Dorothy Rowe

OpenMind - Journal of the mental health association MIND

Nov/Dec 2004

My Friend Sundance and Me

Dorothy Rowe

From infancy I've had a chronic disease, bronchiectasis, where the lungs produce a sticky mucus which, if not coughed up, accumulates and so destroys the tissues of the lungs. With a daily routine of antibiotics, inhaled steroids and postural drainage, and outpatient care from the Royal Brompton Hospital for Respiratory Disorders and my wonderful GP I'm able to lead a very busy life, but every two or three months the bacteria in my lungs go on a wild rampage and produce a number of symptoms which are hard to deal with. Because the oxygen is not getting easily from my lungs to my blood stream my body becomes suffused with a tiredness which no amount of sleep or rest can assuage.

This tiredness doesn't affect my mind. I can think, read demanding books, and get on with my writing. Staying in bed would be fine, but I live alone and need to work, so I have to drag my leaden body out of bed to shower, dress, shop, and keep my appointments. It's not a happy time.

I was in the midst of one of these bacterial rampages and starting to feel very sorry for myself when I got a phone call from Sundance. I've known Sundance for some 13 years. When I first met her at a conference she was slim, beautiful and vibrant. She was a university graduate but she'd had a period of psychosis and had been in hospital. She told me she'd found my books helpful. We kept in touch by letter and phone, and met occasionally when I was visiting the city where she lived. Over these years her life deteriorated as she found it harder and harder to keep a firm and constant grip on herself and on reality. She went in and out of a typical psychiatric hospital while the psychiatrists prescribed bigger and bigger doses of more and more drugs.

In our letters and conversations Sundance and I always talked about her plans to paint, to write poetry, to study music, and further her passion for mathematics. In the first years of our friendship she would start to put these plans into practice and then there would be some unfortunate event in her life, she would become shaky, and the mechanisms of the psychiatric system would roll over her and put paid to all her plans. Nowadays her attempts to paint, write poetry and play her guitar are brief, and when she learns of courses that she would love to do she knows she can't. In her phone call to me when I was ill she spoke about madness and creativity and said, 'How can you be creative when the drugs you're given stop you from thinking?'

Sundance and I have chronic problems that affect us in opposite ways. My body becomes tired and wracked by coughing but my mind is clear. Sundance's body has thickened and she moves slowly, the result of the drugs she's been forced to take. Had she not taken these drugs she'd be physically fit. In her mind there are terrors and confusions and the awful numbing mindlessness of her drugs. I would not exchange my problem for hers.

We do have one thing in common. If we'd been given the appropriate treatment when we each became ill we wouldn't be in the state we're in today. My parents didn't seek any treatment for me because, as they would say, they 'didn't believe in doctors'. There were no antibiotics when I was a child but bronchiectasis is one of those diseases which, if diagnosed early, can be kept in check by a regular programme of some very simple measures. I received no treatment at all until I was thirty and no adequate treatment until seven years ago.

If, when she first got into difficulties, Sundance had met a psychiatrist who knew how to listen to a person's life story and understand what the events in that life meant to that person she would never have been given a diagnosis which set her on such a terrible path. If, from the beginning of psychiatry, psychiatrists had known how to listen like this to a person's story they would never have invented the mental illnesses, their biochemistry and their genes. The lives of all those people deemed to be mentally ill are such that no one could have lived any of these lives and interpreted the life's events in the way that the owner of the life had done and not become emotionally disturbed. We're free to change our interpretations, but to do that we have to be able to think. Sundance told me about how happy she feels when, through the drug-induced mental fog, comes some painting or poem that she can see clearly. She said, 'If you've got mental stimulation you can change.'

OpenMind - Journal of the mental health association MIND

Sept/Oct 2004

Cartoons That Belittle

Dorothy Rowe

While travelling on a train I was forced to listen to a man who was using his mobile phone to instruct a member of his staff. I gathered that his firm was a printers and that he was giving instructions about the preparation of a flyer for a book published by a publisher who I knew specialized in self-help books. As he described how the flyer should be set out I expected him to say, 'It needs an illustration. Do a droopy guy looking miserable.'

