From today’s clinic
It was a pleasant Spring morning in Somerset during a week-long silent retreat. We were being guided, very capably, through exercises based on the four ways of grounding mindfulness by paying attention to: body, feeling tone, mooded mind, dhammas. This particular morning we had been invited to ‘take our mood for a walk’. Initially as I walked I felt quite shaky but this unsteadiness eased when walking barefoot and soon gave way to an inquisitiveness and quiet reflective state. At least on one occasion I felt sad, perhaps even lonely, and it was at this point that the temptation was strongest to race ahead in my thoughts, as if to cheer myself up, imagining and planning, distractions designed to gladden the mind. In the midst of this new-found confidence, time and again, I so easily lose connection with the present, embodied moment. Then in the distance there existed the most beautiful vista – bright yellow rape against big bold trees on the hillside. I saw some children running, chasing each other through the tall meadow and in this moment I remembered so clearly the fun (embodied fun) we all once had as children, thoughts no more of distant thunder.
This analogy came to me during a recent silent retreat, and came in the form of an invitation to imagine the future as a stranger. This not only introduces a degree of apprehension and trepidation of the future, not usually present when we imagine ourselves some years ahead, but also crucially encourages one to take a graded approach to planning, to not assume too much or plan too far ahead. Of course when one meets a stranger one may also be cautiously optimistic that this new person, who let us remember has come into our lives at a particular moment in time, may become an ally or friend at some point in the future, given sufficient time, energy and investment! However then there is a sense of the mind as resisting this notion, as if believing that if one focuses long and hard enough one can anticipate and know the future without having to wait. On the contrary, the future is built on moments and these unfold over days and weeks, each preceding the other, one influencing the next.
Inspired by Eckhart Tolle, and his appeal to each of us to find the ‘watcher’ within, I set out thinking about this and what used to be called ‘the Ego’… The first thing I notice when considering this topic is a strong pull in one direction at the outset, to say that I believe in the need for such a watcher and that a general wariness of the ego is wise counsel. The ego certainly has got lost in translation and requires refreshing and so I begin with a definition taken from the Oxford English dictionary (2012) that hints at the source of the problem because there is not just one but two definitions … here the ego is defined as “a person’s sense of self-esteem or self-importance” (layman definition), and “the part of the mind that mediates between the conscious and the unconscious and is responsible for reality testing and a sense of personal identity” (psychoanalytical). Taking the middle ground, my suggestion is that ‘ego’ is strong will, and here we may even use the analogy of the horse whisperer who, rather than ‘breaking’ the will of the horse (the part that hitherto needed controlling), instead he/ she tries to understand it, even befriend it, in order to transform it.
So why, this urge to chastise the ego as is so often done these days? Is this a misunderstanding out there in the general, public domain of what remains, a technical word? Or is this an example of how we take a word and socially create and expand the definition to fit our purposes? And what of the more ‘positive’ aspects of the ego should they exist? After-all is it not the ego that has a certain strength of conviction, to stand apart from the crowd, and speak out on issues it holds dear and to worry not about appearing ‘different’ to others and what they might or might not think? Here I connect to my roots, of being born of dual-heritage, and to sensing my different-ness, on occasions uncomfortably so, then at other times, recognizing it also allows me a degree of freedom to stand apart, not needing to try too hard to ‘fit in’ (over time, a blessing).
So what of the ego we started out trying to understand? The ego may indeed need watching over, but rather than chastising the ego let us instead embrace it! In fact the ego may even be the watcher we seek, able to occupy that middle ground, overseeing, taking executive control – in short, the ego, is not all that bad!
During a recent Fellowship in London, I completed a number of papers detailing the processes of family adaptation following neurological injury. This impact can be seen across various settings – for example, for children in school and home settings, and for adults in the role of spouse, parent, friend, work colleague and so on. What is clear is that as well as achieving the maximum physical recovery, rehabilitation also needs to redress the disruption felt at the level of self-identity and relationships. For children there is the added factor that the full impact of injury may take years to unfold and become clear, and at each stage of life (e.g. moving schools, leaving home, starting a job) new challenges may present.
Attached are two papers – one that appeared in the journal Human Systems which presents primarily case study material, and a second from the International Journal of Rehabilitation and Therapy in which I chart the theory and research base in this field at the time of writing (2007). I highlight specific service examples of good practice, and countries where this work is flourishing. Further papers (not available here) focus specifically on Multiple Sclerosis, a most disabling condition partly because of its unpredictability, the likely time of onset (midlife/ childbearing), and because it affects more women than men and so plays havoc for aspiring families. I am indebted to the ‘The Multiple Sclerosis Trust’ (UK) who supported this work and a number of succinct reports are available from their website, see Open Door and Way Ahead article. Another paper (below) discusses the interface between music therapy and social relations after brain injury.
My time in London culminated with the publication of a book entitled “A Relational Approach to Rehabilitation” (co-edited with Giles Yeates & Siobhán Palmer), which updates and develops these earlier ideas, and a sample of this work can be seen on Google Scholar at Sample pages. Finally, for those with an interest in the impact of neurological problems on the family, together with colleagues I used to run a networking group for disseminating new research, training events and funding opportunities. For further details, go to TBIFAMILIES network and click ‘subscribe’.
Bowen, C. (2007) Family therapy and neuro rehabilitation: Forging a link. International Journal of Therapy and Rehabilitation, 14: 344–349.
Bowen, C., Hall, T., Newby, G., Walsh, B., Weatherhead, S., & Yeates, G. (2009). The impact of brain injury on relationships across the lifespan and across school, family and work contexts. Human Systems: The Journal of Consultation and Training, 20: 65–80.
