Psychotherapy

Millennials, Smartphones and Mentalisation

Human beings are in a perpetual state of conversation and conflict between our ancient biology and the modern world. Physiologically we evolved to enjoy and seek out sweet tastes as these foods (typically fruit and tubers) tended to contain useful amounts of energy and were unlikely to be poisonous. This tendency to sweetness was beneficial in pre-agricultural environments where these foods grew seasonally, had to be foraged and were eaten whole, but our modern, industrial food landscape - in which sugar is extracted from one food and added to another - is associated with the over-consumption of refined sugar, of energy intake outstripping expenditure and, in turn, many of the ‘diseases of a modern life’: metabolic syndrome, Type II diabetes and heart disease.

Similarly, the conflict of our ancient brains – predisposed to identifying risks in the environment and anticipating and simulating future problems – and the stresses of modern life are associated with increased incidence of chronic stress, anxiety and depression.

On Christmas Day 2016 a group of educationalists, authors, psychologists and psychotherapists published an open letter(1) in The Guardian calling for government intervention on the amount of screen time children are exposed to citing risks to children’s self-regulation and emotional resilience. Their concern is that increased screen time comes at the expense of meaningful interactions with caring adults and self-directed outdoor play. I think these concerns are sympathetic and well-founded. It will be important that anecdotal and hypothetical links are also borne out in good-quality research that looks at the relationship between use of screen-based devices and mental wellbeing so that the issues may be addressed effectively.

It occurs to me that one potential casualty of our screen-based lives is mentalisation. Mentalisation is the capacity to consider the contents of one’s own mind. It may also be referred to as ‘reverie’, ‘thinking about thinking’ or metacognition. Think of it as the ability to think about our own thoughts; to be able to answer questions like Why did I do that? What am I feeling? It is the cornerstone of self-awareness and higher cognitive functions such as planning, attention, decision-making, reasoning and problem-solving.

A number of offender management programmes focus on increasing the capacity to mentalise. Often offenders struggle with understanding the motivation for their crimes or seeing a connection between the circumstances and their actions. ‘I don’t know what happened. I don’t know why I did it. It just happened. I wasn’t thinking’. In a more general sense all of therapy can be said to be concerned with increasing self-awareness, whether the question we are asking is ‘What do I want to do with my life? Or ‘Why do I feel so sad?’

Here’s the thing, a huge part of the process of developing the capacity to mentalise is space. It is within the quiet of safe isolation (as opposed to a fearful abandonment or loneliness) that we become aware of the contents of our own minds. One of the reasons that babies and young children become so distressed when separated from their parents is because they have yet to develop object permanence; when mum or dad are out of sight they ‘cease to exist’ and this is incredibly frightening for an infant. With time s/he is able to understand that a) the parent continues to exist in the world even when they are not immediately available and b) the loving relationship also continues. In the physical absence of the parent the developing child can conjure up images and associations of the parent, and can soothe themselves with the knowledge of that parent and the belief that they will return.

The positive trajectory of this process is that the child will become aware of their own feeling states. If the experience could be put in to words it would look something like, ‘I am anxious because mum/dad has gone away. I feel lonely. I am frightened that they will not come back. But they have been away before and they did come back and it was okay. It will probably be fine.’ But this process requires absence. It needs for the child to realise and acknowledge that they are alone before they can consider how they feel about it. It is a psychological function that developed, along with the rest of our minds, in a pre-industrial, pre-technological world. It is my suggestion that ready access to smart phones and tablets impedes this process by ensuring that we never really experience solitude. As soon as we are by ourselves, at the touch of a screen, we can be connected to an infinite number of others, whether that’s friends on Facebook, a group on Whatsapp, or the innumerable anonymous masses on Twitter. We can immerse ourselves in somebody else’s life, either as observer or participant and the pesky reality of our own emotional world can be avoided for a while longer.

I have had younger patients (Millennials, if you will) look at me in genuine confusion when I have asked ‘What goes through your mind when you are not doing anything?’ They are never ‘doing nothing’. And then horror when I suggest that it might be interesting and useful to spend just five minutes doing nothing to see what emerges.

‘What do you mean?’

‘I mean, at some point during the week, I would like you to spend five minutes doing nothing.’

‘No, I can’t do that. No. That sounds awful.’