Such cartoons often appear on pamphlets advertising training courses for mental health professionals. Open a new copy of Openmind and out falls one or two. This kind of cartoon is supposed to help the mental health workers see the humorous side of mental disorders and their miserable sufferers. Many self-help books are illustrated with cartoon characters looking miserable and, once they have absorbed some cognitive therapy of the simple-minded kind, turning into smilies. These cartoons are supposed to show the sufferers that they should keep their troubles in proportion. Everything is not as bad as they think. Whenever I see such cartoons I think, 'How dare you be so ignorant of what mental distress actually is!'

The 'you' I'm addressing may simply be the printer or editor over whom the author or the workshop leader has no control. But more often than not the author or the workshop leader has chosen to use such cartoons. These people have not realised that cartoons always carry a political message. They make a statement about how certain people may be seen. Some cartoons describe suffering in a very powerful way; in the way that Picasso's Guernica, a painting in cartoon form, showed the world what war does to civilians. Some cartoons denigrate certain people and urge others to hate and despise them. This was how Jews were depicted in cartoons in Hitler's Germany. Some cartoons show us ourselves in a way we should not ignore.

The last is what the cartoons by Fran Orford and Sean in Openmind do. Fran's cartoons take me back to the days when I worked in the psychiatric system and I heard people presenting in all sincerity the idiocies which she depicts with such sharpness of vision. In real life these idiocies can be taken for granted because that's what people have always said or done, but by isolating them in a cartoon Fran shows just how stupid and damaging these attitudes are. Sean's cartoons are not simply about psychiatry's refusal to listen to patients when they talk about their experience. These cartoons show us how we all can take what we hear and re-interpret it so that it fits into our own self-serving way of thinking. Often we want to spare ourselves the pain of having to take seriously the suffering of others.

All those behaviours which psychiatrists call mental disorders come from the most terrible fear of all, the fear that ourselves and our world are going to fall apart and everything be lost. I've written a great deal about such fear, but even I can forget how utterly horrible that fear is. However, over the last few months there have been two events in my life which threatened my security. When I learned of each event I was terribly afraid. I felt there was a bird caught in my throat, wildly flapping its wings and trying to escape. I couldn't breathe. It was some minutes before I could manage to take long, deep breaths and calm myself with sensible self-talk. Neither of these events proved to be the threat I first took them for but they were a good reminder to me that for some people such fear lasts for days, months, even years. This fear permeates every aspect of the person's being and threatens to destroy it.

Cartoonists should think very hard before they dare to depict someone enduring such suffering. My advice to authors, editors and printers would be that, if you can't afford cartoonists of the quality of Fran and Sean, don't have any cartoons at all.

OpenMind - Journal of the mental health association MIND

July/August 2004

Should We Put Our Faith in Drugs?

Dorothy Rowe

The basis of the debate over whether drugs or therapy is the best cure for mental distress seems to be quite clear. The benefits of therapy are hard to measure, and there are lots of different therapies and therapists, but drugs have been rigorously tested and their benefits and side effects are known. Go to a therapist and you don't know what you're getting. Take a prescribed drug and you'll know it's reliable because it's been carefully researched.

That's the theory, but should we believe it?

Researchers both in the UK and in the USA examined the published reports of studies where one drug was compared with another and found that when pharmaceutical companies fund the research that research usually produces results which favour the drug company's own product but when a disinterested organisation funds the research the results are not so clear-cut. Somehow, who puts the money up for the research affects the outcome of the research.

Research on the effectiveness of drugs can take place in two very different settings, in the academic setting of a university department or in what is called a 'real world' setting of a hospital ward, an outpatients department or a GP surgery. It's been found that real world research doesn't produce as good results as academic studies. There are probably many reasons for this discrepancy but one of them may be that for busy hospital doctors and GPs research is just one of their many duties and may come low on their list of priorities while for academics research is of prime importance. Their careers depend on it. Reading about this research reminded me of how, many years ago, a consultant psychiatrist told me how he got good results for the drugs he was researching. He said, 'I put a notice on the outside of my office door which reads, "Do not fail to tell the Doctor that you are much better, otherwise he will be very angry."' He was joking but his joke had a kernel of truth.