Bowen, C., & MacLehose, A. (2010) Multiple sclerosis: Long-term care and the ‘family care pathway’. Social Care and Neurodisability, 1(1): 31–38.
Bowen, C., MacLehose, A., & Beaumont, J.G. (2011). Advanced multiple sclerosis and the Psychosocial Impact on Families. Psychology & Health, 26(1): 113-127.
Magee, W.L. & Bowen, C. (2008) Using music in leisure to enhance social relationships with patients with complex disabilities. NeuroRehabilitation, 23(4): 305-311.
Bowen, C., Yeates, G., & Palmer, S. (2010) A Relational Approach to Rehabilitation: Thinking about relationships after brain injury. London: Karnac.
The first paper I attach is about blaming within family settings.
In interviews about conflict-related problems with parents attending a family therapy clinic, I was privy to a range of views, often as many different views as there were people attending. Within a single description of the problem there is an enormous amount of information, not just about the ‘problem’ but about the person giving the account and about their relationship with others within a system. The importance of consulting with all persons connected to the issues is well-recognised by systemic therapists who place particular importance on inviting every party to a consultation. The reason for this is that individuals personify and give voice to the undercurrents and power dynamics within any context or setting, voices that may have been marginalised over time for various reasons. We can see this type of phenomenon happening in any complex dispute or social event that arises, in which those individuals who are not officially recognised and invited to the negotiation table and/ or are not inclined to reconciliation may continue to ‘act out’ their grievances. The logical conclusion to this is that in order to construct a workable peace one cannot escape from having to talk to the aggressors at some point in the process. These ideas have been developed in a further thesis in which I outline a case for the social construction of trauma by deconstructing the various layers to a conflict (unpublished manuscript).
Returning to the attached paper, here I make further observations about how, when a person describes a problem as shared or ascribes blame to another, this has a certain value in terms of rhetoric, depending on the audience – perhaps by claiming superior knowledge over another, drawing some members into conversation while silencing others … so it performs a variety of functions such as connecting and distancing, attributing and negating responsibility, mobilizing support via outside agencies, etc. If one were to consider the case of a child with behaviour problems, for example, opinion may vary on whether the child has control over the problem (i.e. has intentionality), whether the behaviour is normal for the child (a child of that particular age), how best to manage the problem and, crucially, and who has ownership over finding a solution. In order to track the rhetorical function of blame talk, a grasp of the philosophy of ‘social construction’ is required (i.e. how social entities are encapsulated in dialogue and given material status, not mere adjuncts to conversation). Examples of social constructs would include most mental health classifications such as post-traumatic stress disorder and political ideas such as ‘democracy’ or ‘peace process’.
Bowen, C., Madill, A., & Stratton, P.M. (2002). Parental accounts of blaming within the family: A dialectical model for understanding blame in systemic therapy. Journal of Marital and Family Therapy, 28(2): 129–144.
Bowen, C., Stratton P., & Madill, A. (2005) Psychological functioning in families that blame: Frrom blaming events to theory integration. Journal of Family Therapy. 27(4), 309-329.
Bowen, C. (2003) Intrapsychic conflict in response to trauma: understanding the individual subjective state with a view to linking it to the social/community levels. University of Bradford; unpublished manuscript.
I take a holistic, joined-up approach to thinking, learning and understanding the world. In terms of health beliefs this encapsulates mind, body and soul, and incorporates both individual, wider relationships and other social factors. Therapeutically, an approach which dovetails this approach is family therapy – otherwise known as systemic therapy. In this approach one considers the shared experience of illness and injury and how relationships impact on both illness and individuals. One aim of systemic therapy is to draw on the strengths of individuals and the group and to highlight examples of positive coping in the face of adversity. Recently I summarized systemic theory as based on the following premises:
• Social systems such as families consist of individuals but also relationships, boundaries, hierarchies;
• The parts of a system are inter-related (one part of a social group cannot be understood in isolation from the rest of the group);
• Members of a system are governed by communication patterns (we are constantly in communication with each other even when we choose not to communicate);
• People act on the basis of their beliefs;
• Even behaviours that have negative consequences may have a positive intention;
• The causality of social problems is often ‘circular’; that is to say, the origin of a problem may be different from that which maintains it, and causal and maintaining factors may be distributed across members.
Now to examples of how this plays out in reality …
First a family situation:
• A man who drinks each day and is dependent on alcohol;
• A woman who is depressed and cannot leave the safety of her own house;
• A young girl who is routinely starving herself.
Most definitely each of these is a complex problem in itself but consider how different yet understandable this situation becomes when we are made aware these individuals are part of the same family unit.
Second, a situation affecting the wider health system:
• Due to a financial shortfall there are cuts to services at a local hospital, particularly for people with chronic conditions who require long-term care;
• A group of independent hospitals notices a turn in the market and increases its fees for respite and day centre services across the country;
• A key 3rd sector organization finds it has to double its number of volunteers to cope with the demand for 24-hour telephone and long-term support.
Note how tempting it is to order these events in linear time? Yet any linear analysis depends on when one begins observations and so in many ways it makes more sense to view each development as impact or radiating outwards, forwards and backwards (circular causality).
Third, an example affecting political systems:
• Two neighbouring Governments take differing policies around the control of state media and wider internet access and both have policies and rules that limit the freedom of movement for individuals;
• The inhabitants of the country with greater freedoms are made aware of other countries offering a better quality of life and are able to mobilize to put pressure on their Government to change certain policies;
• For those inhabitants of the country with greater state controls the situation remains the same and the overall feeling of dissatisfaction rises.
Just imagine how rapidly such a situation might escalate…