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CAT in Later Life: Becoming a Historian of the Self

Sutton, L., 1999. CAT in Later Life: Becoming a Historian of the Self. Reformulation, ACAT News Summer, p.x.

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1999 ACAT CONFERENCE KEYNOTE ADDRESS

Dr Laura Sutton, Chartered Clinical Psychologist, has worked in Elderly Mental Health in Southampton for 12 years. In 1995 she took part in the first European Colloquium on therapeutic work with older people, leading to the publication in 1997 of Past Trauma in Later Life: European Perspectives on Therapeutic Work with Older People (Hunt et al, London: Jessica Kingsley) the first book for practitioners specifically on past trauma in late life. Her own chapter looks at CAT as a model for work in residential settings. In December 1995 she obtained her PhD, ‘Whose Memory is it Anyway?’, which was a critique of the way in which memory and ageing is studied in cognitive psychology, developing critical case studies to explore what is allowed/disavowed in memory research in cognitive psychology.

Laura is due to complete her basic CAT training this year from the Wessex course and she has had accepted for publication "When late life brings a diagnosis of Alzheimer’s Disease and early life brought trauma: A Cognitive-analytic understanding of loss of mind" (to appear in Clinical Psychology and Psychotherapy: An International Journal of Theory and Practice). Meantime, she and Virginia West got together last year to organise the first meeting on CAT in Late Life, on December 5th at the York Clinic. As a result Laura was invited to give the keynote address to the ACAT conference this year. We reproduce her the abstract to her talk and the concluding comments from her address. Copies of the full address are available from the ACAT national office, as are her above two publications.

Abstract

I have been working as a clinical psychologist in Elderly Mental Health for some 12 years now, where I have come to question what are the key tasks of therapy in late life. I see this in terms of questions about the nature of intergenerational relationships amidst the sheer ageism of our society and how this is replayed through professional discourses and practices; and the inadequacies of current therapeutic frameworks for addressing the sociopolitics of age when clients so often are thinking about themselves and their lives critically and historically in this way. This is what has brought me to CAT and to my keynote address.

In working with older age groups I have been struck by the massive fallout from War, the deprivation of the years between the wars, the weariness of it all; the invisibility of women through these times; and through all this, the tenacity of "states of being" from early life. I have been impressed and touched by the courage of people in older and old age to change and adapt; and to want, but not always see that they are permitted, to make transitions to new times. Self – and other-reflection in old age I think can have a warm generativity to it, amidst broader issues connected to the remembering and forgetting of people(s) in society and to the end of life.

I want to draw some of these strands together today through some of the clients who have led me to take up CAT for these age groups: ‘Deborah’, 90, a survivor of camps in Java in WW2; ‘Edith’, 84, struggling with the long term effects of early deprivation and abuse; ‘Joan’, 66, referred for ‘challenging behaviours’ in the context of CSA and past domestic violence; and ‘Cyril’ who was in his 70s with multi-infarct dementia and anoxia following a surgical operation when he changed my mind about dementia. Through their stories in therapy I shall return to the main themes – ‘intergenerational re-storying’, ‘ageism’, ‘the remembering and forgetting of people(s)’ – to set out some theoretical and philosophical foundations for CAT in late life, in dialogue with Tony Ryle and Mikael Leiman. Certainly it is timely to be introducing CAT to older and old age in 1999, the United Nations’ Inter-national Year of the Older Person.

The question of how far one is the author(ess) of one’s own story and how much is jointly (re)constructed, is an interesting one. 

Intergenerational re-storying

It brings me to philosophy, principally to Mikhail Bakhtin, the Russian philosopher who was centrally concerned with the authoring [authoressing] of existence. I understand that Bakhtin’s work has been influential in CAT theory (Ryle 1997). I’ve been introduced to it through Holquist’s ‘Dialogism. Bakhtin and His World’ published by Routledge in London (Holquist 1990).