Extensive research has shown that when we consult a doctor we remember only part of the advice we are given, and what we think we remember we often get wrong. Less than 50% of the prescriptions written are actually taken according to directions. Sometimes we take too much of a drug, sometimes too little, and sometimes we don't bother to take the drug at all. In the publications of the Royal College of Psychiatrists there are endless complaints about 'non-compliant patients' and 'treatment-resistant patients'. Patients could equally complain about 'non-listening doctors'. Doctors don't listen is because if they did they're likely to find that their patients had ruined their pet theory.

The drugs currently used in psychiatry have been developed from a theory about how the brain works. For the past 40 years depression has been explained by psychiatrists as a mental disorder which is caused by low levels of the neurotransmitters in the brain called monoamines, namely serotonin and noradrenaline. These pass signals from one neurone to the next. If there isn't enough of these two neurotransmitters communication between the neurones slows down. This is felt by the person as depression. How this slowing down on communication between neurones produces thoughts concerning one's worthlessness and wickedness, utter despair and unforgivable guilt is not explained by this theory.

From this theory came the new antidepressants, the SSRI drugs which increase serotonin levels, the NARIs which increase noradrenaline levels, and the SNARIs which increase both. However, of the patients who are prescribed these drugs only about 50% have a complete remission of their symptoms, while, apart from a small number of severely depressed people, most patients appear to have normal monoamine levels in their brains.(1)

Nowadays many psychiatrist say that, while monoamine levels in the brain are very important, there are other factors which play a part in a person becoming depressed and may play a small part in recovery but that antidepressant drugs are vital in the management of depression. Dr Robert King, a psychologist at the University of Queensland, brought together a huge collection of research reports concerned with the outcome of different treatments for depression. He looked at the kinds of drugs used and the conditions under which they were used, whether drugs were used on their own or in combination with different kinds of therapy, the different kinds of patients and the different circumstances in which they were treated. He wanted to see which of all these treatment methods was the best predictor of whether or not the person would recover. He found that the best predictor of recovery was the strength of the therapeutic alliance. It's not the drugs you take but whether you've found someone to talk to who's not personally involved with you but whom you can trust. But surely the very best therapeutic alliance is the one you can have with yourself.(2)

(1) Peter Farley 'The Anatomy of Despair', New Scientist May 1, 2004.

(2) Dorothy Rowe Depression: The Way Out of Your Prison third edition, Brunner-Routledge.

OpenMind - Journal of the mental health association MIND

March/April 2004

The Books We Want to Read

Dorothy Rowe

Since the publication of my first book in 1978 many people have asked me how they could get the book they were writing published. Almost all of these books were accounts of the writer's life or the life of someone close to them. The writers felt that the life they described was unique and significant, and that a published account of this life would not only give them great satisfaction but it would be of great value to other people.

It is extremely difficult to get a book published, especially if the author has never been published before. However, I would never tell anyone not to bother with writing their story. Indeed, I have often advised people to write, if not an autobiography, then a diary, a poem, or just a few sentences about ideas that are significant to them. When we take what is inside us, our thoughts and feelings, and put them outside us on paper or on a computer screen we are able to look at our experience from a distance, see it more clearly and so gain some control over it. If other people read what we have written they bear witness to our experience, and they extend their own understanding of life.

However, publishers want more in a book than an account of a person's life. The book must be able to attract a great number of readers because that's how publishers make their money. A publishable book is one which excites its readers but does not distress them. Thus, if the story is of terrible events and much pain and suffering, it should have a happy ending with the central character surviving all the catastrophes and emerging a wiser and happier person. Alas, real life is often not like that. As a result many books which should be published aren't.

Two such books came my way quite recently. The first, Losing Zoë, was written by Dorothy Schwarz with Walter Schwarz. Dorothy and Walter are the parents of Zoë, a most beautiful and talented young woman who at university became manic, and then depressed to the point of attempting suicide. Dorothy Schwarz reconstructed Zoë's life from the papers Zoë left behind when, some years later after an outstanding career marked by occasional periods of erratic behaviour, she took her own life.

Such a life raises many questions, some of which Dorothy and Walter asked themselves. Why didn't they realise that high spirits can be a cover for a sense of fragmenting as a person, and an aggressive temper a sign that a person was filled with dread? Why didn't the psychiatrists tell them this?

