The dark ages of the internet – The inadvertent cost of our obsession with the online world

As an update to this article, I believe that the COVID-19 pandemic has meant that our reliance on the internet has exacerbated exponentially as people have had to transition to working, learning and socialising through screens. The costs of this have been widespread mental health difficulties, chronic loneliness and horrendous exemplifiers of how institutional disadvantage (Douglas, Katikireddi, Taulbut, McKee, & McCartney, 2020) means that UK citizens have had a myriad of experiences of lockdown that vary from waiting for the weekly Ocado delivery whilst working in the garden office, to less fortunate people who single-handedly homeschooled several children for months on end whilst effectively imprisoned in a one-bedroom flat in an inner-city tower block – June 2021

I decided to write a blog on this subject after two very separate items in the media that appear to be underpinned by a similar phenomena.  The first story concerns a new technological concept that essentially allows us to observe our elderly relatives over an internet camera link by using an app on a smartphone.  The second was a article from the department of education who have launched a campaign based on research of 2,685 parents in 2017, their findings claimed that only 51 per cent were helping their under-fives learn the alphabet or recognise words once a day or more Department of Education – Chat, Play and Read. Even though both stories tackle social issues that affect individuals on the polar extremes of the human life cycle continuum, the common factor is the rise in use of technological communications and online social interaction.

Hive Link smartphone application

Addressing the first issue, the use of the ‘Hive Link’ app allows people to be constantly connected to elderly relatives or friends who are in their care, yet live independently.  On first glance the app feels a useful tool that allows busy people to be virtually available to their loved ones, it also uses AI algorithms to learn their daily routine and issues alerts if the person is overtly sedentary or unresponsive, indicated by triggers such as a lack of motion or the morning kettle not being switched on.  This allows early assistance to be sent as a precautionary measure based upon signs of the person falling ill or needing medical attention.  For strokes, heart conditions and similar afflictions, this rapid response can be the difference between life and death.  It also allows elderly relatives to remain in their own homes for longer, rather than having to be moved to assisted living or a shared residence.

In essence, it is difficult to make a case to be critical of this type of friendly technology that gives carers peace of mind, whilst simultaneously affording the elderly autonomy with privacy and personal risk management. However, with more exploration, as with most aspects of technology and the internet, there are inherent problems.  The main one of these is the well documented issue of loneliness within the elderly, with a 2015 systematic review by Age UK claiming that 1 million of our aged parents, grandparents and friends feel permanently or periodically lonely, with half of these feeling pets or the television are their primary form of company.  The same research associates loneliness to both physical and mental health deterioration, doubles the risk of Alzheimer’s disease, causes chronic depression, increases reliance on alcohol and exacerbates the suicide rate.

Only 46% of people 65 and over said they spent time together with their family on most or every day, compared to 65-76% for other ages. 12% of people 65 and over said they never spent time with their family

Davidson and Rossall, 2015

My thoughts are that these type of apps do allow us to be virtual supervisors of our older generations, yet they also give us a huge opportunity to simply assume that because the person appears safe, they are also happy.  So, rather than popping round with the grandkids for an hour or dropping by for a chat over a cup of tea, we simply assuage our residual guilt by convincing ourselves that they are happily existing, based on limited evidence of well-being that is assumed from the boiling of kettles and television channels being changed.  It is easy to extrapolate that wide use of this type of technology will change that 12% to much higher figures, as it is a lot easier to swipe through ‘GrannyCam’ on the daily train commute, than it is to make time to visit her that evening after work.

Loneliness in the elderly

The second issue to be considered is the report from the DofE that feels that parents need support in understanding the value of spending time narrating the world to children, as well as formalised reading time.  The report suggests that around half of children do not get daily reading time with a parent; leading to reduced language abilities, delayed cognition, lack of attunement and difficulty recognising and regulating emotions .  As reading is not just about providing an educational bedrock, it also acts as a fundamental link to how a child interprets and learns about the world around them. Donald Winnicott (1957), profoundly wrote how the role of the mother is to show, explain and interpret the external world to the child. My thoughts are that the reasons for the decline of this practice are complex and varied; with issues such as social conditioning and austerity that encourages both parents into full time work, feminism empowering women’s workplace access,  the devaluing of the parenting role, increases in family breakdown leading to lone parenting and people just becoming busier.  All of these are significant contributors to lowering the numbers of parents dedicating themselves to the full time raising of children.  I regularly get parents in my treatment room who complain that the demands of modern life, especially work commitments mean that just getting home before children have to be in bed is difficult and that the list of domestic and professional tasks they have to then complete are never ending.

