by Tom Cutler
Word Prisons — Having rules about how you or others ‘should’ or ‘must’ behave, and making judgements based on these rules.
I responded like this:
It’s not being in a prison to have rules about how you should behave. It is the guiding principle of every religion, all lawmaking, and all moral philosophy, from the school playground to a G20 summit. I don’t need this mumbo jumbo from the Nutty Professor.
In one diary entry, I wrote:
After looking at the SunBurst site I actually feel worse than I felt beforehand. Surely this can’t be the point.
In due course, Lulu replied:
Hi Tom, If you find that your difficulties with the website continue would you prefer to be on the waiting list and not engaging with the online therapy?
I took a deep breath and counted to ten, which I suppose is the plain man’s cognitive behaviour therapy from the time before cognitive behaviour therapy. Lulu’s suggestion that I stop using SunBurst felt like constructive dismissal to me. Had she waded beyond her depth?
*
I am sometimes accused of being overly critical. Cognitive behaviourists have a name for this so-called ‘focus on the negative’: they call it the ‘mental filter’, the idea being that you dismiss or ‘filter out’ the positive in your life and ‘filter in’ only the negative. This is said to be bad. But surely alertness to error, weakness, and flimflam can be a useful quality. My fault-spotting has always been one of the handiest tools in my work.
I remember a particular occasion from my early days in the publishing industry when we were preparing to publish a book that was to be manufactured using several elaborate techniques: special acetates, extra colours and varnishes, foils, laminates, and fancy embossing. The designer and I had to go to the print works to proof the job on press, which means viewing the first samples of each printed sheet — every one of which contains numerous pages, half of them upside-down — and adjusting the colours and whatnot before the machines are run up to speed. The print company had put us in a room with a window overlooking the print floor. Here they had made available comfy sofas, coffee, and cakes, and a vast viewing station for inspecting the inky-smelling sheets as they came off the press.
The designer and the print director were bent over a sheet, paying particular attention to registration and ink colour as I floated around, seemingly purposeless, glancing sidelong at the paper with my eyes lidded. Suddenly I noticed something.
‘You’ve lost an arrow on page 76,’ I said.
Page 76 contained an elaborate diagram featuring a series of small white arrows amid a riot of text, numbers, and coloured squares. Taking out a lens, my two assistants squinted at the tiny marks on the huge sheet, before lifting their heads and looking at me open-mouthed.
‘How in the name of God did you spot that?’ said the designer.
‘Upside-down,’ said the printer.
I couldn’t say how I’d done it. It had just leapt out at me like a face with a missing eye.
‘You’re a bit odd,’ said the designer, ‘but I’m glad you’re here.’
Like many writers, I am unsparingly critical not only of myself, but of everything around me. And it is this which I suppose CBT tries to change. I often have to button my lip at somebody’s slipshod cooking or a language error in a wedding invitation. But sometimes I speak up. This is a mistake. There is no good to be had from pointing out these things. I have had to learn that people do not want you constantly criticising them and underlining their weaknesses. A woman once told me, ‘You spoil everything.’ Maybe it was right for cognitive behaviour therapy to moderate fault-finding in everyday life.
However, the point of CBT is presumably not to make your clients feel worse than they do already, and I wondered whether therapy with a live human being would be any better than the website — was there really anything in it?
We were into February and I was restless and tense. Lea could tell, but she knew I wouldn’t speak about it. I was hardly being fair. Every morning as I examined the bedroom ceiling in the darkness, the knot in my stomach would tighten as I thought of the day to come. It was a struggle to write but I kept my nose to the grindstone.
Weeks passed with no news. By now, spring was on its way and I began to track the progress of the sea kale as it threw out its first shoots from under the barren shingle along the beach.
