Antidepressants · depression · Loss · men's mental health · mental health · Society · Treatment

The drugs do work? – Large scale study provides compelling evidence on antidepressants, but do we want to take them?

This week saw the release of an interesting study Click Here for Lancet Journal which provided clinical evidence that all the major commercial antidepressants outperformed patients who were treated with a dummy dose known as a placebo.  The researchers collected their data from multiple studies that used the gold standard of clinical research of randomised controlled trials.  These type of experiments use control and treatment groups to provide evidence that the treatment group are being directly affected by the drug under investigation, and attempt to eliminate any biases that could influence results.  The published review showed that all the 21 drugs they examined had positive effects on alleviating the symptoms of major depressive disorder.  They showed that the drugs varied in their effectiveness but the graph below illustrates the most commonly prescribed drugs.  Anything to the right of 1 is positive result and shows between 50% to over 100% improvements over non-treatment.


What contributes to the depression?

I see many men who are diagnosed with depression and they often complain of feeling disinterested, exhausted, trapped, avoiding social relationships, unpredictable in mood, angry and full of anxiety.  Chronic cases can be crippling and can effectively leave sufferers housebound, isolated, prone to self medicate with alcohol or drugs, destructive within relationships and work life, and can eventually lead to attempting suicide.  My feelings are that depression is a psychic reaction to feeling trapped within your life.  This can be literally within an unfulfilling career, relationship (or lack of one), or by unresolvable financial problems.  It may also be more abstract with feelings of being constrained by thoughts of failure, lack of self-worth, or one that I often see in men is the loss of tangible identity and a lack of purpose within life.  The quote below is one man’s sentiment of how he struggles;

My biggest difficulty about being a man is that I often do not know my purpose or feel that I am not making a success of myself.

I also believe that the myth of the perfect social media life is a huge problem for many men.  Endless celebrities and entrepreneurs are shown as physical adonises, wealthy playboys and all round happy successes, who do jobs they love for vast sums of money, all whilst they flex their chiselled torso.  This creates an unrealistic expectations of oneself as when compared to the reality of being an average employee, partner or parent, we will often fall short of an unattainable ideal.  This causes perception of our own lives to be downgraded and for us to feel somehow substandard and lazy for not achieving more or looking better.

Men have explained in the treatment room that this existential unfulfillment is difficult to fully comprehend and can occur when one has embarked on a career and family life, and something just suddenly feels missing.  At this stage men will sometimes became obsessed with outside interests such as fitness, social clubs/pubs or online worlds, they can also be vulnerable to temptation of extra marital affairs.  Men will often say that they feel unloved, unnecessary and invisible, as they work long hours and feel excluded from their families, as partners and children function with little input from themselves.  It can be tempting to have the fun and excitement of a new romantic liaison, the result often being a wounding to the relationship that can leave men guilt ridden and shamed, and the relationship to potentially fail.

This man has consented to his views of his mental health challenges being shared, this highlights the pressure of just trying to be functional for others;

Even if people don’t say or think that we should just get on with it, I still feel that it is expected. When my brain just cannot process everything expected of my role as father, husband, and employee, no one will spend time to walk alongside; they just want to say some ‘magic words’ and me to leave them ‘fixed’ in order to meet their needs.

I have never felt so alone, despite family and colleagues trying to help.

Off to an NHS mindfulness course now; let’s see if that helps unlike everything else.

Should I take Medication?

This accompanying piece in the Guardian The Guardian Online Article suggests that more than a million people in the UK should have access to antidepressants.  This is on top of around the 11 million regular prescriptions already dispensed.  Men often ask me if they should go on medication and I always advise to talk to their GP, but we will discuss the process of using antidepressants.

My thoughts are that medication can be helpful, especially when used alongside talking therapy.  My main problem is that although drugs can alleviate the feelings of despair and hopelessness, allow better functioning and an opportunity to see things differently, they cannot fix all our real world problems.  They allow us  to be more proactive in changing parts of their lives they are unhappy about.  However, without additional support and introspection, making meaningful change can be difficult, especially around careers or relationships.  Men can feel stuck as they have to earn a wage and have responsibilities which they feel force them to stay in roles they do not like.  Likewise, the reality of leaving the family home is often impossible, as few people are financially secure enough to afford to find a home by themselves. The resulting separation can often be acrimonious and fears of  not seeing children all adds to the depressive environment of having no choices.  My experience is that these type of difficult problems are not simply resolved through just taking pills.

Another common fear is whether I will be medicated forever and how will life be when I am not taking the pills?  This can be difficult, but working with a good GP should allow a treatment plan that allows for a safe withdrawal process when symptoms alleviate.  In some respects we see the paradox of change we discussed earlier, as unless someone has made significant changes then it is likely the depression may reappear after the treatment ends, my main argument for accompanying therapy with medication.  Something that also often prevents ending medication is both the psychological reliance that I cannot cope without the pills, and the effects of withdrawal.  Even when managed well and clinically weaned off the drugs, withdrawal can last for weeks and often mimics depressive symptoms, making the patient panic and resume treatment.

toon-1861The final issue that many men complain of is the side effects.  Reading the information leaflet that comes with medication can easily induce terror, as side effects can be physical symptoms such as cramps, yawning and nausea, or further mental health issues such as paranoia and anxiety.  Many men often suffer libido loss and erection problems, especially on popular SSRI (Selective Serotonin Reuptake Inhibitors) such as Citalopram and Sertraline.  This can impact the very essence of masculinity and heighten feelings of being a failure who is unable to perform.  I have had couples who have reported that they ceased sex after taking medication, leading struggling relationships to have further losses of intimacy and causing partners to blame themselves or each other for why they cannot have intercourse.  Another paradox, as even though the medication can elevate mood, the crumbling relationship can counteract this effect and cause relapse as marital tension rises.