Part of this ‘Terror of Nothing’ is the result of the well-intentioned but ultimately disastrous insistence on efficiency. We spend so much time manically seizing the day and ‘only living once’ that we risk losing the skill of actually living; of appreciating the moment and being aware of our emotional response to it. We’re so busy working out the best angle for the selfie that we miss the glorious #sunset. But, I think, a large part is that as long as you have a smartphone and 4G you never have cause to be doing nothing. There is no solitude. Whether it’s listening to music, scrolling through a news feed, reading a blog post (ahem!) a distraction is at our fingertips. The modern world is one of constant stimulation, instant gratification and certainty. Suffering from momentary boredom? Play a game! Seen a thing that you like? Order now for next day delivery! Unsure about anything?  Ask Professor Google and be uncertain no more.

The problem with this? The problem is that, in order to live meaningful lives, we need to know ourselves. We need to become familiar with the contents of our minds in quiet moments of solitude. We need to be able to tolerate what emerges there whether it is something we consider pleasant or unwelcome. If it is pleasant, why? If it is unwelcome, what does it mean? And we must be able to tolerate uncertainty. Why? Because that is life. Life is uncertain and vacillating. Whether the ambiguity is about a relationship, a job, our own sexuality, our faith, the truth is that most of the time we are unsure. But the task isn’t to be sure. Certainty is a comforting illusion. The task is to be uncertain and still be able to live; to make choices in the direction of our values. To not be paralysed by fear and ambiguity but to know that, though we are not 100% on this, we are still able to take action in line with a deep knowledge of our own minds, needs and morals.

Our personal devices provide an extraordinary opportunity to improve our lives; connecting people across continents; increasing access to education and employment, to inspiration. But they also have the capacity to distract us from other important internal and external events, like an engaged, meaningful conversation, the innate awe of a beautiful sunset, or thoughtful, purposeful nothing.

 

1. https://www.theguardian.com/education/2016/dec/25/screen-based-lifestyle-harms-health-of-children

Freud on Pornhub

Originally published 21 January 2016

Telling people that you are a psychologist (or even a psychology student) tends to evoke two responses in others: curiosity or hostility.

The curiosity almost always takes the form of the rather hopeful exclamation, “Oh my God! Can you tell what I am thinking? I bet you’re analysing me right now!” This response is so common that there are memes, articles and merchandise based around it. For the most part the curiosity is funny and light-hearted and leads to a normal conversation that sits appropriately in the realms of polite social interaction. It’s the hostility that catches you off guard. During my training I had started a new job, unrelated to psychology, in a corporate environment. My new colleague asked me what I was studying. I told her. She said with a snarl, “I would never go to see a therapist. It’s a sign of weakness. I think you should be able to deal with things by yourself. My dad bought me up to be a strong person and not have to rely on other people for help.’ I said, “Okaaaaaay…”

I get it. Our mental and emotional worlds are bizarre but deeply personal places and people either want to invite you in so that you can help make sense of them, or to keep you out at all costs. Sometimes, mindful of not wanting to betray their hostility, people dress it up in intellectual clothes. I was out at a club once and on hearing what I do for a living the man I was talking to said something about it being complete nonsense. I thought to myself ‘Seriously. We’ve just met and you’re telling me my vocation is  worthless? And when I was polite enough to not even mention your dance moves? Is this really happening? Am I…am I being negged?’ But I didn’t say that. I asked him what he meant. You know, because I'm a professional. He made a comment about Freud’s theories of infantile sexuality being false and irrelevant. He didn’t put it like that though, of course, because he hadn’t read the theories. He apparently had only read or heard someone else’s detracting statements on them. What he said was, “Well I certainly don’t want to have sex with mother. That’s disgusting.” I let out a laboured sigh. Honestly? Honestly?! This is your well thought out counter-argument to over 100 years of psychoanalytic thought?  It doesn't feel nice?  Really? Not even an attempt at a supporting reference? Just your subjective report of a thought you haven’t had about something that was never actually said? Good grief. I could have let it go; it was late, I was having a nice time but I had just come from work and, well, he started it. I had to take a moment to educate the man.

Here’s the deal. This guy was of course referring to the much misquoted Oedipus Complex. First, a little bit of background. Sigmund Freud was a doctor and a neurologist. I make this point in an attempt to demonstrate that the man was primarily trained in the rational, natural sciences. The observable and the objective were the basis of his work and his research. During his clinical practice he became intrigued by a curious phenomenon which he referred to as ‘Hysteria’ but what modern medicine calls Psychosomatic Illness, Somatisation or the more politically correct ‘Medically Unexplained Symptoms’. It is the observation that people frequently present with physical symptoms for which no biological basis can be found. The NHS reports that up to 20% of GP consultations in the UK are for these kinds of symptoms (1). That, according to the British Medical Association(2), accounts for some 68 million consultations. That’s a huge proportion and it made Freud wonder, what, if not physical, was creating these symptoms and, crucially, why?

