Category Archives: psychological conditions


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.


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.

And we’re back!

Happy New Year to everyone! I hope you all had a good holiday and are ready to get back to our discussion about the MBTI and the personality traits of Martin and Louisa Ellingham. I’ve had a few moments to think about my view of where these two characters would land on the MBTI spectrum. When I took the MBTI as if I were Martin Ellingham, I came up with ISTJ, or The Examiner. All of the traits had percentages of 90-100%. (Here’s a description of the ISTJ from one website.)  When I took the inventory as if I were Louisa, the results were ENFJ, or The Mentor, but the Extroversion trait was the strongest while the others were in the 60-65% level. (The same website gives this description for the ENFJ.) While answering the questions as each character I noticed where they would overlap in their approach. To me, Louisa is often just as grounded as Martin and relates to the world on a practical and realistic level to a great extent.

It was a fun exercise and I look forward to reading more comments from you about this and to reading what Abby will write when she gets a chance.

I have also read another article about introverts that I would like to refer you to. This article was helpful to me in several ways. I was impressed by the mention of phone conversations being difficult for introverts because I have previously noted that ME often neglects to use the phone when it would be most convenient and expected. In addition, the article notes how much introverts prefer being on stage to being in a mass audience and making small talk. That led me to think that the move for ME from London to Portwenn actually might have been better for him than he realizes. It took him away from the surgery he loved and felt especially accomplished at, but it also removed him from a large city where he was surrounded by commotion and many people all the time. Essentially he is on stage in Portwenn because of his position as GP and its importance to a small town. He continues to dislike small talk, and we see this at the party for Joe Penhale in S3 when he takes Louisa aside rather than mingle with the other partygoers; nevertheless, in Portwenn he has more time to himself despite the fact that being a GP requires him to interact with patients more than being a surgeon had.

I think we can all agree that the most significant difference between these two characters is that Martin is quite prominently an introvert and Louisa is just as much an extrovert. I think they can both be seen as having had some influence on each other relative to these major differences between them. As series 6 advanced, Louisa was able to encourage Martin to interact with the community more in small ways, e.g. attending the school performance, taking JH to the music circle. At the same time, she also appears to have accepted his desire to stay home and there are no more occasions where she goes out with friends while he takes care of JH. Once again I can’t make the argument that there is any effort by the writers to deliberately reference these two characters’ markedly different ways of dealing with the outside world. However, the introversion/extroversion distinction is so pronounced in these characters, that we have to imagine it was planned.

It’s nice to get back to the blog. Please join the conversation!

Originally posted 2015-01-04 14:19:01.

Myers-Briggs Personality Test

The following is a further explication of the Myers-Briggs personality test that we have discussed in earlier posts. Abby has put together an introduction to the test that should give you a good overview of it. In addition, she has provided a link to a website where you can take the test yourselves. Then, if you like, you can take it as if you are Louisa and/or Martin (and hopefully base your answers to the questions on what you know about them through the show) to come up with their profiles. It will be interesting to see how similar our results are and how they compare to what Abby’s findings are. Of course, all of this is meant to be a fun exercise and not predictive of anything. We hope you enjoy this as illuminating, yet simply another way to look at these characters.

Abby writes:

The post “Dr. Martin Ellingham, Patient” seems to have sparked an interest in learning more about the Myers Briggs Type Indicator (MBTI). While I am not an expert in the MBTI, I do use it with most of my clients in order to 1) understand them better; 2) help them understand themselves better; and 3) help them understand other important people in their lives. So, what follows is an explanation of the MBTI model, as I understand it.

There are a number of personality instruments that have been developed over the years. Some are meant to help mental health practitioners with diagnoses; some for use by business and government for hiring purposes; and a few meant to help people understand themselves better. The MBTI is in the latter category, and, as such, does not pathologize. Indeed, every type in the MBTI model is deemed as having the same worth as any other.

The MBTI was developed by a mother-daughter pair of researchers, Katharine Cook Briggs and her daughter, Isabel Briggs Myers, based on Carl Jung’s work on archetypes. The MBTI looks at four aspects of how we function in the world. Each of these four aspects has two possibilities, or preferences, as they are referred to. So, a person who takes the test ends up with four letters, which is their type. The four dichotomous aspects are Extraversion/Introversion (E/I), Intuition/Sensing (N/S), Feeling/Thinking (F/T), and Judging/Perceiving (J/P). It is important to understand that each of these four dichotomous pairs falls on a continuum. That is, we are not all one and none of the other.

The first, E/I, describes how people “recharge their batteries”. It also involves whether we focus our attention primarily on the outer world or on our inner world. So, the questions to ask yourself are 1) When you are tired at the end of the day, do you recharge by going out and being with friends (E) or by going home and being by yourself (or with one or two other close people)(I)? 2) When you are at a party, do you feel energized (E), or do you tire out early in the evening (I)? 3) Do you consider yourself an observant person (E), or do you miss things because you are so focused on your inner life (I)?

The second aspect, N/S, describes how a person gathers information, or perceives things. Sensing types perceive things through their five senses, and are concrete thinkers who tend to be practical people focused on facts and details. Intuitive types perceive things through internal processes in the mind. They are abstract thinkers, who tend to see the big picture and are interested in theory. So, if there were a group of people tasked to do a project, the intuitives would be the ones to come up with the overarching ideas, while the sensing types would take those ideas and figure out how to make the project happen.

The third aspect, F/T, describes how a person makes a decision, after gathering information through intuition or sensing. This is the only aspect where there is a statistical gender difference: Men are 60/40 T/F, while women are 60/40 F/T. Thinking types base their decisions on logic, while for feeling types incorporating values and human impact are important. So, if you have a married couple, where the husband is a thinking type and the wife is a feeling type, and they are planning a road trip, the husband would likely choose the most direct route (logic) to their destination, while the wife would likely want to make a detour to visit Grandma (values/people).

The fourth aspect, J/P, describes how we structure our lives. Judging types tend to be organized, to like routines and schedules, and are good at completing tasks. They also tend to have fixed ideas about how things should be. Js love the closure that comes when a decision is made and feel anxiety when things are open-ended. Perceiving types, on the other hand, are not comfortable with routines and schedules, but prefer a lot of flexibility. They tend to be spontaneous people who are open and flexible in their thinking. They love possibilities, and so feel anxious when having to make a decision, because once the decision is made, all of the other possibilities disappear. Because of their love of possibilities, Ps tend to jump from one task to the next, not finishing the first before they start the second.