Parent to child attachment

These social challenge are further compounded by our obsession with social media, as well as being constantly available online to employers, making the demarcation of work and life boundaries increasingly blurred.  I think that we are incredibly unaware of just how much our smart devices dominate our attentional sphere. I often see young mothers walking with prams, completely oblivious to their children’s  desperate attempts to interact by pointing, gesturing and cooing at them.  Similarly, I hear of corporate parents tuning out to children because their phones are alerting them to the needs of their transatlantic clients as the stock market in America wakes from its slumber.  Seminal research by (Bowlby, 1969) and numerous others have shown that children need an active, consistent, predicable and empathetic response from caregivers to enable them to form meaningful attachments and develop functional social identities.  They crave parental input and their behaviour amplifies and becomes maladaptive when their cues are not met with reciprocal behaviour.  Weinberg and Tronick (1996) shows compelling evidence of how just briefly ignoring a child’s attention needing cues results in rapid behavioural change and then leads to anger, shame and disappointment Tronick’s still face demonstration.

If this happens enough contemporary attachment research (Crittendon 2016) has shown that children can develop increasingly extreme behavioural strategies that are often interpreted as diagnoses such as ADHD, as well as leading to withdrawal, dysfunctional mental health , lack of affect regulation, poor social adjustment and the sad outcome of simply giving up trying to engage (Fearon et al., 2010, Schore, 2001).  The policy implementation of the DofE may seem to some like an ever creeping advance of the ‘Nanny State’, but it does highlight that parents are often choosing not to to allocate their time having interactive and immersive experiences with their children, and in my opinion this choice is partly influenced by the seductive and authoritarian nature of our digital devices. It may also simply be that younger parents are not realising the value and crucialness of non-digital relationships to infants; as the online world has become normalised as the preferred mode of modern communication.  Recent research (Kildare and Middlemiss, 2017) has published the following findings that they have associated to parents prioritising technology over attending their children:

Distracted parents are less responsive and sensitive to their children.

Enhanced mobile connectivity can distract parents from parent-child interactions.

Children engage in risky behaviours while attempting to regain parental attention.

Distracted parenting could be linked to increasing childhood injuries.

Managing device use is complex and contributes to family conflict.

Kildare and Middlemiss, 2017

These are worrying symptoms of being so disengaged and I become further concerned when we consider the meteoric rise and reliance to digital communication that has captured us all.  From an evolutionary perspective, I feel that for thousands of years humans have thrived on face to face contact, empathetic response, subtle interpretations of emotional states and physical interaction (Crosier et al., 2012).  In the last decade, this has radically shifted to us employing apps to emulate company to our elderly, and on the other end of the spectrum the digital revolution has turned us into parents who feel their children will simply google how to achieve sentience and individuation , rather than having us assisting them with their love affair with the world. Our cognition and psychological schemas have developed to be receptive to ‘actual’ social contact and I wonder if by transferring our lives into a virtual environment will have detrimental effects for generations, as we struggle to acclimatise our psychology to cultural paradigm changes. In the same way that physiologically, our bodies interpret crash dieting as famine and as a result activates metabolic fat storage as a survival mechanism, rather than understand that we are trying to lose a few pounds to fit into a wedding outfit. Will our brains interpret the reduction in physical interaction that have been superseded by our digital relationships as social deprivation, leading to depression, anxiety and unhappiness?

Are we bound to the digital world?

As I was writing this article, my concerns were once again piqued, as a news article informed me that Facebook are implementing code to prevent us inviting dead friends to events and sending them birthday greetings. This sums up the vacuous nature of the digital world, when a computer system has to take responsibility for us not inviting our deceased ‘friend’ to a birthday celebration. In a slightly trite analogy, can you imagine how absurd it would be leaving a event invitation next to a passed acquaintances gravestone? For me, this represents the loneliness and disconnection that a virtual life has the potential to immerse us in. Behaviour and evolutionary psychological adaptation takes generations to accommodate any environmental shifts, and I feel that the two discussed examples of the human condition being transformed into binary internet coding could be what future scholars look back on as the ‘Dark Ages of the Internet’.

REFERENCES

BOWLBY, J. 1969. Attachment and Loss: Vol. 1: Attachment by John Bowlby Basic Books.

CRITTENDEN, P. M. 2013. Raising parents: Attachment, parenting and child safety, Routledge.

