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Over the summer I was invited by The University of Exeter to participate in an email debate with Lucy Johnstone, a clinical psychologist who advocates for the abolition of psychiatric diagnosis, on the topic of whether or not we need an alternative to the diagnostic system.

As a good introduction to some of the problems with psychiatric diagnosis, check out my interview with Lucy from September 2017: Is it Time to Drop Your Diagnosis?

Just to be clear, even though I am arguing in favour of diagnoses for the sake of this debate, my actual position on it is much less partisan than might appear here.

The reason I was invited to participate in this debate was because Lucy’s usual opponents on this topic have proved themselves incapable of civil discourse, so my role was to merely push back against Lucy’s points with some solid arguments and without resorting to ad hominems.

I don’t know whether this will be of interest to any of you, but here it is, reproduced for your consumption, if you’re so inclined.


LUCY:

I’m very pleased to be having this discussion with you. I know that your personal experiences of distress and diagnosis have led you to explore the debates about mental health, and I know you have been quite surprised by the complexity of the issues and the strong feelings they can stir up. However, I am confident we can keep this exchange respectful! One of the ways of doing that is to clarify right from the start that I and other critics of diagnosis are not in any way doubting the existence of despair, mood swings, overwhelming anxiety, terrifying visions and voices and so, or the extreme distress they cause. These are very real and agonising experiences. What we are doing is challenging the accepted explanation for those experiences, as in ‘You are feeling this way because you have bipolar disorder/personality disorder/clinical depression’ and so on.

Our starting point for this debate is the question: ‘Do we need an alternative system to diagnosis?’ In responding, I am not going to be talking specifically about the problems diagnosed as ‘autistic spectrum disorder’ in the latest edition of DSM, for two reasons: because they seem to cover such a wide range of difficulties, from neurodevelopmental to psychological, and because the issues raised by these particular diagnoses have already been explored in detail on this website. Instead, I will talk about the whole range of diagnoses which do not, as far as we know, have mainly or primarily biological or neurological causes. In other ways, we do not have the evidence that these experiences are best understood as medical illnesses, with causes such as chemical imbalances, genetic flaws and so on. So, this excludes dementia, because we know that it is a result of changes to the brain, but this is not the case (despite what you may have read) with ‘schizophrenia’, ‘psychosis’, ‘bipolar disorder’, ‘depressive disorder’ ,’personality disorder’ and so on.

 

DANNY:

Let me begin by saying “thank you” for this opportunity.

Since the various debates surrounding psychiatric diagnosis are contentious, to say the least, I echo your desire to keep this debate respectful, particularly as there is much about your viewpoint of which I am not entirely convinced.

Seeing as we’ve started out in agreement with regards to the kinds of diagnoses up for discussion, why don’t you begin by explaining some of the aspects of diagnosis you take issue with for me to push back against where I find disagreement.

 

LUCY:

It is easy to get into unproductive and sometimes hostile exchanges about whether or not we should be abandoning the current diagnostic system – which is why it is worth pointing out something that very few people, and particularly not service users, seem to be aware of: Whether we like it or not, agree with it or not, this system is on the way out.

As you know, the current diagnostic system is outlined in ICD 11 (International Classification of Diseases) and DSM-5 (Diagnostic and Statistical Manual of Mental Disorders). These lengthy manuals list all the many ways in which people can apparently be ‘mentally disordered.’ They are revised and updated every so often; the 5th edition of DSM came out in 2013 and the 11th edition of ICD has just been published. It is often said that professionals don’t go running to the diagnostic manuals every time they see someone in their clinics, but this language has deeply infiltrated our lives, sometimes without our being aware of it. Newspapers run articles on the tide of ‘mental illness’, celebrities disclose histories of ‘bipolar disorder’ or ‘depression’, we are all urged to overcome the stigma about ‘schizophrenia’, soap operas feature people with ‘depression’, and so on. The issue is not just diagnosis as such. It is a whole way of thinking, which essentially assumes that people in distress are suffering from some kind of medical illness, which, as the saying often goes, is ‘just like diabetes’ or ‘as real as a broken arm.’ And it doesn’t take a lot of reflection to realise that there are an awful lot of interests supporting this idea, from drug companies who make millions out of their pills, to professionals whose status and pay depends on it, and to politicians, who may have reasons for labelling the effects of social policy, such as poverty and unemployment, as ‘illness.’

However, we are in the unusual position where both traditionalists, including some of the senior clinicians who drew up the DSM categories, and critics, are agreeing that the current system is not fit for purpose. I think you’d find very few psychiatrists or researchers disagreeing with this, if you pressed them; and that process of revising the diagnostic manuals from scratch is already underway. And so, our main task now, as I see it, is to move beyond the often circular arguments about diagnosis as it stands, and think about alternatives.

 

DANNY:

According to the “2011 WPA-WHO Global Survey of Psychiatrists’ Attitudes Towards Mental Disorders Classification”, a survey of 4,887 psychiatrists from 44 countries regarding their use of diagnostic classification systems in clinical practice, 93.1% reported using the ICD or DSM in their daily clinical work, and 79.2% reported that they “often” or “almost always/always” used a formal classification system as part of their day-to-day clinical work.

Unless there has been some drastic changes in the seven years since this survey was carried out, I’m not convinced the data shows this to be a system in decline. This being the case your presupposition that the diagnostic system is “on its way out” doesn’t stand.

 

LUCY:

I agree that the diagnostic system is, as you have demonstrated, is not in immediate decline. In fact part of the defence is to carry on as if nothing was the matter. It is also true that in the current system, people will need to retain and use diagnoses for some practical purposes, such as accessing benefits and services, whatever their views on these labels. The point I was trying to make is that it is definitely in crisis – a crisis of validity and legitimacy.

But perhaps you can tell me a bit about your own experience of being diagnosed, if you are happy to?

 

DANNY:

My experience with the diagnostic process was to receive an informal diagnosis of “agoraphobia” issued by a CBT therapist after a brief five minute consultation, and posited in the form of, “It sounds like you might have agoraphobia!”.

Armed with said diagnosis I then proceeded to research everything I possibly could about agoraphobia. From the earliest investigations into the phenomenon by Austrian psychiatrist Carl Otto Westphal in the late-19th century, to even the more esoteric theories such as those made by feminist geographers linking agoraphobia with the architecture of modernity.

In other words, the proffering (not the imposition, at least not in my case) of a diagnostic label facilitated a personal metamorphosis from a clueless victim to an educated patient – the ramifications of which were two-fold.

On the one hand, I became an agoraphobic. It became part of my identity. I suspect that this had less to do with the label “agoraphobia” than being told it was something I “had”. For one thing, agoraphobia served as an accurate descriptor. I did, quite literally, have a fear of going outdoors. However, the word “have” would lead me to believe that there now existed this thing within me. As though I’d been infected with a particular mode of being.

What the label itself did was bestow the iatrogenic effect of self-fulfilling prophecy. Every time I learned about a new “symptom” of agoraphobia I had theretofore never experienced, I would immediately after become plagued by its spontaneous onset. So what began as mere anxiety away from home soon descended into a cocktail of nausea, dizziness, and visual hallucinations.

