Claire BlackCounselling and Therapy in Edinburgh

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Heffalumps and Woozles
Meg John Barker's writing is always thought-provoking while being totally accessible. I love it. Here is a piece on the insights to be gleaned from A.A. Milne's Winnie the Pooh:

Book review: Histories, by Sam Guglani
(published in The Scotsman)

“The feeling passes quickly but it leaves an ache, and for a while everything that follows is filtered through it.” This is a description, from Sam Guglani’s affecting novel, Histories, of the moment a nurse sees a person rather than a patient, the emotional jolt denting hard-won defences. But it may as well be a description of the novel itself. There is something meditative about Guglani’s spare, poetic prose. And unsettling too. It stays with you long after the book is finished.

It may be slight, just 130 pages or so, but this is a novel with serious emotional heft. There are 18 chapters, each told from the point of view of a different person – the consultant physician, the junior doctor, the oncologist, the chaplain, the medical student, the nurse, the patient – and these are knitted together by place, an oncology ward in a hospital, and time, a single week in October.

Guglani manipulates his form expertly, shifting between first person narrative, to dialogue between colleagues, to dictated dictaphone entries, interweaving characters in a way that’s only fully revealed in second or third readings. Structurally, this allows us an insight into how a hospital is itself a kind of microcosm, an organism given life by the coming together of disparate individuals working, however chaoticially, together. Thematically, it provides a multi-dimensional exploration of power and empathy, hope, loss, belonging and the challenge of genuine communication. “Meaningful contact is so elusive, even here in a hospital” reflects Emily, a consultant oncologist fearing burnout, her feelings for her patients “like a valve switching off”.

There is a growing genre of books written by doctors about their profession – I’ve reviewed more than one of them in these pages – but Guglani’s subject isn’t the particularities of a medical procedure or the political plight of our underfunded, overstretched health service, or even the emotional consequences of a job that places enormous demands on those who do it. That’s not to say that these issues aren’t present, but rather that Guglani foregrounds matters of a different magnitude, matters one might regard as even more profound. His subject is his characters’ humanity, as it’s tested and shaped in airless consulting rooms and in wards behind poorly drawn curtains. These characters are scrutinised by an unsparing eye, their frailties and feelings probed with forensic, microscopic precision.

A consultant clinical oncologist in Cheltenham, Guglani has a masters in creative writing from Oxford, writes a column in the Lancet, and is a founder of Medicine Unboxed, an organisation that promotes an understanding of medicine through the arts and humanities. It’s the poeticism of his prose that renders this novel so poignant and evocative. The titular histories emerge, not chronologically, not neatly, but as they would in life: disordered, fragmented, partial. “I collect them around here, histories, hundreds of them,” says the porter, Josh Webster. “Moving people along corridors, talking cheek to cheek or with my head above them. No eye contact, just our voices mingling in the air. That way, you stumble on the story rather than taking it, like happening on it by accident, caught as it honestly is.” This is how Guglani has written his novel and is, in part, why it rewards repeat readings – each time something that we didn’t have adequate information to understand at a first attempt is revealed; characters whose fates are played out late in the novel make cameo appearances in the early chapters and connections become apparent.

In a sense this novel is an examination of communication – what we can make known, even to ourselves. “How to speak and listen to people. The history-taking”, is how the lowly porter describes it. And his view of the medics with whom he works is critical. “Passing them sometimes, I catch the things they say to patients and I’m amazed they get any history at all. Asking what they ask in that way they do. Difficult things, huge things, all the time looking people straight in the eyes.”

Guglani is unsparing in his exposure of the flaws and limitations of the doctors and yet he imbues them with such humanity, our own criticism is tempered. Pomposity, emotional shutdown, crippling self-doubt, swagger – each a coping mechanism, an attempt to bear the enormity of the expectations of those who rely on them, at least in some instances, for nothing short of life itself.

If there’s a weak spot, for me it’s the stories in the collection about characters who would most likely be working class, the hospital cleaner, the porter, a hairdresser patient. The writing remains polished but the voice is less convincing. This isn’t the case with the medics, whether it’s James Chester, the consultant oncologist himself diagnosed with cancer, or Seb, a junior doctor wracked with inadequacy: “It was all perfect snow before he started, the idea of him, of medicine... the idea of him as a doctor. Now there are footprints all over it, mud and slush thrown up. He doesn’t know who to be, how to be.”

