people of these islands are in many cases better informed about American politics than the Americans are. I was astounded to hear one highly acclaimed US pollster remarking in an interview that the polls got it wrong because they had not really drilled down to the backyards of the rust belt and deepest south properly, to the ordinary folk going about their lives. Frankly, I have seen dozens, if not hundreds, of such interviews over the period of the campaign. Maybe they didn't, but we certainly did!

One response from such ordinary folk that stays in my mind is the frequent remark, "He (meaning Trump) knows how to get things done." Competence, it seems, is part of what Sir Harold Evans strikingly called 'the deep ache' in the American psyche - a longing for change that is real and not just cosmetic, and a conviction that nobody in their system knows how to achieve competence in political terms. This is a particularly startling perspective, coming from the nation we have always thought of as the 'can-do's' of the world. Aren't Americans famous for their competence? They get on with solving problems, with dealing with things, not vacillating in the backwoods of denial and polite indifference. If an earthquake tears down their bridges, they build them again practically overnight - don't they? The highly educated, thoughtful, rational US liberal intelligentsia, on the other hand - people whose minds we can only admire for their ability to scope, evaluate and analyse - seemed relatively unconcerned about this same question. There was an assumption that nothing was really broken in the system - yes, it might be unwieldy and gridlocked at times, but essentially the vision of the founding fathers had got it right, and success, justice and truth would be delivered down the line somewhere.

It is obvious that US society is working for some people and not others. Like our own society, it appears that if it seems a bit wacky but basically competent and sound to you, you belong to a different class from those to whom it appears to be messed up big-time. I was rather struck by Mr Trump's acceptance speech at the end of a long night of results pouring in, in which he spoke about the immediate need to 'rebuild the infrastructure' of the nation - roads, bridges, hospitals, airports, and so forth. 'Infrastructure' chimed with me psychologically - raising, as it does, images of the deep psychological underpinnings of the human mind. We sometimes speak of analysis as the means by which we 'restructure the personality.' It implies that a few cosmetic behavioural changes will not do it - there is more wrong than this, which will need more than the cosmetic to put right. Things inside us have got into the wrong places or are too powerful for our good, or are too weak to sustain us and need to be rebuilt. Patients often dream about infrastructure, I notice - about buildings, houses, rooms, old homes, new homes, missing furniture, roads they are travelling on or parked on or lost on - or of being 'off the beaten track', in a dark wood or on a foggy hillside, out in the wild, travelling down a winding river. The possibilities are endless, but these images seem to be deeply ingrained in the human psyche, representing very different archetypal worlds. The Paleolithic - the Stone Age - was characterised by being always 'off track.' Infrastructure was not unknown, that would be wrong to suggest, but it was limited by our standards. Our current world is mostly infrastructure, on the other hand, even if you happen to live out in the wilds of Montana or the far north of Scotland. You will still take a road to get there, and more probably an aeroplane, and you will not be cut off in any important sense from the rest of the world around you - linked by a thousand overhead wires and invisible underground pipelines, or by cyberspace itself, that strange no-land which so many of us now seem to inhabit a lot of the time. These three different worlds - 'off track', 'on track' and 'nowhere land' seem to represent levels of human psychological development, which it is apparent do not go away. New experience does not override old experience, so far as we can tell - it is simply added to the sum total of humanity's extraordinary experience of marching through the planet and carving a route through it as it goes, until 'the world' as we know it is unrecognisable as the world we started out from, in some deep valley in Africa. And each of us can still access those worlds through our own internal experience, through dreams and art and culture and the many varieties of imagining that we espouse.

So the urge to rebuild the infrastructure, which is talked about well beyond America, resonates with me symbolically - it brings with it the flavour of 'putting ourselves right' - reframing ourselves in a cleaner, clearer, less cluttered place, so that we can think to some greater purpose where we have got to as humanity, and where we would like to go from here. I found this hopeful to a degree. When you are coming out of depression, some of the first things you want to do is to tidy the front room, repaint the kitchen ceiling, put the broken catches back on the cupboards. It's often a declaration, that you now see yourself as having a future living here! Not just existing, and putting up with whatever you find around you, but actually 'doing it up' a bit. It also involves some investment in ourselves, however little we may have to begin the process. It doesn't matter that the new rug came from a garage sale, or the colourful vase from a charity shop. What matters is that you have invested a small portion of your energy and resource in it. It matters to you.

