Tony White

There is an interesting coronial inquiry going on at present where I live. A 21 year old woman died from an ecstacy overdose. This is being followed closely by the press. Today it was reported that her boyfriend was dealing drugs and he would give her the drugs for free. He allegedly supplied her with the drugs that she overdosed on.

I can see where this is heading and the boyfriend is going to be cast as the evil cad who led the poor innocent girl astray. How ever it does raise an interesting point about the drug scene and drug counselling. One question which I always sooner or latter ask the drug user and it is usually sooner than later, is, where do you get your money(drugs) from? Surprisingly there are a considerable number of drug counsellors who never ask such a question. To me it is pivotal in understanding how this person runs their day to day life.

This question is far less important to ask the recreational user than the regular user. One asks it of the person who spends quite a bit of money on drugs on a regular basis. There are a number of solutions to the money problem that I have heard over the years.


Grow your own



Some regular heavy marijuana users can supply their habit by growing their own. This is probably one of the ‘safest’ ways to get a supply as it can keep the person out of the dealing side of the drug scene. They are not selling, so the police have little interest in them and they are not having to score from other dealers who will inevitably rip them off at some point When this happens there can be very bad consequences. However one can only really do this with cannabis and cannot do it with opiates, amphetamines, hallucinogens and so forth.

There are others who can use drugs in a regular heavy way and still maintain a job. You would be surprised at the people I have counselled who are in high powered, responsible jobs and have a fairly sizeable drug habit. These people can persist like this for long periods of time because they spend 70% of their income on drugs and survive on the 30% left. This also is a ‘safe’ way to get supplies as they are not doing anything illegal to obtain money. Thus they are just a user and the police have little interest in them.

Most however engage in some kind of illegal activity to get the money for the drugs. This can range from petty crime, to prostitution, to much more serious crimes. These are much more perilous ways to get the money as the police are watching closely and the consequences are more severe.



Of course another common solution to feed a drug habit is to deal in drugs. Not only does one get the money from the deal but every time drugs pass through your hands a bit disappears here and there. This method can provide quite a good supply of drugs but the consequences are dire if one gets caught. And those who are dealing drugs to feed their own habit are usually the ones who get caught. Not the bigger fish higher up the chain who have money as the main motive rather than to feed a personal drug habit.

There is however one other way to get a good supply of drugs that actually breaks the sexual discrimination laws of this country. Females can not really be drug dealers. If they try they wont last very long. In the words of the great Chopper Read, any criminal organisation that does not have physical might and physical intimidation to back it up is a paper tiger. It will collapse very quickly.


Chopper Read. Do see the movie, "Chopper" it is very good.



One thing I learnt early on in my time in prison (as an employee!). The sword is much mightier than the pen. Its all about physical strength and the ability to physically fight. If one is a good fighter and strong then you are at the top of the pile. If one is not physically strong then one is at the bottom of the pile. There are some men who are not physically strong but they have the organisational skills to get some other person to do the physical intimidation for them. These people are also at the top of the pile.

Females do not posses the physical strength and just don’t seem to have that innate aggressiveness to be able to intimidate and threaten other males when necessary. Thus one finds very few female drug dealers. However women do have other wily ways to make an impact.

In order to get a regular drug supply some women will become partners of men who deal drugs. They will support them in their dealing but tend to sit on the sidelines of the criminal organisation. To a female regular drug user a male who is a dealer is very attractive for the reasons I just cited. I am not suggesting that she purposely sets out to ‘trap’ him but she will be attracted to him and thus the relationship can develop from that basis.



She also is in a ‘safer’ position when the inevitable drug bust happens because she is on the sidelines of the organisation. When questioned she can say that she was not directly involved and just a passive observer from the sidelines. Not uncommonly the man who loves her will support her in this claim to the police.

So back to the coronial inquiry of the 21 year old woman who was supplied with drugs by her boyfriend. If he did supply them how active was she involved in that process and how actively was she involved in his alleged drug dealing from the sidelines? We will never know I would say.

Graffiti

Well another ANZAC day has come and gone. ANZAC is an acronym for Australian and New Zealand Army Corps. It is the day when Australian’s honour the men and women who have been soldiers and fought in wars against our enemies such that we can enjoy the freedoms we possess now. For instance both my father and my grandfather we in the armed forces. My grandfather was a doctor in the army and my father was an able bodied seaman in the navy during the second world war.