On the flipside, my diagnosis had the effect of bestowing me with an incredible sense of relief and reassurance. What I feared might be an incurable progressive loss of sanity unique to me, was at once exposed as a common, physically harmless form of anxiety with a tonne of scientifically researched therapeutic approaches to help me deal with it.

Such was the sense of relief that even though I did eventually flirt with the idea of suicide (for reasons beyond my battles with anxiety), I suspect my diagnosis played a part in postponing this period, and possibly even abating it when it arose.

In short, Lucy, my position in relation to yours on the question of “Do we need an alternative to diagnosis?” is not much “no” as it is “not so fast”.

 

LUCY:

I was fascinated by your account of being informally diagnosed, for several reasons.

One, because back in the 1980s I saw a great many people, mainly women, with the same diagnosis. The ‘treatment’, then as now, was to persuade them through a daunting exposure programme until their anxieties subsided. But it was never that simple. So much of it was tied up with traditional women’s roles – trapped by and yet terrified of leaving the symbolic arena of house and home. I remember one woman whose very first panic attack happened as she walked home from a successful job interview, her first real venture into the outside world after many years of childrearing. As she contemplated her partner’s anger and unwillingness to share housework or childcare, she was overcome with terror. Ten years later she was still confined to the home by this false solution to her agonising dilemma.

Two, because you summarise the pros and cons so neatly. Yes, the label gave you relief and hope for a way forward, but at the high price of taking on a new, damaged identity as this mysterious disorder was assigned to you. Diagnosis offers ‘salvation and damnation’, as one paper exploring people’s personal reactions puts it.

Three, you illustrate the extraordinary power of the process. 5 minutes in which you were loosely assigned one of the less stigmatising, more descriptive labels, and you were set for years of untangling the consequences.

 

DANNY:

Firstly, to your point about diagnosis as “salvation and damnation”. No doubt this was my experience. However, I can’t help but wonder how much of this damnation was the result of the diagnostic label per se, versus the manner in which it was proffered. That is, with basically no further elaboration.

I think it’s reasonable to assume that a few modifications in the way this particular therapist delivered her verdict could have gone some way to mitigating the formation of a negative identity. For instance, explaining that “agoraphobia” is merely a descriptive label for a subtype of anxiety; that anxiety is a natural, albeit unpleasant, stress response; to discourage me from late night liaisons with Dr. Google.

At a time when the so-called biopsychosocial model of mental distress is the dominant conceptualization, surely these are all commonly held assertions by even the most biologically oriented clinician?

Which makes me wonder whether the issue of people being told they “have” an illness called depression/anxiety/etc. is primarily an issue of common parlance inadvertently mischaracterizing the issue it’s attempting to explain, rather than clinicians actually believing mental distress to be a medical illness.

What I’m arguing here is that with the possible exception of personality disorders, maybe the problem with diagnosis at the level of identity formation isn’t so much that they are given, but how they are given. In other words, in order to mollify this problem does diagnosis really require a paradigmatic revolution, or would linguistic reformation suffice?

 

LUCY:

I do agree that diagnoses can be given in ways that are helpful and reassuring – where they are simply received as a description, and a way of saying ‘These are common experiences’ – or unhelpful – ‘You have a lifelong brain disorder/flawed personality.’ As a general point people are more likely to find terms at the descriptive end of the spectrum – such as ‘OCD’ – more useful. But in the end, the principle is the same. None of these constellations of reactions is best seen as a medical illness or disorder, and no one has ever produced evidence that they are. What these labels may give with one hand, such as a sense of commonality and validation, they take away with the other, since however carefully they are explained, the person receives the message that the problem essentially lies within themselves. Thus they have joined the ranks of the ‘mentally ill’, with everything else that is implied by that identity. There are better ways! For many clinical psychologists, that means using a formulation instead – in other words, a co-constructed narrative or personal story that serves as a hypothesis about why this form of distress, and why now, and what might help. You can see the point if we return to the woman with a diagnosis of ‘agoraphobia.’ The label did give her some relief and some techniques to manage her fears – but only a personal story or formulation, developed within a women’s group, was able to fill in the wider context within which they had arisen, and highlight the bigger changes that needed to be made in her life.

 

DANNY:

I think this issue of context as it relates to distress might be a good segue into the Power Threat Meaning Framework (PTMF). Why don’t you start with a brief introduction to this document and I’ll respond by voicing my concerns?

 

LUCY:

The project you refer to is an ambitious attempt to outline a conceptual alternative to the diagnostic model, co-produced with service users/survivors. It was funded by the Division of Clinical Psychology of the British Psychological Society, and launched in January this year, with me and Mary Boyle as leaders of the project team.

The central aim of the Framework is to restore the links between personal distress and wider issues of abuse, adversity, poverty, inequality, discrimination, and social injustice in all its forms. In doing so, it also challenges the standards that, particularly in Western cultures, can put us under unbearable pressure to look, achieve, relate, work, play, express our sexuality, bring up our children, and generally live our lives in line with accepted expectations in an increasingly individualistic, fragmented and unequal society.

The Framework poses four key questions. These are an expansion of a popular slogan used by the service user/survivor movement: ‘Instead of asking what’s wrong with me, ask what’s happened to me.’

‘What has happened to you?’ (How is Power operating in your life?)
‘How did it affect you?’ (What kind of Threats does this pose?)
‘What sense did you make of it?’ (What is the Meaning of these situations and experiences to you?)
‘What did you have to do to survive?’ (What kinds of Threat Response are you using?)
It may then be helpful to ask ‘What are your strengths?’ (What access to Power resources do you have?) and to pull it all together, ‘What is your story?’

The Framework is based on a comprehensive summary of the evidence about the negative impact of various kinds of power in people’s lives; the kinds of threat that misuses of power pose to us; and the ways we have evolved and learned as human beings to respond to threat. In traditional mental health practice, the resulting threat responses are sometimes called ‘symptoms’. In contrast, the Framework sees them as originating in creative survival strategies. The Framework also looks at how we make sense of these difficult experiences, and how messages from wider society can increase our feelings of shame, self-blame, isolation, fear and guilt. It shows why those of us who do not have an obvious history of trauma or adversity can still struggle to find a sense of self-worth, meaning and identity, whether or not we have been in contact with the mental health system. The Framework thus does not recognise a separate group of people who are ‘mentally ill’, since we all struggle with the negative impact of power in some areas of our lives, and we all experience distress at times.

By providing a flexible structure for thinking about these questions, the Power Threat Meaning Framework can be used to help people to create more hopeful stories or narratives about their lives and the difficulties they may have faced, instead of seeing themselves as blameworthy, weak, deficient or ‘mentally ill’. These narratives are supported by a provisional set of broad, evidence-based, patterns of response to threat. In contrast to medical patterns, the ones identified by the Framework are based on meaning in its widest sense – personal, social and cultural. This allows us to acknowledge and respect the very different expressions and experiences of distress that are found across the globe, rather than seeking to assimilate them into the dominant Western model.