At the end of March, a letter arrived telling me that I had an appointment with somebody called Odette Pinard, Psychological Therapist in Primary Care (Cognitive Behavioural Therapist). I was asked to come along to the medical centre on 20 April — at the savage time of eight fifteen in the morning — bringing with me the enclosed questionnaire, which I should complete (underlined) with a record of my mood over the preceding week. I couldn’t help remembering that 20 April was Adolf Hitler’s birthday. I hoped it wasn’t a bad omen.
I jotted down a remark in my notebook, thinking that I might one day be able to write something about what was happening to me. Every writer cannibalises his own life, and everything is potential material.
Mon, 18 Apr. 2016
I’m going through a slightly mad phase again, but I’m booked in to see some CBT lady on Wednesday. Oh to be boringly normal.
The following recollections of what occurred from then on come in part from the few CBT session sheets which I have kept, and my diary notes.
As requested, that Wednesday, I rolled up at what used to be called the doctors’ surgery and is now known as the medical centre and sat down in the waiting room. I was as usual much too early.
About ten minutes before my appointment, a forlorn-looking fellow in a frayed military tie emerged from the end of the passage. His hair was neatly combed but was in need of a wash. He was making an effort to look smart but there was a hole in the elbow of his raincoat and one of his trouser hems was trailing. On the way out he caught my eye and gave me one of the saddest smiles I have ever seen.
I looked over the form I had filled in about my mood during the previous week. Running down the side was a series of questions on depression and anxiety. The depression questions covered things like lack of pleasure in doing things, insomnia, and problems concentrating. The anxiety questions concerned worry, edginess, irritability, and restlessness. I had to tick a box for each question arranged in a series going from ‘Not at all’ to ‘Nearly every day’. I had ticked quite a lot of ‘nearly every day’s in both sections, with anxiety winning on points.
The sound of a female voice made me look up: ‘Thomas Cutler?’
Standing at the end of the corridor was a middle-aged lady, nicely turned out, with a heavy necklace that swung as she moved. I gave her one of my standard two-second ‘Pan Am’ smiles and stood up.
The ‘Pan Am smile’ is the name given to the artificial smile said to have been flashed by members of the cabin crew of Pan American Airways as they welcomed passengers aboard. Also known as the ‘polite smile’ or the ‘Botox smile’ it involves a perfunctory contraction of the muscles that lift the corners of the mouth. A proper smile reflecting genuine emotion is called a Duchenne smile, after the neurologist who identified it as involving not only the mouth but also that vital component, the crow’s-feet muscles around the eyes.
I always think I’m smiling a proper Duchenne smile, but people say that when I think I’m smiling I’m actually frowning. I was astonished recently when somebody showed me a series of photographs of myself at a wedding. Everyone around me was smiling beautifully. I looked positively unpleasant.
The lady with the swinging necklace smiled back a cool, expert smile, turned, and walked briskly down the passageway. Clearly I was meant to follow her.
She kept a couple of yards in front of me and I observed her technique as we approached a door at the end, where she stopped, bent forward, and opened it efficiently. She turned and smiled again, holding the door for me. She seemed experienced
, which was a bonus, and her practised routine had doubtless become embedded over the years. Her body language was saying, ‘I am an accomplished professional who knows her business. I’m a good listener but will not put up with any nonsense.’
‘Have a seat,’ she said deliberately, letting the door hiss closed on its mechanism.
With a barely detectable accent, she introduced herself as Odette Pinard. She was already calling me ‘Tom’, but it was unclear whether I had permission to call her Odette or whether I ought to call her anything at all. Maybe it was her Frenchness, maybe her briskness, or maybe all newcomers to CBT feel slightly on the back foot. In the end I settled for calling her nothing at all and kept to this rule until the close of our final meeting.
Odette explained what the plan was, outlining the sessions, of which there would be an initial six. Towards the end we would do a review to see whether we agreed that progress was being made. If it wasn’t we would think about my trying something else.
‘It’s not like psychoanalysis, which can go on for years with no apparent benefit,’ said Odette. ‘It doesn’t suit everyone.’
Was this good sense or a CBT get-out clause for the inevitable failures? I decided to think positive.
