Enjoy your suffering?

A man will renounce any pleasures you like but he will not give up his suffering

George Gurdjieff

Enjoyment of pain is still taboo. Rarely do we hear about what is satisfying about depression, eating disorders, anxiety, etc. Conversations about mental health have only recently become an acceptable topic, we can’t start talking about how we sometimes enjoy our symptoms can we. Yet at times there is a perverse enjoyment in suffering, an enjoyment that if recognised can be used to transform the suffering itself. What is this satisfaction in dissatisfaction?

Symptoms which are nevertheless so little satisfying in themselves”  (Seminar VI, 1959.)

Note “little”, there is not an argument to be made that people love being mentally ill and feeling anxiety is great, etc.

Symptoms serve a function and this function will be unique to the individual. Identifying as “depressed” or “mentally ill” can be a good way of creating meaning in life, not only in finding a place in the world, but also to join a community of others and be able to be involved in something bigger than ourselves. When work and hobbies and home life are all severely impacted by mental distress it can become all-consuming, there can be a sense of “what would be left of me without my illness?”

Worry/obsessions and compulsions are known ways for people to cope with the impact of trauma. OCD takes up a lot of time, effort and thinking space, it’s an excellent way to avoid the more distressing memories of traumatic events. Avoidance strategies, while distressing in themselves are often preferable to experiencing what is being covered up. If I’m terrified of going outside then the impact on my life of staying indoors may not be enough to force me out of the door to face my fears.

Eating disorders can create a sense of control, they can also be used as a way to appear fragile and in need of care. If a child doesn’t experience care and comfort then as an adult they may go about finding this care in a round-a-bout way. In our individualistic culture where self-sufficiency and independence are praised, asking to be looked after is often a shameful thing to want, let alone ask for. Whereas if you’re painfully thin you are showing your pain to the world in quite a socially acceptable way.

Some feel that they deserve to suffer, they have done, said or thought something terrible, even if they do not know what it is and they deserve to be punished:

The satisfaction of this unconscious sense of guilt is perhaps the most powerful bastion in the subject’s (usually composite) gain from illness–in the sum of forces which struggle against his recovery and refuse to surrender his state of illness. The suffering entailed by neuroses is precisely the factor that makes them valuable to the masochistic trend. It is instructive, too, to find, contrary to all theory and expectation, that a neurosis which has defied every therapeutic effort may vanish if the subject becomes involved in the misery of an unhappy marriage, or loses all his money, or develops a dangerous organic disease. In such instances one form of suffering has been replaced by another; and we see that all that mattered was that it should be possible to maintain a certain amount of suffering“. Freud, (1924)

So what happens when therapy attempts to take away these symptoms, often from someone who is vehemently declaring they want to get rid of them? Clinicians often talk about being people not being ready to change, or not being motivated to engage in therapy. Why would you want to work hard to let go of something that is working for you on some level?

If we want to transform the way we suffer asking ‘what is this doing for me?’ is a good start. The more time we spend complaining about how terrible everything is without recognising our investment in our symptoms the less chance we have of breaking free of them.


Normality from psychology to Lacan

The human sciences have provided a discourse of normal vs abnormal to discuss our inner worlds.

This discourse has created a pathological approach to subjectivity by influencing us towards a medicalised view of the human condition. It proclaims that at the root of human suffering are psychological problems that are treatable, either by therapy, medication or self-help techniques. The belief that there is an objective measure of “normal” that we should all be achieving fundamentally encapsulates what it means to be a human in the 21st century. There is very little space outside of this normal/abnormal dichotomy for a human trait or behaviour that isn’t ubiquitous.

We are able to discuss emotions and thoughts with an ease not afforded to older generations. Campaigns to reduce mental health stigma have had a significant impact on how we discuss subjectivity. Our new-found ability to talk about suffering is a positive change, unfortunately this change coincides with pathologising language. The influence of this medicalised discourse can be seen in our use of words like ‘crazy’,’unhinged’ and ‘mental health’, it seems to suppress the subtle nuances of trying to put into words what it is to be human and replaces it with the term “it’s a severe mental illness”.

