Dr. Martin Ellingham, patient

The following is an intake assessment of Dr. Martin Ellingham completed as if he were a new patient seeking therapy. It was written by Santa, a retired counselor, with input and advice from Abby, currently practicing as a therapist. I contributed to some degree, mostly by asking questions and getting clarifications. I think you will all find this quite enlightening. Santa exposes many insightful details about ME as her assessment summarizes all that we have learned about Martin Ellingham relevant to what a therapist would want to know. As she has told me, she is impressed with how many personal details the show writers have provided from Martin’s life throughout the 6 series. I am convinced that her efforts will inspire much discussion. I invite any other readers of this blog to add observations of their own.

This initial analysis is meant to provide a basis upon which to elicit various treatment protocols and approaches to therapy for this “patient” from any of you who might venture to recommend them. We are interested in any treatment plans you might like to suggest.

As you will notice, we have included medication in his care. We figured Ruth would be likely to refer Martin to a psychiatrist and that he would prefer to be seen by an MD. Most psychiatrists would recommend medicines. On the other hand, we consider it important that therapy include establishing a relationship with someone who is competent in many sorts of therapeutic methods. Santa and Abby believe Martin would benefit from individual therapy as well as couples therapy with Louisa. Of course, we have no idea how the show will handle therapy in series 7, but since there are only 8 episodes in each series, we expect that couples counseling may be all we see.

Presenting Problem:  Martin Ellingham, M.D.  was referred by Ruth Ellingham, M.D. (his aunt).  Dr. Ellingham says that he has sought help because his wife of 6 months has recently told him that she is not happy in their marriage and needs to take “a break.”  She told him this shortly after she had a serious accident, which patient believes he was instrumental in causing.  She was in fact on her way to Spain with their 9 month old son, to visit her mother for an undetermined period of time, when she was forced to return to Truro for emergency surgery to correct a potentially life threatening arteriovenous malformation.  The threat of losing his marriage is a source of deep distress for Dr. Ellingham. He acknowledges that he must “change” in order for their marriage to succeed.   However, his desire to change is not very specific and he is uncertain about how to proceed and what he needs to do in order to be “a better husband.”

He further states that for some time before his wife indicated her unhappiness with the marriage, he had been preoccupied with worries about his health, precipitated by a return of a hemophobia.  He had lost his appetite and was sleeping poorly.  He tried to self-diagnose a physical disorder that might be causing these somatic symptoms; he did not consult a physician.  He also reports increased irritability and decreased libido during this period.   He states that he “shut out” his wife from these concerns, although he can’t explain why he did so.  He believes this to be one source of his wife’s unhappiness and frustration with him. Furthermore, he states that he has never understood why she was attracted to “someone like me.”  He now acknowledges that these somatic issues may have an emotional origin and is interested in exploring issues in his family of origin that may relate to his present difficulties, especially as they may relate to his wife’s decision to take a break from their marriage.   He denies that the return of his phobia has anything to do with his marriage, stating that he loves his wife and son very much.  He reluctantly admits, however, that the chaos and disorder attendant upon life with an infant, as well as sharing his living space for the first time, and with someone who doesn’t share his habits of tidiness, sometimes have been difficult to deal with.    He says that he has been eating and sleeping a little better since he made the conscious decision to seek help in order to “change.”  He admits to being “very sad” from time to time at the prospect of being separated from his wife and son.

Mental Status, Affect and Mood:  Dr. Ellingham is a tall, immaculately groomed Caucasian man, formally dressed, in his late 40s, who appears to be his stated age. His clothes are somewhat loose and he says that he has lost weight.  His affect is restricted, and his mood is somewhat dysphoric. He denies suicidal ideation.   He shows no evidence of a thought disorder; he is oriented and his judgment is unimpaired.  He makes good eye contact and is responsive.  His answers are concise and to the point.   His insight into his difficulties is somewhat limited.  During the interview, he occasionally appeared anxious or irritated, or sad, but these emotions were quickly suppressed.

Substance Use:  Patient states that he disapproves of liquor and never drinks.  He has never smoked, or used any banned substances.

Relevant Psycho-Social History:  Dr. Ellingham is currently a General Practitioner in Portwenn, Cornwall.  Formerly, he was a surgeon in London, for 12 years head of Vascular Surgery at St. Thomas.   About 5 years ago, he suddenly developed hemophobia, disabling him from the practice of surgery.  He reports that the phobia developed when operating on a patient who he had recently seen interacting with concerned family members.  Their concern and affection for the patient suddenly struck him in a way that was unusual for him.  He was unable to finish the operation or to perform any subsequent operations.   He retrained as a general practitioner, and relocated in Portwenn, a place where he had family (an aunt, since deceased) and had spent time as a boy.  It is unclear why he chose to retrain and relocate rather than to seek treatment for his condition.   About a year ago, he utilized cognitive-behavioral techniques to desensitize himself to the sight and smell of blood.  This succeeded enough that he felt able to apply for and accept a position as surgeon at Imperial Hospital in London.  This position was not taken up, as he decided instead to marry the mother of his child and remain in Portwenn, where she was most comfortable.  He states that he detests Portwenn, and finds dealing with his patients frustrating on account of their unwillingness to follow advice or sound hygienic principles.   He denies, however, that foregoing the opportunity to resume his career as a surgeon, and living in a place that he dislikes, have anything to do with his dysphoric mood or the return of his phobia.

He reports that he did not expect to marry or to have a child, and his relationship with his current wife has been tumultuous, marked by missteps, separations and miscommunication throughout their courtship and in their marriage.   Nevertheless, he states that he is deeply in love with her, and has been since their initial encounter several years ago.  (She is head teacher at the primary school in Portwenn.)  They did not begin living together until after their son was born, and the decision to marry was not made until 3 months after that.

Patient states that this is his first marriage and his first serious relationship since he was in medical school.  His first real relationship  ended when the woman, a fellow student, chose to leave England to study abroad.  He reports that he was devastated by  this.  With few and brief exceptions, he has neither sought nor welcomed female companionship thereafter.  At the same time, he is clear that his orientation is heterosexual.

Social Supports.  He has lived alone all his adult life.  He reports few friendships of any significance, with the exception of a former classmate from medical school, who is now the head of the Cornwall NHS, and who helped him to relocate and later in his effort to find a job in London.  He does admit to being friendly with one or two inhabitants of Portwenn.   He was fond of his aunt, now deceased, who was living in Portwenn when he relocated, and she was a source of support to him both when he moved to Portwenn and as a child.  He is close to another aunt who now lives in Portwenn, and she is perhaps the only person in whom he feels he can confide.   He reports that he has little time for social niceties, which he considers “rubbish,” and always speaks his mind.  He admits that some may find his manner abrasive.  In any case, he feels that finding a friend among the inhabitants of Portwenn is highly unlikely, as he finds most of them extremely irritating.  He has no church affiliation. His sole hobby is repairing antique clocks, an activity that he does alone. His wife does not share this interest.

Family of Origin Issues:  Patient reports a long-standing estrangement from both parents.   He had no communication with them at all for seven years, until a couple of years ago, when they showed up to ask for money and announce their separation.  During this visit, his mother made clear how much she had always resented and disliked him, to the point of saying that she wished he had never been born.  Predictably, the visit ended badly, and he had no further communication with them until a few weeks ago.  At that point, his mother arrived unannounced, and told him that his father had recently died and she had come to re-establish a relationship with him as her sole remaining family.    It developed that she was without financial resources and that  her real goal in contacting him was to obtain from him enough money to support herself.   Upon realizing the extent of her duplicity, Dr. Ellingham asked her to leave his house and indicated that he desired to sever all further relations with her.

Patient’s childhood was marked by bedwetting, social isolation, ridicule and shaming from both parents, little affection, and harsh punishments, including spanking with a belt and enforced enclosure in small spaces for seemingly trivial infractions.  His aunt recently told him that between the ages of 4 and 6, his behavior underwent a change and he became significantly more defended.  He was sent to boarding school from age six on, where he notes that his bedwetting and social isolation continued and he was the object of considerable bullying.  Uncoordinated and physically clumsy, he did not participate in team sports.    He was, however, good at chess and derived some pleasure from winning competitions.

Patient’s father and grandfather were surgeons, and patient seems to have internalized their belief that a surgical career was the top of the medical profession, and that being a GP was far inferior.  His father was contemptuous of his position in Portwenn.

Patient reports that he had only very recently come to understand that he did not deserve his parents’ treatment of him and that, in fact, it was abusive.   He notes the contrast between his childhood, and his wife’s and his own loving interactions with their son.    He wonders if he might possibly have developed a sense that he does not deserve to be treated lovingly.

Summary and Clinical Assessment:  It should be noted that Dr. Ellingham has recently experienced multiple significant stressors, including recent marriage and fatherhood, marital difficulties, death of a parent, and the severing of ties with his mother.   At this point, he certainly meets criteria for a diagnosis of Major Depressive Disorder, with periods of sadness, loss of appetite, difficulty sleeping, loss of interest in usual activities, increased irritability, and feelings of worthlessness, and guilt.  He has agreed to a trial of anti-depressant medication, and medication to help him sleep.

Dr. Ellingham has a specific anxiety disorder, i.e., hemophobia.  The hemophobia is of secondary clinical concern, although it should be addressed at some point, ideally by returning to a course of desensitization, supervised by a cognitive-behavioral therapist to make sure he reaches a point of “overtraining.”

Dr. Ellingham has few interpersonal skills, and little understanding of their utility.  He tends to have little empathy with others, and has lived as a social isolate for most of his life.  He makes good eye contact, however, and his lack of empathy may well be a result of suppressing emotions he considers “soft” rather than an inability to sense the feelings of others.  While a diagnosis on the autism spectrum, i.e., Asperger’s, can be kept in mind, this interviewer does not currently find much support for such a diagnosis

The clinical impression of this interviewer is that Dr. Ellingham is a man of formidable intelligence, who learned very early in his life to formulate a defensive structure that protected his deep sense of vulnerability and defectiveness.  This was necessitated by emotional and physical abuse, but more significantly, a profound failure of maternal attachment.   This defensive structure includes an insistence on order and control, on minimizing affective reactions, and on a degree of autonomy and lack of entanglement in relationships that might expose his neediness and vulnerability.   In short, intimacy presents serious difficulties for him.  He is unable to seek help from others, and because this “counter-dependent” structure emerged so early – certainly by the age of 6 or 7 – he has been unable to manage or integrate emotional responses that occur in later life.  Another way to say this is that much of his emotional development has been frozen at the “child” level.  Thus, “falling in love” was an experience which essentially blind-sided him, and for which he was in no way prepared.   Ultimately, this impulse was too strong for his defensive structure, and he acted on it.   The burden, however, of living intimately with a wife and child and surrendering much of his sense of control, has been another major stressor, under which, this interviewer believes, his anxiety disorder, as well as other somatizing symptoms,  re-emerged.

