Sunday, March 20, 2011

38. Coda to the coda.


So, I have recently been watching a couple of episodes a day of The Sopranos. It is a particularly fascinating show from the point of view of psychology and psychotherapy. Before I went to study in San Francisco, I remember finding it psychologically unconvincing. I didn't believe that people who could be so loving in some areas of their lives, could also be so brutally violent in others. I have since reformed that view; I no longer find it psychologically unconvincing. That is something I learned through one of my patients last year.

I was working at a rehabilitation facility exclusively for ex convicts and parolees. In order to qualify for therapy, they had to be 'dually diagnosed' - ie have a mental health disorder as well as an addiction disorder. One of my patients was a South Sea Islander whom I shall call V.

V was born on an island with a proud heritage of producing excellent rugby players. He certainly looked the part: almost as wide as he was tall, enormous shoulders and a bull neck, only one tooth remaining, hands that could crush skulls, and a thick head of shorn hair for his 55 years. He had come to America in his late teens and had been an alcoholic for the last thirty years, of which twenty had been spent in and out of prison.

I was V's first ever therapist, and he was probably my tenth ever patient. When I was first introduced to him in the dank corridor of the facility where he was an inpatient, he looked rather frightened. We shook hands - he nearly crushed mine - and I asked him whether he had any interest in rugby. His face immediately lit up. Not many people in California are interested in rugby, least of all in the female-dominated, touchy-feely (not literally - the Ethics Code would frown...) mental health profession.

V smiled broadly, his single tooth glinting like the Matterhorn on a bright morning.

'Rugby's my game, man,' he stated proudly.

We spent the whole first session talking about rugby, something he hadn't been able to do for many years. I was able to reel out the names of his national heroes - Tana Umaga, Frank Bunce, Tuigamala - who were also the heroes of my childhood and adolescence. And thus, somewhat unconventionally, a solid therapeutic alliance was established.

Over the next few months, V told me about his drinking problems, his marital problems, and his sense of shame about having wasted his life. From the very beginning, I liked him enormously. He struck me as very gentle, conscientious, extremely honest, and clearly wracked by guilt on a deep level.

But the things he told me!

He had been arrested on numerous occasions for violence against every one of his three wives. He could never tell me very much about it since their arguments always happened when he was drunk.

He first went to prison following an altercation with a friend of his. V had joined the merchant marine in his early twenties. As a result, he was often away from his wife for months at a time. After one such absence, his wife informed him that while he had been away she had received anonymous phone calls from a stalker suggesting a sexual rendezvous. To celebrate his return, V hosted a bbq at his house and invited his best friends, many of whom his wife barely knew. However, in the kitchen she told him that she clearly recognized the voice of one of his friends, and that he was the anonymous stalker who kept propositioning her over the phone.

V drunk heavily at the bbq. He made sure that his friend stayed until the end, then he suggested going to a local bar. When V's friend went to the bathroom, V took the autographed baseball bat which was displayed on the wall, followed his friend, and proceeded to beat him to a pulp in the toilet. His friend died in hospital of his head injuries.

V was given a reduced sentence of 6 years, I think. However, this kept being extended since V frequently ended up in fights. He was in a high security, level-4 prison where gang culture dictates the norms. V was told that certain areas of the yard were for blacks, other areas of the yard were for Mexicans. 'That's bullshit,' thought V, 'I'm a South Sea Islander, so I'll go wherever I please.' Beef with the Mexicans soon followed.

It was arranged that V would fight the Mexican champ. The following day, V and the Mexican both went through the security gate into the yard with butterfly knives hidden up their rectums. The butterfly knife was attached to a piece of string for 'ease' of retrieval. While the other Mexicans created a diversion, V and the champ went at it. 'He shanked me in the ribs,' said V, 'but I got him in the neck.' Another 6 years.

Interestingly, when V told me the stories of the fights he'd had, there was no showing off, no pride. There were other patients at the facility who walked with a cocky swagger, pumped iron, liked to brag about how tough they were, and whose ostentatious displays of jewelry and gold chains were intended to attest to that fact. V kept himself to himself and consistently sought to avoid trouble of any sort. And yet, even at 55 years of age, and with a pronounced limp, V could have torn the throat out of any one of them using just his single tooth.

However, what V was proud of was his garden. He had managed to requisition an overgrown corner of the parking area to turn into a small vegetable patch. By clearing away all the detritus and digging up the area, he had managed to win a little more ground. At the end of every weekly session, I would accompany him outside to see how his plants were coming along. He had sown tomatoes, carrots, herbs of all kinds, strawberries and sunflowers. He tended them everyday and the speed with which they grew bore testament to the care he lavished upon them.

On one of the first shy days of spring, while we were standing in the sunshine admiring the garden, V said: 'The tomatoes are struggling a bit. The birds keep eating them.'

I replied with a therapist's knee-jerk response, reflecting the emotion, or reflecting what I assumed to be the emotion: 'That must be very annoying,' I said.