I have great gratitude to both of them and all the others who have served in various wars. I almost went to war but I was just a bit to young (fortunately) to end up in Vietnam. I did do cadets at school where young men from private schools are first introduced to the armed forces.



So what do I think about ANZAC day just gone? I recall in my 20s when the night before ANZAC day came around some people, usually younger people would in the dark of night sneak up to war memorials and write things. Slogans such as “Men’s wars rape women” and “ANZAC day glorifies war”. For many a year now this has not happened which is probably a statement about our younger generation. They have no interest at all in challenging society’s values, but that is for another post.

So does ANZAC day glorify war? I don’t tend to agree with that but with the Australian entrepreneurial spirit alive and well ANZAC day certainly has been commercialised. It is good to see the soldiers get their opportunity to march in the parades and many people come out to applaud them and basically say than you. I watch those on TV and it is great to see the men and women marching along with their medals and all. These finish by the middle of the day and then comes the commerce. Does this cheapen the ANZAC soldiers and what they did?



One of the most obvious ways it is commercialised is with sport. Many different sports are played on this national holiday but mainly with football and the AFL (Australian Football League). Without a doubt they have cashed in on the ANZAC spirit and have their ANZAC day block buster games.

Before each game both sides line up on the field facing each other and a bugler plays the last post. How many times did I hear the last post being played on TV and radio yesterday!! It became monotonous and certainly after hearing it a number of time it looses its impact and what it is supposed to represent. So in this way to my mind it does cheapen what the ANZACS are. Maybe have it played once but not over and over.

Also there are the comparisons drawn between ANZACS fighting wars and the battle of two football teams that is used endlessly in promotional advertising. For heaven’s sake it is just a game of football! So in this way I would not say that ANZAC day glorifies war but it has commercialised war one could say.

There is one other thing that is noticeable by its absence. You never see images like this anywhere on ANZAC day.



Well I never saw any. For some reason images like this get no public display. It seems reasonable to argue that they should because this is what war is about, killing people. Many of the soldiers who marched in the ANZAC day marches did precisely that, kill people. My father and grandfather were involved in the system that killed people.

This is never or rarely mentioned on ANZAC day. Why? Well firstly the AFL are never going to show images like this because it would not be good for business at all! Why would it not be good for business? Because people don’t like seeing such images. It makes them feel bad.

For some months I have been counselling a US marine who served in Iraq and was involved in direct combat with the enemy. He says that he gets very offended when people ask him (which they do) if he ever killed any one (which he did). He says that it feels like he is being asked if he has ever fucked his sister. He finds it that offensive and now of course he finds himself that offensive and such questions remind him of that.

So what we humans inevitably do when we are confronted with such images (facts about war) is we sanitise them. We all know war exists and we all know that this means many people are horribly killed like the man in the picture above. But our Child ego state does all sorts of tricky things so we can kind of believe that some how, sort of, kind of, it does not really happen. This is an inevitable psychological process and I would see that we have constructed ANZAC day in such a way that it allows us to sanitise war to ourselves. We can kind of, sort of start to think war is really just like a game of football.


A great footballer or a great warrior?

So I would not say that ANZAC day glorifies war but it does sanitise war. It allows us to honour and thank the soldiers but without experiencing the horror of war.

Graffiti

Happy birthday to you,
Happy birthday to you,
Happy birthday dear Kahless,
Happy birthday to you



Graffiti

Roses says:

“But aren't we supposed to be in Adult ego most of the time? Isn't that when we're able to be objective and logical; matter-of-fact type thing?” (end quote)

Well that is so Roses,

Transactional Analysis theory says that it is best to have the Adult in executive control of the personality. This means that all the Parent ego state and Child ego state thoughts and feelings are under the control of the Adult ego state.

So any interactions the person has with the others comes from the Adult ego state that has understood and tempered the machinations and irrationality of those two other ego states. The person has made a considered decision on what is the best course of action to take and their decision is not overwhelmed by Child or Parent urges and thoughts.


