Take a 40 year old man, who comes to us through their company, or through a GP referral or, for example, through a cardiologist who cannot find a physical cause for concern. He has two children aged 6 and 9. It’s fairly common that there are no babies crying at home, life has settled down, the children are at that really lovely age, still dependent and cuddly but a bit independent and fun to be with. It seems to trigger a work/life guilt complex.
The marriage is often good, though not always. The pressure on providing a reasonably wealthy London lifestyle, thereby providing as a father, performing as a husband and fulfilling all expectations as a ‘corporate son’, is high. Alongside all of this, it is very typical for a parent to have died within the last year or to be obviously aging.
All these things collide at a time that Elliott Jaques described as a ‘mid-life crisis’, now a cliché but actually key to our psycho-dynamic understanding of families.
A patient like this has often come through a high-expectation education, university, law firm or equivalent professional qualification; has been driven to succeed and settled in secure partnership level. In other words, many of their ambitions have come true – partnership, wife, children, nice house – despite the immensely long hours of work.
I want to focus on one very particular aspect that we can trust effectively, and reasonably quickly. The patient I already mentioned, an executive lawyer, broke down in uncontrollable tears at his high powered annual conference when he accidentally spilt a drink. Unable to avoid this depressive episode he went to see his GP who referred him on and we offered, in the first instance, six sessions enabling him to return to work, re-engage with family, and decrease his long-term anti-depressants.
It is my contention that skilfully engaging with what we like to describe as “unconscious family”, that we all carry within us, is one of the keys to recovery.
In a case study like this, the particular psychotherapeutic understanding of the unconscious, recognises that the place of work comes to represent (for reasons that are unique to each individual), the relationships they had with their own family during their upbringing. There is no chronology of time in the unconscious mind, it does not distinguish between emotional relationships from the past, present or even those imagined in the future. All can become dangerously entangled to the point of dysfunction and collapse, bringing on a state of mind from a previous stage in development. Thus, the unconscious family comes to visit and interrupts the patient’s present conscious life.
Specific treatment can help the patient understand their inner world for themselves. For example, the original attraction to their firm and type of work, or to their partner; the sudden dangers of being successful because it represents the overtaking of declining parents. This stops success being the driver and turns it into a dangerous weapon, leaving them potentially ‘parentless’, both in their field of work and in their personal life.
We also help the patient understand how, with particular triggers, the unconscious mind takes over, making it impossible to distinguish their current emotional past and present relationships in their marriage and workplace, from the powerful amalgam of the childhood patterns muddled and lurking beneath.
This way forward doesn’t solve all their problems and stress at once. Longer-term work often follows but it usually gives quick relief from the excessive anxiety that they are struggling with and have often hidden for a long time.
Their underlying psycho-pathology can be both hidden or delayed in presentation by alcohol, addictive substances, extra-marital affairs or, most usually, by actually working harder and harder, and hiding everything under the socially and economically acceptable workaholism.
Much of what we do is as if our consulting room is a microscope. If we can focus in on the relationship the patient sets up with us, as a thing in itself, we can use this evidence to better understand the patient and their experience of others and of themselves.
At Rafan House we have particularly chosen to work in what we call ‘cradle to grave’, ordinary family trauma – engaging with ‘emotional flu’ helping to prevent it from leading to full blown, mental health double pneumonia.
Many people hide their ‘emotional flu’ and so, to spot the early signs, it helps to look beyond the patient’s conscious presentation. The hiding can take many sophisticated forms, both in their presentation of physical health problems and in personal life decisions. But, as you know, the old classics are:
- The very ‘precisely’ made up woman
- The man who politely but with aggression fends off your perceptive questions
- The pathologically cheery – deflecting attention back to you
Even spotting something early, it is easier said than done to get patients over the stigma of acknowledging being mentally unwell and over the threshold of our clinic door. The key to this can be engaging, even just briefly, with the powerful yet often unacknowledged role of the “unconscious family”, making it feel to the patient that it’s a completely normal difficulty
Rafan House has child and adolescent, individual and couples specialists working in an integrated team.
I am always happy to run a workshop or come to your practice meetings to engage with this further and to find what you need for your patients.