Why mental health professionals fail is a question which arises again and again in Lindsay Westfall's autobiography Mother, a book which hits the reader almost as hard as Lindsay's mother hit her. But this book is far more than the story of professionals' failure. It shows how not just that physical and sexual abuse harms the child but that the child who observes this cruelty is also greatly affected. Literary agents rejected Dorothy Schwarz's book because it was 'too harrowing' and might lead unhappy people to consider suicide. Lindsay Westfall's story is one of great courage, of how a person kept on keeping on despite the horrors she encountered, but she tells her story with great anger, sparing the reader nothing. If this book were presented to publishers and agents as a novel they would be likely to see it as being in the popular tradition of the tough, realistic novel like Trainspotting. But an account of a real life? No. The nice people of publishing know that, like them, the majority of readers cannot bear too much reality.

Could the internet be the solution? Perhaps an organisation like MIND could set up a website for e-books where we could read the books that publishers deny us.

OpenMind - Journal of the mental health association MIND

March/April 2004

A Quick Fix

Dorothy Rowe

I've been in Australia meeting clinical psychologists, school counsellors, therapists and counsellors. I found that they were keenly interested in everything I had to say about mental distress, especially depression. There's a high rate of suicide in Australia, and the suicide rate for young men is amongst the highest in the world. The Federal and state governments take the problems of depression and suicide very seriously and so everyone who works in the mental health field is under intense pressure to achieve results. The managers in the government health and education systems see organising mental health services in the same way as they see organising physical health services, that is, identify a problem and create a solution. If a person is ill apply a treatment to cure the illness. Consequently people who are suffering mental distress are said to be ill and given a diagnosis. People are given labels - 'She's a bipolar', 'He's got ADHD', 'She's a BPD' - and their personal experience is ignored. Private health insurers (there's no NHS in Australia) give only extremely limited financing to psychotherapy, and so clinical psychologists, counsellors and therapists who work privately, as many do, know that most of their clients cannot afford long term therapy. As a result at my workshops I would be asked to talk about specific therapeutic techniques which were sure to work. Some people asked me, 'How can I cure depression in four sessions?'

Such expectations make my heart sink. If only we didn't use the language of illness to talk about ourselves and the distress we feel. Instead of trying to force mental distress into the straightjacket of a problem and a solution we'd talk about what it is to be human and about how life presents us not with problems which have a solution but with dilemmas which we cannot avoid but to which we have to adapt in one way or another. We can choose ways which allow us to feel fulfilled and content, or we can choose ways which lead us to feel mental distress.

There's the dilemma of love and loss. If we love, we can lose the people we love. The people we love don't always love us. Lovers can leave, parents grow old and die, children grow up and have their own lives, friends move away. But if we try to avoid the pain of loss by refusing to love we become very lonely.

The possibility of loneliness leads us to the dilemma of being part of a group or of being an individual. You love your family and want to be close to them, but then they smother you or try to make you into what they want you to be. You struggle to be free so you can be yourself, and you find yourself alone.

Being alone can mean being free, but being free means loss of security. Make your house or your life completely secure and you're in a prison. That's the dilemma. The more freedom, the less security. The more security, the less freedom.

How can we balance love and loss, being an individual and being part of a group, being free and feeling secure?

There's no one absolute and forever answer. It's a matter of juggling, of being flexible, ready to change. But change is scary and often we get things wrong. All we can do is to understand that in trying to deal with these dilemmas we are using ideas which we create and which we are always free to change. Many people don't realise this. They think their ideas are real, fixed, and unchangeable. School counsellors in Australia use a teaching programme called ACE (Adolescents Coping with Emotion) that helps teenagers understand that every situation they encounter can be interpreted in a multitude of ways, and that they're free to change their interpretations. They learn that they can't avoid life's dilemmas but they can reinterpret them.

If only there was an ACE programme to teach managers and politicians that life is not an illness to be cured but a process which seen in certain ways can lead to pain, or seen in other ways can lead to wisdom.

______________________________________________________

Ann Wignall, Janne Gibson, Nicole Bateman, Ron Rapee ACE: Adolescents Coping with Emotion Department of Child Psychiatry, Royal North Shore Hospital, St Leonards, NSW 2065, Australia.

OpenMind - Journal of the mental health association MIND

Jan / Feb 2004

HOW'S YOUR SUPPLY OF SELF ESTEEM?