Those are the questions Guglani poses for each of his characters and his exploration is as moving as it is illuminating.

Book review: This is Going to Hurt, by Adam Kay
(published in The Scotsman)

There’s no point in being churlish, the disclaimer is right there in the title. Reading This is Going to Hurt is indeed painful. It will make your eyes water (an account of a patient who suffered vaginal burns from stuffing her lady garden with Christmas lights and then, of course, turning them on) and it may well make you choke on hot tea (it’s very, very funny), but it might cause a different kind of pain too, an ache connected to the parlous state of the beleaguered NHS. Adam Kay was a junior doctor for six years. This is Going to Hurt is a collection of his diary entries from 2004 to 2010. It was borne of a Fringe show Kay did, having hung up his stethoscope, which an editor saw and encouraged Kay to use as the basis for a book. It’s Kay’s attempt to make sense of his medical career before it ended suddenly and sadly (as Kay writes, “sorry for the spoiler – but you watched Titanic knowing how that was going to play out”) and he decided he’d rather take risks on the more manageable scale of laptops crashing and shows being panned - he’s now a successful comedy writer – than life or death. The book is also an impassioned plea for us to wake up to what goes on in hospitals and how they are increasingly being held together by not much more than goodwill and bloody mindedness. It is a truly laudable book, hilarious, moving and caustic. If you’ve been disappointed by the NHS, it will give you a way to contextualise your feeling. If you’re a fan of our (for now) free, universal healthcare you will find much to bolster your belief. And if you can hardly believe Nye Bevan’s creation has survived, albeit clinging on by bloodied stumps, now that the fingernails have gone, you’ll find plenty to explain how we got here. It also happens to contain the best footnotes I’ve ever come across – packed with information, medical and otherwise, and dripping with sardonic wit. “Every doctor makes their career choice aged sixteen, two years before they’re legally allowed to text a photo of their own genitals,” Kay writes. “When you sit down and pick your A levels, you’re set off on a trajectory that continues until you either retire or die.” His own medical career was settled by an expensive education and a father who also happened to be a medic. When he had to specialise he chose obstetrics and gynaecology, “brats and twats” as it was known. And he did a good job, progressing from House Officer to Senior Registrar. He put up with the idiocy and eccentricity of the great British public, bureaucracy that would leave Kafka speechless and a workplace culture that might reasonably be described as the sickest patient on the ward. I want to be clear: I love the NHS. And yet I know the experience of using it can be frustrating and difficult. Kay explains why: an unwieldy structure, anachronistic managerial and working practices, resources completely out of kilter with the demands placed upon them. The patient stories impact and linger in the mind, but so too does the question of how junior doctors have managed to put up with working as they do for so long. There’s the constant unpaid overtime, the cancelled holidays (leave is impossible to organise), the nonexistent social lives (working a 97-hour week pretty much knocks that on the head), the failed relationships and the kind of pressure that’d make the average corporate HR policy spontaneously combust. Kay notes the outrageousness of it all. So when a young house officer arrives in A&E one night having attempted suicide by overdosing on antidepressants Kay’s take is simple: “The only surprise is that it doesn’t happen more often – you’re given huge responsibility, minimal supervision and absolutely no pastoral support. You work yourself to exhaustion, pushing yourself beyond what could be reasonably expected of you, and end up constantly feeling like you don’t know what you’re doing.” The house officer survived but Kay reflects that had she died, “I doubt we’d have got so much as an email… I’m pretty unshockable, but I’ll never cease to be amazed by hospitals’ wilful ineptitude when it comes to caring for their own staff.” Kay’s book is vital and timely. It should be required reading for anyone who ever has any political or financial responsibility for our health services. Kay presents the countless patients he treated but also his own story, the sacrifices, the successes and then the final straw. “I should have had counselling – in fact, my hospital should have arranged it,” Kay writes of the traumatic incident that marked the end of his career. “But there’s a mutual code of silence that keeps help from those who need it most.” And if that doesn’t make you wince, I’m not sure what would. *Claire Black is a Gestalt Therapist based in Edinburgh *This is Going to Hurt is published by Picador, £16.99. Adam Kay will be talking about the book at venues across Scotland from 5 October, including Waterstones Glasgow, Mainstreet Trading, St Boswells and Toppings, St Andrews. For more details go to

