Category Archives: psychological conditions

Laughter/Comedy

Following my post on “Laughter and Civility” several months ago I have been trying to deconstruct what makes us laugh and build a convincing argument that it is appropriate to identify Doc Martin as a dramedy with an emphasis on comedy. For me this was a worthwhile endeavor because I am fascinated by the various philosophical views of humor and laughter. (I also find it important to place shows in the proper categories because I believe we don’t give enough recognition to the impact comedy can have on our views of all sorts of topics.)

In writing about Doc Martin I have often referred to other TV shows that combined serious topics with intentional efforts to be comedic. These included M*A*S*H, All in the Family, The Sopranos, and Breaking Bad. In the above mentioned post one important commenter (DM) noted an episode of The Mary Tyler Moore Show that deserved to be included. Every one of these exceptional shows addressed very important issues while also making us laugh. While there is an argument to be made that The Sopranos and Breaking Bad leaned more toward drama than comedy, the others were definitely designed as comedies first, and I believe strongly that Doc Martin was too. My position on this does not in any way diminish the significant contributions to our discourse on socially relevant concerns addressed by these shows.

In my effort to develop a convincing argument on this subject, I used my usual academic resources and I watched the recent series on CNN about The History of Comedy, and I checked out some other discussions on YouTube. What follows is my attempt at collating all of this information and providing you with a few references to my sources.

My “go to” source is often A Handbook to Literature because it distills terminology into its basics. It seems pertinent to note that in this reference book comedy is identified as “a lighter form of drama that aims primarily to amuse and that ends happily. It differs from farce and burlesque by having a sustained plot, weightier and subtler dialogue, more lifelike characters, and less boisterous behavior.” Furthermore, the Handbook states “in general, the comic effect arises from a recognition of some incongruity of speech, action, or character…Viewed in another sense, comedy may be considered to deal with people in their human state, restrained and often made ridiculous by their limitations, faults, bodily functions, and animal nature…Comedy has always regarded human beings more realistically than tragedy and drawn its laughter or satire from the spectacle of individual or collective human weakness or failure.”

The Handbook also defines comic relief as “a humorous scene, incident, or speech in the course of serious fiction or drama…that are used to provide relief from emotional intensity and, by contrast, to heighten the seriousness of the story.” (We can easily see how in S6 Penhale’s survival exercises were inserted for that purpose. [IMO the story had gotten so somber that Penhale’s antics ended up simply being intrusive and tiresome.] In S7 Mrs. Tischell’s preparations for a romantic dinner relieved the lack of intimacy between Martin and Louisa and heightened the seriousness of that absence. And those are just two of many instances where comic relief is used in this show.)

CNN’s series of episodes that looked at the history of comedy broke it down into 9 episodes so far, with each having a particular theme. The one named “The Comedy of Real Life” seemed the most pertinent for my use and really reaffirmed what the Handbook had to say about comedy dealing with people in their human state. CNN asserts that comedy consists of real life events just twisted a bit, and that comedians bring everyday experiences to the front burner. In addition, it declares real life funny because it’s relatable and viewers realize that many of these situations have happened to them too. They quote Norman Lear as saying “there’s nothing more interesting than the foolishness of the human condition. It takes the comedian to find the moment that helps people laugh at themselves.”

In this episode they also declare that being likable is not believable and there’s no comedy in likable. Furthermore, they contend that outcasts can be lovable. Thus, flawed characters are the essence of comedy.

Insofar as subject matter is concerned, they quote Jerry Seinfeld as saying that romance gives people instant vulnerability and that marriage is rife with comedy because it strains credulity that two people want to make a commitment for life. Apart from that, relationship material is never finished because there are so many ways to be with somebody.

So when Doc Martin begins with the flight to Newquay in which Martin Ellingham quickly reveals his social ineptitude by staring at Louisa Glasson, they are immediately taking advantage of the comedic aspects associated with relationships, and the show continues to build on that quality. Soon they add conflict between these two characters as well as physical humor.

We may experience some sympathy for the pain associated with much of the bodily abuse suffered by several of the characters in the show, but the fact remains that humor is often derived from misfortune including pain. We also often laugh at someone’s clumsiness, including in real life. To substantiate this position I would refer you to President Gerald Ford and his actual falls down (or up) stairs and what fun we all had watching Chevy Chase exaggerate his clumsiness in SNL skits. This brings me to a YouTube video TED talk of a TED talk that stood out to me in that it condensed the study of what makes us laugh into a short presentation. In particular the speaker’s reference to falling down the stairs clarifies what turns that into something we laugh at. As long as the fall is benign and does not involve a violation (as defined by the speaker), the act is funny, and meant to be funny. Of course we can extrapolate from a fall down the stairs to any action that might injure someone but turns out to be harmless, e.g. hitting one’s head, being shot at, jumping through a window or climbing out of one, getting a foot stuck in a trap, slipping off a chair, etc., etc. I would add that feeling nauseated or having any sort of benign illness fits that category as well. It’s funny when the headmaster runs into the water with Martin chasing after him because no one gets hurt; it’s not funny when Holly slips on a wet rock and injures her back. (Then again the aftermath of both events are funny, i.e. Martin being dripping wet while Edith drives by and Holly staying at Louisa’s and Martin attempting to show some sympathy.)

To augment this position I give you a segment of a Dick Van Dyke Show episode If you don’t laugh while also understanding the points he’s making about comedy, I will be surprised. Moreover, I don’t think any of this has changed in the last 50 years. It’s been true from the earliest days of comedy and remains true today. I am quite sure the writers of Doc Martin and Martin Clunes himself are aware of all of this and use it to make this show satisfy the characteristics of a comedy.

The whole premise of Doc Martin is supposed to be funny. A surgeon with haemophobia who is also socially inept and clumsy and decides to move to a small town and practice as a GP is immediately filled with absurdities that would make us laugh. I like to think that the hedge of defining comedy as a lighter drama is sufficient to satisfy us all.

Originally posted 2017-04-23 14:06:03.

Some thoughts on Hemaphobia

After hearing Ruth tell Martin that his hemaphobia could be related to his experiences as a child, I started thinking about the way his hemaphobia is handled in this show. As Ruth says, M’s hemaphobia is a psychosomatic condition that arose while he was doing surgery, something he loved. As a result, he quit surgery and moved to Portwenn to be a GP. Obviously, his fear of blood is not conquered by the move because we see him throw up numerous times and faint once after he is exposed to blood. As far as I can tell, these two reactions are pretty common among hemaphobics. Of course the comedic value is great because a doctor who has trouble with the sight of blood is so incongruous. More than that, though, Ruth has now brought up the likelihood that his parents and something in his childhood may be at the root of this disorder.

Many viewers, including me, have thought that series 6 was much darker than we were used to. After E1 & 2 the series takes a turn mostly because Martin’s hemaphobia returns in E3. He had thought that he had overcome it, and when he operates on the caravan owner in E1, there is no sign of it despite a tremendous amount of blood. It’s not surprising that when he takes blood from Robert Campbell and feels a surge of nausea, he’s disturbed that he has fallen back into that condition. Thereafter Martin has many scenes where he’s sitting in the dark looking forlorn and somewhat lost. He has trouble sleeping too. In short, he seems rather depressed, a condition that often occurs concomitantly with hemaphobia.

Instead of blaming Louisa and their relationship difficulties, it may make more sense to look to his parents and some childhood trauma, possibly between the ages of 4 and 6, since that’s when Ruth noticed Martin became a more withdrawn boy. He’s now had a son of his own and that in itself could have brought up subconscious memories/repressed memories from his own past. Then his mother returns and he’s horrified to have her there and around his son. We see him appear pretty unhappy when he looks down onto the beach and sees Margaret with Mike and James. I could definitely imagine some flashbacks of something that happened in his childhood appearing in series 7.

Both Ruth and Louisa want Martin to seek help from a psychiatrist to overcome the recurrence and hopefully put the matter to rest. He isn’t comfortable talking to anyone in his close circle, and he’s had difficulty confiding in the psychologist he went to before. He tried to desensitize himself without success. Really there are not many other options other than trying psychiatry or hypnotherapy. I’d love to see them try hypnosis on him, but it’s hard to believe it would work with him. Who knows, we might be surprised! Now that he’s banished his mother from his life, perhaps he can have a breakthrough with Louisa’s support. To me, she’s been trying everything she can think of and would be thrilled to be included in any effort he makes to change in any way.

Originally posted 2013-12-07 19:26:25.

The Inevitability of Change

This seems like as good a time as any to mention a couple of articles about personality I’ve recently read. They take up the subject of whether we can change our personality, a subject that has occupied a lot of space on this blog.

Naturally, we have discussed this a great deal because of its apparent importance in Doc Martin. In the show, we have many occasions in which various characters argue people can change, people don’t need to change, people must change, and finally that we are who we are. (Please see the many posts on change on this blog for a fuller engagement with this topic.)

I have also noted that it would be rather strange for a therapist to believe that people can’t change because there would be no use for therapy if that were true. Since Ruth Ellingham is a therapist, and even more importantly one who treats the criminally insane, she would be expected to believe strongly that therapy can make an impact that reduces the likelihood of more criminal behavior, ergo it can change a person’s tendencies. Her conviction in the value of her vocation is reinforced when she reacts to Caroline’s query as to whether she truly believes therapy works by saying she wouldn’t have spent her life doing it if she had any doubts.

Nevertheless, she, in particular, gives us mixed messages by telling Louisa that people don’t change, only to later tell Al he writes his own story, and then tell Martin that he must change or lose Louisa.

In addition I have claimed that we all change over time whether we try or not. All sorts of things in life impact us, especially family and having children.

Well now we have these two articles that inform us that we not only can change our personalities, especially if we have therapy, but we inevitably change over time. (In the second article personality is defined as “‘an individual’s characteristic patterns of thought, emotion, and behavior, together with the psychological mechanisms—hidden or not—behind those patterns,… quoting psychology professor David Funder’s definition.'”

Indeed, as of this year we now have a report that states “in an analysis of 207 studies, published this month [January] in the journal Psychological Bulletin, a team of six researchers found that personality can and does change, and by a lot, and fairly quickly. But only with a therapist’s help.”

For the record, there are some who differentiate between traits that are genetically programmed and traits that are socially induced. Either way, it now seems that there is sufficient evidence to indicate that we can change our personality, or at least how we “present ourselves.”

The other article is much less equivocal about change. It states: “The longest personality study of all time, published in Psychology and Aging and recently highlighted by the British Psychological Society, suggests that over the course of a lifetime, just as your physical appearance changes and your cells are constantly replaced, your personality is also transformed beyond recognition.”

We must conclude, therefore, that whether Louisa or Martin believe it or not, they are changing with every year, and even without therapy. Furthermore, Louisa may not have to actively mold Martin into someone whose personality doesn’t offend her; he may convert to that person gradually over time anyway. And Martin may discover that Louisa is changing her approach as they continue to live together without any intervention on his part. Hell, she may have already changed tremendously by the end of S7!

Originally posted 2017-03-05 15:56:26.

STOP THE PRESSES

I can’t bury the lead…MARTIN ELLINGHAM SAID, AND I QUOTE, “I’M GLAD I’M HERE.”

The question we’ve been trying to answer for years has now been settled: Martin CAN be happy, and is, in Portwenn. They included enough evidence in this episode that he wants to stay in Portwenn that for me they have resolved that issue. As in S7 when Louisa was regularly reminding people in the village that she was now Mrs. Ellingham despite their marital woes, Martin notes several times in this episode that he plans to stay in Portwenn.

Not only that but he can still perform vascular surgery, and does in Portwenn, with a knife, in the ballroom!!

As has been occurring throughout S8, despite being told to suspend his medical practice, ME comes to the rescue several times and diagnoses some rare conditions. The coup de gras comes when he saves the necrosing hand of an artist, demonstrating he can function at a very high level while presented with a lot of blood and under great stress. If there was ever any doubt that his medical knowledge and skills were not up to snuff, those reservations were dashed to smithereens (pun intended).

Now, as for the blood phobia. Any medical board would require that a doctor who has a compromising condition seek therapy. In his case, as in the case of Gregory House, he is an outstanding physician whose infirmity does not interfere with his extraordinary ability as a doctor. Because the board can’t just overlook this matter, these doctors are forced to submit to the authorities and prove they are at least trying to overcome their vulnerabilities. Must he cure his blood phobia to satisfy them? Generally a good faith effort to deal with the problem whether it’s a phobia or an addiction will convince the board that the doctor has been properly diligent about the matter, especially since there is no doubt that these doctors are critical to the health and well-being of their patients.

Will Martin Ellingham cure his blood phobia? I think we all agree that we won’t be witness to much therapy, and I seriously doubt Louisa is going to be the answer to his problem. We might just return to the show and the lives of this couple after he has sought help and reduced, if not eliminated, his phobia. This is really the one area they leave in suspense for the next series. (I want to include a caveat here that this group of writers and producers has been known to feign in one direction and take us in another. There is always a chance that what we see as a likely future plan may end up being a deliberate misdirection. For example, I thought S6 had to begin with the wedding and I enjoyed the humor in E1 tremendously. I expected the rest of the series to continue the humor. Boy was I wrong about that!)

During this last episode of S8 we did see the more typical Jack Lothian script. As in a number of previous series, Ruth, Penhale, and Louisa are all in attendance during the final minutes of the episode. Ruth is there to provide advice and further the action, Penhale enters to demonstrate his allegiance to the doc and as the person who both causes some of the problems and helps solve them, and Louisa is there, of course, because she is his trusted companion (and she needs to get his medical bag).

We finally get a scene in which Martin spends some time with James. As in the charming scene in S5 when James is a baby and Martin reads his medical journal to him, in this episode, Martin explains the origins of stethoscopes to James while allowing him to wear a stethoscope. And James is actually allowed to stand up! He still hasn’t spoken another word, but we’re making progress!

Viewers’ wish for some romance comes when Chris Parsons tries to kiss Louisa and Beth Traywick makes advances toward Martin. They are both still desirable to others if not particularly affection inducing to each other. We could also postulate that now that they are able to converse with each other, that has supplanted the kissing. (Lothian does include one conversation that is interrupted as a throwback.)

I, for one, have found these occasions when Martin is the object of desire by various women to be excessive and unnecessary. I suppose they could be a nod to the experience doctors often have with patients. The disparagement of America is ok, and Beth ultimately does protect Sally and treat her very nicely under the circumstances, assertiveness training aside. Their catfights are somewhat amusing, although nothing close to the ones in Dynasty.

This episode was much more along the lines of what we’ve come to expect from good writers and actors. They found something for everyone to do and they found a way to end the series on a good note for this couple.

[I still may have a few more posts in my future. I look forward to hearing from you all!]

Season 6, episode 7 and the continuing themes

At the 18:07 mark and then again at the 34:19 mark of episode 7 we see a sign on a wall in the background of the scene that reads SECRETS. That, to me, is telling and is the theme of the episode. This episode is very well conceived and executed and begins with Martin hiding his fears about his own condition from Louisa, not being willing to discuss his feelings about his parents and not revealing to Louisa why he can’t go on holiday, Ruth being unsuccessful at prying from Margaret why she’s really in Portwenn, Mike having hidden that he was AWOL from the army and then trying to run without an explanation, and the MPs at first not telling anyone why they’re searching for Mike. Both Al and Joe try to keep Mike from being taken by the MPs by deceiving them.

Secrets, deception, and hidden motives are all methods of controlling one’s surroundings, and that has been one overarching theme for much of series 6 as well as an integral feature of the show (as I mentioned previously in my post about change). This episode magnifies how hard it is for people to change and how that stagnation seriously impacts everyone’s lives. The pivotal scene related to the idea of change/control occurs when Mike has gone to his apartment to pack and leave and still has James with him. It is then that we learn that he is AWOL from the Royal Army because they wanted to “fix” him and his OCD and make him “normal.” But Mike considers the OCD to be part of who he is and doesn’t want to be fixed. Martin shows up at Mike’s apartment looking for James and wondering what’s going on. When Mike explains why he left the army, Martin asks him,”If it wasn’t a part of an order, would you like to feel more in control of your actions?” and Mike answers “Yes.” Martin tells him “the army has a duty of care to you and it’s your decision if you take it or not.” That convinces Mike to turn himself in. This conversation makes it clear that once Mike determines for himself that he is the one deciding to face his demons, he is taking control of his behavior and his life and fighting the control his OCD has over him. Of course, what Martin is telling Mike is what he should be applying to his own situation. It is clear that Martin would like to be more in control of his actions and that he should seek therapy.

When Al takes Mike to the nearest Army post to turn himself in, it is dark and the scene looks ominous with a German Shepard as well as 3 soldiers guarding the gate. Al does what he can to be encouraging, but the setting establishes that what Mike has ahead of him is daunting. Nevertheless, Mike takes the steps toward the gate with some resolve and will, we believe, address his problem with OCD (and with his departure from the Army). This dark and foreboding setting is of a piece with the many other dark scenes in this 6th series. I’ve been troubled by the frequency of Martin sitting in the dark staring into the night and thinking. We can only assume that he’s trying to figure out how he can reestablish control over his phobia and his life. His insomnia is also a side effect of being depressed and he needs help with his depression too. OCD often arises out of an effort by the person to institute control over his/her environment, but ultimately takes control and leaves the person with the sense that he/she is out of control. Phobias are similar in many ways. If one thinks that avoiding a particular thing, e.g. spiders, blood, the outdoors, will prevent them from feeling anxious, and that avoidance leads to a reduction in the anxiety, then the avoidance behavior becomes reinforced. Breaking that cycle is what therapy is meant to do.

During this episode, Martin is shown pondering what’s been happening on several occasions. After Louisa’s accident there are two occasions when he involuntarily falls asleep and awakens to find himself disoriented and disheartened. It’s not surprising that he falls asleep at odd times since he’s been pretty sleep deprived for a while. Lack of sleep along with the depression may also be the reason his behavior at Sports Day is so different from other events Louisa has asked him to attend. Usually when Louisa enjoins him to do something, Martin agrees and tries to handle it as well as he can (e.g. headmistress panel, dinner out, taking James to music time, etc.), but this time he’s not as conciliatory and she finds it embarrassing and infuriating. The whole idea is rather ridiculous since he’s never been good in front of a microphone (think very first episode when Caroline wants him to speak to the town, or Aunt Joan’s funeral) and Sports Day in elementary school was probably painful for him as a child. Louisa should never have asked him to be the special guest and he should never have agreed to do it. Unfortunately, this mistake ends very unhappily and inspires both of them to give some thought to their relationship. We can’t be sure what he is thinking while sitting in the car with James outside the hospital, but he appears to have a sentimental moment when he takes James out of his car seat and holds him up. I could imagine he’s thinking how foolish it was for him to have handled the awards the way he did and prompt Louisa to be so angry with him. Of course that’s speculation. Whatever he’s thinking, it’s serious business and it doesn’t appear that he has any idea that Louisa will decide to leave. As usual, they handle this difficult circumstance the way we’ve become accustomed to: he applies his medical knowledge to her condition while she departs.

It seems to me that he needs regular “wake up calls” to jolt him out of his typical mode of behavior, and she needs to understand that his silence and inability to talk about his problems and thoughts is not in any way related to how he feels about her. Since we know that Ruth will reaffirm his ability to change in the final episode, I expect to see another effort on his part to appeal to Louisa’s better instincts and that Louisa will hopefully recognize that he needs her, loves her, and wants desperately to be a good father to James. He will admit in some way that he struggles to control his behavior, and possibly she will agree to stop leaving. These changes may not be easy to make, but we can hope they will try.

Originally posted 2013-10-17 23:22:38.

What is happiness?

The writers of Doc Martin may not be trying to get into the philosophical definitions of happiness, but the fact that finding happiness is very important in the show certainly makes me want to interrogate it. At the end of season 3 when Martin and Louisa decide not to marry, Louisa tells Martin that he wouldn’t make her happy and Martin responds that she wouldn’t make him happy either.Then in season 6 episode 7 Louisa again tells Martin that she isn’t happy and that she isn’t making him happy. He is flummoxed and can’t understand why people always care so much about being happy. That comment, in turn, bewilders Louisa and she simply gets up to leave. Putting aside the problem I have with Martin saying Louisa wouldn’t make him happy when he’s spent so much time and effort wishing he could have her in his life, and being miserable when it looks like she has rejected him, we can’t help wondering what would make them happy.

If Aristotle is right and “eudaimonia (Greek for happiness) actually requires activity, action,” and that “eudaimonia, living well, consists in activities exercising the rational part of the psyche in accordance with the virtues or excellency of reason. Which is to say, to be fully engaged in the intellectually stimulating and fulfilling work at which one achieves well-earned success,” then Martin’s concept of “happiness” is likely to stem from practicing medicine. However, in recent years the psychologist C. D. Ryff has highlighted the distinction between eudaimonia wellbeing, which she identifies as psychological well-being, and hedonic wellbeing or pleasure. Building on Aristotelian ideals of belonging and benefiting others, flourishing, thriving and exercising excellence, she conceptualized eudaimonia as a six-factor structure:
-self-acceptance
-the establishment of quality ties to other
-a sense of autonomy in thought and action
-the ability to manage complex environments to suit personal needs and values
-the pursuit of meaningful goals and a sense of purpose in life
-continued growth and development as a person
Under this scheme, both Louisa and Martin would struggle to feel a sense of well-being. In particular, Louisa seems to hate not having a sense of autonomy, and she has previously wondered about her sense of purpose. During series 6, we see that she is happy as a mother and is depicted as taking great joy in having a child, and she appears to have a purpose when it comes to being headmistress at the school. What she doesn’t have is the affirmation or reassurance that she is succeeding as a wife and companion. Her autonomy is perhaps compromised most by her inability to get Martin to do almost anything she suggests. He won’t go see a psychiatrist, he won’t talk to her about his concerns, he doesn’t like to participate in most activities, and he doesn’t want to take a holiday with her. Martin seems lost when it comes to feeling in charge of his situation and has not really reached a place of self-acceptance. Obviously his upbringing has a lot to do with this. He feels most comfortable at home and in his routine. On the Ryff scale, he has autonomy but not much else. He does seem to have achieved some sense of well-being from having a wife and child, although at times we’re not sure about that.