Dorothy Rowe

Low self esteem bad: high self esteem good. This has been the mantra of many people, myself included, for the last twenty years or more. Nowadays there are many people who may say they've got lots of self esteem, perhaps because they've been in therapy and have learned not to denigrate themselves, or perhaps because they've been born to parents who have always told them how wonderful they were. It's marvellous when someone who's been leading a miserable life manages to blossom into a happy, confident person. Such people are usually a joy to be with. However, when I encounter people who claim to possess lots of self esteem, I quite often find myself thinking, 'This isn't high self esteem. It's just plain vanity and bad manners.'

In Jonathan Franzen's novel The Corrections there's a character, Melissa, a student, who was always telling people about her high self esteem. When she was talking to her teacher Chip she said, 'I like myself. You don't seem to like yourself very much.' Chip replied, '"Your parents seem very fond of themselves. You seem very fond of yourselves as a family." He'd never seen Melissa really angry. "I love myself," she said. "What's wrong with that?"'

Chip couldn't put clearly into words what he felt was wrong but he soon suffered the consequences of Melissa's great self-confidence. Melissa 'had no patience with people she considered fools.' She insulted her fellow students by pointing out how little they knew, and she very publicly seduced her teacher Chip, which resulted in him losing his job. Melissa was quite unaffected by the pain and destruction she caused to other people. When she tired of someone she simply moved on. After all, if you esteem yourself highly you must always put your own interests first.

Melissa was a monster, but no doubt Jonathan Franzen modelled her on those people who claim that their high self esteem means that they don't have to take account of other people's needs and feelings. Esteeming themselves highly relieves them of the necessity to be unselfish in the way that common courtesy has traditionally required. Certainly such people behave very differently from those people whose self esteem would be described as very low. But there is one feature which both groups of people share.

People who value themselves very little and who believe that they are in essence unacceptable are totally self-absorbed. They worry constantly about getting things wrong, about being rejected, ignored, hurt or humiliated. Such worry leaves them very little time to observe what is happening to other people and be aware of their thoughts and feelings. Those who claim to possess high self esteem are equally self-absorbed since every situation requires them to decide what is in their own best interest. In self-abasement and in vanity the person is totally entranced by his reflection in a psychological mirror.

The vanity of claiming to possess high self esteem is simply the denial of feelings of inadequacy and worthlessness. It's a kind of whistling in the dark. By contrast, when we make major re-assessment of ourselves, when we have the courage to look at the childhood origins of our rejection of ourselves and see that what troubles us is no more than ideas which we can change, and when from that re-assessment we in effect begin our life all over again, the question of degrees of self esteem is no longer relevant. The mirror which has absorbed us for so long disappears, and we find ourselves intrigued and absorbed by the world around us. We study other people and repeatedly confront the moral dilemma of when we should behave unselfishly and when we should put our own interests first. Understanding, accepting and valuing ourselves involves neither self-abasement nor vanity. We simply are.

Jonathan Franzen The Corrections Fourth Estate, London, 2002, pp. 68, 41

OpenMind - Journal of the mental health association MIND

Openmind November / December 2003

BLAME THE CHILD

Dorothy Rowe

In Jonathan Calder's excellent article on ADHD and Ritalin (issue 123) space didn't allow for a discussion of the role of boredom and fear in the behaviour of those boys given the diagnosis of ADHD. When they are bored or fearful, both children and adults become restless and inattentive. We become bored or fearful in response to the situation we find ourselves in. Those professionals who believe that ADHD is a real medical condition seem little interested in the child's situation the child, and in how that child sees that situation.

In the early 1960s before ADHD and Ritalin were invented, I was an educational psychologist working in Sydney. If a teacher felt concerned about the behaviour of a particular child I would be summoned to examine the child and decide whether the child had some emotional need which was not being met by the school. By far the majority of my referrals were boys aged between 6 and 14 who would not or could not conduct themselves in the orderly, obedient, hard-working manner which the teachers required. I was able to give the boys tests, talk to the teachers, and see the parents, often visiting them at home. A few of these lads proved to have what we now call special needs. Significant number lived in a state of unbroken anxiety, often bordering on terror. By far the majority were simply bored.