I am wondering if one of the aspects which might appeal to you is that the general patterns of distress are described as things people DO not things they HAVE – survival responses, which served a function at the time and perhaps still do, but which are not symptoms of a medical illness. You can see how the ‘agoraphobic’ woman I described above could perhaps be understood in this way. At one level, her overwhelming anxiety offered an (unconscious) escape from an intolerable dilemma. At another, we can see how the dilemma itself had wider roots – in her relationships, in gender role expectations, and perhaps in a whole socioeconomic structure of waged labour and isolated nuclear families. And of course, a label of agoraphobia, while seeming to provide an explanation, at the same time confirmed her feeling of deficit and failure by locating the whole problem within her as an individual. PTMF could, in theory, offer her a different narrative and hence a different way forward.

You might or might not want to reflect on your own story from this perspective, but I would be very interested in your thoughts and questions.

 

DANNY:

Since critics cite the issues of validity and reliability not merely as shortcomings of the diagnostic paradigm, but as justifications for its dismantlement, surely it’s a reasonable requirement that any proposed replacement, if it cannot directly redress those shortcomings (that ever elusive Holy Grail of biological psychiatry), should, at the very least, avoid falling into the same traps.

On this front, it appears the PTMF may indeed be guilty of a kind of conceptual hypocrisy, albeit with the burden of validity and reliability shifting from the clinician to the patient. Let’s refer back to my own experience to explain what I mean.

Back in August 2017, I decided to record an autobiographical episode for my podcast. As I began to cobble together the disparate chestnuts that had tumbled from my tree of anguish over the years and attempt to verify them with family and friends, an uncomfortable realisation set in. Though some of my memories were indeed accurate, many of my most treasured (and troubling) memories turned out to be fictions where I’d either misremembered the content, misinterpreted other people’s actions or intentions, or sometimes, apparently, just completely fabricated the entire incident. Of course, this raises the question of whether it was they or I who were guilty of misremembering; a fact that doesn’t negate the problem, but, on the contrary, augments it.

If our accounts of what happened to us are inevitably susceptible to inaccuracy and bias, this raises two important questions about validity and reliability as it relates to viewing mental distress through the lens of the PTMF.

Firstly, how can we make a reliable connection between what happened to us and the nature of our mental distress as it stands?

Many instances of mental distress will not be as transparent in terms of cause and effect as say, for instance, a depressed mother grieving the loss of a child. In my own case, the personal cataclysm to which I tend to attribute my mental deterioration is the bankruptcy of my nightclub business in 2008. But in my more sober, objective moments I struggle to see why the shame of failure would years later result in trips to Tesco for a loaf of bread becoming as emotionally harrowing as a sojourn into a Hieronymus Bosch painting. Any attempts at establishing a cause and effect relationship are only successful with the adoption of psychoanalytic leaps of faith into the realm of the symbolic, which in my eyes only serves as yet another nail in the casket of validity.

Secondly, how can we be sure we are addressing the appropriate issue when attempting some sort of emotional reconciliation?

For instance it’s easy to imagine a scenario in which somebody presenting with severe anxiety is able to trace the origins of their distress back to what they consider mistreatment in past relationships, while at the same time being completely oblivious to the fact that it was their own loathsome behaviour which caused their ex-partners to mistreat them in the first place.

To this extent, the question “What happened to you?” may lead to conclusions which are no more valid or reliable than the conclusions reached by the question “What’s wrong with you?”

And if the answer to either of these questions is that subjective interpretation trumps objective truth, then in the spirit of Agrippina, the PTMF contains within it the seeds of its own demise by legitimizing the opinions of those for whom psychiatric diagnosis represents something real and important and so justifying the continuation of the very paradigm it seeks to replace.

 

LUCY:

Thanks for your thoughts. This could turn into a book! But I will address your points as well as I can within the word limits.

You have made interesting points about reliability and validity. We have discussed this at some length in the PTMF. Essentially, we are arguing that such terms do not sensibly apply to narrative-creation, and it makes no sense to judge narratives in the same terms as diagnostic categories. They are not in a head-to-head competition – they are fundamentally different processes, based on fundamentally different views about the nature of the problem. So, does that mean that anything goes? As you say, what if your memory, or story, turns out to be factually inaccurate?

The PTMF notes that ‘there can never be one final, accurate and truthful account of the origins and meanings of someone’s difficulties.’ However, as with any hypothesis, we can test out its usefulness in practice. In other words, does it lead to helpful ways forward? But narratives may also imply a different kind of test. Does the narrative ‘fit’, from the perspective of the person? Does it offer relief, make sense, does it feel true at a personal level? PTMF discusses the difference between historical truth and narrative truth. In making sense of our suffering, the latter may take priority. So, while you may have misremembered some details in your own life, that may be less important than the meanings implicit in your own version. Perhaps X didn’t happen precisely on Y date with Z, but the version you recall will not be random. It will be a way of conveying something that is an important truth for you, and understanding that truth may help you to make sense of your distress, and ultimately to move on from it.

This perspective on ‘truth’, ‘reliability’ and ‘validity’ supports our preferred term of ‘narrative’ throughout the PTMF. This is inclusive of, but broader than, the specific type of narrative that is called a formulation in UK clinical psychology circles. It allows us to respect, value and learn from the numerous culturally-specific ways of expressing and healing distress around the globe, including art, music, dance, community rituals and so on, without seeking to impose Western diagnostic concepts and medical interventions, as the movement for Global Mental Health is doing.

In addition, I will just remind readers about the many other fields in which diagnosis is currently embedded and for which alternatives would need to be found in the brave new world beyond diagnostic thinking. We have discussed various possible alternatives in Chapter 8 of the main PTMF document. Obviously, personal narratives would not be suitable for many of these purposes but it would not be too hard in principle to use concepts such as ‘regular episodes of acute distress’ for welfare access if they were endorsed by a MH professional and supplemented, as at present, with a description of someone’s needs. Trauma-informed services could make diagnostic clusters and pathways unnecessary. There is already a great deal of research based on non-medical descriptive terms like ‘hearing voices.’ Formulations already replace diagnoses in some court reports. And so on.

To return to your own breakdown, which you described in one of your podcasts: I take your point that a detailed psychoanalytic hypothesis about your struggle to buy a loaf of bread is not what you most needed … but I wonder if it would have made sense to see this (but only you can tell if this fits) as part of a threat response to the catastrophic events in your life, when everything had gone into meltdown, everything felt unsafe, and you felt judged as a failure? Moreover I wonder if your sense of blame and shame at the collapse of your nightclub might have been relieved by critical evaluation of your beliefs about striving and achievement – beliefs that align with ideological messages about individualism, competition and personal responsibility? To me it sounds as if you demonstrated extraordinary levels of determination. The loss of your business could not have been avoided, but perhaps the PTMF might have helped you to create a narrative that alleviated some of the emotional consequences in ways that your diagnosis of ‘agoraphobia’ did not do.