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Book review: The Mystery of Sleep: Why A Good Night's Rest is Vital to a Better, Healthier Life by Meir Kryger
(published in The Scotsman)

It tires me out just trying to come up with a topic that’s prompted more words than how to get a good night’s kip. Books, the best known of which is probably Ariana Huffington’s The Sleep Revolution, endless blogs, countless magazine features, a slew of opinion pieces, each telling us how to sleep better and longer and, inevitably, ramping up our fears if our sleeping is problematic. There’s no argument that sleep is vital to our health and wellbeing and millions of us experience a nightly struggle with it, exacerbated by how we work (too much) and relax (increasingly online). Insomnia, Restless Leg Syndrome, sleep apnea, you name it, a huge number of us experience it. And although much of what is written about sleep is by people who purport to be experts, that term is sometimes stretched beyond credulity. Meir Kryger, however, is the real deal. Despite our current obsession with sleep, as a specialist area of medicine sleep studies is comparatively young. It came into existence in the 1970s and Kryger was among its first exponents. Now a Yale Medical School professor, Kryger recorded one of the first cases of what became known as sleep apnea. Having written books about sleep disorders for other doctors, in 2004 Kryger wrote his first book for a general audience, an exploration of how sleep disorders affect women differently from men. His follow-up, The Mystery of Sleep, broadens his target from women to “the entire family and society”. And why not? The National Institute of Health in the US (Kryger’s book is very much US-focused) estimates that between 50 and 70 million Americans of all ages have sleep-related problems. And we’re not faring much better over here. Each chapter of Kryger’s book begins with a short description of a patient who has come to his sleep clinic for help. In a career spanning 40 years, he has treated more than 30,000 patients with sleep problems. What’s striking is how often the dishevelled individuals with bags under their eyes and stories of woe sitting opposite Kryger have sat in front of many other doctors over years and years. The problem of misdiagnosis of sleep disorders is one of the reasons Kryger has written his book – to help readers to identify issues with their sleep and to inform them as to how best to speak to their doctor so as to be understood. He highlights the way in which drugs often prescribed to treat depression, for example, can include side effects which impact on sleep. Be informed is his advice, quiz your doctor – what are you being prescribed and why? The book is structured in four parts. Part one explores the physiology of sleep and its role at each stage in our lives, from infancy to old age. Part two focuses on sleep disorders and tackles our body clocks. Part three gets to grips with insomnia, while part four describes how to get help for common sleep problems. Therapeutically-speaking, the importance of sleep can’t really be overstated; like eating well and being physically active, sleep is a basic pillar of health, including mental health. But what constitutes a good night’s sleep is unique to each of us. And it’s got less to do with number of hours and more to do with how we feel when we wake up. According to Kryger: “You should not wake up feeling as though you have not slept. You should not feel as though you won’t be able to function until you have had one or more cups of coffee. Struggling to stay awake while driving or falling asleep or feeling uncontrollably fidgety at movies, public meetings, or even in front of the television or computer screen are all signs that you may be sleep deprived. You should not feel as though you are about to fall asleep while reading.” There’s no doubting Kryger’s experience or his enthusiasm. The tone of the book is that of the most comprehensive leaflet you’ve ever picked up in the surgery, informative but not exactly scintillating. And what’s perhaps a little disappointing is the lack of contemporary context. In the opening pages, Kryger bemoans the political errors made by sleep-deprived presidents. Obama faring poorly against Mitt Romney in the first debate in 2012. Bill Clinton’s wry self-assessment: “Every important mistake I’ve made in my life, I’ve made because I was too tired.” But there’s no mention of Donald Trump – perhaps to do with when the book was written – glued to his smartphone in the early hours, firing off a tirade of tweets when sleep might do him (and the rest of us) more good. What’s more surprising still is that Kryger doesn’t take issue with the onslaught of technology creeping into our sleeptime routines. Certainly, he advises keeping technology out of the bedroom, but he offers no insight into the current fashion for making the one third of our lives we spend at rest the newest arena in which we can measure, learn, practice and improve our performance. Doesn’t exactly sound restful, does it? And I think I’d probably sleep easier knowing the learned doctor’s thoughts.

