An erstwhile blog about mental health

It has been a long time since Ive written a blog. These blogs were originally an enthusiastic exploration in an attempt to improve my work and teaching in management of mental health in General Practice. It turned into largely disillusionment about the mainstream direction of mental health care.

So often there’s a family in crisis and lots of government departments involved wanting employment, training, school attendance as outcomes… but the family doesn’t have stable accommodation. They dont have an income to pay their bills, they have an ever present threat of retribution for non compliance, and commonly other threats in the form of court orders and family violence. How does one think about completing a school assignment with all that going on? Children experience a world of disconnect and that the system doesn’t care. How does a stretched, stressed, usually single parent provide for the needs of such children when to do so risks their only source of income.

So much money is spent by this system, but never where it is needed. Ive seen these families do well when stimulus packages and cash payments relieve their stress. I saw it in the GFC and through the covid lockdown. Something must be wrong when relieving financial stress and bringing some equality through an external impact on the wealthy, makes such a difference to the people who are really suffering.

And we never look at these things that work and say to ourselves “maybe we should do more of that”

In our work with clients I think it’s the same. Something makes a difference and instead of doing more of that with this client, and being attuned to the things with each individual client, we turn our single success into a new theory and ram it down ther throats of all our clients. Just look at who is on the current lecture circuit doing just that. That’s what the system does too and it causes damage.

So I have a few proclamations from my 30 years as a doctor and from my General Practice which has specialised in mental health.

A good mental health practitioner is good with a diverse population of clients and is invested in the clients that they seem to make worse. They build strong relationships and most importantly they care. They admit their mistakes and they can apologise if their ideas caused hurt. They dont claim to have the answer. They never blame their client. They dont give up on people. They aren’t wedded to theories and they discredit unhelpful theories that clients have picked up from the broken infrastructure that have caused suffering and disempowerment.

I believe that we will look back in 100 years at our theories on mental ill health and be embarrassed. Like so many generations before us we will see that our constructs and explanations damaged people.

I value scientific exploration. But true science explores the phenomenon to be explained and if the explanation doesnt fit it is thrown out. We dont bend people to our explanataions, we must change our explanations…or better still, don’t have any explanations…at least for the next 100 years!

“I don’t believe just ‘cos ideas are tenacious it means they are worthy” Tim Minchin

From suffering to acceptance as the start of your future

Did you ever watch MacGyver? An action TV series of the 1980’s. I used to really like it but it was never high brow. Then I was reading an article maybe 15 years ago by Humberto Maturana on conservation and change. The article was describing how in a particular emotion your intelligence is maximal. The example given was MacGyver. The emotion this character was always in was one of acceptance both of his environment and of his own abilities. He didn’t ever say, darn, if only I had a different candy bar I’d be able to fix that acid leak. He didn’t ever wish the contents of the lady’s handbag contained an item that wasn’t there so he could more easily defuse the bomb. He just saw things exactly as they were while holding what needed to be done to survive, and hey presto, he solved the problem. I can still laugh when I think of Maturana citing MacGyver in a serious scientific article.

Emotional pain, just like physical pain is pretty horrible when you are connected to it. You escalate it when you say…..this thing that is how it is shouldn’t be how it is. I wish it wasn’t how it is…… That’s how to increase your suffering. Suffering happens in the space between how it is and how you wish it was.

But I wish it wasn’t like this you say! Well my Grandmother would then say “Spit in one hand and wish in the other and see which gets full fastest”

Once you get that it is how it is, everything you have ever learned about getting through things like this will be available to you. You will be maximally intelligent. When it is how it is and it isn’t how it isn’t you are right there, at the start of your future

The funniest conversation I’ve had this week about that was with a man who was railing against the justice system, which let’s face it, is broken. It isn’t how it should be, that’s for sure. He was suffering by wishing it would function the way it is supposed to. Ha!