Each week, she explained, she would review my mood form and my ‘session bridging worksheet’ and discuss the progress I’d made, along with any problems I had had during the last seven days.
‘CBT is based on the idea that thoughts, feelings, and actions are interconnected,’ said Odette, ‘and that negative thoughts and feelings can feed on themselves. We try to tackle problems in practical ways; we won’t be going back over your past very much.’
This approach sounded more congenial than dredging up a load of childhood family relationships. A practical attack was more my cup of tea. While I have always found the conjectures of Sigmund Freud suggestive, I am sceptical about the usefulness of psychoanalysis. On one occasion when Freud was at a psychoanalytic conference with one of his famous cigars in his mouth he was asked if he was not aware of its phallic implications. ‘Sometimes,’ he retorted, ‘a cigar is just a cigar,’ which sounds like the usual Freudian escape ticket, of which there always seems to be one to hand.
Having written this cigar quote down, I did what I always do and checked it out to see if it was authentic. What I found was that Alan Elms, a sometime psychology professor, discovered years ago that there is no record of the remark before 1950, more than a decade after Freud’s death. He concluded, disappointingly, that it was too good to be true.
Checking and correcting are typical of me. If there’s a wonky picture I must straighten it. If a door is open to the wrong angle (according to my own rules) it troubles me and I have to get up and adjust it. This used to drive Lea nuts, but she now grudgingly indulges me. If I am getting petrol I am obliged, by little squeezes of the pump trigger, to get the petrol meter and the price to display precise whole numbers with no decimals, and it is almost impossible to get both to do so simultaneously. All this is pretty exhausting.
Odette said I would have a fifty-minute session once a week for six weeks. We would work together to tease out the thoughts, physical feelings, and actions connected to any problems I had had, and try to adjust my thinking and behaviour if she felt they were unrealistic or unhelpful. I would then go away and try to practise these techniques, and report back.
While I listened, I scanned the room. It was a windowless purpose-built space, with a desk against one wall. There were two hard chairs, separated by the corner of the desk upon which sat a large computer. The lighting was chilly and there were no pictures. At the junction of wall and floor, the vertical plaster met the concave skirting, which curved into the smooth floor covering, with a line of white mastic visible at the intersection. It was as if the allowance of sharp corners in such a room represented the very antithesis of cleanliness and health.
‘So how did you get on with SunBurst?’ asked Odette.
I told her the gory details of my unhappiness with the website and its various idiocies. I went on about this in some detail and stopped only when I found myself shaking with anger.
‘No human being should have to put up with that kind of thing!’ I barked.
I was aware of Odette looking at me. Was my reaction in proportion? Probably not. She was writing something down.
‘So how have you been feeling?’ she asked.
My outburst hung in the air like gun smoke.
‘I’ve lost all my mirth,’ I replied.
I’m not sure Odette got the reference.
‘Like Hamlet,’ I added.
She had a look at my mood sheet, making notes on the computer as she did so. I’d ticked ‘anger’ and ‘irritability’, ‘restlessness’, ‘memory and concentration problems’, and ‘difficulty making decisions’. I hadn’t ticked ‘Thoughts of harming yourself’.
‘Let me explain how CBT works,’ she said.
I bent over the table to get a better view as she sketched out a diagram.
‘The first thing is the trigger. It’s: “Trigger, Thoughts, Feelings, Behaviours.”’
She drew arrows connecting the four headings in a sort of circle.
‘What I’m going to ask you to do next time it happens is to write down the trigger situation that’s causing your negative feeling. For example, someone might have been critical of you, so you write that down, okay? Then you write down what thoughts this triggers. It might be, “I’m not good enough”, or something like that. Next, write down the physical feelings this has caused in you, you know, like annoyance, or resentment, or whatever. Then finally you put down your actions, your behaviour — what you actually did. It could be something like, “I made a defensive excuse.”’
She tapped the pencil on the table to show she had finished.
‘You’re looking confused.’