It is this interviewer’s impression also that his feelings about his loss of his surgical career, both from his hemophobia and the decision to remain in Portwenn, are unresolved and probably contribute to his depression.

Last, there is a hint of some traumatic event between the ages of 4 and 6, which should be explored as the therapeutic alliance becomes stronger and the patient’s symptoms of depression are resolving.

Recommendations:   Dr. Ellingham’s wife, Louisa, should participate in some sessions with the treating therapist.  He has never been able to share much of his inner self with her, and may need support and assistance in doing so.  Helping her to understand his difficulties may go a long way toward healing their marital problems.    Couples counseling is also recommended, if his wife will agree to it.

Nevertheless, Dr. Ellingham could benefit from individual therapy.  He has many losses to grieve, among them the loss of his career (and identification) as a surgeon, and the loss of his parents, both now and as a child.  He needs to repair a sense of himself as defective and undeserving of love.  He certainly needs to develop better access to his own emotional life.   A cognitive-behavioral strategy or “restructuring” negative thoughts would be a good place to start.  The experience of a therapeutic alliance with a treating therapist would be of significant benefit to him.

 

 

Originally posted 2014-12-07 14:34:19.

63 thoughts on “Dr. Martin Ellingham, patient

  1. Linda D.

    My goodness, Santa, Abby and Karen! This is the most awesome post I have ever seen and I know it represents both hours of work and an enormous amount of cumulative skill and experience! Thank you all for your wonderful post!

    I am at a loss as to how to respond to it except to say that Martin and Louisa would be so lucky to find help of this quality. I think for sure, it would go a long way to resolving their marriage and relationship issues and undoubtedly, save their marriage. It would also have the potential for Martin to learn so much about his past, especially with his family of origin, and to understand fully how interactions with his family damaged him so much. I hope that Louisa comes to understand this as well. She really has NO idea about all of this because he has not shared much with her during their relationship. I have little doubt that when she learns all he has endured, she will see him in a very different light and will want to participate in therapy to help him. She may even learn more about HER early life experiences which may help her to change some things about herself. They both have endured drama in their early lives which has affected how they relate to each other and others. Knowing a lot more about each other can’t help but solidify their relationship which, thankfully, is based on a deep love for each other and for James. With that, there is much hope for success in therapy. We all want very much to see them succeed and be very happy.

    I suppose the BIG QUESTION is whether they can find help like this. And, will Martin be able to lower his guard enough to benefit from it? Also, will Louisa hang in there after the events of Series 6? He surely has never had a more important reason for getting to the bottom of his hemophobia, depression, and somatic issues. He knows he may have run out of chances to save his marriage and to keep his family intact. That is a HUGE incentive for him I believe.

    I like what you have said about the loss of his career and his identity as a surgeon AND his dislike of Portwenn as being major contributors to his depression, no matter what he has told Louisa in the past and no matter that he DID stay for her sake. That HUGE issue has to be resolved. Perhaps, after couples counseling, Louisa will come to understand this big “elephant in the corner” and find a way to help him have his career and identity back. That does not necessarily mean a move to London. Perhaps an opportunity might come up in Truro or Wadebridge where he can do surgery. The people of Cornwall deserve a fine surgeon just as those in London do. Maybe, they can retain a home in Portwenn for weekend and summer visits. She may have to sacrifice her love of Portwenn for him but for sure, he will have to give her solid reasons and real intimacy and affection to convince her that she can succeed elsewhere and that he understands what moving for his career really means for her and James.

    Thanks again for this wonderful post!

  2. Carol

    Awesome post! Wouldn’t it be neat if series 7 opened with a counselor typing a report like this into a computer (or however that is done now)? It’s sure going to be a necessary part of any therapy they may go through. The question is will our Doc spit out all of that info to anyone. He will probably need considerable prodding.

    What about trauma therapy? Any thoughts on that-if this is the same Abby that helped me with one of my stories, I’d love for her to address trauma in a reply.

    Thanks again. It’s amazing what we know already, isn’t it?

  3. Abby

    Yes, Carol it is the same Abby who gave you input on your story. The above clinical assessment of Martin is not a treatment plan, but just a formal way to gather information from a patient so that the therapist can conceptualize a path forward. The next step would be to develop a treatment plan, consisting of goals, objectives, and interventions. So, a major goal would be to resolve M’s depressive symptoms and an objective would be to work through his family of origin issues, which include the trauma he experienced as a child. An intervention for this objective might be EMDR, which stands for Eye Movement Desensitization and Reprocessing, which is a specific treatment for trauma. There are certainly other ways to work with traumatic memories, but EMDR’s effectiveness has been validated by research. If anyone is interested in a further discussion of working with M’s traumatic memories, please leave a reply.

  4. kjacobson@mindspring.com Post author

    One thing that has occurred to me since publishing this post is that in S2E2 when Louisa is being interviewed for the position of head mistress, she makes a point of saying that one of her strengths is that she is a good listener. She tells the panel that being a good listener is important because it means that you are still prepared to learn. To be able to encourage others to learn one must be open to learning as well. I think we can apply this strength of hers to what she needs to do now. She needs to listen to Martin and his concerns because he wants to learn to be a better husband, and she should be open to learning herself. Hopefully, the writers will recall that speech she makes in S2 and employ it as Martin and Louisa go through therapy and talk to each other about their backgrounds and concerns.

    I am surprised there haven’t been more comments about this post yet. I hope no one has felt hesitant to comment because of feeling unqualified. We welcome all comments and I would like to think the lag is due to readers taking time to digest it all and formulate something to say. Please feel free to join the conversation!!

  5. Laura H.

    Hello to This Wonderful Blog and all who have posted. I’ve enjoyed immensely my reading of the archives and all your great posts and replies. Thank you for all the great information through references and articles…wow, really informative…and yes, like you, I need talk among fellow addicted folks to keep me going until the next series. I only found you about a month ago, and I caught on to the Doc Martin series only last May, first through Acorn watching and now having my own full set of DVD’s. DE as future patient is a really interesting thread. Might I pose a theory…or should I say, a possibility of a route to take, when looking into the past via therapy? We are told by Ruth that she noticed when Martin was growing up that he was an emotionally okay four year old…but by the age of 6, he had “all but shut down.” I wonder if there was someone in ME’s young life…say from birth to age 4 or 5, perhaps a nanny or babysitter, as I really can’t conceive of Margaret being a full time mother. And a trauma might have been ME’s loss of this significant woman in his life because the woman was getting too close to ME, so Margaret got rid of the woman and sent him to boarding school. This woman may have also been the woman patient 40 years later that was to be operated on by ME, the one with the clinging family that might reflect back the love they had for her, showing what a loving woman she was, and though ME might not have recognized her, perhaps subconsciously he knew this was she. At least the drama of the family thinking they might lose their beloved could have triggered ME’s onset of his blood phobia. Not sure if therapists are circumstance detectives, but I sure would like to know if ME had a beloved caretaker at a young age that he lost (and might have had many characteristics similar to Louisa’s?) and the identity of his surgical patient and family years later that seemed to bring back the trauma. Is this a stretch or anyone else put these two possibilities together? I just can’t reason that Aunt Joan would be his first experience of affection…and if Margaret got rid of Aunt Joan’s connections with ME, then she might likely have considered an affectionate nanny someone she did not want ME to have a relationship with either. We’ve heard no evidence of a caring nanny but maybe he was too young or can’t remember…only subconsciously pushed down the feelings of abandonment trauma?

  6. waxwings

    Karen,

    Santa and Abby and you have done a brilliant job clinically cataloguing the many details about Martin’s sad life that the writers have given us. Quite an achievement to sum them up this way. They are numerous and very specific and it’s amazing to see them so “tidy” in a case statement. As they unfolded on set, we never quite experienced them so clearly. Bravo for your professional skills so artfully applied.

    I think the confusion for me comes when I ask: what are you challenging us to do with the clarified picture you give us, or at least how or what does this clarity and stream-lined imaging of Martin show us? Surely one answer is what a therapist might discover taking on Martin (or we hope so). Could a therapist discover all of this from Martin alone? Improbable. He/she would need help from someone like Aunt Ruth. (Perhaps that is why she is the referring party?)

    Is the point to add to this intake history? As it stands, it seems very comprehensive and quite succinctly summarized. Can’t think what more to add.

    Is the point to advocate FOR professional counseling, either individually for Martin or together with Louisa as a couple in Series 7? I think you, the authors, assume this as a given. (After all, we’ve been clamoring for this for a year).

    And if so, then is the point to agree or disagree with either the kind or amount of counseling for Martin, either alone or together with Louisa? Personally, I feel unqualified to answer that. (Counseling is always a feel-your-way-as you-go kind of thing, both with the counselor and the counselee…) But I also believe that it is Martin who has the most serious issues to face, and the most work to do alone, which you three have also suggested here.

    Is the point then to ask us to register our opinions on what might happen with counseling in Series 7? Perhaps this too is a given, but again, unfamiliarity with the therapists’ tools leaves me a bit hanging. Of course, we all have our thoughts on what we’d LIKE to see happen with Martin (and Louisa and baby James), but a therapist’s best role is one of opening up and letting the counselee find his way. What way will Martin discover is the interesting question. There is so much for him to learn, to process, to accept about what happened to him. How much can he absorb? How much can he see or believe?

    Might the question be how will therapy open up or produce a new or renewed or even somewhat different Martin? And continuing down that avenue, how could therapy also provide some new ideas for Martin himself to embrace? Or for that matter, the show and new episodes? For example, might counseling illuminate a “traumatic” event (or events) and reveal something new in Martin’s storied past that links to his recent life and future situation? What might that have been?

