14 December 2006

Self-healing systems

[End of post edited 16/12]
When we think of cybernetics we usually think of bits of machines being incorporated into people, but this is an error caused by film and other media. It's actually a useful idea for patients in psychiatric hospitals and many other people too...

Cybernetics is really about self-managing systems. It comes from the Greek Κυβερνήτης (kubernites - meaning steersman, governor, pilot, or rudder; the same root as government).

A very simple example of a cybernetic system is a bathtub. You turn the taps on and go to make a cup of tea or iron some clothes. There's plenty of space to hold the water most of the time, but the space is limited. If you are distracted by whatever else you're doing, there is a safety mechanism: the overflow. When the water level gets too high, it starts to escape down the overflow. This is self-managing in a way - you don't need to intervene in order for the overflow to start to work - it works when a predefined critical point has been reached.

In a way this example is oversimple: it almost fails to be cybernetic because it is only a very primitive loop (and the taps fill the bath up quicker than the overflow can empty the excess water, so it does overflow eventually anyway. There are more impressive examples from many fields, but I think this one reflects nicely on the fragility of the cybernetic system that is the human body.

Which brings me to my experiences in psychiatric hospitals, and out in the community for that matter. Quite a few years ago now I read some of Carl Jung's writings. While I liked these quite a lot, I always felt that he was just missing some of the context of what he was thinking about and I never bothered remembering sources or doing anything too 'academic' with what I was reading.

Despite this I now find myself regularly recalling an idea I certainly read in Jung's work, though I can't find a direct source tonight. I talk about this to people and it seems to help (but I don't go into the detail I'm mentioning in this post).

What Jung said was that as we live our lives we develop 'habits' (this may be my term, but I know he was a fan of Bergson too) to deal with situations we come across regularly. So we go to work and we have quite a small range of different things we need to deal with, and at root there is only one thing we need to do - 'our job'. There is a similar situation at home and in the other places we go to regularly.

I don't have space to go into it in detail here if you haven't come across the idea before, but many people have observed and commented on the role of habit in our lives. In many ways we let the habits get on with themselves so we can concentrate on the more interesting things in our lives.

The problem comes because the world around us is constantly changing, and over time the habits we developed to be able to cope with the world usually begin to fall out of sync with the changes around us. The fact that we don't pay much attention to our habits makes this even more of a problem: we do things automatically because in the past they've helped us to live, but now as our automatic, habitual actions begin to cause us problems we remain blind to the cause as we're not paying attention to those parts of our life.

So we find ourselves increasingly having problems that are distressing because we can't understand them - they even seem irrational and unjust. The natural self-healing process that then comes into play often characterised as depression, although it can appear in slightly different ways or be given other labels. The point is that even if our conscious mind can't see what's happening to us, our subconscious can feel it and does react. The subconscious reaction is not particularly directed or understandable (my earlier post on the space not enclosed by words is relevant here in a way) but it takes the familiar form of a 'turning-in-on-oneself'.

The outward affects of this 'turning-in-on-oneself' are a tiredness, a difficulty in engaging with people or things, a slowing down. Eventually the conscious thought processes that define us as individuals can become so broken down that strange and unruly elements of our subconscious are regularly coming through into our consciousness. Sometimes these incursions of the unconscious are distressing and unpleasant, but some of them are much more positive. The key that Jung discovered is to engage with them. This is one element of his work that became a foundation for the various practices of psychotherapy that we find today. We can engage in them through journal-keeping (or other forms of writing), through drawing or painting, or through a range of other expressive practices.

Eventually, after the body has been shut down sufficiently to break the bad habits that have been constraining it, the idea is that we will be able to begin to go in new directions, begin to learn new approaches to dealing the world, techniques that will hopefully become habits that are more appropriate to today's world.

OK, so I said I don't go into that sort of detail. I suppose the main thing is the idea of habits, those habits getting out of sync, and then our bodies shutting down so that we can have a new start. This is a positive way of thinking about mental distress that seems to be sadly lacking in some institutions (as far as I can tell from what the patients say to me).