CROSIER, B. S., WEBSTER, G. D. & DILLON, H. M. 2012. Wired to Connect: Evolutionary Psychology and Social Networks. 16, 230-239.

DAVIDSON, S. ROSSALL, P. 2015. Evidence Review: Loneliness in Later Life. Age UK.

DOUGLAS, M., KATIKRIREDDI, S.V., TAULBUT, M., MCKEE, M. and McCARTNEY, G., 2020. Mitigating the wider health effects of covid-19 pandemic response. Bmj, 369.

FEARON, R. P., BAKERMANS-KRANENBURG, M. J., VAN IJZENDOORN, M. H., LAPSLEY, A.-M. & ROISMAN, G. I. 2010. The Significance of Insecure Attachment and Disorganization in the Development of Children’s Externalizing Behavior: A Meta-Analytic Study. 81, 435-456.

KILDARE, C. & MIDDLEMISS, W. 2017. Impact of Parents Mobile Device Use on Parent-Child Interaction: A Literature Review.

SCHORE, A. N. 2001. Effects of a secure attachment relationship on right brain development, affect regulation, and infant mental health. Journal of Infant Mental Health 22, 7-66.

WEINBERG, M. K. & TRONICK, E. Z. 1996. Infant affective reactions to the resumption of maternal interaction after the still‐face. Journal of Child Development, 67, 905-914.

WINNICOTT, D. W. 1957. The Child and the Outside world: Studies in Developing Relationships, London, Tavistock.

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 also attempts 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, with the graph below illustrating the most commonly prescribed drugs.  Anything to the right of 1 is positive result and shows performance against the taking of a placebo.

As a counter argument, Prof. John Read  critiques the study and asks for a more balanced approach in his Letter to the Guardian.  He questions the data’s neutrality, the agenda of the researchers (whom they work for) and how drugs are unable to manage the actual social distress caused by problems one is exposed to in their life.  Other critical voices have also cautioned that an effect size demonstrated here barely outperforms baseline readings.  Effectively, questioning that these medications have negligible real life effect on mood, challenging the notion that they help alleviate anxiety and depression at all.  It is worth noting that the measure being used, the Hamilton Scale is cited by the National Institute for Clinical Excellence (NICE) as needing at least 3 points to exhibit a scientifically significant effect.  Therefore, it could be argued that the range of results below would register very little improvement to real world symptoms.

Always check with a GP on the best medication for you, as side effects and the disorder that a person has will have an impact on the most useful and safest treatment that is prescribed.  It is worth noting that these results do not suggest a hierarchy of how good a particular drug is and should not be used to take certain medication over others.

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.

The 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.

 

 

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I’m going to kill you…!?!?! The angry face of the humiliated man.

I struggled a little this week to come up with a good topic to talk about.  I’m not sure why but I have been busy and slightly consumed with writing academic work so maybe my mind was in researcher mode rather than therapist.  I like to keep abreast of the latest cultural and political ideas and what with the election and the recent terror threats and tragic tower-block fire, the theme of the week has been anger.  In fact, not just angry but vitriolic, consuming vexation… There was even a day last week entitled the day of rage. So, as always the topics for my blog can emerge from the strangest places and even though anger is engulfing Britain at the moment, I failed to pick up on it and gained my muse today from the recent events in Big Brother.  I used to watch this show religiously as it essentially re-enacted many of psychologies seminal studies, such as Milgrim’s obedience and Asch’s classic expression of conformity.  I was completing my undergraduate degree at the time that the show had just started to be a cultural phenomenon and I loved watching the real life application of dry old accounts of social psychology that I was being introduced to in the lecture theatre.

Anyway, the show has become tired and at best a platform for aspirational Z list celebrities, but I was interested in a recent incident and tuned in to have a look for myself as whatever Big Brother attempts to grossly pantomime, it does at times capture the essence of the human condition and how we socially interact in participatory sense making.  The news story that ran was that the show faced being pulled (not dissimilar to Zimabado’s prison experiment that quickly spiraled to due degradation practices and power abuse) because of a  mass brawl that was started by three imperious men.   The gist of what happened was that the three individuals had started to be powerful and domineering figures who had as a group started to play increasingly nasty pranks and antagonise mainly female housemates.

One young lady had stood up to the ringleader Lotan, who was constantly berating her use of fake tan and general personality and she challenged his behaviour by asking him what sort of role model does he want to be to his young son?  Her intention was to make Lotan reflect on his immature and at times bullying antics and she attempted to place him as person who could potentially be responsible for passing on misogynistic and macho beliefs to the next generation of men.   Incidentally, he had also enlisted two weaker men as lieutenants, who effectively provided him with an echo chamber to assert his dominance and create a group social norm that bullying could be construed as laughable banter and that if you thought otherwise you were too stupid to get the joke or no fun.

