“I see a lot of people during the lockdown finding isolation more positive than negative in the sense that they want to have space of their own. Again, the socio-economic factors have to be recognised here. For most people in the world, a lockdown doesn’t mean being on your own because you are in a small place with a lot of other people. You might be living in one room with your family or people that you work with, so it’s only a privilege for some to be able to retreat. In terms of my practice, though, a lot of people say they find the lockdown a great relief.”
CFAR IN ASSOCIATION WITH BRISTOL UNIVERSITY 2018/2019
Ego, Ideal, Superego
Four public seminars on the theme of Ego, Ideal and Superego will take place throughout the year. No prior knowledge of Lacan is assumed and the seminars will all include clinical examples involving the kind of problems and questions common to diverse currents in contemporary psychoanalysis and psychotherapy.
Saturday, June 22, 2019 – DARIAN LEADER – Psychoanalyst
Ego-Ideal-Superego: what can we hope for?
After distinguishing the concepts of ego, ideal and superego, we ask the question of how these can be changed – or not – during an analysis. Is the ego diminished or even abolished? Can the Ideal be challenged or displaced? And does the superego become harsher or less punitive?
Attendance Fee: £15; students £10; staff and students at Bristol University free admittance.
Venue: Merchant Ventures Building, Room 1.11, Woodland Road, Bristol BS8 1UB
Time: 10.00 am – 12.00 midday. Registration: 9.30am on the day
Please address enquiries to
Elizabeth O’Loughlin at firstname.lastname@example.org
Jill Brown at email@example.com
Kurt Lampe at firstname.lastname@example.org
In the 1950s, researchers at Edinburgh University conducting a study into sleep concluded that there was little difference in sleep time between using a well-sprung mattress and a wooden board. Try telling that to retailers of £500 multilayered mattresses. For sleep, as the psychoanalyst Darian Leader reminds us in his richly researched and entertaining Why Can’t We Sleep?, has been commodified: it’s big business.
Before advancing reasons for insomnia, and why one in three adults complains of sleep difficulties, Leader delves into the history of sleep research and competing theories about why we sleep, which have culminated in a remarkable inversion of concern: a shift from anxiety causing problems with sleep to the present, where the lack of sleep leads to anxiety.
Some judgments, though, have resisted change. In the 1960s the eight-hour “ideal” sleep was shown by the researcher William Dement to be a “fallacy”, yet today, argues Leader, sleep experts promote eight hours as the desired gold standard – almost as a human right.
Leader rolls his eyes at the zeitgeist of the “new science of sleep”, with its notions of sleep as a self-help curative for ailments ranging from dementia to unhappiness, all achievable “with sensitive temperature control and software that will tailor the environment to their unique circadian rhythm”.
There’s no consensus on the point of sleep. But there is agreement that it is a time for the processing of memories internal body clocks’ association with sleep cycles have long been recognised, but sleep wasn’t always undertaken in one unbroken block. The historian Roger Ekirch argued that prior to the 19th century sleep was biphasic – taken in two parts with an hour or so in between when the person was awake.
With the Industrial Revolution, maintaining nonstop production lines necessitated shift work and changes to patterns of sleep. Today, businesses’ co-option of sleep in enhancing productivity is illustrated by firms such as Aetna offering $25-per-night rewards to employees (monitored via sleep trackers) who manage 20 nights of sleep for seven hours or more in a row.
Goal-oriented sleep research becomes problematic when it approximates the maxim: “What the thinker thinks the prover proves.” We might be inclined to look more closely at conclusions drawn by Nathaniel Kleitman’s classic 1939 study Sleep and Wakefulness, says Leader, when made aware that his university research “was heavily funded by corporate sponsors keen to engineer more productive workers”.
Leader also questions the value of extrapolating into the real world conclusions drawn from experiments carried out in unnatural environments. Contemplating the validity of experiments with patients isolated overnight in sleep clinics using EEG, he observes: ‘They don’t have sex with a bedfellow or masturbate, and yet this entirely artificial subject is the one we expect to give the real facts about sleep.”
Darian Leader is speaking in Bristol at the CFAR/Bristol University Lecture Series on the 22nd of June 2019.
Carina Hakansson speaks about the groundbreaking ‘Open Dialogue Approach’ to the in-patient treatment of psychosis in Sweden. [Click here to view the talk on YouTube]
If the postwar age of anxiety was supposed to have ended 30 or 40 years ago, a swath of media articles now suggest a dramatic comeback. A new and widely reported study claims a massive increase in anxiety disorders in the UK, with an estimated 8.2 million sufferers compared to 2.3 million in 2007. The pressures of modern life, we are told, must play a large part here, with job stress aggravating the difficulties of urban populations.