We can talk about personal growth and empowerment, about being inspired and fulfilled. There is a belief that we could all undertake some sort of journey to achieve the ultimate goal of normality. A normality where worry and anxiety don’t really exist, a normality where we are able to work and enjoy, within a vacuum, fitting in and being self-reliant. We seek masters to tell us what to do and how to do it. Treatments and techniques to rid us of our problems.

What about an alternative?

One of the things that appeals about Lacanian diagnostics is the complete absence of a ‘normal’ clinical structure, there is no position of ‘mental health’. With Lacan you are either psychotic, neurotic or perverse. Any ideas of cohesive, sane, rational people are phantasms, as all subjects are split subjects. We lack. Contrary to most ego-centric ideas there is no solid self to be found underlying everything and ‘running the show’, if we just keep looking, we won’t find it. We are alienated by language, within inter-subjectivity we can have beliefs about ourselves, a conscious ego, but that is not a cohesive subject, it is not a Cartesian subject.

“When we choose thought we lose being” Tony Myers

Therapy culture can attempt to try to strengthen the ego, as if an ego free of lack is a normal and healthy one. We can seek masters that can empower us towards completeness and the ‘rational standard’. We can judge ourselves for our ‘psychological problems’ and weirdness. Or we can accept that we lack and that normality does not exist. There are very few places that can allow us to explore this and act as a vehicle towards that acceptance, but paradoxically certain types of therapy can be one of those places. Just don’t expect to find a master that does not lack



Is mental illness glamorous?

Apparently there is nothing romantic about mental illness. Which is odd because the internet is awash with dark pictures depicting distress and impassioned quotes. Tumblr especially has a large collection of pro-self harm and thinspiration imagery. Does finding beauty in pain make it more acceptable? What is the function of strongly identifying with being depressed, mad or terrified?

A culture that admires and reveres mental illness has developed over the last decade on social media and like most sub-cultures it exists on a spectrum. On the severe end self harm is encouraged and eating disorders are idolised within a culture of competition. To take your own life is a way of becoming forever recognised as a suffering being.

What does denying the romanticism that some people see in suffering do to the debate around ‘glamorising mental illness’?

The backlash against this glamorisation appears to involve stating firmly that it is neither attractive or trendy and that it needs to stop. These articles inevitably go on to talk about what mental illness ‘actually is’:

“It is not cool or romantic. It is waking up crying because you are alive another day. It is feeling as if you have no purpose on Earth. It is the blanket of pain at 3 a.m. and the thoughts of suicide that are screaming in your mind.”

This feels rather simplistic and patronising and appears to be missing the crucial point; that some people find meaning and validation in suffering. As a society we are often told to ‘man up’ or’get on with it’. Not functioning well enough in a career or in a relationship is often judged as weak. From a young age children can be told ‘don’t cry, you don’t need to be upset’. Does this lack of validation about the suffering we experience, both from within the family and within wider culture encourage some to create emotionally-charged material that is popular with others?  Perhaps if someone is feeling stigmatised then romanticising what they are experiencing makes it more bearable.

Glamorising pain obviously has a downside, it can encourage vulnerable people to sink into further troubles and take up coping mechanisms like self harm that are often not advantageous. But to intervene and have a conversation about this we need to recognise the reasons behind the allure and fascination of suffering.


Against the 1 in 4 statistic

In my last post I touched on the 1 in 4 statistic, so often used when discussing mental health. Like most mickey-mouse statistics it is catchy and easily understood, it’s been used globally by the NHS, mental health charities, anti-stigma campaigns and the WHO to name but a few. This widespread use has entered the phase into mainstream discourse. What are the implications of this?