I asked him if he’d ever had a tool that was a bit broken, but he could make it work. He told me about a drill he had that was dicky if you moved it through it’s gears. At first he’d thought it was broken, but the necessity to use it had him fiddle with it. He’d somehow learnt the trick and could use it pretty effortlessly despite it being kind of broken. If someone asked to borrow it though, even when he explained what to do they struggled. He somehow knew it had taken time to learn and he wasn’t entirely sure how he had mastered it. It was how it was and it wasn’t how it wasn’t and he’d learnt it as it was…. not as it was supposed to be. He could use it by not expecting it to work the way it was supposed to, but instead, working with it the way it was.

Lifes like that.



Integrity is something we know is important to have ourselves and to recognize in others if we ever want to successfully collaborate in work or play, but just like love and trust we don’t always know how to speak about it’s presence. We more often have an emotional or body experience of its absence.

I like how Werner Erhard speaks about integrity. He makes it doable and seeable and gives some clue as to its absence before the inevitable pain hits.

He speaks about integrity as wholeness and therefore as workability. If a wheel is whole it works. If there’s spokes missing or broken then it doesn’t work.

In dealings with other people integrity is about keeping your word. If you don’t keep your word, if your word is broken, then your dealings with other people don’t work. You are out of integrity.

If the person you are dealing with has no idea about how to keep their word, then no matter how kind and loving they seem, your collaboration will not work.

Some people are very slippery with their word. There’s no point getting upset about that as people will always behave like themselves, but it’s important to see. So often we feel the hurt or the let down before we see what was broken. It’s so much more confusing when a basically kind and loving person does it, but seeing where they broke their word, or actually never gave their word even when you thought they did, can help to clarify. They may be kind and loving, but you can’t collaborate with them.

Humberto Maturana says that ALL relationship problems are resentment for broken promises that were never made.

One map to navigating unworkability is to clarify what isn’t working and ask for a promise. When that promise is then broken you have grounds for complaint, until that time you are just stewing about something that they aren’t doing that you wrongly assumed they promised to do.

The classic relationship one is that by living with someone you assume they will do their share of the housework. When they don’t you get resentful. But they actually never promised to do your version of their share. A simple conversation clarifying promises can make all the difference. If someone says they cannot promise what you are asking, it’s actually a gift of clarity. You then get to decide whether or not you want to continue with what they are willing to promise, or not. That’s for you to decide and the consequences are then yours to manage.

Thats my take on Werner’s take on integrity. I like it.



Rebranding Therapy

Therapy is effective. The effect size is large. It is as effective as bypass surgery for angina. A treated person is better off than 80% of people who do not go to therapy.

How has something so effective managed to have so little appeal?

Gandhi articulated a strong sense of how the institution that grew up around the Indian quest for home rule similarly missed the hopes and wishes of the people.  This clip from Richard Attenborough’s movie encapsulates the rift.

We make speeches for ourselves and those middle class affluent people who have time to wonder about popular pseudoscience. But the people who are toiling under the sociopolitical heat of poverty and disadvantage remain dispossessed.

By 1997 Apple computers had been around for a long time, were reliable and easy to use but had no mass appeal. When Steve Jobs returned to the company he cut down the range of products from almost twenty to just four. All four were successful due to their high performance, affordability and aesthetic design.

Imagine consolidating 400 models into just four, highly performing, affordable and aesthetic models of psychotherapy. One for the inventors, one for the doers, one for the dreamers and one for the explorers.

Every person’s map of the world is as unique as their thumbprint

Margaret Mead said that she thought Milton Erickson invented a new therapy theory for every individual he saw. For a young student that sounds like an insurmountable task, but Rob McNeilly said that he didn’t invent it, he just listened to each individual’s theory and respectfully expanded it.

Erickson suggested that therapists should explore anthropology. The ability to observe and discover is much more important than to theorise  or impose. He did not colonise his clients, and I suspect he learnt a lot more from Margaret Mead than she did from him.

Theres a lovely paper, Ethics and Second Order Cybernetics by Heinz Von Foerster

He says….

Margaret Mead learned fast the colloquial languages of many tribes by pointing to things and waiting for the appropriate noises. She told me that once she came to a tribe, pointed to different things, but got always the same noises “chumulu.” A primitive language she thought, only one word! Later, she learned that “chu mulu” means “pointing with finger.”