An example of the Child ego state getting expressed without Adult control. His Adult is probably unaware he is doing it and thus does not have control over the Child ego state



This is one of the many ways that Transactional Analysis and CBT are similar. CBT does the same. Both systems assume that rationality is the healthy psychological state. The psyche that is dominated by the Adult ego state is defined as the state of psychological health.

To my mind in some ways this is a very dubious assumption. We are all born with a Parent and Child ego state that at times are irrational in some way. So Adult control of them could be seen as Adult ego state repression of them. They are not allowed free and unfettered expression. If this is so then an Adult dominated personality is not a healthy state because it involves the defence mechanism of repression dominating the personality.

I have recently put together another article from my blog posts that is to go onto my website, although it is not there yet as my website guy is away, but it should be there shortly. It is titled, “Siblings - rivalry and jealousy”.



In it I state:

“What is being presented here is that jealousy and sibling rivalry are normal emotions for children to experience during childhood. In contrast to this much of the psychological literature on jealousy presents it as a bad emotion that needs to be avoided. Indeed envy is counted as one of the seven deadly sins and of course envy and jealousy are largely interchangeable terms. There are many program and techniques which describe how to over come your jealousy and descriptions of how parents can seek to avoid their children becoming jealous. To my mind this is erroneous and misses the significant psychological growth that can be gained from jealousy.” (end quote)

To restate this relevant to this blog post. The many programs around that work to stop feelings like jealousy basically are seen to assist the person to get Adult control over that emotion. If that happens then one basically thinks the emotions away. And this is one of my main criticisms of CBT and the Adult ego state dominated personality. Feelings are thought away and not expressed. To my mind this is a dangerous thing to do if used consistently over time.

Humans are naturally irrational at times and this irrationally needs to be allowed to be expressed or one is repressing a significant part of the personality.

The first diagram shows how the theory says it should work.



1. The husband says or does something
2. The wife listens to what her Parent ego state says about what hubby said
3. The wife listens to what her Child ego state says about what hubby said
4. Her Adult then makes a decision based on the first three transactions on how to respond. In this instance she responds from her Adult but she could also decide to respond from her Child or Parent

In the second diagram



1. The husband says or does something
2. The wife makes a spontaneous response from her Parent with out consulting the Adult
3. The wife makes a spontaneous response from her Child with out consulting the Adult

TA and CBT theory really do not like the second diagram and would define that as a state of psychological ill health. Indeed if one wanted to get sociological one would say that governments don’t like diagram two. Governments do not like their populations to act is such irrational (non Adult dominated) ways. So one could argue that this psychological theory is used in the service of keeping the powerful in power. However that is for another blog post.

I certainly see diagram 2 as healthy at least some of the time. The spontaneous undeliberated response is psychological health at least some of the time. Most people have a lot of trouble with this because it means surrendering to ones irrationality or emotions. It involves trusting self to a degree that most don’t. This is too frightening for most people and they will complain that they are loosing control, to which I will respond, ‘Yes you are”. An example of this may be when I ask my clients to have a panic attack in front of me.

Its like using mood stabilising drugs. What is wrong with having unstable mood some of the time at least to some degree. Diagram 1 is like a mood stabilising drug. It’s all about control of the personality and that is often over done in a society like Australia. This to my mind it is a pathological state.


Can this Free Child really happen if one has a personality that is dominated by the Adult executive? My answer is, no, as you loose that spontaneous free aspect.



Note to Roses. Do not say this in any of your TA assignments or you will probably get a big black mark. There are a lot of people who would disagree with what I have said here.


Implications for counselling
What the counsellor spends a good amount of their time doing is looking for the non-Adult dominated communications. Looking for the irrational communications that the client is making.

It seems safe to say that people’s verbal communications are going to be much more dominated by Adult than their non-verbal or body language communications. People will display their unconscious urges much more in their body language than in their verbal language.

I often find myself saying to trainee counsellors - Turn down the audio and turn up the video. That is listen less to what they have to say and listen more to they have to do. Stop listening and start watching because that allows one to avoid the Adult dominated communications.

