 'Diagnosis determines intervention.'
There’s a very big difference between ‘What’s wrong with you?’ and ‘What’s happened to you?’ Jo Watson’s book, Drop the Disorder (2019) is a timely and courageous personal-professional challenge to the creeping influence of the biomedical model into social-psychological therapeutic thinking and practice. In her aptly titled article in the book, ‘There’s an intruder in our house!’, she reflects with a pained air of near-despair on this gradual, alarming and depressing diagnostic drift: ‘It wasn’t always like this. I joined a profession that held a shared belief about the nature of human emotional distress. We understood that the many forms of human suffering we witnessed – ranging from feeling low and suicidal to self-injury, hearing voices, overwhelming anxiety and dissociative experiences – were responses and reactions to what had happened in people’s lives and, in many cases, the resourceful and creative coping strategies they had developed to survive. We clearly and consistently made links between emotional distress and causal factors like poverty, racism and abuse. There was a deep, collective ‘knowing’ that social circumstances were linked directly to human suffering and this acknowledgement translated into a connection with the political arena. Yet, as I write, this work has been consumed by a biomedical monster that has crept into our house and made itself very much at home. In fact, I don’t feel this is my home anymore.’ Jo is challenging a fundamental risk of the biomedical therapeutic model, that it locates a perceived problem in an individual, irrespective of a broader context. In doing so, Jo echoes disaster management expert Marcus Oxley’s insight (in a different arena) that, if we see a pattern of symptoms in people attending an Accident & Emergency unit, it may well reveal something implicitly about conditions in that context. It’s always about the person, but it’s rarely only about the person.
9 Comments
 'The reality is that you will grieve forever. You will not 'get over' the loss of a loved one; you will learn to live with it.' (Kubler-Ross & Kessler) At 15, I was fatally wounded. At 18, I died. That’s how it felt and, at times, it still feels now. There are some scars that never heal. A trauma of unwelcomed loss is being forced, harshly, to let go of an imagined future, a hoped-for dream. This tearing experience can leave our hearts, our bodies, bleeding. I was a shattered romantic who spent day after day, year after year, pleading with God to take my life. I slid into a heavy, dark dysthemia. Nothing could bring healing, happiness or hope. It's fertile ground for addiction, to search for anything that will make us feel alive, provide even momentary relief. We may immerse ourselves in whatever distracts and enables us to avoid having to face again, all too wearily, those severe memories and tortured feelings. My own torment was that searing-painful images would surface over and over in my dreams, as if trying to reconcile the suffering at some deep subconscious level, yet leave me waking the next day in suicidal mood. I wish there was a simple answer, a miracle cure. I live in a culture that holds out delusional promises and expectations of a pain-free, pleasure-filled possibility of a life. I live in a world where hurt and damaged people, more and more, seek solace and escape in drugs or other diversions. I find my spiritual hope in Jesus who (to me surprisingly, yet in a strange way reassuringly) carries the scars of crucifixion after his resurrection. Whatever I may go through now, this will not end in death. Over the years I have learned, and am still learning, how to live with my own scars rather than to attempt to bury, hide or erase them. I’m still, at times, ambushed by grief. It takes me by surprise and leaves me temporarily reeling. I’ve learned to be thankful and, gradually, to allow people and relationships to drift away rather than to cling so hard. I’ve learned to discern how pain triggered from the past can reveal someone or something important that I’m not noticing here and now. How do you deal with your scars? How do you help others to do so too? (Nick is a change leadership consultant and trainer for trauma-informed practice agency, Rock Pool)  ‘I was so focused on what I had lost, that I lost sight of what I had found.’ (Jerry Orbos) Orbos, a priest, recounted a story of when, as a small child living in a very poor village, he attended a fiesta. It was a special, exciting party and he was thrilled to be given a balloon. Some moments later, he was given an ice cream too. He could hardly believe it. On taking the ice cream, however, he accidentally let go of the balloon which floated away out of reach. Looking up helplessly, Jerry felt completely distraught. His mother, noticing his distress, whispered, ‘Jerry – look at your ice cream’. A loss that impacts deeply can leave us feeling hurt, mesmerised, transfixed and paralysed. We may struggle to breathe, as if caught in a trance state and unable – or unwilling – to break free. We may notice this when a person loses, say, a relationship, job or home that really matters to them. ‘What do you need?’ offers valuable empathy and support. ‘What are you not-noticing?’ can help break the gaze; enabling someone to see people, relationships and resources that lay hidden in plain sight. How do you help people to let go of what is lost? How do you help them to see what they can’t see?  ‘My life has been filled with terrible misfortunes; most of which never happened.’ (Michel de Montaigne) Imagination can be a rich blessing and a painful curse. On the one hand, it can enable the most amazing creativity and innovation; on the other, it can cause the most terrible suffering and pain. Learning to handle and harness the power of the imagination can be a very valuable skill. Yet it can feel like trying to tame a wild horse. We sense and feel its power and potential but can never quite control it. Sometimes it can inspire or entertain us; at other times, it can terrify or overwhelm us. I remember an advert for an organisation that supports people with a frightening, degenerative, physical disease. It said quite simply, yet so poignantly, ‘It’s what goes through your mind that’s the worst’. I remember, too, a colleague who comments that, ‘The past exists only in memory; the future exists only in imagination.’ Imagination creates the possibility to experience as-if reality, now. So, if that means experiencing our happiest dreams – good; if our worst nightmares – not good. An opportunity and a challenge is that the brain doesn’t distinguish sharply between actual reality and as-if reality. This means that, if we imagine something vividly enough, it can be as if, mentally, emotionally and physically, we go through that experience for real. That's great for fields like, say, Appreciative Inquiry that capitalise on positive imagination to create a better and brighter future; not great for professionals who experience, say, vicarious trauma or secondary traumatic stress. How do you draw on the immense power of imagination to achieve positive change? How do you avoid or address its potentially damaging effects? You may have heard the expression, ‘To hit rock bottom.’ It’s often used in relation to reaching the lowest possible place in life, a place that is in effect devoid of all resources and hope. To hit rock bottom suggests a falling experience – having fallen from a better situation…to a deteriorating situation…to the hardest of all possible situations where it really couldn’t get any worse. Some argue that when things get that bad, they may need to be so before we find ourselves motivated enough to make the necessary, fundamental – even drastic – changes needed to resolve or improve them.
There are some parallels with use of extreme, evocative images, e.g. that of a ‘burning platform’, in change leadership. This fire metaphor conveys that the status quo is under threat and that we, by extension, are under threat too unless we wake up, smell the proverbial coffee and…not sure what comes next…presumably drink it – or at least use it to douse the flames?! It’s like, ‘Change or die’. It suggests that, at times, we need to compel ourselves or others urgently by painting dramatic, real or imagined (and sometimes a bit of both) scenarios that radically incentivise or force us to change. But do we really need to hit rock bottom or to face the wall first? Are there ways to galvanise sustainable change without prerequisite anxiety or near-despair? I believe we can learn here from the therapeutic arena. Some examples: in working with people at risk of free-fall, we can ‘raise the bottom’ or help ‘create firm footholds’ (e.g. support people early to face and deal with real yet less-devastating crises); use ‘motivational interview techniques’ that increase people’s intrinsic desire to change; use spiritual-existential coaching to help people build deeper and stronger foundations. As leader or coach, have you ever hit rock bottom, felt yourself falling or worked with people who have? If so, who or what made a difference? Have you tried reasoning with someone when they’re feeling intensely emotional? It’s hard to think clearly, think straight, when we’re stressed. Some brain research says it’s almost impossible. When we’re stressed, we flick out of reasoning mode into fight-fight-freeze mode. The brain gets flooded with chemicals that are intended to enable us to survive an emergency, a crisis. Trying to hold a rational conversation with someone in that state can be like pouring fuel onto a chemical fire.