I think Martin is right to question why happiness is such a significant feature of life to most people. We can’t be happy all the time. What we need is an overall sense that our home life is satisfactory, that our social lives are fulfilling, and that we have a sense of success in some aspect of our lives. The home life is the one in doubt in this series and Louisa cannot find that place where she is in a comfort zone, while Martin hasn’t really pondered whether his home life is how he’d like it to be. Surely having his mother in the house has changed their home life tremendously. It was somewhat rocky before, but now they have very little time alone and his mother is demanding and quite judgmental. I don’t care who you are, when your mother criticizes you, it hurts.

Marriages all have ups and downs, although this marriage has not been allowed to have many ups so far. Talk about no honeymoon!! Poor communication is often the reason for marital discord and boy is this marriage dealing with that! Ruth can talk to both of them and they are lucky to have someone like her to turn to. They need an intermediary and an opportunity to work together in some way. Go take a walk with James, take a drive somewhere for a couple of hours, go have that picnic Louisa dreamed of (without the earthquake), build something together, whatever. Even if something crazy happens it would still be something they did together and would not take Martin outside his comfort zone. I think they could both be “happy” after that. Louisa’s injury has a chance of bringing them together. We’ll see what happens.

Originally posted 2013-10-15 17:31:57.

More on Cognitive Behavioral Therapy

In an earlier post I noted that “no treatment works for every patient and it may be that the difference in outcomes is only because of that variability.” I can now add that there have been advances in the understanding of who can benefit from cognitive behavioral therapy as opposed to medication and you can read about it here.

Originally posted 2013-10-05 15:26:13.

Doctors, patients, and stalkers

After learning that Mrs. Tishell returns to Portwenn and will probably continue her fixation on Martin, I realized I should say something about doctors and the real experiences they have with patients/nurses/and the general populace becoming infatuated with them. We also can’t overlook the very real affairs doctors sometimes have with their patients. In addition, in a small town patients and doctors often interact on a social basis even if there’s no intimacy involved, but it can be awkward.

I know about this sort of thing because in the small town in North Carolina where my husband practiced medicine for many years we had numerous encounters of this kind. Sometimes I wondered if we were living in a mini Peyton Place! I guess you could say that doctors are in a position of authority and may often save patients from dire circumstances. Many times patients confuse concern for their health and welfare with other deeper feelings for them. Then there are the patients, like Mrs. Tishell, who have psychological problems and develop delusions that their doctor loves them. In Doc Martin it’s funny that this grumpy and rude doctor becomes the object of the chemist’s affection because most of the town thinks he’s obnoxious and calls him “tosser” and any number of other names. She, on the other hand, tries to impress him with her medical knowledge and does as much as she can to get his attention. He never gives her any reason to think he’s interested in her, but that doesn’t stop her from believing they have a close connection. She’s not really a stalker, but when she cracks and abducts the baby, she reveals how delusional she’s become. In Portwenn, like in the small town we lived in, women could be calling the doc at all hours of the day and night, or leaving him messages on his cell phone, or sending him presents (much like 15 yo Melanie does in season 1, episode 5). Then it’s up to the doctor to figure out how to get them to stop and it’s not always so easy. We shouldn’t forget Mrs. Wilson who also wants to get Martin’s attention and flirts with him. She even gets him to make a house call for a totally trumped up reason. In her case, his status appears to attract her, although she may just be intrigued with making a new conquest. Martin is not susceptible to her advances and his naivete keeps him from realizing what she’s up to. His naivete is probably the reason he never notices Mrs. Tishell’s efforts as well.

I found it very amusing and startling when Martin accuses Louisa of possibly having de Clerambault’s syndrome or Erotomania after their intimate conversation in season 2, episode 8 when he declares his love for her while under the influence of wine the previous night. Here he is staring at her through windows and following her liaison with Danny, and then being obviously relieved when she tells him that she and Danny have split, but he can’t handle it when she comes by the next evening to tell him she loves him too! (Once again the writers, or consultants are pretty amazing with their knowledge of medical terminology.) In their case we have a mutual attraction to each other that must jump many hurdles before and after they finally end up together. Louisa, nevertheless, has to decide how to manage going to Martin as a patient after they establish a personal relationship. Several times she considers changing to a doctor in Wadebridge because of how awkward it is to talk to Martin about her personal health problems. She signs up for prenatal care in Truro, although there are occasions when she ends up having Martin treat her during her pregnancy. Naturally it is odd and difficult to have Martin as her physician when she is unsure of their relationship and trying not to force him into a situation that she’s not sure he wants. Moreover, if they were married, he wouldn’t be her physician. Doctors (by law in America) don’t treat their own families, unless there’s an emergency and no other physician is available.

I can state unequivocally that socializing with one’s gynecologist or gastroenterologist is quite uncomfortable. He’s either done a gynecological exam or a colonoscopy on you and now you’re having a drink and making small talk. The doctors are professionals and do their best to just be friendly, but it’s kind of hard to forget that they’ve been up close and personal with you. I was often friendly with their wives too. How weird is that?

Alternatively, in our small town, there were several physicians who had affairs with patients. Of course, that is considered unethical and, in at least one case, the physician lost his license to practice medicine. But where do you draw the line? What if you are a doctor and you fall in love with someone who lives in your town and who happens to be a patient? In the case of Martin and Louisa, there is some grey area. Both of them are unmarried, they are consenting adults, and there is only one doctor in Portwenn.

But in most cases, Mrs. Tishell is a much better example of what happens. The delusional patient is set right by the doctor and hopefully receives treatment and overcomes her infatuation. Being a doctor certainly involves more than patient care!

Originally posted 2013-10-04 02:58:38.

Psychological Conditions

There are many psychological disorders brought up in DM. OCD is the one that appears in two characters. In season 2, episode 5 Tricia Soames, a teacher Louisa has hired, shows signs of having OCD and eventually admits to DM that she has many of its symptoms. Then in season 6 Mike, the nanny, clearly exhibits typical traits of the disorder, e.g. excessive need for order, feeling unsettled if colors or pens are not lined up, etc. Although Martin is supposed to have Asperger’s, he appreciates Mike’s orderliness and has some signs of OCD as well. Asperger’s is often combined with some OCD traits and would also make it hard for anyone to have a close ongoing relationship (Note: I chose this particular performance because he does such a good job of beautifully describing what it’s like to have a severe case of OCD and also have a relationship.) OCD is often a method of managing feelings of anxiety and is listed under the constellation of anxiety disorders in the DSM IV (I haven’t seen the DSM V yet.) Whether Martin has Asperger’s was cleared up by Dominic Minghella on his own blog where he states that he intended Martin to have this affliction. The writers have done a good job of giving Martin many of the characteristics of Asperger’s. He has impairment of social interaction with a tendency to stiff body postures and facial expressions, very few peer relationships, lack of effort to share enjoyment, interests, or achievements with other people, and lack of social or emotional reciprocity. His keen interest in medicine as well as in clocks fits the criterion of abnormal intensity or focus on a particular activity. His intense interest in medicine makes him a fabulous doctor, but it also makes it harder for him to empathize with his patients. Added to these are Martin’s need to always wear a suit and tie no matter what he’s doing (except sleeping). Then there are his hyperosmia (or heightened sense of smell) and his clumsiness, both typical criteria. Of course, some of these behaviors are used for comedic value — it’s funny when Martin doesn’t understand how to react to what people say or when he doesn’t smile at anything or get jokes. It’s also funny when his height and clumsiness have him hitting his head on low door frames or ceilings, falling up or down stairs, tripping into gulleys or other natural settings, etc. I would also argue that his clumsiness makes him somewhat more endearing. It’s hard to be austere when you’re bumping into things and falling down regularly. None of the above actually keeps him from handling medical instruments dexterously or from kissing Louisa lovingly, or even from being sexually compatible with her. And he somehow manages to run down narrow streets with only rare moments of bumping into people or things along the way.

There are several other anxiety disorders presented in this series: hemaphobia, agoraphobia, panic disorders, trichophagia/trichotillomania (or hair eating and pulling), and PTSD. There are also a variety of methods of treatment mentioned for these, including cognitive behavior therapy, medications like Fluoxetine (better known as Prozac), and simply allowing the afflicted person to act out. Penhale has success with getting cognitive therapy for his agoraphobia, but Martin is only temporarily relieved of his hemaphobia by this therapeutic approach. We might think that Penhale is more open to any therapeutic approach and finds success as a result, while Martin is more conflicted about the efficacy of the treatment and whether he really wants to move to London and, therefore, the treatment isn’t as successful. Of course, no treatment works for every patient and it may be that the difference in outcomes is only because of that variability. (Mrs. Tishell has also been treated by cognitive behavior therapy and the rubber band she snaps on her wrist in series 6, episode 5 is a technique to pair a painful stimulus with being attracted to Martin. The fact that she has to snap it so often makes one wonder if the therapy hasn’t really been effective enough. Also, she has not voluntarily decided to do CBT and that markedly reduces the chances of its success.) CBT appears to be a popular treatment strategy in England and may be used more partially because it is less costly. (Just a guess.) Also, writer Julian Unthank sure knows a lot about CBT. Mrs. Tishell mentions guided discovery, validity testing, and keeping a diary – all methods used with CBT.

Ted’s trichophagia isn’t treated by any more than a possible procedure to remove the hair ball in his gut and moving to live with his daughter. Mrs. Cronk’s panic disorder is generally handled as hyperventilation and a personality quirk. And Stewart’s PTSD is accepted by the village and tolerated as understandable considering his military service. On the other hand, Dr. Dibbs treats her anxiety disorder with Fluoxetine, and that doesn’t seem to reduce her anxiety, but her condition is complicated by the fact that she has Cushing’s disease which can be accompanied by anxiety symptoms. In season 6, episode 4 we have Mr. Moysey and his hoarding due to depression but also the anxiety accompanying living on his own after many years of being taken care of by his wife. I know Ruth is quite perceptive when she tells Mr. Moysey that he probably started hoarding after he lost his wife and sister in one year and wanted to protect against any further loss by keeping everything. Nevertheless, I would postulate that he also has some anxiety issues. I should note that Ruth, as a psychiatrist who treats the criminally insane, would be accustomed to using psychotropic drugs. Criminals are not likely to be willing to undergo cognitive behavior therapy! Once again the inclusion of these anxiety disorders and the many forms of treatment is, to me, very insightful and demonstrates some in depth understanding of anxiety disorders by the writers.

Other psychological conditions mentioned in the first 5 series are psychoses either related to medication or genetic disease or poisoning, addiction (to gambling), hallucinations (probably due to Lyme disease and grief), bipolar disorder, and two hard to define but clearly abnormal behavior patterns. Mrs. Tishell brings on her psychotic break by taking a combination of medications, Mr. Strain the headmaster has porphyria which causes his psychotic break, and Mr. Coley has carbon monoxide poisoning that affects his ability to behave normally. Pauline falls victim to gambling and its addictive qualities. Mrs. Selkirk first appears to be suffering from hallucinations brought on by grief but actually has Lyme disease. Louisa’s father’s friend who ends up tying them all up and holding them at gunpoint is very unstable and clearly not taking his medication. His behavior is a pretty good example of what can happen when a manic-depressive has a manic episode and won’t take his Lithium. The two who are hard to pin down are Michael, the strange young man who steals Ruth’s hubcaps, and Victor Flint, the father who dresses like a woman and can be violent at times. They both have symptoms of mental disorders but their behaviors are not specific enough to clearly identify them. Victor’s symptoms are called a psychosis by Martin, but they appear to have elements of many different psychological disorders. It’s not really that important to pin it down exactly. Suffice it to say he’s got some mental derangement.

The plethora of psychological conditions in this show probably is representative of most locales. Mental disorders are surprisingly common in society. I don’t know exactly what’s in store for the final episodes of series 6, but I’d like to think that Louisa can be the sort of woman/wife who will recognize how to sympathetically deal with Martin’s continuing difficulties, especially his hemaphobia. As far as Mrs. Tishell, who knows? And nanny Mike is not likely to change much since his OCD doesn’t keep him from functioning well-at least so far.

Originally posted 2013-09-29 17:54:13.

Some Cosmic Rationale

Hello, it’s me again. I actually came up with a post I thought was worth writing.

I’ve written a lot about happiness because it seemed a topic that kept coming up during the show. This post will be about the flip side: depression. Previously Abby and Santa suggested that the low mood Martin Ellingham exhibits in S6 looked to them like Major Depressive Disorder. (Research in the US and other countries estimates that between 30 to 50 percent of people have met current psychiatric diagnostic criteria for major depressive disorder sometime in their lives, so it would be quite unsurprising for ME to have experienced a bout of it.) Not too long ago, Santa sent me an interesting article written by a researcher who looked at depression as an evolutionary adaptation that can be a helpful and useful way to react to various stresses in life. I finally got around to looking up more about this concept and have found some very interesting views related to it. (We would have to say that by S7 ME is no longer in a major depression. His MDD was short-lived.)

(Once again I caution us from assuming that the writers, et. al. had any notion that any of ME’s behavior could be assessed in this way. I just find it fun to see how we could apply these theories to this character.)

So let me review what hypotheses several well respected psychology researchers have noted:

In The Depths: The Evolutionary Origins of the Depression Epidemic, psychologist Jonathan Rottenberg, professor of psychology at the University of Florida, “presents a compelling inversion of conventional wisdom.” In his book he refers to a variety of studies that indicate that “low mood narrows and directs our attention to perceive threats and obstacles. It also helps conserve energy, facilitates disengagement from impossible goals, and improves our capacity to detect deception and to assess the degree of control we exercise over our environment. Some studies even suggest that low mood can improve skill in persuasive argument and sharpen memory.”

That is not to say that depression is something we should all hope to attain. Rottenberg cautions that “depression can be a useful response in particular conditions, but it can also be a debilitating condition that mars quality of life and even interferes with evolutionary goals of survival and reproduction. The behavioral mechanism that helps us disengage from impossible goals can become a generalized condition that inhibits the pursuit of any goals, even perfectly attainable ones…Depression too can be both a valuable defense and a devastating vulnerability.”

(We shouldn’t overlook how serious this condition can be; however, this show does not allow the depression to reach the point of becoming debilitating to the extent that ME cannot function. To the contrary, when he’s at a very low point, the car hitting Louisa and the discovery of her AVM mobilize him pretty darn quickly.)

Rottenberg’s conclusion that depression can be useful is further confirmed by other researchers. For more than 30 years, UVA psychiatrist Dr. Andy Thomson (Med ’74) has been treating patients, and most often he treats them for depression. Thomson and his collaborator Paul Andrews, now at McMaster University in Canada, believe that depression is an evolutionary paradox. They, too, theorize that if it didn’t confer any advantages, it should have been selected against and occur only rarely in the population. In their view, “depression, psychic pain, alerts you to the fact that you have a problem, stops business as usual, focuses your attention,and can provide a signaling function that you need help.” “Basically, it forces you to think.”

In an article in Scientific American they argue that “depressed people often think intensely about their problems. These thoughts are called ruminations; they are persistent and depressed people have difficulty thinking about anything else. Numerous studies have also shown that this thinking style is often highly analytical. They dwell on a complex problem, breaking it down into smaller components, which are considered one at a time.”

Furthermore, “many other symptoms of depression make sense in light of the idea that analysis must be uninterrupted. The desire for social isolation, for instance, helps the depressed person avoid situations that would require thinking about other things. Similarly, the inability to derive pleasure from sex or other activities prevents the depressed person from engaging in activities that could distract him or her from the problem. Even the loss of appetite often seen in depression could be viewed as promoting analysis because chewing and other oral activity interferes with the brain’s ability to process information.” In addition, “laboratory experiments indicate that depressed people are better at solving social dilemmas by better analysis of the costs and benefits of the different options that they might take.”

They have their detractors. Dr. J. Kim Penberthy, a clinical psychologist and associate professor in the department of psychiatry and neurobehavioral sciences at UVA admonishes them that “ruminative thinking that accompanies clinical depression has been shown to impair thinking and problem solving…In fact, mindfulness-based psychotherapies directly challenge rumination in depression and have been found to be very successful in preventing relapse in clinical depression.”

Penberthy is clear that “clinical depression is conceptualized by clinicians and researchers as having a biopsychosocial etiology, meaning that it is caused by a combination of biological, psychological and social—or environmental or cultural—factors.” She explains that people likely have some genetic predisposition to unipolar and bipolar depression, and these kinds of depression may run in families. But clinical depression has also been associated with early physical or psychological trauma, such as abuse or neglect, as well as repeated psychological insults later in life.

However, in contrast, Thomson argues that recovery may actually require ruminative thinking to solve the problems that trigger depression. Thomson says that evolutionary psychology is inclusive of biopsychosocial causes.

That depression can be viewed as an advantageous adaptation could be applied to Martin Ellingham because he falls into depression after his home life becomes more chaotic and he has a recurrence of his haemophobia as well. He has seemingly previously protected himself from outside stressors by walling himself off from society and retreating into his home, as well as by sublimating his emotions by working on clocks. His attempts to limit his exposure to external forces have now come up against falling in love and all of the attendant demands on him. We have recently been noting that several times throughout the timespan of the show, ME has expressed an inability to control his feelings for Louisa. Therefore, throughout S6, we have a man who can’t control his sentiments for his wife, no longer has the upper hand at home, and has lost whatever limited control he had over his phobia. He has trouble sleeping, has stopped eating very much and their sex life appears to be nonexistent. (They have covered all the bases by including all of the ingredients mentioned by Penberthy of physical and psychological trauma coupled with abuse and neglect, and repeated psychological insults later in life.)

But if Rottenberg is correct, ME’s depression may be providing him with a means of improving his capacity to assess the degree of control he exercises over his environment. His depression also seems to give him time to think, as Thomson says. As Andrews and Thomson declare, “depression is nature’s way of telling you that you’ve got complex social problems that the mind is intent on solving.” In a sense what ME does is ruminate and come up with a solution to his dilemma. He decides to seek therapy, and he makes up his mind to be as willing to make concessions as possible. The fact that nothing seems to work at first may be more due to the requirements of the plot than to what might have happened under real world conditions.

[BTW, here are some of the lyrics to Billy Joel’s song Pressure (from which I took the “cosmic rationale idea”):
Don’t ask for help
You’re all alone
Pressure
You’ll have to answer
To your own
Pressure
I’m sure you’ll have some cosmic rationale
But here you are in the ninth
Two men out and three men on
Nowhere to look but inside
Where we all respond to
Pressure
Pressure]

Originally posted 2016-09-14 15:59:45.

The Blood Phobia

This show began with the premise that a highly respected vascular surgeon in London became hemophobic and could no longer perform surgery. He,therefore, made the decision to move to Portwenn in Cornwall where his aunt lived and practice as a GP. Since that opening rationale, the hemophobia has been the one thing about Martin Ellingham that continues to bedevil him.

At first the notion that a vascular surgeon would become phobic of blood seemed ironic and amusing. What a funny thing to have happen to someone who is defined by working with the veins and arteries that carry blood to every part of the body. Although we could, and some viewers do, think of this as being tragic, I am quite sure it was meant to be humorous.

It meant he had to live in a small village where he was very different from the townspeople; he had to become a GP and treat all sorts of medical conditions, sometimes of minor significance and sometimes life threatening, and often due to foolish mistakes made by the patients. He went from a doctor’s doctor, a medical specialist who was referred patients who had serious vascular problems, to a primary care physician who saw anyone who walked in the door. He also lived near a family member for the first time in his life and fell in love with a local woman.

The symptoms of the blood phobia tended to be nausea and/or vomiting and he did his best to hide these from the town. Unfortunately, his secret was discovered and he became a figure of ridicule for a while. (All of this was in the service of adding to the humor of the show to a great extent, although we were given some background information about his childhood that could have contributed.) He had his first signs of this disorder supposedly when he associated surgery with some feelings for a patient and her family. This was, as far as we can tell, the only time when he could not complete his duty as a medical professional.

Each series saw him trying to deal with his hemophobia and having a variety of problems coping with it. Most of the time he has managed to suppress his immediate sense of nausea and recover sufficiently to successfully treat any problem no matter how bloody. However, some series have used the blood phobia as a major theme. In S4 we saw him try to desensitize himself so he could return to doing surgery; in S6 he became depressed and suffered from insomnia; and now, in S8, we have him being told to suspend his medical practice because a patient has accused him of malpractice due to his phobia. Otherwise there has never been a time when his hemophobia has led to him being unable to complete a task, even one involving lots of blood. Several scenes have included blood spraying onto him and during those he has neither fainted nor been unable to continue. One in S8 is a femoral artery that has been cut. Since the femoral artery is below the heart it tends to bleed profusely, as happens in the scene. When he arrives, Penhale is already covered in blood as a result of trying to put pressure on the wound. ME immediately gets sprayed with blood on his face and upper body, yet he suffers no symptoms of his phobia.

