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There’s something about sitting in a GP surgery waiting room that can make some people feel anxious…..Men, in particular, often avoid this if they possibly can.  On 14th July, we had a discussion on  BBC Radio Nottingham’s Morning Show,  asking the question ‘Why don’t men go to the Doctor’s?’ as part of a campaign by a local GP to encourage more men to have health checks and not ignore symptoms which might need attention.

There are all kinds of influences on people: for example, family, social, cultural, educational, economic and environmental.  In Western society, historically, there has been cultural and social pressure for men to be macho and tough; signs of weakness or vulnerability have been discouraged; men have been seen, traditionally, as the ‘provider’ for the family. These attitudes are changing, more slowly in some places than others; parental modelling will be one influential change factor.

It follows that, if as a man, you believe that admitting to having something medically wrong, identifies you as weak, or significantly diminished as a man, you will be reluctant to acknowledge this. This feeling might be intensified if you were influenced by your father, and other male figures in your life, having this, often unspoken ‘code’. 

We all tend to prefer ‘control’ over ‘chaos’, and when, in therapy, I ask people to complete a scale indicating their atttitude to this, on average,men score higher than women in believing that control is/should be in the hands of the individual (rather than ‘fate’ , ‘luck’ or external factors being responsible).

Once we tell someone else (eg the GP) that we think there is something wrong with us, some of that control may feel like it is passing into someone else’s hands, a potentially scary feeling. If we have to ask for time off work to go to see the GP, this also entrusts some elements of knowledge to, for example, a line manager.

If your GP is a complete stranger, this is potentially even more worrying.  Building a trusting relationship, man to man, takes time, and tends to be generated and consolidated by a shared interest, rather than the sterile clinical setting of the surgery; there may also be a social construct of the GP being ‘superior’, a ‘power’ figure, which could exacerbate the sense of threat and vulnerability. 

Also, if you are someone who strongly prefers ‘being in control’ to a state of uncertainty and ‘going with the flow’, you are likely to want quick answers (a short-cut, ideally) , and find it particularly stressful to have to wait for various tests to be completed, which is the usual process of medical diagnosis. Searching the Internet may seem like a better alternative, but it is likely to increase anxiety, often needlessly. 

These, and other reasons, may contribute to some men ignoring symptoms, hoping they will go away, and/or becoming highly anxious when they do not, and a belated visit to the GP becomes necessary. There are no quick answers to changing attitudes, but fortunately it is becoming more acceptable for both men and women to reach out for help, sooner, as I observe from my case-load, which is currently 55% male. Having the courage to take this ‘risk’ improves quality of life; and courage is not something that the human race has historically been short on!

On Monday 15th June, Nottingham magistrates sentenced a man to almost a year in prison, for a series of vandalising rampages through the city centre, culminating in the defacing of the statue of Brian Clough. And on that day, on BBC Radio Nottingham’s Morning Show with Sarah Julian, we were discussing the psychology of vandalism Why, oh, why do they do it? 

My theory, supported by what was later said in court in this particular case, is that STRESS – often arising from boredom – drives this addictive compulsion.  The urge to trash neat (and sometimes attractive) symbols of order, which may be internalised as ‘the smug satisfaction of society’, and replace this with mess and chaos, is often fuelled by alcohol/drugs; these provide a temporary sensation of invincibility. The ‘high’ of this is combined with a surge of adrenaline due to the risk of being caught and punished. Once the first damage is done, the compulsion to do more is overwhelming.  Being part of a group (with the connotation of belonging ) is a powerful driver; this contrasts with the sense of alienation/exclusion sometimes felt by those who want to destroy/damage property in this way. 

In my experience as a magistrate, individuals may not be able or willing to explain this; sometimes, they may simply not remember what happened….