As was said above, all of the pairs should be viewed as being on a continuum. Therefore, we may be 60% feeling and 40% thinking. If we are close to 50/50, we will display behaviors of both preferences. If we are more toward the ends of the continuum, we will mostly show our stronger preference. We can, and should, draw on the less preferred preference when appropriate. So, going back to our couple taking the road trip, the husband would be able to see his wife’s point about visiting Grandma, even though his mind didn’t automatically go there. And, his wife is perfectly capable of seeing the logic of taking the most direct route. The MBTI is not about putting people in boxes, but simply to help them understand their “default settings”.

If you would like to take the test yourself, here is a free website: If you take it, be sure you answer the questions quickly, not thinking too much. It’s important to answer as you really are, not the way you wish you were or think others want you to be.

After reading this post and perhaps taking the test, please jump in and make your guesses as to Martin and Louisa’s types. Once we have some responses, I will share my guesses with you. Keep in mind, there are no right or wrong answers on this, because these are fictional characters (WHAT?!) we are talking about. I look forward to reading your replies.

Originally posted 2014-12-20 13:35:57.

Dr. Martin Ellingham, patient

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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



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

Happiness is…

It seems to be a good time to revisit the concept of happiness. Rather than look at the many theories of happiness, it might be more productive if we stick to the show for evidence of what they consider signs of happiness.

What has been hardest for me is grasping how in two episodes Martin can go from, “Marry Me, I can’t bear to be without you,” to “You wouldn’t make me happy either.” It’s a bit easier to understand how Louisa, who has vacillated between finding Martin exasperating and being passionately drawn to him, could come to the conclusion that getting married might not be appropriate at this time. She hears all the jibes about Martin and his temperament and can only muster that he’s straightforward and moral when trying to describe him. For someone who’s been seen bicycling, surfing, enjoying the scene at the pub, and going out with friends, his preference for staying home and rarely doing anything beyond reading or working on his clocks might finally make her think twice. (I should say here that due to her upbringing and parents who were inclined to party a little too much perhaps, she might like someone who’s trustworthy and grounded even if he could be a bit dull.) We certainly have to take into account that throughout the final episode nearly everyone has been cautioning them against marriage and the Fates are against their marriage as well. We watch as Murphy’s Law takes charge. But if Martin can’t bear to be without Louisa, that would necessarily mean that he is miserable without her and bereft of any sense of happiness. That is exactly how he appears after their date goes wrong. Why is he now thinking that he wouldn’t be happy with her (ostensibly only 3 weeks later)?

Also, when in S4, Louisa snidely remarks that he may find being with someone prickly and emotionless like Edith makes him happy but she’d rather remain hormonal and filled with emotion, she is tacitly saying that she wouldn’t make him happy after all. Of course, Martin is once again totally baffled by her reference to Edith. Still, after S1, there is a concerted effort to keep Martin from looking happy in any overt way. The closest we ever get to seeing him look happy is a hint of a smile when he takes Louisa’s hand or when she says something complimentary to him, or when he looks at the ultrasound of their baby.

The first question we should ask is do we think there is evidence that ME has any awareness of the state of being happy? To answer this question we actually do have to consider the 4 major theories of happiness: Hedonism Theory, Desire Theory, Objective List Theory, and Authentic Theory. Simple descriptions of each can be found here. The proponents of the Authentic Theory believe that their theory takes all of the other theories into account. Happiness is a pretty complex subject that continues to be debated and refined. The dissertation by Ryan Hanlon Bremner written in 2011 does a very good job of addressing the various ways we use the term “happy.” While interrogating the philosophical approaches to this state, Bremner notes: “As long as the vast majority of people in Anglophone societies claim that one of their major, if not their main, goal is to ‘be happy,’ this desire and correspondent striving possesses a magnitude of importance that should not be ignored.” The fact that DM writers have made a point of whether Martin and Louisa are happy, both at the end of S3 and in S6, inspires us to look into what that means. They, too, are indicating that being happy is an important goal.

So what could Martin mean by saying Louisa wouldn’t make him happy after recently being despondent that she doesn’t want to see him anymore? At the risk of overthinking this, and not simply dismissing it as a goof or miscalculation by the writers/producers, it could mean that he’s nervous that he will have to make too many changes in his life to accommodate her. Daniel Haybron, a contemporary philosopher, believes that “well-being consists mainly in the fulfillment of the self’s emotional and rational aspects—i.e., in being authentically happy, and in success regarding the commitments that shape one’s identity. But our subpersonal natures may also count, so we might add, secondarily, the fulfillment of our “nutritive” and “animal” natures: health and pleasure.”

When given a chance to reflect, Martin may have gotten cold feet because he has reached a sense of well-being by distancing himself from others, sticking to his routine, and being content to treat medical conditions successfully and even insightfully. In addition, he has his own diet that he follows quite faithfully. He’s been doing all these things for around twenty years which means they are rather entrenched. He is pretty inflexible when it comes to his daily regimen and he resists modifying it. When Peter Cronk stays with him, for example, Martin is lost because he has trouble finding a way to manage someone else in his home and he doesn’t do very well with it.

What makes him happy? Well, his sense of well-being comes primarily from his work. He is confident of his medical knowledge and ability and we see him display satisfaction in saving a life or making a diagnosis. He accepts the gratitude he gets from the many patients, who sometimes grudgingly admit that he saved their lives, with some puffing out of his chest or pulling down of his shirt cuffs. He’s clearly pleased with himself. Next may be preparing fish/dinner. He takes pride in knowing how to clean and cook the fresh fish and vegetables he buys regularly, and putting together a nutritious meal. We can’t forget the clocks he enjoys working on. Saving the clocks is somewhat analogous to saving lives in that he staves off likely termination.