The reaction she received was not one of sombre contemplation but an intense rage which led to a fully grown,  muscle bound man to leap up in a murderous rage ,throw anything in sight, square up and threaten all forms of torturous death and destruction upon a physically diminutive teenage girl who had simply asked him about the type of man he wanted to portray to those watching.  His rationale was that she had offended him by bringing family into an argument. There seems to be a bizarre code in the show that pretty much anything goes but do not talk about my family, it is like some sort of working class form of the mafia’s omerta of silence.  My feeling here is that it was not that the challenge had breached some odd and arbitrary code of discourse but she had humiliated the man.  By implicating how his actions may lead to his own son to become bigoted and sexist, she had inadvertently triggered a primal anger that has been ignited by humiliation.

Humiliation is the abasement of pride, which creates mortification or leads to a state of being humbled or reduced to lowliness or submission. It is an emotion felt by a person whose social status has just decreased. It can be brought about through intimidation, physical or mental mistreatment or trickery, or by embarrassment if a person is revealed to have committed a socially or legally unacceptable act. Whereas humility can be sought alone as a means to de-emphasize the ego, humiliation must involve other person(s), though not necessarily directly or willingly.

This comment caused Lotan to appear foolish and ashamed in front of his peers and diminished his status as a respected man who will be able to pass on a legacy to his son. I am not familiar with how much contact he has with his son but this may have resonated with his own feelings of being an inadequate father who maybe was not doing enough real parenting and who may have been already experienced a private shame about not being a more active and available, as well as the loss and shame generated by the failed relationship with the child’s mother.

We have all experienced the burning embarrassment and crushing loss of status that humiliation brings to the psyche.  It can be activated by others ridiculing us or our own clumsiness or incompetence in cultural and social ceremonies.  I think that being humiliated by people close to us in public arenas is often the ember that starts the fight that ends the relationship or symbolically initiates the first occasion we raised our fists in anger and retribution to someone we love.  The reality is that humiliation is often the reason that lovers murder their partners or a furious husband bludgeons the love rat who seduces his bored wife during the fallow phase of a suburban marriage.  David Buss, an evolutionary psychologist writes about this type of sequence to slaughter in his book the ‘Murderer Next Door’.  His message is that murders are not acts committed by unknown evil psychopaths but are often the social product of a humiliating encounter with a friend, partner, stranger or family member.

The evidence suggests that most homicide victims know their killers and that when Buss surveyed 1000 ordinary people about their murderous impulses, he was caught in an avalanche of dark and twisted fantasies of torturous murder towards seemingly innocuous targets such as parents, children and siblings.  These fantasies were further investigated to reveal that the targets were chosen because at some time in their history, this person had transgressed a boundary and caused humiliation and degradation. These acts were often put downs or off colour comments about sexual performance, appearance, family background or skill at an activity and in the scheme of things may be viewed as inconsequential or petty.  The reactions are anything but…  Take a moment to reflect on how you have reacted to a humiliating remark or event.  Did you shout and scream, throw a punch, cut a family member from your life, call a close person an unspeakable expletive or threaten to leave and never return…?!?

Going back to the event on Big Brother and making a hypothetical exploration of what if…?  I wonder had security not been called in or had other contestants not rushed to intervene and had Lotan been close to a kitchen knife or heavy object, he may have been taken over by the responsibility abdicating ‘red mist’ and when he regained composure may have been looking at the young lady laying prone on the floor with her head caved in or a knife protruding from her chest.  He may have played out his violent fantasy to try and redress the narcissistic wound inflicted by the suggestion he was a poor father and he may have regretted his actions for the rest of his life.

I often see men, who in various guises have been faced with humiliation that has been directly struck, indirectly experienced from more subtle discursive insinuations or born of institutions and organisational patriarchy.  Sometimes, this first realisation is terrifying as one wrestles with the dark passenger who whispers coldly in your ear to claim vengeance and flashes a scene of macabre and arousing massacre vividly in your imagination.  I always say to these men, who are often gentle and kind in their everyday lives, that these are natural thoughts.  The skill is being able to understand their function of preventing emasculation and to not act upon them, but instead to allow them to be expressions of our shadow selves and incorporate them into our everyday selves in order to be sentient, thinking, feeling and existing humans who are all potentially the murderer next door.