‘Not confused,’ I said. ‘It’s just that that’s not the way it is. There’s no trigger. I wake up niggled and I stay niggled. I’ve always got this knot in my stomach.’
Odette rubbed the back of her neck.
‘How much alcohol do you drink?’ she asked.
I explained that I medicated my anxiety with it and that it worked. She became brisker. Unless I could cut my drinking right back for the next six weeks, she wasn’t convinced that CBT would help me.
‘It compromises the therapy,’ she said.
We then had a long discussion in which I queried the whole notion of alcohol units. It was a pointless piddly argument and we were both becoming irritated. I decided that the situation needed rescuing.
‘All right,’ I said, ‘I’ll do my best to cut down the alcohol and I’ll fill in the paperwork as you suggest.’
‘Oh good,’ she said. ‘Well, time’s up. In fact, we’ve gone slightly over.’
Odette stood and handed me the session bridging sheet to fill in for next time. She held the door open. ‘See you same time next week.’
She gave me a smile. It looked more Pan Am than Duchenne. As I went down the stairs I cleaned my hands with the alcohol gel I always carry. I felt, as usual, that I’d got off on the wrong foot. At home I made a note in my diary:
Quite hard work this morning owing mainly to my refusal to leave my brain at the door. I was reminded of Bertrand Russell, who, when his brother was trying to teach him some mathematics, asked why he should believe the axioms of Euclid. His brother replied, ‘Well, if you don’t we can’t continue.’ This is how I felt today, having to accept the dubious axioms of CBT or we couldn’t continue. Trouble is, my argumentative insistence that some evidence of their truth should be given seemed to annoy the therapist. Came home feeling angry, but I don’t know why. Everyone says I always seem so calm but there’s this constantly suppressed rage.
Having promised to moderate my drinking for the six weeks of the CBT I decided to cut it out altogether. I am a black-and-wh
ite thinker. With me, it’s all or nothing. I stayed off the drink entirely for the next two months.
During the first week of CBT, I kept a lookout on my thoughts, feelings, and actions, and scribbled down a few notes for the following session. It rained a lot that week and I had to take an umbrella to my next meeting with Odette Pinard.
Weds, 27 Apr. 2016, session 2
Wet and windy today. Going up the stairs to the waiting room I had to pass that jazz mural in banana yellow and fluorescent green. All those zigzags, sharp edges, and screaming colours. Hospitals and doctors’ surgeries are full of this rubbish. It’s enough to give you an epileptic fit.
‘Any feelings about last week’s session?’ asked Odette.
‘Yes,’ I said, ‘this room. If I were designing a consulting room I would never use cold blue lighting like this. It’s an elementary mistake. This place ought to be warm and inviting but it looks like somewhere cadavers are dissected. There are no plants, no rugs, no softness. And that mastic down there is not smooth. Whoever put it on didn’t take enough care. How can people be expected to relax in an environment like this?’
Odette was looking at me quizzically and writing something down.
‘So what is it especially about these lights?’ she asked.
‘Well, first the colour temperature is too low — they’re cold. Second, they’re fluorescent. They’re making my head spin. It’s like the supermarket. I find those places impossible: fluorescent lights, all those people, all that noise, and the turmoil of all those shelves, all those labels, all those smells, all that bloody advertising. It makes me scream.’
I was breathing hard. I received another puzzled look.
‘Your depression and anxiety scores are about the same as before,’ said Odette languidly, going over the sheet. ‘How has your week been? You said last time that you were finding social situations “taxing”.’
‘Still very difficult,’ I said. ‘We’re going out to dinner in three weeks with a couple of friends and I’m already starting to get tense. One person I can manage. Two is more difficult. Three is absolutely exhausting. I could just say no and let them get on with it, but it’s not fair on my wife. Anyway, I want to fit in, so I go along with things. I have learnt over the years — trained myself — to imitate what other people do in social situations, because I don’t seem to know how. I’m always pretending to like it, to be someone else. It’s exhausting.’