It has only made him faint 2-3 times: with Edith in S4; almost on the jetty in S8; and while treating a patient in S8. The time on the wall never really materialized, the other times he fell to the floor. When it caused him to be depressed in S6, he searched for physiological causes. At that time he took his blood pressure and EKG but could not find anything of consequence. In S8E7 he once again takes his blood pressure and pulse rate. Considering that this phobia is often associated with a drop in blood pressure and heart rate, those symptoms would not necessarily indicate anything significant about the health of his heart. At the end of S8E7 he is shown deliberately cutting his finger and looking at it. That, too, does not cause him to feel faint or become nauseous. If we are about to be given a reason to believe that his heart is having problems, that would have to be a separate issue from the hemophobia, IMO. It would be a new development.

On the other hand, it is well accepted that blood phobia is often caused by direct or vicarious trauma in childhood or adolescence. We can easily suppose that childhood trauma might be the basis for his developing hemophobia as much as any event during his surgical career. Or, the surgery he had trouble performing after meeting the family was actually more a reaction to his childhood trauma and was then associated with blood.

Maybe dealing with his childhood, and its obvious deleterious effects on him, through therapy would be the best way to reduce the hemophobia, which isn’t keeping him from functioning anyway. The solicitor who is now accusing him of being unable to treat patients due to his phobia is clearly wrong and I would expect the whole town of Portwenn to be willing to defend him since losing him would mean they would be without their excellent GP.

Change is in the air

I know I’ve written plenty about the question of whether people can change as well as whether we would want Martin or Louisa to change very much. Well, I want to add a little more to this topic. (It seems I never tire of revisiting this theme.)

in a NYTimes Mag from a month ago I read an article about a BBC America show called “Orphan Black.” I haven’t seen the show, and plan to watch it, but the show sounds like it’s an amazing tour de force for the lead actress, Canadian Tatiana Maslany. The show is about a group (greater than 6) of persecuted clones all played by Maslany. According to the article, “The question at the show’s heart is whether the clones have free will…” Maslany considers her role in “Orphan Black” and her own experiences as an actress to be “about volition and autonomy.”

Maslany mentions that she appreciates Gena Rowland’s performance as a strong female character in “A Woman Under the Influence” (1974). In this film Rowland plays Mabel, who struggles to handle life as expected but just can’t pull it off. Ultimately she’s sent to an asylum to be “cured.” However, when she returns, her husband is troubled by how she has been forced to conform to society’s norms and blames himself. He literally tries to slap her back to herself; he wants her to be herself again. As Maslany states: “He can’t handle the fact that she’s been sent away to be changed and to be made homogeneous and made easy on the palate.”

What all of the above says to me is that there are two parts to this change issue: how actors can alter their appearance and their skills so that they morph themselves into all sorts of characters, even within the same show or episode; and, there have been many examples of shows or films that are fascinated with the idea of whether people can change. In Mabel’s case, she gets stuck in a no-man’s land of being an outcast when she’s behaving as she does naturally while also not being accepted in her new guise of conforming to conventional social norms.

As the writer of the article notes, “Great acting is as much about destruction-selective, temporary self-annihilation – as creation.” At the same time, Maslany asserts that when she portrays an unlikable character, she is still being her real self and applying the worst bits of herself. Actors enjoy playing characters that require them to molt and become “Other,” yet they understand that they really can’t completely shed their innate selves.

Furthermore, a recent interview of Joseph Gordon Levitt by David Letterman showed them  agreeing that acting is basically like lying because actors get up and pretend to be someone else for a living. We all can suspend our disbelief sufficiently to allow each actor to take on various roles and apply his/her skills coupled with his/her personal traits to create a screen personality. In real life, it may be harder to reach that level of acceptability.

As in the case of Mabel, we believe Martin and Louisa should change; however, we don’t want them to be too easy on the palate. As I argued a long time ago, deciding to change involves the notion of free will with volition an integral part of that. Of their own free will, Martin and Louisa hopefully will do what they can to evolve into a more successful couple.

When we consider what it will take for Louisa and Martin to work on making changes such that they can have a happier marriage, we are watching two actors whom we’ve come to know as the characters in a show and who have used their skills as well as their true personas to create that pseudo-reality. Neither member of this couple will be sent to an asylum, but Martin, like Mabel, does not conform to social expectations. In S7, we are hoping to watch them change identities, but only enough so that we aren’t troubled by it.

Originally posted 2016-05-22 14:48:41.

People can change, and do, on TV

The theme of whether people can change, and especially whether Martin and Louisa can change, has occupied many of our discussions. DM is not the only show in which this theme has been prominent and in which the answer appears to be that people can change. I think we have all concluded that with desire, therapy, and effort, people can change the way they react to situations and relationships. The one caveat is that people don’t always change for the better.

Another outstanding show of recent years is “Breaking Bad,” and it, too, addressed the question of whether people can change. However, the overriding arc of that show was the monumental metamorphosis of Walter White from a milquetoast into a highly respected presence in the drug world. Essentially the show followed his relentless progression from quiet, law abiding high school chemistry teacher to amoral and ruthless manufacturer and seller of methamphetamine. There’s no question that writer and creator Vince Gilligan was arguing that people can change, and will, under certain circumstances. In the show, we also witness a “ne’er do well” work hard to maintain his principles while being enlisted to help White. This young man, Jesse, may be lacking in ambition, but Walter shocks him over and over as he descends into pathological behavior. Against all odds, Jesse manages to survive, although he is anything but unscathed.

The spinoff show from “Breaking Bad,” “Better Call Saul,” has just completed its first highly successful season. It, too, includes the theme of whether people can change, and makes some very interesting points about it. I was a tremendous fan of “Breaking Bad” and I confess to being an equally avid fan of “Better Call Saul.” (If you read this blog, you know I’ve mentioned “Breaking Bad” several times because of its excellent writing and acting, including their design of making the main character an anti-hero. He’s given all sorts of convincing and justifiable motives for converting himself into a criminal while maintaining many decent and admirable qualities.)

As a recent recap in the NYTimes states: “In ‘Better Call Saul’ we’ve seen another lead character evolve, though less dramatically — from scam artist to earnest plaintiffs’ attorney, with the occasional moral lapse.” The writers of “Breaking Bad” posed the question of “Can people change?” and then demonstrated how that can happen. In the new show, they add another dimension to this question and show that some people don’t change. The next to last episode depicts the main character’s brother, Chuck, as unable to imagine that his brother, Jimmy, has shed his earlier traits as a con man to become a respectable lawyer like him. Oddly enough, Chuck becomes the scam artist while Jimmy earns our admiration due to how he treats his clients and his brother. As the article notes, “Jimmy is a force for good, if we can judge by his ventures in elder law. But now he can’t have a perch at a corporate firm and the respectability that it confers.”

This episode “deals with identity, conceived here as a combination of what you do and what you, and others, think about what you do. Jimmy is a nice guy whose brother thinks he’s a menace.” The character for whom the show is named has not appeared yet. We will presumably find out that Jimmy becomes Saul, a slick manipulator of the law, and basically reverts to the “Slippin’ Jimmy” that he used to be known as because he rejects the world of corporate law.

In “Breaking Bad,” Walt had developed a reputation of a dedicated and competent chemistry teacher as well as a devoted father and husband. They even loaded his home life with a teenage son who was born with cerebral palsy and handicapped. In the beginning of the show, Walt drives his son to school and tries to keep strong ties to his son despite knowing that teenage boys are always testing and experimenting. We first get to know Walt as someone we admire. Therefore, we have sympathy for him and realize how hard he has worked to be the upstanding father, husband and teacher everyone has come to know. As he changes, it’s hard to jettison our earlier impressions of him.

How does all this relate to DM? In my mind, we are also dealing with characters who have to find a way to reconstitute themselves as different from how others have always perceived them. Can Martin Ellingham not only try to become a better husband, but also become a person Louisa and others view as being a less introverted version of who he has been? Will others be able to believe that he really wants to be more ungrudging about the somewhat tangential information patients want to talk to him about? Will Louisa be convinced that he’s voluntarily expressing his inner thoughts to her? Can the various residents of Portwenn stop seeing him as, and calling him, a “tosser?”

Will Louisa find a way to reject her first impulse to leave whenever she’s upset about something at home and become a woman who tries to listen and probe and tolerate? How much will she be able to overlook or accommodate?

And, at the risk of repeating myself too much, would the show be too different if all of the above happens? Whereas “Breaking Bad” was literally devised as a show about a man’s evolutionary deterioration, “Doc Martin” was not originally about a doctor who wants to become more likable or better at being a husband and father. Our enjoyment of the show stems from much of the behavior that makes ME so difficult.

However, when we look at how the voting for favorite episodes turned out on portwennonline.com, we can’t help but notice that it was those episodes in which Martin and Louisa have the most romantic scenes that came out on top. I have to assume the people involved with the show have noticed that too. Thus, they have the demanding challenge of trying to satisfy their audience while keeping the characters believable to us. We, and the residents of Portwenn, know them as particular types and might have trouble accepting too much change in them. They also know each other as having certain dispositions. When Martin calls Louisa “darling” in S6E2, both we and she look at him quizzically. It’s very odd to hear that term of endearment coming out of his mouth.

We also deem it necessary for them to work on their relationship so that their marriage can flourish, and we expect that to be a significant facet of S7. Just how they balance the requirement to change with what’s important to keep the same will be the key to the success of this next series.

Originally posted 2016-05-22 14:47:01.

Social Anxiety, Happiness, Fixing People You Love, etc.

Over the past few months I have been collecting articles that relate to many of the topics we have been discussing on this blog. I don’t think they merit individual posts so I am collating them here in one post. Please respond to whichever ones take your fancy.

I’ll begin this collection with the topic of social anxiety and other related subjects:
ME certainly does not like to socialize, and there have been several times when it was clear that speaking in front of a group was unpleasant for him and he was incredibly bad at it. He rarely wants to attend social events like parties, and he turns down all offers to have a pint or have a friendly interaction with Joe (or Mark from earlier series).

An article I read made me wonder about the origins of social anxiety and whether the humorous set pieces in DM where he unequivocally turns down an invitation to a wedding or an opportunity to join a group could also be associated with other events in his life and shed some light on the plight of people who suffer from social anxiety.

The article quotes, Stefan G. Hofmann, the director of the Social Anxiety Program at Boston University: “Social anxiety is a result of the fear of a possibility that we will not be accepted by our peers. It’s the fear of negative evaluation by others, and that is [part of] a very fundamental, biological need to be liked.”

“Social anxiety is a very normal stage that children go through, [along with] separation anxiety and stranger anxiety.”

Also, “Social anxiety disorder is the most common form among all the anxiety disorders. It actually is also ranked, in comparison to all the other mental disorders, as one of the most common disorders, next only to depression and substance use disorder. Thirteen out of 100 people meet criteria for social anxiety disorder [at some point in life].”

“The definition of a mental disorder is that it causes either significant distress, and/or significant interference in one’s life. So you might be able to perform normally during daily life, but you’re terribly distressed around these social situations, such as meeting people, giving speeches, or doing things in front of people.”

We have a pretty good example of this disorder in the character of Martin Ellingham. (BTW, I wouldn’t say that negates anything I said about him as a superhero. Because superheroes need to hide their identities they harbor a higher than average need to be alone and often do not socialize unless it helps them capture the villain.) He would rather stay at home, especially with Louisa and James, than attend any of the community events in Portwenn.

This sort of avoidance of social interaction also connects to another article that was in today’s NYTimes. This article brings up both being in social settings and how to achieve happiness. We might say that both ME and Louisa could use more of what we might call networking or perhaps associating with others on a personal basis. Like many people who work, they have plenty of interfacing with colleagues and clients/patients/students/parents while having very little with someone in whom they can confide. Along those lines there is a humorous article, also in the Times, about complaining. The author loves to complain and says, “Being a person is terrible. And complaining about it is the purest, most soothing form of protest there is. Complaining feels so good. It’s like casting off the oppressive wool coat you’ve been buried under since October on that first truly beautiful warm April day. Pointlessly yelling into the void about some minor injustice you’ve suffered is the perfect relief for the giant wave of anxiety crashing against your insides, a balm for the wounds that riding public transportation with people who don’t use headphones while they listen to music can inflict upon your weary soul. It doesn’t even have to be verbal. The shared grimace and eye roll between me and the other woman who was inconvenienced by the oversize suitcase the man in Seat 3B tried to sneak past the flight attendant can feel better than a long hug. Complaining is a hot bath for your feelings.” Obviously she would not recommend anything close to repressing one’s feelings. In fact, she might consider ME’s outbursts about the townspeople very healthy for him. Not only that, but the occasional shared eye contact between ME and Morwenna or Louisa connects them in a somewhat intimate way.

That leads me to another article that recently appeared in the NYTimes. In this article the wife of a married couple, Peter Pearson and Ellyn Bader, who have established a couple’s therapy institute is quoted as saying,“he’s lots of things that my best friend isn’t, but my best friend is lots of things he’s not.” Her point is that having a close connection to one’s spouse does not satisfy all of our needs in terms of having someone to talk to and divulge intimate thoughts to. Sometimes those thoughts might be about one’s spouse! This pair also challenge “the notion that you shouldn’t get married to change someone.” ‘I think that’s what marriage is about,’ Dr. Bader says. ‘It’s where some of the juices come from, and it’s also how you get the best out of the person you marry.’ Of course we know that part of the reason ME and Louisa don’t have personal friends is the constraint of the show. Whereas they bring in all sorts of outsiders during each series, and in S8 we seem to have at least one new addition in each episode, most of these are “one and dones,” as they say. We will never see them again and they do not develop into anyone who becomes a confidant. Louisa has had Holly and Isobel, but they did more confiding in her than she did in them. Martin has had Roger Fenn and Chris Parsons very briefly and not often. With them he listens and rarely reveals much, especially after S1.

The change comments are interesting. We might argue with that position; however, there is certainly some indisputable validity to them. If we don’t acknowledge that we change throughout our marriage, we would be denying the truth, and I doubt any of us has never tried to change something about our spouse.

In regard to the notion of changing someone you love, there was another article in the NYTimes that engaged with that topic. They distill their argument by saying, “To make us feel loved and valued, our spouse must convey appreciation for the person we currently are. To help us grow, he or she must emphasize the discrepancy between that person and the person we can ideally become, typically by casting a sober, critical eye on our faults.” They admit that this balancing act is very demanding and hard to achieve yet extremely gratifying. Their examples appear to recognize that it usually falls to one spouse (or partner) to fulfill this task. In the case of ME and Louisa, we could say that ME is fairly comfortable in his role as GP and the sense of accomplishment it gives him and that it’s Louisa who is still searching to find that level of satisfaction both at home and at work. We might actually want to applaud ME for pushing Louisa to raise her competency both at home and at work, and even in her new endeavor to become a child therapist, if it weren’t for the fact that he rarely demonstrates any affection or loving support for her. He’s more in the territory of belittling her and showing off his own abilities and knowledge. She could use more expression of love and appreciation!

I am clearly always thinking about what we see in this show while I read the newspaper. These articles also appeal to me on a personal level. I’m interested to see what kind of reaction I get from all of you.

How’s the Therapy for You?

We have now come to the end of S7 on AcornTV, and that means I feel free to publish my thoughts on a number of things about it. Here is the first of several posts:

During the promotion for S7 marriage counseling/guidance was brought up as a key facet of how Martin and Louisa would be dealing with their marital problems. Since “Doc Martin” is a dramedy, we would be surprised if there were a lot of lengthy counseling scenes; however, in the operating room scene at the end of S6 we heard Martin tell Louisa that he needed help from her to become a better husband. Prior to that we heard Ruth tell Martin that if he wanted to get Louisa to return to him, he would have to work hard to change. It didn’t seem like too much of a leap to expect some real effort to use marriage guidance to improve their marriage.

We have been through 6 series that have contained many medical emergencies and lives saved. We’ve learned about a myriad of rare medical disorders and all have been treated properly by Martin Ellingham with an expertise that demonstrates his superior medical knowledge and skill. We would expect no less from any depiction of marriage counseling. Sadly, that is not what we get. The following is my view of the marriage counseling and where it disappoints. Whereas we can learn about how to diagnose and deal with a variety of medical conditions from watching this show, we should not accept what we see in S7 as a good representation of marriage therapy. (Abby and Santa, regular participants of this blog, reviewed what I wrote and provided me with feedback and their professional experience. Abby is a practicing therapist who sees married couples for counseling and Santa is a retired therapist. They have written some previous posts on psychological aspects of the show and its characters.) This post is intended to focus on the accuracy of the therapy sessions first. I will add a few thoughts on the purpose of the therapy scenes at the end. Please bear with me on this because it’s going to be a long post.

In series 7 each episode includes a brief look at therapy sessions. We have to keep in mind that what we are shown is only a couple of minutes of each therapy session that is scheduled for one hour. I would like to think that what they choose to show us is the most important exchange of each session, but no 2-5 minute interlude can give us a sufficient amount of information. We are left with many unknowns about the therapy. Nevertheless, I don’t think it’s fair to excuse the problems with how the therapy is depicted simply because of the brevity of what we’re shown.

Our first introduction to the therapist recommended by Ruth is that she conforms to how Ruth described her, i. e. she is a no nonsense, direct person who has set standards and practices and will not change them for anyone. She demands that Martin shut off his phone and leave it at the entrance to her office; she tells him that being late for any reason is unacceptable and could lead to a termination of their sessions; and she won’t be deterred from treating his problems by any questions he poses about her background and reason for being in Portwenn. She won’t allow him to usurp her role as leader in this setting. These rules seem a little too rigid because he is the only doctor in Portwenn. According to Abby, it would have been better for them to clarify what constitutes the kind of emergency that would be an acceptable reason for him to arrive late for a session. Dr. T wants him to make therapy a priority and the act of discussing this issue would be a good way to convey that message.

Her approach appears to work well with Martin and he exposes more of himself to her than we’ve heard him tell anyone else, including Louisa. He recognizes that due to his being an unwanted child he has an inability to form adult attachments; he exhibits poor communication skills; he has unrealistic expectations of others, and a blood phobia. Of course he’s done his homework and decided what her diagnosis will be, but she is quick to brush off his easy judgement and makes clear that therapy is not like surgery; it’s a process. Although Dr. T appreciates Martin’s effort to arrive at a diagnosis, she doesn’t dispute it. Abby notes that “the first order of business, other than taking a history, is to establish a therapeutic alliance.” We can now look forward to watching the process proceed. We have set before us a series of issues that Martin has delineated and that we would assume will be how Dr. Timoney will plan her therapy.

Dr. Timoney begins quite understandably with asking Martin what he is coming to her for. He tells her, after asking her about herself, that he wants his wife to return to him, that he wants her to be happy, and that he blames himself for her unhappiness. Dr. Timoney’s first command for Martin is she wants to meet Louisa. That seems reasonable since Louisa plays an important role in the direction of the therapy. On the other hand, Martin probably has no idea when Louisa will return and appears to have neglected to tell Dr. T that important fact. Fortuitously, Louisa returns soon after, and that night over dinner Martin has a chance to inform her that he’s been seeing a therapist and that she wants to meet Louisa. Luckily, Louisa agrees to meet Dr. T even though she has some reservations. She figures she’s going to shed some light on Martin’s problems for Dr. T. In other words, we start therapy on tenuous footing including that as far as we know Martin has only seen the therapist once prior to Louisa’s return, due to time constraints he needs her to agree to see Dr. T on the same night that they are reunited, and he tells her nothing about his session with Dr. T.

When Louisa meets Dr. T for the first time, we see her enter the building but it appears that we pick up the conversation sometime after it begins. By the time we are brought into the conversation, Louisa is in the act of explaining that Martin has a hard time expressing his feelings, although she’s sure he loves her. Louisa then makes some derogatory comments about Martin’s parents, all deserved. She is especially clear that Martin’s mother is very cold and that she can understand why Martin is emotionally repressed. When asked about her parents, Louisa identifies them as normal, but she does reveal that her Mom left home when she was 12 and that her father was incarcerated when she was a child.

Since the show has made a fairly consistent effort to inform us of the childhood traumas of both Martin and Louisa, we have been led to believe that these are critical to the formation of these two characters. We’ve met all four parents over the years and, through a dream sequence that Martin has one early morning after James has been born, and probably triggered by a butterfly crib mobile, we know that Martin has suffered from the harmful effects of a bad tempered father when he was young. We also know that he’s been punished by being locked in  a space under the stairs and by physical means, and that he wet his bed until he was 11. Thus, when the counseling sessions begin with Dr. T learning some intimate tidbits about their parents, we anticipate more inquiry into the parent/child dynamic. Childhood is when the most significant impact on our lives occurs and we deem it crucial to this couple. But that is not to be after all.  Dr. T does not pursue this line of analysis and we do not hear her ask much about their childhoods after this. At the very least a good therapist would have explored how these experiences may have negatively impacted how Martin and Louisa relate to each other. The best therapy would have delved into their childhoods and considered how these experiences shaped them.

Instead, even though Dr. T wonders whether there is some connection between how Louisa’s relationship with her father might correspond with how she deals with Martin, she decides that it would be best for them to enter couples therapy. There is no transition during which she looks into Martin’s individual concerns. Since he made the initial contact, she might have wanted to probe more deeply into Martin’s feelings about why things were difficult before Louisa left. What does that mean anyway? Moreover, we see Louisa immediately resist the notion of couples therapy. We also note that Louisa is not receptive to the suggestion that both parties may be in some way responsible for the problems. Nonetheless, Dr. T moves on with couples therapy without a second individual meeting with either of them. Once therapy transitions to couples counseling, the objective changes. In couples counseling it is the marriage that is effectively the client and not any individual. The mission is now to set goals for the marriage to reach a satisfactory level of success for this couple.