In the picture above I am sure Prince Charles is speaking to the woman in a very appropriate and respectful manner. That is what his audio says. She also looks quite attractive and has a good rack which is what his video says. This is no criticism of him, he is just a member of the male gender of the human species. If males could get their Adult ego state down below their waist line more often the world would probably be a much simpler place.



So what is my point? Well by watching his video tells me all sorts of things. First it says that he is probably of a heterosexual orientation. So if you have a client who is saying that he thinks he may be homosexual and then is displaying such video then that is incongruent.

In counselling I say watch the hands and the feet. These extremities often seem to display the Child, non-Adult dominated communications. Hence one can see why I assert that approaches that define rationality and the Adult exectutive in the personality as healthy use the defence mechanism of repression. This is why I would say it is not a healthy state but a pathological state.

Graffiti

KazzaB states about the previous post:

"I loved reading about the german women. What was the reaction from the other people around the pool? I think that's wonderful and something I'd love to aspire to. To not feel self conscious and just accept yourself as you are is a real gift”



There would have been three reactions from all the others at the pool KazzaB

One third would have responded from their Child ego state: I know that as I watched them I was interested and curious from an anatomical point of view because I never get to see a body like that without it being almost completely covered up. What does the body do with all that fat and extra weight? Where and how does it put it on the body?

One third would have responded from their Adult ego state: These people would have observed and viewed them and maybe asked a question like, “Is that a cultural thing where over weight German women can display their bodies like that?”

One third would have responded from their Parent ego state: “Look at those fat women, they are disgusting and should be ashamed of themselves. They are obviously weak willed and should go on a diet”.



That’s it KazzaB. There is always going to be those three responses. Obviously the Parent ego state response is the most contentious one. You can get laws changed where one can’t make discriminatory statements about over weight people. But you can never stop people thinking and feeling Parent ego state responses.

This is where I think most political groups fail. The “Fat is good” political force in society stands up for their rights and get laws changed that say you can’t poke fun at fat people and so forth. To my mind they also need to openly acknowledge that people will always have a Parent ego state and that means that some of them will always think derogatory and discriminatory thoughts. Those can never be stopped and this needs to be openly stated.



Those German women would know that. That some of the people watching them pool side would be thinking that they are fat and ugly. Somehow they have their own internal thinking structured such that it does not modify their behaviour or their perception of self (I assume).

Part of that would be an acceptance of self. That is they are focusing on self and not others. The question is not - “Do they think I am fat and ugly?” instead it is - “Do I think I am fat and ugly?” And it is in this way that the political groups are actually bad psychologically for the over weight people. The political groups are focussed on changing others. Their focus is on how others behave which to my mind is the wrong thing to do. It is not about focussing on self it is about changing others.

This is what I like about the Pro-ana groups. Whilst they do give out unfortunate advice to teenage girls on loosing weight and so forth, it is a self focussed approach. It says to the girls “I live the anorexic lifestyle and that is (I am) OK”. They are not trying to change others.



That is why I like the last sentence in your comment KazzaB, about the self acceptance. We always know how others will react. One third will be from Child, one third will be from Adult and one third will be from Parent. But that focusses on them and not on what I think and feel.

Graffiti

Last night I went with a few friends to the Mustang bar. Doesn’t that sound cool. Said in a very nasal way the “Mus-Taaang Baaar”. I have been to a few bars in my time but never the Mustang bar before. With today (Monday) being a bank holiday (as Kahless calls it) it was going to be a good Sunday night out at the bar with my cohorts.

I went there all ready to have a go on the mechanical bucking bronco in the corner and line dancing with a group of men wearing oversized hats. But when I got there I discovered it was not “Mustang” as in cowboys but Mustang as in the mustang car, sleek and fast! The place was full of the trendy set with fast women and men having a mid life crisis. The kind of place where women go looking for men with money and men with money go looking for women who are looking for men with money. Which ruled me out for getting lucky that evening.



Kind of tragic really. Most of them would have been much better off dressed in their pyjamas and sitting at home in front of the TV. But I ended up having a grand time indeed. There was one other thing I noticed at the Mustang bar. There would not have been one real boob in the entire place and the botox had been flowing like the Amazon river. It was a plastic surgeons showcase!

Now I actually have no problem with plastic surgery. In the psychotherapy business it is kind of frowned upon and that the person who gets the fat sucked out of their thighs or their buttocks raised a few centimetres must be neurotic.