[added bit:] The question is, how can this be used, especially from the more non-interventionist stance of an advocate. Clearly it would be wrong to go and start talking to all our new clients about this idea: the main thing is to get people to speak out, and it's important that we concentrate on listening at first. I think it's more about putting things into context, especially after we've known people for a while. Advocacy isn't all about listening, it's more proactive than that, we set goals and develop action plans, and in between we need to care about the relationship we have with our partners. This relationship needs to be empowering, and it seems to me that helping people to find a context where their 'illness' can become more of a 'healing process' can help to give a little more hope to their situations. [end edit]

A more extreme example: when a very ill patient talked about his medication killing him, and wanting to die anyway but not by being poisoned by doctors, I talked about these ideas very productively with him. I explained the idea that mental illness was a self-healing process, that it could be seen as a 'little death' - a death of the old to make way for a renewal, and that these feelings of dying were a natural part of the process. I even went so far as to suggest that in a way the meds needed to make him feel like they were making him die, as they were trying to help him along and speed up this process of (partial) death and rebirth (though I think this is probably taking the analogy a bit far). N.B. Please see the distressed comment and my reply below.

I hope that some people who read this may get some insight, that this may ring a bell or touch a cord of recognition inside you. If that does happen then you'll find your own way of using the idea in your practice.

This is not advocacy in its pure form. I struggled with doing this sort of thing at times, and I do it sparingly. I do think it's relevant to engage with people in a wider and deeper context as an advocate than would happen if we simply did our jobs. Of course citizen advocates and others have known and practiced this for ages, and perhaps it's because my recent role has been as a professional/case work advocate in a very formal setting. I did also touch on these issues in my earlier post about advocacy and therapy.

I'm going to publish this without even proofreading as it's getting late. I hope it's come out ok.


Anonymous said...

A very distressing post this. I have only stumbled across it by accident whilst looking for something else. Re: the patient talking about medication - this is not only not advocacy in its purest form it is, in my view not advocacy in any form. I find it utterly irresponsible that you could suggest such a notion to such a clearly vulnerable person. As advocates we are not there to offer our own world view but to respect the world views of others. Who are you to tell this person this? I appreciate you may have been well meaning, but it is precisely these appraoches that seriously damages adovcacy and advocates. This appraoch of yours seems to be verging on counselling/advice which is certainly advocacy is not. I hope that you will refelct on this.

Henry said...

Several replies:

1. I'm sorry you were caused distress.

2. I didn't use very good language in that part of the post: if I could edit it I wouldn't say 'I explained@ or 'I suggested' - this isn't how it happened. I talked about these ideas in general terms, I reflected back things he had been saying to me, I offered him an option of a way of thinking, I didn't impose anything on him.

3. These ideas about medication are certainly not my world view. My world view is that anti-psychotic medication is generally a bad thing, although I accept that some people find it helpful (in the absence of alternatives).

4. I said earlier in the post that I don't go into this level of detail when I'm working with people as it wouldn't be appropriate. I also said that I was mentioning an extreme example here.

5. This blog is not supposed to give people answers. It's not about good practice. It's about opening up areas that challenge me and could challenge others. It's also written in a sometimes complex philosophical style and the posts are often long to accommodate some of those ideas and relate them to practical work.

6. My professional practice is different from the things I talk about on the blog, although there is obviously some overlap. Generally the advocates I work with find my approach very measured and professional and I keep my world view quite separate (although in some ways it helps keep me going in what I do).

7. I worked with this particular man almost every week for 9 months. In fact he spoke to me more than anyone else apart from the other patients. I also always team worked his ward and always discussed my work with him and others with my partner who is a very experienced, professional and well respected advocate.

8. Everyone I respect in the world is hated by some people, and maybe if my anonymous commenter ever comes back to see if I've refelcted (sic) on their comment they'll hate me even more, but that's life, and I'm not sorry for that.

Bipolar girl said...

The last thing the mentally ill need is some well intentioned, but ill informed amateur spouting nonsense about death and rebirth!