Our introduction to couples therapy with Martin and Louisa begins with E4. When we join the conversation, Martin and Louisa are already seated facing Dr. T and Martin appears to be answering a question about whether he thinks environment has a strong impact on personality development in children. For some reason he mentions that his parents would leave him with his aunt every summer as related in some way to his conclusion that environment is important. Once again, Dr. T does not follow up and asks nothing about his relationship with his aunt or about what visiting her might have meant to him. (From what we’ve seen, we would think that it was a very positive experience during which he received the love, affection, and acceptance he had been missing at home.) He has mentioned that he was an unwanted child, which is pretty significant, but has left out the abuse and neglect he suffered. Most therapists would have wanted to know what brought him to the conclusion that he was unwanted. But here Dr. T moves on to asking Louisa if she’s uncomfortable. (Abby writes that she would have asked Louisa what it was like for her to hear what Martin is revealing. She notes that “it is important to develop empathy between them” and that Dr. T’s question about Louisa looking uncomfortable could have been a good way to transition to this. Unfortunately there is no follow up that takes place.)

Both Martin and Louisa look uncomfortable, and the seat they are asked to use certainly seems very hard and stiff itself, but also they are estranged and have never been extremely prone to overt expressions of affection, especially in public. Martin asserts that he appreciates Louisa, which is more evidence of Martin trying to change and become more expressive. This leads to Dr. T asking whether Louisa considers Martin appreciative. She rightly says that to her he is usually quite nice but not so much to others. Dr. T appropriately cuts Louisa off once she gets going on listing all the things she finds troubling about Martin, and we get the impression that Louisa has a lot of pent up criticism about him. It may be a sign of Dr. T’s observational skills that she notices their self-containment and asks them to list three positives about each other. Louisa is able to produce three things fairly quickly, and they are telling in that they are rather impersonal: Martin is a good doctor, he dresses smartly, and he keeps the house tidy. This last item is strange to find on Louisa’s list because she usually isn’t so happy about it. Then it’s Martin’s turn and his list is much more personal: Louisa is a good and caring mother, she’s active, and she’s very beautiful. Their choices represent well what is important to each of them. For Louisa Martin’s outstanding medical ability has always been preeminent. She is also attracted to his outward appearance and professional attire. After that she seems to struggle for a third thing to add. For Martin Louisa’s interest in being a good mother is preeminent and why he has nothing to say about her achievements as headmistress. Being active matters to him on a health level, and we know he has considered her beautiful from the moment he first saw her. Louisa seems flattered despite the omission of her ability as a headmistress.

What follows is an assignment to hug three times a day and say something positive to each other every day. As I wrote in my post on Hugs and Kisses, this assignment makes sense because it asks them to add physical touching, and that can be extremely effective in bringing people closer. It also requires them to think of something they can say to each other that should be complimentary. It switches the emphasis away from the negative.

As always, we know that watching Martin and Louisa hug three times a day will be both amusing and endearing, and it is. This was precisely what I hoped therapy would do for the show and this couple. By the end of E4, we see a lot of progress even though Louisa still struggles to find something positive to say to Martin. Therapy is making a difference despite being relatively lacking in thoroughness.

E5 starts with Martin already having a bad day due to an unpleasant confrontation with a young girl and being shadowed by Buddy. They arrive a bit early for their therapy session and are seen waiting in their car by another patient, something they both appear to dislike. Dr. T asks about how the hugging assignment went and Louisa answers that Martin has trouble with spontaneity. Martin immediately accuses her of the same. But we are quickly off to Louisa asking about doing something with Martin’s blood phobia. Louisa has finally raised that condition with Dr. T.  because she would like to redirect therapy to make it about Martin. At this point, according to Abby, most therapists would acknowledge the importance of Martin’s haemophobia but make sure the hugging exercise wasn’t neglected. There was too much material involved with the hugging for the therapist to simply move on without spending more time on it. Dr. T can’t really address the haemophobia specifically with Martin if she is focusing on the marriage, but she suggests the blood phobia is connected to Martin’s desire to be in control, and despite his disagreement with that, she sticks to her analysis and gives them another assignment. (There is some dispute here about the origins of the haemophobia because we’ve heard Ruth tell Martin that this sort of phobia often has roots in childhood trauma. Abby would be inclined to agree with Ruth even though Martin certainly has control issues. As a person who needs to feel in control, Martin probably felt safe until the event that brought on the blood phobia took place. The onset of the phobia was enough to bring on significant anxiety and make him terrified. Since then, he has found a way to maintain control, but each time the phobia reappears, it reminds him that he isn’t in control and he is thrown into another state of fear.)

This time their assignment is for Louisa to take charge of an activity and Martin must do whatever she asks of him. The odd thing about this is that he’s trying to do even more than that already and has chosen to live in an unsavory place so that Louisa and James can stay at the surgery. He also offers to bathe James regularly and to take care of James when Janice is unavailable. He’s very cognizant of not impinging on Louisa’s privacy and treads lightly around her. But both Louisa and Martin agree to this assignment without objection either.

The picnic Louisa chooses as her activity is disrupted by Angela Sim having a mental breakdown at the beach and that breaks up the family occasion. On the other hand, Louisa is grateful that Martin was there to help Angela and the episode ends with both of them entering the surgery together, which should be a good sign. Then again, there is no mention of how that assignment went to our knowledge but we join the session near the end this time. (Abby finds this assignment strange because Dr. T should have noticed that both Louisa and Martin have control issues. Louisa has tried to take charge of most of the sessions. “If she gave them this assignment to show how Louisa sets Martin up, then why wasn’t the assignment explored the next session?  Why did you choose a picnic?  Is it something you thought Martin would like?  What food did you pack?  Were there things both of you like?  So much valuable material that could have been gleaned from a discussion like this.”)

Once again Dr. T decides to give them another assignment which entails going on a date together. Dr. T makes a valuable contribution when she comments that Louisa may equate love with being left alone, since her parents left her when she was a child, and now she has fallen in love with a man who she says she didn’t think would last in Portwenn. Her comment that Louisa sets Martin up for failure is also so that she can continue to be disappointed in him. Abby notes that Dr. T was planting seeds that she hoped would germinate either during therapy or afterwards. Each time in the world of Dr. T’s therapy, however, there is so little follow up that we can only be frustrated, and that shows poor practice methods.

It is here when Louisa admits that falling in love with Martin was not a conscious act in any way connected to how she might conceive of the emotion of love. Perhaps that is a nod to the incomprehensibility of choosing Martin as the man she wants to marry. We can’t explain what leads us to fall in love and love is rather mystifying. Again, as far as we can tell, Dr. T just leaves that hanging too.

Dr. T provides very few guidelines for the date so it’s particularly nice to see Martin bring flowers for Louisa, make reservations at the location where they first met and make special note of that. They have a slightly tense conversation about Louisa’s impression that Martin wouldn’t last 5 minutes in Portwenn. Then Martin brings up Danny and confronts Louisa about telling Danny about their private lives, but Louisa is honest in her answer and quick to apologize. For me her behavior is conciliatory and she hopes to have a nice dinner. The disruption comes when Louisa takes a call from Danny that causes her to feel compelled to leave. It is understandable that she would leave her phone on to be available for any calls about James, but she should never have accepted a call from Danny, and he should never have called her.

When Dr. T sees them next, Louisa describes the dinner date as a disaster, but that seems a pretty extreme appraisal. Again, Dr. T does not ask Martin to venture his own feelings. Martin’s anger at Louisa for divulging their marital problems to Danny is not similarly played out with Rachel. Time and again Dr. T allows Louisa to be the one to give her evaluation of each exercise with no effort to balance what she says with what Martin thinks. Quickly Dr. T comes to the conclusion that Martin and Louisa should make a list of what they like about being on their own, and tells them they should not consider a decision to separate as a failure. (Abby can’t help having a strong reaction to this procedure, and I decided to include it all: “This scene is so far from good practice that I cringe at the thought that people will think this is what therapy is.  First of all, she doesn’t explore why Louisa found that date to be a disaster.  ((Santa would add, “If there’s anything that’s not typical of therapy, it’s letting pass a pregnant comment that ‘it was a disaster.'”)) She didn’t elicit Martin’s view on the evening.  She didn’t explore the entire assignment:  How was the date arranged?  Who asked whom?  Did Martin pick her up?  How did that go?  What was the drive like?  Where did they go?  How did they feel sitting at the table with each other?  What did they talk about?  Where did the evening break down?  Was there a better way they could have handled it?  There was so much that could be gained from such a post mortem that it is frustrating for me to see it just dropped.  And then to suggest they think about the positives of being separated after such a short time leaves me just dumbfounded.  One might wonder if she was using reverse psychology here, but that would be a very dangerous game.”)

It is also very bad practice to have never explored the history of their relationship and the course of their short marriage. We have no evidence that she ever has tried to investigate these areas.

What we have then is several short-lived efforts to spend time together, hardly any review of what took place during those occasions, usually a willingness to hear only one person’s assessment of the assignment, and ultimately a suggestion that perhaps saving their marriage is not such a good idea, and that that would not be considered a failure.

The final time Martin and Louisa go out to see Dr. T takes place after Dr. T’s car accident and head injury. She acts very erratically and chooses an exercise for right there in her office. It seems a bit silly as she asks Martin and Louisa to march in place. We can no longer take her seriously as a therapist.

When we make a final survey of the therapy, it is hard to be very impressed by it. The length of time they spend going to therapy as a couple is probably 5 weeks. Over that period Dr. Timoney has learned that both Martin and Louisa had childhood experiences that were damaging and are likely to have caused some residual harm. In Louisa’s case she has concluded that Louisa interprets love as being intertwined with being cast aside; we don’t know how she looks at Martin’s childhood. What she thinks about Martin is that he likes to be in control. She notices that they are self-contained, at least around her. Hopefully she also realizes that Louisa has a good deal of bottled up anger toward Martin based on how easy it is for her to express criticism of him. She should also notice that Louisa is usually the first one to give her impression of how each assignment went, and that she often does not reciprocate Martin’s efforts to offer compliments. We see almost no follow-up after Louisa disparages each assignment, and there is very little probing of either Martin or Louisa. Without asking for more information, how can you trust that what’s reported is accurate? (I would argue that it isn’t accurate or reliable.) Needless to say, I would expect a therapist to inquire why Louisa is so angry at Martin and possibly elicit from them what it would take for her to be able to get over her strong vexation with him. It seems clear that Louisa is the barrier to any reconciliation. Furthermore, as Santa notes, “they were never coached in how to talk to each other, which I would think would almost immediately have been identified as a significant issue for them.” Martin has admitted to having poor communication skills. We know that this show is built on Martin and Louisa being unable to complete most conversations for many reasons. It would have made sense to address that.

There are many other problems with the therapy and its short term basis. Most therapy lasts for several months, not several weeks. The marital troubles have built up over a fairly long time and dealing with them cannot be expected to work so quickly. Certainly, any couples therapist would do her best to find a way to keep the couple together, especially since that is why they have engaged her. To give up and advise them to separate after such a limited time trying to help them, would be a sign that this therapist is lacking in proper skills and not gifted as advertised. Both Santa and Abby concur on this point.

(As often happens, I read an article in the NYTimes that seems pertinent and wanted to share it with you. It’s helpful that the article provides both sides of therapy and this therapist is loathe to end therapy when she feels there is still much to work on. Importantly, she notes her own failures in treating this patient and hopes to be given another chance to help. Unlike Dr. T, she does not tell the patient that she is an extremely challenging case and she never implies that the situation is hopeless. What Dr. T says is extremely unprofessional, according to both Abby and Santa. To quote Abby: “You do not tell a couple that they are the most challenging case you have ever come across, especially when the therapy has not been successful.  This is very blaming, and in a more sensitive client could induce shame.  It is important to end with something positive, if only with an invitation to return when and if the client feels the need to do so.” Santa adds: “We understand dramatically why she said it — to build suspense about whether they can reconcile — but it’s just dumb.” Having this doctor behave in an obviously grossly unprofessional manner and say something plainly stupid puts in question how Ruth portrayed her originally. Maybe this therapist wasn’t such a good choice after all.)

I would be remiss if I didn’t write anything about how the therapy sessions function as a plot driver. Anytime a particular activity is used repeatedly, it’s worth determining how it contributes to the plot. In this series each episode except for the first one begins with some interaction with Dr. Timoney; therefore, the therapy sessions are given some importance. The key role each session has is to tell us what the episode will be about;  it drives the action. Another way it operates is to get this couple into the car together and spending at least one uninterrupted hour together. On the other hand, the time spent in therapy substitutes for the more valuable use of time during which they could have talked to each other. Dr. T both creates a space where they can express themselves, something they have trouble doing, and interferes with their ability to relate. If she used the time wisely, she could lead to a greater closeness between them. Finally, like any other outsider, Dr. Timoney brings another character into the village and into Martin and Louisa’s lives. She challenges their preconceptions and unites them, even if it is at her expense.

Alternatively, Dr. T is unknown to the town until she crashes her car; Ruth knows of her but they don’t seem to have interacted much based on their coincidental meeting in the pharmacy in E7; and no one other than Morwenna and Ruth knows that Louisa and Martin are seeing her until she tells Sally after her head injury. This time the outsider stays one. Even her departing scene is exceptional because they make a joke of it, although at least they agree.

All in all, we are given a pretty dim view of therapy. Santa states, “As both Abby and I have said, therapy isn’t really all about the presentation of illuminating, penetrating insights by a therapist, but that is the impression that you get.” Indeed, therapy is depicted as unsuccessful and it is the random thoughts of a variety of characters, many of them dimwitted, who appear to be of more value. The art teacher tells her daughter she loves her as she is; Mrs. T makes a few pointed comments about marriage to ME; and Janice tells Louisa she knows Martin better than anyone. Finally, Mrs. Winton conveys the power of love and commitment despite being in a rather crazed state. The message seems to be to trust in the folksy wisdom of people around you rather than in professionals, a position we wouldn’t expect from a team that has been characterizing Martin, and some other doctors, as professional, highly knowledgeable and capable of saving lives.

(Oh, one last thing…we hear Martin advise patients to seek counseling several times throughout the show and that appears contradictory to how therapy has been handled in S7. What good is it to have someone evaluated if you have very little confidence in the process? I’m not sure what to make of that exactly, but his view that Mrs. Tishell would not have been released unless the professionals were sure that she was under control is certainly disproven. By the end of S7, Sally seems to have arrived at some place of acceptance that Clive is who she should be with, but she never stops stalking Martin and making inappropriate comments to him. The evidence against therapy is stronger than that in favor of it.)

 

Originally posted 2016-08-02 09:05:10.

Good Grief! Or Fear, Loss, and Time

Our blog supporter, Santa, has noticed that there is a significant theme of loss running through this show. I am embarrassed to admit that I hadn’t picked up on that, but now that she has mentioned it, I certainly can see much evidence of it. In the case of Doc Martin, we have to consider the amount of loss, with its concomitant sense of grief in all its forms, as one way it incentivizes us to sympathize with the main protagonist as well as others who experience loss in the show. Although we can identify many characters in this show as having experienced significant losses, I want to focus mostly on Martin Ellingham as a means of investigating how loss is both subliminally and overtly accentuated and most likely forms the basis for how viewers become dedicated to the show. The regular inclusion of the experience of loss impacts viewers emotionally such that they find themselves receptive to the relationship between Martin and Louisa as well as Martin and the town. (I think the idea of loss is cunningly used to also make viewers more likely to tolerate the behavior of other characters in the show too.) As caring people, we are inclined to pity characters who suffer in some way.

Once I started thinking about the occasions of loss in this show, I began to notice that each series contains at least one example of loss for Martin Ellingham. S1: ME arrives in Portwenn after losing his ability to perform surgery. At the same time he has lost his home and his daily routine. S2: ME thinks he has lost his chance to have a relationship with Louisa because Danny has displaced him. Then, when things seem to have gone his way and Danny leaves, he goes one step further and insults Louisa by accusing her of stalking him, curtailing the likelihood of being in a romantic liaison with her. His parents come to visit and he is forced to realize that they never wanted him and they have no respect for him. Therefore, he could be said to have lost any illusion that his parents care about him, although we know he continues to believe his childhood was fairly normal. S3: He subverts his date with Louisa and once again loses her. He manages to win her back, but the series ends with her telling him she doesn’t want to marry him after all and she departs for London. S4: He appears to have lost any chance at reuniting with Louisa, especially after she sees him with Edith when she first returns from London. He certainly loses his chance at a job as a surgeon in London by still being unprepared and by giving it low priority, and then because he changes his mind. S5: Joan dies and he loses the aunt he had a strong attachment to. Once again he loses whatever family harmony they had developed when Louisa leaves after he neglects to consult her one too many times. S6: He loses control over his blood phobia and his emotional stability, and he once again loses any close feelings he’s had with Louisa as he sinks into depression. S7: He loses his home and his hope for recuperating his marriage. His concern for Ruth and effort to prevent her from leaving by rushing to the train station shows how much she means to him and that her departure would mean another loss for him.

In general the losses he suffers are ones most associated with family, either his childhood and his interactions with his parents or the times when he tries to create a family of his own. We can even link his original onset of haemophobia and his consequent departure from surgery to family in that the reason he could not perform surgery was the realization that a family and a real person were involved. Edith and he had been engaged at one time only to have her terminate the relationship; now Louisa has become his love interest, but their efforts to connect are cut off over and over again. We could say that ME longs for the family he never had.

We can start with the loss of his childhood, which may have begun immediately after his birth. We know his mother rejected him at the outset, that he was treated harshly from an early age including punishment by being locked in small spaces, that he was sent away to school at age 6 3/4, and that he wet his pants until he was 11. We are pretty sure he got no affection from his parents, and Ruth has noted that he went from an active and engaging little boy until the age of 4 to a withdrawn and quiet young boy thereafter.

They’ve made so much of his childhood and his summer stays with Aunt Joan that we can hardly ignore their effort to make a connection between those circumstances and how he behaves as an adult. However, what seems to be at the core of all of these scenes during which we either see or hear about what went on in the Ellingham family is they were all fundamentally rejected by their parents. We especially gain some insight into Ruth’s childhood when she first tells Louisa that her childhood “gifted her with a chronic case of social awkwardness…distant mother, overbearing father, a succession of quasi-sexual encounters at a very young age” and a tendency to alienate or overshare. Later she mentions that she was never allowed to call her father “Daddy.” That must have been true for Joan and Christopher too. Furthermore, both Joan and Christopher have had troubled marriages. Joan went the route of an extramarital affair while Christopher simply spurned his wife. Among the three siblings, there is only one child, Martin. Kind of says a lot right there! On the other hand, if Martin had a cousin that would have complicated the story unnecessarily. This way we have parents who rejected him, an aunt who loved him but whose influence was limited due to his parents and their Victorian ideas, and another aunt who is equally unemotional and repressed as he is but can relate to him on a professional level. Later Ruth becomes more personal and more protective of him, but by then he is in his forties. Whatever contact he had with his extended family involved losses — loss of summers with Joan and lack of regular interaction with Ruth.

As a result of all of the information we’ve been given about Martin and the Ellingham family, I think we have to put some thought into how loss in this show is heavily placed on family and parental rejection. Therefore, rather than look at loss from the perspective of death, despite death being a factor here too, I want to introduce a different angle from all the theories related to death and dying.

The theory that has really intrigued me is that of Ronald P. Rohner, professor Emeritus of Family Studies and Anthropology at the University of Connecticut. He has developed the PARENTAL ACCEPTANCE-REJECTION THEORY or PART which grew out of cross-cultural studies he’s done to determine how children cope with parental rejection. In an article entitled “Introduction to IPARTheory,” several pertinent statements stand out beginning with “many rejected persons close off emotionally in an effort to protect themselves from the hurt of further rejection. That is, they become less emotionally responsive. In so doing they often have problems being able or willing to express love and in knowing how to or even being capable of accepting it from others.” We have certainly seen ME protect himself by using distancing methods like medical speak or inappropriate comments. He rarely leaves himself open to accepting expressions of concern or love from others. Aunt Joan can grab a hug now and then, but Martin is usually very uncomfortable with it. And any time Louisa tries to demonstrate her feelings for him, he is quite edgy or embarrassed. (As always I want to remember that much of his behavior is meant to be funny, and it makes us laugh to hear him make remarks that are clearly so off-putting. Here I’m just trying to apply some rational thinking to it as well.)

The article also notes that “insofar as children and adults feel their attachment figures don’t love them, they are likely to feel they are unlovable, perhaps unworthy of being loved.” In addition, this research asserts that “rejected individuals develop a fear of intimacy.” This exact sentiment seems to get played out when Martin is told by Ruth that he doesn’t think he deserves Louisa and when Martin is unable to confide in Louisa. (Adult attachment figures are usually romantic relationships. In 1987, “Hazan and Shaver argued that adult romantic relationships, like infant-caregiver relationships, are attachments, and that romantic love is a property of the attachment behavioral system, as well as the motivational systems that give rise to caregiving and sexuality.” (A Brief Overview of Adult Attachment Theory and Research by R. Chris Fraley | University of Illinois))

Martin seems to have carried over his childhood attachment issues into adulthood, which is not always likely to happen. Studies also quoted in the above overview note “attachment styles in the child-parent domain and attachment styles in the romantic relationship domain are only moderately related at best.” I cannot expect that the writers of this show would have looked up any of this and simply may have made an educated guess that Martin’s experiences in childhood would lead to having problems with attachment in adulthood. Regardless of the exact conditions, Martin and Louisa’s rocky love life is connected to their childhoods and their relationships with their parents. The loss and recovery dynamic they go through time and again could easily be associated with their latent insecurities due to their perceived rejection during their childhoods.