This man generously allowed me to share his journey which demonstrates the complex nature of his own relationship with his mental health and treatment.  I feel this shows how hard work, medication and support can help combat depression, but also shows that we can often be taken unexpectedly by our illness…

I certainly feel things have improved socially since I was first diagnosed with ‘nervousness & depression’ in the late 70s. [generalised anxiety disorder – as it later became known] Attitudes are more sympathetic and people less likely to judge or discriminate against you these days. It’s easier to find and get help.

However, on the inside I still see my condition as a failure, as a weakness. My partner is incredibly supportive and understanding but in spite of her help and love I’m especially hard on myself. Despite and the rational arguments and evidence to the contrary I still feel the need to be masculine, strong and silent. The brave protector and stoic provider for my family. Not the dark, uneasy, tormented shell I currently am.

At 53 I am able to look back on over 30 years of this behaviour pattern, something which in itself I find particularly upsetting. I often fear that if I’ve 30 years of this to look back on, I’ve therefore another 30 years of mental health issues to look forward to.

I’ve always found these winter months especially difficult and this year is no different. I know it’ll pass and I have a great many tools and techniques picked up over years of therapy and learning which help me function on a day to day basis. But still, here I am …again.

I am pleased to see that medication has been shown to be effective and can be a lifesaver for those who cannot cope with what life throws at them. However,  I am not sure if a nation of people taking psychopharmaceuticals for the rest of their lives is a measure of public health progress.  I think that there needs to be more done to treat the causes of why so many of us feel depressed, rather than just fixing our symptions by changing out brain chemistry temporarily.  I have some thoughts and may share them in my next blog.

Thank you to the men who allowed their voices to be used in this article.




Christmas · Couples · Family · Relationships · Society

The dark side of Christmas… How expectation, conflict and the mess left behind can take the sparkle out of Christmas.

With Christmas fast approaching, I have noticed a growing sense of arousal and hysteria within both my personal social groups and client work.  This time of year always seems to have the same tangibly electric crackle in the air, which carries a multifaceted identity and a sinister sense of ambivalence.  People’s moods can be highly unpredictable, as stress is either induced instantly or felt as a growing feeling of pressure as the clock counts down.  People seem to oscillate from being excitable and euphoric into abrasive annoyance and irritability.  Both of these emotional states are underpinned by a similar neurological frameworks of being intensely aroused, a highly uncontained disposition that can see behaviour switch quickly from frivolous fun into unbridled aggression.  These types of states often accompany highly emotive occasions such as weddings or football matches.  These events can see lightning switches in atmosphere as tension suddenly overspills and causes the heady feelings of enjoyment to morph into the threat of hostility.  At this point, our limbic systems move into automatic mode and our threat response starts to activate, this causes previously innocuous activity such as crowd pushing or ‘friendly banter’ to be interpreted as personally targeted acts of war.

'Poinsetta! ' 'Poinsettia!' 'Poinsetta! ' 'Poinsettia!'


This highly emotional context seems to dominate the month of December and people seem to be both looking forward to having some well deserved time off from normal life, whilst holding an anticipatory dread of having to meet high expectations and manage the uncertainty Christmas can bring.  Statistically, it is estimated that divorce rates double in the period just after the Christmas break Huffington Post Article, I always see a spike in couples therapy referrals in January.  The reasons for this are complex , with the simplest being that some couples are already planning separation and feel it will be inappropriate timing to do so just before Christmas.  Therefore, they try to have acted fun with a person with whom they are simultaneously attempting developmental closure with.  This causes high levels of anxiety as one metaphorically sits in a party hat with a smile, alongside trying to hold at bay the seething resentment, rage and loss of a sinking relationship.  This is a highly volatile state as the ego has to manage two very disparate positions and the actual self becomes further from the portrayed false self that is needed to socially navigate the festive period.  In some respects this could be literally interpreted as the horrendous festive activity of being forced to stand up and perform a cringe inducing charade.

With the idea of high arousal in mind, other circumstances that initiate relational breakdown is that people spend a disproportionate amount of time together.  Hectic modern life routines mean that many families will rarely spend lengths of time together during normal week cycles.  With longer and more erratic working patterns, couples can literally pass the other going to work, managing the home and caring for children.  Christmas essentially forces people into the unusual situation of being with each other for long periods of time and removes the usual escape hatches that can be activated if tension becomes overwhelming.  This forced togetherness is further exacerbated by the intensive consumption of alcohol and compounded through the presence of periphery family members who are we often have fairly fractious relationships with.  A sniping remark or the disguised critique and disapproval is easily taken as a call to arms as we feel humiliated or devalued by those we would usually skillfully avoid.

"Do you remember when Christmas was all about the family getting together and having a big fight?"
“Do you remember when Christmas was all about the family getting together and having a big fight?”

Interesting dynamics are in play during the Christmas break, as individuals often place massive expectations onto one day.  The pressure for everything to be perfect is immense and on many levels is both unrealistic and unachievable, a formula that sets us up to inevitably fail.  The desire to make a fantasy into reality is one that I feel is underpinned by the high levels of disappointment that accompany most people’s everyday lives.  The feelings of not achieving youthful ambitions or being trapped in careers and social structures that are not quite what we expected are somehow transposed into Christmas.  The nostalgic childhood magic that made Christmas special translates into the adult domain and our hopes and dreams become pinned on achieving the perfect day.  All the personal and professional failures of the year will somehow become bearable if we can create the idealised version of what Christmas should be.  Unfortunately, most Christmas’s do not achieve this as ovens fail, presents are not quite right or somebody finds the drunken courage to tell a relative what they really think of them over the dinner table.  When this occurs I believe it can reenact all the losses of the past year and we feel shame and anger as Christmas once again fails to be perfect panacea to resolve the difficulties we experience in the real world.  This then leads to blame, criticism and conflict… The familiar cocktail of conflict that many families see erupting out of nowhere during a game of Pictionary or in the hazy and drunken lull that occurs post dinner.