    But in the end, I return always to my favorite question on this blog site: can people change, and if so, how? If therapy is part of the “change,” then how can it help and why is it essential, if it is? My offering here is that people can change on their own if they are lucky and persistent and willing to suffer – a lot. But that process may be expedited considerably by finding the “right” counselor and accepting the “better living through chemistry” assistance for a while. (The suffering is a given, no matter which course is chosen). What will “going to therapy” look like for Martin is the question this particular blog essay poses for me. Thank you all three for your contributions to it.

  7. kjacobson@mindspring.com Post author

    I want to welcome you and thank you for reading the blog and making a comment. Although I’d like to defer to Santa and Abby for their more professional opinions, I think your idea that Martin was attended to by a nanny/caregiver as a baby and very young child, and who was affectionate and caring, sounds very plausible. It stands to reason that Margaret would not have wanted to care for a baby or young child, and your view that she would have dismissed someone once she noticed Martin looking comfortable around her also agrees with what we know she did with his relationship to Aunt Joan. As you say, dismissing a cherished caregiver when he was 4 would have been very upsetting to him (traumatic even), especially if he was then left with his parents as his only source of affection. At that point he may have been subjected to their abusive treatment for 2 years until he was old enough to go away to boarding school. Somewhere along the way he started thinking of their punishments as acceptable and “normal,” and deserved.

    The connection to his surgical patient might be a little strained, although I could imagine the scene triggering memories long buried. At this point we are really speculating way beyond what we have been told or shown throughout the series. As you know, I am always at pains to avoid doing too much of that.

    Please continue to read and comment. There are other posts to come.

  8. kjacobson@mindspring.com Post author

    Marta, I can understand your uncertainty and hope Santa and Abby will clear up most of it. One thing Abby and I have discussed is how much therapy would change Martin, or “fix” him. Abby says that he would remain fundamentally the same but the goal would be to bring him much greater ability to recognize how his behavior is impacting his life and his relationship with Louisa. He would be working on trying to apply what he learns in therapy to improving his home life and to convincing Louisa how important she is to him. So the change would be in his actions and not in his essence as an individual. At least that is what I took away from what Abby wrote to me.

    For the rest, I’ll let Santa and Abby respond.

  9. Linda

    I, personally had to read and re-read the post, not as with some other posts because I had trouble understanding it but because it was so AMAZING AND THOUGHT PROVOKING! Don’t worry about the slow start Karen! This one is quite a challenge for us lay people but it will provoke a lot of interesting commentary. Santa is right in saying that it is hard to know exactly how and what to respond to. As always, readers of the blog will have many different takes on this subjects. It is just SO AMAZING that it will take time for people’s brains to wrap around all that has been presented!

    I agree with you that Louisa is going to have to realize and fully understand that SHE must realize that Martin’s issues run very deeply and will not be resolved quickly or easily. This assumes he will be willing to really face his issues head-on. If she pushes too hard, there will be disappointment and possibly failure. I am quite sure she has NO IDEA how messed up he really is and unless she knows, how can she be expected to act appropriately to help him? So, he is going to tell her a lot as is Ruth. If she were to be allowed to read his intake comments, she would be shocked. But, she does need to know and there may be value in having her have an intake assessment too. She has issues from her family of origin too. He knows a little and has met both of her parents. There was no love lost on either of them. Perhaps it was because of the way he saw them treat Louisa but also because of things she said about them. She was disappointed over and over by both parents apparently. Her relationships have obviously been affected somewhat by her own family. Perhaps revealing more to Martin will help him see that him revealing his deep issues is not a failure.

    Waxwings makes many great points about what is expected from responders to the post. I think Martin has suffered a HUGE trauma which needs to be revealed. That, I believe, is the basis of his hemophobia which has led to the loss of his beloved career and his identity. He has said being a surgeon was the only thing he was ever good at. If this trauma is revealed, (and I am sure his parents will be involved), it can’t help but change him, hopefully for the better. I suspect it would open the discussion about the other issues. Series 7 has the potential to be VERY dramatic! I am a bit concerned about it really. How on earth can there be humour in it when Martin and Louisa have so much to work through?

  10. Santa Traugott

    Marta, I do think a therapist could get this information in say, 90 minutes, which intake assessments often run, or even 60 minutes. A good bit of it is observational. Also, most new clients fill out paperwork where some of this stuff is answered in checked boxes and so on. Actually, I don’t think Abby or I would write such a long, formal assessment, but rely on our own interview forms as well as the paperwork. Mine, at least, usually ended with a summary statement on five different axes, (one of which included a diagnosis and/or a “rule out”) plus a couple paragraphs of case formulation. I worked in hospital and agency settings where productivity was highly valued, and believe me, there wasn’t enough time to get through required paperwork, let alone lengthy and carefully composed essays about a new client.

    Where one see or more precisely hear at statement like that is at a case conference, where a case is presented for discussion.

    Let me tackle the “trauma” and the “nanny” questions. We agree that Margaret was at minimum rejecting and more likely actively emotionally abusive (think shaming). Christopher seems to have been both emotionally and physically abusive. It doesn’t seem at all likely that there was any kind of maternal bonding. But Martin, while damaged, has somehow grown up to be a person who can love, bond with his own child and his wife. That’s quite an accomplishment, when early attachment was so poor. So I have to think that there was a figure in there, like a nanny, that gave this infant/toddler some form of maternal care, that he bonded with. Those who said that if Margaret noticed this, she probably would have fired the nanny, are on to something, I think! I don’t think he would have been going to Aunt Joan’s for summers until he was at least 5 or 6, and most of the important attachment stuff happens before then. So I don’t think she was the person who took the place of his mother.

    People have fastened on this remark of Aunt Ruth’s that something happened to Martin between the ages of 4 and 6 to change him into the over-defended person we see today, but I’m not entirely sold on the idea of trauma per se, and I wouldn’t be surprised if this doesn’t turn out to be a thread that was never followed up. But I do think that the loss of a surrogate maternal figure could have been a devastating blow.

    Your favorite question on this blog site — can people change and if so how — is also I think there series’ favorite question. I don’t think they intended it this way — probably they never actually envisioned a run long enough where the question would be relevant. But as time has gone on, that has become the key question for Martin and a very high-stakes one.

    I could give an answer to that from my point of view, but I think I may have already say enough. My own view is pretty psychodynamic, strongly influenced by “ego” psychology and on a good day, I can perhaps understand enough object relations theory to throw that into the mix. But there are certainly other perspectives from which to look at Martin Ellingham, e.g., the spiritual, (broadly construed) for one. From that perspective, the question of “what is wrong with this man” and what needs to change, might be very different.

  11. Linda D.

    Your theory about Martin losing a significant care giver makes a lot of sense. Martin has had some real emotional moments when looking at James in his crib , or in his stroller and who can forget the scene when they touched foreheads and Martin told James he was, “Sorry about all this” when Louisa was leaving for Spain? He touches his son tenderly and speaks softly to him. He frequently checks his forehead for temperature. Where did Martin learn to do this? It is apparent to me that these actions show that James is very important to Martin and interactions elicit very quiet but strong emotional responses from Martin. So, well done on this observation Laura!

  12. Laura H.

    Thank you for the welcome. And thank you for creating this blog.
    Yes, I think you make good points about the patient ME describes to Roger Fenn that brought a halt to his career as a surgeon. It is outside the facts of the series to speculate some connection more between them than surgeon and paitent/family. He characterized the event to Roger as a routine procedure…so why would the family “cling” to the woman? That puzzles me. He says that it was a turning point for him as a surgeon…that the woman was somebody’s mother, somebody’s wife…his realization of this…and then he could not do the surgery. But why react to the emotional scene then? It would be safe to assume he had seen similar scenes before surgery…why then…why that one? You may have hit it when you said that dialogue/scenes created for the early series when ME talks of this to Roger might have only wanted to touch on it briefly, not expecting that it might need a broader brush later. Very perceptive! Thanks!

  13. Laura H.

    You have some really good points about the tenderness that comes from Martin concerning James, Linda. Indeed…where did that come from? Thank you for pointing those out! Two particular scenes made me question whether Margaret physically/emotionally cared for the infant/toddler Martin. One is when she holds James briefly but can’t really do it and hands him back to Mike, even though James is latched onto her blouse. The most telling to me, though, is that she assures Martin that she will look after James while he rushes to the hospital after Louisa’s accident. He returns home to find her asleep on the couch and not knowing anything about what is going on with James. I’m not out to bash Margaret…for who knows what her own difficulties might be…but this is not a baby person or one ever likely to take care of a baby, so she probably had someone else do it. Yet, still conjecture.

  14. Abby

    Like Santa, I don’t know if there was some kind of discrete traumatic event between ages 4 and 6, and I also agree with her that the disappearance of a beloved nanny might have been enough to have pushed him over the edge and cause him to shut down. What we do know, however, is that he suffered from developmental trauma, both physical abuse and neglect, and it could have been the cumulative effects of this trauma that caused his shutdown.

    Trauma that occurs during the development of the brain negatively affects how the brain develops, and depending on the age of the child at the time of the trauma, different brain structures are damaged. With Martin, if as it appears he had early and ongoing abuse and neglect, a lot of damage might have been done. Now, fortunately, the brain is a lot more plastic than we used to think, so a lot can be done to help people. I will try to find time to write about some therapies tomorrow.

  15. Santa Traugott

    As to how we might expect therapy to help Martin to change, my mind keeps going back to an old formulation of Freud’s — “where id was, there shall ego be.” Meaning, as best as I understand it, that where you have a lot of primitive impulses locked away, and tightly repressed, that these would come to the surface where they could be looked on in the light of day by our executive functioning, observing ego, and either seen rationally as not dangerous and to be feared, or as something over which we could in fact, exercise some control. This enables people to let go of defense mechanisms to which they have clung tightly and which are in reality, dysfunctional for them. Only with Martin, I keep thinking that one would have to say, “where superego is, let ego be.” That is, I suspect that Martin has what is sometimes called a highly punitive superego — he is almost excessively concientious, and he has internalized very rigid, high standards of what he should be, at which of course, he constantly fails, since like the rest of us, he’s human. But this leaves him with almost a free-floating sense of guilt and defectiveness against which he then is always defending, with more and more repressing of his inner and more authentic impulses.