That the Doc Martin writers, et. al. planned for the members of the Ellingham family to show signs of suffering from these sorts of repercussions is unlikely; however, we can retrospectively observe how some of their behavior fits the theory. (My personal position is that much of the development of these characters comes post-hoc. They started with the irony of a surgeon who can’t perform surgery due to the sudden onset of a blood phobia, and who moves to Portwenn to be near his aunt with whom he spent several nice summers, and who is skittish about fitting in. After the first series, they realized his behavior needed some sort of origin and bringing in the family would add conflict as well as more sympathy for him.)

All of the older Ellingham generation show different levels of coping skills. Martin’s behavior has some signs of Asperger’s, but PARTheory points out an alternative diagnosis: reaction to being rejected. More than anything, however, the Ellinghams are a family in which loss plays a significant role and they have compounded the losses encountered by Christopher, Joan, and Ruth by passing those on to Martin. The family heritage is filled with doctors along with emotionless misfits.

Martin does suffer some loss through death too. The biggest blow would have been from Joan’s sudden death. He may try to comfort himself by judging her age as within expectations for lifespan, but she was the only source of affection for him apart from Louisa. Although she is replaced by Aunt Ruth fairly quickly, Joan had been the one member of his family who had had some history with him. Her death leaves him more than ever in search of a family circle. It isn’t long before he abruptly learns about his father’s death. In both cases, Martin is given no time to adjust to the news. The loss of his father intensifies the loss of control he feels from the return of his haemophobia and he retreats even farther into his protective cocoon. Nevertheless, even when he is in the doldrums in S6, he considers his family to consist of his wife, his son, and Ruth. That he essentially chases Louisa away and finds himself alone again after she leaves for Spain with James, accentuates the losses he has engendered in his life.

Whenever there is loss, it is usually accompanied by grief, or a grieving process. The stoic in Martin Ellingham never exhibits much behavior associated with grief with the exception of the scene following the concert date when Louisa decides to end their dating, and some scenes in S6, e.g. when he sits in the car with James while Louisa is in the hospital and again when he becomes tearful after the operation on Louisa. In those two occasions his emotions get the better of him and we are intended to empathize with the pain he experiences from knowing that he has come close to losing Louisa. The sight of ME struggling with his feelings pulls at our heartstrings, and it may be the best reason to have taken such a dramatic turn in S6.

I have already mentioned Elisabeth Kübler-Ross and her 5 stages of grief in a previous post. She expressed her theory in 1969 in her book On Death and Dying. The five stages are: Denial, Anger, Bargaining, Depression, and Acceptance. These stages are self-explanatory I think, and we should keep in mind that not everyone goes through each stage and the stages may be experienced in a different order. They were primarily developed for people who had been given a diagnosis of a terminal illness. Her theory has been supported by other studies, but, not surprisingly, there also have been studies that have modified it or come to other conclusions. George Bonanno argues there are four trajectories of grief: resilience, recovery, chronic dysfunction, delayed grief or trauma. And Susan Berger, Ed.D., LICSW, has identified 5 ways we grieve. In her model there are nomads, memorialists, normalizers, activists and seekers. I think both of these theories can add dimension to our basic understanding of grief.

Bonanno, a professor of clinical psychology at Teachers College, Columbia University, did his work in the early 2000s. He’s credited with using scientific studies to support his theories and with replacing older notions about grief with the demonstration that most people exhibit a lot of resilience following a loss. Resilience surfaces even when people face extreme stressors or losses, which contradicts the stages model of grief. His article “Loss, Trauma, and Human Resilience” explains his theory.

Following the loss of control over his haemophobia, Martin’s ability to handle the arrival of his mother is compromised. Her news of his father’s death, and her imposition on their home life, are rather traumatic. Due to the adjustments Martin has had to make to having a wife and child, perhaps his depression is more like PTSD and that’s why it doesn’t last into S7. (Admittedly, I am groping here, but it’s fun to speculate.)

Berger notes that most people fall into the category of nomads, and Martin could easily fit into that group. We could also make a case for him as a “normalizer.” He doesn’t have many friends, but he has decided to emphasize family first and then the community, mostly consisting of Morwenna, and possibly Penhale and Mrs. Tishell. They all contribute to returning his life to its former state.

Other losses registered in this show are:

  • Louisa essentially has lost her mother and father during childhood. She has lost her job in Portwenn and in London. She has felt the loss of having the occasional closeness she has gotten from Martin. So many times he’s told her he can’t bear to live without her, he loves her and will always love her, he thinks she’s beautiful and a caring mother, etc. However, he has also shut her out time and again, treated her disrespectfully, and embarrassed her in front of others. He’s also shunned many of her efforts to be affectionate. She can’t help but be confused and disoriented by his erratic behavior towards her.
  • Joan has lost her association with Martin when he was a child. She’s lost her husband and her relationship with her brother is very strained. She is on the verge of losing her farm and possibly her car/driving privileges. The loss of her farm would be devastating to her. Some of her friends have died and her lover, John Slater, is terminally ill. She’s a fighter, but her life has been very tough.
  • Ruth has never had much of a family life and her attachments to siblings appears fragile. Moving to Portwenn has meant losing her life in London and her professional interactions. At least she takes trips back to London to refresh herself from time to time. She has probably gained a few things too. She has never had as close a relationship with a relative until she establishes herself near Martin, and this has led to becoming close to Louisa and others in the town. But her constant refrain is that she isn’t ready to stop working, and continuing to work now means traveling. By the end of S7, we see a Ruth who may be thinking of being more active at the B&B rather than attending more conferences.
  • Bert has lost his wife and then his fiancée, and now he’s lost his home. He flits from job to job with little attachment to any of them — perhaps until this new plan of making whiskey. His most recent venture, the restaurant, has had many ups and downs until failure finally overtakes it.
  • Mrs. Tishell has lost her dignity and her mind. Her husband’s long absences mean that she is alone much of the time and she doesn’t seem to have any friends.
  • Al struggles to find his way. He’s lost his mother, although his father did a good job of filling that void. He’s abandoned many ideas and he’s lost in love. He may now have lost his independence from his father.
  • Penhale has lost his wife, his brother, and has a lonely existence. This new attraction to Janice seems pretty pathetic and destined to go nowhere. Once we hear that she’s been married 3 times at such a young age, we can’t expect anything reliable to come of her potential romance with Joe.
  • Many townspeople have lost much. There are many broken families, and several have had deaths in their families.

All in all, for a comedy/dramedy, we have a lot of loss in this show. It’s fascinating to consider how they have managed to make us laugh while depicting characters with so much deprivation. It does make for a show with an undercurrent of misfortune that I would speculate causes viewers to feel closer to the characters. At the same time, the tribulations are varied enough and often arise from such zany circumstances that we can’t help but find them funny. Bert’s restaurant certainly made me think twice before eating out!!

 

 

 

Originally posted 2016-03-18 16:10:42.

Professional Opinion v. Folk Wisdom

After writing so much about the poor representation of professional therapy in S7, I want to say something about how Doc Martin weighs in on the reliability of professional advice as opposed to that of all sorts of other people in Portwenn. Part of the problem with making such distinctions is that there could be many reasons why those decisions were made by the powers that be. I think that one very likely reason is that Martin Ellingham’s skills need to be differentiated from the other professionals. His medical knowledge is supposed to appear superior to any other doctor or nurse.  As a result we see him berate and humiliate other doctors and nurses. One reason we may see various residents of Portwenn make comments to him (and Louisa) is that small towns are like that. His neighbors can hear the baby cry or they quickly know about any altercation. Many times Louisa finds out about something Martin did by hearing from someone in town. He’s a prominent person in the town and eventually becomes a part of life in Portwenn. The townspeople begin to offer unsolicited advice as a way to reassure him even when they ought to be aware that he won’t be very appreciative of it. Indeed, that adds to the humor — his general irritation with anyone giving him advice is only further evidence that he is abrasive and unwelcoming. So, we recognize how the advice coming from either professionals or non-professionals works as an integral part of the character development and plot. On the other hand, the preponderance of examples of really clumsy, deficient, and blundering professionals seems to me to demonstrate a bias against professionals. Meanwhile, the number of times we can point to when non-professionals provide insightful and meaningful counseling also gives us pause and makes us wonder if the position of the show is that professionals are suspect and should rarely be respected, and regular folks, the uneducated but replete with life experience types, are the ones to listen to.

The show has included a fairly large number of medical professionals throughout the years, and when you look at them, most are quite incompetent. Among the doctors who can be listed as questionable are Adrian Pitts (S1), Dr. Milligan (S4), Diana Dibbs (S5), Colin Westmore (S6), and the doctor who treats Louisa after her car accident (S6). Adrian is the pits with an even worse bedside manner and attitude than Doc Martin and an insulting treatment of his female coworkers. Dr. Milligan (who may be either a psychiatrist or a psychologist) seems lost and has transgressed patient confidentiality by talking to Edith about Martin and admitting to accepting her suggestions. Diana Dibbs is clearly an anxious mess who abuses drugs, unethically shares her drugs with patients, writes prescriptions without proper examinations, and doesn’t realize she has Cushing’s disease. Colin Westmore is obviously out of his league and much too novice and hesitant for anyone to have confidence in his abilities as a surgeon. The doctor with no name who treats Louisa has neglected to check her adequately and is unaware that she has a DVT, which can be life threatening. (Dr. Timoney in S7 is definitely not a medical doctor; however, like Dr. Milligan, she is quite lacking in therapeutic skills and struggles to deal with marital problems. She eventually divulges confidential information and acts unstable.)

We should put Edith in this category as well because as much as she appears knowledgable about her field, she misses the diagnosis of diverticulitis and would have rushed into unnecessary surgery with little compunction. As we’ve discussed in previous posts, she also unethically asks Louisa about her sex life when gestation age is determined by a woman’s last menstrual period not when she last had sex. In fact, her sleazy demeanor while undermining Louisa to Martin makes her appear petty and disturbingly unscrupulous.

Then there are the other professionals, e.g. the Vicar, the Constable, the Chemist, and the Doctor’s Friend. Most of these are also depicted as compromised in some way. I appreciate the humor, of course, but still it’s hard to overlook the general tendency to denigrate the professionals. The Vicar is a drunkard, both Constables have major hangups: Mark is very insecure while Joe has been phobic and is buffoonish, the Chemist has her Martin obsession and medicates herself to the point of psychosis, and the Doctor’s Friend…well, he’s about as unctuous and repellent as possible. Louisa easily catches him distorting his negative appraisal of Martin with opinions from suspect residents of Portwenn.

In addition, we are presented with a group who we could consider professional, but who occupy a sort of grey area between actual professionals in their fields and pseudo-medical professionals. This list includes people like Sandra Mylow, the Herbalist, Anthony Oakwood, a research psychologist, Janet Sawle, a scientist, Molly O’Brien, the midwife, and Angela Sim, the veterinarian. They are in fields related to medicine and consider themselves qualified to make medical recommendations; however, we find their training and expertise lacking. Sandra earns Martin’s disdain when she willingly provides potions for people she’s never met, not to mention the fact that he considers her type of medical care akin to trickery. Anthony Oakwood is arrogant and his study of psychology is belittled when he excuses his son’s behavior with the jargon of a researcher rather than a parent. He’s the stereotype of a pedant and stunningly out of touch with reality. (We might have thought Martin’s tendency to be engrossed in medical journals and medical terminology could have ended up giving them something in common, but Martin has no respect for this egotistical Ph.D.) Janet Sawle is presented as a mad scientist concocting who knows what in her basement, and Molly O’Brien takes extreme positions about women’s health. Once again she’s a caricature of a midwife with few redeeming characteristics. It doesn’t take long for Louisa to dispense with her once she needs real medical care for a UTI. (There was a point during this scene when I thought “they” were making fun of the serious scenes between Martin and Julie Graham when Julie plays a midwife in William and Mary and gives birth to her baby in a birthing tub.) And, finally, who can take a homeopathic veterinarian seriously? Not only is it patently absurd that anyone can understand dogs by running their hands over their bodies and sensing a deep connection with them, but also she medicates herself with dog medication and becomes hallucinatory. I guess we could say she learned her approach to medicine from her father, who, by the way, is also remembered as mostly incompetent. His best treatment plan was giving Stewart placebos for his PTSD.

All of the above might be considered credentialed in some form and, therefore, people from whom we might expect unsolicited advice. Oddly enough, however, there isn’t much worthwhile advice emanating from the professionals listed above. For the most part the doctors with whom Martin interacts need his advice and have nothing much to say that might help him. The two medical doctors who stand out from this crowd of relative losers are Edith and Ruth. Edith focuses on Martin’s blood phobia and seems determined to rid him of it so that he can move back to London. Her motive Is mostly selfish because she wants to reignite a romance with him; nevertheless, she is helpful in confronting the phobia. What she suggests doesn’t work, but at least she gives it a whirl. She also tries to discourage Martin from losing heart about leaving Portwenn by telling him he’ll feel much better once he gets to London. (Of course this takes place after he has been pretty forthright about not wanting to be with her and she is unwilling to accept that.) Ruth is another matter. As both an aunt and a doctor, she tries to balance her medical advice with personal concern for him. She seems unconvinced at first that marriage is a good choice, although she does what she can to get the marriage off to a good start. She recommends seeking therapy to conquer his blood phobia in S6, does her best to get rid of Margaret, who she knows could only be there to cause trouble, and she continually tries to smooth things with Louisa. In S7 she finds a therapist she believes will be a good fit for him, convinces Louisa to participate in the therapy sessions, and checks in from time to time to see how he’s doing.  Of the medical professionals, she is the only one who offers useful advice even if we later decide that her suggestion of Dr. Timoney turns out to be a bust. Although she says a few contradictory things about whether people can change, I think her best advice comes when Martin is desperate for some guidance after Louisa leaves for Spain. Ruth first asks him if he wants to be with Louisa and then answers his affirmative response by telling him he must change and that he will find that harder to do than most. (Ruth gives others some good advice too. She tells Penhale he can attract more friends by being more complimentary; she tells Al to write his own story and stop delaying; and she tells Margaret to leave Martin alone.)

On the other hand, all of the aforementioned pseudo medical professionals have no qualms about giving advice to Martin. Sandra tells him he should consider doing more for his patients than prescribing medicine. Janet Sawle is suspicious of modern medicines and too many antibiotics, although her reservations are complicated by the uneasy relationship she has with her ailing sister. Molly O’Brien expresses popular concerns to Louisa about the overbearing demands of too many male doctors on their female patients and the hazards of using too many antibiotics. Naturally, her advice to ignore Martin’s recommendation to take antibiotics for Louisa’s UTI backfires and Louisa spikes a fever. (Both the Sawle case and Louisa’s condition point out that the fear of antibiotic resistance is sometimes carried to extremes and there are times when antibiotics are necessary.) Moreover, Molly’s portrayal of women being victimized by their male physicians is particularly offensive to Louisa. She considers herself well equipped to handle Martin and her life. Angela Sim’s advice to Martin mostly arrives through the vehicle of Buddy who she channels as if she is a dog psychic. She tells Martin he and Buddy have unresolved issues. In a scene reminiscent of the one with Sandra Mylow in S2, she also tells him he’s small minded because he can’t think outside the box of routine medical treatments. Later she tells him that “Buddy knows how lonely and unhappy you are, and he wants to help you. You must let him into your life. You need Buddy. You need to accept him.” At this point she starts to appear off-kilter, which could be construed as undercutting her advice. While she’s right that Martin is lonely and unhappy and needs help, hearing that from a dubious source will not have much of an impact on Martin.

But what happens throughout each series is many occasions when we have non-professionals who have no hesitation offering their opinions and advice to either Louisa or Martin. These include relatives, employees, patients, and so-called friends. Some stray townspeople jump into the advice business from time to time as well. Top on the list of non-professionals who have their own notions of what Martin should do is Louisa. Aunt Joan never holds back either. Bert can say some remarkably insightful things. Al, all the receptionists, Roger Fenn, John Slater, Muriel Steel, Danny, both Eleanor and Margaret, Mark Mylow, Peter Cronk, William Newcross, Wallace Flynt all give advice at some point. Even the fish monger, neighbor Mike Chubb, the dry cleaner, and caravan owner Bellamy take a turn. We can’t leave out Pippa, Erica Holbrook and Annie Winton either. In fact, the American Tourist has some words of advice for Martin before she leaves.

Louisa’s advice starts at the intake interview to determine whether they should hire Martin Ellingham as the next GP in Portwenn. Before the interview ends, she warns Martin that the Portwenn community prefers a doctor with a good bedside manner and she will be keeping an eye on him. Along the way she encourages him to have a laugh, to be friendlier to Mark Mylow, more talkative, less smarmy, more proactive, and to say something nice to her from time to time. She also wants him to be more involved with James, more interested in participating in her activities, and more sensitive to his family members, e.g. Ruth’s birthday or Margaret’s visit. Her best advice, in my opinion, is that sometimes people are different and that’s what makes us love them. I also like her advice to Martin when he’s planning to turn in Peter Cronk in S7. She becomes the Louisa we’ve known before and wants Martin to consider the impact Peter’s mistakes have already had on him before bringing in someone who follows the rules so strictly as Penhale often does.

Joan is filled with ideas of how Martin should behave. She’s happy to have him living nearby, but still seems to treat him as if he’s a young boy in her care. Since she’s the mother he never had, he allows her a certain latitude that others don’t have. Therefore, he accepts her criticism, judgements, and encouragement along with her casseroles. She wants him to pursue Louisa only to reach the conclusion that they are “chalk and cheese” and can never get along together. Later, when she finds out Louisa is pregnant and Martin is the father, she expects him to take an active role during the pregnancy despite any resistance from Louisa. She also tells him to remain a part of James’ life even if he leaves for London as planned. And during the broadcast of Louisa’s labor and delivery, it’s Joan who cheers him on to express his love for Louisa. She is disappointed in him when he takes too harsh a stand with patients and uses sarcasm on occasion to correct him when she thinks his behavior is out of line, for example when Helen Pratt dies or when Muriel Steel acts demented or when he insults her friend who caters the concert. Joan is by far the most outspoken of his relatives and quick to comfort him as well as to upbraid him. She certainly makes him think about what his next step should be. Her best advice in my book is telling him a child needs a father even if that father is far away. (Joan gives Al great advice too when he’s troubled by whether Bert is his biological father. She reminds Al that Bert has devoted his life to taking care of Al and whether he’s his biological father or not should not matter. We can speculate all we want about why they have Joan give such insightful comments about fathers — her father was awful, her brother is a rotten father, and she is a woman with a big heart — but her advice sets these two men straight.)

Amongst the best advice on the show for me is that given by Bert in S1E1 when he tells Martin “You need patients and we need a doc. Now we don’t all have to love one another, do we?” That comment makes Martin stop and think, and he changes his mind about leaving. Martin learns about the aged when he takes care of Muriel Steel. She dislikes his condescending manner, puts him in his place, and then comes around to realizing that being at a senior citizens facility is actually quite pleasant. Simultaneously, Joan suggests to Martin that it was her fears that had prompted Muriel’s hesitations about moving, and he seems to learn a lot about growing old. I really like Mark Mylow’s comments when his sister is visiting about being stuck dealing with people we don’t like because they are family. I also enjoy the advice Martin hears from the fish monger after Louisa has left him in S5: “No shame in cooking for one…Nobody cares about me. I might as well sit around all day in my “Y” fronts…You just hang on in there Doc. What’s for you won’t go by you.” Again, Martin gives that some thought.

The conversation Martin overhears between Pauline and Al about another couple that “he’s too shy; he’s always waiting for the girl to make the move. He’s always waiting for permission, and when you give him permission, he messes up” functions as advice and leads to Martin changing course with Louisa.

What are we to make of all these sources of advice throughout the show and their place in the storyline? Can we simply dismiss as humorous and irritating the many times when all sorts of people suggest some lesson to be learned to Martin? There are obvious pearls of wisdom mixed in with the random comments we hear. Roger Fenn tells Martin that becoming a parent introduces one to a whole new kind of love; and Erica Holbrook shows him that mothers can adapt and accept their children as they are. Mr. and Mrs. McLynn, Clive and Sally Tishell, and Jim and Annie Winton give us a few good thoughts on commitment and love. When we look back over the 7 series, it’s hard not to come to the conclusion that they are making the point that each of us have life experiences that teach us more than any insights we can learn from professionals. After surveying the characters from all 7 series, the evidence seems pretty clear that the doctors come out badly. With the exception of Martin and Ruth Ellingham, the doctors give deficient to awful advice, have generally terrible attitudes towards their patients, and are treated as inexperienced and often poorly trained.

Expert advice isn’t always reliable and over time the experts reassess and may change their positions. However, if the expert advice tends to be given by inferior figures, we can’t really consider that a fair representation. Homespun wisdom isn’t always wrong either, but I balk at a 26 year old woman who has been married 3 times already guiding Louisa in any way. It’s funny, but once again undercuts the show’s generally positive appraisal of lay people’s advice.

If nothing else, this exercise has given me a reason to recap some of my favorite dialogue. I’m sure I’ve missed some of the moments you’ve liked the most. I look forward to hearing from you on this topic.

Originally posted 2016-03-03 18:12:38.

Another Take on Introversion

Well, not many of you were very interested in contributing to my post on Depression, but that isn’t going to stop me from taking another stab at Introversion!