I don’t agree with that even though I do understand the logic behind it. Yes there are people who feel self hatred and think that if I change this and that physically then I will feel better about myself. Of course it does not stop the self hatred. Then there is the 20 year old young woman who wants to have a boob job and that probably is not such a good idea.


Physical beauty

Many years ago I was holidaying in Bali and was staying in one of those huge super duper hotels where the swimming pool is as big as a medium sized lake. The regulars go down every day and spend it lying by the pool, drinking beer and eating peanuts and chips. On this holiday there were three German women who were regulars by the pool. I know they were German because I eaves dropped in on them and picked up the vernacular.

Now these ladies were big ladies and I mean big. They also all wore very small bikinis. So there was a lot of flesh to be seen and there were many rolls of fat on display. But the thing was they could not have cared less. They would strut around the pool area and not give a damn. They did not try and hide themselves or look around at who might be watching or comparing them self to anyone else as far as I could tell. They talked and laughed loudly and they continually ate and drank whilst relaxing pool side. Then there were the other women who had obviously been living on carrot sticks and lettuce leaves for the past 10 years who were obviously very body conscious. They would dash as quickly as they could from their “loll-about” seat into the water so no one could see them.

I had much admiration for those three German women and this is what the psychotherapy set would see as good. That individual who accepts self as they are and is not trying to transform into something else. Which is a bit odd really as psychotherapy is all about change, but it is also about self acceptance as well.



That is the logic behind why getting plastic surgery can be seen as a neurotic act. It is a dramatic display of a non-acceptance of self. But I that really true? I had a colleague who was also a very good friend for many years. She was physically quite attractive. She was a good looking woman and she also had one very large “honker”, which is an Australian term for nose.

She would come to me and we had many a discussion about should she have rhinoplasty. Now that is a really bad name to call it and they must change the name, pleeese! Here is this kind woman with a large nose talking about maybe having surgery which is called rhinoplasty. Which obviously comes from the word rhinoceros. For heaves sake it is saying she looks like a rhinoceros!



I would always tell her to go for it and get the nose job. Eventually she did and from what I saw if anything she benefited from it psychologically. So there maybe some women who do benefit from plastic surgery, physically and emotionally. So if a woman wants to get a boob job, go for it I say!

Graffiti

Myalterego asks in a recent post of hers:
“Is there a rule that therapists should never apologise?”

In my involvement in counselling and psychotherapy over the past 25 years I have never heard such a rule being stated. I know that I have and do apologise to clients when necessary. I see nothing wrong with it. It certainly is not often that I have felt the need to apologise but I have done so.


Did Bill ever apologise for his errant ways?



What have I apologised for in the past? Most often it would be a practical thing like a mix up in appointments that was my fault. However I can recall some times when a patient has protested that my comments to them have been unfair or uncalled for in some way. I have gone away and thought about it and may have even spoken to someone about it. In the next session I have apologised to the client and that I agree with them that my comments were unfair or unnecessary.

Myalterego asks in a recent post of hers:
“Is there a rule in therapy that it (apologising) undermines authority/transference/focus on the patient to apologise?”

I think if anything it would enhance the transference relationship and the relational contact. If a therapist apologises to a client, to me that shows a respect for the client as a person and an acknowledgement to the client that the therapist is realistic about them self as a person and a clinician.


Sometimes it is difficult to remain realistic about ones self.



Every body stuffs at some time and of course than includes therapists when they are working. Every body knows this including the patients. So if a therapist never apologies or acknowledges they have erred what does that say to the patient about the therapist. It is certainly not going to add to the client's sense of trust in the therapist as a person or a practitioner

Myalterego asks in a recent post of hers:
“Is any problem always the patient’s pathology?”

My answer is, No. In any relationship therapeutic or otherwise, both parties sooner or later contribute to the relationship difficulties in some way. This also begs the question as to why a therapist would refuse to apologise to a client. Off the top of my head I have come up with a short list.
1. The therapist has a need to be seen as perfect and idealised by the client.
2. There is some kind of personal insecurity in the therapist. “If I admit to the client a failing of mine then they will see I am incompetent, a fake, etc just like mother told me I was”
3. They have power issues, so if they apologise then they have a sense of a loss of power in the relationship.
4. They simply lack the art of introspection. This is typified in personalities like the narcissist, hysteric and the paranoid. They are not ‘able’ to see their own contributions or failings and thus it is always the ‘fault’ of the other person.
5. The person is angry. I think it is safe to say that when someone is angry at another then they are far less likely to apologise than if they were not angry.