All of the above touches him on some personal level; however, his connection to people beyond medical cases boils down to family, Edith, and Louisa. We know that the only affection he’s gotten from family really comes from Aunt Joan. He must have had some intimate contact with Edith considering she alludes to his having seen her naked before. Hopefully he didn’t get stabbed by her hair or protruding bones! Once he sees Louisa, he knows he wants to get closer to her. Eventually that happens and the embrace they have after he’s asked her to marry him and she’s agreed shows him with an expression of joy and relief. We see expressions akin to this when he holds her hand both at the concert and then at the Castle, when she gives birth to their baby, and when he sees her at the entrance to the church on their wedding day. I cannot imagine that we aren’t supposed to think that he achieves a sense of well-being when he’s with Louisa.

My conclusion is that Martin does experience happiness on many occasions, but that his life hasn’t always been happy. Conversely, as philosopher G. H. Von Wright believes, it would be possible to say that someone had a happy life, even if for a long period of time he was a most unhappy person. We see both of these scenarios being played out and now we hope to see the happy periods combined with an overall sense of well-being. He’s got a wife, a son, and Ruth. He’s got his medical practice and ability. He should stop being so miserable!!

Originally posted 2014-10-14 18:11:55.

Normal On My Mind

Blame the NYTImes again! Last Sunday they published an article on what study subjects identified as normal, and the results add a fascinating layer onto our previous discussion of what the term normal means.

In our past look at the use of the word normal in Doc Martin (see “Normal Is A Loaded Word”), we toyed around with substituting several other words, e.g. typical, proper, conventional. What this article brings up is another word: ideal. For me the biggest takeaway is their determination that “when people think about what is normal, they combine their sense of what is typical with their sense of what is ideal. Normal, in other words, turns out to be a blend of statistical and moral notions.”

It may be useful, as my husband suggested, to think of normal as lying on a bell-shaped curve, as many of our concepts do. The height of the bell would be the best interpretation of what we usually accept as normal, while the side to the right of the curve would be gradations of ideal, and the side to the left would be heading toward totally abnormal.

The SD at the bottom of the graph is standard deviation from the mean/median (or average/midpoint) of a sample. When applied to this example, what the article is arguing is that when people are asked to judge whether something is normal, they actually are likely to see normal as where the +1 SD is on this bell curve. In other words, they see normal as being one standard deviation towards ideal.

If we apply this to the show, we could regard Louisa as struggling with this dynamic. She has been living in a fantasy world of judging normality in the community, in her parents, and subsequently in Martin Ellingham and herself on a scale that leans toward ideal when the real world, as portrayed in this show, is actually leaning toward 1-2 SDs in the opposite direction. In other words, she is surrounded by a world that tends toward the abnormal.

By the end of S7, she has come to the realization that the community is filled with unusual people, and that she and Martin are also unusual. We considered this disclosure strange coming from someone who had continuously been portrayed as accepting the differences in people. We thought her revelation came out of nowhere, and I’m not ready to reject that entirely, but…

In looking at the ending of S7 in this hypothetical manner of a bell curve, I wonder if the writers were using the above rationale when they wrote Louisa’s closing dialogue so curiously. It would have been better, IMO, if they would have provided some sort of clue for us to use since, according to the article, “however deeply ingrained this cognitive tendency may be, people are not condemned to think this way. You are certainly capable of distinguishing carefully between what is typical and what is good.” On the other hand, they caution that “most often, we do not stop to distinguish the typical from the acceptable, the infrequent from the deviant. Instead, we categorize things in terms of a more basic, undifferentiated notion of normality, which blends together these two importantly different facets of human life.” If we want to be generous, we could decide that Louisa has had some sort of epiphany explained by her recognition of how to distinguish between the typical and the good.

Originally posted 2017-02-01 16:05:46.

Louisa’s Difficulties and Martin’s Hand Wounds

After Santa and a few others mentioned the last scene in S6E3 where the camera recedes (a dolly-out shot) as M continues to treat the cut on the palm of his hand, I went back to look at it. Their comments had to do with the camera work accentuating M’s isolation, which I think they are right about. Then I started thinking about how that episode has always bothered me, beginning to end. I have been a staunch defender of Louisa, but if I were to find a time when I think Louisa is depicted as lacking sympathy or sufficient concern for M, it would be in this episode. I want to discuss that and then move on to another pet peeve of mine-whether DM is medically accurate.

The episode begins with loud knocking at the front door before 6:30 a.m. L is annoyed at being awakened so early and stays in bed while M goes downstairs to see who’s at the door. It isn’t long before her alarm rings and the baby starts crying. She didn’t get much more time in bed and I would have expected her to get up with M like she does in S5 when Morwenna shows up too early for work. (I think that time it was only 6 a.m.) When L comes down to see what’s going on, M asks her if she can identify the man who has been dropped off after being found unconscious on the beach. She has never seen the man before and is in a hurry to get James dressed. We can hear James crying upstairs. She, therefore, doesn’t want to get M water for the pt. The look he gives her makes her change her mind. I would have expected her to be willing to help with the water without objection. The next time we see her, she is ready to head out to school and finds many things to express concern about to Michael before she hands him James. Here we have a mother’s difficulty with leaving her baby, while she overlooks her husband’s needs. We know M has gone upstairs to get dressed, but we don’t know what, if anything, was discussed while they were both getting ready for the day.

By the time L is ready to walk out the door, M has confronted his blood phobia’s return. L notices something is up with M, but ignores it and leaves for work. (This may not be surprising since he looks like he’s deep in thought and he isn’t much for affectionate goodbyes.) They’re really both on edge, for different reasons.

As the day continues, L is distracted by mixed feelings about leaving JH and doesn’t read Becky’s article for the newspaper. The next day she gets angry with Becky over publishing it without her permission. She’s still bothered by leaving JH with Michael. Thus, work is stressful at the same time as L is stressed by her dual roles and M can only say “I told you so.” We should give her some space for dealing with so many stresses.

The following day begins with Ruth visiting and finding M rocking JH because they had a bad night. Of course, lack of sleep puts additional stress on both parents. The day turns out to be trying in many ways with L dealing with Bert’s anger over Becky’s article and M dealing with the recurrence of his hemophobia and then rescuing Ruth from her stalker and getting his hand cut.