Through many observations and in treatment with his patients Siggy deduced that there was something psychological at play and something of which his patients were not themselves aware.

The ‘unconscious’ is the term given to the processes that go on in our minds automatically and outside of our conscious awareness. If you see a ball coming rapidly towards your face you do not think to yourself ‘Incoming threat to facial integrity. Aversion procedure: close eyes. Turn away. Cover face with hands.’ If you did you would be out cold on the floor with a broken nose before you could say 'Have you had an accident that wasn't your fault?' But you do the actions anyway, evidence of an automatic (unconscious) response to the external stimuli. Far from necessitating blind faith, neuroscience now provides a compelling case for the brain basis of the unconscious (3). Neuroscientist and author Sam Harris is one of the more recent and recognisable to say ‘Free will is an illusion’ (4) so compelling is the case, he says, for power of the unconscious.

The unconscious, Freud believed, played a huge part in determining our behaviours, beliefs and personalities and the Oedipus Complex was the metaphor that he used to describe some of the behaviour that he observed in children and the child-like aspects of his adult patients. That’s right, it was a metaphor. An allegory. Freud used the very entertaining (you should read it) Greek tragedy ‘Oedipus Rex’ as a symbol of the intense feelings that a child experiences for the opposite sex parent. He did not say that children want to have sex with their parents. Children at the age he was describing do not (or should not) have any notion of what adult sex is. What does happen, to which many parents will attest, is that children will talk of deep love for their parent. Little boys who want to ‘marry mummy’ are so common that there are adorable (and of course wholly innocent) YouTube videos posted about it. This is what Freud was talking about, that intense love that children feel that means they want to have that parent all to themselves, exclusive of the other parent. Matrimony is what little children understand love and ‘exclusive possession’ to mean. No sex but deeply intense feelings that are as close as sex gets for little children. That said, the child comes to understand, or so the theory goes, that these feelings are unacceptable or dangerous and that they should be abandoned. They are pushed away into the far recesses of the mind not to be thought of again. Having forgotten about the intensity of their childhood feelings and overlaying their adult knowledge people hear the word ‘sex’ in the context of their parents and freak out: ‘I don’t want it be true. It can’t be true. It’s nonsense!’ The powerful social and biological incest taboo (Freud talks about that too) means that we won’t even allow ourselves to think about those infantile feelings, employing all sorts of defences to deny, suppress or repress them. Inevitably though, what cannot be thought about will find its expression in some other way.

That’s why I chuckled to myself when I read an article from the popular science blog ‘IFLScience’ which listed statistics from PornHub, the world’s most popular porn website, on the UK’s most popular porn searches (5). Three of the top five searches by men were for mother figures: ‘step-mom’ (sic) was top, followed by ‘milf’ (mother I'd like [to] f**k) and ‘mom’ at positions three and four, respectively.  ‘Step mom and son’ also made an appearance at number nine. Freud was not right about everything and there were a few important things that he abandoned due to social pressure. But it looks like he was on to something with this one.

 

1. NHS Choices – Medically Unexplained Symptoms. http://www.nhs.uk/conditions/medically-unexplained-symptoms/Pages/Somatisation.aspx

2. British Medical Association. Media Brief. http://www.bma.org.uk/-/media/files/pdfs/news%20views%20analysis/press%20briefings/pressbriefinggeneralpracticeintheuk_july2014_v2.pdf

3. The Neural Basis of the Dynamic Unconscious. http://www.nyu.edu/gsas/dept/philo/faculty/block/papers/BerlinTreatment.pdf

4. How Free Will Collides With Unconscious Processes. http://www.scientificamerican.com/article/how-free-will-collides-with-unconscious-impulses/

5. IFLScience – Here Are The Most Common Porn Searches In The UK http://www.iflscience.com/health-and-medicine/here-are-pornhub-search-habits-british-public

6. Metro (online) - Lesbian, British and step mum among top PornHub search terms this year. http://metro.co.uk/2015/11/18/lesbian-british-and-step-mum-among-top-pornhub-search-terms-this-year-5509619/