So today, as happens on many Sundays, I was reading the NYTimes and saw an article of interest. This article is one I enjoyed because of its new twist on another subject we’ve been writing about for some time, introversion. The author, a columnist and contributing editor from the Greater Boston Area, considers whether using the excuse of being an introvert is really just a rationalization for simply being rude. I particularly liked the part where she notes:
“Society has a rich history of people seizing on social evolution as an excuse for bad manners. From the Romantic poets to the transcendentalists to the Summer of Love hippies, many have rejected a supposed facade of good behavior in favor of being true to their inner nature. Good manners are mere mannerisms, the argument goes, which serve only to put barriers in the way of deeper connections.”

One reason I like this part is because she references the Romantic poets, many of whom wrote about sitting around, like Coleridge, under Lime Trees thinking about life, or transcendentalists like Henry David Thoreau, who took himself into the woods to think about life, and then there are the hippies who also liked to muse about life while being one with nature. All of the above indulged in high minded philosophical ideas by withdrawing from society, believing they had reached a more astute concept of our world. In other words, they had pretty good impressions of themselves as a result of coming to the conclusion that social interaction, and following social mores, was accepting the dictates of others rather than being true to themselves.

In a later paragraph, the author takes a somewhat critical view of introverts when she says: “self-indulgent introverts [risk] crossing the line into antisocial behavior.” Since we’ve spent so much time determining what it means to be an introvert, and learning how all personality types fall on a spectrum or continuum, I find her identification of introverts as self-indulgent a form of indictment. Nevertheless, there’s no doubt that they can be perceived as antisocial. It means something that some synonyms for antisocial includes terms like unfriendly, reclusive, standoffish, and even sociopathic.

We need to draw a distinction between the personality trait of introversion and being labeled as antisocial. However, there is a hazard that what is a personality trait to one person could appear to be acting unfriendly to another.

For a simple explanation of how some introverts function, I found this site helpful. There is something identified as Introversion.

And now we have the case of Martin Ellingham. There are signs that he falls somewhere on the Introversion scale. Similarly, there are signs that he is also rude and antisocial. We know he likes to withdraw into his house to read and work on clocks; but we also know he is willing to go to parties or out for a drink or dinner if the right person asks him (namely either Louisa or one of his aunts).

Finally, Dell’Antonia takes up the notion of control or self-determination, another one of our favorite subjects, when she states:
“I may be naturally reserved, and more comfortable alone than I will ever be in a crowd, but I am not at the mercy of my nature. There are many excuses for failing to conduct ourselves with courtesy, for avoiding gatherings and conversations we don’t think we will enjoy, or for just putting on our pajamas and staying home. Too many of them boil down to just that one thing: We care more about ourselves than about the needs of others.”

Maybe she’s right…some of us may be hiding behind the guise of introversion when we are really more concerned about ourselves than others. Perhaps introverts should force themselves to join in more, and perhaps they would like it if they did.

There is an aspect of ME that falls under the category of self-aggrandizement. He thinks he’s better than the idiots and ignoramuses living in Portwenn, and he feels perfectly justified telling them so. We laugh when he tells someone they would be stupid not to listen to his advice (or have been), but it is offensive at the same time. When they frequently call him a “tosser,” they are literally telling him he is being selfish and inconsiderate. Is that the writers telling us this character is simply rude? I mean, we have to be honest and admit that he crosses the line fairly often.

What do you think about this view of introversion? If there are still psychologists and social workers reading this blog, please let us know what your reaction is. (I know, I’m deliberately nudging you to respond. Still, I am interested.)

Originally posted 2016-09-25 15:29:48.

Aliens

S7E7 includes an invasion of outsiders to Portwenn. There’s Erica Holbrooke and daughter Bernadette, the new art teacher and her daughter; Inspector Salter looking to switch Penhale to a new, larger location; the American tourist who’s played by Sigourney Weaver, alien extraordinaire; the Wintons, whom we’ve never seen before, and intrude into Martin’s space; and, most importantly, Dr. Rachel Timoney, who previously has never shown her face in the village. (Perhaps all of her patients have been word of mouth.) Each of these newcomers disrupts the normal order of things, and that’s the point.

What is an alien but someone who is not normally seen in a certain setting. And this episode spends a significant amount of time asking us to think about the concept of normality. To a great extent normal is defined by what’s abnormal in regards to where we are situated, and the definition is constantly changing. When Louisa asks Dr. T if struggling is a normal part of the process, Dr. T answers “normal is a loaded word” and that is an understatement. Each community has its own norms, and every social setting does too.  Dr. T might have answered that many, if not most, couples go through various trials before they arrive at a place where they are comfortable with where their marriage is. Therefore, it is normal to struggle for a time. Instead she makes a point of mentioning that the term “normal” has strong emotional implications. Moreover, in “Doc Martin” normal is a loaded word due to the many quirky people we’ve come across, not the least of whom is Martin Ellingham.

In this show, we have accepted that Martin is different, or not normal by the standards used by most of us. He is rude, abrasive, and confrontational to most people. He has a tendency to say what’s on his mind no matter what the setting, which means he has no concern about insulting people. If he’s served canapés, he sees no reason not to note that they are “salmonella en croute,” and when Bernadette is practicing the violin, he gives a blunt appraisal of her ability, which is that listening to her play is excruciating and what she’s playing is not music. We have come to expect Martin not to conform to how most of us have been taught to behave, and we usually enjoy his peccadilloes.

Because his alternative behavior can offend Louisa, he has tried at times to modify his behavior, but he’s typically unsuccessful at doing that. Furthermore, she notices when he’s being artificially nice and finds it transparent and unnatural. In this series, he’s once again doing his best to show Louisa how much effort he’s making to accommodate her. So far his adjustments have done very little to convince her that they should reconcile, and we can see that he is troubled by this. It’s possible that he thought she would come around much sooner once she noticed his determination to set things right, but she is being steadfast in her decision to take her time before yielding. In E7 she once again sends him on his way without so much as a nod to his routine of putting James Henry to bed at night.

Besides Martin both Bernadette and Penhale are identified as different, or abnormal. Bernie’s mother considers her gifted in many areas and has separated her from her peers. Erica is prone to actively pursuing the unusual and her art classes reflect that. Louisa wants her to have the kids do “normal” art like landscapes and drawings of rainbows while Erica asks the students to “confront who we are as people” and express their true selves by mounting their beloved stuffed animals and dolls on a display board. She upsets the children and her daughter by imposing an exercise on them and asking them to give up what comforts them. It seems they all have formed attachments to comforting objects and, therefore, it is “normal” for them to hate being separated from them.

Penhale stands out from the norm because Portwenn has been crime free while he’s been on duty. We know that he has done very little to produce that outcome, and, if anything, he’s wanted something criminal to take place under his watch, but his record looks outlandishly perfect to his superiors. Would he be able to reproduce that outcome if he were to move to the larger city of Exeter? Our suspicion is no. His unusual results are based on the size and character of Portwenn and not on his expertise.

Nevertheless, Inspector Salter notes that the men on the 5th floor want to know who is 3021. And Erica wants to know who these children are. And Martin and Louisa want to know who they are and how they can reconnect. Even Bert wants to find his true identity.

Of course, our American tourist is out of place in Portwenn. She also adds to her alien nature by being manipulative, demanding, and too convinced of her own knowledge. She is impatient and wants her glaucoma drops immediately, then she questions Martin’s decision to examine her only to find out that her doctor prescribed the wrong medicine for someone with her symptoms. Even as a patient she’s different. Her decision to give Morwenna a book about being assertive as a woman reflects her own behavior and can be seen as an effort to change Morwenna.

The fact that there is no real “normal,” begs the question of how to judge what we should change. Not only does our concept of normality change, but also we need to know ourselves, as Erica implies. We need to revisit the idea of whether people can change, but for now, a hint about that is the words that are printed on the art class board: “We Are What We Are.”

The other thing I would say about this episode is that its title, “Facta Non Verba,” is, to me, hard to apply to this episode. Translated from the latin this phrase means “Deeds not Words” or can be interpreted as “Actions Speak Louder Than Words.” But, instead, this episode elevates words to a status above actions, and much of the episode accentuates the importance of words. During the opening therapy session Dr. T asks Martin and Louisa to create lists, to write down what they consider good about being apart. Later she tells Martin that it is the act of thinking and writing the lists that is important. Their final interaction with her has them engaging in wordplay with Dr. T writing down the words they suggest. She also tells them that she’s both “all” and “right.” Isn’t this another reference to how we use these words, and to the ambiguity of words?

At the pharmacy Dr. T loses track of what she’s saying and she calls Ruth senile. Ruth corrects her, telling her she’s not senile, and we can probably guess that Rachel really meant to use a different word, perhaps senior. Rachel also has a fairly nonsensical talk with Penhale whose closing remarks are that her words have helped him by giving him someone who can relate to what he’s feeling. Words can have a powerful impact.

Finally I think it’s worth looking at the lyrics of “Should I Stay or Should I Go,” the song mentioned by Penhale while talking to Martin about whether he should take the job offer in Exeter. (As an aside, this song was written by The Clash, a punk rock band from the late 70s, early 80s.) The words sung by The Clash seem to be right on the mark for this episode. The last scene has Martin telling Louisa that he can’t live like this anymore and she turns to go into the house with a lot to think about.

Here are the lyrics to the song:

Darlin’ you got to let me know
Should I stay or should I go?
If you say that you are mine
I’ll be here ’til the end of time
So you got to let me know
Should I stay or should I go?

It’s always tease tease tease
You’re happy when I’m on my knees
One day is fine and next is black
So if you want me off your back
Well come on an’ let me know
Should I Stay or should I go?

Should I stay or should I go now?
Should I stay or should I go now?
If I go there will be trouble
An’ if I stay it will be double
So come on and let me know

This indecision’s buggin’ me
If you don’t want me, set me free
Exactly whom I’m supposed to be
Don’t you know which clothes even fit me?
Come on and let me know
Should I cool it or should I blow?

Split

Should I stay or should I go now?
Should I stay or should I go now?
If I go there will be trouble
And if I stay it will be double
So you gotta let me know
Should I cool it or should I blow?
Should I stay or should I go now?
If I go there will be trouble
And if I stay there will be double
So you gotta let me know
Should I stay or should I go

 

 

 

Originally posted 2015-11-10 18:16:29.

Sally Forth

Episode 6 is not just about Martin and Louisa; Sally and Clive Tishell play an important part due to how they handle their marital reconciliation. After Clive returns in E4 and surprises Sally, their decisions about the future of their marriage are used as a sort of guide to a better marriage. What they do is pretty much a model for how a married couple should reconcile, and how it can be done without a therapist.

When Clive resurfaces, he immediately embraces Sally even though he’s been gone for a long time. He doesn’t hold back despite the circumstances under which he left. It’s Sally who is cautious about taking him back and has no difficulty confronting Clive about being gone. Sally is beside herself over Clive’s return and tells Ruth about it as soon as she sees Ruth passing the pharmacy. Ruth’s advice to Sally is to have a frank conversation with Clive, which prompts Sally to succinctly list what they should talk about. They should discuss where their relationship has gone in the past, and where they are going in the future, and whether it’s apart or together, and if it’s together, how they will do that. There’s not much Ruth can add to that! (I was reminded of Sally’s monologue in the final episode of S5 when she recounts the on and off again relationship between Martin and Louisa so bluntly.)

It doesn’t take Sally long to get around to having a talk with Clive, and she lays out her feelings quite openly. Clive is agreeable and admits he was worried about what Sally would say if he asked her, before he returned. Next Sally tells Clive she’s changed and is no longer the woman he married. He accepts that and asserts he would marry her all over again anyway. He immediately disarms her and goes farther when he says, “I’m here for you Sal, if you’ll have me.” Her anger is defused but she’s still only willing to let him sleep on the couch.

It’s not difficult to juxtapose this exchange with the one we saw between Martin and Louisa when Louisa arrived unannounced in E2. Not only do they struggle to reveal their true feelings, but also their discussion is filled with unspoken psychological baggage. Martin never disarms Louisa by opening his heart and declaring he’s willing to do almost anything to convince her to take him back. Louisa is also unable to speak openly like Sally about how Martin disappointed her. Instead their separation becomes more laden with what is left unsaid. It’s as though the message is that the act of communicating is the fundamental solution to marital problems and eliminates the need for outside intervention.

In E5 we watch Sally as she continues to prepare casseroles to put outside Martin’s front door. Clive catches her in the act of cooking, but instead of getting angry and accusing her of any wrongdoing, he tells her he doesn’t know what she’s up to and doesn’t want to know. He’s letting the past stay in the past. Furthermore, he once again takes responsibility for not having been more attentive and possibly causing her to turn to untoward behaviors. But he suggests trying to trust each other and move on together. His next comments are the most critical: he tells her he ran away when she most needed him, but he’s there now and came back for her. It isn’t long before Sally takes the big step of throwing out her next cooked meal for Martin Ellingham and all the containers she had stored for more meals to come. This act is hugely significant for Sally.

Once again we can contrast Clive’s confessions with the total lack of admission of fault by Louisa. She, too, left when Martin most needed her, and she, too, has come back now. However, she isn’t willing to leave the past in the past. Martin has told Dr. T that he trusts Louisa but telling Louisa directly would be more effective. Moreover, he wants them to move on together yet has trouble expressing that to her. Martin even denies feeling lonely in the final scene of this episode, reinforcing the sense we have that he continues to avoid acknowledging his true feelings. All of their repressed and unsaid sentiments are placed at the root of their estrangement. Both Sally and Martin have suffered through major psychological events. Psychosis accompanied by delusional disorder marked by self-medication and criminal actions for her. Haemophobia followed by self-treatment and Major Depressive Disorder for him. They are both damaged by these experiences but Sally is not one to repress very much, and that seems to be healthier.

Now here we are in E6 and Sally finds Clive doing his best to help in the store. Already Clive’s efforts to demonstrate to Sally that he is sincere about rekindling their marriage are reaping big dividends. She has dropped her resistance to his advances and is ready to invite him back into their bedroom. Soon Sally is preparing Clive’s favorite meal for dinner and herself for a romantic evening.

The idyllic dinner Sally plans is precisely offset by the dinner plans of Martin and Louisa, even down to the replacement of the wine glasses on the dinner tables. The two dinners are intercut such that we watch both couples striving to make the evening a success, but in both cases that is not to be. Both end with medical emergencies and what appears to be a reconfirmation of their dedication to their spouses. Louisa makes clear that Danny has overstepped his boundaries and Martin seems satisfied to hear her put Danny in his place. Meanwhile, Clive has had a heart attack from applying testosterone gel combined with taking a pill to help with sexual arousal and Sally is overcome with anxiety that he might die. The difference in the level of emotion between Sally and Martin is exaggerated for comedic value as well as to demonstrate her newfound passion for her husband as opposed to Martin’s revulsion for such overflowing of emotion and his well-measured response to Louisa’s outburst. It would be nice to see Sally lower her excitement level and Martin increase his.

Nevertheless, Sally and Clive have proven that a marriage can be revived with a commitment to talk to each other, to be open about what they want from each other, and to accept responsibility for the mistakes that both of them have made. Sally would probably be categorized as a character with a small role that has a big impact. Throughout the show Sally has mostly been used as a thorn in Martin’s side, much like the dogs that follow him relentlessly. This time her impact is played out in how she lets bygones be bygones. It’s nice to see Sally used as more than for comedic gestures. Of course, she isn’t totally over her obsession with Martin. But we’re getting closer.

 

 

 

Originally posted 2015-11-05 20:08:02.

Forgiveness

One thing we haven’t discussed yet is the whole idea of forgiving. A recent NYTimes article addressed this act; its primary focus was on the act of asking for forgiveness. But there are two sides to every issue, and the other side to this one is being the one in the position to offer forgiveness.

To apply this idea to Doc Martin, we first have to establish whether either of these characters should ask for forgiveness or would be the one to offer to forgive. Martin has asked Louisa to forgive him several times already: when she’s giving birth; when they rescue James from Mrs. Tishell; and most recently, when he’s about to perform the AVM surgery. In the first instance, she was ready to ask for forgiveness too and they almost simultaneously decided to reach out to each other. On the second occasion, Martin was proximally responsible for James’ abduction because he allowed Mrs. T to care for James; but more globally it’s not entirely clear that he was the only one at fault for how Louisa reacted to his decision to leave Portwenn. It was Louisa who sort of became a moving target in that she had such mixed feelings about being in a relationship with him. In a sense we could say she owed him an apology for doubting he would want to be an active father and for making hasty decisions. The final time Martin asks for forgiveness she is sedated and may not even remember it, but he is primarily right when he says he hasn’t been a very good husband.

The NYTimes article quotes Frederic Luskin who runs the Forgiveness Project at Stanford University. Luskin’s work has identified nine steps to asking sincerely to be forgiven but the steps can be distilled to four. The first one is to “admit vulnerability,” which means you must admit your responsibility for causing others’ pain. It’s particularly important in families for the offending party to acknowledge that they have done something to hurt another family member.

The second step is to apologize sincerely. “A true, authentic apology is one in which the speaker says: ‘I’m sorry, because my poor choice of action or words directly caused harm to you. That it’s my bad and yours. And that I recognize you feel hurt as a direct relationship of what I did.’ ” Furthermore, according to Dr, Luskin, “when a person accepts responsibility and promises to make amends… it has an almost universally positive effect.”

Thirdly, people like to be asked for their forgiveness. It may seem obvious but approaching the person you think you’ve wronged and simply asking them to forgive you is important.

Lastly, those asking for forgiveness must thank the person for forgiving them. The final act must be a joint expression of gratitude for being asked to forgive and for offering to forgive.

When someone has offered to forgive and the offending party acknowledges the charity that’s been extended to them, that moment of receiving forgiveness “is this moment of true humanity when we are seen for who we really are and loved anyway.”

Once again, there’s no way to know if these steps were in the minds of those writing this show. Nevertheless, they’ve done a good job of following them IMO. They have left things quite lopsided though. Martin has so far been the one to admit fault thereby leaving himself vulnerable; he has promised to make amends, or change his behavior; and he has asked for forgiveness by appealing to Louisa each time to accept his apology and even to help him.

Louisa has responded favorably to the first two appeals and acted willing to take him back. At the Castle, she told him outright that she had been waiting to hear him say something nice. He has finally done that during this scene. The last time is different. Perhaps if she had not been in an operating room and prepped for surgery, she would have had a more welcoming response, but this time she isn’t ready to accept his confession. We haven’t seen her forgive him fully yet.

Since so much of S7 has been a reversal of what’s happened before, this time she should be the one to admit fault and ask for forgiveness. During the first 4 episodes Louisa has said “Thank You” to Martin numerous times, and that’s a good start.  Maybe now that he has made a sincere effort to not only say he’s sorry, but to demonstrate by his actions that he really means it, she will express her gratitude by accepting his apology and complete the cycle of forgiveness.

 

 

Originally posted 2015-10-01 15:37:51.

Rating Happiness

Another recurring topic in the show is the issue of happiness, which I have written about so much already. But, since S7E2 has Martin telling the therapist that he’d like Louisa to be happy but that he considers happiness overrated, I couldn’t ignore that once again happiness is being prioritized. (I can’t guarantee this will be the last time I write about this emotion either.)

When I first wrote about happiness on Oct. 15, 2013, I wasn’t sure how much this emotional state mattered to the show. Now I can’t help but think that it occupies a very important place philosophically and situationally. Since I don’t want to repeat myself and you all can look back on the previous posts, I will just give you a rundown of what I have written so far about happiness.

The Oct., 2013 post discussed Aristotelian notions of eudaemonia and how psychologist C. D. Ryff has modified them. I then applied Ryff’s six factor structure to Martin and Louisa and what might make them happy. (Oddly enough, I recommended an intermediary and suggested they do some simple activities together, and in S7 they seem to be doing all of those things.)

The next time I wrote about happiness was on Oct. 14, 2014, when I looked at how important it is to most people to be happy and tried to determine what may provide a sense of happiness to Martin based on what we’ve seen on the show. I wondered if Martin’s daily routine, while fairly rigid, might also be a source of happiness for him and provide him with a sense of well-being. Despite any objection he may claim at times, he also appears to exhibit some real happiness whenever Louisa responds positively to his overtures.

I wrote again about happiness on March 31, 2015 when I looked at marital happiness. The post delineated John Gottman’s Four Horsemen concept, or the four major negative communication styles that can lead to significant problems in a marriage. Gottman also offers some ways to reverse the damage negative communication can have. The suggestions for improving communication led me to suggest that a little more affection between Martin and Louisa and some sign that they appreciate each other could go a long way to bringing them happiness in their marriage. If S7E2 is an indication of things to come, it is filled with moments where they are quite willing to thank each other. We can only hope for some affection! (Some trailers have shown them hugging and that’s a start.)

Next I wrote about happiness on July 28, 2015. (See, I really have taken this issue to heart!) This post had to do with how important many countries think happiness is to their citizens. The UK is one of those countries, and the Prime Minister started talking in 2010 about his interest in using the government to help with making British citizens happier. I also referred to the film “Inside Out” because it makes the point that without sadness, there can be no joy. Other articles I read around this time made similar points, i.e. that experiencing happiness is conjoined with the fear that it may end. In addition, most studies on happiness emphasize the importance of self-governance and the conviction that people who feel in control of their own destiny usually feel more fulfilled. Also, well-being can be measured subjectively and objectively.

The July post was quite long and eventually got to talking about Martin Seligman and his Positive Psychology ideas. Seligman is convinced that happiness is an essential facet of living a quality life, and that applies to all cultures. He has come up with exercises to increase happiness and decrease depressive symptoms, and they have lasting results. The application of these exercises demonstrates that people have some control over their level of happiness.