By the last scene, L has learned of M’s scuffle with the stalker at R’s house and says, “what a day!” She sees him cleaning his wound, and asks how his hand is. She’s not satisfied and asks again if he’s all right. He covers up by asking her about her day and putting some gauze over his wound, keeping it covered from L. L tells him about how she’s handled the Becky matter. It would be a nice exchange between them if it weren’t for the hand issue. L tells him he looks pale, but reads Becky’s article about him anyway, asks if he’s really ok, then leaves him. Of course, he says he’s fine; he says that every time. But I had to wonder why L would read an article to him that criticizes him just when he’s dealing with a wound after a long, tedious day? They first agree that Becky has a right to free speech, but it’s rather harsh to read a critical article about M at that moment. If it’s meant to be funny, the joke falls flat, including L’s judgment that Becky’s only ten and has written this piece well.

Louisa at least has a mixture of concern and lack of concern. She always meets with his resistance to tell her very much, and that can’t be easy. So I give her a less than satisfactory assessment during this episode even though she can’t be faulted entirely.

Then I started thinking about all the times M has wounded a hand and how difficult that would be for a surgeon. Their hands are exceptionally important to them.
S2: Martin gets his wrist caught in a trap while looking for Mark in the woods
S4: falls and hurts hand on broken glass
S6: hurts wrist falling down a hill in E1
gets his palm sliced by large knife during scuffle in E3

Hand wounds are often quite painful and this last one should have been. I also think it should have been looked at in the ER and L should have insisted on taking him there. Most doctors think they can take care of their own medical problems only to find out they need help. (I know because I’m married to one of those! Don’t bother a colleague-it’s embarrassing.)

In the above episode there are several medical and logical instances that are not very accurately presented. Not only does Martin seem to have a clean gauze bandage handy in his pocket to wrap around his bleeding hand immediately after it is cut, the knife isn’t dripping from blood after the event. Martin seems to have a high pain threshold throughout the series, and in this case he would have to because palms of hands have a lot of nerve endings. Following the altercation, he offers to make Ruth a cup of tea to calm her, which means he must feel good enough to not deal with his hand immediately. We also have to assume the cut wasn’t very deep because he can move his fingers and the wound stops bleeding pretty fast. Also, Martin had to have held his hand so perfectly following the cut, and the cut must have been rather shallow, or the skin would not have been aligned as well as it looks in the final scene, nor would the edges have adhered to each other so well. Furthermore, all surgeons are very alarmed by any injury to their hands. Surgeons sometimes joke that they are all cerebellum, brainstem and hands. At the beginning of S6E4, Martin no longer has a bandage on his left hand and he can hold the baby without a problem. We don’t know exactly how much time has elapsed between these two episodes, but unless it’s at least a week later, it would be surprising for him to not have it bandaged anymore. In S4, his phobia kept him from even looking at his wound and he kept the bandage on for quite a while.

In addition, Ruth gives Robert an injection of either Largactil or Benzodiazepine. She suggests either to Martin, and we’re not sure which one he has in his bag. Both of these meds are used to treat all sorts of psychiatric disorders related to psychosis, anxiety, schizophrenia, etc. Neither would be likely to work so fast that the patient would collapse on the floor immediately following an intramuscular injection of it. It would be more likely to take a minimum of 5 minutes rather than 10 seconds to take effect. For the purposes of the show, the medicine has to work fast, but it’s not accurate.

There is always a spectrum of plausible to possible to likely in every medical condition. Naturally there are individual differences for everything too. But I think the accuracy of the medical cases in this show is very much along the lines of what Philippa says in one interview: they ask the medical consultant if something they’ve come up with is possible and if he says it is, they leave it in. The medical accuracy in this show is better than most yet still not really that stringent.

Originally posted 2014-05-22 17:23:25.

And Now for Aunt Ruth

I realize it has taken me a very long time to follow up my post on Aunt Joan with one on Aunt Ruth. Family demands have been the reason. A colleague of mine once told me that family keeps interfering with one’s work. This blog isn’t exactly work, more a labor of intellectual entertainment. Still, I try to keep up with it.

Ruth’s relationship to Martin has been very different from what Joan’s has been. While Joan had taken Martin under her wing and helped provide love and a refuge from his horrible parents, Ruth has never spent much time with M on an individual basis. She has memories of him as a child, and she speaks to him every year at Christmas time, but there’s no evidence that she and Martin have any close ties. Their ability to communicate is based on their choice of professions and on their similar approach to personal interactions. She’s the middle child between charming but artificial and demeaning Christopher and warm and totally disarming Joan, and she has a little of both of them in her. They’ve all grown up in a family that Ruth describes as “distant mother, overbearing father.” We also know she was never allowed to call her father “Daddy.” Ruth mentions to Bert that because of her profession, she’s always on the lookout for personality disorders, that it’s an occupational hazard. Well, there were many members of her own family who had personality disorders. It may seem too stereotypical to say that she went into psychiatry because of her own emotional difficulties, but it’s something to consider. The fact that she decided to enter a side of her profession that deals with very disturbed individuals, the criminally insane, tells us that she chose an area of psychiatry in which there is less talk therapy and more medication therapy. She must approach her cases with a degree of detachment greater than most psychiatric care and her personality is suited to that. I would argue that her general manner of interpreting situations is clinical, quick to identify essential factors, and objective, although there are moments when she has breakthroughs of emotion. Throughout this show, we are presented with the dichotomy of emotional responses against rational ones and asked to weigh which one works best. The character of Ruth brings that comparison more into the foreground.

In contrast to her siblings, Ruth has never married or even had much of a love life. The only indication that she’s had any sex in her life is when she tells Louisa that she had a “succession of quasi-sexual encounters at a very young age.” That doesn’t have a positive implication and she may have been scarred by these in some way. It’s a leap to say too much about that, but the message is that she really doesn’t know much about love and intimacy.

Everyone in the family seems to dislike Christopher, so they all have that in common.