 

DANNY:

In light of your response I’m happy to concede that a direct comparison between the validity and reliability of narrative-creation and psychiatric diagnosis is probably misguided. However, this issue of subjectivity as it pertains to narrative still raises questions related to both politics and personal responsibility.

To the latter, this central question as to how power is operating in one’s life seems a somewhat myopic analysis, with the individual imagined as a passive receptacle of external influence, with seemingly no consideration given to how the power and influence that they themselves wield could be contributing to their own misery. Even if culpability is entertained, the PTMF seems to facilitate immediate deflection to the most distal corners of society in almost any scenario.

E.g. I treat my partners badly because I’m angry. I’m angry because I’m impoverished. I’m impoverished because I’m unemployed. And I’m unemployed because… the government… because capitalism… because *fill in the blank*.

I’m not saying these aren’t legitimate contributory factors, but my concern is that in attempting to alleviate the burden of responsibility for mental distress that results from locating its origins within the individual, the pendulum may swing too far the other way so that the individual is now emancipated from any and all responsibility to the extent that narrative creation just becomes an exercise in apportioning extrinsic blame.

As for my political concerns, let’s take the example of a stay-at-home mum feeling depressed and posit the question, “How is power operating in your life?”

While the liberal housewife might feel the power of conservative tradition mooring her to the family home while she yearns to climb the corporate ladder, her conservative counterpart might feel crushed by the judgment of liberal media for whom unless she supplements the rearing of children with some form of careerist pursuit, her role in society is dismissed as little more than a patriarchal affliction.

So, whose account of the sociological power structure affecting their mental health is correct? In abstracto, the primacy of subjective meaning in the PTMF enables both accounts to be true, but what concerns me is how this might play out in the therapy room.

This is a particularly interesting question when considered in light of the fact that more than 90% of academics working in the social sciences – the fountain from which the majority of research underpinning psychological therapy trickles – are on the political left, versus 50% of the general population. (https://www.adamsmith.org/research/lackademia-why-do-academics-lean-left)

Couple this with numerous references to Foucault, Marx, and Smail throughout the PTMF, and we now have an anti-capitalist oriented manifesto in the hands of a profession tasked with changing people’s thinking that is overwhelmingly populated by people on the political left.

Would a wholesale shift to the PTMF paradigm really accommodate (or even permit) more conservative and/or libertarian conceptions of distress, or would the PTMF merely empower a population of people opposed to such ideologies to enforce a kind of Orwellian shift from wrongfeel to badthink; from medicalizing distress, to politicizing it?

Will the conservative housewife formerly diagnosed with depression now be suffering from “internalized misogyny”? Will men such as myself who proudly subscribe to more traditional conceptions of manhood and who feel emasculated by their anxieties be deemed as infected with “toxic masculinity” and the focus of our treatment shift from addressing “symptoms” to fixing our attitudes?

To be clear, I am not saying that these are the intentions behind the PTMF. But like any document the PTMF is subject to interpretation and is only as benevolent as the intentions of its practitioners.

 

LUCY:

It’s a shame we can’t go on debating this for another 5,000 words! I’d just like to say briefly that you raise some very important points about the need to find a midpoint between acknowledging people’s personal agency and responsibility, and equally, recognising the wider pressures and contexts within which we all exist. We have tried to redress the balance in the Framework, given the individualising tendencies of almost all the standard models – whether biomedical or therapeutic. From the PTMF point of view, locating the origins of your struggles in your negative cognitions is no better than citing your chemical imbalances. Our standpoint is expressed in one of our core principles: ‘The PTMF assigns a central role to personal agency, or the ability to exercise influence within inevitable psychosocial, biological and material constraints.’ We have been accused of supporting both Marxist and neoliberal agendas, which may be an indication that we fall somewhere in the middle of the two extremes you describe! Obviously we have limited control over how the PTMF is interpreted and used. Nevertheless we hope that it has at least expanded a central debate of our times and maybe taken us a few steps further towards a more humane and effective conceptualisation of human emotional distress, which places the person (or family/social group) and their truth, whatever that may be, at its heart. For some people, that will continue to be a diagnostic understanding. But at the very least, we need to be making alternative understandings available – within and beyond services.

 

DANNY:

As you’re signing off with an emphasis on balance and compromise, I’d like to do the same.

Even though I’m sold on the potential value of narrative, I’m forced to question its necessity based on the fact that the cessation of my own anxiety was achieved not as a result of biographical vivisection, but rather through the application of a set of ideas and techniques that I discovered by following the signpost of a diagnostic label.

However, as much as personal accounts such as mine may highlight the utility of diagnosis, in a world where no other system exists I can’t help but feel that declarations of “It worked for me” reek of a kind of solipsism akin to pulling up the drawbridge on the people for whom it proves either useless or damaging.

I’ve read suggestions that PTMF is nothing new, that psychotherapists in practice already take personal narrative into consideration, that nobody claims diagnosis to be a perfect system, and that it’s constantly improving.

But as long as poverty stricken single mothers, grieving spouses, and victims of abuse continue to be branded with chemical imbalances and disordered personalities, such defences of the current paradigm sound like little more than the oblivious platitudes of ivory tower academics in denial.

So, what are those people whose lives were tainted by diagnosis to do in the meantime? Sit back and wait the same quarter century it took the diagnostic system to cease declaring homosexuality a mental illness before it finally does right by them as well? Surely another world is possible.

While I doubt the PTMF’s ability to supersede the natural human inclination towards phenomenological categorization, I have no doubt about its potential to temper the hubris and overreach of the diagnostic monopoly, to elevate the importance of social context, to provide an alternative to those for whom it isn’t suited, and possibly even repair the damage for those it has harmed.

To speak in Nietzschean terms, part of me wonders whether much of the rabid opposition to the PTMF from certain quarters is because it threatens to deal the hammer blow capable of finally exposing the bloated entrails of their false idol. To which possibility the nihilist in me says, “Service users of the world unite, you have nothing to lose but your labels.”

 


For those who are interested in exploring the Power Threat Meaning Framework further, the documents plus links to videos and other resources can be found here:

https://www.bps.org.uk/news-and-policy/introducing-power-threat-meaning-framework

Image courtesy: David Goehring

Last month, on the 23rd of June, my father David Whittaker passed away. I spoke about the experience in episode #059 “The Day My Superhero Died”.

Due to multiple complications with the postmortem, it took more than a month before the funeral was held.

We finally laid the poor fucker to rest yesterday on the 24th July, with barely twenty people in attendance, most of whom hadn’t bothered to come and see him for years, and not to mention the half-dozen lame excuses from those who couldn’t even be arsed showing up at all.

This being the case, I’ve decided to post the eulogy that I read during the service, for no other reason than I want as many people as possible to know just how fucking awesome my father truly was!


HE WAS A LION ONCE

I

So, the reason I’ve decided to get up here and speak today is what you might call a sort of Pascal’s wager.