In the movie What the bleep do we know? we heard that Indigenous people on Caribbean Islands could not see Christopher Columbus’s ships as they passed by. In that somewhat shocking discovery we get a glimpse of our own unfathomable blindnesses. We can only see what we understand and believe. Believing is seeing….not as is commonly said the other way around.

Every person is as unique as their thumbprint. No two people understand the same sentence the same way. Learning to be more interested in our client’s unique understanding allows us to curiously enter their territory and evocatively expand their vision.

Who were we before our learned limitations?

  • The obsession with measurement tools in therapy and popular psychology is an interesting cultural phenomenon. The field jumped on the coat tails of medicine when it was achieving breakthroughs by measuring actual biochemical and physiological entities like blood sugar and blood pressure, exploring what bodily processes affected them and what treatments could alter them. The more understanding about the processes the more advances in treatment and the more trust that was built with patients who really just wanted a cure.

The trouble is that measuring traits like personality and thoughts and beliefs, or even brain activity are just not the same. You can study the brain but you can’t know one single thought it is having. The issue of the influence of the observer is more troublesome than in any other field as it’s always the brain that is building the theory of how the brain works. As Jay Haley so eloquently put it, therapists are part of the truth they seek.

Scientific method has been discarded in favour of the illusion of science. Correlation stands for cause and researcher’s beliefs about what the amygdala, hippocampus or limbic system must be doing so influence what they find. Careers are made on marketing and charisma in a field where you can find a study that supports anything you believe in and as a practitioner you haven’t been taught the skills to critically evaluate that study. The scenario that results would be like teaching firefighters how to start a fire but not how to stop one.

Psychological tools that measure human traits are universally measuring learned limitations.  As if knowing more about our learned limitations ever helps us unlearn them! The last decade has seen a rise in measuring outcomes of therapeutic interventions but again the emphasis has been on addressing what isn’t working. Therapists discover areas they need to work on and find ways to practice outside of the therapy room. It’s an encapsulation of what client centered strength based practitioners have been doing with clients. Find out what’s missing and create a way for the client to learn and practice. The therapist becomes the coach for the clients deliberate practice.

What would be different if we had chosen to measure strengths and abilities? If we’d found a way to disclose those often transparent abilities that people have, that leaders like Erickson could see.  Leaders whose reputation was built when people saw he was getting good results with difficult cases. These leaders didn’t self promote and only knew a platform as something you stood on to catch a train.

Despite all of that, there is a long tradition in every culture of humans who are suffering being helped by other humans. The modern iteration of psychotherapy seems only to be palatable to a small cross section of Western society. The people who could most benefit don’t seek it out even though we know it is as effective as most medical interventions. It doesn’t show up as useful and so often has been tainted by association with punitive measures starting as early as being required to see the school counselor because of a behaviour issue or being subjected to testing because there is clearly something wrong with you. What would be different if the emphasis on those early interventions was on finding what is right with you so that teachers are better able to help you. And what if the emphasis in modern psychotherapy was on finding what was right with you so that therapists were better able to help you?

Man Overboard


I haven’t written a blog for a while. I came to a standstill in the exploration of excellence in the field of therapy and went on a kind of experiential sabbatical. I think I came to the conclusion that the current paradigm would work if it wasn’t for the people. A bit like the old saying that the operation was a success, but the patient died. People also say that hospitals and schools would run smoothly if you did away with patients and students.

I thought it might be useful to look at the problem of mental illness culturally, since looking at it medically didn’t get us anywhere… and by that I simply mean that there is no evidence that we have improved outcomes for people since the medical profession took on he task of treating emotional suffering after the Second World War.

Returning to the topic of cultural change takes me back to hang out with some splendid explorers. The ones I like are Humberto Maturana, and the others who came out of Chile’s turmoil with a fascination in ontology, Heinz Von Foerster and his connections with the Macey conferences and beyond, and then the greats who have created it without necessarily talking about it intellectually like Nelson Mandela, Mahatma Gandhi and Desmond Tutu. 