The education system was based on intelligence tests and state-wide examinations which determined which secondary school each child would attend and what course each child would follow. The child was expected to conform to the system, not the system to the child. (Sounds familiar?) My group of bored, badly behaved boys had scored IQs around average or a little lower on a group paper and pencil intelligence test. I gave each of these boys an individual test, the Weschler Intelligence Test for Children or WISC. This test gave two IQs, a Verbal IQ and a Performance IQ. The Verbal IQ tests required the kind of verbal abilities which the school curriculum demanded, while the Performance IQ required the ability to think non-verbally in terms of symbols, and of depth, distance and shape, all the abilities vital for engineers, tradesmen and sportsmen but not needed for the school curriculum. My bored boys did badly on the Verbal IQ test and well, often extremely well, on the Performance tests. They were caught in an educational system where every day they were expected to do what they did badly and be punished for that, but they had no opportunity to do what they could do well. No adult had had the wit to devise a syllabus where reading, writing and maths were combined, say, with the designing and building of a billy-cart (a fore-runner of the go-cart) or the creation of the perfect Australian cricket team based on the performances of batsmen, fielders and bowlers. Nowadays there are many teachers who could design such a syllabus, but there's little call for such talent. The league table for schools is all that matters.

The other group of boys, the frightened ones, usually had parents who were still suffering from the effects of the Second World War, perhaps as ex-service men and women, or prisoners of war, or as stateless refugees who'd lost everything, home, family, even identity. Post Traumatic Stress Disorder hadn't been invented then and the parenting gospel was still that sparing the rod spoilt the child. So there was no one to suggest that perhaps these wounded adults, far from caring for their children, were terrorising them with their unpredictable and dangerous behaviour. I was able to refer only a few of these boys to a Child Guidance Clinic. With most of them all I could do was talk to their teachers, try to explain the situation the boy was in, and hope that, out of their humanity and experience, they could fashion a place for the boy in the school where he could feel safe.

Families like those of the frightened boys still exist, and in great numbers. In the UK there are many families not yet recovered from their experiences in one of the endless conflicts that have been raging since the end of the Second World War. There are many families who have not yet recovered from the dreadful recessions and unemployment of the 1980s, and even more families are ravaged by the use of illegal drugs. Children don't cause wars, or poverty, or addiction in their parents, nor do they fashion educational systems, yet adults prefer to locate the fault in the bored or frightened child rather than ask themselves what they have done to create such a world.

OpenMind - Journal of the mental health association MIND

May 2003

THE KEY TO THE PRISON

Dorothy Rowe

Isn't it curious how a small event can change your life? In 1983 I was asked to give a lecture, and after it someone asked me a question, and, as a consequence my life, and the lives of some other people, changed.

At that time I was head of the Lincolnshire Department of Clinical Psychology and had written two books, both rather academic. These books were a result of my research into depression, something which interested me because I had been born to a depressed mother whose difficult behaviour had been the bane of my childhood. When I'd first trained as a clinical psychologist I'd been prepared to accept the medical view of depression, that it was a physical illness, but as I listened to my depressed clients, came to realise that they, like my mother, had certain strongly held beliefs which predisposed them to becoming depressed. I had reached a stage in my work where I could see a direct connection between these beliefs, a disaster in a person's life and subsequent depression.

Such a view of depression wasn't acceptable to the medical profession, but changes in the 1970s meant that people were far more ready to criticise the medical profession than they'd been in the past. That revolutionary decade saw the introduction and adaptation of ideas from the eastern philosophies of yoga and Zen, and from the ancient methods of natural health and alternative medicine. As a result many people were taking the care of their mental and physical welfare into their own hands. These changes penetrated even sleepy Lincolnshire. A group of people who were skilled in these methods formed a group to promote these new ideas, and in 1983 they invited me to give a public lecture on depression.

On the afternoon of the lecture I jotted down some brief notes on a piece of paper. My headings were 'Definition of depression, The six beliefs which created the prison of depression, How pride prevented change, Living with a depressed person, How to dismantle the prison of depression'.

The audience for my lecture was hardly cheerful, but they did seem to be appreciative. The next day I went to Lincoln Market to shop and called in at Greens Health Food Shop where the manager, Mr Heath, told me that he'd enjoyed my lecture and asked, 'Is that lecture in a book or pamphlet I could give to my customers?'

