Category Archives: therapy

Hugs and kisses

Now that Acorn has posted E4, we can turn our attention to the assignment of hugging 3 times a day. Dr. Timoney gives them that assignment after seeing them together for the first time. She precedes the recommendation by observing that they seem very self contained. At the time they are seated next to each other on a small bench, but Louisa has also said she feels a little smushed and asks Martin to move over. He has no place to move.

We can say there is some symbolism in that.

Also, Dr. T tells them that most couples touch in some way, possibly holding hands. I think that is a rather surprising remark to make to a couple seeking marriage counseling. They are evidently experiencing some tension in their marriage. If they were holding hands, that would be a signal that their relationship wasn’t nearly as imperiled as we would presume, wouldn’t it?

Interestingly, the one sort of touching they’ve done most throughout the show is holding hands. Holding hands, like most forms of touching, makes people feel closer to each other, and the times we’ve seen Martin take Louisa’s hand are definitely accompanied by both of them responding with pleasure, e.g. following the concert or after they’ve retrieved JH from Mrs. Tishell at the Castle.

Asking Martin and Louisa to hug each day and say something positive to each other makes some sense. Dr. T is perceptive enough to notice that outward signs of affection are sorely lacking in this couple, and starting with that could break the ice. There is some truth to the idea that hugging, or any kind of physical touch, has a significant impact on humans. An article in Psychology Today lists three major benefits:

  1. Security. A lot of time has passed since the Harlow studies, showing that poor monkey babies prefer a cloth doll without milk as a mother substitute over a metal doll with milk [2]. Worldwide we agree that babies need to be held. There is evidence that adults who were frequently hugged and cuddled during early childhood display fewer stress symptoms than less-hugged counterparts [3]. Physical affection also alleviates stress reactions in adults who report less existential anxiety even when touched only briefly [4]. We are simply wired to find touch reassuring, as many studies of first impressions show [5].
  2. Positive Feelings. As adults, we can live without hugs, of course, but we do seem to be happier with them. We release the hormone oxytocin when touched, which elevates feelings of attachment, connection, trust, and intimacy. [6] When we’re hugged, we feel less lonely. I speculate that students feel less devastated by academic problems when well-hugged, well-assured, and well-bonded. Apparently, hugs facilitate social bonding and the experience of participating fully in this life, which, to me, is  true happiness.*
  3. Better HealthAnother commonly mentioned benefit of hugging lies in our improved health, as when we are touched our heart rate, blood pressure, and levels of the harmful stress hormone cortisol are lowered [7]. Reach out and hug, and your life might not only feel better, but last longer.

It is the power of touch that has driven the worldwide movement to offer hugs to strangers that began in 2004. For more on this you can check out wikipedia. The idea is that we can bring the world together by offering hugs to random strangers. There has also been a study of strangers and kissing that you may want to watch. See here. If you watch this video, you can see that a kiss can cause just about anyone to let down their guard even though it is accompanied by some embarrassment. We don’t see that with Martin and Louisa at first, but later kisses elicit more loss of inhibitions.

Martin has clearly suffered from not being hugged and cuddled as a baby and now he finds hugging generally unappealing. Aunt Joan gets away with a few hugs, although sometimes Martin looks mighty uncomfortable in her arms. He usually avoids physical contact with others and recoils when they try to touch him. Louisa is the only person he wants to touch and wants touching him.

Thus, the assignment to hug is grounded in a bona fide effort to bring Martin and Louisa together by having them touch each other. At this point in their marriage they have grown apart to such a degree that physical contact has diminished to almost nothing. Once the assignment is given to them, they do not shrink from it. In my opinion, Louisa likes physical affection and it’s not surprising that she would be the first to initiate a hug. The first hug is awkward and they hug again almost immediately. The ice has been broken, although nothing is ever simple with them, and Martin once again ruins the moment by telling Louisa his watch is caught on her cardigan. Nevertheless, by then Louisa has admitted that she likes hugging Martin and that she isn’t going anywhere. (One of those hints that the marriage will recover.)

