• There are a few options, but I like the idea of 1:1 mentorship in the form of deep inner work in the workplace. Again, some options for this already exist. I’m going to skip past why I don’t think they are very good. My wish is for more opportunity to explore the deeper factors as to why mental health workers don’t do their best work. What I’ve seen is that these factors include fear, anger, shame, defensiveness, social maladroitness, projection. So let’s address them!

    The book ‘Reinventing Organizations’ and much of Joe Hudson’s work at Art of Accomplishment are the templates I have in mind. The idea is to use one’s work as a vehicle for personal growth. Things like workplace errors, conflicts, avoidance of making decisions, all become grist for the mill of emotional and spiritual development.

    For example, among psychiatry registrars there can be a lot of avoidance around approving the letters we dictate to GPs. We speak into the dictaphone and at one point perhaps we hesitate. It doesn’t register as a big moment but two days later we read what we said in plain text, with all the awkwardness and unresolved uncertainty glaring back at us. It’s a bit like looking at one’s practice in the mirror. “Did I really say that?” and “I can’t believe I decided to do that..” and “I really don’t want this to be in the patient’s file.”

    Using work as a spiritual practice we might have a sample of our dictations read out to us and be invited to do an emotional inquiry-style meditation while sitting in the discomfort. Or we could just have a discussion about it. We would then apply these practices to more consequential decisions.

    “But what about…”

    An objection which tends to come up is that many people don’t want to be that vulnerable with their co-workers. Workplace patterns have the same deep-seated psychological origins as relationship patterns, and so unravelling them can bring up a lot of emotions, or resistance to the emotions. People’s minds ask “how will I be able to face my co-workers?” and “will my boss trust me after we’ve explored the bad decisions I’ve been hiding from them?” My (somewhat uncompassionate) response is “clearly you’re unable to face your co-workers as it is” and “your boss already doesn’t trust you.”

    I understand that you can’t usually talk people out of their resistance, and to be honest I have no desire to work with anyone who doesn’t want to be there. I am so passionate about this work that the idea of the space being contaminated by soft coercion is repulsive to me.

    Fuck “workplace wellness.”

    With that out of the way, there are practical things we can do, experiments on how best to combine pairs and groups. It could be that we take a registrar from one hospital, a registrar from another and a couple of GPs from different practices. Ultimately the target demographic is anyone who sees psychiatric patients in any setting (GPs, Primary Care Nursing, CMHT staff, Addiction Services, Counselling Services, Homeless Services, Housing Agencies, etc) and who is sincerely interested in this kind of personal development.

    I’m confident many of them will be.

    Finally

    My theory is that institutions fail to the degree that they invite egoic self-conflict. Meaning, people who don’t really want to be there, people with relational trauma that stops them relishing any task that someone else told them to do, staff who are secretly sceptical of or hate psychiatry and the people it serves, registrars who identify as hampered poets (not looking at anyone in particular) etc etc. This creates enormous drag on the system. Meanwhile we are trying to solve climate change and AI unemployment, as well as the fact that many people with Schizophrenia don’t have secure or acceptable housing.

    At the psychological level the most sustainable energy source is enjoyment. This is what psychiatry needs more of the most (sorry, Mental Health Commission) and it is the ultimate aim of work as a tool for spiritual development. When we learn how to enjoy the conflict, the projections, the anger and defensiveness, because we see the freedom that’s available in them and by moving through them, then we will have sustainable growth. We will at least have made our inner world a better place, and who knows where that will lead.

  • One of the big misconceptions about psychiatrists is that you have to primarily work in a cognitive way. Meaning you make intellectual decisions, requiring your awareness to reside primarily in your head rather than the rest of your body. I want to illustrate how this has not been the case in my practice.

    Last Thursday I had a patient come into my clinic who was having a dreadful time with a family member abusing her emotionally and making physical threats. This relative had the history to make the threats credible, and my patient was distraught when she talked to me about it. She was too scared to go to the police because she was afraid of what he would do to her if she did. She sat in the chair opposite me and with tears flowing began to disgorge information about conversations and arguments and the chronology of the falling-out.