Our introduction to Ruth is when she arrives for Joan’s funeral in her blue, old model Mercedes. She approaches Martin, who is standing with Louisa and the baby, and says “condolences and that sort of thing.” She has suffered a loss as much as Martin, but she treats Joan’s death as if Martin has lost a lot more than she has. Martin does not reply in kind, which seems to indicate he, too, considers Joan’s death more of a loss for him (or that he always finds it hard to express sympathy). Ruth has heard about Louisa and the baby from Joan, but Louisa has never heard about Ruth. When Martin asks Louisa to accompany Ruth into the church, we get more of Ruth’s cynicism and frankness. She tells Louisa not to lie about having heard about her, or, if she chooses to lie, she should do it with more conviction. Once seated in the church, Ruth tells Louisa that she isn’t much good at small talk, that her “upbringing gifted her with a chronic case of social awkwardness,” and that she “either alienate(s) or overshare(s).” She also has no hesitation in asking Louisa if she plans to try to marry again, and says she looks the type. Her question is great because it exhibits her social awkwardness while also expressing something we viewers wonder too. After the funeral we learn that Joan has chosen to leave the farm to Ruth even though it was Martin who salvaged it for Joan, but Ruth remarks that Joan “was determined to get me out of London.” (Ruth also notes that she only gave Joan slippers for Christmas, a remark that’s both funny and another sign that Ruth has a cynical approach to life.)

She plans to stay for a week at first, but eventually decides to stay on and write a book. Soon after her arrival in Portwenn, Martin bumps into Ruth outside the green grocer. She has not yet adapted to life on the farm, but it’s her cough and overall appearance that Martin notices, along with her evasiveness about her health. This is also when Ruth makes the important observation that she is proud of Martin for doing “serious medicine” again. I enjoy her equation of being a GP with doing “serious medicine” as opposed to whatever doing surgery is. She has a vastly different opinion of Martin’s current medical practice than either of his parents has, or what he himself has. As they part company, Ruth sends her love to the family. Her tone carries a touch of formality and another of amusement. On the show there is an ongoing difficulty with defining who comprises one’s family, and her comment is a reminder of that.

It turns out that Ruth’s evasiveness is due to her suspicion that she is dying from lupus. We learn this because she must seek Martin’s help after she cuts her finger. While treating her deep cut, M discovers that she doesn’t feel pain and eventually manages to get R to reveal her suspicions about her health. We also see her get emotional for the first time. She’s brought to tears about the prospect of dying and reacts with uncharacteristic affection when M tells her his very different and much less dire diagnosis. The enthusiastic hug she gives Martin after he tells her she has Sjogren’s and not lupus is the only time they have any physical contact. The overt affection he and Joan shared is not a part of his relationship with Ruth; however, Ruth and he share a trust and compatibility he can’t find with anyone else. Ultimately, he looks to Ruth for advice and guidance that Joan would have been less capable of giving him.

Although S5 is very much about how Martin and Louisa deal with living together with their baby, Ruth has little to say about them as a couple until E5 when M takes the baby to Ruth’s for breakfast. It is then that Ruth observes that Louisa won’t like moving to London and that Martin and Louisa shouldn’t stay together for the baby’s sake. Her comment seems to take M aback and he denies that that is the reason they are staying together. I find this a stark contrast to the way Joan relates to Martin about Louisa and the baby. Joan is anxious for Martin to tell Louisa how much he wants to be with her and the baby; she seems certain that M is quite attached to both of them. The other thing that happens during this breakfast is that Ruth feels the need to point out to M that his baby wants his attention. She seems to be indicating that he’s not attuned to his son. For me, the fact that he has taken the baby with him to give L a break, dressed him, and gone through the rigamarole of getting him in and out of the car and stroller is evidence that he’s responsive to his baby.

E6 opens with Martin, Louisa, and James Henry having dinner with Ruth at the farm. Ever practical Ruth immediately asks who will look after the baby while L is at work. L answers that her mother will be taking that on, but M expresses doubts about her reliability. Ruth then wants to know about the back-up plan, which prompts L to ask if R is offering to help. Of course, R has no desire to help with the baby and the conversation deteriorates when M and L disagree over whether L could take him to work on occasion. There’s no escaping the tension between these parents. Dinner is followed by a trip to a shed where R wants to show them some items J was keeping: a clock that M remembers from his childhood and pictures of M as a young boy. This venture marks the first time L hears anything directly from R about M, and that M tells her anything directly about his childhood. M informs L that he went to boarding school at age 6 3/4 and took a taxi, then a train, then a bus. When L remarks that M doesn’t look very happy, R tells her he was happier at school than at home.

Later in E6 there’s more tension when M brings L a pamphlet about a boarding school at which he wants to hold a space for James. M has chosen a particularly bad time to bring up the boarding school idea because L is about to leave JH and go to work, and the whole idea horrifies her. They drop it for the time being but there’s more trouble ahead because when L gets home after a rough day, she discovers that M has moved the chocolate digestives and that he would like her to lose some weight. Ruth arrives just as L accuses M of calling her fat. Walking into this maelstrom puts Ruth in a difficult position. She has come to bring Martin the key to the clock and to bring L more pictures of M, and she certainly doesn’t wish to get in the middle of their discussion. Nevertheless, she can’t help noticing the school brochure and knows the previous headmaster had to leave because of embezzlement charges. Ruth innocently mentions another boarding school, which prompts L to snap about the whole idea of sending JH to boarding school at all. Thus, R is once again caught in the middle and the psychiatrist who habitually judges other people appears stunned and off balance.

Soon after, Louisa runs into Ruth in town and they talk about the pictures of M. Louisa is troubled that Martin always looks so sad, but R says it was always pointless to ask M to say cheese. She follows that with a comment that people don’t change, an echo of what Joan once said to M, and mentions the christening date. Once again L chooses to lie (without conviction) to R, and acts as though she knows about it. There’s no doubt that R notices. So far Ruth has accidentally inserted herself between Martin and Louisa all too frequently.

It’s hard to say whether Ruth has strong feelings about Martin and Louisa, but she has her doubts. She must notice that they both care about each other, but she also recognizes the significant differences between them. Since Ruth’s general approach is to be objective, and because of her own deficiencies when it comes to male/female relationships, I think she must be concerned that M and L are struggling as a couple. However, we have now reached E8 and M and L go through all sorts of challenges in this episode with R very much along for the ride. R gets involved only because she happens to see Penhale lose control of his car and jump the retaining wall. She then accompanies M and Penhale to the pharmacy to get JH from Mrs. T and get Penhale the correct eye drops. R is valuable because she explicates the medicine, finds the note Mrs. T has left, and reminds M that he needs to tell L what’s happening. She and Penhale accompany M to the school to get L and then join the search for Mrs. T. R is not much comfort at this time as she can’t help giving a clinical analysis of Mrs. T’s condition which includes a degree of uncertainty about the safety of JH. But in the hotel, R takes control, tells M and L to stop bullying the desk clerk and tells the clerk “a child may be in danger so grow a backbone, check that damn machine, and tell us if anyone has checked in with a baby or not.” She helps them look for Mrs. T. in the hotel, reminds them that Mrs. T. is not thinking rationally, and tries to calm M when he gets a phone call from Mrs. T. At this stage, R’s sensible approach keeps M and L from getting too heated about the circumstances.