So who is this father fella who lives in my house?!?!

With fathers day coming up this weekend, I thought I would discuss the role of fathers in contemporary families.  I think that many men are struggling with their identities and positions within modern society and this is a conversation that I regularly have with men during therapy.  Traditional roles of men have been changing over the last few decades and the old fashioned view of fathers that people of my generation know have transformed beyond recognition.  The classical view of a father who is serious, emotionally distant and called upon to provide resources and discipline now seems like parody from a dusty Dickensian novel.  This role was familiar and eagerly adopted within the nuclear family during the post modern decades in the late 20th century. Mother’s were often at home and had given up careers to take the mantle of childcare and the men would work during the week and provide the home with resources. Something, that I often discuss with men in my therapy space is what are the roles of a father.  It is a simple question but one that many often struggle to answer and this confusion epitomises how men have lost a solid and historically stable identity as times have altered.  I rarely get a definite answer to the question and to compare the same enquiry in the context of mothers, I tend to get a much more concrete picture of what mothers do.

I think that the adoption of feminism during this time began to instigate social change as women raised aspirations to have careers and equality, and were not simply there to raise children.  Although this has been a progressive step in altering eons of patriarchal dominance, the change in women’s positions has had to alter the rest of the system and as a result has dramatically shifted the role of fathers.  The crux of the conversations that I have with men and their families is one where men essentially feel redundant at times and unsure of the function that they provide.  This undoubtedly brings pathology and I often work with men who have undergone emotional breakdowns, suffer with substance abuse and presents chronic mental illness.  It is no surprise that the middle aged man of 2017 has embraced this mid-life crisis in a much more dangerous way than the previous generation.  Instead of buying a sports car and finding a new girlfriend 20 years his junior, he now suffers diminishing mental health and in extreme cases takes his own life as written about here; Thoughts on the male suicide epidemic.. Statistically, men in their middle age period are the most at risk population of successful suicide attempts.

My feelings are that as a group, these men feel disenfranchised and unsure about the roles that are now available to them.  Increases in family breakdown mean that many men find themselves adrift after leaving the family home and this exacerbates their sense of impotency.  Women have managed to embrace their more empowered roles with great success and have at times demonstrated they can care for families and be competent in the workplace.  Therefore, the requirement for men to be the hunter/gatherer is no longer needed and I am seeing more women who vocally express that they can function without any input from men in the family.

My experience of my own father was one that is familiar to many, where he would be fairly absent within the week and would turn up at some point in the evening.  He would often be unapproachable, tired and irritable, and as a child this would often generate a mixed feeling of wanting to share my day with him and being wary of antagonising his volatile mood.  Robert Bly discussed this experience brilliantly in his book Iron John and describes these men as ‘remote fathers’.  Weekends would sometimes alter this pattern with fun trips castles or visits to seaside towns but the fatherly role for my generation was one of distance and provision of resources.  Most emotional problems and day to day matters would be handled by mothers and men would only become involved in extreme crisis or matters that were gender specific.   Even though the father was absent and hard working, his role was defined and had been handed down from generations previously.

Current fathers are now in disarray as men now are seen as misogynistic or uncaring if they take on the old ways but at the same time they often lack the emotional toolbox to respond to children as effectively as mothers.  There are men who through necessity or choice have managed to negotiate this change but stay at home fathers are often viewed by society as either ironic heroes or not fulfilling their vocational potential.  I often see many men who feel useless and directionless when they not only have expectations to provide, but also to be able to connect to families emotionally and offer expert compassion, empathy and support.  During infancy men often struggle to acclimatise to being sidelined and also what they can offer a newborn.  This struggle usually lessens as toddlers have personality and fathers often revel with the playful and silly types of interaction.  As the children age, the relationship often becomes more complex and father’s struggle to understand child experience and the playful period stops as the child’s needs mature and the father often becomes treated as one of the children.  This lessens his authority and relegates him in the family hierarchy.  I think this is the point where fathers often try to reestablish dominance by using heavy handed tactics to contain their children and they are then experienced as unreasonable, aloof or angry.

So, on Sunday spare a thought for fathers who have inadvertently been sacked and re-employed, but have not necessarily been given the job description or asked if they are happy with the new role they are expected to fill.  I think that men will start to adapt to their new role but this generation may be the unfortunate guinea pigs where problems are identified and ironed out before the new wave of fathers take the reins.

So, where do I sit then?!?!?