And there is a community and a commonality about this process, I think, which might be better at helping us to deal with difference than we think. I doubt, myself, whether difference can be argued away, protested over, or otherwise somehow neatly erased. I don't believe in the wall. 'Something there is that doesn't love a wall,' said Robert Frost, one of America's greatest poets. Perhaps so. The question is not whether the wall can be built - walls have been built around the entire planet, remarkable feats of engineering, from the Great Wall of China to the Iron Curtain, and we can build them for sure. The question is: do walls do what they are expected to do?

'Before I built a wall I'd ask to know
What I was walling in or walling out
And to whom I was like to give offence.'

The wall sneakily manages to undermine and get undermined, Frost points out. There is an interminable process of rebuilding this particular infrastructure that goes on forever. It is never final, never completed, always needing attention. And do he and his neighbour really need a wall? His neighbour replies,

'Good fences make good neighbours.'

But Frost thinks this mantra is one that his neighbour learned from his father, and might do well to question.

Reading the American election runes: reflections of a psychotherapist

The American election has probably overwhelmed you as well as me. The sheer amount of coverage is wearing, and I imagine we're all relieved it's over, as well as the Americans who have had to make the hard choice today. I don't envy them. I found the insistent voice of Donald Trump particularly wearing - though Hillary can be pretty hard on the ear too. Partly, I know, it's the difference of accent and tone, and nobody is to blame for that, but it feels sometimes as though they are drilling into my ears with a corkscrew. Sometimes I would like to say, 'Please speak to me a little more softly, a little more kindly. Speak to me a little more reflectively, instead of repeating the same old slogans as though they had any real nourishment left in them!' It's as though politicians - and ours are as mistaken as theirs - have forgotten that if you want people to listen, you need to lower your voice a bit, rather than wind it up into a hysterical shriek. And the drilling of their monotones teaches the crowd how to respond, with wild shrieks and hysteria and flag and slogan waving. "This is how Americans do their elections, " say the sage correspondents. But is it a tradition that is rapidly wearing thin, I wonder? Does it have an emptiness at the core of it, which all that noise and yelling is trying so desperately hard to suppress?

The election has raised so many important issues for democracy that now, of all times, we need a lot less yelling, stridency, posturing and sloganising, and a lot more calm and thoughtful reflection, it seems to me. The fact is, we have lost a lot of faith in our institutions and ways of doing things, which seemed to work at one time but seem to be losing their savour a bit more every day. I don't want to repeat what has already been said in thousands of words on this theme, but to add this: we need to worry the most about our lack of trust in institutions, in other people, in the intentions of the world towards us. The dominant anxiety in our western cultures seems to be paranoia. Nobody can be trusted any longer. Everyone is out for him or herself. They have all got their snouts in the trough (notice the animal level of the imagery - other people are less human than us!) Everybody lies - it's foolish not to know that. They will get you if you let them. And so on . . . . It's not that presidential elections have not been bitter and personal before - they have. But this time, there has been an open refusal to grant the most basic honour and decency to the other side. Things have been said, as commentators remark, which may be hard to make good, whoever wins.

Well, for sure, some people are dishonest. Some politicians are not to be trusted. Some people lie routinely. Most of us do this on occasion, for all kinds of reasons, not necessarily bad ones. Parents, in my experience, routinely lie to their children, with the fixed belief that it is better for them not to know the truth. As though we could protect them from the genuine pain and suffering of the business of being a live human being. My attitude is that it's not what you say, but the way you say it, that makes all the difference. If the motive behind the words is the desire to punish, to hurt, to control, to repress, they will be damaging, because though you may deny it later, the truth of what you really meant will be heard and felt at a deep level. The denial simply adds to the pain of it.