    YEs, therapy can certainly help with this process. Abby will say more about this, but my sense is that while such change, which amounts to basic personality change — moving someone out of dysfunction so severe that it was once labeled a “personality disorder” as opposed to a “clinical syndrome” like “major depressive disorder” — is usually thought of as requiring long term therapy, usually psychodynamic and sometimes (more rarely today) psychoanalytic. But there is a growing recognition that ,a lot can be accomplished with shorter-term cognitive behavioral work. This would directly affect the distortions of thinking which accompany and drive, e.g., a punitive super-ego. People can make significant progress, especially if supported in other structures of their llife — e.g., their significant other doesn’t have a vested interest in them staying as they are, but rather understands what they are trying to do and can be supportive.

    So another way to look at this as in the old “Parent, Child, Adult” analogy which I think I first became familiar with in Eric Bernes’ book Games People Play, which came out roughly in the 60’s. ( I think of Parent as our superego, child as the old concept of id, adult as our ego.) When you look at Doc Martin, he is almost always acting as parent (to his patients, for sure and more problematically, to Louisa). Notice that his interactions with Aunt Joan were almost always of the parent-child variety — sometimes he was her parent, sometimes her child. Sometimes he acts as a child, when he loses his temper, lashes out or runs away. It is striking when you see him in an adult-adult role — which usually happens with Aunt Ruth, or Chris Parsons, or even with Edith, by the way. But notably, very seldom with Louisa. She’s either trying to parent him, with bossy instructions about how to behave, or being his child, displaying untidiness and disorder which parent has to clean up after, just for example. In fact, it might be instructive to look at their whole set of interactions in this framework.

    Finally, in this long ramble, this framework of parent-child-adult reminds me that another way to look at Martin Ellingham and his troubles is through a family therapy framework. To family therapists, the concept of “enmeshment” and failure to separate from family of origin is huge. I think family therapy is actually a very powerful form of therapy and I especially like the “Bowenian” model, which I could elaborate on, if interested. But from that viewpoint, I would have to say that what is basically wrong with Martin is that he has literally never separated from his family of origin — his degree of estrangement being exactly the inverse of, and stemming from a deep enmeshment with them. He has entirely internalized their view of him, and he so far has failed to get past it and see himself as he really is — in other words, take an adult view of himself.

  16. kjacobson@mindspring.com Post author

    I just read an article in the NYTimes (where else?) that I think will help towards a better understanding of where we’re going with this post. Please read this

    In this article the psychoanalyst brings up the perils of therapy and expresses concern that “I act as a dark conduit, providing a place for a demonic contingency to rear its fateful head. As consolation, I remind myself that our biggest problem as therapists is simply that nothing happens.” He also notes that “The word ‘case’ comes from the Latin casus, meaning chance, event or happening. We might say that ‘case’ simply means accident. Accidents are what come to life in analysis when someone is asked to speak freely, to say anything, alerting the analyst to something deep at work. Freud once wrote that when it comes to personality, the ‘accidents of life’ matter most. Accidents, not heredity or biology, are destiny. Every case is a story of the accidental.

    One of the things I miss most about my own analysis is the suddenness with which strange events could emerge, knocking you over backward. And toward the very end it felt as if you could time-travel, bouncing between a past and present whose surface was fabricated by an ancient mythology, the wondrous accident that was your existence.”

    What can happen in analysis, it seems, is change based on a chance recognition of what might have been an instance that impacts us. Anyway, if any of you has had any experience with therapy, has known anyone in therapy, has wondered what therapy you would be interested in trying, or has studied various therapeutic approaches, those events could give you a springboard for observations of what might happen with Martin Ellngham during therapy and which therapies might make more headway with him.

    I wonder about our emphasis on Cognitive Behavioral Therapy because it seems to me to be effective in giving a patient a means to manage his/her difficulties without necessarily completely exploring them in depth. But I have had no experience with this therapeutic method and would be very interested in trying it myself. It is my understanding that every therapist receives therapy at some point themselves. What worked best? How much insight does a patient need to have to improve? All fascinating questions to me.

  17. Mary F.

    Santa, Abby, when do you have office hours? I’d really like to make an appointment! ….lol!

    Yes, ME would be most wise to consult with you, I think you have some great ideas about how to explore and deal with his many issues, having gathered together many of the bits and pieces which make him up to be one of the most complex characters I’ve ever had the pleasure of viewing on television.

    I will continue to read your interesting commentary but I think right now I really don’t have much to add and will sit out the blog till the show begins anew. I would like there still to be a bit of mystery and surprise left to discover about him, although the “ghost” of a nanny is very intriguing!

    Carry on!

  18. Linda

    During Series Episode 3, Blood Is Thicker, Martin discovers that Victor Flint has a psychosis which makes him take on the identity of his estranged wife Doreen, who allegedly, left him and her boys 8 years before. Wallace explains to Martin that Victor was afraid if others found out their mother was gone, that the boys would be taken into care. The boys were worried about their Dad and were doing all they could to take care of him and one another and to keep their family together. Victor was taking herbal remedies from Sandra Mylow for an unknown reason. She stated that she had prescribed them for Doreen Flint but that she had never actually seen her! She gave the remedies to Victor. When I re-watched this episode, I realized the themes running through it were: “family”,”damage done to children upon abandonment of a parent”, and “issues around mixing drugs and herbal remedies”. “Wallace Flint told Martin that “Mum/Victor” would get bad for a while and then recover but that he had noticed this this time, Victor got very bad and was not getting better.
    As the boys were leading Victor to the police truck, Martin tells Mark that he believes Victor’s psychosis was probably caused by abandonment issues, related to his wife leaving. Laura’s post reminded me of this!

  19. Linda

    Yes, Laura! Those scenes were very telling. Martin made it clear on a few occasions that he DID NOT want his mother to have contact with James. In the scene you mention, Margaret did offer to care for James but Martin was very vexed about it and finally, Mike said HE would do it in spite of his need to get away from the army officers. Martin was so muddled and so rushed, trying to get to the hospital and Louisa that he might not have been sure who was actually caring for the baby. When he found his mother asleep on the couch, he was infuriated with her because James was with Mike at Mike’s place and Margaret was asleep and unaware of where he was. You are SO right. She was NEVER a baby person! Great observation!

  20. Linda

    This was a great article Karen! It was VERY interesting and thought provoking! You amaze me by being able to find appropriate articles to share!

  21. kjacobson@mindspring.com Post author

    Linda, I think your analogy to Victor is valuable, especially because you picked up on the abandonment comment. Whether the writers included that comment deliberately or not, Martin clearly recognizes how feeling abandoned can lead to psychological problems. He isn’t connecting Victor’s feelings of abandonment to anything in his life at this time, but we might consider his use of this terminology important for series 7 and his own mental health.

  22. kjacobson@mindspring.com Post author

    Mary, I hope you won’t feel like you can’t participate any longer. There will be other posts that you may want to comment on. I hate to lose you!!

  23. kjacobson@mindspring.com Post author

    When I read this I had to wonder how many couples relate on an adult-adult level most of the time. I think men often relate to colleagues and friends on an adult level while relating to their wives on a child level. It’s amazing to me how many of my friends pick out their husband’s clothes when they go out for dinner or travel, for example. In a way, this concession is a means of having fewer arguments and of just letting go when at home. Nevertheless, I consider your observations valuable in terms of providing another way we can view the relationship between Martin and Louisa.

    What I think we have been trying to do with this post is continue the introduction of various approaches to dealing with psychological problems that was begun by DM and the comment that mentioned Winnicott. Then Marta mentioned Miller, and we now have a few other names to consider. By putting together an intake assessment, Santa has given us the foundation upon which we can build a treatment plan that could or might be considered for Martin and/or Louisa. We’re doing this in full knowledge that we will be very unlikely to see any of this on screen; it’s purely an intellectual exercise. We’re enjoying the process.

    I am a total nerd when it comes to all of this and love learning about what goes into finding the best therapeutic method to help someone with all sorts of experiences that have compromised them and their life. In the end, we will probably see couples counseling with many funny and awkward situations that may also include some good insights into these characters. Hopefully, that will also turn into a way for this couple to make a new commitment to each other while being entertaining.

    In the meantime, we can have fun putting our heads together and using what we’ve been shown on screen to evaluate the characters and their backstories.

  24. Laura H.

    Linda, in rereading this post by you, it jumped out at me something that is possibly a real key to help for Martin and Louisa. You pointed out that even though they know some about each other’s family of origin, that more knowledge about each of them by the other could be helpful. A ray of hope flashed through when you said this, as I recalled or asked myself if they each had responses to the other when it seemed the family of origin was looming as problems or was the topic at hand, in other words, do they have empathy for the other regarding this? If so, perhaps a thin foundation from which to build? A touching moment in S6E4 is after Martin and Louisa have discovered that Louisa’s mother has added “tonic” to James’ milk bottle, and thus given him alcohol. Rather than going into a tirade over this, when they are both in the bedroom assessing James, Martin shrugs and says that there doesn’t seem to be a lasting effect on James, and then after Louisa’s insistence this is the last straw with her mother, he strokes her cheek in his special loving way and tells her he has bought a fish. He is showing her empathy, as if to say, “I know what you’re going through.” The time Louisa displays empathy is when they have eaten dinner with Ruth at the farm, and Ruth takes them to the shed that contains an old trunk with Martin’s grandfather’s clock, which also contains photos of Martin at age 6 and a half with no smiles and looking rather dismal. Louisa groans. Maybe this is not the same degree of empathy, but she hasn’t had the on-the-spot experience with Martin’s mother yet, as he has had with hers. Martin, though, shrugs it off as if it were nothing…so these two scenes might be telling as to how each of them are regarding their family difficulties? The ray of hope, though, seems to be that they are empathetic toward each other, even though scenes showing this might not be balanced. I’m hopeful for them, if they can have more knowledge of the extent of each other’s family experiences. In fact, by sharing a family abandonment background, it might solicit more understanding on the parts of each of them prompting more empathy for each other.