    I had 15 minutes to spend with her. There was no way I was going to be able to help her situation because my only recommendation would have been to go to the police. From a psychiatric point of view there was nothing I could prescribe her which would meaningfully improve her life. She was already seeing a therapist, with limited results. Previous psychiatrists had been over the same story with her. She continued divulging and what I did was keep some awareness in my body and soften any tension resulting from feeling like my time was being wasted. And when the impulse came, somewhere in my gut, I interrupted her.

    I apologized for interrupting her, not to appease her but just to acknowledge that she had a lot to say and I wasn’t allowing her to fully say it. She was okay with it. She soon resumed her divulgences, because this was obviously a core pattern for her especially with anyone in a helping role. Again I interrupted her, allowing a note of exasperation to enter into the tone of my voice while maintaining an open heart. Once more she received this well and the whole interaction ended up being quite brief. I didn’t change anything in her management plan. She left the room praising my kindness.

    You could look at this story and you could think, well, okay, you didn’t prescribe anything, or make any other kind of important decision, so you didn’t really need to go into your head. Aside from the fact that any patient in distress makes a psychiatrist think about risk assessment, the point is that if I had approached the interaction headfirst I’d have gotten badly lost in the details she was giving me. The appointment would have run over time. I’d have been stressed and off centre and my head would have felt tight and dense. It would have been difficult to think through the next cases that came in the door.

    Psychiatry has many such situations. If you live in your head you will get badly lost in the morass of detail and emotion which certain patients point at you. It’s not their fault and they’re not necessarily deliberately trying to cross boundaries or upscuttle you, but this is just the way that certain interactions go, more so in the emergency department where patients tend to be sicker, but also in clinic betimes. If you don’t know how to act and even to think and decide from your gut, I think your most likely experience will be to leave work with a tangle of uncomfortable sensations plus cognitive slowing/heaviness, and you will likely blame the nature of your work itself rather than the approach you’re taking. Meanwhile in work there might be some stuckness between finding the correct answer and carrying it out.

    As for how to make difficult and complex prescribing decisions, I would say again, study the theory until the point where this too can move from your gut. Or if you’d like, just from your body. Sometimes it’s helpful when you speak about embodied decision-making to be less precise about where in the body it’s coming from, rather than going looking for a sensation specifically in your gut region. It may be that your heart is a more appropriate point of focus for a given decision, e.g. if there is counter-transference.

    But yeah, your body is still going to tell you how certainly the symptoms meet the criteria to prescribe a medication, and your body will also tell you when it’s a bit too complex to make a quick decision and when you need to go talk to someone or look up guidelines. To illustrate Alexander Lowen’s claim that there is no effective thinking without feeling concomitantly, I would also say that when you sit down to study, you’re looking for a feeling of opening, one might even say wonder, (although that can be too strong a word at times), but even the subtle openings into the information, the subtle heightening of focus that doesn’t feel like a shear force within your system, but instead actually feels relaxed while the focus heightens. There’s maybe warmth and softness there too, and this is a good feeling to follow. It is the feeling that makes it so that study doesn’t have to be a form of self-coercion.

    All of this is to say that Psychiatry can be an embodied practice. And I would even go so far as it should be, in the sense that if it isn’t you are going to run into unnecessary problems.

  • Claude tells me that I already know what to do next, and my nervous system is simply acclimating to the expansion. All of which I already knew.

    Things that are good: void-based battle-hardened coaches telling you that this is normal.

    An emotion on top of an incomplete other one makes for contraction, which is what part of me wants, so I listen to music as the next way to fill the void. The void which is always waiting for me, there when I get back out.

    What is there to do?

    I think that helping people is where this naturally goes.

    Because what else would there be to do?

    Is your alternate answer, perhaps, another missive from the contraction?

  • When we interact with others, we are defending ourselves from disintegration.

    Obviously we don’t think of it that way, usually. It’s not that easy to notice. But every time we have a judgement, however subtle, that is what we are doing.

    Let’s say someone is getting a bit too excited. They have a “bit that they do,” a little dance type movement, or some singing, or a joke that goes on for too long. You perform tolerance, expecting it to stop soon. But it doesn’t. Instead they seem to infer an invitation to draw it out even longer. Now you’re really judging them. You feel tense, and start to look around the room as if hoping for rescue.

    Somewhere along the way you decided that you were not going to allow yourself to have that amount of excitement. Someone cringed at you, and now you are cringing at someone.