Sometimes therapists get self centered and narcissistic like when they are idealized over time.



Sometimes however it is a very difficult judgement call for the therapist. I recall being at a week long training event where I was one of the five leaders and there would have been 30 to 40 participants. At one point I was doing therapy with a woman who I knew well and she stated that I was being too harsh on her and that I should stop being so. I felt that I was not and so I continued as I had been. She cried and so forth and after the work when there was discussion there was about 90% of the group agreeing with her and in essence saying that I should apologise to her. I still didn't but I came under great continued pressure to do so over the next few days. I certainly considered what I was doing with her many times in the next few days but decided that this was the approach required at that time. After the week ended she continued in her individual treatment with me and as it turned out it was a major turning point in her therapy with me. She saw me being able to stand up to all that pressure and thus her level of trust in me was enhanced considerably.


Finally it seems cogent at this point to highlight another aspect of conflict and disagreements in relationships which of course is most often when apologies are necessary. Humans are great at getting into relationship and awful at getting out of them. This can of course apply to therapeutic relationships as well.

If two people disagree and believe they are right and that the other should apologise what is most likely to happen? The will move away from each other and not see each other again. So if two people are in a relationship, have an attachment but are tired of the relationship one way to get out is to have a disagreement or some kind of dispute. Of course the content of the dispute is irrelevant but instead it is just a means by which both parties can finally get out of the relationship.


Human relationships. Easy to start and hard to stop.




One other thing needs to be said about the therapeutic relationship that makes it different to many other relationships. One would hope that a therapeutic relationship does not end with a dispute of some kind. Where either the client refuses to attend again or the therapists refuses to see the client again. If this happens then it probably breaks the golden rule.

What is the golden rule? The most important factor in the termination phase of counselling, is that the client does not leave the therapeutic relationship in the same old self defeating relationship patterns that they have done so before.

If the relationship ends in a dispute then it is quite likely that the patient has left the relationship in some kind of script reinforcing manner. It is incumbent upon the therapist to do all they can to not let this happen. It is far less incumbent on the client in this way.

If the therapeutic relationship terminates without any hostilities then the client probably has been able to avoid using the end of that relationship to further their life script.

Graffiti

Escape hatches and the suicidal

As far as I know the term “Escape hatch” and its relationship to the suicidal was coined by a man called Bill Holloway who wrote a number of unpublished monographs in the early 1970s. These were on a variety of topics one being the area of suicide and its management. After that a man called Harry Boyd picked up the term and wrote more about it in the late 1970s. I have not seen the term ‘escape hatch’ and the suicidal being used since that time.



The term escape hatch is an intersting one and a very apt choice by Holloway. An escape hatch is usually a good thing. It provides a way to get away from danger or bad things. Most people would like to have an escape hatch as it would make them feel safer and more comforatbale and indeed better able to deal with any current dificulties. The individual can think,”As I have an escape hatch that means I can always get away and cannot get cornered”. If they know this then they will deal better with what they are currently involved with day to day.

However the way it is used by Boyd and Holloway is in a negative frame of reference. They see it as necessary to close the suicide escape hatch. They acknowledge that suicide can be seen as an escape hatch that alows one to escape from very undesirable stress, feelings of depression and so forth. Of course they see suicide as a very poor method of escape. They would suggest other means by which the person escape from the emotional pain. A commonly held view I think it is safe to say.



Suicide as a solution.
Inherent in the concept of suicide as an escape hatch is the idea that suicide is a solution to a problem. There are some who don’t like this idea at all and will argue vehemently that suicide is not a solution. They may argue that suicide does not solve problems because the person is dead and therefore has no knowledge of the problem being solved.

If suicide is seen as an escape hatch then that implies that the person is escaping from something such as their problems. This is a view that I agree with in part and that suicide does solve problems in the sense that if the person is faced with divorce, then dies, thus he does not have to face it. So in this sense the problem is solved.