The dreaded post-Christmas slump is also always gnawing in our unconscious, as like the alcoholic or drug addict, the fantastic high of intoxication is always accompanied by the inevitable depression that follows.  Many families overstretch themselves financially and also hold that fearful feeling that once the festive period is over, the cold, dark days of winter that demand the payment for the extravagance are not far away.  In terms of psychology this creates an emotional context of threat that people often defend themselves from using over-exaggerated performance of childish excitement and denial of reality that sees people behaving like parodies of Disney characters.  Again this distances us from our authentic versions and compounds the difficult self-discrepancy described previously.

The final challenge at Christmas is the reactivating of previous traumatic experiences.  We will often unconsciously grieve for bereaved loved ones who are no longer here and the avoidance of morbid subjects means that the forced fun of Christmas makes these difficult emotions to share.  Many parents will also feel upset at Christmas, as families can no longer be together, or we become nostalgic at historical trigger points such as relationship breakdown, arguments and parents leaving home that occurred in or around the festive period.  This can cause unhelpful social comparison, where we start to validate our sense of self by seeing others as having more functional families or distorting how happy we once were at previous Christmases.  The effect of this can lead to people feeling isolated from the festivities around them, leaving them described as a killjoy or Christmas Scrooges.  It is worth bearing in mind, that for many Christmas has been experienced as traumatic or is feared to be a place that they will be shown up as not being good enough and will be forced to face their usually locked away attachment losses.  So, my advice is to enjoy Christmas by removing the need for it to be perfect and let it just be a day that it can be okay to feel slightly less than exuberant.  It may also be worth framing a classical family dispute as potentially an integral and necessary part of the developmental process and not a damning indictment of shameful dysfunction.




Gender · Harvey Weinstein · Men's Issues · Men's roles · Relationships · Society

The allegations of Harvey Weinstein -Contradictions and complexities of gendered violence…

The last few weeks has been dominated by the news story about the film giant Harvey Weinstein and has once again shined a light onto the abuses of male privilege and power, with a stark reminder of how this can lead to abhorrent misuse of position and violation of the vulnerable.  That being said, it is interesting how social media has castigated a person who has denied the allegations and has not been officially charged or convicted.  Action has been taken though as he has been ejected from the Oscars committee, denounced by his wife and openly harangued by scores of celebrities.  The whole situation has draws many parallels with the UK Jimmy Saville scandal, the most notable being that these abuses were known by many, yet were not disclosed.  Various positions are taken on this, the most liberal being that such power is difficult to challenge and that once one incident is made public, others find courage to speak out.  Less sympathetic positions claim that individuals turned a blind eye or ‘put up’ with their abuse in order to further their careers.  Like Saville, Weinstein was able to make and break careers of aspiring stars with a single word.  My personal experience is that people are often not heard when they disclose or are forced into silence by the ramifications of speaking out.  I have often worked with clients who only found courage in unity and were only able to discuss their trauma publicly after another comes forward.

I condemn Weinstein’s alleged as much as anybody and if these are taken to court, I hope that he is justly convicted of his crimes.  The first contradiction of what has happened is the treatment of Weinstein in comparison to how Donald Trump has seemingly brushed off equally inappropriate behavior.  Trump has been accused of rape by an ex-wife, openly spoken of ‘grabbing women by the pussy’ and been caught on tape numerous times objectifying women and discussing the sexual attraction he has to his own children.  Yet, one man who is still in a position of legal innocence has been thrown to the wolves and the other holds office and status as the most powerful man in the world.  Both men hold privilege and power in the upper echelons of American society, so it cannot be argued that one does not hold enough sway to dismiss the accusers as hysterical, jealous or delusional.  I personally find this really difficult to reconcile as surely having a man like this running the country is far more dangerous than a man casting for movies, so how do we decide upon the type of witches that we hunt?


My personal feeling is social media that has allowed a mob mentality which sweeps people away with the popular choice and that half of the American population actually invested in Trump and so to now denounce him would be an admission of poor choice and oversight.  Conversely, I have seen a number of Weinstein’s movies, but had no real investment in him and knew very little about him prior to these reports.  The surge of post modern feminism has also made the scalping of Weinstein a desirable task, as he represents the gross patriarch who leers over the young actresses on his couch before deciding the fate of their lives.  Maybe Trump is less accessible as he seems a little more ethereal and removed from the public sense of personal interaction.  It also feels like an emancipation of the female position by women reasserting their sense of self as talented performers and not just pretty dolls to parade around movie sets, following the direction of the male overseers.

The second contradiction is one that has emerged for me on the basis of a couple of recent personal experiences.  I like to think myself as adopting an egalitarian stance where men and women deserve comparable treatment in areas such as pay and legal rights.  I also feel that women should not be harassed or intimidated as sexual objects, either professionally or in the social arena.  I also feel that the rise of the ‘banter’ brigade has simply re-framed bullying as banter, the activity is often about making a minority or a vulnerable person feel intimidated.  Bullying has negative connotations and positions one as abusive, but by exchanging the word for banter we can displace the responsibility onto the victim and accuse them of being too serious or not joining in with fun of the process.