V thought for a moment, then he said: 'Well, it is a little annoying, but I don't mind so long as they're not greedy. The birds have to eat too.'

Wow, I thought to myself. Who would have thought that a violent murderer could be capable of such moments of transcendent generosity of spirit, far beyond most enlightened souls, let alone most normal people.

What have I learnt from this? Well, firstly that I shouldn't be so quick to make assumptions. And secondly, that there is much less consistency in the world than I used to believe. Now I see that everywhere. America is the country of freedom, of liberal gun laws, of unrestricted commercialism. And yet it is illegal to sit on a beach after dark, or to sip a glass of wine in an empty park. Switzerland is a country of precision timekeeping, punitive speeding fines and women's suffrage only since 1971. And yet I remember a shop in Zurich where it was possible to buy most recreational drugs over the counter.

Consistency is something that humans endlessly expect. But in fact there is no reason why things should be consistent. We create ourselves and the world anew every moment. That, I think, is an existential perspective.

37. Coda

When I told Alliant that I planned to leave the program, they informed me that I would only have 10 days to move out of my apartment and leave the country before my visa was revoked and I became an illegal immigrant. Since Saybrook is primarily a distance learning university, it does not offer student visas to foreigners. However, I didn't think this would be a problem since I knew I could re-enter the country on a tourist visa, so long as I left at least once ever three months.

I don't want to go into the details since they are very boring, but despite doing everything by the book, it became increasingly difficult for me to stay in the US. Entering the country was becoming more of a hassle each time. In fact, the first time I tried to enter on a tourist visa, I was held in the immigration centre in Vancouver airport for four hours and forced to buy a $1000 one way ticket back to the UK, although I already had one (but hadn't brought it with me). Anyway, I could probably have stretched out my time in the US for longer had I really wanted to, but I actually started to get fed up of living (and spending money and - formerly - working for free) in a country where I felt that I wasn't welcome, at least not in the eyes of the state.

And, of course, the great benefit of distance learning is that you can do it from anywhere.

So, back in October last year, I applied to work for the Gaza Community Mental Health Project (GCMHP - a Palestinian NGO) based in Gaza City. The situation in Gaza is something I have felt strongly about for a long time. As far as I can tell, it demonstrates the humiliating, frequently brutal, and wholly illegal subjugation of one nation by another. I don't think I see Hamas through rose-tinted spectacles either - I don't condone any form of violence - but I do see them as responding to a historic injustice, rather than perpetrating it. For anyone who is confused about the beef between Palestinians and Israelis, I think that the following website offers a clear and concise summary of the history of the conflict:

http://www.ifamericansknew.org/history/

I applied to GCMHP to work in a therapeutic capacity since that is now something of which I have a little experience. GCMHP wrote back to say that they thought therapy would be difficult given that I don't speak Arabic but, having looked at my CV, would I be interested in working for their Public Relations department? They are looking for someone with language and writing skills who could raise the profile of their organisation in the West. I have never considered myself a PR person, chiefly because most PR people I have met have been vapid posh girls in fashion PR. However, given that the cause is one I believe in (ie the amelioration of mental health in Gaza), I thought to myself, why not? At the very least it could be a stepping stone to other roles in the area.

Armed with a letter of invitation from GCMHP, I applied to the crossing between Israeli and Gaza (called Erez) for security clearance to permit me to cross into Gaza on March 1st. I was advised that the process usually takes 10 days. However, I thought it best to apply ahead of time, so I emailed all the relevant material to the Erez officials on December 14th last year. After a bit of to-ing and fro-ing, and tweaking of my application, they told me that everything was in order and that I should call them a day or two before I intended to travel. I called them at the end of February, as instructed. They informed me that they had still not received my security clearance. For the last three weeks, I have been phoning Erez every couple of days. They have now had over three months to give me clearance, and still no joy.

Fortunately, I don't think this is personal. I have a friend who works for the UN in Gaza. He tells me that a lot of the foreigners who work in Gaza have experienced long delays recently. What right do the Israelis have to deny me entry to territory which doesn't belong to them? I suspect this is just the first of many frustrations.

I recently spoke to the Egyptian embassy in London who were extremely friendly. I asked whether I would be able to cross into Gaza from Egypt at the Rafah crossing. They have forwarded my request to Cairo. I am hopeful that something will give before the end of the month.

In the meantime, I have been biding my time in the English countryside. I have been working on a new painting, which is a pleasant way to relax. I have been studying and have come to the conclusion that pretty much everything I believe about therapy can be found somewhere in Irvin Yalom's magnificent tome, Existential Psychotherapy. And I have been proofreading my new novel - To Greet the Sun - which finally comes out in June this year.

I have also been watching a couple of episodes per day of the last few series of The Sopranos . That is actually what I wanted to write this post about, but I got carried away. I will save it for my next post.