To the ‘casual’ vandal – as opposed to the one who is specifically targeting a person or persons’ property as an act of revenge or to publicly shame –  there may not appear to be a victim of this crime. But most people will lose a at least a little of their sense of well-being when they encounter evidence of vandalism; depending what it is, of course, some will be outraged! Vandalism erodes our sense that the world is basically an Ok place, and we are Ok (and safe) in it. And perhaps, at a subliminal level, this is what the vandal wants the rest of us to feel… some of that sense of his/her own not-ok in the world?

With graffiti, the vandal leaves his/her ‘tag’ – a public statement of a right to exist and be acknowledged, demanding the  ‘respect’ he/she hungers for  – by disturbing our well-being, if necessary.

Psychologically, the cry is for recognition of this anxiety/anger, understanding, and a way back into inclusion.

As the numbers of reported cases of Swine Flu increase, BBC Radio Nottingham broadcasts a balanced view. Nevertheless, some people are experiencing higher levels of anxiety about their health and today I spoke about this on The Morning Show with Frances Finn, and producer Tom Whalley. Tom has become aware that his humorous take on his own preoccupation with his health has become more acute recently, due to the ‘pandemic’ and 5/6 threat scale. 

Health Anxiety is much more common than people generally realise; this is because, often, the individual is embarrassed to admit he/she is worried, when intellectually they acknowledge that their fears are unecessary. Typically, amongst family, friends or work-colleagues, the person might make light of it, even joke…..whilst seeking reassurance that, for example, a particular sensation, skin pigmentation, or other minute change revealed by repeated self-examination, is NORMAL.  The slightest doubt or uncertainty feels intolerable and the person can’t help checking with others, or on the internet, or with the GP etc. People with Health Anxiety tend to screen out information which could allay their fears (eg 5000 people died worldwide with ordinary flu in the same period as 100 of Swine Flu). They may experience panic attacks when they focus on the body sensations naturally produced by being anxious, misinterpret these as a sign of something serious, and as consequent anxiety grows and sensations build, induce a panic attack. 

Thoughts are dominated by ‘What if…?’  and fears of something catastrophic and unbearable happening to self (and/or loved others).

This form of insecurity can arise due to parental modelling; sometimes it develops following a health scare/diagnosis of a condition (eg epilepsy/asthma/diabetes/heart problem); or it may be a focus for other (avoided) feelings which the person would otherwise have to face.  Anxiety is closely associated with anger,  and it may be that the underlying belief is that something important to the person, is, or was, very  unfair/wrong. 

Initially, clients often come to therapy for help with stress or panic attacks, but the news about Swine Flu, provides an opportunity to raise these concerns with the ‘comfort’ of normalisation; ‘after all, everybody’s talking about this, aren’t they? ‘……. 

In fact, anyone who has been feeling depressed, anxious or stressed about difficulties in their life (relationships, work security etc), will have a tendency to feel more so when specific BAD NEWS which could affect them personally, is dominant in the media (eg credit crunch/ Swine Flu). This is because they are already feeling some sense of helplessness, and personal ‘radar’ may be set to ‘search’ for reinforcing information! (Pandemic -which means global epidemic – may be interpreted as ‘universally fatal’)

Treatment for Health Anxiety focuses on the meaning that the person makes of the body sensations, and testing out unhelpful beliefs.  ‘What is the WORST you fear could happen? What would that be like/mean to you?’  It is important to encourage new behaviours and distraction to replace the repeated self-examination and reassurance seeking (which requires co-operation from family/friends etc). Experimenting with inducing structured ‘panic attacks’ in the therapy room can be very effective in illustratingthe meaning of the sensations and how we can correctly interpret them and ‘control’ them. Teaching self-soothing techniques, such as muscle relaxation and regulated slower/deeper breathing is also potentially helpful.

However, whilst some people express their inner fears through Health Anxiety as described above, there are others at the opposite end of the continuum who also have health-related fears; they AVOID any self-examination, regular health check-ups/tests, visits to GP etc.  This, of course, is in its own way, equally unhelpful behaviour.