Previous posts have considered how getting the gender balance right is notoriously difficult, as the rise of feminism has diminished the agency of some men; So who is this father fella who lives in my house?!?! and How do I look?!?!? – How a men are being forced into physical perfection.  This shift has led to men feeling disenfranchised and worried about their role as traditional male traits such as strength, decisiveness and protection have been transformed into misogynistic characteristics.  Whilst I agree that when these traits are over-amplified they can be seen as abusive, removing them completely is equally problematic, as it leaves many men unsure of how to behave and socially situate.  The result of this is completely detrimental to empowering women in the workplace as it now being seen that men will avoid contact with female colleagues as a measure to avoid being accused of sexual assault or inappropriateness – NY Times Article.

This is complicated further as men are sometimes called upon to be gentlemanly, manly and macho, but are then derogated for doing too much of this or incorrectly applying it.  One very apparent example of this is from Channel 4’s First Dates programme, a show that essentially puts couples in a restaurant for a first date.  They share a meal and then decide how the date went and if they would like a second.  The restaurant is frightfully expensive and the diners are often young and low earners.  There is often a really awkward exchange as the bill is produced and the man balks at the cost, he is then looked at by his date and has to make a decision to pay or not.  In accordance with a feminist position they should split the bill, but there is often offence when the woman is asked to contribute or the man simply says he is paying half.  The same woman has on occasion expressed highly political ideas about feminism over dinner, or chastised the man for his clumsy sexist remarks and attempts of flirtation.  Again a contradiction is highly apparent, as we cannot hold an equal gender perspective but also adhere to an old tradition of men paying the bill and expect a virtual stranger to pay for our dinner based upon chromosomal configuration.  Interestingly, gay couples on the show have a very different culture and the etiquette is that they ‘go dutch’.  This seems to suggest that being the same gender removes any assumptions about the role of who takes financial responsibility.

Going back to my recent experiences, one was at a professional workplace where I was a  single man in a group of women, I am often in this position as this profession seems to be heavily female weighted.  A discussion was occurring around how a man cheating in a relationship was to be dealt with and that he deserves fairly extreme physical violence such as being ‘punched in the face’, a story was also recounted about how a cheating ex was attacked with a shoe to the back of the head.  None of the people were violent by nature and generally never deal with issues through this type of force.  Yet, nobody challenged the behaviour and the group seemed to condone that this was an acceptable punishment to use for infidelity.  I spoke up, expressing my discomfort and made a hypothetical comment about would they cheer if I had a story of how my partner betrayed me, so as result I headbutted her and broke her nose.  I was looked at with disdain and astonishment, so I stated that they were actively encouraging gendered violence that is acceptable by women on men, yet given the same situation the other way round the behaviour receives universal condemnation

This is not an unfamiliar position, as it seems that the portrayal and response to media stories that express severe sexual violence to men, such as castration or penectomy are seen as funny and deserved for unfaithfulness.  This article talks of a female celebrity quite happily threatening this sort of violence against a partner during a radio interview.   Yet if a scorned man mutilated his partners breasts and genitals in a retaliatory assault he would be seen a psychopathic sadist.  Going back to First Dates, more subtle acceptances of one directional gendered violence is seen between the shows filmed sections.  Each encounter is summarised by a little cartoon to show how well the date went and if it goes poorly, a sequence will often show a woman slapping a man across the face.  Again, let us reverse the process and consider how unacceptable it would it be if I went on a disappointing date and as I stand up to leave, I slap my date across the face, citing her views on Brexit and my choice of blazer as unpalatable.


Another recent personal experience occurred this week as I attended a course at a University, which was led by a woman and contained a class of mostly women.  On both days the trainer began to make jokes about the incompetence of men when given responsibility for childcare.  This continued with remarks that men ‘must be trained’ to spend money on their women at Christmas and to treat them more.  I sat and listened quietly whilst the women jeered and howled at the notion of  ‘how this is what domestic life is like…’   This took place at a reputable educational institution on an IT course.  I wonder what the reaction would have been if this discussion about training and controlling women was orchestrated by a male trainer to a majority of men.  I imagine such pejorative sexism and discrimination would have been seen at best as  inappropriate and probably been the subject of a formal complaint.

How can we crave gender parity when such disparity exists, as when women are the aggressor their behaviour is often deemed acceptable, but when men are the protagonist it is inappropriate, chauvinistic and exploitative.  Both genders must take responsibility for preventing violence and for the more subtle discourses that maintain them.  We must hold fair views that apply to us all and not allow one gender to be treated differently over the other.  It is hypocritical and unhelpful that men are demonised when women can behave with similar impunity unchallenged.  Simply drawing attention to gender violations with lazy hashtags such as #mettoo polarise the debate, as I can imagine that we all need to also say #ihave, as given the right circumstances we can all make or behave along the unpleasant spectrum of disrespect and abuse.  That being said, rape and sexual violence must be seen as far more severe and traumatic than sexist discussions, but both examples perpetuate injustice that can cause escalation from unsavoury beliefs to harmful action.  The use of hashtags are an example of this problem, as #metoo has been rightfully claimed by the survivors of horrendous ordeals, but has also been used by a person who was described as sexually attractive by a workmate over dinner (LBC Radio – Nick Ferrari show this week).  It is difficult to imagine how they are both representative of the same phenomenon.


It us worth considering that gendered abuse is complex and is something that we are all capable of when imbalances of power are not dealt with.  By simply labelling all men as abusive and all women as victims, we will cause more harm than good and will miss the nuances of a difficult debate.  The evidence of this in the treatment room is that domestic violence is now mostly effectively responded to when perpetrated by men on women.  Yet, when men are being abused, they often speak of lack of support, ridicule, marginalisation, victim blaming and minimisation by social networks and authorities, as well as a lack of accessible support services – Academic Article

Bereavement · Coming to Therapy · Difficult Emotions · Loss · Men's Issues · Men's roles · Relationships

The pain of bereavement… How loss makes us disorientated.