  25. Laura H.

    Karen, I chime in with others that this IS a very interesting article!
    When the article talks of a chance happening that impacts or is somehow connected with another chance happening, and which can be linked back to and possibly diminish the linked chance happening, it brings Martin’s blood phobia to mind. Since Ruth talks of blood phobia is often the result of a childhood trauma, is it possible that this is more in the form of an accident or chance happening…and linking back to it from another chance happening (inability to perform surgery) might be helpful? Just speculation. Somehow, though, Martin and Louisa’s relationship or making it better might require a separate kind of therapy. This is all guess work on my part, so please take it as such.

  26. Laura H.

    Santa, this post is totally fascinating! The information here is astounding. Thank you for posting this! A scene that recalls some proof, to me, that Martin has not successfully separated from his family of origin is when Margaret chastises him for losing weight and how will that look to his patients? The next scene is Martin in his surgery room getting himself up on the scale to check out his weight. In essence, Margaret has bullied him, and he is buying into it. He doesn’t seem to have separated from her opinions of him.
    He is still the little boy she likely spoke to that way.

  27. Linda D.

    What would have seemed “routine” to a skilled surgeon would not have seemed so to the family of his patient I expect. Having been through a few such surgeries myself and with loved ones, I note that I was always amazed at how cool and collected the surgeons and nurses were. I was amazed at what they were able to do and obviously I was more than a little concerned at the outcome of the procedure. I was pretty calm when it was me who was the patient and MUCH less so when it was a beloved family member! So, I think the way the family acted made sense. Why that particular surgery triggered a response in Martin Ellingham is indeed baffling, as it must have been to him. That, it would appear, is the central question that needs to be answered! Nothing has been said about whether he sought help then, or took time off etc. I wonder how much time passed between this surgery and when he began to re-train to be a GP?
    I have a hard time believing that the patient whose operation triggered his blood phobia was someone he knew but I can buy that she might well have reminded him of a beloved caregiver who was taken from him at the time he was very attached to her. The event might have been very ugly and troubling and no doubt had Margaret written all over it. When Ruth first mentioned that hemophobia was often rooted in a childhood trauma, did she know what had happened? If yes, would she not have discussed it then, or later with Martin, knowing how troubled he was? Or, did she just suspect something had happened because she noticed a dramatic change in Martin around age 6? Her distain for Margaret (and Christopher) had been made very obvious when she confronted her in Portwenn. Clearly, Ruth felt Margaret had damaged Martin in the past and was loathe to see this treatment continue. I find it interesting that Martin thought he had a “healthy” childhood which might mean that whatever bad had happened to him had been shut out of his memory. It is so sad that he believed he was at fault for the problems as a child and even accepted the punishments as “normal” and “deserved”. It is lovely that he treats James so gently and recognizes that Louisa is a skilled and loving mother. I cried when he asked her for help to be a better husband and father. What a GREAT speech that was!

  28. Mary F.

    Thanks Karen, you won’t lose me and I’ll definitely jump in when I feel I can add something new to the conversation.

  29. Abby

    As promised I will write a bit about treatment for trauma. First of all I need to say that the foundation of any therapy is the relationship between the therapist and client. Without that nothing works. With all therapy the therapist must create an environment in which the client feels safe enough to go into those dark places. This is especially true for those who have experienced trauma. The first one I would like to present is Eye Movement Desensitization and Reprocessing (EMDR).

    EMDR is based on an information processing model, and was developed as a specific treatment for trauma. The idea is that a traumatic experience is not processed by the brain in the same way as a normal experience. When we have a normal experience, the brain first takes in all of the sensory experiences (sight, sound, smells, taste, touch) plus the thoughts and feelings that happened at the time and decides if it is worth keeping. If it is, it sends it to the part of the brain that makes sense of things, where it is organized, categorized, and sent to long term storage. I need to stress that this is a GREATLY simplified version of what is going on in the brain, but I hope this gives you some sense of the process.

    When a traumatic event occurs, however, all of the sensory, cognitive, and emotional components of the experience are never made sense of and remain in the brain in sort of loose fragments. When the traumatic memory is triggered later on, these fragments pop up and cause flashbacks. The part of the brain that contains these fragments does not have a sense of time (i.e. it is always NOW.) So for the person experiencing the flashback, the trauma is happening now. It is not in the past. They are completely in it. This all happens at an unconscious level. What EMDR does is to help the brain finally process the fragments, form them into a coherent whole, and send them to long term storage. In that form, the memory has time attached to it, so when the person remembers the trauma, he/she knows it was in the past.

    EMDR incorporates what the person believes about him/herself with respect to the trauma, the emotions and the body sensations experienced, along with the visual (and/or other senses) memory itself. It uses bilateral stimulation (left-right-left-right) in the form of eye movements, alternating tones, or tapping to facilitate the processing of the traumatic material. It trusts that the brain is capable of healing itself, so the therapist’s main role is to make sure the client is moving through the material and not getting stuck. If the person does get stuck, the therapist has interventions to help him/her to resume moving through the material.

    EMDR has some good research behind it, and I have had success with many clients with it. However, as with any therapeutic model, it is not the right approach for everyone.

    I will try to write more tomorrow about another model of therapy that is used to treat trauma.

  30. Abby

    I would like to discuss some other modalities for treating trauma, but first I need to add to my discourse on EMDR. It is important to understand that in EMDR, addressing traumatic memories is not done at the beginning of therapy. Much preparatory work needs to be done before the client is ready to tackle such difficult material.

    So, now on to the next therapeutic modality.

    Somatic Experiencing (SE) is one of a number of body-oriented therapies, which have been used for a variety of problems. SE is a model I have not been trained in and do not use, but I thought I would take a stab at presenting it, since I believe it has a lot of value. It is based on the observation that one never sees wild animals suffering from PTSD. That assertion may sound silly, but the developer of SE thought it was an interesting enough observation to do research on why that was the case. It turns out that when a wild animal is under stress (attacked, chased, etc.), once they are safe they perform actions with their bodies to discharge the energy that was built up during the dangerous situation. These actions include shaking, twitching, and deep breathing and work to reset the autonomic nervous system (ANS) that became dysregulated during the frightening situation. According to SE, humans have difficulty reregulating the ANS for a variety of reasons, such as enculturation, thinking, shame, and discomfort with bodily sensations.

    In SE, the therapist helps the client focus on bodily sensation due to the dysregulation of the ANS that was left over from the traumatic event. Through increasing awareness of the residual tension (energy), the therapist guides the person in incrementally discharging the energy. SE does not ask the client to talk about the traumatic event, which is different from other therapies for trauma, such as EMDR and CBT, which is the next modality I will present.

    Cognitive Behavioral Therapy (CBT) has become the workhorse of the therapeutic world. The cognitive part deals with thoughts and beliefs that underlie dysfunction, while the behavioral part is concerned with the ways in which that dysfunction expresses itself in how we act in the world. The premise of CBT is that from a very early age we conclude things about ourselves, other people, the world, and the future, and it is these conclusions (bieliefs) that become the filters through which we view everything for the rest of our lives or until we consciously work to change them. So, we may develop the belief “I’m not good enough” when we are small, and that belief may cause us to be shy in school so we don’t have many friends, which we interpret as a confirmation of “I’m not good enough”. And on and on it goes throughout our lives. I think it is also important to understand that these early beliefs are largely unconscious and are experienced as feelings in the body.

    CBT is used in trauma in a number of ways, ranging from systematic desensitization to stress management to reframing or restructuring our thoughts. For the purposes of this post, I will talk about stress management and reframing/restructuring thoughts.

    As part of the behavioral piece the therapist gives the traumatized person tools to reduce their anxiety. These include a variety of breathing techniques, meditation (sitting or moving), use of the five senses (ex. listening to music, smelling a flower), and aerobic exercise. Also part of the behavioral piece is encouraging the person to incorporate more positive activities in his/her life (ex. socializing, hobbies).

    The cognitive piece of CBT helps the client to look at any negative thoughts and/or beliefs around the traumatic event and to begin to look at them in a different way. The therapist will also work with any negative beliefs the person formed during his/her development even if the trauma occurred as an adult. This is because when a child concludes a lot of negative things about him/herself it makes him/her more vulnerable to PTSD later in life. Certainly if the trauma occurred during childhood, these early belief will be paramount.

    I would like to wrap this all up with a bow and talk about what I think is the most important tool in trauma therapy, or in any therapy actually. This is Mindfulness, which is being able to observe your thoughts, emotions, and body sensations without judging them. It sounds simple enough, but if you have never tried it you may find that it indeed is simple, but not easy. This is not the kind of watching ourselves that we do in self-consciousness. It is pure observation. It is the single most important thing a therapist can teach a client, because there simply is no change without awareness.

    So, when we look at all of the different therapies I have presented, they are all dependent ultimately on being the objective observer of our own inner life, without judging anything that you find.

    I hope these two posts have been helpful to you as you consider how best to help our dear Martin with his demons. Please let me know if you have any questions, or if you have things to add.

  31. kjacobson@mindspring.com Post author

    Abby, thank you for all the details about these therapeutic approaches. I did not realize that CBT had become the main treatment protocol and that it is so versatile. I am aware of how serious it is to be treated for anxiety and trauma, but at the same time, I can’t help visualizing how breathing techniques and meditation, listening to music, or using any of the 5 senses could be turned into something humorous as well as effective.

    I can imagine a moment when Martin and/or Louisa might attempt to apply some of the above techniques and have a sudden experience of self-awareness that would lead to one or both of them discerning what they need to do differently. We know whatever they show them doing with therapy can’t take much time, which means we will see some changes occur in a much shorter time frame than would be likely to happen in a real therapeutic setting.

    All of your descriptions have definitely added to my understanding of how therapists handle their patients and I am grateful for learning about all of it.

  32. kjacobson@mindspring.com Post author

    OK, here’s something that made me think about Cognitive Behavior Theory and Depression. Today there have been articles about the recent release of the CIA torture practices that applied psychological theories about how to induce helplessness into the subjects. The research that is behind acting helpless stems from studies that were done in the 60s by Martin Seligman and others. In one article about his research I read: “Other cognitive behavioral theorists suggest that people with ‘depressive’ personality traits appear to be more vulnerable than others to depression. Examples of depressive personality traits include neuroticism, gloominess, introversion, self-criticism, excessive skepticism and criticism of others, deep feelings of inadequacy, and excessive brooding and worrying.” Martin Ellingham has several of these depressive personality traits, including introversion, excessive skepticism and criticism of others, deep feelings of inadequacy (at least in interpersonal relationships), excessive brooding and worrying. If I’m making proper sense of this, the way they have set up this character is to be prone to depression, and the abuse he suffered as a child led to feelings of helplessness in regard to being able to escape the abuse. Essentially he gave up trying to evade the abuse and may have been depressed as a child too.

