Psychotherapists! ACTION!

Psychotherapists! ACTION!
Poster of the film Afterward by Ofra Bloch

Commentary on the event dedicated to the film Afterward, organised by Stillpoint.

Affected by the current political situation in Ukraine and the panel discussion that followed the screening of the film Afterward, Adam Goren, Child and Adolescent Psychoanalytic Psychotherapist, wrote this piece. He wonders if the awareness of the numerous ways in which societal factors influence children and youth might not spur the profession to think again about the importance of action: not on the battlefield, but in the clinic.

We are grateful to Adam for kindly sharing the article with us.

Watch the recording of the panel with Ofra Bloch, Bassam Aramin, Thomas Casagrande, Pamela Cohn, and Aleksandar Dimitrijevic, organised by Stillpoint

Watch it. Witness. Al Jazeera. Eastern Ukraine. 2016. You’re looking at a documentary by Danish filmmaker Simon Lereng Wilmont. You don’t need to know anything about him; he wants your full attention on ten-year-old Oleg, his play mates and his terrified grandmother, Alexandra. Here’s the scene. Late afternoon, in the village of Hnutove, the Donbas. Oleg and a bigger boy pick their way across barren heathland acting normal, braving it out. In the distance, through a twilight gloom, you and they can hear the rumbling of war: the sporadic boom of big guns, the occasional flash of artillery fire, lighting the horizon. These are the pathetic cliched words and phrases I use to describe something terrifying beyond imagining.

Oleg tries to look calm; he keeps up conversation for reassurance; asking questions, making knowing statements. The older one does what older kids do; he’s nonchalant, protective, seemingly inured to danger, mildly mocking Oleg’s stupidity, ordering him about. He tells him to gather some sticks for a fire. It’s lit. There’s an eerie silence, and Oleg looks about him wide-eyed and wary as if a bear might lumber in. The older boy walks off some distance for a moment. Oleg calls out. And then, suddenly, he’s caught. The taut-stretched skin of his mighty-hearted child’s-courage tears. This is it; this is the moment; this is the fathomless terror of death coming howling in, rocket propelled, at 295 metres per second. His panic is contagious, and the boys scarper to their mortar-pocked homes.

Poster of the film The Distant barking of dogs by Simon Lereng Wilmont

God knows if this sensitive, articulate, loving little boy is still alive. Some are not. A semi-conscious child, somewhere between baby and toddler, writhes about in agony with a gaping shrapnel hole in its back, in a dust-filled bombed-out Syrian apartment, whilst a woman screams in the background. Its movements are jerky and desperate, lessening each second. I’m watching the TV in horror, thinking somebody for goodness’ sakes do something, but it’s all way too late. The child stops moving and dies. On the way to work next day I pull over on to the hard shoulder and weep.

In the West Bank of the Palestinian territories, a young girl with a lively mind, is shot in the back of the head outside her primary school. It takes two days for her to die. Not far away, on another day in another year, a young Staff Sergeant calls his mom to tell her he’s scared. Shortly after, an RPG sidewinds its way through the back of his armoured vehicle, incinerating him and another three barely-men comrades. That was my cousin. He was a late child and, like any unexpected gift, all-the-more cherished for it. I think his mum and dad died of heartbreak.

A few weeks ago, in a Zoom event organised by Stillpoint, the American Israeli psychoanalyst Ofra Bloch presented her new documentary Afterward. The film was meant to focus on encounters with Germans reflecting on the transgenerational legacy of genocide. It ended with Bloch realising, in a very personal way, that war with its brutalising impact on our humanity, cuts down all the moral high ground, leaving victims and perpetrators of us all.

Ofra Bloch

On the discussion panel was Bassam Aramin, a Palestinian man, also in the film; an Israeli-designated terrorist and former prisoner who was determined to use his jail time to better know his enemy. Whilst in prison, Aramin had something of a ‘road to Damascus’ moment, waking to his adversary’s humanity. He went on to co-found Combatants for Peace, a group working with like-minded Israelis and Palestinians towards a two-state solution, as well as running Parents Circle Family Forum, bringing together bereaved families on both sides. But Bassam, who’s been to Auschwitz, studied the holocaust and who understands the suffering of Jews, is no peacenik. So long as Palestinians are oppressed and dehumanised, he will be a fighter for their rights and freedom. It was Bassam’s daughter, Abir, who was shot in the head.