    What is happening in the moment you tense up and seek rescue is that you are deflecting against destruction of who you are. The part of you that’s protecting against getting cringed at again is in survival mode. It’s enlisting judgement, and your judgement will seek to enlist agreement from others who are also judging. Most likely the judgement infrastructure is protecting against grief for all the missed excitement which others got to participate in.

    Now let’s look at it from the point of view of the excited person. Chances are they are in the dynamic with you. It’s quite possible that their excitement is tinged with shame. After all, they are hanging out with someone who is judging them. As you disconnect, they keep dancing, singing or joking around. It’s almost as if they’re defying you, their way of defending against the judgement you’re emitting.

    In a way, they are asking you to accept them for who they are, which sounds like a reasonable ask except that it entails the destruction of whatever part of you refuses to identify with them in that moment.

    So ‘Being With the Other In Their World’ is no joke. Performing curiosity just won’t cut it, because when it comes to the vulnerable parts of them, they can always tell. Just as a child can always tell when their parent’s attention is loving and when it’s distracted.

    Let’s do one more change in perspective. Say I’m the defiant excited one. I’m being all zany, I’m enacting my identity as The Charming Creative, and it’s causing my friend to freeze. I see this and feel abandoned. I could judge them, and this would rescue my identity as a charming creative – I just need to find better friends, ones who are more willing to put their own judgements aside to be with me in my idiosyncrasies, to see that I’m really being vulnerable and at least give some element of caring attention; more ideally, join me and have us pursue self-expansion in unison.

    Or, I could ask “what’s making you go silent?”

    Here is the move that constitutes my “being with the other in their world.” I am including their authenticity rather than prioritizing the defence of my right to express mine. Once I do that, I am opening myself to the possibility that I am not as charming as I think I am. I am opening myself up to destruction in a very real sense. I now have to include the fact that some people respond to my excitement as if it were distasteful, or even a threat. I don’t have to believe that it’s really either of these things. I just have to (i.e. I get to choose to) create bandwidth for the part of “the other’s” consciousness that’s perceiving me that way. This means feeling my fear and my shame. It could also involve feeling anger or sadness.

    Lastly, I should point out that when I ask “what’s making you go silent?” the answer I’ll probably get is “oh, nothing.” Because the other is unlikely to want to be seen judging someone for their behaviour. Our judgements can be a very intimate part of ourselves. The point is that even asking what is happening for them is a move of opening myself up to annihilation since I need to give up the certainty that the people rejecting me only have bad reasons for doing so.

  • A couple of days ago, I was leading a small group in Circling and was asked to explain Circling Europe’s principle of ‘Being With the Other in Their World.’ I described it in somatic terms as being like standing in front of an ocean and letting the waves wash up and around you, circling your feet, then letting them recede again. And taking in the vastness of the ocean.

    Last night I found out that Kate Bush’s song Cloudbusting is about the son of Wilhelm Reich, Peter, experiencing his father as ever less reachable as Reich senior falls deeper into obsession with orgone, pointing metal tubes at the clouds in Maine in an attempt to extract universal life energy and manipulate the weather.

    My impulse as I stood in my bathroom this morning in the aftermath of sobbing was to go find out everything about Kate Bush’s relationship with this story. It would be easy with Claude. But that would not be wonder. It would be curiosity. It would not be taking in the vastness of the ocean. It would be gathering a few details about ocean geography so that I could move on to something else.

  • One of the benefits of Circling is that it allows you to see underneath the authority of social convention. You get to see the ‘why’ behind the punishments which society implicitly or explicitly hands out for certain behaviours. For instance, many people are punished for vulnerability. They are met with silence, distance, or gossip. They may be said to be “trauma dumping.” Trauma dumping is certainly not a good thing to do, but from that person’s perspective they might see themselves as trying to find acceptance for the part of themselves that doesn’t fit so neatly into the fun and games. Trauma dumping might not be “real vulnerability” but “real vulnerability” can be hard to define prospectively.

    So a person in pain has quite a dilemma. Suffer in silence and feel isolated, or share the pain and… also feel isolated, plus possibly humiliated. Such a person might be advised to see a therapist, and this is often what they should do, but it might be difficult to extrapolate their learnings outside the therapist’s office which rarely mirrors the context of normal social life.