Saturday, March 19, 2011

36. May your journey be long.

I know I have not posted on this blog for quite a while, and in fact I think I will be laying it to rest quite shortly. There is a new one in the offing.

I quit my PsyD in Clinical Psychology last summer. I transferred to an MA in Humanistic and Transpersonal Psychology at Saybrook University. From the outside, and from a careerist perspective, that might seem like a knight's step sideways and backwards. However, from my point of view, it has turned out to be a great move.

Saybrook University used to be called The Humanistic Psychology Institute. The administrative offices are in San Francisco, although the university itself operates primarily by distance learning. That suits me very well. In fact, it reminds me of my undergraduate degree - I download a reading list, do the readings, then write a few essays which I email to my professors all round the country. If you are interested in a subject, and sufficiently disciplined to do the work, then it's great. I don't need to waste any more time sitting in tedious classrooms with second rate professors droning on, as at Alliant. I really think that distance learning is ideal for postgraduate degrees. The undergraduate/campus experience is great to have, and an interesting learning process in itself, but you only need to do it once.

Furthermore, Humanistic and Transpersonal Psychology is a fascinating area. I have completed papers in the Psychology of Shamanism, Eastern Psychology, the Psychology of Conflict Resolution (actually that was not so illuminating), and Existential Psychotherapies. What I particularly appreciate about the Humanistic/Transpersonal perspective is:

1. The interest in human potential. Clinical Psychology only concentrates on the negative - on mental illness and on what happens when things go wrong. I concede that is part of the definition of 'clinical', but I don't think you can have a robust concept of mental illness without also investigating mental health. For my money, mental health is not just the absence of mental illness; that is a depressingly negative way of looking at it. Rather, mental health is something to be achieved, something that can constantly be improved. To me, it signifies the realization of an individual's potential, 'self-actualization', the capacity to find satisfaction in work, the ability to love, to find meaning in life, to 'flow', to transcend our 'skin-encapsulated egos', perhaps even to engage with a spiritual dimension (however you choose to define that).

In the West, I think we grow up with the belief that we reach our mental and cognitive peak in our late teens, and that the most we can hope for after that is to maintain a plateau until the inevitable decline into mindless senility. But I now believe that a healthy person should continue to learn and to develop and to grow in depth and understanding and wisdom throughout life. That view is much more prevalent in Eastern cultures/religions/psychologies/philosophies (the distinctions are often blurred), and it is a tragedy that many people in the west are still unaware of the concept of their own human potential.

I don't want to sound trite or predictable, but the developed, civilized world can seem a depressing place. Material and commercial values are inescapable. The fascination with celebrity is ubiquitous. Our dreams have become so tawdry - frequently they consist of no more than the furtive snatching of frotted pleasure between enseamed sheets, and even that leaves us cold. What passes for entertainment is, in most cases, an insult to the meanest intelligence. We drink and drug ourselves to anaesthetise ourselves to the groundlessness and the emptiness. I increasingly find myself in agreement with the prescient analyst R D Laing; he argued that psychopathology was a sane response to an insane world. Humanistic psychology may not have all the answers, but at least it addresses these questions.

2. I also like Humanistic Psychology because it doesn't endlessly try to keep up the tiresome pretense of being a strict science. In fact, it believes that any method of accessing human experience is worthy of serious investigation. Humanistic psychology is interested in literature, art, philosophy, biography, mythology, anthropology, meditation and altered states of consciousness, shamanism, parapsychology, phenomenology...anything that sheds some light on the experience of being human. It doesn't restrict itself to experimental data in the way that clinical psychology would like to (yawn).

Anyway, I think I needed to go through two years of Clinical Psychology at Alliant in order to come to these personal realisations. At times it was hard - it was not pleasant to feel myself in the role of the nay-sayer, the disbeliever, the doubting Thomas, especially when many of my peers seemed to be such zealous believers. I don't think that I even want to be a therapist anymore - at least not right now - despite the fact that in Existential Psychotherapy I have finally found the modality that truly resonates with my most fundamental convictions. But maybe it's about the journey rather than the destination.

In 1911, the Greek poet Constantine Cavafy wrote the poem Ithaca, about Odysseus' return home. But Cavafy does not urge haste. Quite the opposite, he tells Odysseus to take his time and hopes that his journey will be a long one:

Πάντα στον νου σου νάχεις την Ιθάκη.
Το φθάσιμον εκεί είν' ο προορισμός σου.
Αλλά μη βιάζεις το ταξίδι διόλου.
Καλλίτερα χρόνια πολλά να διαρκέσει·
και γέρος πια ν' αράξεις στο νησί,
πλούσιος με όσα κέρδισες στον δρόμο,
μη προσδοκώντας πλούτη να σε δώσει η Ιθάκη.


Always keep Ithaca in your mind.
To arrive there is your final destination.
But do not hurry the voyage at all.
It is better for it to last many years,
and when old to rest in the island,
rich with all you have gained on the way,
not expecting Ithaca to offer you wealth.