Humberto Maturana was interviewed by Bernhard Poerksen to create the lovely book “From Being to Doing” In it he spoke about his time in Chile after the coup where Pinochet assassinated Allende and the country was thrown into tyranny. Everyone who was able, tried to get out while they still could, including Maturana whose friend Heinz Von Foerster scrambled to get him a University post in North America so that he and his family could escape. 

In the ten days or so that it took for a position to be secured Humberto had watched as all the free thinkers and movers and shakers fled the country. As a University lecturer he found himself wondering what would happen to the young people, to his students, and what would happen to democracy if all the democratically minded people left.

He had in the past been fascinated by the stories that his friend Heinz told about cultural change that happened in Nazi Germany, of which Heinz had personal experience. In those phenomena that shocked the free world, including that there were good people who actually didn’t know what was happening and were upholding and supporting the regime that was perpetrating atrocities. How did that blindness get created? 

Maturana was beginning to see how. Curfews were being imposed and people disappeared under cover of night. Plausible stories of cover up and some sense that things must be happening for a greater good because the country was still functioning began breathe life into a bizarre unreality.

He decided to stay.

One of the many things I admire about him was his ability to maintain his dignity in the face of potential oppression. Here is a chilling example:

He and a hundred or more other University academics were invited to dine at the palace with Pinochet. History did not build confidence in situations where large groups of people were rounded up by dictators and many of them feared for their lives. 

Pinochet gave a toast to the fatherland and they sat down to a delicious meal. Before dessert was served Pinochet stood again from his seat where only a few meters away Maturana heard him say “Ladies and gentlemen, the sole purpose of this meeting is to get to know each another. That is all. You may feel quite safe; there will be no demands on you of any kind.” 

He sat down again and Maturana then picked up his glass and stood and said “Ladies and gentlemen, I would also like to toast our fatherland with you. We are gathered here today in the company of the president, and that is a rare occasion under any government. I will therefore seize the opportunity and bring out a toast with you and the president to the effect that we all who are here today contribute to the intellectual freedom and cultural autonomy of our country, Chile”

Now you can imagine the terror in that room as he spoke, but Maturana understood that power only exists where their is obedience. By standing with dignity and preserving his autonomy he helped to restore the dignity of everyone in the room. Pinochet clapped his hands together three times and the room exhaled. Later, in the mingling, Maturana was urged to approach Pinochet who shook his hand and said “I share your good wishes for this country”

Take another moment to share Maturana’s reflection: “It really was a bizarre situation”

Twenty or so years ago, we began seeing a cultural shift in government departments in Australia that had trickled down from some big shifts in leadership. Books were written like “Tampering with the Asylum” and there was enough political commentary for most people to see that something fishy was going on. It wasn’t yet so mainstream that you couldn’t stand up and call out acts of tyranny, and a common analogy of the day was that of the Emperor’s New Clothes. Back then you could be the little boy who stood up and said “But the Emperor is naked”

Not long after this a colleague said “Yes, but the world isn’t kind to the little boy who says that”

That comment has stuck with me as I have watched in government departments as piles of such little boys (and girls) are chewed up and spat out, and we are now seeing this spread from government department to private industry and to schools.

I no longer use the “Emperor’s New Clothes” analogy, as it’s too dangerous, and have moved through the “moving the deck chairs on the Titanic” analogy and am more and more seeing people drowning and flailing in the water in these organizations.

The Fat Man in “The House of God” instructed his hospital Interns: In any emergency, take your own pulse first. Or, said another way, when the oxygen masks fall in the plane, fit your own mask before helping others. If you’ve ever tried to help someone who thinks they are drowning you have likely experienced that the flailing force of their grasp to be saved can be life threatening for you.

I used to think that people higher up in the organisation should know better and have a responsibility to the person under them. It might be true, but it isn’t useful to have that expectation if nothing comes of it. I began to think instead that they were under the influence, like the good people in Germany who fought for Hitlers regime believing that it was right. I often shared stories with people who were damaged by such treatment, of the denazification programs that happened after the war that helped those good people grapple with the terrible things they had done. This reframe helped to make the damage seem more cultural than personal, which sometimes helped the pain. 