This is my first post in a few weeks as I have been busy with work and research and have also not really felt like writing.   Today’s post will have a personal element as I suffered a loss during the week and I am hoping this will be a way of both processing the event and achieving some learning for when I work with clients undergoing their own losses.  Much of my work is centred around loss and these can be located on a very varied spectrum.  The most obvious are the bereavements of family and friends, but loss can also take the guise of the breakdown of intimate relationships, loss of a job, changes in health or as more abstract losses such as when one loses personal choice, autonomy or liberty.

I have worked with some really excruciating losses with clients in recent months, the most difficult perhaps being the sudden passing of a child.  It is easy to empathise and imagine how this type of event would cripple the most resilient of people.  I think the underlying feeling expressed here is that it does not represent the expected natural order of the world.  At some level we all understand that parents and grandparents will eventually die and that as you approach middle age this becomes normalised as peers experience the parental departure. Even though when it happens it can be devastating, there is a part of the psyche that expects and understands that this is an existential inevitability of being human.

When the bereaved is a child, this mechanism is disrupted and the loss intensifies by the natural order of the world being defied and the perceived proper sequence of events becoming disjointed.  In these type of cases, clients often struggle to reach acceptance that the person has gone and they will often voice irrational bargaining narratives that they would swap places or that life will forever be contaminated and never as good as it was before the death of their child.  These type of expressions are not usually heard when the loss is in line with the natural order of things.  The function of the counterfactual expressions are often around alleviating guilt on not saving them, or simply that they are still here, yet their child is not.


Another loss that often affects men I work with is how ill-health of themselves or a loved one forces an aspect of their identity to shift.  Many men, including myself define themselves by their vocation and we still have societal discourses that men are less masculine or emasculated if they adopt traditionally feminine roles of being either stay at home parents or a carer for those in need.  I have worked with numerous men who occupy archetypal male personas and have strong and masculine jobs such as policeman, builders or financiers.  When these roles are removed through circumstances such as declining health the individual suffers a catastrophic loss to a core identity component.  This leaves men wondering what their roles are and places them into unfamiliar positions of marginalisation and disempowerment.

An interesting phenomenon that occurs here is that men will often fantasise about their previous life, which they view as empowered and idyllic.  Similarly to the loss of a child, there is a real resistance to change expectations, to renegotiate their roles and decide what is now meaningful, rather than clinging to the memories of what they used to ascribe value to.  I think that this type of impasse epitomises the position of not being able to reach acceptance, a position that is often seen as the successful resolution of grief. I often wonder that is this ‘stuckness’ related to the increased levels of atheism that are now prevalent in contemporary British culture.  We may become isolated and helpless through our grief, as we no longer have the strong spiritual and religious beliefs that previous generations were able to use to sooth and re-balance perceived injustices and unfairness that often accompanies unexpected loss.

In comparison to the types of loss described above, mine feels inconsequential but as I always say to clients “We live the lives we do and that our experiences are valid”.  This sentiment is explained by the idea that we cannot simply compare our situation hierarchically to others by looking at people who have undergone greater suffering, or at the other end of the spectrum seem to lead easy and charmed lives.  I think that this type of rationalisation does not allow us to connect with our emotional state and can leave us with shame or anger as we try to suppress and resolve our own situation without being able to authentically process our emotional material.

My loss was of a pet bearded dragon, imaginatively named ‘boy beard’, I had been his owner for over 15 years and raised him and his mate ‘girl beard’ from small ‘moustaches’ to fully grown dragons.  When he died on Monday, I was expecting it and was relieved, as he had been shutting down for a few weeks and was ancient by species standards.  Yet,  I have spent the last few days feeling tremendously melancholy.  I have even had some bouts of uncontrollable tears and intrusive thoughts about missing him.  I rarely cry and this has been a comfort to me, as it enabled me to understand that he was a hugely important part of my life.  I have always been puzzled by the anthropomorphism of placing human emotions and traits onto animals, but I can say that I genuinely loved boy beard.

After much thought, I think I loved what he represented to me and that he had become internalised as a sense of security and safety.  I have many friends, but have always felt distance and an innate feeling that I am able to leave human relationships and survive. This has probably been derived from the fractured and at times unsupportive family of origin that I hail from.  I keep in touch with relatives, but I suppose that unlike many people they are not the place I go when in need or relationships that I greatly invest in.  The fear of being vulnerable and exposed is too much and somewhere I do not trust that these relationships will be consistent and available.   As a result boy beard had been a stable and constant ‘secure base’, that I had symbolically internalised as the ‘good mother’, a role that has been vacant for me for some time.  He was always available and never questioned me or asked too much.  He also had the fantastic ability to just allow me to be in his presence and feel content.  This is much like how Bion describes containment or how Winnicott talks about the holding of the infant by mother, that ultimately allows the infant to just sit and be without tension or impingement.

This was vitally important as the last 15 years have involved family estrangement, my journey into psychotherapy, loss of relationships and periods of physical, financial and emotional instability and uncertainty.  Boy beard was my transitional object, a symbolic entity that I was able to equate to reassurance and safety when distressed, and importantly was an object that I could take wherever I went and at some level represented home, safety and the feeling that things would be alright.  This is perhaps why his passing has had such a profound effect on my sense of well-being, as it has disrupted my sense of safety in the same way a toddler is inconsolable when leaving his favourite bear on the bus.  Like the missing teddy, I have fond memories of boy beard and will forever think of him as source of comfort when I feel that I am struggling.

Addiction · Coming to Therapy · Difficult Emotions · Men's Issues · Relationships

Can you have an addictive personality? Exploring how addiction may not simply be down to a personality trait.