Now Santa has referenced another article about happiness and it offers a nice overview of the research in this area as well as some interesting views about the subject that have not been mentioned enough in the previous posts. For me the section about “What Research Says Happiness is Not” is of great value.

Happiness is not:

  • Having all your personal needs met
  • Always feeling satisfied with life
  • Feeling pleasure all the time
  • Never feeling negative emotions

The article goes on to say, “An especially important part of the happiness equation is the negative feelings you may be feeling right now. As nice as it might seem, happiness is not the absence of negative feelings. As Dr. Vanessa Buote, a postdoctoral fellow in social psychology, explains, real happiness is about taking the good with the bad:

One of the misconceptions about happiness is that happiness is being cheerful, joyous, and content all the time; always having a smile on your face. It’s not—being happy and leading rich lives is about taking the good with the bad, and learning how to reframe the bad.

You can experience negative feelings and overall happiness with your life at the exact same time. In fact, learning how to do that is essential to being a happier person.

Furthermore, “Lahnna I. Catalino, Ph.D., at the University of California at San Francisco, suggests that overly pursuing happiness can actually backfire on you…Remember,  [due to genetics] you have a limit that you can’t control. Don’t beat yourself up about it, you’re just being yourself. Instead of trying to force yourself to be happy, Catalino advises you simply reflect on the moments and activities that give you joy. So stop trying so hard.”

 After reading this, we can put ME’s position that happiness is overrated in perspective. I would guess that he has concluded that Louisa needs to be happy but that he does not, and that he assumes he will never reach a state of happiness so why even try. However, as we have seen throughout the show, he can achieve happiness at times; he just can’t stop having negative feelings. Presumably he beats himself up about it and feels defeated when he continues to struggle and cannot fit the model of happiness he’s formed from watching others. As the quote above states, ME needs to learn how to reframe the bad, and we have to hope therapy gives him some help with that.

Originally posted 2015-09-19 16:46:15.

The Pursuit of Happiness

This post will interrogate what it means to be happy in greater depth. Even though I’ve written several posts on happiness already and have recently added some posts on emotions, which include joy and sadness, I want to look at this so called unalienable right further. I have been surprised by the number of articles that have recently appeared in the NYTimes and elsewhere about the concept of happiness. Then I did a little more digging and discovered that, like the US, many countries consider happiness a major goal for their citizens and one that government can assist in. In fact, in 2010 British Prime Minister David Cameron made a speech about his concern for sustaining his countrymen’s happiness and asked the Office of National Statistics to devise a new way of measuring wellbeing in Britain. I wouldn’t even be surprised if the writers for DM included some of the references to happiness as a result of Cameron’s speech on wellbeing. Series 5 and 6 came along after that speech and contained many scenes that related to the happiness level reached by several characters, e.g. Martin and Louisa (of course), Al, Bert, Ruth. The scene at the end of series 3 in which Martin and Louisa declare that they wouldn’t make each other happy had already taken place, but, in my mind, that may have been the set piece for starting down this path of thinking about happiness.

Before I go into all of the articles and try to put their contents into some sort of coherent form, I want to mention that I have now seen the film “Inside Out.” The film is brilliant in addressing a serious subject by using animation and humor. The central concern is what goes on inside our minds when we deal with major disruptions in life.  In the film the key protagonist is an 11 year old girl named Riley whose family is moving from Minnesota to San Francisco. The fact that she is 11 plays a major role because along with the change in locations she is experiencing some emotional peaks and valleys due to puberty. For me, an important message of the film is that joy is Riley’s most prominent emotion, but joy needs to drag around sadness, literally. Joy wants sadness to suggest ideas about how to make Riley’s life go well, but not take away the joy of memories. In the end, though, this growing and developing child must lose her attachment to those memories so that she can enjoy life again in a new setting. The idea is that without sadness there can be no joy, and without family and loving support from them, there is difficulty transitioning to a new stage of life.

Since “Inside Out” is a Walt Disney production, it is especially coincidental that last weekend an article titled “The Happiness Project” appeared in the NYTimes Style Magazine, and that the article makes some similar points about happiness. The article is about how Disney, its parks and films, brings happiness to many and inspires non-Americans to love America. (I should say here that many Brits only visit America to go to Disneyland. There are several non-stop flights from London to Orlando on at least 5 airlines, and they contain 11,257 seats per week. When we were in England, we met quite a few Brits who had been to Disneyland, and nowhere else in America.)  For one thing, the author of the article, Andrew O’Hagan (a British novelist), argues that “the idea of Disneyland has a fear of disaster embedded in it. Happiness, after all, is like that. We can hardly live with happiness for fear of it suddenly ending.” Later he states, “happiness is paired with a basic drive to do something that defies gladness.” These comments come in the midst of a long article about how happy visiting Disney makes people and that some people cry with happiness when they visit the park. They also are combined with a description of the joy he gets from taking his daughter there. This reconfirms that joy often is conjoined with family. It also might highlight the fact that S6 of DM and its downward trajectory could be used as a springboard for getting Martin and Louisa on a much better path to finding joy once more. The fear of losing happiness is rather prominent in their marriage.

Ultimately, the film “Inside Out” reflects what most of the research on happiness has found. People consider family a significant source of happiness. In addition, like most studies on happiness the film indicates that there is a lot of self-governance involved. As a result, the issue of control frequently comes up.

We can also see this in David Cameron’s speech on wellbeing in which he said: “We have got an instinct that people who feel in control of their own destiny feel more fulfilled. That’s why we’re giving parents real choice over schools and patients real choice over where they get treated. We have an instinct that having the purpose of a job is as important to the soul as it is to the bank balance, and it’s there in our hugely ambitious work programme to get people off welfare. Our instinct that most people have a real yearning to belong to something bigger than themselves – that is leading our plans to bring neighbourhoods together, to increase social action and to build what I call the Big Society.”

He goes on to say: “Let me give you three examples where I really do believe there is a link between what politics and government does and people’s happiness, contentedness and quality of life.

One is I do believe if you give people more control over their life, if they feel they have more of a say, they are authors of their own destiny, that actually increases people’s self-worth and wellbeing. Now that has a real effect on, for instance, education policy or health policy. We should be trying to give more power to the patient and the parent to have more choice over where they are treated, where their kids go to school and the rest of it. So that has a real-life effect.

The second one was mentioned – relationships. It is absolutely right that people’s wellbeing often depends on the quality of their relationships, so we should ask as a country, why do we spend billions and billions on the consequences of family breakdown, but so little on trying to help families stay together? £20 million on the budget of Relate, but £20 billion on the consequences of social breakdown, so again if we think about wellbeing, rather than just GDP, we might actually change that.

Another one is planning policy. People, definitely, the way your happiness, contentedness, wellbeing does partly depend on your surroundings, and your surroundings depend on planning policy and how much you are involved and have a say over your neighbourhood and what it looks like. So therefore, I would say: give people more power over the planning policy in the neighbourhood and they will be more contented.”

The ONS did follow up on Cameron’s request. and produced a  report: “Reflections on the National Debate.” In total, ONS held 175 events, involving around 7,250 people. The debate generated 34,000 responses, some of which were from organisations and groups representing thousands more. The quotes on each page of this report were taken from online contributions, where permission was given to reproduce the participant’s words anonymously.

The following are the salient points, in my opinion:

The term ‘well-being’ is often taken to mean ‘happiness’. Happiness is one aspect of the well-being of individuals and can be measured by asking them about their feelings – subjective well-being. As we define it, well-being includes both subjective and objective measures. It includes feelings of happiness and other aspects of subjective well-being, such as feeling that one’s activities are worthwhile, or being satisfied with family relationships. It also includes aspects of well-being which can be measured by more objective approaches, such as life expectancy and educational achievements. These issues can also be looked at for population groups – within a local area, or region, or the UK as a whole.

The debate ran between 25 November 2010 and 15 April 2011 and was conducted both online and at events around the UK. The debate was structured around a consultation paper, which asked five main questions:

  • what things in life matter to you?
  • of the things that matter to you, which should be reflected in measures of national well-being?
  • which of the following sets of information do you think help measure national well-being and how life in the UK is changing over time?
  • which of the following ways would be best to give a picture of national well-being?
  • how would you use measures of national well-being?

The main questions from the consultation questionnaire are listed below with the most common answers from a predefined list.

What things in life matter to you? What is well-being?

  • health
  • good connections with friends and family
  • good connections with a spouse or partner
  • job satisfaction and economic security
  • present and future conditions of the environment.

All the age groups highlighted the importance of family, friends, health, financial security, equality and fairness in determining well-being.

Having a general sense of well-being is important to nations and individuals. When Martin asks “Why does everyone always have to be happy?” in S6, we can now answer that asking that question truly demonstrates how out of sync he is with the world. However, we also consider his question one that reflects his personal agony and desperation in the face of hearing Louisa say that she plans to leave again. His question is plaintive and shows how pitifully sad he is with his life. Like everyone else, his sense of well-being would be likely to derive from health, good connections with his spouse, and the conditions determined by his environment. Until he performs Louisa’s AVM surgery, his health is a major concern for him, his connections to his spouse are precarious, and the conditions of his environment are problematic. The surgery is accompanied by some phobic symptoms (vomiting), but he’s able to carry on; he expresses his sincere wish to work on their marriage and be a better husband; and we can only hope that they can find a balance at home between their need for quiet and some private space while spending time with JH. S7 may be headed toward managing some of these essential elements for achieving happiness in this marriage.

In addition to Cameron’s emphasis on the importance of control for reaching a sense of well-being another article I came across also emphasizes control in regard to happiness. In “Two Ways to Be Happy” (NYTimes, June 1, 2015). the author describes studies that draw a distinction between primary control and secondary control. Primary Control is that ability to directly affect one’s circumstances; Secondary Control is the ability to affect how one responds to circumstances. These researchers assert that for most people secondary control is most important for life satisfaction; however, for those in committed relationships, primary control is more important. Their explanation for this discrepancy is that it’s possible that having a partner may help people deal with adversity the same way secondary control does. (This assumes you have a partner who is allowed to help with adversity, a definite problem with Martin and Louisa.)

Previously I wrote about Carol Ryff’s theories of happiness and eudaemonia. I also mentioned Aristotle’s theories and that many others have written their views about this emotion. However, the person most associated with psychological studies of happiness is Martin Seligman. What makes his studies more impressive is his belief that the complete practice of psychology should include an understanding of suffering and happiness, their interaction, and the use of interventions to relieve suffering and increase happiness. In an article on Positive Psychology that was published in American Psychologist (July-August 2005), he and his co-authors try to answer the question “What makes life worth living?”

Seligman, et. al. developed a guide that describes and classifies the strengths and virtues that enable human thriving. (They call it the CSV for Classified Strengths and Virtues: A Handbook and Classification.) They have determined that there are 24 strengths and 6 overarching virtues that span all cultures. The strengths include: kindness, fairness, authenticity, gratitude, open-mindedness, prudence, modesty, and self-regulation. The virtues are: wisdom, courage, humanity, justice, temperance, and transcendence.

Here is a Table that explains their findings:

Screen Shot 2015-07-27 at 10.57.31 AM
They contend there are 3 defined routes to happiness:
a) positive emotion and pleasure (the pleasant life)
b) engagement (the engaged life)
c) meaning (the meaningful life)
They have determined that the most satisfied people are those who orient their pursuits towards all 3 but put the greatest weight on engagement and meaning. Furthermore, they believe that happiness brings many added benefits. “Happy people are healthier, more successful, and more socially engaged.” The goal, therefore, would be to provide a means for people to reach a state of happiness because then they will build on that positive cycle they’ve been establishing.
The team devised some exercises to see if they could increase happiness and decrease depressive symptoms. They were pleased to find that some of the exercises led to a sense of happiness that lasted for 6 months (which was the maximum time period for which they checked). Those participants who continued to do the exercises benefited the most and were the happiest.
They conclude that since these exercises reduce depressive symptoms lastingly, they could be another means for treating depression, especially in talk therapy. They recognize that the individuals in their study were only mildly depressed and were motivated to become happier.
Their final judgement is that “the  pursuit of happiness is [not] futile because of inevitable adaptation or an immutable hedonic set point.” In other words, they believe that despite happiness being subjective and self-reported, everyone can reach a rewarding level of happiness through consistent effort. Furthermore, pursuing happiness is a valuable goal because of all the advantages that result.
I want to close this post by saying that, like the article above, there is a book entitled The Happiness Project that was written by Gretchen Rubin and published in 2009. Much of the book is pretty simplistic, but she did a lot of reading in preparation for writing it. She read all of the big names associated with the philosophy of happiness as well as several novelists’ views on happiness. She has a blog and suggests various ways people can work on being happier. For me, there are two significant comments she makes. One is “the opposite of happiness is unhappiness, not depression,” by which she means her suggestions are not to be mistaken for treatments of severe depression.
The other is more comprehensive:
“According to current research, in the determination of a person’s level of happiness, genetics accounts for about 50 percent; life circumstances, such as age, gender, ethnicity, marital status, income, health, occupation, and religious affiliation, account for about 10-20 percent; and the remainder is a product of how a person thinks and acts…It seems obvious that some people are more naturally ebullient or melancholic than others, and that, at some time, people’s decisions about how to live their lives also affect their happiness.”
So we are back to the idea of whether people can change and we now have a lot of data that supports the conviction that we are capable of changing our level of happiness. I think we can generalize that to other aspects of our emotional lives. We are the authors of our lives to a great extent, especially if we have a strong desire to make certain changes. Why does everyone always want to be happy? Because happiness is an important emotion and being happy makes our lives worth living.
[I am very sorry that for some reason the font changed in this post and I was unable to figure out how to make the spacing function normally after I included the Table. Believe me, I tried!]

 

 

Originally posted 2015-07-28 21:46:04.

More on Emotions and How They Work

In our continuing effort to learn about emotions and consider all the implications involved with emotions, I thought I would mention another article I recently read. This time the article has to do with the movie “Inside Out” currently in theaters, but which I haven’t had a chance to see yet. I have my grandsons staying with me and plan to take them to see the movie sometime this week. I’ve heard only good things about it, which is remarkable in itself!

The article is written by two professors of psychology who have studied emotions for decades and were asked to be consultants on the film. I’ll let them do the talking here:

“‘Inside Out’ is about how five emotions — personified as the characters Anger, Disgust, Fear, Sadness and Joy — grapple for control of the mind of an 11-year-old girl named Riley during the tumult of a move from Minnesota to San Francisco…Riley’s personality is principally defined by Joy, and this is fitting with what we know scientifically. Studies find that our identities are defined by specific emotions, which shape how we perceive the world, how we express ourselves and the responses we evoke in others.

But the real star of the film is Sadness, for “Inside Out” is a film about loss and what people gain when guided by feelings of sadness…the movie’s portrayal of sadness successfully dramatizes two central insights from the science of emotion.

First, emotions organize — rather than disrupt — rational thinking. Traditionally, in the history of Western thought, the prevailing view has been that emotions are enemies of rationality and disruptive of cooperative social relations. But the truth is that emotions guide our perceptions of the world, our memories of the past and even our moral judgments of right and wrong, most typically in ways that enable effective responses to the current situation.”

(This last paragraph reinforces what I once wrote about emotions in my post of 7/03/2014 titled “The Rational v. The Emotional.”  In that post I came to the conclusion that no matter how much we try to be rational, emotions govern our lives and our decisions. I also asserted that emotions are at the root of all behavior and cannot be extricated from the rational.)

In addition, the professors argue that “sadness prompts people to unite in response to loss” and that we should embrace sadness. If we apply this assertion to Martin and Louisa (and they were in the real world), we might be relieved because they have been overcome by a great deal of sadness during S6. The losses they have had to contend with include loss of independence, loss of autonomy, loss of private space, and perhaps the loss that results from the final cutting of ties to one’s mother despite knowing that she is despicable. Louisa would count the loss of affection and the feeling that she is loved by her husband. There may be additional loss ahead in S7; however, these losses, and the concomitant sadness, may lead to the sort of united response we would like to see.

As we saw in the previous post, sadness is a core emotion that can lead to a sense of relief and clarity. Wouldn’t it be nice if the sadness both Martin and Louisa have been experiencing could expedite a period of clarity followed by a stronger bond between them?

Originally posted 2015-07-14 21:13:15.

Is Martin Depressed?

I am ready to return to posts about the many topics of interest we have explored previously. The first subject I find fascinating is whether we are correct in diagnosing ME as suffering from Major Depressive Disorder. Of course, the reason I came to this question is by reading an article in the NYTimes in March that mentions accelerated experiential dynamic psychotherapy. This type of therapy is new to me, although the therapists in our group may be familiar with it. The article is intriguing, however, because of the example used.

The patient in the article had been diagnosed with intractable depression and “he had been through cognitive behavioral therapy, psychoanalytic psychotherapy, supportive therapy and dialectical behavioral therapy” without success. He had also been medicated without a significant change other than intolerable side effects. Most importantly, he had grown up in a very detached and cold family atmosphere. The therapist recalls that “Brian had few memories of being held, comforted, played with or asked how we was doing.”

The therapist writes: “Based on what he (Brian) told me, I decided to treat him as a survivor of childhood neglect — a form of trauma. Even when two parents live under the same roof and provide the basics of care like food, shelter and physical safety, as Brian’s parents had, the child can be neglected if the parents do not bond emotionally with him.” It is the emotional engagement that is so important to children.

The therapist goes on to say: “One innate response to this type of environment is for the child to develop chronic shame. He interprets his distress, which is caused by his emotional aloneness, as a personal flaw. He blames himself for what he is feeling and concludes that there must be something wrong with him. This all happens unconsciously. For the child, shaming himself is less terrifying than accepting that his caregivers can’t be counted on for comfort or connection.”

Furthermore, this therapist explains that “to understand Brian’s type of shame, it helps to know that there are basically two categories of emotions. There are core emotions, like anger, joy and sadness, which when experienced viscerally lead to a sense of relief and clarity (even if they are initially unpleasant). And there are inhibitory emotions, like shame, guilt and anxiety, which serve to block you from experiencing core emotions…Children with too much shame grow up to be adults who can no longer sense their inner experiences. They learn not to feel, and they lose the ability to use their emotions as a compass for living. “

This description strikes me as being analogous to what we’ve been told about Martin’s childhood and what we see in his behavior as an adult. (Again, I am not proposing that the writers thought this all through when they created the character of Martin Ellingham. I am simply continuing to do more armchair analysis.) The portrayal of ME is weighted more towards the inhibitory emotions in general, although we’ve seen occasions during which he has appeared either joyful or sad, e.g. when he holds Louisa’s hand after the concert or when she accepts his proposal of marriage, and when Louisa tells him she doesn’t want to see him anymore. By the end of S6, ME has begun to experience many of the core emotions, particularly joyfulness and sadness. We know he feels joy during his wedding ceremony and the initial arrival at the lodge, and we know he’s sad during much of the latter episodes, but most especially when Louisa tells him she’s going to Spain and departs for the airport. (We see him tearful in the hospital following the AVM operation, and that’s a sign that he has begun to be in touch with his core emotions even though his tears are due to a mixture of relief and concern.) We may see him squashing his core feelings at the very end of S6 when he once again has trouble expressing any emotion in Louisa’s presence, but at least we know he can access his core emotions.

In the article the therapist encourages his patient ” to inhabit a stance of curiosity and openness to whatever he was feeling. This is how a person reacquaints himself with his feelings: to name them; to learn how they feel in his body; to sense what response the feeling is calling for; and in the case of a grief like Brian’s, to learn to let himself cry until the crying stops naturally (which it will, contrary to a belief common among traumatized people) and he feels a sense of visceral relief.”

I am pretty sure we will never see anything like this sort of therapy take place on the show, and they appear to be using couple’s therapy rather than individual anyway. Nevertheless, we’ve never shied away from considering the best form of therapy for someone in these circumstances and I don’t see why we should stop now! It certainly seems true that Martin’s childhood was similarly lacking in emotional attachment to either of his parents and that he could easily have developed a sense of shame.

There is much action for S7 that has been filmed in interior locations where no one outside of the cast and crew knows what has taken place. It’s possible that we may see some tears from ME and/or LE, and we may see some openness to expressing core emotions to each other beyond Louisa’s displays of anger we saw in S6. I hope to hear what all of you think of this distinction between core emotions and inhibitory emotions as well as what anyone knows about AEDP therapy. Actually, anything this post brings to mind is welcome!

Originally posted 2015-07-10 14:03:49.

Immutable Personality Traits Plus

First, I need to say that I have been having a lot of trouble with my modem and that is one of the reasons it’s taken me this long to write a post. In addition, my week has been extremely busy and has not allowed for much writing. When I post this, it will be after dealing with many frustrations with both computer and time!

As previously mentioned, I want to write something about Santa’s recent comment that referred to the show “Mad Men” as asking the question “Can People Change,” and whether I think literature has often posed that question too. I’ve been mulling over the general acceptance of the Five Immutable Personality Traits that Santa directed us to because that stance is mentioned in the article. I suppose a little review is appropriate here.

