Cognitive Analytic Therapy, or Can You Make a Mad Man Sane?

Anonymous, 2009. Cognitive Analytic Therapy, or Can You Make a Mad Man Sane?. Reformulation, Winter, pp.11-13.

Background

When I was asked to write this, I must admit I was surprised and just a little bit daunted. What follows is an honest appraisal of what happened to me and how the process of CAT affected me and my life.

Madness - The dictionary definition features a variety of synonyms: deranged in mind, insane, crazy, frenzied, angry, and infatuated. If that is an accurate assessment, then I suppose I was “mad” because I was all of those things. But then again isn’t everyone? It is, though, a question of degrees.

Certainly, I felt and exhibited the whole gamut of those emotions. My wife, family and friends didn’t know what to do next. I didn’t know what to do because I didn’t know who I was or what the hell was happening to me. I had recently had a liver transplant; a life saving operation which literally gave me the gift of life. I should have been on top of the world, “A man barely alive”, who was literally rebuilt. I had the opportunity to again thrust myself into the maelstrom of life, to tackle the issues, the injustices, to “make a difference”. I needed to make up for the mistakes of the past. But I was falling apart, not physically, all well there, but psychologically and emotionally. I found no solace in simply being alive. What was the point of life if you didn’t know what the hell to do with it (I would have used another word other than hell which begins with an “F”, but sensibilities of one’s audience must play a part).

I was a 51 year old Welshman who grew up in a tough industrial steel town. I had a brain and “got out” of the expected route of school to industry and then an early death from some industry related disease. I went to college and then into the teaching profession. Two wives, three children, twenty seven years teaching man and boy followed. I became a head teacher, well liked, respected and good at my job. I had also, however become an alcoholic. At 47, I was forced out of my profession through mental ill health, chronic depression and nervous breakdown, (looking back now it was alcohol related) in short, I simply could not cope anymore. In April 2007, I was diagnosed with Decompensated Cirrhosis of the Liver. It was a death sentence, not that I realised the full implications until later. So began the “war” as I called it, the battle to survive, I gave up alcohol, battled the addiction and won. Fantastic health professionals kept me alive just long enough for the transplant, (I was told I had less than two weeks if that liver hadn’t become available). Now I had to deal with God’s intervention. Why me? What about the guy who died? What if it all went wrong? When would it all go wrong again? I had also become infatuated with a beautiful young nurse. Nothing wrong with that; it happens a lot. But I was married with three children. She had just got married. I went to the wedding. What was one of the definitions of madness, Infatuation? Well I was certainly infatuated. When I told her how I felt, she of course broke off all contact, I was bereft.

Cognitive Analytic Therapy

I had been receiving psychiatric support and counselling from the very early days post operation. The balance of my mind was disturbed. I simply couldn’t come to terms with what had happened to me. The how, what, why, who? There were the questions about me, my life that I couldn’t even begin to interpret let alone answer. I lurched from one crisis to another each one deeper, more destructive than the last. At this point, I was contemplating suicide. Incredible, I had spent the last year fighting to stay alive and here I was considering taking my own life. It was at this point that I was referred for CAT. But, as normal, nothing is ever straightforward; there was a waiting list. So I waited. But even as the wait began I started to put all my faith on this procedure. I had already built it into a life saving event. I had no idea even what it was all about, and although I wanted it to be the Holy Grail, I did wonder whether this was yet more “psycho babble bullshit”. As the wait continued my mood swings and behaviours became more severe.

I had heard briefly of CAT through my contacts with counsellors and a friend who was a trainee psychologist. My experience of “counselling” was less than inspiring, and I was reaching the point where I thought that all things psychological were a mythical creation by a bunch of people who had worked out a better system for printing money than the Bank of England.

Counselling to me was well meaning people who had allegedly been trained and who listened to your woes, made warm coo-ing noises, then told you about their woes, where you then ended up counselling them. So I suppose I wasn’t exactly going into it in the most positive frame of mind. However I was now desperate for help. I had realised that because of everything that had happened to me in the recent past, my fault or not, I was descending into despair. I was afraid that I would once again be entering a tunnel that ultimately led to hell itself.

I wanted a cure for the mental malaise and desperation that I felt. CAT I hoped could be that cure, the magic bullet. It didn’t cure me. As time progressed I realised that CAT isn’t designed to do that and to be fair when dealing with mental illness putting a plaster on it and resting up for a couple of weeks isn’t an option. In the long term what it did was to give me the tools to make the magic bullet myself, to understand; therefore to realise; and to effect the answer.

The course was for sixteen weeks. I have to admit I couldn’t for the life of me see what anyone could talk about for sixteen weeks but I thought all would become clear. The initial phase was simply background building, I told my therapist everything that had happened in my life half expecting her to hang herself, a la the scene from the film “Airplane”. That didn’t happen and my perception was that actually she did care and believed that she could help me come to terms with my problems, who I was, and how to manage my mental instability and move forward with my life. That was a key moment, the creation of the trust that was needed for me to believe that this process could actually work. I prefaced everything I said with what I tell you this week I might say the exact opposite next week depending on my mood. While nothing as extreme as that did happen, I did act and react according to how I felt at the time. Ongoing events have a habit of impinging especially when you are trying to reinvent yourself.