By the end of E4, Louisa decides to hug Martin one more time. This time Martin asks her if the hug is spontaneous or part of the assignment. For me that is the one problem with making it an assignment…how will anyone know if the hug comes from a sincere desire to be affectionate or is a way to fulfill the assignment. Not only does his question create some ambiguity to the end of the episode, but also it points out the uncertainty that still exists in their relationship. But hey, we finally get some overt affection from this couple and it’s something to enjoy even if it is short-lived.

Originally posted 2015-10-21 22:01:52.

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.

I Am Woman

I decided to start the conversation about S7 with a post about women because two new women were introduced in E1. Both of them will play central roles in this new series, and there are several others who will join the cast in this series too, e.g. Caroline Quentin as animal rescuer Angela, Sigourney Weaver as American tourist, and others. I hate to make generalizations, but when I think back on the past six series, I can only come up with a few men who have been depicted as capable as well as stable, while there are many strong women who populate the show.

Among the men who are admirable that come to mind are: Martin Ellingham (despite his many psychological problems), Roger Fenn, John Slater (even though he seems to be a womanizer), Danny (even though his religiosity is excessive), Robert Dashwood, Michael (even though he has a major problem with OCD), and perhaps the Colonel. All the rest are doofuses (or gits, if you want a British term), or have major deficits. They are most often incompetent, incapable, or incredibly prone to doing ridiculous things.

The women, on the other hand, are mostly hardworking, insightful, and helpful. They take charge of their households, are excited to learn new skills and put them to use, and are often the top wage earners in their families. They frequently are forthright and self sufficient. It’s an interesting contrast. (If some reviewers have trouble with Cornish people being portrayed as dumb and foolish in this show, they should also have a problem with how the male characters are represented.)

In S7E1, we learn that Ruth has recommended a young, female therapist for Martin to see. She tells him Dr. Rachel Timoney, who does not suffer fools gladly, should be a good choice for him. When Martin arrives for his appointment, he first thinks the woman standing outside the front door is a receptionist, or something along those lines, and asks her to get Dr. Timoney. This mistake is a little strange because Ruth told him the therapist she is recommending is female and writing a book during her stay in Cornwall. Maybe we should chalk up his immediate response to his being discombobulated by the lifeboat accident, etc., or maybe he is typical of most men and still thinks of most doctors as male. His immediate reaction is to tell her she’s so young. He has had misgivings about young doctors previously, e.g. the vascular surgeon, and he wouldn’t be the first doctor to think experience counts for a lot; however, we also know that he is not thrilled to be seeing a therapist and could be looking for some reason she won’t be a good choice. (He has also told Ruth that he has been hunting for a therapist but hasn’t found anyone suitable.)

By the time he has had a few minutes with Dr. Timoney though, she has impressed him sufficiently for him to decide to come back. As Ruth noted, Dr. Timoney is demanding and quickly tells him that he has to set his phone aside while talking to her. Uncharacteristically, he hands over the phone right away. She expects punctuality and a commitment, and has set rules during her therapy sessions. She begins the first session, as seen in the E2 preview, by asking a direct question: “What are you afraid of?”

As usual the choice of that wording is important. She doesn’t ask him why he’s there or what she can help him with; she asks him what his fears are. She seems very perceptive from the outset in that she immediately notices he may have a high anxiety level.

Thus, we begin S7 with a continuation of strong women being essential to the plot. We will watch to see how Louisa gets along with this female doctor. She wasn’t happy with Edith, and these two strong women will undoubtedly come to loggerheads at times. Dr. Timoney may, and I imagine will, be the catalyst that brings them together again but not necessarily due to her therapeutic prowess. (That remains to be seen.)

The other significant female addition is Janice, Morwenna’s vain friend who becomes the new nanny. After Michael, it’s not at all surprising that this new nanny is the exact opposite. She cares more about herself than about James Henry and is anything but OCD, from the looks of the house. Nevertheless, we know that she will spend a lot of time on screen and be a critical new character.