Even though none of us has made note of this well-known list, the traits have usually been identified by the acronym OCEAN, or some other arrangements of the letters. OCEAN stands for:

O – Openness to experience

C – Conscientiousness

E – Extraversion

A – Agreeableness

N – Neuroticism

You can read about how these traits became identified as immutable here. I would like to make clear that since the original composing of this list many studies have disagreed with whether they are immutable and, after further study, most psychologists agree that change often occurs within these categories due to many factors. These factors include age (generally accepted as after the age of 30), environment, health, marriage, and work. (I would add having children.) There is also a variability in the constancy of personality traits wherein certain traits stay consistent and others change. Therefore, the article Santa referenced was really being too perfunctory when it mentioned the immutable traits. The article states: “You can change your reaction to things, you can change your behavior to the people around you, you can become different enough that you  seem different, but underneath it all, you are still you.” Actually, the situation is much more complicated than that. Nevertheless, considering the scope of the article, we can use both positions: the one that considers change as it is represented by superficial modifications in behavior, and change as it is represented by more permanent and substantial permutations of one’s personality.

I say this because the article takes into account the aging of the cast as the show continued through ten years as well as the aging of the viewers over that time span. As we all know, as the years flow by, we begin to look older. Apparently, “Mad Men” is one of the few shows in which the aging of its stars has been incorporated into the show. Rather than trying to pretend that those years have not really passed, as most shows, including “Doc Martin,” most often do, the creators of “MM” decided to have the cast age along with its audience.

How have we changed? Who knows how many ways life has impacted us over the past ten years? (In my case, I only started watching “DM” in the past two years, but I can still say that a lot has happened in those two years.) Do life experiences change us? My answer would be a resounding “Yes.” Sheryl Sandberg recently wrote in her essay about losing her husband only  one month ago, she has learned a lot about loss and what to say to others, about some practical things, and that resilience can be learned, that connections to others change, and she has learned gratitude. If she can learn all those things in one month, just think what we’ve learned in two years, or ten! The writer of the article notes, she has changed throughout the time during which she’s been watching “Mad Men,” yet she believes she is the same person. She acknowledges that there is no clear yes or no answer to the question “can people change?”

In my humble opinion, I am not the same person as I was when I was in college, or since I had children and grandchildren, or since my parents have grown old and my father has died, or since some close friends have died. Those experiences have changed me in more than superficial ways. Perhaps my college friends I haven’t seen in decades would say I haven’t changed (except to have aged), but I know I have. Some events have softened me and others have made me tougher; I’ve learned a lot about myself and realized what is most important to me in life. The question is not whether people can change, rather how much can people change and what sorts of circumstances lead to those changes? If we look at the OCEAN traits, where can we find significant areas of change?

Openness: sometimes called intellect. Although someone may be open on some areas to new experiences, they may be less open on others. Again, in my opinion and based on personal observation, once someone is introduced to a new activity or lives through a momentous event, he/she can become more open. A trip, meeting a person of another culture, having an accident — many events can open one up beyond one’s usual approach.

Conscientiousness: High scores on conscientiousness indicate a preference for planned rather than spontaneous behavior. I think the operative word here is preference. We may want things to be planned, but life teaches us that plans usually have to be changed. We plan to have the baby after we graduate, but the baby comes early; we plan for the movers to deliver our furniture on a particular day, but they come much later; we plan to surprise someone with a special ticket to a concert, but they get sick the day before. If we’re rigid, we’ll be stuck over and over. Eventually we learn that we can’t control the world.

Extraversion: The trait is marked by pronounced engagement with the external world. Even though I think this is one of the traits that is toughest to change, traumatic and/or extraordinary events can change one’s approach to the world in either direction. We know people withdraw under certain circumstances. I think, under the right conditions, people can also be drawn out and become more willing to participate.

Agreeableness: Agreeable individuals value getting along with others. On a large scale we know that strongly prejudiced people can have conversion events in which they become aware that their biases were based on false premises. There are also breakthrough moments when a person may realize that he/she cares enough about another to want to be more agreeable. Conversely, there can be major events that cause one to lose faith in others. (Bernie Maddoff may have caused a few of these changes.)

Neuroticism: Those who score high in neuroticism are emotionally reactive and vulnerable to stress. They are more likely to interpret ordinary situations as threatening, and minor frustrations as hopelessly difficult. This may take a lifetime to change, but with regular and steady good outcomes, can change.

I haven’t applied these to “DM” because I am certain you can all do that as well as I can.

When it comes to literature, I can state unequivocally that most, if not all, great works of literature emphasize characters changing in some form. When I think back on the earliest novels, such as Pamela by Samuel Richardson, or Don Quixote by Cervantes, the characters are on missions to make changes in themselves or in the world. Indeed Chaucer’s and Boccaccio’s tales were meant to be stories of warning, political commentary, and philosophical messages that would bring about change through shining a light on the authorities of the time. Presumably, those authorities would recognize the absurdity in some of their rules and laws and have some sort of insight into themselves. In terms of personality traits, many characters want to change to improve their chances to capture the hearts of someone they love. Don Quixote loves Dulcinea although he realizes he’s dreaming about her loving him back. Pamela is first the victim of her employer’s lust and then the victim of his guilt and desire to win her love despite their different social status.

The novel that perhaps has the most to say about someone changing is Metamorphosis by Franz Kafka. Why does Kafka have his protagonist become a large beetle? It has a lot to do with personality changes, both those of Gregor Samsa and those of his family. And he is quite convincing that people can change!

Across cultures, across time, and across genres, change in how people behave, how they approach the world, and how they manage their fates has always been a prominent theme.

Finally, I think it’s important to remember that all of these personality traits are on a continuum, just as the Meyers-Briggs Personality Test demonstrated. Our personality traits fluctuate along the continuum and are not fixed.

I hope I’ve addressed what Santa was asking. I look forward to hearing what everyone has to say about this topic. Also, I hope to have a chance to write several more posts in the near future. My internet connection should be repaired by tomorrow afternoon, fingers crossed, and I’ll be better able to post more in less time. Thank you for sticking with me!

 

Originally posted 2015-06-07 11:04:56.

Marital Happiness

Not surprisingly, my attempts at writing light posts have fallen pretty flat. There’s not really much anyone can say about them anyway.

Since we know there will be marital/couples counseling at some point in S7, I figured another topic of interest might be what it takes to achieve happiness in a marriage. I’ve written about the topic of happiness a few times because I think there is a significant emphasis placed in the show on happiness and its importance. I have to assume they purposely chose to underline this mental and emotional state. (Among the many intriguing topics brought up on this show, making happiness one seems rather curious to me. While taking Martin deeper into depression as the show goes along until in S6 he reaches Major Depression, they continue to broach the subject of the overall importance of happiness. (Why else have the conversation in the hospital near the end of S6 between Louisa and Martin in which, after she tells him she’s taking James to Spain, she says “I’m not happy and I’m not making you happy am I” and he answers “Happy…Why does everybody have to be happy all the time?” That question hangs there while Louisa looks at him crestfallen. Once again she’s asking him if she’s the reason for his problems and his answer is indirect and noncommittal, as it was before. Besides, is this an existential question? Are we supposed to wonder whether being happy is even on his radar? Or should we ask whether being happy is a state he has lost any desire to strive for? In spite of all these uncertainties in regard to happiness, I will go ahead with this post about happiness in marriage and couples.)

I have now learned that John Gottman, who is a professor emeritus at the University of Washington, is considered an authority on marriage and its major pitfalls. He is known for his work on marital stability and relationship analysis through scientific direct observations, many of which were published in peer-reviewed literature. Gottman was recognized in 2007 as one of the 10 most influential therapists of the past quarter century. He is best known for his Four Horsemen concept ( which is a reference to what can bring on an apocalypse in a marriage). It defines four major negative communication styles that can cause significant problems in a marriage: Criticism, Defensiveness, Contempt, and Stonewalling.

It might be useful to go through each of these and see how Martin and Louisa have been depicted in relation to these behaviors  and what we might like to see them do to change them. If we’re talking about change, and we have heard both Martin and Louisa say they think people can change, we should consider what particular changes could best help their marriage. Since Gottman has studied marriage, his assessment seems a pretty good place to start.

John Gottman’s FOUR HORSEMEN OF THE APOCALYPSE:

1. Criticism: Attacking your partner’s personality or character, usually with the intent of making someone right and someone wrong:

Generalizations: “you always…” “you never…”“you’re the type of person who …” “why are you so …”

2. Contempt: Attacking your partner’s sense of self with the intention to insult or psychologically abuse him/her:

– Insults and name-calling: “bitch, bastard, wimp, fat, stupid, ugly, slob, lazy…”
– Hostile humor, sarcasm or mockery
– Body language & tone of voice: sneering, rolling your eyes, curling your upper lip

3. Defensiveness: Seeing self as the victim, warding off a perceived attack:

– Making excuses (e.g., external circumstances beyond your control forced you to act in a certain way) “It’s not my fault…”, “I didn’t…”

– Cross-complaining: meeting your partner’s complaint, or criticism with a complaint of your own, ignoring what your partner said

– Disagreeing and then cross-complaining “That’s not true, you’re the one who …” “I did this because you did that…”

– Yes-butting: start off agreeing but end up disagreeing
– Repeating yourself without paying attention to what the other person is saying – Whining “It’s not fair.”

4. Stonewalling: Withdrawing from the relationship as a way to avoid conflict. Partners may think they are trying to be “neutral” but stonewalling conveys disapproval, icy distance, separation, disconnection, and/or smugness:

– Stony silence
– Monosyllabic mutterings
– Changing the subject
– Removing yourself physically
– Silent Treatment

So lets look at the Four Horsemen as they relate to what we’ve seen transpire between Martin and Louisa. (Perhaps a slight caution is appropriate here. Louisa will seem to be the instigator or culprit most often because she does most of the talking. Also, to a great extent the humor of the show often depends on these problematic sorts of interactions. I wouldn’t want to have them work on making themselves too much different at the expense of the humor.)

At various times in the show we have heard Louisa use some of the phrasing associated with the “Criticism” category. She has said, for example, “Everything’s always up to me, isn’t it? You never do anything or say anything to help us move on…”(S3E1) Or, “Why are our conversations so combative?” (I’m paraphrasing here). In both cases, she implies that Martin is causing the difficulty between them. Granted, these occur before they are married, but they exemplify the sort of interaction that belittles Martin. Louisa clearly thinks she’s the victim and being wronged. Although we haven’t heard her use that terminology during S5 or 6, she’s come close. She’s told him that she’ll be the one to question her mother’s behavior and that he’s expecting too much to want her to keep the baby quiet during his office hours. One occasion that stands out to me is on the first morning following his mother’s arrival in S6 when she has to leave the kitchen to find Martin after talking to his mother in the kitchen. She finds Martin tinkering with a clock in his office and angrily asks him what he’s doing. The implication is that he is guilty of leaving Louisa to deal with his mother by herself and she finds that absolutely wrong. Even the time when Louisa quickly comes into the kitchen to tell Martin to take James to music class is accusatory. “We don’t want him to grow up to be shy and introverted?” (motioning towards Martin and leaving us to fill in “like you”). Martin has asserted to Louisa that he doesn’t want James to be like him, but now Louisa is reminding him of that at a point when Martin is under pressure to agree.

The next category is “Contempt,” and they are both guilty of doing this from time to time. Most often this behavior is in the form of body language on both their sides. Louisa is more likely to roll her eyes when Martin does something annoying, which is admittedly humorous, but she also does it when she’s meant to be angry with him. For example, after Martin asks Dennis to come to dinner, and once again hasn’t taken the time to check with Louisa first, Louisa looks irked. This time she gives Martin the stink eye and then closes her eyes in frustration. The one action that Martin cannot seem to alter is making decisions without Louisa’s input, and she is always incensed by it. Because Martin has no awareness of how unhappy she is when he neglects to consult her, he innocently puts himself in a position to receive her disdain. I don’t think Louisa is supposed to be deliberately insulting him here; she is simply reacting naturally, if with anger. (It’s remarkable that Martin frequently has so much trouble simply asking Louisa’s opinion, especially since that is the one thing that always puts her off.)

Martin sometimes behaves contemptuously towards Louisa when talking about her job and her students. He belittles the value of the school that she heads and the students she cares so much about. She is proud of how she handles the troubles that take place at the school and it’s demeaning that he considers the school subpar and her as easily replaced. We do see a sneer and a curling of his lip at times when he refers to what he witnesses at the school and her importance there. He also uses some hostile humor, e.g. when the students get sick due to daring each other.

“Defensiveness” is the third category. I’m not sure I can think of any examples of this. Martin has sometimes protested that he didn’t mean what he said to be taken the way it was, but that’s not the same as acting defensively to ward off an attack by Louisa. I really don’t remember Louisa using this tactic either. If any of you think of a time when this happens, please help me out.

Number four is “Stonewalling.” This one is huge in this show. I don’t want to confuse Martin’s lack of talking skills or introversion with deliberately avoiding giving an answer or knowingly removing himself.

Martin is the one who exhibits this behavior most frequently, of course. The example I used above where Louisa has to find him in his study is one of several. He also immediately absents himself once he and Louisa have gotten the bedroom ready for his mother’s stay. Their first night together begins with Martin walking off without his bride and making it difficult for her to keep up. I would definitely put the scene at the Sports Day celebration as a good example of him stonewalling. His silent treatment begins early that day when Louisa tries to eat breakfast with him and suggests a weekend outing. It continues when Louisa reminds him of his promise to speak at Sports Day. It reaches its apex at the celebration and then he walks off.

Louisa is not immune to this reaction either. Leaving is her métier, or her default position. When the going gets tough, Louisa gets going.

In both cases, my feeling is they are demonstrating a sense of disconnection and distance from each other.

There are ways Gottman suggests of reversing these behaviors. Here are some basic recommendations:

– Learn to make specific complaints & requests (when X happened, I felt Y, I want Z)

– Conscious communication: Speaking the unarguable truth & listening generously

– Validate your partner (let your partner know what makes sense to you about what they are saying; let them know you understand what they are feeling, see through their eyes)

– Shift to appreciation (5 times as much positive feeling & interaction as negative) – Claim responsibility: “What can I learn from this?” & “What can I do about it?”

– Re-write your inner script (replace thoughts of righteous indignation or innocent victimization with thoughts of appreciation, responsibility that are soothing & validating)

– Practice getting undefended (allowing your partner’s utterances to be what they really are: just thoughts and puffs of air) and let go of the stories that you are making up

Surprisingly, I noticed that when Louisa requested that Martin take James to music circle, it was she who wouldn’t listen or talk about it. In that instance, Martin asked if they could talk about the plan and she cut him off. She was in a hurry and had a lot of driving ahead of her, and that often makes it harder to take a few minutes to discuss anything; however, he is offering to talk and she refuses and becomes critical.

Is that enough to keep him from trying again? It has to be more complicated than that. They’ve had some good conversations at times and they clearly want to find a way to resolve their marital conflicts. I don’t see them ever hugging for very long, but a little affection can go a long way. Louisa kisses Martin spontaneously from time to time, including in S6. Martin needs to do more of that. We know he can; he has kissed her without prompting before they got married. Everyone likes to be complimented and shown some appreciation. It was nice when Louisa told Martin she would miss him before leaving for work. He didn’t respond, but I imagine those words touched him as well as embarrassed him.

This show would not remain what it’s been if Martin and Louisa no longer clash, but maybe we can get an answer to that question left hanging about happiness. It’s just possible that their happiness hinges on each of them providing the support and companionship they each need. That’s not a terrible way to leave this couple…A little sappy, but not terrible.

 

 

 

Originally posted 2015-03-31 18:21:24.

Attached to Feeling Ineffectual

Since I have obviously run out of personally generated ideas, and the NYTimes seems to regularly publish articles that I find relevant to the show, I hope you don’t mind if I continue to refer to what I’ve read.

The Times has been publishing a series of articles called “Couch” that “features essays by psychotherapists, patients and others about the experience of therapy — psychoanalysis, cognitive behavioral therapy, group therapy, marriage therapy, hypnotherapy or any other kind of curative talk between people behind closed doors.” That has turned out to be incredibly fortuitous, especially because we have been mentioning all of the above on this blog.

This week the article is written by a psychiatrist in private practice in Cambridge, MA and is about a possible explanation for having little tolerance for risk and choosing known dangers over unknown ones. The patient in the story and Martin Ellingham have one thing in common: his father is a brilliant, larger-than-life figure who bullied and belittled him. In the patient’s case, he has continued to try to impress his father. When, at last, this patient’s father and he decide to work together on a business venture, he continues to feel disparaged or ignored until their business becomes a success. Oddly, however, it is at this point that the patient feels worse than ever.

The psychiatrist’s assessment is that having success with his father is unknown territory for the patient and that makes him extraordinarily frightened. “What if he lets himself taste victory and it still fails? There is so much to lose now. Maybe even more terrifying, what if he gets what he wants? Then who would he be? He does not know how to assimilate the identity of successful entrepreneur and worthy son, however much he has coveted it. Doing so would represent a bizarre kind of loss: That is not who he has known himself to be.”

Here’s another way of looking at ME and his achievement of marriage to the woman he has pursued for so long. Is ME now overtaken by fear because he has married Louisa and there’s so much to lose if he fails? Furthermore, having a successful love life is alien to him despite having coveted it for a long time, and now he may be having an identity crisis. He wants to change and has wanted to for a long time, but, faced with having reached such an exceptionally desirable state, he’s not sure how to handle it. He is not who he has known himself to be.

In conclusion, the psychiatrist writing the article boldly states: “We are all afraid of acquiring what we can so easily lose, whether professional status or someone to love. We are caught in a dilemma. Pursuing these commitments can be terrifying. But letting ourselves ignore them can be dangerous, even fatal.” Although I’d like to think that many of us can withstand the sense of accomplishment that comes with success in an important chapter of one’s life, I have to agree that these kinds of major adjustments are accompanied by trepidation. In the case of ME, he has allowed himself to be vulnerable because of his supreme love of Louisa. He might find it very anxiety provoking, even to the point of putting him into a dangerous depression, but his decision to follow her and to work on their marriage should take him out of the danger zone.

Success has immobilized him for quite a while; hopefully he will be rescued from the edge of the abyss by his own efforts to accept this change and by discovering Louisa needs him as much as he needs her. It’s her turn to reach down and grab him as he’s falling. (Sorry, sometimes I get carried away.)

Originally posted 2015-03-15 15:50:42.

Making Hard Choices

Recently I read an article by Ruth Chang, a professor of philosophy at Rutgers University, and then watched her TED talk.  The talk had to do with what makes some choices hard; the article was closely related to that but also about being the person you want to be and creating a new you. When she refers to hard choices, she’s talking about decisions we make between two options that are “‘on a par'” or between alternatives that are equal in value and are difficult to choose between because of that. There is no wrong answer, but they may not be equally good either. What she argues is that the choice we make must be something we can stand behind and commit to and thereby turn it into a position of value. To me, the strongest statement she makes in the article is “when we choose between options that are on a par, we make ourselves the authors of our own lives.” This assertion reverberated with me because it sounds very similar to what Ruth tells Al when he’s at loose ends. She tells him in S6E6, “we are the authors of our lives.” (I doubt the writers knew about Ruth Chang. Her TED talk was given on June 18, 2014 and the filming of S6 was over by that time. However, her earliest articles on this subject appeared in 1997 and thereafter she continued to write about this subject regularly.) Like so many interesting issues in human behavior, there are both psychological and philosophical ways to view them.

There are many hard choices confronting Martin and Louisa. We have been discussing the personality traits of these two characters. Presumably these would play a role in how they would go about deciding between the options they must face now. Ruth Chang’s article uses the tradition of making resolutions for the New Year as a starting point and ends by noting: “Our task then is to reflect on what kind of person we can commit to being when making those choices.” I think we can put this to work for the situation at hand, especially because it relates to making changes that can lead to being a different person, and change is what Martin plans for himself.

I’m going to take a stab at some of the hard “on a par” choices Martin and Louisa have to make and see what all of you think about these and what others you come up with.

1. Louisa must decide whether to return to the house. The alternative is to live in Portwenn and be separated (right now she can’t leave because of her recent surgery). This decision would be on a par because Louisa loves Martin and wants to be married and parent JH with his father; however, Louisa knows being married to Martin is difficult and Martin would continue to have a relationship with JH even if they lived apart.

2. Martin must decide whether to confide in Louisa and admit he needs her help. The alternative is to decide that he continues to be unable to have an intimate conversation with Louisa. This decision is on a par because Martin wants to be with Louisa and he recognizes that she has been very disturbed by his secrecy and unwillingness to reach out to her; however, Martin struggles to allow anyone into his inner world and he knows it will be arduous to convert himself into someone who asks for help and shares his thoughts.

3. They must decide whether to seek counseling, marriage or individual or both. The alternative is to try to reconcile on their own, possibly with Ruth’s help. This decision is on a par because both Martin and Louisa are aware that a counselor could be helpful and counseling has been recommended by both Edith and Ruth; however, Martin is skeptical of most counselors and likes to manage his own care, and both of them will want to go to counseling in a location not well-known by Portwenn villagers. Finding a way to budget the time for that may be too much trouble.

I could go on, but I’ll leave it to you to suggest other hard choices. I’d like to consider how this philosophical view can be combined with the psychological traits we’ve been discussing too.

In addition, I’d like to refer you to an article by Ruth Chang titled “Commitments, Reasons, and the Will” in which she discusses internal commitments. On page 78, Chang explains, “a promise to love and to cherish has greater normative significance than that of incurring an obligation through a promise. This is because it is backed by an internal commitment—something the promisor has done all by himself that gives his subsequent promise special significance or meaning.” We know Martin is a moral man, and we consider Louisa moral as well. They have taken the step to get married after having many vacillations in their interaction as a couple. Now that they’ve taken a vow to be together, they have made an internal commitment that Chang makes a strong argument about — it changes who they are and the significance of their relationship. That has to play some sort of role in what they decide to do and in what kind of people they want to commit to being.

Originally posted 2015-01-14 17:16:21.