Bakhtin was born in a town south of Moscow and in the first chapter Holquist writes about his life (p 12):

"Bakhtin lived a long life: he was born in 1895 and he died in 1975. His longevity is in itself not so unusual, but in his thought nothing is ever ‘in itself’. If, then, we put his life into the context of the wars, revolutions, famines, exiles and purges which he managed to live through, the fact that he reached the age of 80 years becomes more remarkable. Given such massive displacements, it is less surprising that for almost sixty of those years he never ceased to think about the mysteries of locating a self……the more one knows about the life of Bakhtin…his meditation on the possibility of selfhood makes its way through the most powerful doubts about its existence that have been raised across the spectrum of the human, social, and even the so-called precise sciences".

Bakhtin’s own story here has a familiar feel to it in the experience of being a therapist to older people. It makes me wonder, what are the tasks of therapy in late life? Peter Coleman (1996, 1998, and forthcoming) has compiled the major reviews of storying, life review and reminiscence in psychogerontology, and concludes that one of the tasks of normative identity management in late life (in CAT, ‘self management’) lies in "becoming an historian of the self".

Here we have the notion of "becoming": transitions are permitted. We have the notion of becoming a "historian of the self": reflexivity on the self is permitted. Thus CAT with its central concern on the restorying of the self has clear relation to developmental tasks in late life, particularly for those who are ‘stuck’ in this task in some way, for example those who haven’t a strong sense of self to ‘history’. (Sutton, forthcoming).

This is a radical view of ageing. Coleman (1996) points out the dominance of medical models of ageing in Western culture and whilst affirming that physical ageing is a hard fact, is resolute that it is not the only position from which to view ageing.

Ageism

Bob Knight (1996) in his book on Psychotherapy with Older Adults identifies the ‘loss-deficit paradigm’ as part of our ‘practitioner heritage’ in ageing. Ageing is defined largely in terms of physical loss and functional decline (such as cognitive decline). He argues that we need to develop ‘maturity-based, cohort-specific, and developmental’ models of ageing. ‘Maturity-based’ and ‘developmental’ as I hope comes across in my talk. Meanwhile, one of the cohort-specific aspects not addressed by Knight is I think the position of women in society.

There’s a growing body of work on this, in terms of the invisibility of these cohorts of women (eg Forster 1996). Certainly, what comes through so much when working with older women in therapy is their lack of voice in society. This has intrigued me in relation to CAT theory with its focus on Vygostsky’s ideas about the internalisation of speaking as "inner speech"; which makes thought possible. I asked Tony Ryle where this leaves people who have little voice. He said I’m looking for ‘inner speechlessness’. I thought that this is just what I’m looking for, for if ‘inner speech’ makes thought, and thereby remembering, possible, then ‘inner speechlessness’ makes no-thought, and thereby forgetting, possible. This then permits the possibility of an adequate theoretical account of the profound interdependency of remembering and forgetting (Shotter 1990), and of ‘false remembering’ and ‘false forgetting’ in power relations (Ryle 1998).

The remembering and forgetting of people(s)

Bakhtin’s view is that there is nothing ‘in itself’. Things – people – exist only in relation to an other. This insistence on ‘the other’ is said to be a hopeful philosophy for it adds a check to monopolistic thinking and acting (Holquist 1990). It also adds the dimension of ‘the other’ to memory theory. Cognitive psychology, in abstracting memory as a cognitive faculty and then measuring it, is, as Middleton and Edwards in Collective Remembering (1990) point out, a ‘single minded’ approach to memory. Donald (1991) notes that ‘memory’ has been stored extra-corporeally for so long (hieroglyphs for 2000 years, books for 500, computers for 50) that memory is easily conflated with information. Stiles (1997) suggests however that the psychological residue of events is more properly characterised as something like a ‘voice’ rather than a book or a file to be retrieved and processed: I’d also like to see work on voicelessness in relation to forgetting. This is why I expect dialogism to be more suited to many questions about testament than information processing models could ever be.