Those who work with the suicidal would most often see closing the suicide escape hatch as a worthwhile thing. I would suggest that this is so as well but needs to be considered in another light as well. It is not as simple as it seems. It also shows another dimension or factor that must be taken into account when working with the suicidal patient.

As I mentioned above most people would see an escape hatch as a positive thing. Below are two examples of the suicidal escape hatch and one way in which it can be a positive psychological function.



Louise in discussing the option of killing herself:

“Having the option there in the back of my head actually serves to help me. It doesn't help once the danger is more immediate. When it starts making messes. But on a day to day basis it is nice.”

“It helps with the more minor bad things like 'yes this situation is bad, but it's not quite bad enough to kill myself over, which if it does get worse is an option.'

Most of the time I have a method picked out. I'm very protective of the method of the moment. I feel like sharing it corrupts it.
There have been times where I felt my method had been corrupted or somehow made unusable. And it immediately has pushed me into a depression, often times making me want to die more. I've had times where I became suicidal because I felt my option to kill myself was ruined. Feeling that option is taken away from me makes everything feel like it is crumbling around me.
It's such a strongheld belief that I will kill myself eventually, I just don't know when. It might be at 90. It might be at 25. A threat to that belief I have trouble handling

I visualize the method in my head a lot though during times of stress. It's soothing”
(end quote)


Soothing? One of the most basic tasks of the developing child. Learning how to self soothe.




Marissa in describing what she does at home sometimes:

Sits in a chair in her lounge room and can see the drawer in her kitchen that has many pills in it. It gives her a sense of security or relief somehow. She reports that the pills give her a sense of security for whenever everything just gets too bad.

She imagines putting the pills into little piles and taking one and then two and so forth. She has created a ritualised suicidal fantasy that gives her a sense of solace and relief because it reminds her that she has an escape hatch should she require it one day.

Marissa states:
“The pills are a comfort because they give me a sense of choice when I am in that place.”

“What happens when those pills beckon me?
When my eyes go back to the drawer time after time
What do I imagine when I'm staring at it
Thinking about the pills inside
And the oblivion they could bring to my mind”
(end quote)

Clinical implications
First one needs to be clinically aware that closing the suicide escape hatch can in fact make the situation worse. In such circumstances the client needs to be able to see other ways of easing the pain (alternative escape hatches) before the therapist suggests closing the suicide escape hatch. If one is using the closing escape hatch approach as suggested by Harry Boyd one would need to monitor closely the client’s reaction to that over the next week or two.

If one is suggesting a no suicide contract then the therapist must be clear to the client that the NSC is not closing an escape hatch, all it does is delay the person taking the escape hatch for a certain period of time. It may in fact be a good way of monitoring how much the individual sees alternative escape hatches as viable options.



Secondly, as the case examples show the suicide escape hatch can provide some positive feelings to the Child ego state. This means that if a therapist is working with a suicidal client so they no longer have suicide as an option then they are taking away something that feels good to the Child. Hence we end up with a Parent contract. So the therapist has to deal with a Parent ego state contract contained within the treatment plan for the client to cease being suicidal.

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References:

Holloway, W.H.
“Shut the Escape Hatch” in The mongraph series. 1973. Midwest Institute: Ohio.

Boyd, H.S. & Cowles-Boyd, L.
“blocking tragic scripts”. Transactional Analysis Journal, 1980, 10(3), 227 - 229.

Cyberfriend asks:

“I guess the circumstances triggered the dont exist injunction to be acted upon.

But what can determine the when?”
(end quote)




That is a very Gordian question my pommy friend. Why a person would act on the Don’t exist injunction at one point and not at another? As is hypothesised people most often will make these early decisions like the Don’t exist decision within the first 6 years of life and then it remains in their psyche and only becomes ‘operational’ when certain conditions in life arise. They have decided that suicide is a viable solution to certain life events.

One way to answer your question is to look at the different form the Don’t exist decision can take. Seven alternative suicidal decisions have been proposed:

1. If you don’t change I will kill myself
2. If things get too bad I will kill myself
3. I will show you even if it kills me
4. I will get you to kill me
5. I will kill myself by accident
6. I will almost die (over and over) to get you to love me
7. I will kill myself to hurt you.