I explained that I'd just been talking from notes, but later, as I walked up Lincoln High Street, I realised that the notes I had scribbled down formed the outline of a book. decided to write this book, not as an academic study of depression, but as me talking to my clients and to their relatives and friends.

I sent the manuscript of the book to David Godwin who was then psychology editor at Routledge. He asked the advice of a colleague who had been deeply depressed, and she, having read it, advised him to publish it. A year later it was published, and shortly after it won the Mind Book of the Year Award, and my life changed for good.

Changing for good didn't mean I suddenly became as rich as Jeffrey Archer, far from it, but the book sold steadily year after year. I study why we behave as we do, and such a study never comes to an end, so a second edition of the book was needed, and now a third edition. I know now why my mother behaved as she did, but the book has proved to be more than just me clarifying my ideas. It has indeed changed people's lives.

Soon after the book was first published I began to be accosted by strangers after lectures I'd given or by mail saying accusingly, 'You wrote that book about me.' Disturbing though this accusation was, it did at least show that I wasn't just writing about my own fantasies. Then came the people who'd say to me, 'That book changed my life.' Sometimes the person said, 'That book saved my life.' Sometimes I would ask, rather nervously, 'For the better, I hope,' but usually I could see the answer on the person's face. It was an ordinary face and not the tight, chill mask of depression.

These people hadn't been cured by magic. They'd read the book closely, thought about it, and faced what their depression had prevented them from facing. They'd turned my book into a key to unlock their prison of depression.

Dorothy Rowe Depression: The Way Out of Your Prison, third edition, Routledge, 2003.

OpenMind - Journal of the mental health association MIND

March 2003

WATCHING YOU WATCHING ME

Dorothy Rowe

The Metaphysical Poets were a group of seventeenth century poets, including John Donne and George Herbert, who wrote complex, beautiful poems about life, death, God and salvation. In the BBC television drama Wit Emma Thompson played the role of Vivian Bearing, the 50-year-old Professor of Metaphysical Poetry who learns that she has advanced ovarian cancer which her surgeon proposes to treat with a new and 'aggressive' procedure.

Vivian is always very calm, very rational, a woman of very few words. No matter how much pain and discomfort she is in, when her doctors ask, 'How are you?', she always replies, 'I'm fine.' However, she confides in us, the audience, and we see the interweaving of her experience of her progress towards death with her increasing appreciation of the wisdom of the poets whose work she knew so well. We also see her face as she watches the doctors as they assess the progress of the cancer and the effects of their treatment while ignoring her. Just from her face we get a good idea of what she thinks of these men. However, these men are oblivious to the fact that, as they study her body, Vivian studies them.

Medical training has always required doctors to see only bodies and disease, not real, whole people. Nowadays doctors would say that they consider the whole person, but this attitude is certainly not universal. My GP certainly sees people as people, not as walking illnesses, but when I read my latest issue of the British Journal of Psychiatry I see that little has changed in the thirty years I have been reading it. All mention of individual experience is excluded. There are no people but cases, no record of people making decisions and acting but records of 'behaviour' which is explained in terms of biochemical changes, genes, and lit up areas of the brain. Objects, not people, are studied.

Objects are very different from people. When scientists study a rock or a collection of cells the rock and the cells are not studying the scientists. Objects move because forces act on them or because their physical make-up contains processes which engender movement, such as the process of internal combustion in a car's engine or the processes of growth in a living cell. People move because they are active agents. They assess the situation they are in, make decisions and act. They are always engaged in interpreting what is happening and acting on their interpretations.

We fail to understand this at our peril. Yet we often do, chiefly because taking other people's interpretations into consideration involves so much effort. I act, you interpret what I do, I interpret your interpretation of my interpretation, then you interpret my interpretation of your interpretations, and so on throughout the entirety of our interactions together. No wonder communications between people so often break down.

When we make the effort to understand another person's interpretations we are treating the other person seriously as an equal. In doing this we reduce our power over the other person. People who want to be powerful cannot afford to treat other people as equals. The ultimate inequality is to treat other people as objects.

It takes courage to be able to acknowledge that our interpretations aren't the only possible interpretations. People who lack such courage usually defend themselves from their fear of uncertainty by insisting that their way of seeing things is the only right way, and that anyone who doesn't share their interpretations is either mad or bad. This belief underlies the endless conflicts between people who differ in their nationality, race or religion.