I am fascinated by the number of strong female characters in this show. I would venture to guess that many of the viewers are female, and having strong women in the show appeals to that audience, maybe subconsciously. Also, there seem to be more shows with strong women in lead roles these days. It works for me!

 

Originally posted 2015-09-12 11:52:32.

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.

Change! What is It Good For?

Now that S7 is over, we have to revisit the theme of change. There is no other theme that has been as prominent in this show as this one, and what we find at the conclusion of S7 is not what might have been expected. The show had continually asserted by means of various characters that people can change. But by the closing scene, that conviction is very much in question.

I have taken some time rereading my previous posts on the topic of change (and there are several), and also done more thinking about how the show has weighted their stance in favor of people being capable of change and being impacted by certain significant experiences such that they involuntarily change. I have now developed a more fully reasoned perspective on this subject and decided that we need to divide it into two parts. There are core changes that take place following major events in our lives, and there are more superficial changes that we can institute by using our free will. What is depicted in Doc Martin encompasses both. By the end of S7 we still don’t have a clear picture of where this show lands on this subject, and that gives us some reason for disillusionment. They have left us with a very confused conclusion about whether change is possible or constructive, and all I can surmise is that they don’t have an answer to this premise or don’t want to provide one.

In my view some of the instigators of core changes in people originate in family and childhood. Not only does becoming a parent change us in fundamental ways, but also how our parents treat us throughout childhood is extremely momentous. Furthermore, a loss of a parent, either through death or departure, significantly affects us and can vitally change us. In Doc Martin we have all of these events and they are given substantial clout.

By the end of S6, Martin has suffered through an incredible amount of parental damage, and it has to have changed him in essential ways. We’ve heard from Ruth that Martin changed from being a vulnerable and sensitive child at age 4 to being quiet and withdrawn by age 6, and she places the blame squarely on his parents’ treatment of him. We are privy to a flashback from Martin’s boyhood when his father yelled at him for simply entering his study without knocking, and we know that he has been at the receiving end of physical and emotional abuse and neglect. When Martin’s mother arrives at his doorstep in S6, she immediately mentions that his father has died. But, really, his father disappeared from his life years before and only made a brief appearance in S2 with the unfortunate result of embarrassing Martin in front of Joan. When Christopher leaves Portwenn then, Martin tells him not to come back. He tells his mother the same in the last episode of S6. With her departure, any contact with his parents ends.

Louisa, too, has dealt with the loss of her parents. In her case, both of her parents cared less for her than for their own selfish desires and she has come to believe that she didn’t really need them after the age of 12. When her mother shows up in S5, we hear Louisa have trouble explaining why she wrote her about being pregnant. She tells Martin it wasn’t rational, which means she had a compulsion to tell her mother despite their long term separation. As in most cases, the child in Louisa still wants to believe her mother will be different this time and be interested in her.

We have other cases of parental loss with significant damage in this show. Al’s mother first left and then died; the Flint boys’ mother abandoned them and their father became psychotic as a result; and Erica Holbrook and her daughter Bernie have been deserted by the man of the house. In every example, the children have been deeply affected.

Another form of core change in one’s life is the birth of a baby. As Roger Fenn says to Martin in S2, it can clarify what it means to love someone. His remark cuts Martin because he has just been soundly deflated by his parents’ lack of love for him, but we can clearly see how the birth of a son causes Martin to respond to the world differently. He makes room in his life for the baby and has a renewed commitment to Louisa.

Two other ways in which circumstances are likely to change us at our core are through becoming terminally ill or by being sent into battle. This show gives us several scares regarding potentially fatal illnesses and two cases of sudden death. Roger Fenn contends with throat cancer and resorts to caustic remarks, while Jim Winton turns into a bedridden man whose wife becomes obsessed with finding a cure for him. I doubt she ever would have abducted a doctor at gunpoint under any other circumstances. Helen Pratt’s death turns her husband Phil into an angry, vengeful person; Jim Selkirk’s demise leads to his wife hallucinating. Stewart returns from Bosnia a delusional man who is afraid to mingle with the community, and Mike Pruddy has become burdened by excessive OCD and is running from the military authorities. He’s an extremely capable man whose afflictions keep him from creating a solid future for himself.