Its worth stating that there is no solid data behind the one in four statistic. I wont go into criticising the study the statistic is based on, for more details see here. The reality is there has never been a longitudinal study into any rates of mental illness or subjective states of suffering. The WHO attempted it, but the results came out as nearly 1 in 2. Regardless of the validity of any statistic we should not need to rely on catchy phrases to reduce stigma about mental illness.

1 in 4 attempts to “normalise” and reduce stigma by putting forward the idea that a quarter of us will suffer from a mental health problem, therefore as it is such a large proportion of the population it must be half-way acceptable mustn’t it? and actually 25% of us are not shouting at trees with tin foil hats on are we? Unfortunately this partitioning off of a quarter of the population just  continues to generate and advance the very stigma that the statistic is trying to diminish.

1 in 4 puts forward that if a quarter of us suffer from mental illness, then mental illness is common and if mental illness is common then it is nothing to be ashamed of, but this just reinforces the view that if something is “abnormal” then it is shameful. If it was 1 in 40,000 it would still be unfair and immoral to discriminate.

We can see this discrimination occurring in response to rarer and less understood diagnoses. Most people will have experienced some sort of anxiety or felt down at points, talking about depression and anxiety is much more acceptable than disclosing schizophrenia or a personality disorder. I wonder whether shame is more apparent in people who have been diagnosed with more “severe and enduring” disorders.

1 in 4 also serves to downplay the terrible suffering that some people experience. 1 in 4 implies that it isn’t such a major deal, lots of people encounter it and get by just fine. This undermines the seriousness of the distress and pain people endure on a daily basis and the consequences of this. 800,000 to 1 million people die as a result of suicide every year. Lets have compassion for everyone that suffers and not just because it is “normal” or common.

On common unhappiness

In Studies on Hysteria (1895) co-wrote with Breuer, Freud wrote about “transforming your hysterical misery into common unhappiness”. What is common unhappiness and what can we take from it that can help us to better understand the way we suffer?

Freud appears to suggest that a state of unhappiness is an unavoidable norm:

“No doubt your fate would find it easier than I do to relieve you of your illness. But you will be able to convince yourself that much will be gained if we succeed in transforming your hysterical misery into common unhappiness. With a mental life that has been restored to health you will be better armed against the unhappiness.”

Is he being a fatalist or a realist here?

The well-known statistic 1 in 4 seems to suggest he was being fatalistic:


This statistic is often banded about on social media. It is catchy and easily understood. However, it came from studies carried out in the 80’s and 90’s using structured interviews. More recently the WHO assessed rates of depression in the population, the results far exceeded 1 in 4 and ended up being reported as a crisis.

There is another explanation for these results however and it resides in the flaws in the measures used to assess the symptoms of subjective experiences of things like depression and anxiety. The reality is that no one really knows how many people suffer from “mental health problems”.

There have been efforts made to diagnose mental illness only when it starts to impair abilities in functioning. In the DSM-V the language has shifted from:

“clear evidence of clinically significant impairment in social, academic, or occupational functioning.”


“clear evidence that the symptoms interfere with, or reduce the quality of, social, academic, or occupational functioning.”

Perhaps this is where we can make the differentiation between mental health problems and ordinary unhappiness? If the symptoms we experience are getting in the way of us doing things like having relationships or going to work, does that tip the balance into having a clinically significant medical illness? What if I’ve just been diagnosed with cancer and how I feel about this is making me not want to go to work or see my friends?

There does not appear to be an accurate and precise definition that will define in absolutes whether the subjective  pain and objective symptoms experienced by someone is an illness or not. This is not to say in any way that mental illness does not exist, it is more to highlight the difficulty in recognising subjective states of distress that would benefit from some sort of supportive approach (mindfulness, therapy, medication), while at the same time not medicalising ‘normal’ reactions to life events.

What sort of paradigm or approach does a good-enough job of recognising this dichotomy?