Even from the early stage my therapist understood where I was coming from. She was intuitive and we quickly established that my current attitude, mode of behaviour was steeped in the events of the past especially my relationship with my father and mother. That being said, the first “eureka” moment was the realisation that my relationship with my grandmother and her death when I was a very young boy had critically affected my development as a man and my approach to life as an adult. I was, as a boy, extremely sensitive, I cried a lot, actually still do. This didn’t go down well with a steel worker father who believed your only way to survive was to be hard and ruthless. I suffered untold physical abuse at his hands. Part of my problem was that I never sorted out the past with him. I also realised eventually that, although what he did was wrong, he believed it was best for me because the world I was born into didn’t take any prisoners. My Nana was my comfort blanket, she looked after me gave me love care and protection from the nasty world that I inhabited. Her death took away the comfort blanket and I was now exposed to whatever the world, or particularly my father, could throw at me.

It was from this juncture I created my alter ego, to give him a name, Alan, which was my father’s name. Alan became the hard nosed, forward driving, ruthless individual who couldn’t be hurt. The little boy who was sensitive and cried a lot was crushed and submerged beneath my Mr. Hyde. Don’t get me wrong, it stood me in good stead. I became immensely ambitious and by and large succeeded. I was a deputy head at 28 and a head teacher at 31. Alan prevailed, I lived and worked flat out, but when I crashed I did so big time. I had two breakdowns, severe depression followed and the cycle had been created. I surged to tremendous highs and collapsed to unbelievable lows. I put this down to Wayne, the weak little boy who cried a lot coming through. My therapist worked with me on a simple diagram which had a top and a bottom. I lived either at the top or in the latter years, more often at the bottom. The top being Alan’s world which I saw as success and the bottom being Wayne’s world which was weakness and failure. To me, I had failed, as a teacher, husband, father and ultimately as a man. I never lived in the calm waters of the middle; a place where the qualities of Alan and Wayne could co-exist, even help and support each other. I likened it to an episode of Star Trek, where Captain Kirk had been split into two physical beings, by the transporter, each physically identical. One was ruthless, ambitious and utterly bereft of compassion. The other was soft, sensitive, loving and compassionate. The upshot of the story was that neither could survive alone they could only live as one.

Over the weeks I began to recognise my trigger points. What made me surf the waves from crest to trough and slowly, almost accidentally at first, I began to control the intensity of the mood swings. In short I had become aware of what was happening to me. I used the diagram to control my emotions; I practised techniques of thinking before acting. It didn’t always work and I still did things, said things that were rash and foolish, but slowly they lessened and I became calmer in my acts and deeds.

But there was something else that was causing my underlying instability. In the days of dying, as I have said, I had become infatuated with a young beautiful nurse. By now she would have nothing to do with me, understandable when you consider her position. When you fall in love, however absurd and unlikely, and that love is unrequited, and you are eventually rejected; the emotional resonance is huge and destructive. I couldn’t understand what had made me like this, yes I was ill, yes I was dying but there were lots of nurses that cared for and helped me, I didn’t fall in love with them. Then, the second “eureka” moment, which came directly from the CAT, happened. The nurse, my nurse, was the first one to show me the care and love that my Nana had done. She was warm loving and made me feel safe when the “bogey man” was hiding under my bed; the bogeyman being my imminent death. My love, or what I called love, was simply the search for the care and warmth that my Nana had shown me. The little boy who cried a lot and had been crushed under my alter ego had surfaced and screamed for help. The nurse, however unwittingly, had answered my call but like my Nana she too was to leave me alone, hence my path towards self destruction. My understanding of that fact was the key to what I regard as, and call, my recovery.

I have moved on from those times and I am as happy now as I have ever been in my life. The two sides of me now co-exist, sometimes there is friction, but mostly harmony. We both realise that we need each others’ strengths. Alan gives the little boy who cries a lot, strength to face the hardships and problems. Wayne tempers the ambition, aggression and thoughtlessness of Alan.

The bottom line was the fact that “I” had allowed the little boy, you remember, the sensitive little boy who cried a lot, to co-exist with and support the go-getting, hard-nosed ambitious man I had created. I now ask the question what part the Cognitive Analytic Therapy played? Firstly, it helped me to come to terms with things I already knew, but hadn’t accepted. Then it helped me link up the moment of Nana’s death and its effect on the person who I had become. I now understood who I was and why I was and how I got there. I wasn’t the bad person I had come to believe. I was, and am, an ordinary man with lots of flaws but lots of good parts. The key to it is accepting all facets of my character and personality, to temper the highs and lows with the understanding of who I am. (And not to fall in love with 25 year old nurses!!!)

This may sound like a lot of “Tosh” but it is a genuine attempt to put into lay mans terms the effect that Cognitive Analytic Therapy had on me. As the recipient, in the end I think I have gone a long way to resolving the issues; but it was the facilitator, my therapist, who made me ask the questions, face the facts and address the behaviours. Without it, at the risk of being melodramatic, I may well have taken my own life.

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Full Reference

Anonymous, 2009. Cognitive Analytic Therapy, or Can You Make a Mad Man Sane?. Reformulation, Winter, pp.11-13.

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Petratou, V., 2012. The 16 + 1 interview. Reformulation, Summer, p.43.

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Cognitive Analytic Therapy, or Can You Make a Mad Man Sane?

Cognitive Analytic Therapy

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