So we all get it wrong pretty regularly. But now we seem to live in an age where mistrust, suspicion, paranoid anxiety, are regarded as the only sensible way to be. Anyone who believes in anything is a fool and gullibly naive. I want to challenge that attitude, because it seems to me to be the most pathological of all positions. Ok, we had an MP's expenses scandal. But only quite a small number of our representatives were found to be guilty, and they were severely punished. Ok, the Iraq War was not our finest moment as a civilisation. But the massive, exhaustive Chilcot enquiry found that no one actually had the overt intention of deceiving the nation. The government made many mistakes, did a lot wrong, but they did not do that. Ok, the encyclopaedic case of Hillary's emails will haunt us to our graves, probably without ever knowing what the heck the emails were all about, or whether they mattered. Ok, the judges decided that royal prerogative was not enough for the government to act in invoking the immortal article 50. They did not say: so that meant we could not leave the EU!

But if the FBI says there is no case to answer regarding the emails, why do we keep on believing that there is no smoke without fire?  The answer of course is, why trust the FBI? Aren't they all in the Washington plot too? Similarly, if the Chilcot enquiry did not meet your expectation, why not dismiss it as a white wash? Weren't they manipulated by the 'powers that be' as well? There is no limit to what can be thus discounted, once paranoia sets in. Evidence, unfortunately,  means nothing to a paranoid state of mind, as you will learn if you've ever tried to argue a paranoid person out of their conviction. Evidence is simply evidence that the suspect is even more tricky than you thought! If you don't believe, you don't believe believe believe, no matter what. You don't believe in belief. I have the sense that paranoia involves a desperate need to drill down into the deepest, ugliest depths of human depravity, and to expose it once and for all. No revelation is therefore dark enough to suit the enquirer. All must be exposed. There is worse under the surface of the surface, if only we can pinpoint it. We must find out how deeply and irrevocably bad people are!

I always wonder why this is so, and if we can succeed in exposing it, what's supposed to happen then? Suppose we found out that the whole Western establishment was beyond any kind of human decency to a man and woman. Would we really feel better for this knowledge? I suspect not. Could we mend the situation in that way? It's a bit like God saying to Noah, 'I'm about to destroy the human race, so get prepared!' And Noah saying, "You cannot be serious?"

Of course there are classic psychoanalytic interpretations of this search for badness. The one who is really being sought for her badness is the mother who failed to meet your needs in infancy. She was a bad breast, and no possible good could come of her! There may be deeper explanations even than this one, surrounding our difficulty in trusting. In a real sense, we were all deprived infants once, whose needs were not perfectly met. Perhaps the beginning of hope comes when we realise this, with all the pain there is, but without any longer the desire to retaliate. Retaliation, it seems, does not do it. It does not hit the spot. It doesn't heal, because it does not do anything to face up to the real pain we ourselves have suffered. Neither exposing Hillary, nor the FBI, nor Chilcot, nor the judges can heal that pain. Knowing the terrible badness of the world around us does not make us feel better. To hit that terribly painful, deprived spot, it seems we have to be prepared to change our attitude towards ourselves. At bottom, our worst fear is that we are the worst of the lot! We are surely the worst we can possibly imagine. So naturally Donald and Hillary are capable of the same, and cannot possibly be trusted!

Some modern expressions are useful, I tend to think, if pretty crude. Like: 'Get over it!' for example. If we can get over the feared badness of the world, by getting over the horror of our own badness, we can begin to look forward with a smidgeon of hope. If I am capable - well, nearly - of being loved and trusted, perhaps others are too? This change of attitude toward ourselves will have profound consequences for our relationships. It will not make other people, whether aspiring leaders, or prospective mates, or just friends, into ideal mothers, who will never let us down. Now we know better - that everyone is a flawed person who will be frequently mistaken and sometimes occasionally do wrong, just like us. But the wrong - the bad bits - does not cancel out the good bits in ourselves or others. Both exist - both the good and the not so good exist in human life, side by side, with an equal capacity to be influential, and to change lives. Knowing just how powerful these aspects of human nature can be, we may possibly tread a bit more carefully in future, in making easy assumptions about  just how bad other people are.