For the majority of people in the UK going to a Dr with a complaint about mental health will involve being diagnosed with an illness, such as Generalised Anxiety Disorder, being prescribed medication and a referral for CBT to learn skills to cope. For some this will be the best approach and have the best outcome for the individual. For others short term therapy is not wanted or is not helpful. If someone is willing and able they could choose to access a different type of therapy.

Psychoanalysis first put forward the idea that the inner world of humans can be understood. Not by carrying out large statistical studies (that seem to tell us a lot, but actually tell us very little about someones unique experience) but within the inter-subjective analytical relationship. Psychoanalysis has an important part to play in giving unhappiness a space to be explored without making judgements about whether it is “ordinary” or not.

Perhaps there is an argument for offering longer term therapy on the NHS.


What does a hole in your chest have to do with attachment?

Psychoanalysis has attempted to put forward answers to this particular question for decades. The contemporary psychoanalytic attachment theories of  Paul Verhaeghe and Peter Fonagy throw up interesting perspectives, but to discuss this one has to touch on the pioneering literature on attachment.

Take Balint’s ‘basic fault’, this describes an experience felt by some that something universal and essential is missing inside. He theorises that it stems from a ‘failure of fit’ between a babies needs and the primary caregivers responsivity to these cues (crying, smiling, yawning, etc). Winnicott and Balint both stress the importance of a holding environment (a secure, safe and loving environment where emotions can be safely expressed in a reliable and trustworthy relationship) without which there may be an experience of an internal/external black hole.

If there is a ‘failure of fit’ and the child is unable to form a secure attachment it sets the child up for a higher risk of suffering in later life, as Winnicott states in one of his earliest works:

‘I find it useful to divide the world of people into two classes. There are those who were never ‘let down’ as babies and who are to that extent candidates for the enjoyment of life and of living. There are also those who did suffer traumatic experiences of the kind that result from environmental letdown, and who must carry with them all their lives the memories of the state they were in at moments of disaster. These are candidates for lives of storm and stress and perhaps illness.’

We know that around 60% of people have a secure attachment style. Does that mean 40% of us are walking around with a painfully empty chasm in our chest, feeling not quite ‘real’ inside and desperately trying to fill our lack?  Or is this phenomena to a lesser extent an intrinsic part of being a human subject?


What does CBT have to say about emotions?

I’ve spent the day at Christine Padesky’s conference in London. An expert in her field, Aaron Becks Californian-based prodigy pretty much wrote the book on CBT.


Listening to her today reminded me of what always fails to surprise me about CBT; the almost complete denial of past events and how they may be contributing to someone’s symptoms. CBT will work with what it calls core beliefs in longer term therapy, however as CBT is generally offered short term (especially in the NHS) the majority of the work is based on intervening at the level of the presenting symptoms, such as lack of activity, negative thoughts, etc.

I have written about the efficacy of CBT elsewhere. It is sufficient to say that there is no one size fits all approach to distress and a lot of people have greatly benefited from a practical skills based approach to therapy.

Attempting to answer the question posed by this post is a difficult one, the answer appears to be “not much”. Today we were given examples of current stressful events in a case study, these were cited as “environmental” causes or triggers for the emotion that was being experienced. The focus was primarily on what changes needed to be made by either changing negative thoughts or targeting behaviour that may be maintaining the particular emotion that the person has come into therapy for.

I wonder if CBT is doing itself (and the people who have no choice other than to accept it) a disservice by substantially ignoring the individual and collective causes that lead people to suffer in the first place.


Why Ordinary Madness?

Is suffering our natural state as subjects? Or has the cultural influences of psychiatry given a lot of us identities as disordered?

Cultural attitudes are shifting, it is much more acceptable now  to discuss the fact that we suffer. But what has stigma and repression since time immemorial done to the mainstream discourse and thought about our internal worlds?

Freud spoke about transforming neurotic misery into common unhappiness. His language is obviously of its time, but are we as a society disavowing this and taking ourselves on a fool’s errand to look for a cure-all to the “Global crisis of depression?” (WHO).