Seeing the people who differ from us in their views as either mad or bad allows us to claim that we know exactly how these other people think. Thus in conflicts such as that between the Israelis and the Palestinians both sides can claim that they know for certain that the other side desires nothing but their enemy's destruction, while a depressed and anxious person can be absolutely certain that everyone she meets despises her.

Understanding other people's interpretations is difficult because we all use different words and images, yet, if we try to understand others in the way Vivian Bearing tried to understand the metaphysical poets, we'd find how alike we all are, how we all want to love and be loved, and for our life to have significance, and how we struggle to understand the meaning of life and death.

Wit was written by Margaret Edson and broadcast on BBC 2 on December 17, 2002

OpenMind - Journal of the mental health association MIND

January 2003

ARE YOU SUITABLE FOR THERAPY?

Dorothy Rowe

Jonathan, who'd read one of my books, wrote to me to tell me what had happened to him when he'd asked his GP to refer him to an NHS psychology department for therapy. He was sent an appointment, but when he went along he was told that this was an assessment, not the start of psychotherapy. A week later he was sent a letter which stated that he was 'not suitable for psychotherapy'. He was very distressed by this and wrote to me to ask, 'Does this mean I can never get any psychotherapy?'

This happened about four years ago, and I hope that by now all psychology departments have worked out much kinder ways of letting some of the people referred to them know that they will not be offered an appointment because they, the psychologists, don't have anything to offer them. However, there is a long tradition in the psychiatric system of blaming the patient for the failures of the professionals.

Nowadays psychiatrists call those patients who fail to respond to the psychiatrists' treatment 'treatment-resistant patients'. In the olden days, before psychiatrists learned management-speak, they were quite straightforward in their prejudices about certain patients. I worked with psychiatrists who believed that therapy only made those that they called 'schizophrenics' worse. However, these psychiatrists were quite frightened of university students who may have become psychotic after taking illegal drugs. (It wasn't the effect of the drugs the psychiatrists feared so much as the possibility that the students were brighter than they were.) So they gave the students the diagnosis of 'drug-induced psychosis' and sent them to us psychologists. Unhappily married, middle-aged women who refused to respond to the standard treatment for endogenous depression (pills and ECT) were shunted off to us. Sometimes a psychiatrist would take against a particular patient, and say to me, 'Look, I can't stand this chap. Will you take him off my hands?' One of the nicest men I've ever met was referred to me in this way.

This was back in the days when we psychologists didn't have managers looking over our shoulders, telling us how many patients we should be seeing, irrespective of the depth of distress each patient suffered. Today psychologists are well aware of the managers' need that waiting lists be kept short and large numbers of patients be seen, even though this 'seeing' may make not an iota of difference to the patient's individual predicament. Psychologists know that they have excellent skills to help people who have relatively new and clearly defined problems, but that they are no better than most therapists and counsellors in helping those people whose distress is rooted in childhood and permeates every aspect of their life, and that they are no better than the rest of society in dealing with the effects of social and economic conditions over which we have no control.

Psychologists, like therapists and counsellors, want to be able to think of themselves being good at their job. Unless they are completely honest with themselves they can easily allow themselves to use the jargon of management and of therapy to condemn the people who fail to get better.

It is obvious that if someone is sent along to therapy against their will that person is unlikely to benefit from therapy. Recently I was at a conference where a particular therapeutic method for adolescents who were not fitting in to school was discussed. The therapist using this method remarked that he wouldn't accept anyone who hadn't chosen to attend, but later in the discussion he referred to such teenagers as being 'in denial'. They wouldn't admit that they had a problem. Such language ruled out the possibility that these teenagers didn't have a problem intrinsic to them but that they were responding in socially unacceptable ways to the pressures and expectations put on them by their family, their school and society. Indeed, this possibility had already been ruled out. Psychiatrists had already diagnosed such teenagers as 'suffering from Oppositional Defiant Disorder', a diagnosis which absolves all adults from responsibility for a teenager's reaction to a situation created and forced on to the teenager by adults.

When we suffer from mental distress we are more than inclined to take to heart every negative comment someone may make about us. So please remember that no one is unsuitable for therapy. It is just a matter of finding the therapist who can offer you the help that you need.