Martin Coles, in the preface to Collective Remembering (Middleton and Edwards 1990) has this to say:

"When that tiny segment of society whom it is fashionable to refer to as social scientists attempt to study the process of memory and forgetting, issues of power and self-determination are rarely ( I am tempted to say never) at issue…

Once the mind and memory are seen as extending beyond the ‘individual skin’ to encompass both the cultural milieu and the ‘body politic’, other dichotomies fall too. The notions that psychological content can be strictly separated from process, or that science can be strictly separated from history by its reliance on the experimental method… [will] come in for pointed, sceptical scrutiny…In these new practices, issues of power and self-determination of people(s) will no longer be cut off from scientific inquiry into memory".

This sets up the possibility that in the psychology of ageing, memory is not separated from reminiscence. That is, cognition is not separated from meaning. It’s this re-uniting of cognition and meaning – the ‘cognitive’ and the ‘analytic’ – mediated as I understand it through Mikael Leiman’s merging of Vygotsky’s inner speech and object (human) relations theory that makes his saving CAT from cognitive psychology I suspect so important. And offers older people in relation to younger researchers a valued history in living memory.

In the United Nations’ International Plan of Action on Ageing, the culminating statement of humanitarian and development aspect of ageing (UN, 1998, p10/11) is that:

"A longer life provides humans with an opportunity to examine their lives in retrospect, to correct some of their mistakes, to get closer to the truth and to achieve a different understanding of the sense and value of their actions. This may well be the more important contribution of older people to the human community. Especially at this time, after the unprecedented changes that have affected mankind in their lifetime, the reinterpretation of life-stories by the aged should help us all to achieve the urgently needed reorientation of history".

For Coleman (1998 and forthcoming) becoming a historian of the self is important not only for one’s own sake but for others’ too; I’d like to say intergenerationally. After all, nothing is ever ‘in itself’.

References

Coleman, P (1996) ‘Last Scene of All’. Inaugural Lecture delivered at the University of Southampton, England, on April 23rd (copies available from the university)

Coleman, P G (1998) The story continues: persistence of life themes in old age. .Ageing and Society

Coleman, P G (forthcoming) Creating a life story: the task of reconciliation. To appear in The Gerontologist

Coles, M (1990) Preface to D Middleton and D Edwards (Eds) Collective Remembering London: Sage

Donald, M (1991) The Origins of the Modern Mind Harvard University Press

Forster, M (1996) Hidden Lives. Penguin

Holquist, M (1990) Dialogism, Bakhtin and His World. Routledge: London

Knight, R. (1996) Psychotherapy with Older Adults London: Sage

Middleton, D and Edwards D (1990) Collective Remembering, Sage: London

Ryle, A (1998) Letter to British Journal of Psychiatry, 173, 179

Ryle, A (1997)

Cognitive Analytic Therapy of Borderline Personality Disorder: The Model and the Method

. Chichester: John Wiley & Sons Ltd

Shotter, J (1990) ‘The social construction of remembering and forgetting’. In D Middleton and D Edwards (eds) Collective Remembering. London: Sage.

Stiles, W B (1997) signs and voices: joining a conversation in progress. British Journal of Medical Psychology, 70, 169-76

Sutton, L (forthcoming) ‘When late life brings a diagnosis of Alzheimer’s Disease and early life brought trauma. A Cognitive-Analytic understanding of loss of mind’. To appear in Clinical Psychology and Psychotherapy. An International Journal of Theory and Practice.

UN (1998) International Plan of Action on Ageing and United Nations Principles for Older Persons. United Nations Dept of Public Information. New York.

Jason Hepple and Laura Sutton have written a new CAT text on working with older people entitled

Cognitive Analytic Therapy and Later Life: A New Perspective on Old Age

you can order your copy from Amazon.co.uk via ACATonline.

Laura Sutton

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Full Reference

Sutton, L., 1999. CAT in Later Life: Becoming a Historian of the Self. Reformulation, ACAT News Summer, p.x.

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CAT in Later Life: Becoming a Historian of the Self
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Opinion and Debate : Boundaries
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