More and more, though, I am seeing that those people doing the damage are just drowning too.

Erickson was asked to see a patient in a mental institution around the middle of last century. The man kept saying “I shouldn’t be here” he said this over and over, even in response to attempts to help him. Erickson simply walked up to him and said “But you are here” to which the man replied something like “Oh shit, how do I get out”

I see so many people grappling with injustices in our present day culture, and I do so myself, all the while saying “It shouldn’t be like this”

“But it is like this”

Oh shit….. 

Darkest before the dawn

“There comes a time when silence is betrayal.” Martin Luther King Jr.

I wasn’t around when women were not allowed to vote, but I was alive when indigenous Australians’ newly granted suffrage was reflected in our constitution. It’s hard for me to imagine what it would be like to experience such discrimination.

In a way I was lucky, because I have a Tasmanian Aboriginal ancestor and I was born during the time of the stolen generation, though I was too white and privileged to be at any risk so that never had any grip.

I remember the shock I felt when I lifted my head from my busy middle class white life to watch Nelson Mandela’s inauguration, and was hit by the realisation that he had just voted for the first time in his life in the election that made him president.

My first child was born during the finals of the 1995 World Cup, so I missed the enormity of South Africa’s win in their first inclusion in the tournament after a decades’ long ban opposing racism and apartheid. This story, portrayed in “Invictus”, is one of my now favourite movies.

I am happy to live in a world where people can have their own opinions, and can hold their political and religious ideas dear. Where they can live whatever doctrine they believe in as it applies to them in their own homes. These opinions could be like what color to paint your lounge room, or what you think constitutes art. They could even share their opinions with their black LGBTI neighbor over tea and scones while their children played happily together in the back yard with the Muslim children from over the back fence.

I don’t know though, how to live in a world where a law of the land can apply to one human being and not another? I can understand why we do not let our children vote, but how do I live in a world where, say, we let children with blue eyes vote and children with brown eyes not vote?

I don’t think there has ever been a time in history where one human being didn’t discriminate against another, and if we are waiting for this eventuation to create world peace, I think we will be silent for a long time. But there have been times in our history where great leaders allowed us to transcend our primitive human tribalism and see a world where there is space for us all.

This poem, Invictus, gave Nelson Mandela strength to stand when all he wanted to do was lie down. Twenty Seven years in prison for being black with an opinion can do that to a fellow. I love this poem and offer it so it may also inspire all oppressed Australians in our darkest hour.

Out of the night that covers me,
Black as the Pit from pole to pole,
I thank whatever gods may be
For my unconquerable soul.

In the fell clutch of circumstance
I have not winced nor cried aloud.
Under the bludgeonings of chance
My head is bloody, but unbowed.

Beyond this place of wrath and tears
Looms but the Horror of the shade,
And yet the menace of the years
Finds, and shall find, me unafraid.

It matters not how strait the gate,
How charged with punishments the scroll.
I am the master of my fate:
I am the captain of my soul.
William Ernest Henley


And from Winston Churchill

“The mood of Britain is wisely and rightly averse from every form of shallow or premature exultation. This is no time for boasts or glowing prophecies, but there is this—a year ago our position looked forlorn, and well nigh desperate, to all eyes but our own. Today we may say aloud before an awe-struck world, ‘We are still masters of our fate. We still are captain of our souls.’”
—House of Commons, 9 September 1941


The mood of Australia is pretty happy with shallow and premature exultation. So I dare to dream of a time for boasts and glowing prophesies where all humans are equal under the law. Who is with me on this? WHO IS WITH ME?

Finally feeling hopeful about Mental Health Research

You might remember, about 5 years ago the National Institute of Mental Health in the U.S. finally said enough! This whole idea of clustering symptoms of mental ill health into diagnostic categories was a great idea, but it just hasn’t got us anywhere.

I remember my heart lifting and a cheer tried to escape but was quickly crushed by what I read next. They were now  going to focus on neural pathways. So instead say of studying PTSD, anxieties and phobias say, as separate entities, they were going to look at fear pathways, with modern laboratory techniques and neuroimaging, and I felt my heart sink. I think because what I read didn’t really sound like a change in paradigm, or how we think about human suffering, just a new thing to look at with old eyes.