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Book review: The Old King in his Exile by Arno Geiger
(published in The Scotsman)

Arno Geiger grew up in the house that his father built in the Austrian Alps. His grandparents were farmers, his father, August Geiger, born in 1926, the third of 10 children, may well have been a farmer too had the Anschluss and the Second World War not intervened. In 1944, aged just 17, August was conscripted. Sent to the Eastern Front as a truck driver (he didn’t even have a licence) in February of 1945, he was picked up by Russian forces. Now a PoW, a bout of dysentery landed him in an army hospital for a month before he was dropped on the Austrian-Slovakian border to make his own way home. August’s wartime experience was formative. Indelible. Traumatic. His way of coping was to never again leave the home from which he’d been forced. He created routine where there had been tumult, order where there had been chaos. He became a local government clerk. Then, at the age of 37 he married a primary school teacher 15 years his junior and they had a family. He stuck to the same routines every day of his life, organised his workshop meticulously, eschewed holidays with his family – he had no desire to leave what was familiar. And then came the onset of Alzheimer’s. The Old King in his Exile, first published in 2011 and now translated into English by Stefan Tobler, is a deeply moving account of the impact of a disease that remains in many ways inexplicable, impacting on each person in a unique way. It’s a memoir of searing tenderness, full of feeling and yet never sentimental. Written over six years and published while the author’s father was still alive, it explores themes of profound importance: what makes a life worth living? How do we belong? How can we cope with ageing and illness and death? It’s life-affirming, funny and generous; a roadmap to help navigate the most disorienting territory. August Geiger was in his early 70s when he started to change. Words eluded him, everyday tasks became mysterious, his carefully constructed routines failed, his familiar surroundings became strange, even unrecognisable. The early years of his illness were the worst. Sticking with the pattern of a lifetime, August didn’t speak about what he was experiencing. His family were baffled and, at times, terrified. Geiger writes movingly of his guilt about these early years, the missteps and misunderstandings, the frustrations and fear. And then came the epiphany: the understanding that if he was to get to know his father before he was entirely robbed of his memories, it was he, the son, who would have to find a way to do so. “As my father can no longer cross the bridge into my world,” he writes. “I have to go over to his.” This proved to be no easy task. And yet the disease became a lens that allowed Geiger to see life – his own, his father’s, and the endeavour that we’re all involved in – anew. “There’s something between the two of us that has led me to open myself more to the world,” he writes. “Which is, of course, the opposite of what people normally say that Alzheimer’s does – that it cuts connections. Sometimes it creates them.” At moments Geiger’s writing is pragmatic – he’s insistent on the futility of truthful or factual explanations for a person who has lost their way of understanding the world, encouraging instead a more empathic response – at others, it’s poetic, he turns to writers including Kafka, Hardy and Tolstoy for succour. But always, he is astute; not harsh, but startlingly honest. Geiger argues there are more similarities between us and those with Alzheimer’s than we may care to admit. “The world is confusing to all of us, and when you look at it with a clear eye, you see that the biggest difference between the healthy and the sick is simply the degree to which they are able to conceal the confusion. Underneath, chaos roils.” He’s honest too about the impact of his father’s illness on the family. He found a way to connect and learn from his father, but his sister, despite enjoying reading what he writes, can hardly bear what’s happening: “She couldn’t find it interesting, just heartbreaking.” His brother simply “couldn’t deal with it”. Geiger too, at times, is overwhelmed. “Sometimes, standing under the shower, I had the feeling that I was still running,” he writes. “Once, when I passed the wardrobe, I felt a need to sit inside it.” But these moments are temporary. He finds a way, in spite of the disease, to connect with his father and in doing so he understands something more clearly about life. “Alzheimer’s certainly has not benefited my father, but it has taught his children and grandchildren a thing or two. And the duty of parents is to teach things to their children, after all.” We’re fortunate that Geiger has been generous enough to share these precious lessons with the rest of us. *Claire Black is a Gestalt therapist, based in Edinburgh