Once they reach the place where Mrs. T. is holding the baby, R joins them at the entrance door. Here she is both a voice of reason and the person they can both react against. She continues to make an effort to keep them from getting too worked up and argues with both of them at times: she argues with M about what to do and she argues with L over how to respond to Mrs. T. R continues to be clinical while L just wants her baby back. R stands next to L while M talks to Mrs. T., and there are several occasions when she and L appear to have the same reaction to what they are hearing. However, the two women clash significantly about what M should tell Mrs. T. Louisa argues for a much stronger expression of M’s feelings for Mrs. T. than R recommends. M takes L’s advice and tells Mrs. T. that he had Penhale come with him “because he wanted to share our wonderful love.” Since Mrs. T. still hesitates, L tells M to say something even stronger and shushes R when she says that L knows nothing about psychology. M follows L’s advice again, and although R has one more warning about L’s errant advice, M’s expression of love works and Mrs. T brings down the baby. What has really taken place is L guiding M to tell her his true feelings. Through L’s success, we have witnessed emotions, in the person of L, winning over reason, in the person of R. Ruth’s final act is to usher Mrs. T. away from M and L and leave them to finally talk things out with each other.

We still have S6 to get through, and Ruth has a larger role in this series. My overall sense of Ruth’s assessment of Martin and Louisa in S6 is that, despite her continuing doubts that they belong together, she now wants to help them stay together. She expresses reservations before and during the wedding, but offers to help with JH so they can have a night alone, is available to both of them for talks and assistance, and has become a very important member of their family. She is protective of Louisa when Mrs. T. returns and tells L she will check on Mrs. T. when she gets back to the pharmacy. She wants to help M deal with his hemaphobia by recommending a good psychologist, and she is protective of him when his mother returns. The scene when Ruth tells Margaret she’s worried about the pain Margaret can still inflict on Martin, and to go home, is priceless. And, of course, the last episode makes us abundantly aware that Ruth is the person Martin can turn to in his anguish. She sets him straight about his insomnia and blood phobia, motivates him to confront his mother, encourages him to go after Louisa, and is where Martin wants Penhale to take JH when they arrive at the hospital. She hasn’t become any more emotional, but her common sense approach has softened just enough to show true affection for M and L.

Originally posted 2014-04-06 21:07:27.

Laughter and Civility

Our last discussion was about attachment theory, and I had been considering writing a post about that, but I have found a different reason to take up my “pen” again. Recently there was a review in the NYT of several books that have been published on the subject of civility. Therefore, I was moved to write about that. (I’m sure some of the current public behavior we have been witnessing had something to do with this urge, but, the fact that laughter has sometimes been connected to civility also made me want to write about it.)

Somewhere in the back of my mind I remembered that the philosopher Thomas Hobbes had written about his theory of laughter. I think I remember it because of the example he used. Hobbes’ theory revolves around those who laugh because they feel superior to someone else as when we laugh at someone who slips on a banana peel. To Hobbes, a society built on laughter would be a society built on mockery, or people laughing at the misfortunes of others.

It surprised me to learn that Hobbes was one of the few philosophers who gave laughter much consideration. Aristotle, for example, wrote more about tragedy and how tragic characters were generally of average or better than average standing. In his view, in comedy individuals of lesser virtue are the norm and we look down on them. The bottom line seems to be that humor is often a consequence of denigrating someone.

I confess to being guilty of this, and suspect most of us are. Moreover, Doc Martin is rife with humor based on this model. Whenever ME walks into a door frame or low ceiling, slips in mud, or drives his car off the road; whenever Penhale attempts anything resembling actual police work; whenever Louisa dangles from a hospital bed or says something that is misinterpreted, we are in the arena of Hobbes’ Superiority Theory of laughter. We could add other characters, e.g. Mrs. Tishell, Bert, and Janice. Each one of these characters has been depicted in comedic settings that would be categorized as a pratfall. A pratfall is basically a stupid and humiliating action. It is something that has been a part of comedy for as long as we can remember. And the remarkable thing about it is that it often involves a perceived highly-competent individual who becomes more likable after committing a blunder, according to something called the pratfall effect. I would venture to say that all of the above characters benefit from the pratfall effect. Thus, we can summarize that we laugh because we recognize how inept these characters are while we also find them more appealing as a result.

Furthermore, I then came across a recent article by Emily Nussbaum, TV critic of The New Yorker Magazine, on jokes article It seemed perfect that the accompanying picture is of a golden banana peel with the potential that there could be a tangential connection to Hobbes’ Superiority Theory. Nussbaum lists Mel Brooks, Rodney Dangerfield, and Don Rickles as practitioners of a type of humor that she calls insult comedy. (I would put Dame Edna in this category as well.) In the process of being rude, these comics also reveal some very incisive points about society and politics.

Indeed Nussbaum comments that the political journalist Rebecca Traister described this phenomenon… as “the finger trap.” “You are placed loosely within the joke, which is so playful, so light—why protest? It’s only when you pull back—show that you’re hurt, or get angry, or try to argue that the joke is a lie, or, worse, deny that the joke is funny—that the joke tightens. If you object, you’re a censor. If you show pain, you’re a weakling. It’s a dynamic that goes back to the rude, rule-breaking Groucho Marx—destroyer of élites!—and Margaret Dumont, pop culture’s primal pearl-clutcher.”

Isn’t that exactly what happens to ME when Bert sets him up with his fake injury using ketchup? Nothing ME did at that point could have salvaged his dignity. Another time this trap appears is when Pauline takes a picture of ME sleeping with the dog on the floor and then shares the picture around town. ME gets comedically “punished” regularly, either with pratfalls or with irreconcilable humiliations. His most prevalent rejoinder is one of superiority towards those who are discourteous to him. There’s almost a “tit for tat” element played out.