Last week a prominent addiction academic published results that have been accumulated from thirty years of research and refute the highly popular idea that certain people have predisposed addictive personalities Mark Griffiths -The Myth of ‘Addictive Personality’.  This is a claim that I often hear within the therapy room as men talk about their own compulsions as genetically inherited phenomena.  Last week’s blog post posited the idea of neurological processes leading to some men being unable to move away from strings of superficial romantic liaisons that lead to entrenched and repeating behaviour of trying to gratify a desire for the ‘honeymoon period’ chemical buzz associated with fledgling relationships.  These type of conversations have been similarly applied to alcoholism, recreational drug use, gambling and pornography, but all seem to conclude that the addict is an unfortunate victim of the genetic lottery, where they have inherited a defective DNA blueprint that removes control and ultimately any autonomy.

My position as a social constructionist is in accordance with the published paper and suggests that this type of discourse alleviates responsibility from the addict and as a result would concluded that the addict can never recover or will always be waiting for the next form of addiction to accost them.  I agree with Griffiths that this position makes us helpless and also means that the addict’s social network will be responsible for managing the addictions or policing this person’s behaviour, so that they are forever kept away from the gym, betting shops, the internet and any form of licenced premises. Griffiths couches his findings within a positivist scientific framework by suggesting that the addictive personality has some correlations to the popular psychological theories of personality traits.  He has identified that individuals who score high on traits of neuroticism

Neuroticism is a trait in many models within personality theory, but there is little agreement on its definition. Some define it as a tendency for quick arousal when stimulated and slow relaxation from arousal; others define it as emotional instability and negativity or maladjustment, in contrast to emotional stability and positivity, or good adjustment. Others yet define it as lack of self-control, poor ability to manage psychological stress, and a tendency to complain

and low on conscientiousness

Conscientiousness is the personality trait of being careful, or vigilant. Conscientiousness implies a desire to do a task well, and to take obligations to others seriously. Conscientious people tend to be efficient and organized as opposed to easy-going and disorderly. They exhibit a tendency to show self-discipline, act dutifully, and aim for achievement; they display planned rather than spontaneous behavior; and they are generally dependable. It is manifested in characteristic behaviors such as being neat and systematic; also including such elements as carefulness, thoroughness, and deliberation (the tendency to think carefully before acting.) Conscientiousness is one of the five traits of the Five Factor Model of personality and is an aspect of what has traditionally been referred to as having character. Conscientious individuals are generally hard-working and reliable. They are also likely to be conformists. When taken to an extreme, they may also be “workaholics”, perfectionists, and compulsive in their behavior. People who score low on conscientiousness tend to be laid back, less goal-oriented, and less driven by success; they also are more likely to engage in antisocial and criminal behaviour

are more at risk of developing addictions.  He also notes that people who fit this criteria are not always addicts and that other addicts do not show these levels of personality trait.  Therefore, we cannot simply say that any one trait of personality is a definitive marker for being addicted.

My position is more rooted within social psychology and the individual’s actual lived context, rather than their inherent character.  I feel that addictions are often used as substitutes for meaningful and effective relationships and whenever I have worked with an addict, they have always spoken of a history of fractured or inconsistent relationships with important caregivers such as parents.  The use of substances, sex, gambling etc. is then used a way of managing and regulating both anxiety and psychological distress. These patterns become established as they temporarily experience relief or escape from an unpleasant state during the placing of a bet , sexually releasing or through becoming intoxicated.  As the pleasure drops and the difficult feelings reemerge they go back to their addiction and essentially setup a mechanism of self-soothing.  This mechanism then becomes established as a way of negotiating stress and starts to setup a psychological dependency that is the the root of uncontrollable compulsion.  This process is a substitute for the individuals inability to always regulate their own distress, which has become maladaptive due to past experiences where attachment interactions have been inadequate.

These individuals have internalised this history of insecure relationships, which means that they relate to a world that has the potential to be uncertain and unsafe.  So what causes the addict to choose certain addictions and not others?  I think that this has a lot to do with availability and will be determined to what sort of activities or substances can be easily attained and also what can be maintained financially and socially.  This is the idea of being able to partially function in terms of keeping some relationships and normal practices, as well as satisfying the addictions.  For example the ease of access to gambling and pornography means that men can access these services quickly and privately, and can effectively still work and be partially active within society.  I have heard stories of men masturbating in work toilet facilities using smartphones or following bets on obscure foreign sporting events in the middle of the night whilst their partner sleeps on completely unaware.

One point to note is that addictions such as exercise are very difficult to identify as problematic because they are often seen positively and encouraged as healthy living practices.  In comparison, drug use is usually met with social disapproval and certain drugs such as heroin instantly provoke interventions or concern by others.  In contrast, drugs such as cannabis and cocaine are increasingly being viewed as acceptable by certain groups, which can lead to there use and abuse being unnoticed or minimised. Alcohol, steroids and stimulants are are also being seen as perfectly normal practices, especially in aggressive male environments such as bodybuilding communities and intensive city vocations, where the discourses around working hard and playing hard are activated and alcohol and party drugs are used as in networking rituals, to facilitate social bonding and establish hierarchical structure.

The last component that I feel contributes to addiction and to what practice is chosen, is the experience of a traumatic trigger that has a relationship to the addiction.  This can be something like being raised by an alcoholic father or a less obvious interaction which was built around a  risky event, for example; a one off bet that led to high wins or losses, or being disturbed during a sexual encounter.  Therefore, my feelings are that the addiction is born from an insecure relational history managed by self-soothing, access to the addictive behaviour and a related trauma trigger.  Relating to the journal article and thinking about the idea of how high neuroticsim is a predictor of addiction, individuals who are neurotic present with histories of turbulent relationships and have the need for lots of intensive arousal to make experience meaningful, as well as having a likelihood of experiencing various traumatic events that have occurred due to living unpredictable lives. Similarly, low conscientiousness can be framed as not always taking account of consequences and having a tendency to avoid responsibility for actions by blaming others or saying that the addiction took hold of them and diminished their control.