    What does anyone make of this possibility?

  33. waxwings

    Karen, I think you are definitely on to something here vis-a-vis Martin Ellingham and the aspects of helplessness that he exhibits in some aspects of his personal life. It is obvious and well documented throughout the six series of the show. I have long been disturbed by this.

    You reference this week’s current torture news items on former APA President Martin Seligman’s work on “learned helplessness,” a theory he derived from his work in the 1960s with dog experiments, in which random electric shocks broke the dogs’ will to resist. (This research, btw, was applauded by the CIA division of Behavioral Science as “good science” and was applied in their torture regimen, per this week’s news.) I have long known about Seligmans work, and became concerned in 2002, when it was learned that Seligman was lassoed into the CIA “schooling” of CIA torture psychologists Drs. Mitchell and Jessen (the overseers of the CIA program) at a CIA-sponsored conference in San Diego in which he gave a special lecture on his “learned helplessness” research.

    We know Seligman was on to something powerful. I have always been chagrined by Martin Ellingham’s inability to speak up for himself, or defend himself forthrightly against personal attack, and generally, to be silent in the face of his parents’ brutal assault on his person—as a human being and their son. They disrespect him totally and he seems “helpless” in the face of their assault together (in earlier S2 efforts) and then alone, when his mother visits him in Series 6. ME shows definite signs of having been “broken” long ago, so much so that his parents feel they can get away with continuing their assaults on him into his middle age. This is appalling. It can only be a result of their psychological and possible physical “breaking” of him as a person at a young age. What was it they did? What happened to him in childhood? It is tragic and terrible to watch it play out in adulthood. It definitely should be a part of the “profiling” intake statement on ME that a therapist might do.

    I have been hoping to respond to Santa and Abby on all of their good contributions in recent days explicating therapies that could be applied to ME in therapy. These are very interesting but alas, I haven’t the time right now to respond. It is not for lack of interest.

    One thing your (Karen’s) “learned helplessness” post today suggests to me, though, in quick response to all of this is: I still seriously doubt that an ME intake therapist could possibly garner the information laid out on this blog site a few days ago. How could a person such as Martin, with such a lack of self awareness and “learned” ignorance about his impact on others, and on Louisa, possibly give a therapist the information laid out in the professional “intake” statement?? Not to mention providing an adequate insightful description of his current problems associated with his poor understanding of the impact his early childhood traumas had on his “learned helplessness”—a condition extant throughout this TV series. He wouldn’t know all this, only that he had to go for help to find it out!! He just knows that something major is terribly wrong in his personal life with Louisa, and that his aunt has informed him that something terrible happened to him in early life. This is all he knows. How do therapists find this out?

    It feels as though the information in the “intake” statement would be the result of many sessions of therapy with a sensitive and smart person and could not be known ahead of time….To then go to specific exercises (like EMDR on traumatic memories, or CBT on learned beliefs about oneself) has to be preceded by specific discussions. It is those discussions I would be interested in and would want to know more about and what they were, and/or how they would be conducted.

    I am fascinated by Abby’s descriptions of EMDR and SE and CBT — and I feel out of my league to comment very well on them, but they do provide a wealth of information for thought and reflection, which I am giving them. Both Abby and Santa have done a lot of work on educating us and I am learning a lot!! Thank you both.

    PS: It would be quite interesting to know what former APA (American Psychological Association) President Martin Seligman thinks about what the CIA did with his “learned helplessness” science. It is sad to make the leap, but we can see how powerful the results can be when we watch Martin Ellingham in this series…

  34. Santa Traugott

    Waxwings, a skilled interviewer can gather a lot of information in a 90 minute intake interview, combined with questionnaires filled out beforehand, and observation. I really don’t think it’s much exaggerated. Especially if the patient is not verbose or circumstantial, you can get through a lot of material. And I wouldn’t expect ME to be either of those. And though I should blush to admit it, assessments may not be written until after the second session, especially if the assessment is done by the treating therapist.

    Another way to think of the material in the “assessment” is as a case presentation to a supervision group. Or as a teaching example.

    The association of Martin Seligman with this learned helplessness theory and the latest revelations about the CIA is rather jarring, as he is more known today for his work on “authentic happiness” — “Dr. Martin E.P. Seligman co-founded the field of positive psychology, and has devoted his career since then to furthering the study of positive emotion, positive character traits, and positive institutions.” http://www.authentichappiness.sas.upenn.edu/faculty-profile/profile-dr-martin-seligman

    Your comments about Martin Elliingham’s “learned helplessness” brings to mind his coment to Louisa in the Ambulance in S1E6, where he says that it’s too bad he had to leave his career as a surgeon, because “it’s the only thing I was ever good at really.”

  35. kjacobson@mindspring.com Post author

    This is, I think, another case of the writers, et. al., probably not deliberately planning to introduce learned helplessness into the ME character, but doing so intuitively or because it worked for them to further the story. As Santa’s write up notes, and as we have recognized, there is no explanation for why he decided to retrain as a GP rather than seek help to overcome his hemophobia and remain a surgeon in London. They had to devise a reason of some sort and came up with a man who is a mixture of certainty and hesitancy. It’s only natural that his hemophobia would lead to some compromise of his confidence, but we see him especially unable to react with any assurance when dealing with Louisa and his parents. Those people who he has personal attachments to are where he exhibits helplessness. It’s good for the story that he can’t find the will or strength to follow Louisa or confront her about leaving most of the time, and when his parents appear in S2, it’s good for the story that he is dragged around by his father and stunned by what his mother tells him. It elicits our sympathy for him, which they need us to have because of the many times when we might be disturbed by his treatment of villagers/patients.

    It’s kind of amazing how things going on in the news and in various current articles have brought to light several dynamics in the show. I suppose we have to acknowledge that, once again, this is a sign of good writing and good character development.

  36. Linda D.

    I think you have made a good list of Martin’s depressive personality traits although I am not sure about EXCESSIVE brooding and worrying. Certainly, he does worry some about his declining health because he tries to find a physical cause for how he is feeling. I am not so sure he “broods” excessively. I don’t think he even considers psychological reasons for how he feels. Did we see him worrying or brooding over the issues with the baby and his job in London and with his feelings that were still strong for Louisa? He seemed more “resigned”, (yet miffed), to the fact that she was going to raise the baby without him and that she didn’t have any intention of getting back together with him. Was he even sure what HE wanted? There have been moments when he tries to figure out what to do when rejected by Louisa. Is he brooding then or just replaying the event to try to understand where things went wrong? He seems to act fairly quickly to fix things. He tried to get the Spencer’s back together, he often see Auntie Joan when things went awry with them or he had been unkind and he went to see Louisa the next day after the concert, presumably to patch things up. He told Louisa that he didn’t worry about his life – just kept busy with his work and hobby. I am probably wrong about this and I expect that worrying and brooding scenes would take up much too much time in an episodes so we have to read through the lines!

    I am excited to read more about this. It is SO interesting but it does take time to digest for us lay people! Thanks for a great post Karen!

  37. kjacobson@mindspring.com Post author

    Linda, I have to agree that we don’t see “excessive” brooding until S6 when he is depressed. His depressive traits are magnified tremendously in S6, to the point of making us depressed!!

  38. Amy

    I am in the midst of watching S6 and was wondering what was it that triggered the return of the hemophobia. I found this post very interesting with respect to that question and many others. It seems Santa believes that it was the stress of the disorder caused by living with Louisa and the baby. Is that correct?

    I found this post wonderfully insightful, and having the benefit of reading it AFTER S7, I just wish the writers had hired Santa as their consultant (or as the therapist treating M & L). It would have made for a much more believable and hopeful season.

    As for the hemophobia, I’ve wondered if it returned because Martin was being forced to deal with so much intimacy. His first occurrence was caused by empathy with a patient and her family. He no longer could distance himself as doctors generally are trained to do. Even after the cognitive therapy, he vomited when James was born, a highly intimate and emotional moment. I’ve wondered whether the hemophobia is a sign of his fear of intimacy rather than a sign of his fear of loss of control. Does that make any sense? (FWIW, I am NOT a psychologist or therapist or social worker, so have no expertise in this area.) If so, is its return in S6 a sign of his fears of getting too close to Louisa and James or perhaps his fear of losing them?

    As I watch S6 again, I am struck by how hard he tries (inviting that couple to dinner, taking care of James, going to the concert) and how terribly impatient Louisa is with him despite his efforts. I like her less and less!

  39. Santa Traugott

    Thanks for the kind words, Amy.

    I do indeed think that it was the stress of his marriage and its demands for intimacy plus the loss of control over many aspects of his environment, that brought on his breakdown. All his persnickety ways, what Louisa disdainfully labeled “your OCD” seem to be to be in the service of carefully walling himself off against any disorder, which I think is a stand-in for emotional disorder and upset. So Louisa wants from him what he cannot give, or at least without great difficulty, and that is intimacy. That’s stressful, plus his usual ways of keeping himself in order, by meticulous ordering of his environment, aren’t available.

    Now, in S7 we learn that perhaps there is an additional factor — that Louisa constantly sets him up to disappoint her. Perhaps she does it because she can’t accept that she can’t change him, and keeps having expectations of him that he can’t live up to. Dr. T’s belief, it seems, is that she does this because she needs him to disappoint her, so she has a reason to leave him before he abandons her. (I suppose the Sports Day fiasco was one of those set-ups.) Anyway, not living up to what she wants him to be is another twist on the stress scenario.

    I do think his hemaphobia is about fear of intimacy. I guess what I’m trying to say is that it is almost inseparable from his fear of losing control — after all, being open and intimate with someone implies that you are letting barriers down, going with the flow of your relationship, etc.

    On FB one commonly hears the comment, “well, she knew what he was when she married him.” Well, precisely. She knew at some level that he was what he was, and that trying to turn him into her idea of a head teacher’s husband, or a “normal” person, was probably going to backfire. (I don’t think she could have expected quite such a spectacular failure.) And maybe Dr. Timoney would say that that was HER way of keeping distance from him, by constantly creating tension and dissension between them, with her unrealistic expectations just being a way to deal with her fear that he would leave her. So it was a push-pull game, at least on her part.

