tisdag 14 augusti 2007


When I read the quoted part below from the readers’ letter “British Journal of General Practice Article” yesterday I came to think of diagnosis: For what purpose? For whose sake? For whose sake and purpose not only in medicine?? (honestly I am a bit ironical here... And maybe also angry? :-))

The best way to deal with and protect oneself against "heart-sink" (or other sorts of) people in private life what would that be? I.e. to longterm deal with them and not live in constant tension (and fear maybe) for them, tension for meeting more of that sort?? To use ones life and energy on other things, living maybe instead of trying to avoid dangerous people of all sorts... But I don't want to minimize the problems people have... Sometimes people have to do something immediately, not wait for enlightenment about their own problems (or how I shall express it) if their lives are in immediate danger because of a violent other (most often a man?? Do I dare to write this?) or something:

“To sum up what went before: I would like to suggest that the ‘heart-sink’ patient’s behaviour and attitude begin to make sense, and are entirely appropriate and consistent, if we bear in mind the strong possibility of a past history of abuse, in the widest sense of the term: emotional, physical, sexual. We could decide to see the ‘heartsink’ patient as someone for whom things went seriously wrong early on in life: in a relationship of trust, at a vulnerable stage in development.

Our hearts sink for the best of reasons. Feelings are always true and always rational, i.e. they are always appropriate and proportional to their original cause. They can therefore be trusted even when it may be impossible to link them to anything in the patient’s present circumstances; and even though their original cause remains undiscovered during all our consultations together. Our difficulty in ‘getting the picture’ may indicate we are dealing with a patient’s repressed experience, re-enacted in exact but obscure ways, using the listener/doctor as a ready-to-hand and convenient figure of transference.”

I’m not sure what the proper translation to Swedish of “Heart-sink” would be? There is the expression “Heart-sick” which means “modfälld, nedslagen” in Swedish…

Gwenda Delany also writes that:

"But there is no true healing without uncovering the past."

And the sentence before this:

"Examining feelings of past abuse is intense for the sufferer, a pain matched only by that of keeping feelings repressed by heartsink strategies."

Dr Judith Burchard writes in her appendix to this letter for instance that:

"When A grows up the situation changes. The repression of her anger is no longer necessary and is in fact counter-productive for A’s wellbeing. Sadly, because A is herself unconscious of the anger it will probably remain repressed. She lives with the unconscious anger inside her and is compelled to express it in some way. The anger may be expressed towards herself (as in depression, self-harm or psychosomatic illness), her children (as child abuse) or towards others over whom she has power (as in violence or bullying). Conversely she may re-experience her own anger by developing relationships with other people who will abuse her."
Addition: Gwenda Delany also writes in chapter 4:
"Repetition compulsion: repressed experiences are stronger than reason or argument or cognitive therapy; willy-nilly they are enacted again and again in many different ways and in many different settings throughout the patient’s life, unless and until the intolerable repressed feelings and their triggering events have been identified and consciously experienced and reacted to (with sadness, anger or indignation) by the sufferer. The only way this can be done is for the patient to revisit them: if all else fails, alone; but let’s hope she can do so in the company of someone willing to listen, during some form of ‘talking’ therapy: which fortunately may be as informal and ad hoc as an encounter in our surgeries.."

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