This is a fairly light subject that suddenly came up in a very apparent way in practice last week.  Often in family therapy the family come in and will have their first dilemma and potential argument about where to sit and who sits next to or doesn’t sit next to who.  Once the seating plan is established, subsequent sessions are always interesting as sometimes clients choose the same seat and other times they swap.  We often have conversations that are initiated by these choices and perhaps the most exciting session is when someone takes my chair and we can have all sorts of fun with them as the therapist asking the questions.

One of my favourite memories was a young six year old girl absolutely loving the position of the therapist in one session and asking her older siblings and parents some really enlightening and well thought out questions about topics the rest of the family constantly avoided bringing up.

A more subtle use of where do I sit? is from my individual work with male clients.  My private practice furniture arrangement is the classical long couch for my clients and the armchair for myself.  I do not ask clients to lay down whilst I perch sinisterly, looming behind them asking them to recount abstract words about their parents that pop into their head as portrayed in classical psychoanalysis.  I am happy for the client to lay down if comfortable but most just sit and we talk face to face.

The intriguing aspect to this is as the couch has three possible seating choices… discounting perching on an arm.  What I have noticed is that where the client orientates on the couch is very telling and incredibly meaningful to how they relate to the world. The following are general observations I have made of types of clients and where they sit.

Certain clients will sit very close to me and these seem to be men who are seeking closeness and intimacy and often feel quite exposed in therapy.  They have often just started treatment and in terms of how they relate to people around them, they have a desire to please and will place others needs before their own.

The men who pick the far end of the couch are sometimes wary of intimacy and feel comfortable keeping an emotional and physical distance between themselves and others. They are often men who have learnt to be self sufficient and will find it hard to identify and express emotions.

The middle seat is one that can have a couple of meanings.  The first is that the man is wanting to dominate the space in order to portray importance and assert authority in the therapy, this is often because the client feels threatened by the emotional intimacy that the therapeutic encounter potentially establishes between two men.  The other is when the client has been in treatment for a while and is feeling comfortable with their position and the relationship between us.

So when you next sit down with other people, just glance at the furniture and the positions you, family, colleagues and friends take in relations to each other.  Then have a curious thought about what types of relationships these people have and where they are all positioned.  Family meals will never look quite the same again and you might really struggle with finding the right seat…

I can’t get them in, but then I can’t get them out… How men can be helped to get help.

I think that Prince William and Harry’s recent campaign to raise awareness for mental health has had a profound effect on men who were toying with the idea of seeking treatment.  By seeing a grown man who served in the armed forces describe the impact the tragic loss of his mother two decades previous had upon him was both courageous and encouraging.  Harry spoke about how he experienced periods of intense anger throughout his life and finally decided to talk about his feelings and try to understand what his anger was telling him.

I see anger often being associated with loss and I think for men it is a helpful emotion as it gives us energy and also reasserts our potency and masculinity, two things that are often removed from us when we lose control of crucial aspects of our lives.

On the back of this campaign, I received numerous requests from adult men for treatment through my private practice.  The common factor was that they shared was a long standing issue that they had wrestled with for some time and had finally asked for help as it was beginning to intrude on their everyday functioning.  My feeling was that the recent disclosure by the royal brothers had given them permission to ask for assistance without the stigma that requesting aid signifies weakness, a belief that exists in most men’s minds due to the messages of self-sufficiency and resilience that men are subject to from infants.

I am so pleased to be seeing more men in my practice as for years men seemed to be dragged kicking and screaming into therapy by exasperated partners on threat of divorce, or sent like naughty school children to the headteacher by the authorities after social care or judicial interventions.  Saying this, I always smile to myself that after the first few sessions it is often the man who is first into the treatment room and the man who is there as the hour is up with just one more idea that has been triggered…  I have at times had to work extremely hard in convincing the men that it is okay to go out and tackle the world without seeing me every week…
As I always say it is the client that has the answers to their problems and I just ask the questions that may help find them.

New blog about my experiences of working with men and their mental health.

This is my first blog and I hope that you enjoy the subjects I will be blogging about in relation to men and their mental health.

The aim of this blog is to create a place where the issues that I feel that men bring to the consulting room can be thought about.  I am surprised at how often the same type of presentation occurs and started to think that if this is indicative of men in wider society, it would be great to have a public forum for other men to share in the experience and perhaps find the courage to start to talk about their own stories.

I am always up for contributions or suggestions from anybody who reads this on what to discuss and welcome the female perspective on how they view the men in their lives and the challenges they face.