*The Old King in his Exile, by Arno Geiger is published by & Other Stories, 160pp, £9.99

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Book review: Irresistible: Why we can't stop checking, clicking, scrolling and watching by Adam Alter
(published in The Scotsman)

Steve Jobs, a former editor of Wired and a founder of Twitter – each of them, while designing, disseminating or delivering new technologies, placed very strict limits on how much technology their own kids could use at home. Game designers who avoid gaming, addiction experts who wouldn’t touch the newest smartphone with a barge-pole. These are the startling facts which open Adam Alter’s book, Irresistible. So what do they know that we don’t?

Alter, an Associate Professor at New York University’s Stern School of Business, argues that we struggle to manage our use of technology – just a quick look at my likes on Instagram, or my retweets on Twitter, or whether I’ve been tagged in a photo – not because we’re lacking in willpower but because it is designed with the express aim of making us addicted. In the words of a “design ethicist” whom Alter interviewed: “there are a thousand people on the other side of the screen whose job it is to break down the self-regulation you have”.

Alter uses psychological studies, interviews and scientific research to explore the ways new technologies get us hooked. And he’s very good on the how – the techniques by which social media, gaming and apps push the right neurological and emotional buttons to lure us in and keep us clicking – using this to build a case for a new understanding of addiction. “We’re all,” he states, “one product or experience away from developing our own addictions.” Overall, though, I yearned for more on the why. “Tech isn’t morally good or bad until it’s wielded by the corporations that fashion it for mass consumption,” he writes. “Today, unfortunately, many tech developments do promote addiction.” Indeed. Alter’s focus, though, is on revealing the manner in which they do this in order that we might learn to better manage our appetite for online stimulation.

And let’s be in no doubt as to the scale of our habit. In the UK, 47 percent of adults use social media every day. Across the world, 2 billion people use smartphones, 1.5 billion people use Facebook alone and 60 million new photos are posted to Instagram every day. According to the most recent GlobalWebIndex report, we spend a global average of almost two hours a day on social and messaging networks. And while we do so, we are messing with our social interactions, our sleep and our problem solving abilities (why remember anything when Google always has the answer?). And if, as Alter contends, addiction is produced largely by environment and circumstance, we are at a point in human history when both are more conducive to addiction than anything we’ve experienced before.

Click, refresh, click, refresh. Our susceptibility to goal-setting and feedback – numbers of steps taken as tracked by our fitness gadgets, number of “friends” – these achievements give us a high we strive to emulate or improve. As Alter writes: “where substance addictions are nakedly destructive, many behavioural addictions are quietly destructive acts wrapped in cloaks of creation. The illusion of progress will sustain you as you achieve high scores or acquire more followers or spend more time at work, and so you’ll struggle ever harder to shake the need to continue.”

The argument here is that substance addictions and behavioural addictions are very similar, and whereas we know a lot about the havoc wreaked by the former, we’re much less clear about the latter. And there’s an additional problem, because when it comes to engagement with the online world abstinence is no longer a realistic option for most of us, since technology is omnipresent. Perhaps even more worryingly, these developments are still in their infancy and we have little idea of what their long-term impacts might be.

That’s not to say that Alter struggles to provide salutary warnings about what we’re risking. From the Japanese workers who, unable to switch off omnipresent technologies, succumb to karoshi – “death from overworking” – to the young people who flunk out to satisfy obsessions with online games such as World of Warcraft, to the less extreme but still insidious damage done to our ability to connect with each other socially and intimately, we are flirting with real dangers and they’re only increasing.

In the final section of the book, Alter turns his attention to potential solutions and attempts to strike a relatively positive tone. He espouses a prevention model – we must educate children in how to use these technologies safely rather than waiting until problematic behaviour is entrenched and then attempting to change it. And we must understand that technological advances need not be addictive but can be used for more benign purposes. “Our attitude to addictive experiences is largely cultural, and if our culture makes space for work-free, game-free, screen-free downtimes, we and our children will find it easier to resist the lure of behavioural addiction.” Sounds great, I just wish I knew how we might get there.

Irresistible is published by The Bodley Head, £18.99


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