The focus on socio-economic conditions is surely a good thing. In the 1980s, Thatcherism encouraged a redrafting of work-related problems as psychological ones. As each person became a unit of economic competition, it wasn’t the market’s fault if they didn’t get a job but their own. Injustice in the marketplace was glossed over as individual failure.
Hundreds of books and articles have questioned this without gaining media exposure, so why the visibility of the new research? I was puzzled to find not a single sentence in the report linking the supposed increase in anxiety to social causes. In fact, there was no explanation at all, and the headline-grabbing prevalence rate for the UK was estimated from Iceland, Norway and Switzerland.
Here, we find a perfect expression of the new mental hygiene movement. Anxiety is grouped together with dementia, stroke and neuromuscular conditions as a “brain disorder”, and the authors urge an approach that uses “comparable methodologies for both mental and neurological illness”. Disorders are listed in terms of their cost to the economy rather than to individual lives, families and communities. […]
Strictly Bipolar is Darian Leader’s treatise on the psychological disorder of our times.If the post-war period was called the ‘Age of Anxiety’ and the 1980s and ’90s the ‘Antidepressant Era’, we now live in Bipolar times. Mood-stabilising medication is routinely prescribed to adults and children alike, with child prescriptions this decade increasing by 400% and overall diagnoses by 4000%. What could explain this explosion of bipolarity? Is it a legitimate diagnosis or the result of Big Pharma marketing?
Exploring these questions, Darian Leader challenges the rise of ‘bipolar’ as a catch-all solution to complex problems, and argues that we need to rethink the highs and lows of mania and depression. What, he asks, do these experiences have to do with love, guilt and rage? Why the spending sprees and the intense feeling of connection with the world? Why the confidence, the self-esteem and the sense of a bright future that can so swiftly turn into despair and dejection? Only by looking at these questions in a new way will we be able to understand and help the person caught between feelings that can be so terrifying and so exhilarating, so life-affirming yet also so lethal.
Meaning has been stripped from the diagnostic enterprise, in favour of pure external classification.
Clinicians who want to pursue a dialogue here find that they are allocated less and less time with their patients by a bureaucratic and managerial healthcare system. The tragedy is that this deprives us of having any authentic understanding of the symptom, and it introduces a rigid, normative vision of human behaviour. We can know what is a disorder, and what isn’t, without listening to what the person has to say.
Yet nail biting might be a totally irrelevant detail for one person, a terrible curse or a pleasurable habit for another. Classifying such behaviour externally as a symptom, without taking into account what it means to that person, is profoundly inhuman. It is yet another vehicle for imperatives telling us how we should live and how we shouldn’t.
Discussion this week about appalling cuts to mental health services focused on the diagnostic categories “depression” and “anxiety”. Though there are good reasons to question and critique the use of these terms, they have drawn attention away from a major redrafting of diagnostic and prescription trends. While it is claimed that up to one in four people will suffer from depression at some point, over 25% of these subjects are now likely to receive a diagnosis not of depression but of bipolar disorder.
In the early 20th century the prevalence of manic depression was put at less than 1% of the population, but this figure exploded with the ramification of the bipolar categories. If bipolar 1 was often equated with classical manic depression, bipolar 2 lowered the threshold dramatically, requiring merely one depressive episode and one period of increased productivity, inflated self-esteem and reduced need for sleep.
Bipolar 2 and a half, 3, 3 and a half, 4, 5 and 6 soon followed. Today there is even “soft bipolar”, which means a patient “responds strongly to losses”. The World Health Organisation deems bipolar the sixth main cause of disability for people aged 15-44. In children, the diagnosis has increased by over 400%.
Historians of psychiatry have all made the same observation: it was precisely when patents ran out on the big-selling tricyclic antidepressants in the mid-90s that bipolar suddenly became the recipient of Big Pharma marketing budgets. Websites helped people to diagnose themselves; articles and supplements appeared all referring to bipolar as if it were a fact; and nearly all of these were funded by the industry.
Dr. David Healy, a psychiatrist at the University of Cardiff and a vocal critic of his profession’s overselling of psychiatric drugs, has achieved a rare kind of scientific celebrity: he is internationally known as both a scholar and a pariah.
In 1997 he established himself as a leading historian of modern psychiatry with the book “The Antidepressant Era.” Around the same time, he became more prominent for insisting in news media interviews and scientific papers that antidepressants could increase the risk of suicide, an unpopular position among his psychiatric colleagues, most of whom denied any link. By 2004, British and American drug regulators, responding in part to Dr. Healy and other critics, issued strong warnings that the drugs could cause suicidal thinking and behavior in some children and adolescents.
But Dr. Healy went still further, accusing academic psychiatry of being complicit, wittingly or not, with the pharmaceutical industry in portraying many drugs as more effective and safer than the data showed.
He regularly gets invitations to lecture around the world. But virtually none of his colleagues publicly take his side, at least not in North America.