If one finds they belong no where that may activate the Don't exist decision



These give some idea as to the life circumstances that a person will need to have before acting on their internalised Don’t exist injunction. For instance with number two decision we find that person known as the share market simpleton. This person has taken great risks in shares and now they have lost everything and this could be in their mind when - things get too bad - and thus they will act on the Don’t exist injunction.

With such people one would be questioning them on what - “If things get too bad” - means. It may be related to the loss of money, or marriage or even their reputation. Once you have identified this then you can begin to understand and make predictions about when this person will act on their Don’t exist injunction.

One could take decision number five - “I will kill myself by accident”. Enquiry into the individual’s life on what they are doing that is risky and then looking at any Child ego state magical thinking around the risks they are taking. This will again allow one to make predictions about when this person will carry out their suicidal decision.


This mother made a smart decision




Suicide decision four - “I will get you to kill me” - sometimes happens in domestic violence situations. Alternatively people on death row can have made this type of Don’t exist decision early on in life.

Decision three - “I will show you even if it kills me” - is sort of suicide from a rebellious position. In this situation one would be seeking information about the person’s current relationships and finding out who and what they would want to ‘show’. Once the information is elicited then one again is more capable of answering the question that Cyberfriend asked - How does one determine when a person will act on their Don’t exist injunction?

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Cyberfriend makes note of an instance of self harm and suicide

“The person I discussed here...

The self harm rapidly escalated
He put his partner in hospital (she was lucky not to be killed by him)
He was imprisoned on remand,
a week later (the day after coming off suicide watch) he hung himself.

I still think him stabbing himself was manipulation,
not sure whether hanging himself was.

Though in honesty he did his partner a favour,
as she in now safe and doesnt need to go into hiding.

So how does his original self harm fit within your categories?”
(end quote)



Suicide and self harm are two completely different psychological processes although often the layman puts them together.

Having said that one can have three groups:
Those who are suicidal and not self harming
Those who are self harming and not suicidal
Those who are both suicidal and self harming

So some people will have both but they still involve quite different psychological motivations

The truly suicidal individual has the definitive feature of having a Don’t exist injunction. This is the psychological process that makes for the ‘true’ suicidal person. A message they have in their head, that for some reason they, others or the world would be better off if they were dead.



Self harming has nothing to do with the Don’t exist injunction. Instead it serves other psychological functions such as I showed in my original list:

1. Gang behaviour tattooing type of self harm
2. To make self feel real. Dissociation, detached from reality. Cutting closes the gap.
3. To make self feel something. No feelings at all just numb
4. Tension relief and pressure stress build up
5. Physical expression of emotional pain. Cutting provides concrete evidence of pain
6. Cutting as self nurturing. Allows caring of self. Munchausen Syndrome
7. Self punishment and self hate
8. Manipulation and to get attention

None of this includes a Don’t exist injunction nor is it about attempting to kill self. Instead the self harm is being done for alternative reasons as I have listed.



However there are people who do make suicidal statements and gestures who are not suicidal. These people are not suicidal as it is never their goal to kill self and they do not have a Don’t exist injunction. If they do die by their own hand then it is an accident not a suicide as their intent was not to kill self. Some make these gestures for manipulation of some kind. So people can use both self harm and suicidal gestures for manipulative reasons.

Regarding the person you described who was on remand in prison I can make some guesses as I did work in a prison where I ran the suicide watch programme for three years. Those who are making suicidal gestures for manipulative reasons are usually seeking to get onto suicide watch and mostly are not the truely suicidal person.



The inmate you describe was on suicide watch. He must have then made all the right noises and behaviours to appear to be not at current risk and then he is taken off suicide watch. The next day he completes a suicide by hanging in a prison which is usually not an easy thing to do. So he must have done some prior planning which means he probably made a decision to kill self days before and then simply played out all the necessary moves and completed his goal.

This has all the hallmarks of the truly suicidal person who has a Don’t exist injunction. So it is unlikely that it was a suicidal gesture to manipulate the system in some way. This means he falls into the group that are both suicidal and self harming.

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