I am not saying that laughing at such situations is malicious, even if Hobbes would make that argument; however, I am proposing that we should step back and think about what it is that makes us laugh.

The Superiority Theory leads us to a discussion of the subject of self-esteem, which is how one views oneself or one’s attitude towards oneself. Self-esteem has been the subject of much study with prominent psychologists like Abraham Maslow and Carl Rogers, placing it in an important position in human development. I think we can leave it at the place where we recognize that there are people who have anything from high self-esteem to low self-esteem, and each of those markers is associated with particular personality characteristics. (We have already analyzed ME and LE on the MMPI, and we could get into where they fall on the Rosenberg Self Esteem Scale, but that is not what I want to concentrate on in this post.) More important is whether our own self-esteem is implicated in why we laugh, or accept without much reservation, that it’s admissible to laugh when comedians are uncivil to others.

First we need to agree on what it means to be uncivil. Civility goes beyond mere toleration, but may inherently imply a mutual co-existence and respect for humankind. It may interest you to know that George Washington wrote Rules of Civility as a teenager. It is a list of 110 ways for how to behave civilly. Obviously he felt compelled to set down some guidelines during his youth, and we can only imagine he had a reason to think society needed to know them. More recently there have been articles in psychology journals that address this concern as well. In the mentioned article, civility is defined as “awareness, self-control, empathy and respect…It requires us to treat others with decency, regardless of our differences. It demands restraint and an ability to put the interests of the common good above self-interests.” Even though I have not tried to find the statistics on current uncivil behavior, I think we can agree that between the online bullying and the overt impolite conduct too many young people exhibit towards adults (not to mention the name calling and other forms of belittling practiced by adults), we can come to the conclusion that uncivil actions have only increased. Should we be troubled by the expression of uncivil comportment in our comedy?

The controversy about civility and how to deal with it has been long standing. In that same recent book review in the NYT mentioned above, Hobbes is noted as having “feared that strident expressions of disagreement would threaten the diversity of views in society (much as hate speech is now thought to do), so he advocated an ethic of ‘civil silence,’ or public discretion: People could differ privately in their opinions as much as they wanted but should not openly dispute one another. Locke, by contrast, wanted to preserve public debate, but worried that too much diversity of opinion might jeopardize productive disagreement (the sort of concern campus speech codes now reflect). So he urged an ethic of ‘mutual charity,’ which required people to cultivate at least a minimal appreciation for the views of their opponents, or else be disqualified from debate. Both thinkers, in other words, imagined bringing about a tolerant society via suppression or exclusion — the very forces you would think a tolerant society would want to avoid.”

The review goes on to note that Roger Williams, a 17th C religious radical, “asked not that everyone keep quiet or respect his or her enemies, but merely that everyone not do anything to stop the conversation from going. Williams’s ‘mere civility’ demands more of us than Locke’s or Hobbes’s civility, in that it requires we have thicker skins about other people’s rudeness or disrespect; but it also demands less of us, in that we no longer have to muster respect for, or mute our criticism of, views we abhor.” In other words, he contrasts forbearance with tolerance.

Who is acting uncivilly in Doc Martin? Topping the list is the group of girls who regularly walk past ME and call him a tosser amongst other things. They are particularly bad when they mock him after Louisa leaves him and suggest he might want to date one of their mothers. Actually I have trouble thinking of any teenager in this show who isn’t disrespectful. From the boys on the beach who tell off ME to the delinquent Eleanor engages to watch James Henry to Becky Trevean and her cohort, they are all extremely impolite and disturbingly combative. Then there’s Becky Wead who writes the critical article of him in the school newspaper and Kelly Sparrock who tells him off and treats him with disdain even while he’s trying to diagnose her seizure disorder.

Apart from these members of Port Isaac’s community, we can include many others who speak disparagingly about the doc, often reflecting an obvious contempt for him. This group would include Allison, Danny and his mother, Mark’s sister, and Caroline (the radio Portwenn personality).

Among the people who are uncivil we can’t leave out Martin Ellingham himself. Could there be a more derogatory and insolent person than him? He is pugnacious towards his patients, generally suspicious of many of the motives of the townspeople, including Louisa, and, of course, has no social skills at all. His character is deliberately constructed in this manner, but we shouldn’t overlook this aspect of his personality. He cannot even restrain himself from giving the people of Portwenn a lecture on diet when he is delivering a eulogy of his beloved aunt.

The fact that these are offset by quite a few people who admire his medical ability and who manage to appreciate him despite his own uncivil behavior redeems him and provides sufficient agreeableness to his character. And Martin Ellingham is himself recuperated by some of the kindnesses he is capable of displaying.

I have previously argued that we don’t want to “fix” ME, or probably any of the characters. I would still maintain that though comedy may stem from uncivil behavior, it is rather harmless in this show. Still, the more we tolerate uncivil treatment of others, the more we may be accepting creeping incivility in our world.

Originally posted 2017-01-22 12:45:51.


I decided to write more about the question of whether Martin Ellingham has Asperger’s because I think that question is very pertinent to the whole issue of whether he can change. As I’ve written previously, the DM series brings up the question of whether people can change throughout the six series and there are various answers given when it is posed. On this blog we’ve been wrestling with the issue of change for quite some time and it’s very much a concern of most of us in general.

We’ve all noticed the frequency with which the topic of people’s ability to change comes up and on occasion there are contradictory positions taken by the same character. Ruth stands out to me as one of these characters because in S5 E6 she tells Louisa that people don’t change when she mentions to Louisa that Martin has told her to mark her calendar for the christening. Louisa replies that people can change if they want to and departs in a bit of a huff because Martin has never discussed the christening date with her. (Of course, Joan has previously told Martin the same thing as Ruth during series 3 and Martin has disagreed with her.) Ultimately we know that Ruth reverses her position on this and tells Martin that he will have to change to save his marriage and that he can if he works hard enough. She’s also told Al that we write our own stories and he needs to get motivated and take action to begin a new chapter in his life. I’ve also noted that Ruth must be convinced that people can change because she’s a psychiatrist and changing people’s behavior is certainly the goal of psychiatric care.