    Circling is much more ecological. You are in it with other people who are mostly not paid to be there and who have no role to fulfil. There is no script, nothing that has to happen. You are invited to bring as much of your experience as possible. Where therapy is psychological, Circling is more spiritual. And I think the spiritual plane is a vital one to include in any deep exploration of vulnerability. As Father Intintola says about Tony Soprano, it is difficult to heal the mind without also healing the soul.

    I have a story about how my relationship with vulnerability changed. Early in the ‘SAS’ facilitator training I did with Circling Europe aka Transformation Connection, we were exploring our experiences of being in a new and unfamiliar group. One woman said she had a desire to “kick the group,” ie to test its boundaries and how it would respond to rebellion. When this woman was asked if she had a desire to “kick” anyone in particular, another woman chimed in and said she had a desire to kick me. She said that in the 1:1 Circling session she had had with me prior to us all rejoining the large group, she had found the session really boring. I indeed felt kicked, and said as much.

    The reason I picked this story is that we are so often told by spiritual experts that telling the truth is a spiritual imperative. A fine substitute for psychotherapy, as Jordan Peterson once asserted. And so we often jump into deep inner work with a kind of brazenness, an all-guns-blazing approach to disclosing our inner experience. That woman felt very vulnerable sharing that she felt bored with me, which I could tell from her visible relief when we got back on friendlier terms. I had seen it as a pointlessly insulting thing to say, and was beginning to decide that if honesty and vulnerability were really so fruitful then she and I were going to need a new definition.

    You can define vulnerability as speaking one’s truth even when it’s scary. I got this definition from Joe Hudson who runs the company Art of Accomplishment. What Circling allows you to do is “feel into” that truth and watch it change from moment to moment. You could start out feeling angry at someone. The anger becomes a story about them, e.g. that they are “entitled.” At that point your truth seems to be saying out loud how you’re judging them. But wait – there is care emerging. You see holes in the story, or you realize you really don’t want to hurt their feelings. Then you remember the numerous times someone pointed out your caretaking pattern. You think “I need to learn to be less nice, to not manage other people’s impressions of me, to not soften my presence so other people feel comfortable.” So you sit in the circle telling yourself you should share your judgement, all the while feeling a weighty sense of dread.

    These are the complications of speaking your truth in the real world. And these are the outside world patterns of self-restraint that Circling is so good at digging up. I have still not figured out what that weighty feeling of dread means. Does it mean that I don’t actually want the intimacy of self-revelation in that moment, and that that is the truth to respect? Or is that yet another rationalisation to stay quiet and comfortable in the corner of the room? As I got better at Circling I noticed that when society “punished” me for being honest, I was often actually not being fully truthful. I was speaking with a hardened defensive air that broadcasted a lack of trust in the recipient. Or, I was so confident that words were The Truth when in reality there was a strong chance that two months later I’d have disavowed them myself.

    Circling is so challenging exactly because these are the questions it faces you with. Another spiritual cliche it brings to life is that there is no ‘should’ when it comes to self-examination. This kind of practice requires a sincere willingness. If you didn’t really want to be there, it would be torture. But for those that do want to jump in, it can be incredibly exhilarating. I have found few things that so rewarded my off-piste flavour of curiosity.

  • Probability is the backbone of evidence based medicine, but it doesn’t describe reality with the depth that explanatory theories provide.

    Let’s say that I am studying physics and I calculate the probability that earth will be struck by an asteroid in the next five years. I don’t know what a typical probability calculation would come to, but imagine it was 1 in 50,000. Now imagine that someone in the physics department comes to me and says they have finally replaced the lens on the best telescope in the building; I look through it and see an asteroid hurtling through the galaxy towards us. The probability then obviously changes. To take another example, anyone who has been involved in match fixing knows that the odds you get at the bookies are not an objective statement about reality.

    So probability has assumptions. But could you not say that all theories contain assumptions? Yes, but the point is that while they may use probability instrumentally, good theories do not speak fundamentally in terms of what will probably happen, but instead speak of what can and cannot happen, the conditions under which things happen, and why they do happen. In other words good theories provide explanations. Physics can explain why you cannot travel faster than the speed of light. Microbiologists can tell you the conditions under which antimicrobial resistance happens at a level that causes problems for doctors and patients.