The take-home message here is that many men are addicts, but my belief is that these addictions are both understandable and treatable.  By subscribing to the myth of the addictive personality, we run the risk of being incapacitated by addiction and effectively being slaves to negative behaviours or substances.  The first step to taking back control is to accept the behaviour as part of us and taking the responsibility for allowing it to happen.  This allows us the potential of being able to make alternative choices in the future and not simply being a victim of a genetic lottery…



Coming to Therapy · Couples · love island · Men's Issues · men's mental health · Relationships · Society

Where has all the love from Love Island gone?… How relationships fade as fast as they form.

So a month after the finale of Love Island and its seems that the promises of perfect matrimony and the finding of soul mates have become shipwrecked upon the jagged rocks of relationship breakdown.  What has caused this rapid decline of romance from excited and anticipatory talk of settling down to many of the new relationships nose diving into the ex-partners graveyard?  A simple and sceptical analysis would say that the show is a constructed entity and the relationships are dramatised, with the contestants simply trying to launch a potential career in day-time television.   Therefore, the romances are scripted to engage viewers and any observed relationships are attempts by the production crew and cast to create a love fantasy that the viewers can indulge in.  This makes perfect entertainment senses as trying to promote a ‘Love Island’ that is devoid of any love would leave us with a desolate version of the Bear Grylls show where miserable middle classes become eternally frustrated whilst trying to start fires and catch fish.  What is more interesting is that this pattern of intense passion and expectations of lifelong partnership that very quickly turns to disharmony and disintegration is one that I often see within couples in the real world.

The very concept of Love Island seems like a fairly artificial place to meet a partner as the couples have limited choice, enormous amounts of time together and no escape-hatch to other stimuli and networks external to the show.  This creates a very intensive environment where relationships move rapidly, simply based on the amount of contact time.  By comparison, it is unlikely that traditional courting would have this level of time together so early on, so the pattern plays out at a slower pace.  Many men describe this initial and intense part of the relationship as a ‘honeymoon period’, and there is a real expectation that this is part a prescriptive journey that inevitably comes to an end after a few months.  The relationship at this point is categorised by lots of sex, intrusive thoughts about the other person, prioritising time with them over usual work/social activities, elation and positive mood.

Neurological explanation is that this process floods our neural system with the hormone oxytocin, this neurotransmitter facilitates bonding and is linked to our very early experiences of birth, feeding and maternal security.  Our brains become consumed with a natural drug that makes us feel good and motivates us to spend more time with the source of our pleasure.  Unfortunately, as with any pleasurable high, repeated exposure starts to lessen the effect and the effect diminishes over time.  Interestingly, oxytocin also has a sinister social side effect where we begin to establish allegiances by creating in/out groups.  Love Island exhibits this perfectly where we observed couples became collusive and suspicious of the other couples, as well as fostering competition, rivalry and envy. This neural circuit activation is also one contributory factor which causes some men to be promiscuous, serial cheaters or unable to commit to relationships.  In these cases the internal chemistry of the man acts very similar to that of a drug addict where desire must be satiated and moving to new partners gives a temporary high.  The behaviour starts to become entrenched and circular as once the buzz of the relationship lessens another source must be found.

Men with these compulsions have often struggled to establish fully secure early attachments and as a result require higher and more frequent levels of oxytocin to feel emotional and physical intimacy.  One presentation that occurs alongside compulsive pleasure seeking is the absence of guilt and conscience, this can be construed by the man’s partner as lack of care or even maliciousness.  Men who exhibit this lack of concern about the consequences of their actions do so because they have a reduced capacity for empathy, this is due to experiencing positive affect from the new sexual encounter which makes identifying with another person’s distress difficult.   Previous post It’s your fault I had the affair… has looked at how blame is attributed during infidelity.  The pleasure associated with new relationships begins to setup an unrealistic benchmark that longer term relationships have no possibility of reaching and maintaining and therefore this cognitively positions them as unfulfilling and monotonous, this motivates behaviour to seek a new relationship that offers the promise of the hallowed honeymoon hedonism.

We create a socially constructed, illuisonary and idealised template of how we should feel in a relationship for it to be deemed satisfactory and when our current relationship loses the initial high it, a comparison is made against this template and we reject the relationship as failing or not right for us.  The process is self defeating as these are not objective comparisons but a natural process of a relationship neurologically plateauing and then being dismissed for a new relationship that generates the much sought after high.  This is a very similar process to how psychological substance dependency is established.

I also think think that the mystical and almost supernatural form of language that gets used around new relationships contributes to maintaining this biased comparison.  We enact terms such as ‘soulmate’, ‘fate’, ‘destiny’,’we have a chemistry’, ‘they are like a version of me’ and ‘we just get each other’ when we want to position the relationship as almost pre-ordained.  This is a bizarre contradiction as the same people often dismiss religious, spiritual or unexplained phenomena as nonsense and unscientific, yet they describe relationships as having mystical and cognitively irrational properties.  Similarly, when the relationship fails we employ the language of mumbo-jumbo to describe why; ‘we just don’t fit’, ‘turns out they were a psycho’, ‘they have issues’, ‘they changed’, ‘just doesn’t feel right’, ‘the sparks gone’ etc…

Alongside the chemical explanation and how it sets up an unattainable expectations, we also have numerous social factors that compound the problem.  When partners first meet they work very hard to be what they believe the other wants them to act.  For example if a partner is fond of dogs we may over inflate our own affinity to pets so that we seem likeable.  We may also espouse political or cultural attitudes that seem desirable, an example here would be a allegiance to gender equality when a private view may be one which is more patriarchal and that women are better suited for being the main caregiver with children and that men should be the primary worker.  The main issue here is that we begin to create a false-self that in context is completely understandable, we want this person to like us so we simply say, do and act in ways that will please them and increase their fondness of us.