Blaise Pascal was a physicist during the enlightenment, and Pascal’s wager is the philosophical idea that even if you don’t believe in God, it’s still in your best interest to behave as if you do believe in God and live a pious life regardless, because if your atheism is misplaced and God does exist, then the payoff of getting into heaven is worth the sacrifice of earthly pleasure.

I don’t know if I believe in any sort of afterlife. I’m sort of agnostic about the whole thing to be honest. But what I’m about to say is a Pascal’s wager in the sense that the main reason I’m saying it is just in case my dad can hear me. I don’t know if he can. But on the off chance that he is up there somewhere, and able to bare witness to this, it’s worth eschewing my own scepticism and doing it anyway.

Of course, I could have done this at home on my own, in the kitchen or whatever, but in that scenario, either somebody hears it or nobody hears it. At least this way somebody is guaranteed to hear it even if he doesn’t. And I think its a message worth hearing.

Because, as presumptuous or arrogant as this might sound, with the exception of maybe my mum and his sister Joyce, whatever you’re memories of my dad, they probably don’t do him justice.

II

I’ve never written a eulogy before. But having done a bit of research it seems they tend to adhere to a fairly standard format.

The first thing you’re supposed to do is cobble together a bunch of hobbies or character traits of the person you’re there to remember. So, the things that, on paper at least, made my dad my dad, or made David David.

Alright, so my father loved fishing, and drinking scotch, and watching cheesy horror movies. Whoop-di-doo. So do millions of other people.

So, then what you do, to add a personal touch to those attributes, is flesh them out with a couple of humorous anecdote. The intention being to convey how quirky and unique my dad was, while at the same time conjuring up a sense of nostalgia and fondness in whoever happens to be listening.

So fine. Fishing. I remember this one time he was trying to recover his rod rest from the water and fell in the pond. “Ha-de-ha”.

Whisky. “Two fingers”. That was his slogan, his measurement, how much to pour. “Want a whisky, dad?”, “Aye, two fingers”. And me’ dad didn’t exactly have Donald Trump baby hands either, so he weren’t messing about.

Horror movies. The last one I remember watching with him was “Sharknado 2”. Which for those of you who aren’t in the know when it comes to high brow cinematic masterpieces, is a film about a tornado that spawns over the ocean, sucks up a load of rabid sharks, drifts inland and then deposits them on New York City. So, it’s basically raining sharks that eat people.

Again, fine. Fond memories. And certain aspects of them are indeed unique to my dad.

However, and this is not to denigrate the efforts of other sons who have given speeches at their father’s funeral and who might not be quite as cynical and pedantic as I am, but to reduce my father’s life and the impact he had on me to a handful of vacuous anecdotes, for me at least, would be, quite frankly, an insult.

III

So, I know a lot of people will remember my dad as the disabled old man that he became.

Especially new people. Like every time we’d take him to the hospital I’d see the way the doctors and nurses would speak to him, in that sort of condescending manner that people tend to address people who present as frail. Like they’re either deaf or stupid.

And then when he’d try to speak to them, because his illness meant he couldn’t enunciate properly, they couldn’t understand what he was saying, and so they’d just sort of nod at him, patronizing, like “Yeah, yeah”. Hoping that if they agree with him enough he’ll shut up.

And it’s not a perfect analogy, but that dynamic that I’d see play out all the time sort of reminded me of one of Aesop’s fables where there’s a lion in the jungle, laying on the ground close to death. And all the animals of the land are crowded around, taunting him and making fun of him. And then this little mouse scurried on top of the lion, and starts dancing on his nose and says, “Look, he can’t do anything to us now!”. And all the animals start laughing and carry on making fun of the lion.

Then with all the energy left in his body, the lion lifts his head and says, “Fine. Mock me now, but, I was a lion once.”

IV

The mistake the animals are making in that fable is the same one a lot of people made about my dad. They’re addressing the form but ignoring the character.

And I reckon if my dads character could have unzipped the ramshackle flesh and blood veneer he was cloaked in, and stepped outside of it, and discarded it, the sheer size of that character could crouch on it’s heels in a midday sun and still cast a longer shadow than a thousand men standing on each others shoulders with their backs to a dawn sunset.

And you might hear that metaphor and think, “Fine, very poetic”. But the problem with poetry is it’s easy to dismiss as little more than pretence.

But it’s a claim I stand by. And not because you’re obligated to allow such a claim to go unchallenged, because this is a funeral, and I’m David’s son, but on the contrary, I think it’s a claim that stands up to scrutiny.

So, the things I’m about to say about my dad aren’t merely the sentimental platitudes of a grieving son, but are in fact the sober reflections of one man examining the character of another.

V

Now, to say that a guy who couldn’t even button his own shirt could somehow overshadow a thousand able-bodied men, that’s one hell of a claim. So, let’s not hide behind your obligation to take my word for it. Let’s quantify it.

How many men, at the age of 21, could meet a girl on a Saturday, be passionate enough to fall madly in love by Sunday, be decisive and daring enough to propose by Tuesday, be an attractive enough prospect for the girl to say “yes”, committed enough to spend two years scrimping and saving to bring it all to fruition, and then devoted enough to be a man of his word and honor his promise to love, honor and protect that same girl for 49 years?

How many men can say that they would dedicate their lives to raising a child that isn’t biologically their own. While too many men nowadays can’t even seem to muster the decency to honor the most basic of fatherly obligations to children born of their own flesh?

How many men, in raising their children, can honestly say that they never once raised a hand to that child, never once told them what to think or what kind of person they were expected to become, never allowed that child to witness them in a state of base drunkenness or seething anger, and not because he was good at hiding it, but because he simply didn’t conduct himself in that way?

How many men can say that their children have never once seen them treat the child’s mother with anything but affection and respect, and never given that child any reason to worry whether one day his father’s reckless behaviour might reduce the family unit from three to two?

VI

When you’re trying to honor someone’s memory it’s easy to overstate the case of the person you’re referring to. For instance, marriage is a two way street. My dad wasn’t the only person responsible for making his marriage to my mum, Linda, a success. And she surely deserves her share of the credit.

But still, in order to be loved, you need to be lovable. How many women can claim to have wed themselves to a man who managed remain lovable for nearly half a century?

As for the way I feel about my dad, people will say, “Well, of course you idolize him, he’s your dad!”. Well, no. Not “of course”. Plenty of my friends growing up had fathers who were tyrants or deadbeats. A sons adoration is not a given, by any means.

In fact in my case, my father had even more to prove, because he faced a kind of metaphysical competition that most fathers don’t.

It’s a common thing for adopted children to fantasize about their origins. They like to romanticize that out there somewhere is this beautiful family in a beautiful mansion, pining away, just waiting for their long lost son or daughter to get in-touch so they can be reunited and live happily ever after.

I never had that fantasy. It never even crossed my mind to seek out a bunch of strangers no matter big their window cleaning bill was. And that’s got a lot less to do with my loyalty than it has to do with the fact that I knew instinctively that there was nothing better out there waiting for me.

Or let’s assume it was loyalty. Where could I have possibly learned that from?