    As it stands, psychiatry contains no explanations for why any major mental illness happens. We do not know the underlying cause of Depression, OCD, Bipolar Disorder, Schizophrenia, or anything else. This is despite (more accurately: because of) the copious use of probability in research. We know something about the genes and environmental exposures that are relatively tightly associated with developing those conditions. But there is no explanatory pathway for how any given gene or experience actually causes any given thought, be it an obsession, negative cognition or delusional belief.

    Now let’s talk about p values. When you do a study comparing an antidepressant to placebo, p values describe the probability that the effect that follows administration of the drug would have happened if the antidepressant had no intrinsic therapeutic capacity. A low p value refutes the null hypothesis stating that the drug has no effect above placebo. Some people would say that p values “falsify” the null hypothesis. But when you falsify a hypothesis using probability, you don’t get explanatory resolution.

    A ‘statistically significant’ result is saying that there is a systematic effect. It’s saying that antidepressants are doing something. That’s basically it. It doesn’t tell you what the systematic effect is due to. That’s left up to us psychiatrists to conjecture about. When it is left to us to conjecture, without a way of experimenting to adjudicate between the conjectures that each of us brings to the debate, then the knowledge category we’re working in is primarily philosophy rather than science. We can use probability statistics to assist in our criticisms of each other’s conjectures, and there is benefit in doing this, we just need to be clear what epistemic domain we are working in.

    It’s important to understand that we currently lack the experimental and statistical mechanisms to grow our knowledge quickly. What I have tried to show is that we don’t have scientific explanations for mental illness because our research methods aren’t trying to find them. What the methods are trying to do, without us being explicit about this, is assist us in philosophy. We treat patients using philosophy. And we often succeed. But the rate of knowledge growth in ours and many other biological fields pales in comparison with physics because physics historically made greater use of experimental falsification, where the aim was to find an occurrence that was in direct, logical, non-probabilistic contradiction of the theory being tested.

    There are reasons why physics found it easier than biology to do this, one of which being that there are limits to the experiments we can ethically perform on humans. By some accounts physics is also moving away from the use of falsification, which sounds to me like a bad thing. Furthermore, humans are more complex than planets and atoms. This makes falsification of theories pertaining to humans very difficult to do, and especially when the theory is meant to apply to humans in general. The clear solution to this is to see that each patient requires their own modified theory of mental illness, and the requisite approach to psychiatry is one of being epistemically energised. This might sound like advocating eccentricity, but actually most psychiatrists already understand what I’m arguing. It would not be rare for an experienced psychiatrist to look at a powerpoint slide and express skepticism about the usefulness of whatever the research is purporting to prove.

  • In this essay I am assuming some prior familiarity with Kapil Gupta’s arguments about prescriptions, which he defines as shoulds, how-to’s, 5 step plans and emphasis on method and technique. He’s worried about disempowerment of the student, saying that once you ask a teacher how something is done, you are placing your capabilities in the hands of your teacher, and will be forever returning after practice to ask “did I do that correctly? how should I do it differently?”

    But there is a form of prescription which is suggestive and experimental and which does not claim to hold some final truth worthy of the student suspending their intuition. For example, a meditation instructor could say “for one week, spend 5 minutes twice a day observing the energy movements in your body.” The student could follow this instruction slavishly, and when they don’t notice anything they could conclude that something is wrong with them and return to the coach for help. Or, they could think, “that’s an interesting experiment, I’m excited to see whether I notice any energetic blockages when I find myself in a recurring negative situation this week.” If the student doesn’t notice anything interesting, they can simply move on to whatever is the next experiment that piques their curiosity.

    What is important to understand in this example is that it’s not inevitable that the student becomes dependent on the teacher. If after a succession of experiments the student doesn’t find anything interesting, if he doesn’t develop any new capabilities, he will naturally lose interest in what the teacher has to say. Certainly the teacher could try to manipulate the situation so that the student doesn’t realise that his instructions are useless. The teacher could say “keep trying, one day it will come” (a phrase that Gupta often uses as an example of how teachers can keep students on the hook). But many teachers don’t. Gupta promises to speak in absolute truths; he is not doing so here. In reality many students are highly skeptical, and teachers are constantly having to renew their proof of benefit.