Bassam Aramin

When the panellists wrapped-up, the audience was invited to comment. Cutting through the awkward silence, Bassam wondered, not a little ironically, whether, if no one had anything to say, we shouldn’t all go home?

What made us so shy? How could a group of therapists and sympathetic lay people be silenced like this? Shock perhaps? An instinct for self-preservation?

It is as if we happened upon a road accident or the bloody consequences of a street brawl and were half inclined to watch, (screens at the ready), and half inclined to beat it, but not to get involved. After all, what would make us competent or qualified to help? This was not our collision. We might make things worse; we might put our foot in it, inadvertently hurt someone, get hurt ourselves, be accused of taking sides, get sued for negligence.

Bassam Aramin cuts to the quick of a dilemma at the heart of my work as a psychotherapist with deeply traumatised children.

Psychotherapy has sometimes been characterised as intervening after the facts or at least in some rare interlude between them. Children are sometimes described as not ‘ready’ for therapy because their lives are in too much turmoil. The trouble is, whether it is about yesterday’s bust up with an adoptive parent, or about an episode of serial rape ten years ago, the injured child can live their days as if horrible pasts and benign presents are terminally collapsed together. In this scary past-present, everyone’s a potential assailant, abuser or source of anxiety and pain. Such children confront parent, carer, teacher or therapist with facsimiles of trauma scenes they seem perpetually compelled to repeat. These children have limited use for bystander commentary or therapeutic neutrality. What they want and need and provoke in sessions, is action: to calm, to hold, to comfort, to nurture and to play out; to palpably bear witness to and contain the consequences of the obscenities and violence done to them. But I think they need and want more.

Photo by Simran Sood / Unsplash

17-year-old Aime is struggling with behaviour and attendance at school. She keeps getting up and walking out of lass in a tornado of expletives and tears. Her foster-come-adoptive father is a functional alcoholic who just lost his job as a pilot. Her adoptive mother, sexually abused as a teenager, teeters on the verge of emotional collapse. She tries to manage by treating Aime like the foster child she used to be, and by plotting fantasies of escape. Seeing the family’s distress, I try to engage them all in various combinations to no avail. Aime finds therapy claustrophobic and oppressive. I cannot contain her parents’ volatility. Even if they are sometimes calm in sessions, between them they erupt.

Pretty soon, Aime rightly concludes I make no tangible difference to her life and begins absenting herself. She then worryingly goes missing for a night, and after she returns, an interagency network meeting is called at her school. The school Head, who I’ve never met before, addresses Aime directly. She smiles benignly and tells her she’s sympathetic to her predicament. But when she starts sliding into a patronising and humiliating inditement of her troubling behaviour, I cut her short. Leaning forward, I ask her if I’m really hearing right: is she, an adult with her considerable power, actually shaming this young person in front of all these people, whilst overlooking the school’s myriad shortcomings in meeting her needs? I then list them one by one, explaining their impact. Aime never came to therapy again, but later that day my phone buzzed with a text message, caller unknown, simply reading, ‘CHAMPION’

Psychologists like Lucy Johnstone and Richard Bentall suggest we need to stop thinking of something called ‘mental illness’ as a discrete biologically or individually located disease. Neither should we limit our model to intimate relationships. Rather, we must think of mental distress as a misery symptomatic of societal malaise; misery the consequence of the way justice is administered, capital distributed, power exercised, society organised; in short, as at least in part a measure of the way we look after ourselves and our own.

Such a perspective implies a complete change in the way we view and engage with children and families coming to Child and Adolescent Mental Health Services. If children’s distress is in some part a product of their wider environment, is it not incumbent upon us to act on those agents who are inadvertently or intentionally a cause of their misery? Daily, I am confronted with stories of institutional deprivation, complacency, stigmatization, discrimination, denigration and neglect, unfolding like any number of slow-motion car crashes, piling insults high upon devastating injuries. This is what moves me to act. That is what makes me a kind of therapist-activist. Are you one too?

This article originally appeared in a professional journal The Bulletin by the Association of Child Psychotherapists, Issue Number 280, 2022, under the title "ACTION!".

Adam Goren is a psychoanalytically trained child psychotherapist and lead clinician at a CAMHS (Child and Adolescent Mental Health Service) team in London, England. He specializes in working with traumatized adopted children and their families. He is also an essayist, painter, and printmaker producing work concerned with creatively traversing borders and boundaries in search of new perspectives.

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