Or maybe it was just because I had a father who somehow managed to make fishing trips to Mill Brow and driving round in a Ford Transit van delivering curtain rails during the summer holidays a more attractive prospect than pining after some imaginary billionaires.

How many dads can make that claim?

VII

Okay, now we’re getting somewhere. Now the real uniqueness of my dads character is starting to emerge. But let’s take it one step further.

So, my dad had something called myotonic dystrophy. The normative, medical description of this illness is “a genetic disorder that causes gradually worsening muscle loss and weakness”.

Now that tells you what the illness is, but it doesn’t really tell you what it does. When a doctor gives you a diagnosis of myotonic dystrophy, here’s what he or she is telling you:

Here’s this disease. And it will kill you. But before it does, it’s going to ruin your life. It’s going to take away your ability to work, it’s going to take away all the things you enjoy doing, and slowly but surely it’s going to claw its way into everything you hold dear, and destroy it. Or at least try to.

You’re going to lose your ability to speak. You’re going to lose your ability to drive. You’re going to start falling over. A lot. And when you do fall over you won’t be able to break your fall because your hands are going to be useless, so you’re going to smash your face on the floor. You’re going to choke on your food. You’re going to get chest infections. You’re going to struggle to wash yourself. You’re going to struggle to dress yourself.

Every day you wake up, you’re going to be a little bit weaker and a little bit sicker than you were the day before.

And it’s going to torment you every waking moment of your life. From the moment you open your eyes and struggle to peel your head off the pillow. To the moment you go back to sleep at night exhausted by the effort it’s taken to complete tasks as simple as taking a shower and getting dressed.

But that’s not all, David. It gets worse. Because when it comes to things like diabetes, cancer, and heart disease, there are treatment options available. There’s a chance of turning things around. And even in the worse case scenario, if we can’t turn things around, we can slow it down.

But not for you, David. There’s nothing we can do for you. There are no pills for this illness. No experimental drugs trials. No genius doctor over in America if you can just somehow manage to stump up the cash. We can’t treat it, we can’t stop it, we can’t slow it down.

But don’t worry, David, this won’t affect your brain. You’re brain will be fine. In other words, you’re going to get a front row seat to your own physical demise without the dark fortune of senility to alleviate at least some of the suffering.

And if that wasn’t bad enough, should that time ever come that merely existing becomes unbearable, by that time you won’t even possess the dexterity to fashion a noose or weild a razor blade, nor the strength to pull a trigger, or even unscrew the lid from a bottle of painkillers.

In other words. The outlook is bleak. And you’re trapped. And there is nothing we or you can do about it.

VIII

So, bearing this in mind, how many people, given a fate such as this, could honestly say that it wouldn’t make them angry, or bitter? And that when they found themselves in the thick of it, that they wouldn’t give in to the temptation to indulge in self-pity or to complain about it?

It’s become a cliché to make the retrospective claim that somebody didn’t complain about their illness. It’s what everybody says about everybody who’s passed. So there’s no weight to it. But there should be.

Because for one thing it’s not always true. Plenty of people descend into anger and bitterness over lesser afflictions than the one my dad suffered. That’s not to say some people aren’t justified in doing so. But plenty of people aren’t justified in some of the objections they raise about their own circumstances. And by “plenty of people” I mean people like us.

We all like to think we’ve got the strength of character to take the process of our own demise on chin like my dad did. But then we only need to recall ourselves throwing a pathetic little hissy fit over first world problems like the WiFi not working, or Sky+ not recording the football, to realise just how weak and petulant we are in comparison.

Millions of us, everyday, moan about things that don’t matter. My dad didn’t even moan about the only things that do matter.

While some of us are having little temper tantrums because we can’t find a parking space within spitting distance of the entrance to the supermarket, my dad couldn’t even hug his grandchildren properly. But there was never any, “Why me?”, “This isn’t fair”, “I’ve had enough”. He got on with it.

In the case of hugging his grandkids he gave them a sort of clumsy huddle that was more like a pat-down from a police officer than it was a hug. But he did what he could. He always did what he could. And he didn’t moan about it.

IX

See, now all of a sudden when we think back to this claim that seemed so ridiculous at the start, of David the frail old fella with the walking stick possessing this transcendent personality… Doesn’t seem so ridiculous now, does it?

This man who couldn’t even clench a fist, but deserved to be called a fighter. This man who could barely even speak, but somehow managed to say so much. This man who could barely even stand up, but somehow managed to tower over everybody around him.

That’s character. And as I think I’ve just demonstrated fairly conclusively, my dad had that in spades.

So, if you’re here to pay your respects to David Whittaker the poor old disabled fella with the walking stick, who couldn’t talk properly, because he had that terrible illness. I don’t know which David Whittaker you’re talking about, but you ain’t talking about my dad.

Because my dad was so much more than that. And if I can grow to be half the man that he was, that’ll still make me twice the man that most are.

In other words, when I grow, I want to be just like my dad. And so should you. In fact, so should everybody. Because the world would be a better place for it.

Reading time: 3 mins

For the past year or so I’ve made it possible for you guys to support the podcast by making donations.

As a way of giving a little something back to those of you kind enough to do so, I decided to produce some subscriber-only bonus content such as the Quick Fire Question’s portion of my interviews and hosting some AMA (Ask Me Anything) episodes.

In order to make this content exclusively available to paying subscribers, I had to set up a membership section on the website which kept bonus content hidden by requiring members to sign-in in order to view it.

There are various options available to implement such functionality, but without boring you with too much technical minutiae, in short, most solutions didn’t suit my requirements, and the few that did are simply too expensive or too complicated to implement.

For the past few months I’ve been plodding along with a free solution that I cobbled together myself using a selection of freely available WordPress plugins. However, it soon became evident why such a Frankensteinian approach was free.

Firstly, it required a lot manual input on my part. Secondly, reliability was poor as there were a ton of bugs and compatibility issues.

Despite all the difficulties, as of last week enough of you guys had pledged monthly donations that we were about 60% of the way to making the podcast break even financially, and thus well on the way to becoming completely self-sustainable.

However, despite this progress, as some of you may have noticed, the frequency of my output has decreased a little over the past couple of month; a direct result of all the extra time required to manually implement and maintain this rickety membership functionality.

Since the whole point of enabling you guys to support the podcast is so that I can spend more time producing content for you, it becomes completely counterproductive when maintaining such a system takes up so much time that I struggle to produce more content as a result.

So this week, I’ve taken the difficult and costly, but more sustainable decision to scrap the self-hosted membership option, cancel everybody’s subscriptions, and make the shift over to Patreon.

Patreon, for those of you who aren’t familiar, is a membership platform that makes it easy for a people to support the creators whose content they enjoy and in return gain access to various subscriber-only perks.

It’s everything I was doing before, only they deal with all the payment processing, membership sign-ups, and providing you with access to the subscriber-only bonus material, while I just concentrate on the task of producing content.

I know it’s a pain in the arse signing-up to yet another website, but for those of you willing to do so, I promise to make it worthwhile.