Other examples of occasions when people recount important changes in their lives include Martin being unable to perform surgery due to the onset of haemophobia. This phobia leads to a total departure from his immediate life. Margaret tells Martin his birth changed how Christopher looked at her and behaved towards her. She blames the deterioration of their marriage on that event, and at this point she plans to leave Christopher for another man.

From the time when Martin asserts to Joan in S3 that he can change if he wants, we watch Martin try to make that a reality. He tries to be nice to Holly and a few other patients; he tries to treat his haemophobia in S4; and he tells Louisa in the last scene of S5 he plans to change and not be like his father. In S6 Martin changes, but not for the better. He goes into a major depression due to the recurrence of his haemophobia as well as the upheaval in his home life and the appearance of his mother. Then he tries to change again by deciding to follow Louisa to Spain and next by telling her he wants to be a better husband. In S7, Martin has returned to someone who can take his haemophobia in stride. He tries to change for Louisa by doing everything he can think of to demonstrate his devotion to her. (So there is a chance that the remark he makes to Louisa at the end of S7 that he’s tried and it’s only made things worse refers to all the above efforts to change.)

Another huge change is the disappearance of his beloved clocks. What happened to them? We have to conclude that they no longer fill the void they once did.

Other times when the notion of change is promoted include when Louisa tells Danny that we make our own decisions, and when she tells Ruth that people can change if they want to; when Ruth tells Al we are the authors of our lives and we can change them if we want to; and when Morwenna becomes more assertive in S7. Ruth also tells Martin he has to change if he wants Louisa to stay with him. (As I’ve said before, Ruth should be convinced that people can change because she is a psychiatrist. As such she believes she can help people change.)

But the show also gives us several arguments against people’s ability to change. We see that despite therapy, Sally Tishell’s obsession with Martin has not changed, although she has decided to return to her marriage with Clive. We see that Bert and Al have not changed and are back in business together. We have also heard Joan tell Martin in S3 that “we are what we are” and can’t change (which is echoed in S7 by the same message written on the board by Erica Holbrook) and Louisa tell Martin in S3 that he can’t just act nice, he has to want to. We’ve also heard Ruth curiously telling Louisa in S5 that people don’t change and Louisa realizing that her mother hasn’t changed; Margaret telling Louisa at the airport in S6 that Martin is not going to change; and ultimately, Louisa telling Martin in the final scene of S7 that she doesn’t want him to change how he feels about her. In that final scene, Louisa reaches the conclusion that everyone is unusual and we are left to decipher what the final message about change is.

By the end of S6 I wrote that I thought the position the show was taking was “regardless of our life experiences, each of us has the power to change our lives and turn them into something close to what we want. We should stop wishing things were different, stop finding excuses, and do what we can to transform them.” Now I’m not so sure, and maybe the “deciders” on the show aren’t sure either.

Personally, I think change is good for us and inevitable as we grow older. We don’t want to stagnate; we want to remain curious and experimental. We want to become more sympathetic to others and more caring to our family. We want to grow as human beings and never stop growing. We want the acceptance of society.

George Takei, an actor and a Japanese American who was interned during WWII recently wrote to the mayor of Roanoke Virginia: “Mayor Bowers, one of the reasons I am telling our story on Broadway eight times a week in Allegiance is because of people like you. You who hold a position of authority and power, but you demonstrably have failed to learn the most basic of American civics or history lessons. So Mayor Bowers, I am officially inviting you to come see our show, as my personal guest. Perhaps you, too, will come away with more compassion and understanding.” Changing hearts and minds is a never ending struggle, yet must be tried through every means possible.

Life is filled with change, both internal and exogenous.

 

 

Originally posted 2016-05-22 14:50:15.

How’s the Therapy for You?

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

 

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

Professional Opinion v. Folk Wisdom

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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