    I bought into Gupta’s message because it does have sociological accuracy. People do throw ‘Shoulds’ at each other. People indeed rarely stop to consider why the person hasn’t already done what they are advising them to do. Many coaches do exploit their clients. But these dynamics are not intrinsic to prescriptions, which are simply the introduction of a possible course of action that hasn’t already been taken. Mark Manson’s article ‘The Point Is To Stop‘ is one of many examples of how mainstream writers acknowledge and guide against the very risk that Gupta thinks he is unique in warning against.

    With some effort I am avoiding the devaluation of Gupta that so often comes after one has idealised a teacher in the way that I did. He is a genuinely unique voice and speaks profoundly about existence. But he too is human. As Adyashanti put it when talking about Osho’s terrorist behaviour, one can be profoundly well-developed along certain dimensions of personal growth while being stunted along others. He says:

    “Enlightenment… that’s part, that’s part of the game. That doesn’t guarantee you’re going to know how to be in good intimate relationships, that doesn’t mean you’re not going to be able to delude yourself, doesn’t mean you’re not going to be seduced by power or desire necessarily. It doesn’t guarantee that.”

    I wonder how Gupta’s lack of sociability has affected the trajectory of his significant and impressive personal development. He describes himself as a hermit. He does not like people. I wonder whether he is projecting the disempowerment he feels in relationship onto others who are more thoroughly socialised and who have learned to work through dynamics of dependency rather than make them a pretext for distancing themselves. But then, that might be my own projection. To Gupta’s credit, he always points out that everything that a person counsels arises out of their own specific circumstances, and that the most important thing in hearing his words is never to take them on faith.

    As a closing message, I would also like to acknowledge that for all that I have said defending prescriptions, the teacher-student relationship is indeed fraught with the risk of dependency even when the teacher is actively working to mitigate the risk. I have hopefully demonstrated that the reliance on the teacher can be time-limited, but the element of reliance does indeed assume a life and momentum of its own, and the overall direction of our culture is to add to it. As the Buddha apparently said, one of the core tenets of seeking enlightenment is to not buy into society’s prevailing belief systems.

  • I signed up for Art of Accomplishment’s Groundbreakers retreat, and then realised I probably didn’t have enough money.

    Already on the verge of burnout, paying north of 10 grand would mean reneging on my promise to take the next month and a half off work which I had made to myself. The decision to pay or not to pay is cutting to the core of an identity question: am I going to change my priorities and start doing normal people things like saving for a deposit on a house? Or am I going to continue pursuing this off-piste spiritual journey which I seem to have designed in such a way that no one around me has the necessary context to be able to tell me that it is a bad idea?

    A lot of fear has come up. AoA (Art of Accomplishment) make a big thing of welcoming fear, since it’s a signpost to authenticity. It’s a sign that a part of your identity is under threat, which they say is a good thing because identity is what blocks out your more expansive, evolving, essential self.

    I’ve been wondering about what part of me is being faced with annihilation. The part of me that says “hell yeah I’m going to pay loads of money, why wouldn’t I, with all the pain I’ve been through?” The part of me that is such a good customer whose praises all the coaches gather around after hours to sing, and deserves to be seen as a sincere seeker (wait til I leave them scrambling to fill the space when I drop out…) The part of me that thinks he knows what’s going on, thinks his judgement is better than other people’s and he’s really on to something with this AoA stuff, which everyone will look back and recognise in wonder, 10 years hence.

    There is something self-disparaging in how I’m characterising the identity that might be departing me. This itself is probably the identity of The Self Aware Person. Fear bursting through all of this. The thing about genuine fear, I’ve come to believe, is that if I know it’s healthy then I’m only on the edge of it. If I know it’s going to lead to something better, ultimately, then there are layers left for me to feel.

    I need to be held in my fear, and I don’t know how to reach out for that.

  • Is all thought management? (But then what about poetry, what about revolutionary philosophies)?

    How would you know it; what would it mean?

    It would be a delay, a dysrhythmia.
    It would cause a contraction in awareness, like “wait, what was I saying again?” as you expand back outwards.

    Even epiphanies in their final form have been fixed in a formulated phrase. Their sparks are preverbal. Life on the outside is for them soon to become the canned goods of the intellectuals. A lower fractal of management is cooing at apercus like this one.