In addition I have previously mentioned that Dominic Minghella, the creator of the series, intended Martin Ellingham to have Asperger’s and says so in his blog. Here’s what the question and answer were:
“Doc Martin appears to show signs of Asbergers [sic] Syndrome. Is this intentional or just the way the character developed? I am married to a man with Asbergers [sic] and watching the series together has been a great help to us both.


Dominic Minghella
on 5 April 2012 at 9:59 pm said:
Hi Maureen,

It was deliberate. I seem to be surrounded by people with aspergic tendencies, and am probably not immune myself. It seemed particularly to suit the concept of Doc Martin: it’s almost as if he knows he has this issue and has deliberately put himself in a place where he will have to improve on his areas of weakness. Anyway, I’m so glad you and your husband are enjoying the show. And thanks for taking the time to write.
Best wishes

So I think that should put to rest whether the doctor was initially supposed to have this disorder. It also subtly addresses the likelihood that the plan for Martin was to have him work on changing himself.

In addition, I have delineated all of the typical Asperger’s traits the show has included in my post of Sept. 29, 2013 titled Psychological Conditions. The list includes many attributes given to Doc Martin.

We must begin with the fact that this is a fictional character and he may not fit the exact parameters of the disorder. Secondly, there is a spectrum that allows for all sorts of differences within the Asperger’s diagnosis. Nevertheless, I am struck by how close his mannerisms do mirror those associated with this disorder, and I’m not judging these as either good or bad. They are simply his manner of behaving and part of him. A 2008 article in Psychology Today written by an Asperger’s sufferer notes, “More aspies than not feel a tremendous amount of empathy, compassion, sadness, happiness, and so forth. What is at issue is their reticent expression.” I think we see that Martin Ellingham has empathy and compassion and can feel sadness as well as contentment. The whole article is worth reading and very much applies to what we see going on with Martin in this show. Another article explains that “Reciprocal, or back-and-forth, conversation is not in the skill set of a person with ASD.” It also states, “Parties and gatherings are rarely attended by them, except when it is with their own family. They tend not to belong to groups, clubs, or organizations, and usually do not have a social network. Living and working alone is often much preferred, and because the syndrome can be accompanied by a superior intelligence, they can excel when left to create and design independently without the distractions of the social environment.” Remarkably, it goes on to say, “Polite niceties seem phony and dishonest to the person with AS. Social convention eludes them. The term ‘brutal honesty’ has often been applied to their list of characteristics, and although their tactlessness may appear to be rude to most people, it is not meant to offend. Rather, it is meant to harmlessly and straightforwardly inform. They might point out to you, for instance, that your breath is bad when your relationship does not warrant such intimate or sensitive discussions.” Sound familiar? There’s more…the article continues: “Many, if not most, people with AS had been bullied in school and in the work place and suffer from trauma-related disorders as a result. Most often they have been rejected, ostracized, or worse, openly criticized in social settings. It hurts them terribly and causes them to feel like outcasts – the single most disturbing and painful of human experiences. Loneliness and isolation are their constant companions.” In DM Martin appears to have no concerns about being alone, but he has a definite yearning to be with Louisa. Louisa is not only beautiful and smart, she’s also an insider in this town and their association makes him much more accepted in Portwenn.

This article also addresses treatment options: “The syndrome cannot be ‘cured’ entirely but treatment for the disturbing symptoms of anxiety, depression, mood swings, trauma, sleep disturbances, OCD-like symptoms, digestive problems and phobias is available and effective…ASD treatment specialists find that social skills training, anger management skills training, trauma recovery methodologies, mindfulness techniques, and cognitive/behavioral therapies are all helpful. Dietary and nutritional consultation is extremely important as well. Self-esteem and assertiveness building, and stress management techniques are all useful for bringing about a feeling of well-being and confidence. Medicine for the symptoms that trouble people on the spectrum can be effective. However, above all else, the person on the spectrum must begin the journey of accepting himself completely and embracing the syndrome that brings them valuable talents and traits. Self-acceptance brings with it a comfort in social situations and it chases away depression and anxiety.” The list of disturbing symptoms reads like a close reflection of what Martin is dealing with in S6: anxiety, depression, mood swings, sleep disturbances, OCD-like symptoms, phobias. Moreover, when Louisa wants Martin to go on a trip with her and James and Martin tells her he can’t, he’s really being honest. Leaving home to stay overnight anywhere is anxiety provoking for him in many ways and he literally can’t do it. He just doesn’t tell her in a way that she can understand, and she interprets it as a personal affront to her. If anything it looks like the writers, etc. have decided to deepen Martin’s Asperger’s disorder in S6.

Martin’s Asperger’s is further complicated by the additional problem of having had remote, cold, and generally uninvolved parents. His mother tells him in S6 E8 that he was always a strange, awkward little boy. She never had any love for him and his unusual behavior due to his disorder was certainly something she wouldn’t have wanted to deal with. Therefore, he had the double whammy of a childhood syndrome compounded by neglectful and even abusive parents. It’s amazing he managed to excel in school, become a physician/surgeon and have any sort of social life. The fact that he was sent away to school and had some time with Aunt Joan perhaps salvaged what it could of his early years. Another story, this time written for The New Yorker in 2007, is worth reading to get a personal view of what it can be like to grow up with Asperger’s and not really grasp what makes you different until much later in life. This man had very involved parents and eventually became a successful music critic with a family and friends who are patient and forgiving, and who has various other means of coping, including therapy and medication.

In my opinion the final episode of S6 suggests that Martin is now highly motivated to make some significant changes and that, if there is a S7, he, too, can learn to accept himself by seeking help from Louisa and through therapy. Crucial to his ability to make these adjustments will be a wife who really adopts the principle she expressed in S1 E6 when she said sometimes we love those people who don’t quite fit in because of their differences. His powerful affection for his son will also be a motivating force. It seems to me that once Louisa learns about Martin’s disorder and his family background, she will be able to try to build the patience and acceptance to enjoy their life together. I can imagine some very poignant yet humorous episodes that could deal with all of the above.

Originally posted 2014-01-04 03:05:09.


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.



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:
-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
You’ll have to answer
To your own
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

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.