Cognitive behavioural psychology points us helpfully towards some signs that a person may be in that kind of emotional place. For example, they may be speaking in very black-white/either-or terms, unable to see nuances or alternatives in a situation. They may be assuming intentions in others or predicting outcomes with unfounded certainty – as if they know the future for sure. Physically, they may be struggling to rest or sleep, missing meals or avoiding normal patterns of social contact. The vivid image that comes to mind for me is that of a lot of dust being kicked up into the air. Until the dust settles, we are unable to see clearly. This is a reason why leaders who try to lead change and transition as a purely rational-technical process often encounter greatest resistance or other attitudes or behaviours they consider irrational. It’s also a reason why coaching and training may fail if the coach or trainer doesn’t take the client’s or group’s emotional state into account. So what, if anything, can we do to address this? We can offer time and space for people to feel and process their emotions. ‘How are you feeling as we talk about this?’ As the person or group talks, the dust often settles enough for them to start to make sense of their experience and to see and discuss the beginnings of a way forward. We can also offer empathy and support. ‘What do you need?’ It values and respects the person or group and shows care, responsiveness – and standing-with.  I will facilitate a leadership meeting tomorrow. One of the questions I will pose is: ‘Who or what has inspired you most in 2016 – and why?’ We are, after all, approaching the end of this year and it can be valuable to pause in the midst of all the busy-ness of business as usual to reflect, notice, learn, thank and celebrate. At the same time, as we reflect on the why question, it will touch and reveal our underlying beliefs and values. It’s something about who and what matters most to us in life.
Our responses to the inspire dimension will also say something important about ourselves and the cultures we inhabit – although these often lay out of awareness, more implicit to us than explicit. Psychodynamic theory refers to this phenomenon as projection. It’s as if we sometimes notice qualities in others that we don’t see in ourselves. I may project these qualities outwards and see the image that I project…and yet I attribute what I see to you rather than to me – or to us. That said, however, it can be and feel truly life-giving to gaze, even for a moment, at the amazing qualities of people and things that inspire us. To be inspired is to be impacted. Something shifts, something changes. It evokes and energises a dynamic within and between us. This is the influence of role models. It is something we do well to pay attention to as leaders, coaches, OD and trainers too. As one colleague put it: ‘We are always influencing – but not always in the way we hope!’ Without doubt, the person who has inspired me most this year is a young woman, a Filipina, who gives her life, day-by-day, selflessly and unselfconsciously to love and care for others. To meet, to see, to feel, the way she lives and engages with the people around her, especially the poor, has been nothing short of breath-taking for me. It has challenged and inspired me deeply to be a more loving and outward-focused person. So…who or what has inspired you most in 2016 – and why? Ignorance is bliss - until we realise our ignorance. Therein lies a painful paradox at the crux of films like, The Matrix and Vanilla Sky. There can be something deeply unsettling, disorientating, releasing about a dramatic shift in awareness like a sudden waking from sleep. Our eyes are opened, we can see and now we face fresh possibilities, choices and responsibilities. Ironically, the existentialist French philosopher Jean-Paul Sartre described this experience bleakly as, ‘condemned to be free.’