The problem is that this is not possible to maintain over time and we begin to revert to type. This can be perceived as that we have changed or that we are no longer making an effort by the other person.  This occurs simultaneously with us having a greater threshold for the prospective partners undesirable traits, as due to the oxytocin rush we want more of the good feeling and we let transgressions or failings pass without criticism.  Over time the chemical high lessens and we begin to be more judgmental and can become antagonized by the same traits we previously found endearing.  An example here is that a spontaneous and fun seeking person could be viewed initially as exciting and adventurous but after a period of time may be seen as childish and immature.  In real terms, both partners start to act less accommodating, as well as being more critical and less tolerant. Again, this can be perceived as not putting in effort or not being of consistent personality, another fallacy that we believe we possess and that thoroughly concerns us when we see instability in the other.

To summarise, when we see relationships that appear to be all consuming, indulgent and fulfilling in the initial stages but then to fall apart as quickly as they occurred, we need to consider the actual chemistry that is going on.  In the case of Love Island, we can dismiss the issue as ‘showmances’ or scripted pantomimes, but is interesting to explore the pattern further as it often manifests itself in everyday relationships.  The bias that we establish around relationship expectations that occur when we stop over-performing our pretend desirable traits and overlook our partners negative are forever doomed to disappoint us by positing the view that something better must be around the corner.  So to coin a popular island based phrase “There are plenty more fish in the sea”, but unfortunately in the end they all taste the same and maybe we need to treat the fish we have with care and not be so demanding of their capabilities, otherwise we may end marooned on Love Island all by ourselves.

Men's Issues · Society

Why can’t young, British men stop binge drinking?

This week the local government in Malia, Greece officially banned large groups of young British holidaymakers from visiting after numerous years of alcohol fuelled ‘rampages’ that bring carnage to their picturesque Mediterranean community Daily Mail Article. Interestingly, the ban only applies to tourists from the UK and young people from Germany, Russia, Holland etc. are not subject to the same prohibition.  So what is it that makes the British exceptional in terms of not managing their alcohol consumption? The government seem to see this problem being created with how marketing firms portray youth, attractiveness and the ability to attract the opposite sex as being dependent on being completely inebriated and have proposed restrictions of advertising;  Guardian Article.  This new 2017 Bacardi advert echoes this glamorisation of alcohol being associated with having fun, looking good and the promise of offering young people access to a desirable lifestyle; Bacardi Advert.

I think that the role of advertising is but a partial factor and a reductionist stance would be taken if we suggest that the problem lies solely with manipulative advertising executives and the ease of gaining cheaply purchased alcohol .  Other government initiatives have wanted to target the financial aspects of alcohol and essentially tax the industry to a point where people reduce consumption because they can no longer afford to purchase it.  I think that it is far more interesting and enlightening to consider the relationship that British men in particular have with alcohol and  the resulting culture of binge drinking, as this problem is not restricted to young men going abroad and similar scenes of alcohol fuelled revelry can be witnessed in UK town centres every weekend.  I think that the idealised masculine image that advertising conveys, where men are positioned as sexually potent and attractive when they are assisted by alcohol plays into bolstering the hidden and fragile male sense of self that has been discussed here previously in How do I look?!?!?



The fantasy is that by consuming alcohol, men become more confident, attractive and are then able to be socially successful. There is also a strong element of drinking being linked to being convivial, again this plays on a very accessible discourse that being young means a real commitment to having as much fun as possible whilst you are able to, as in comparison adult life is full of responsibilities, hardship and difficult decisions.


One group of researchers recently proposed that one cause of excessive alcohol use was that the activity had become enmeshed with people having fun and propagating entertaining drinking stories that create a shared social narrative and bonding between those who are part of the group.  They produced an excellent and summary of their findings in Branded consumption and social identification: Young people and alcohol, that suggested that young people weighed up risks associated with dangerous levels of intoxication and the potential fun that could be had.  This ‘calculated hedonism’ is a process that ultimately leads to risk taking, with a pay off that hopefully allows the highest amount of enjoyment with the least amount of negative consequences. Unfortunately, this is an often misapplied theory, and I have worked with numerous young men who have served prison sentences, been seriously injured or have destroyed social and professional relationships through excessive and regular drinking.  Having been a young man and now an older man who thoroughly enjoys and looks forward to drinking, it is easy to understand how this relationship can become unbalanced and calculated hedonism can lead to miscalculated ruin.

Men also often discuss the function of alcohol as a social adhesive and that because of how alcohol is so ingrained in our culture with rituals of celebration and manhood; ‘wetting the babies head’, ‘toasting success’, ‘birthday drinks’ and paternalistic tribal ceremonies; ‘stag parties’, ‘university club admissions’ ‘watching sports’ etc. consuming alcohol is vital to masculine social group inclusion.  This idea is also looked at by the aforementioned researchers who suggest that traditional patriarchal communities such as factory work-forces, trade unions, town community centres and religious groups have been made redundant in contemporary culture and as a result alcohol has now replaced them as the vehicle that ensures social cohesion and acceptance.

One point of interest is that highly defined groups such as Muslim communities, which as a rule abstain from alcohol, have traditional religious structures that allow men to be part of a shared collective that allows male bonding without the use of drinking. Conversely, young men in Britain who are not part of any alternative communities have very little in the way of forming groups that can be a safe place to express masculine needs and explore males issues. As a result an unhealthy dependence on drinking can be formed which is further reinforced by the advertised promises of success and manliness. This comes alongside the lack of alternative bonding outlets that together constructs a social reality that by not drinking, young men face isolation and communal pariahdom.