    That’s why that final scene was so telling, in my view — she finally understood that he would never leave her, and that perhaps she can leave those games behind.

    Thanks for giving me the opportunity to think about how S7 adds to or changes this original analysis.

  40. Amy

    Thanks so much for your response, Santa. Having just watched the last two episodes of S6, I am feeling rather weepy. This second viewing of this season felt very different than I’d remembered it from two years ago.. Louisa really comes across as more the “villain” than Martin, and maybe the writers knew that in S7 they were going to put her issues into more focus. Waiting two years between S6 and S7 for me meant that I’d forgotten just how tough she had been on him when he was his most vulnerable. Now I see S6 as a prelude to what happened in S7: Martin really trying to change and Louisa continuing to be unwilling to see how she was hurting him.

    Your points make a lot of sense: fear of intimacy does seem linked to fear of loss of control. And Louisa does seem to act like the best defense against abandonment is a good offense. I just hope S8 leads each of them to some level of understanding. The seesaw of the relationship is exhausting!

  41. kjacobson@mindspring.com Post author

    Oh boy, I feel like we are once again going too far into psychoanalyzing these characters and their motivations. The first, and most important, purpose for having Martin and Louisa be unable to find themselves in wedded bliss is because plot must have conflict AND there is never going to be a Martin who “gets” what Louisa would like him to be OR a Louisa who will stop being independent and afraid of being too vulnerable herself. If giving us their childhood backgrounds has been for any purpose, it has been to allow us to understand that both of these adults have had traumas as children that continue to affect them as adults.

    From the beginning of the show Louisa has been concerned that Martin will not treat the community of Portwenn as people but as patients, and that is offset by Martin doing exactly that much of the time. As much as his confession explains that the derivation of his haemophobia was suddenly relating to a patient as a person, he continues to be pretty business like with most people. (I guess we could imagine that he went back to that to try to curtail his haemophobia, but it didn’t work.) He shows flashes of kindness and caring beyond the superficial level of treating their medical conditions, but primarily he softens with Aunt Joan and with Louisa (and then with Aunt Ruth). But even with them he can be abrupt or unsympathetic. Obviously we see him say some very undiplomatic things to Louisa and we also see him respond without concern to Joan at times (one time that comes to mind is when Martin shoots her in the leg with the Colonel’s gun and he tells her it’s just a flesh wound). In addition, we should never forget that some of their altercations are there for comedic reasons. When he invites Dennis to dinner on the spot, it’s meant to be a sign that he wants to do something to demonstrate to Louisa that he’s trying to be sociable, but it’s also funny. He knows nothing about how she feels about Dennis, and his first instinct is to make the dinner invitation for that night. In the scope of comedy, that’s right up there with many other awkward invitations made on the spur of the moment, with the immediate reaction of “WHA?” from Louisa. (BTW, it’s another example of how he neglects to consult her.)

    I agree that there was a much harder Louisa in S6 after Martin started to shut down, and there were times (as I’ve mentioned before) when I thought she was incredibly harsh, e.g. when she reads him Becky’s nasty comments about him as he’s nursing his cut hand. But they give her plenty of reasons to be incapable of realizing what he’s going through. In particular, he never tells her his haemophobia is back. And there are many other reasons. I would refer you to my post of March 17, 2014 titled “In Defense of Louisa, S6” for the others I consider important. There are also plenty of worthwhile comments to that post. Even though I can find lots of reasons to defend her, I would like to have the more fun loving and happy Louisa back.

    S6 has Martin acting utterly unreachable and uncommunicative. In S7, I believe they deliberately turned the tables and made Louisa the one who can’t acquiesce or allow herself to give in to her feelings. They reversed many things in S7, and it worked at first, but then it became tedious. If we agree that the last episode of S7 got them to a place where they have a better grasp of what each of them has contributed to their marital problems and have come to the ultimate realization that despite all of this, they want to be married and stay together, then there should be no more question about that piece of it. I can see how they might find “AHA” moments where suddenly they intuit something about each other they never comprehended before, but I will definitely be surprised if there are any deeply psychologically exploratory scenes.

    [Amy, you might be interested in knowing that Santa thought for a long time that S6 and S7 were planned as a unit. I can really see how that could be the case, although we are always reminded by MC and PB that they are never sure there will be another series until they find out how successful the current one was.]

  42. Santa Traugott

    I think it’s my inveterate tendency to try to make sense of things. Maybe it’s my own need for order! 🙂 Even if it’s exaggerated or invented
    largely for the sake of conflict (or dragging out the story line) it seems to me at least, that one should be able to tell oneself a plausible story about what’s happening. I find it very unsatisfying if the clear sense is that the plot twist or whatever is thrown in from left field, and you can’t really tell a plausible story about it, except that it needed to be that way to get on wit the story. The clanking of the off-stage machinery is all too visible then. As the disjuncture between the end of S6 and the beginning of S7 will always remain unsatisfying to me, precisely because I can’t make sense of it.

    So it’s not so much psychoanalyzing, as trying to figure out what I would think, or how I interpret a couple in real life, about whom I had all the clues that the writers have dropped through the series, and who I had watched behave in all the ways we’ve seen. What story can you tell that pulls those pieces together and makes a kind of interpretive sense. (I must say, in real life, if I saw folks behaving this way, I’d want to, like Nicole Hollander’s Love Fairy, wave a magic wand and tell each of them to get out while the getting’s good.)

    The idea that they behave this way just because the writers want to set up situations that keep them apart is unsatisfying in a couple of senses: 1), it relieves them (and us) of the obligation of telling a story that makes sense which is always for me more appealing, and 2) I really think it doesn’t do justice to the thinking and care that has gone into fleshing out these characters. Not always successfully, I grant. And in a sense, I’m setting up a straw man here, because I don’t think you really meant to go that far.

    I say this, even though as you well know, I was not a happy camper about the direction the show-runners chose to go in the last two series, and as someone who is quite pessimistic that they can return to form in S8,

  43. Santa Traugott

    By the way, isn’t there some law of thermodynamics that says that for each action there’s an equal and opposite reaction? I think that applies here in the relationship between Martin and Louisa. That is, it’s pointless to try to sort out who is more or less at fault. The great Louisa wars, on other forums, have always seemed rather silly to me. It’s all transactional.

  44. kjacobson@mindspring.com Post author

    I was thinking you would get me for not giving them enough credit for using plots that are significantly associated with the problems with which they’ve saddled each of the characters. You are right that I should have been more generous about that. I definitely think that they meant to make a connection between the commotion at home and Martin’s inability to cope with it as one element of his downward slide in S6. The return of his haemophobia, though, seems more of an afterthought to me; sort of like they said to themselves they had forgotten about it too much in S5 and this sixth series is going to be one in which practically everything that can go wrong does.

    We have the excellent and fun wedding and wedding night where much goes wrong, but the sense is the marriage is going to be all right, and then one thing after another starts making home life difficult. Not only does Martin’s blood phobia return and this time totally confound and upset him, but his mother shows up with the news his father died. She stays with them to make their home life more crowded and miserable. Louisa deals with Michael and his OCD as well as his general high standards that make her feel unworthy, plus she has mixed feelings about being away from James. Mrs. T returns with all the emotions that adds. Then Martin keeps pushing her away, she gets hit by a car and breaks her clavicle not to mention her heart. Let’s not forget she also has a DVT. And finally she is diagnosed with an AVM and needs an emergency operation. Is there any more they could have done to make that series more of a total collapse?

    So I am with you on them giving all the action some thought, but I consider some of it complicated by almost trying to do too much, and both S6 and S7 were good examples of that to me. In S6 we could have done with less physical trauma and less emotional upheaval; in S7 there was too much effort to recuperate the humor and forestall the reconciliation to the point where much of it wasn’t that funny and the continued inability to talk became too transparent a gimmick. (I still wonder, too, about why they decided to exclude his clocks in S7. It may only be to give us something new to think about.)

    The psychological part is very hard to pin down, and the fact that they appear to find therapy fairly worthless, based on how the therapist is portrayed, says to me they spend less time thinking through the parts about the psychological impacts. Does Louisa set Martin up? I think that’s just as hard to swallow as that she needs to assert more control. She is in as much control of their relationship as any woman could be, and has been the whole time.

  45. Amy

    These comments are all so fascinating and so helpful. I tend to agree with Santa in that I would prefer to think that writing fiction is not simply about creating conflict for conflict’s sake. I understand there needs to be conflict to keep a plot moving, but too many tv shows (not so much books or movies) keep recreating the same conflicts as they run out of fresh ideas.

    DM isn’t the worst offender—certainly shows like Grey’s Anatomy and Nashville (to give two current examples) have now had too many couples fall in and out of love too many times. It’s so clearly a manufactured plot device, and in my mind destroys my ability to help me suspend disbelief and enjoy the show. I hate it when shows change a character’s personality to create a conflict.

    So I prefer to dig deep inside the characters and hope that the writers will as well to find creative ways of developing conflict rather than repeating old tropes and patterns of will they–won’ they.

    I don’t see them fixing either main character, but a little growth would be believable, creative, and provide lots of continuing opportunities for conflict. I am more optimistic than Santa that that can and perhaps will be done.

  46. kjacobson@mindspring.com Post author

    Amy, I’m sorry if I ever gave you the impression that I think writing merely consists of conflicts that have to be resolved. There is a lot of hard work and imaginative thinking that goes into good writing and developing strong stories. Words are powerful and I am nothing but in awe of good writers. I’ve spent much of my life reading and analyzing books and would feel bereft without that in my life. I would never have started this blog if I hadn’t thought Doc Martin has been written excellently. The first five series exhibited some of the best writing I’ve seen in a TV show. They managed to create a show that combined humor with addressing many serious issues in a truly witty and accessible manner. The last two series have been a disappointment to me, however, and I have begun to wonder whether their stated desire to keep things fresh has dissipated, or at least declined. As you say, using the same conflicts and tropes becomes less and less engaging with every reiteration.

    Although I can envision future storylines that could advance the relationship between Martin and Louisa, I am doubtful that there is a compelling reason to keep the story alive. Sometimes the best stories are the ones that end at the right time, with the space to allow the viewers to use their own ideas about what happens to the characters.