This awareness-raising phenomenon raises important practical and ethical questions for those working in people professions. The Brazilian educator, Paulo Freire, emphasised the importance of 'conscientisation', critical consciousness-raising, as a means to liberation. He argued that people are in some ways unaware of themselves, their circumstances, until enabled to see through fresh eyes. This resonates with a Chinese proverb: ‘If you want to know what water is, don’t ask a fish’. A girl I was working with recently from a very different cultural background to my own reinforced this point: ‘I didn’t see myself until you saw me.’ Her interactions with me as an outsider enabled her to see herself in a new light – as if for the first time. This idea of metaphorically (and sometimes literally) stepping back to notice what we had previously not noticed, to critique and reframe our insights and experiences, to open up new choices and actions, is at the heart of reflective practice. Yet someone challenged me strongly on the ethics of this last night: ‘Who are we to raise others’ awareness like this? What if it leads them to be less happy, more frustrated in life?’ If we enable people to reflect, critique and de/reconstruct their current realities, what if they and others experience the net impact as negative? Is it always true that it is better to be aware than to be unaware? Who makes that decision? If you work with people, I’d love to hear your thoughts and ideas on this! ‘We need to talk.’ 4 short words that can send a chill running down the spine. Perhaps it taps into being caught out as a child. That look from a parent or teacher when we know we’re in trouble. My wife called me into a room. ‘I want a divorce.’ 4 short, sharp words that created that same cold shiver. The room starts to spin, pulse races, breathing feels difficult. Fight, flight, freeze. Shock.
I want to run but my feet feel glued to the ground. It’s like I can’t move. Words clutter my brain and I speak but it all comes out clumsily, awkwardly, wrong. I feel angry and sad and understanding and confused. My wife’s face is telling its own story but I can’t read it. She looks absolutely the same and yet completely different. This is the woman I’ve known for 25 years. Scared – intimate strangers. Life change really can feel like this, especially unexpected, out-of-the-blue change. It can send us reeling, a psychological, emotional and physical jolt. Debilitating and disorientating, dizzying in its effects. It draws deep spiritual and existential questions into sharp focus. ‘Why is this happening to me?’, ‘How could we have got here?’ It feels like grasping at mist, straining to take hold of God. Perhaps you’re a leader, leading people through organisational change. Perhaps you’re a coach, therapist or trainer, working with people through transition. Here are 4 words of advice in such situations: Empathy: give people cathartic space to feel; Listen: create opportunities for people to talk; Patience: allow time for people to process what they're going through; Speak: 4 words – ‘I am with you.’ Jackie LeFevre of Magma Effect is an inspiring and thoughtful guru in the values-related field. One of the things Jackie talks about is the importance of exploring the values and beliefs that lay behind people’s actions and behaviours. Two people could behave the same way but with very different reasons for doing it. Dave believes that people should arrive at meetings on time. For him, it’s about ensuring that time spent at meetings is efficient and effective. Sandra also believes it’s important to arrive on time. For her, it is about showing personal respect for colleagues in the room.
Why is this important? Covey in The Speed of Trust observed that, ‘We judge ourselves by our intentions and others by their actions.’ The risk here is that I assume your intention from your behaviour then respond and relate to you as if my assumption (that is, my own belief about you in that situation) is true. What is more, we tend to notice things that confirm and reinforce the belief we already hold and don’t notice things that would challenge or contradict it. All kinds of misunderstandings can occur and these can prove limiting or damaging to relationships. This tendency is exacerbated if we are feeling tired, pressured or stressed. Somebody walks past my desk who normally stops and speaks to me. This time, they don’t speak. In fact, they don’t even look at me. I begin to hypothesise. If I’m already feeling anxious about the relationship, I may start to dream up an elaborate fantasy: ‘I’m sure they’re angry with me.’ ‘It’s because they didn’t like that email I sent.’ It’s a classic example of cognitive distortion. If we notice we are doing it, e.g. if we think we are reading the other person’s mind, it can really help if we simply stop and…breathe. I discovered a useful ‘3 Hypotheses Technique’ in Latting & Ramsey’s Reframing Change that can be used to surface such assumptions and open up alternatives. The first step is to take note of what we assume the person’s action or behaviour means. The second is to assume the person has a positive intention. The third is to assume the person is being driven by external circumstances. If we are able to entertain the possibility that more than one of these could be true, it can create sufficient psychological and emotional shift to enable us to respond with far greater reality and freedom. |
Nick WrightI'm a psychological coach, trainer and OD consultant. Curious to discover how can I help you? Get in touch! 
Like what you read? Simply enter your email address below to receive regular blog updates!
|
RSS Feed