I currently offer four different subscriber tiers at $2, $3, $5, and $10 per month. The more you pledge, the more perks you gain access to, including:

  • Bonus content from the podcast
  • Members-only newsletter
  • My AMA (Ask Me Anything) episodes
  • Live Events
  • Access to our private Facebook Group
  • Sponsorship credit

So for those of you who have supported me so far, thank you so much for you support. If I see you on the other side, awesome! If not, I hope you continue to enjoy the podcast regardless.

Thanks, Danny

Reading time: 6 mins

I’ll be the first to admit we probably don’t need another mental health blog or a podcast. It’s a subject that’s become part of the cultural zeitgeist over the past few years, so there’s already a shitload of established material readily available out there.

Nor is this a business endeavor. As career choices go, from what I gather, blogging and podcasting are a fucking terrible idea. Unless you’re good at marketing, apparently. Which I’m not. Nor can I be arsed learning. I did look into it. It bored me.

So, with this in mind, I guess the obvious question to be answered is why bother?

Let’s start with with blog.

I’ll go a lot deeper into my own personal circumstances some other time, but in short, at this point, I’m at the tail end of a five year battle with various mental health issues. Hypochondria, anxiety, and agoraphobia mainly.

Reduced to a pithy list of diagnostic labels, such a confession lacks gravitas. But it’s no exaggeration to say that the psychological hell that lies buried beneath each of these labels have at times pushed me to the precipice of my own personal threshold for pain.

I’ve felt shame and embarrassment. They’ve reduced me to tears. I’ve had moments where I genuinely believed I was losing my mind. The behaviors they compelled me indulge in have nearly torn my family apart. I’ve felt desperation to the point I’ve found myself praying to a God I’m not even sure I believe in. For a brief moment there I even flirted with the prospect of suicide.

Nowadays, I like to think I’ve left the worst of it behind. That I have somewhat of a firmer handle on my own destiny. However, I am by no means “cured”. The truth is, I’m still very much on the road to recovery. I like to describe myself as 90% recovered, and forever chipping away at that final 10%.

This blog will serve as an exposition of each side of this arbitrary statistic. As both a retrospective analysis of the slow steady hill climb that lies behind me, and as a constantly evolving speculation about the potentially even steeper road that lies ahead.

I’d feel remiss if I didn’t acknowledge the arrogance in voluntarily stepping into a limelight of one’s own construction, and declaring oneself worthy of being heard. But let’s get one thing perfectly straight. I have no desire to turn myself into your fucking anxiety guru.

I don’t have any secret techniques up my sleeve (nobody does). I’m sure many of the ideas I posit won’t amount to much more than vacuous philosophizing. Some of my practical suggestions will sound little better than the amateurish broscience of your typical self-help guru.

Nevertheless, I truly believe that my experience has furnished me with certain nuggets of wisdom that can only be found among the searing embers of introspection that pave the flaming trail of mental suffering. And I can’t help but dare to hope that in sharing the lessons I’ve learned along the way, I may have the potential to help you grease the wheels of progress in your own journey.

But herein lies an important distinction. My journey isnt, wasn’t, and couldn’t ever be the same as your journey.

I won’t spend a single moment of my time here speaking on aspects of mental health I have no direct experience with. Rather, I’ll only endeavor to expound upon the thoughts, techniques, and philosophies that have worked for me. Whether or not they have the potential to work for you, and more to the point, whether or not you choose to apply them to your own situation… Well, that’s on you.

As for the podcast?

If there’s one perk to mental illness, it’s that the search for information about your particular malady can quickly lead you down the utterly fascinating rabbit hole of the complexity of the human mind. And before you know it, what began with a simple Google search for “what is anxiety?” has resulted in a bookshelf littered with the works of Freud, Jung, Skinner, and Beck.

At the time of writing, I’ve just spent the past few months taking in part in a clinical trial for Metacognitive Therapy (MCT) for hypochondriasis at the University of Central Lancashire with a guy called Robin Bailey.

With my new found interest in psychology, I was never going to allow Robin to administer his MCT protocol uncontested. I challenged his assertions. I questioned the psychological presuppositions of MCT. I waged philosophical debates about the nature of cognition. We discussed the results and methodology of clinical trials, and argued the pros and cons of myriad different psychological therapies.

Robin has a PhD. I’m a high school dropout. I rarely came out on top (though I reckon I had him on the ropes a couple of times). But I always left his office more enlightened than I had been prior to entering, and more importantly, always that one step closer to recovery.

This podcast is my attempt to recreate those sessions. To sit down and have long, in-depth conversations with world class intellects about all things psychological, and to hopefully extract some helpful, healing advice along the way.

Before I finish, a word about the title I’ve chosen for this little project. “My Own Worst Enemy”. For those of you whose mental illness was something that befell them due to circumstances beyond your control, this name might seem ill conceived. Inconsiderate even.

But while there is indeed a hint of self-deprecation in there, in that I firmly believe beyond a shadow of doubt that my own psychological deterioration was almost entirely self inflicted, that’s not really what I was going for.

The name isn’t meant in reference to the origins of mental illness, which do indeed differ from person to person, but rather, it’s meant to refer to the subjective experience of mental suffering itself, many aspects of which, I suspect, are universal.

It’s about the internal battle we wage against ourselves in our own minds. It’s about falling into the trap of making our illness our identity. It’s about treating ourselves with a level of cruelty and neglect we would never dream of inflicting on others. It’s about knowing precisely the things we need to do to aid our recovery, and then procrastinating or making excuses. It’s about fooling ourselves into believing that we’re especially broken, a special case, that can’t possibly be fixed.

Taken together, it’s a recognition that the only person standing in the way of our recovery is ourselves. In other words, it’s about taking responsibility. For your past, your present, and your future.

Taking responsibility isn’t about self-blame. It’s about self-empowerment. Nor does taking responsibility mean we must walk the road to recovery alone. On the contrary. Taking responsibility enables us to spend our time seeking out the people who can help us, instead of looking for someone to blame.

It’s this perspective that forms the fundamental philosophical underpinning of this entire endeavor.

If you, like me, are your own worst enemy, but you want to figure out how to be your own best friend, then we have enough in common that maybe there’s something in this little project for the two of us after all.

Welcome to My Own Worst Enemy.

Danny 🙂

 

Image courtesy Rosmarie Voegtli

Reading time: 8 mins

How many of you can relate to this experience?

You’ve decided, for whatever reason, to start a blog. You agonize for days over a name for your project where the .com, .net, or .org hasn’t already been snapped up by some arsehole domain squatter. Fifty attempts later, you finally settle on something you’re happy with and fork out a couple of quid on GoDaddy.

You buy a little web space, install WordPress, and upload a swanky, stylish, modern template that makes you look all premium and professional and stuff. And just like that, you’re ready to go. The world is your oyster.

You click “New Post”. A big blank page opens up before you. Oh, the potential. The little cursor seems to flicker with impatience, ready to skitter across your screen spilling syllables by the boatload. You crack your knuckles in preparation for the wordy symphony you’re about to hammer out on your keyboard. Just call you Williwig van Shakeshoven.