On Monday this week, I took part in an interesting debate on BBC Radio Nottingham, on the Morning Show with Frances Finn: ‘when are we in our prime – physically, psychologically, productively ???’  

There must be as many views on this as there are people…. My focus, of course, is psychological fulfilment; to me, this means, feeling ‘good in your skin’ (the French have a saying ‘il faut se faire a son visage’  -this translates literally as ‘you’ve got to get used to the face you’ve got’  – this is not just about accepting how we look, physically, but also, learning to accept oneself, for better and worse! …understanding the ‘shadow side’ of your personality, coming to terms with your demons. This is about being able to see the funny side of life, being philosophical….wise and serene…living for the moment and facing forward with a sense of ‘glass half full’ 

I believe this time in our lives may be momentary: for example, ecstatic moments such as the wedding day, the birth of a child, achievement of a major sporting victory/artistic recognition… and when it is more enduring, it is probably episodic, and comes later in life rather than earlier. All our experiences contribute to the development of our inner peace, even (and perhaps, especially, our traumas).

Ultimate fulfilment is likely to be a direction, not a destination – as Carl Rogers, father of Person-centred counselling, believed.

In the lead up to our 20’s, we are establishing our self-identity, sexual-identity, academic-identity, early career steps and seeking financial independance; probably ‘seperating’ from parents. This is a time of making sense and meaning about ourselves by comparison with others. The big question is  ‘who am I?’ ?’

20’s-30’s … this is more about ‘where am I going?’ we may be carving a path in relationships, accumulating material possessions, engaged in workplace competition. This is a time for pursuing interesting cul-de-sacs, as our creative energy is high…

30’s-40’s:  we now tend to focus ‘what is my priority?‘ Towards objectives, child-centric, materialistic, bursts of creativity, comparison with others.

40’s-50’s – the challenge of the ‘mid-life crisis’ …’is it now or never?‘  pursuit of lost opportunities, the star of a time of critical reflectivity, changes of direction; increased interest in non-materialistic issues, eg spirituality, environment, politics… A reminder: this is the start of the second half of our lives! 

50’s-60’s: ‘what does the future hold now?‘ a time of adjustment and development/enhancement of different interests; grieving losses, includig self-related. Existential issues….

60’s-70’s: ‘keep on rockin’  energy for new experiences and special interests; reflection on the past, especially losses; enjoying social contact of various kinds.

70’s onwards; ‘making the most of life’  – in every feasible way!

Today on the Morning Show with Frances Finn at BBC Radio Nottingham, we discussed Post-traumatic Stress Disorder (PTSD).

PTSD can develop when you go through a near-death experience, or an event happens which makes you fear, or actually have, a serious injury; it can also occur if you witness the sudden or shocking death or injury of another person, especially of someone close to you. Even a diagnosis of a life-threatening illness or sexual abuse can result in PTSD. 

The key elements of the experience are: shock, fear, helplessness or horror.

Not everyone develops PTSD; some people are especially susceptible – children, the elderly, adults who have a rigid sense of the world as a safe place (“bad things only happen to other people, probably because they have been bad/ the world is fair / good people get rewarded for being good”).

Symptoms of PTSD include: flashbacks/bad dreams giving rise to panic attack experiences; sleep disturbance; numb emotions; irritability; difficulty concentrating; sense of pointlessness; loss of interest in usual activities; avoidance of reminders of what happened (and rigid extreme beliefs for ‘self-protection’)

PTSD usually develops within 3 months of the experience, but can also show itself years later.

Help is available! Your GP may prescribe medication, but will probably prefer to arrange counselling for you; cognitive-behavioural counselling is especially effective; we aim to help you ‘join up the dots’ of the experience, understand the links between thoughts and feelings and behaviours, gain new persepectives and a feeling of greater control, and formulate coping strategies and a relapse prevention plan.

Above all, we normalise the symptoms of PTSD: it has been your natural response to this terror. We urge friends and family to support you also; this is not a matter of ‘snap out of it’ or ‘move on, put it behind you’!