  47. Amy

    I understood what you were saying. Karen, and I didn’t mean to oversimplify it. I have been trying to learn to write fiction, and the two books that I’ve read about fiction writing (recommended by others) both emphasize the need to have conflict and resolution building throughout a novel and a screenplay so I was reacting to that part of your comment. (One of the books was McKee’s story, which I know you have talked about on the blog.)

    But I know you know that writing is a lot more than creating conflict and resolution. I’ve read enough of your blog to appreciate your literary analysis!

    You know my feeling—I’d have been happy to end the series with the wedding episode, although I was not ready then to say goodbye to these characters. But looking at what happened after that episode, in retrospect that seems like where the story should have ended,

    Now that they have continued the story in ways many of us find unsatisfying, I do hope they can bring it to a better resolution next time. I know you disagree, and I understand that. Maybe I just am still not ready to say goodbye to Portwenn!

  48. kjacobson@mindspring.com Post author

    We are on the same wavelength after all, Amy. We have no say over whether they will continue, and it looks like they will, so I suppose wishing for a better conceived and written next series is about all we can do. Since MC and others seemed to have been pleased with the writing of the last series, and even the therapy sessions, I am not convinced that the next series will make many changes. I think what you and I, and so many others, are registering is the fear that the quality is suffering in service of the financial compensation, and we’ll be witness to a show that we’ve greatly admired becoming trite and ordinary. They could have ended the show successfully at the final episode of S5, or after the first episode of S6, and been very proud of it. Now here we are at the end of S7, after watching them wrap up most of the storylines and get the Martin and Louisa marriage back on its feet, but they still continue…

  49. Amy

    Well, sort of back on its feet! I just hope they move forward, not backwards. Even sideways would be ok with me!

    Thanks again for all your comments and insights. I am enjoying this so much. Now that I am up to S7 and have no way to watch it (not on Netflix and I don’t have Amazon), I guess I will wait for you to start your repostings. Or go back to the beginning again!

  50. Santa Traugott

    I totally agree that the assignment for Louisa to “control” something was way off base. She has always had the upper hand in that relationship. Can’t remember where the doggicide incident comes, but there she just told him flat out not to do it and he obeyed. Morwenna went to find her, knowing that.

    I looked again at Louisa’s segment in the ATF promotional video for S7, and once again, maybe for the third time in an interview, she stressed that Louisa always thinks that she can change Martin — she gets discouraged, but then something happens to give her renewed hope that she can tweak him to her satisfaction and she gets sucked in again. [In this interview, she also said that when the series opens, Louisa is “new” to the village, having just returned after some period away, presumably college and teaching.]

    Anyway, stripped of the psychological stuff, I think the predominant motif of the whole series, the basis of conflict, might be, the possibilities of change versus “we are what we are.” Louisa and Martin are strongly attracted to each other, yet each knows (I think Martin does too) that their incompatibilities would make them unhappy. Louisa thinks she can change Martin enough to make living with him tolerable, and I think Martin thinks that he loves her enough to tolerate the things that irritate and drive him nuts, including her efforts to change him. Both are wrong, not once, but over and over. How do they deal with this when they finally figure it out?

    I think Martin decides that if she can’t accept him as he is, then he has to let her go (reluctantly). Louisa decides that, if she can’t change him, she has to accept him as he is. That’s it — stripped away of psychologizing.

  51. Waxwings2

    Amy, you can watch Doc Martin S7 on Acorn TV (purveyors of “the Best in British TV”). (Just google “Acorn TV” to learn how to sign up). When you subscribe (it’s only $5/month, you get the first month free, and you can cancel anytime if you don’t like it. I have found the service a great bargain, to say the least! Marta (aka waxwings)

  52. kjacobson@mindspring.com Post author

    I think you’ve described the nub of the show perfectly. The only slight modification I would add to your final summary is the same thing you and I have differed on before. I think when Martin tells her he can’t go on living like this he’s still hoping she’ll finally crumble and invite him to move back. That is, I think his demeanor appears to still be hopeful and his decision to take the step to get out of the car and tell her right then is because he feels that their recent interlude with Dr. T has given him some room for hope. (It was Louisa who asked him to go with her to see Dr. T because Dr. T has said she thinks she has a great idea that will help. They ride together in his car and he would have reason to think this is a positive sign, no? The ride back together also seems to be heading in the right direction so to speak.) If I read you correctly, you have always thought that he has finally come to the conclusion that things will never turn out well and he has to come to grips with that, while I think he still holds out some glimmer of hope that Louisa will say, “You’re right, this has gone on long enough.” (But I also think the fact that she doesn’t agree quite yet is once again purely so that they don’t go home together until the end of E8. I’m sorry, but what we might expect from Louisa based on her past behavior isn’t going to happen here because the plan is to have the resolution occur in E8, and I can’t help having a hard time getting past that. That stuff going on with Dr. T, etc. was only meant to deceive us once again.)

    Nevertheless, the theme of change is preeminent and has been throughout the show, and you are absolutely right to consider that the key issue. I think I will probably start the repetition of posts with the ones on change. I’m sorry I haven’t done that yet, but I will soon!

  53. Santa Traugott

    Maybe a better way to put this is, that Martin comes to believe that Louisa is unable to accept him as he is, that although she might still believe in the possibility of change, he thinks that he is what he is, probably cannot change to her satisfaction and that, to avoid prolonging the agony of their indecision, he needs to let go. Of course, he hopes that she will give him some encouragement at that moment, but she does not, and he accepts that, and leaves.

  54. kjacobson@mindspring.com Post author

    All right. I’m not sure we’re going to get anywhere with this…we’re beginning to pick at nits!! For me there had to be something that prolonged Martin and Louisa’s reunion. Everything they did as assignments failed, then Dr. T failed them again at this late meeting, and the climax, or turning point, of the show arrives when Martin presents Louisa with an ultimatum. We are now set up for the denouement. What will Louisa do now? Stay tuned to watch the next episode in which Louisa appears ready to concede, but cannot until she has concluded the hunt for Martin, admitted that she’s been wrong, and thereby demonstrates that she really is committed to this relationship.

    I know…I’m being too cynical. But it’s all there. I’ve been watching The Night Manager lately, and they’re following the same pattern. I still enjoy it anyway. Freytag was right!

  55. Amy

    Marta/Waxwings—I am not ever sure where my replies go on here, so I hope you find this. Thank you! II will look for it on Acorn—but I take it I’d have to watch on my laptop, not my TV?

  56. Amy

    Santa and Karen, I am trying to follow your last series of comments, but I need to go back to the episode you are describing in S7. Even though I only saw it a month ago or so, I’ve realized that watching a second time when I am not caught up in the plot reveals a lot more to me. I can say that watching S7 once through, I never got the sense that Martin himself was giving up, but that he was depressed that she had given up.

    And for what’s it worth, I do believe people can change. Not into something completely different, but into a better version of themselves. If we didn’t believe that, why would so many people go into therapy and why would so many people be happy with the results? I don’t think Martin could become Mr Sociable, but I do think that he could learn to trust Louisa enough to be more open and more expressive IF she could just meet him halfway and be more accepting of his limitations. I read the end of S7 as her way of saying she is ready to try to do that.

    Call me a cock-eyed optimist or a hopeless romantic, but I do believe they could make each other happy and I do believe people can change!

  57. kjacobson@mindspring.com Post author

    Amy, if you have either Roku or Apple TV, you can watch Acorn TV on your TV screen. We enjoy many good shows that way too.

  58. kjacobson@mindspring.com Post author

    We are going back and forth about the last scene of S7E7 when they return from their very strange meeting with Dr. T during which she wanted them to run in place. Louisa had been expecting some important revelation that could help her and Martin, and had gotten Martin to join her, but what they got was a deranged therapist. They return to the surgery and Louisa seems rather dejected that this session went so unpredictably bad. She says goodbye and gets out of the car only to be stopped by Martin who now tells her he can’t go on living this way anymore. He thinks they should start figuring out what to do about James, etc. That exchange ends the episode. Santa is arguing that Martin has decided that he can’t change enough to make Louisa want him back and he is resigned to letting her go. I think that he is using the ultimatum as a ploy to get Louisa to stop delaying and continues to hold out hope. I also think the show is set up to position this ultimatum at the end of E7 with Louisa being somewhat non-committal at this point because they want the reconciliation to take place at the end of E8. It is the so-called climax or turning point of Freytag’s pyramid and will be followed by the denouement in E8.

    We have also all along believed that there is a conversation between Martin and Louisa that somehow had to have taken place at a time after this last scene of E7 and the first scene of E8 during which they set up the dinner date and make plans to discuss their next steps. It’s just odd that we go from a discouraged Louisa at the end of E7 to a bright and cheerful one the next morning (if it is the next morning). That’s a gap that confounds and is confusing. Then we see that Louisa greets Martin with a smile, stands next to him when Dr. T appears to apologize, agrees with Martin that she won’t miss Dr. T, and has clearly planned a dinner with Martin’s favorite foods. The distinct impression is that Louisa is ready to tell Martin she wants him to return home; however, he goes missing and E8 goes through the “series of unfortunate events” until they sit together in the final scene of the episode and series and talk.

    When I republish the posts on change you’ll see that I have also argued that we are mostly convinced that people can change and therapy is one proof of that. The show has given us mixed messages about this though, and we’ve gone through the many discussions about change that have been included throughout the seven series. There are caveats to whether people can change too. I’ll do my best to republish these posts by the end of this weekend.

  59. Amy

    Karen, thanks for the detailed recap of that scene. Now I recall it more clearly. I am currently out of town on a trip, so will have to watch it when I return and see how I react to that scene. I now do recall feeling like Martin had no hope that Louisa was interested in reconciling, but not that he himself didn’t want to, but perhaps on a second viewing I will feel differently.

    I am looking forward to your reposts! I may be slow in responding since my computer time will be very limited, but I will be reading and eventually responding. 🙂

  60. kjacobson@mindspring.com Post author

    I have Roku and had to search for Acorn TV to place it on my available services list. Maybe Apple asks you to do something like that too.

  61. kjacobson@mindspring.com Post author

    Have a fun trip and don’t worry about this stuff. There’s lots of time for these discussions!

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