Ive checked in now and then since then and have not felt my spirits lifted.

So, this morning, after a week of frustrating conversations with the old old paradigm I thought I’d check in again. Now this is not new, it’s a talk from 2013, and it may have been on the NIH website for some time, but it lifted my spirits. I think there’s still a bit of blindness from looking through the medical model, but in relation to my frustrations about psychotherapy research I think it’s fantastic.

I said to Rob, “you should listen to this” and he said “give me the short version!” So here goes.

In the old paradigm when we make a mental health diagnosis, we are making it with symptom clusters, and that’s like saying “You have a headache disorder, or stomachs ache disorder” without going any further, and then giving that diagnosis the same authority that we might give diabetes. And that really isn’t any more advanced than the ancient Greeks description of melancholia.

The major problem though, is that with all the modern techniques for neuroimaging, for structural and functional analyses of the brain, the findings don’t map on very well to the disorders. I’ve often thought it will turn out to be like diabetes, which was described early on in relation to excessive urination, but when we finally discover some biochemical cause, we have two distinct entities, diabetes mellitus, and diabetes insipidus, which are so dramatically different in their cause and physiology that had they been discovered biochemically  would never have been given the same name.

And that seems to be the problem. That DSM has given a whole lot of heterogeneous symptoms the same name, so no wonder we haven’t come up with a specific diagnostic test or specific treatment. From a paper titled “The drug hunters” the report is that “On average, a marketed psychiatric drug is efficacious in approximately half of the patients who take it.” He presumes that those are the people who have the thing wrong that the drug treats.. (a bit of a stretch but an interesting idea)

(At this point I want to caution myself about this seductive pull to turn the mysterious unfathonableness of the human condition into a simple machine, but for the sake of the short version I will press on.)

So RDoC,  stands for Research Domain Criteria. The statement in RDoC’s strategic plan states, “Develop for research purposes new ways of classifying mental disorders based on dimensions of observable behavior and neurobiological measures.”

There are four components.

The first component Is to identify these fundamental components that may span multiple disorders. So they look at circuits in the brain. Circuits responsible for dealing with threat, looking for food, memory, that kind of thing, and you start to see how lots of these circuits will be at play in different ways in different people who might all say fall under the current umbrella of depression.

The second component is “To determine the full range of variation from normal to abnormal.” This is very cool I think, because they are starting to see all symptoms on the spectrum of normal, and that there has been some adaptive behavior say that has taken a normal behavior to extreme. Watch the video for some useful observations about Schizophrenia and Bipolar. I think clinicians have long seen symptoms on a spectrum of normal, but for researchers to finally get this is a huge step forward I think.

The third component is to integrate genetic, neurobiological, behavioral, environmental, and experiential components, so that the complexity of the human experience is not lost in the science. And they are not just giving lip service to that complexity the way the “biopsychosocial model” did.

And the fourth component is to develop some measure, which might just start with what can be measured and seeing what that lines up with. They seem to be starting from a position of not knowing, and being willing to discover, even if it’s at odds to what they think they know.

The other heartening thing is that they are looking at neurodevelopment. Acknowledging that things that happen to the developing human have an impact at many levels, and understanding more about that impact can inform what to do about it, both with treatment and prevention. They are also looking at the impact of environment, both positive and negative.

So that’s the short version, and I recommend the long version….



How would you describe the experience of being loved? A newborn thrives in its presence. You can see it on their faces. The well loved child. It’s hard to describe. Perhaps a sort of contentment. The faint smile of satiety.  Nothing missing. And in its embrace the experience of being allowed to just be who you are.

Judgements are suspended. Both good and bad. If you are distinguishing beauty, charm or whit, you are not there.

The space where negations delivered under the guise of love are felt for what they are, not heard for what they might be, and are not allowed in.

And in that space, awareness expands. Synergy is created.

Is this the space where healing happens?

Can it be that simple? As simple as….

As you wish…..