But hang on a minute. Hold your horses, sunshine. Let’s not be too hasty now.

Online, as in real life, first impressions matter. There’s fifty gazillion other blogs floating around out there in the ether. A bajillion of which already cover your chosen topic. Umpty-seven of which are authored by writing geniuses with God-tier marketing skills and eleventy-squillian subscribers.

You can’t just wing it and toss out any old codswallop. Not if you hope to compete with these behemoths of the blogosphere. No siree, Bob. You need to hit these motherfuckers with a haymaker of an opening gambit. Come in like a wrecking ball, like that little Miley Cyrus fella says.

Your first ever blog post needs to be fun. It needs to be witty. It needs to be informative. It needs to be profound, amusing, intelligent, relatable. It needs immaculate spelling and punctuation. It needs flawless grammar and syntax. It needs structure and flow and character and style. It needs to be, well… Perfect.

Oh, the pressure. Your heart sinks. You sit and stare at your laptop screen. All that white space glaring back at you that mere moments ago felt like a blank canvas of infinite potential suddenly morphs into a bottomless abyss of nothingness. The words don’t come. The cursor flickers, slow and laboured. On. Off. On. Off. On. Off.

Five days later, you still haven’t written a thing.

Ladies and gentlemen. Welcome to writer’s block.

Shit.

Oh, don’t worry. I know I’m being a drama queen. But that’s anxiety for you. And this, along with depression and other mental health issues is what this blog is all about.

Anxiety, however, is my specialty. I’m the Michael Jordan, Tiger Woods, Lionel Messi, Roger Federer of worry. Place me in any innocuous situation and I can catastrophize the bejesus out of it.

My heart skips a beat, I’m going to have a heart attack. Every minor stomach ache is stage four bowel cancer. If a loved one doesn’t answer their phone after three attempts, they’ve died in a car crash. And the content of my first blog post is as important to humanity as Charles Darwin’s “On the Origin of Species”.

What this latter delusional anxiety boils down to, is self-consciousness. I. Care. What. You. Think. I wish I didn’t. I’d like to pretend I don’t. But I can’t. Because I do. And that’s that.

Like all world-class professionals though, I have my off days. And today is one of those days where I’m off my anxiety game enough to be able to step back and take a sober look at this self constructed predicament.

Those of you with experience in CBT might be familiar with cognitive restructuring exercises. These are (usually) written exercises where you identify your negative thought patterns or limiting beliefs and then subject them to a little rational scrutiny. The goal being to contradict them and thus undermine the emotional power they exert over you.

Let’s say you berate yourself for being a “loser”. You might look for evidence why this isn’t true, such as listing off some past victories. Or maybe you could reframe past mistakes by finding the important lessons they contained, and thus turn them into a win.

The limiting beliefs fueling my writer’s block in this particular instance are twofold:

1) It matters what you, the reader, think of me. Therefore…
2) My first blog post needs to be perfect.

There are plenty of surface level criticisms to be leveled at these limiting beliefs, and plenty of vacuous platitudes I could employ to counter them. Why do you care what people think? You can’t please everyone. Who says it needs to be perfect? There’s no such thing as perfect. Ruh, ruh, ruh.

However, for your entertainment, I reckon I’ve discovered a couple of deeper misconceptions in these limiting beliefs which are slightly more profound, and infinitely more amusing.

First of all, I said a moment ago, that I care what you think. You! But who is this “you” exactly?

As this is the first draft of my first ever blog post, by definition, there’s no blog to be read yet and hence no readership. So this “you” that I’m speaking to isn’t a separate other you at all, because an actual other you doesn’t technically exist yet.

Even if I claimed to be writing for a future you, having imagined what you might be like, you’re still no more real than the nudist Kerry Washington I share an apartment with whenever I start daydreaming at a stop light.

This you that I’m so desperate to impress is really just a Frankenstein’s monster of my own paranoid projections. In other words, you aren’t you at all. You are actually just me in disguise and relabeled with the pronoun “you”.

This whole situation is like  sitting in front of the mirror and being worried about having something of interest to say in case the reflection staring back at you disapproves in some way.

In short, I’m worried what to say myself because if I don’t say the right thing and impress myself, I’ll disapprove of what I have to say, and then feel bad about myself as a result.

Jesus!

But this is just a transient issue. The fact is, there will at some point in the future be other people who aren’t me who read this blog post. Which brings me to the matter of whether or not this first blog post even matters.

It doesn’t. And neither does yours. Not that it doesn’t matter, period. It just doesn’t matter yet. And by the time it does matter, what it actually says won’t matter much anyway. In fact, the worse it is now, the better it will eventually be.

Confused? Let me explain.

I’m sure there are some examples of bloggers out there who went from total anonymity on a Monday, to a viral sensation by Wednesday off the back of their first blog post. And good for them. But for the rest of us, no matter how revolutionary it is, our first blog posts will go completely unnoticed.

Launching a blog is like setting up a market stall in the middle of the desert. The only people who know you’re there are you parents and three of your friends. Sure they’ll pay you a token visit. Maybe they’ll tell their friends, and if you’re lucky, some of them will pop by for a minute or two.

But after this, the bulk of your early readership will consist of little more than the occasional straggler who stumbles across your blog by sheer fluke of a misspelled Google search.

If you want to get past this and build an audience, you have to expand your inventory. Write and write and write some more. Rack up those blog posts until people begin to arrive on purpose. By which point your first blog post is buried so deep in the archives, even you might struggle to unearth it.

Regardless of what your anxiety might try to tell you, your first blog post will not shape the first, nor the lasting impression that 99.99% of your readers will form of you. That’s the responsibility of future blog posts you haven’t even thunk about thinking about yet. So, save your writer’s block for those.

The sole purpose of your first blog post is to get yourself off the starting blocks and into the race. Nothing more. For everyone else, the only use your first blog post will serve is to satisfy the curiosity of those readers who want to see how much of an amateur you were when you first started out.

So, do these future readers a favour and let your first blog post be shit. The shitter the better. With any luck, by the time anyone actually reads it, you yourself will have turned into the kind of blogging royalty that will intimidate the next generation of newbie bloggers into a bout of writer’s block about their own first blog post.

Genuine spontaneous side note. As I sit writing this, finally coming to the end of my own first blog post, I’ve begun to suspect that writing your first blog post about the anxiety of writing your first blog post is probably one of the biggest clichés in blogging. But bollocks to it. I’m not going to check. I don’t even want to know.

Anyway, I’m sorry if you stumbled across this blog post while searching for some practical advice on how to construct an amazing, original, SEO-friendly masterpiece that will make you an overnight viral sensation. I’m not saying it can’t be done. I’m sure it can. I’ll bet it has. But I don’t know how to do it.

I don’t know what makes a great first blog post. I don’t even know what makes a good first blog post. But, in my humble opinion, the perfect first blog post is the one that gets published.

Here’s to perfectoin!

 

Image courtesy: Drew Coffman