John Marzillier – To Hell and Back

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Book Review, John Marzillier, Psychiatry, Psychological Therapies, Psychology, Psychotherapy, PTSD, To Hell and Back, Trauma

A wise, thoughtful, compassionate and skillful book about PTSD revealed through the words of those who have experienced this.

It’s funny how synchronicity works. Because I read Noel Hawley’s highly recommended Before The Fall, which I highly recommend, and which features a small boy who suffers a profound traumatic event, and clearly would be diagnosed with PTSD, and because I have a professional interest in the subject, I was reminded that John Marzillier, a British clinical psychologist and later, psychotherapist had written a book on the subject.

I had been moved and beautifully taught much in another book by him, The Gossamer Thread, where he explored his wide journey of development as a practitioner, and the deep exploration, refining, and ambiguity in human relationships that happen throughout all our lives, within and without any kind of formal therapeutic setting, simply because human beings are complex, and so each and every encounter between self and other is fraught with – an endless possibility.

Duke and Duchess of Cambridge and Prince Harry: Promoting the charity Heads Together to open up discussion of mental health issues

So, I started to read the in some ways, more geared towards the practitioner, slightly more left brain, slightly less poetical/metaphorical To Hell and Back: Personal Experiences of Trauma and How We Recover and Move on. And during my reading and reflecting period, mental health, particularly linked to the experience of dealing with psychological trauma, suddenly became positive news, due to Prince Harry, and also Prince William, speaking openly about the deep, hidden effects caused by their mother’s death. Public figures speaking out in such a way, honestly, – particularly public figures who are, not being rude, part of the Establishment rather than famous for flashier, sex-and-drugs-and-rock-and-roll lifestyles, not to mention ‘reality TV’ famous only for being famous ‘stars’, will be listened to more seriously.

Expression of emotion is more common, and I would say, generally a good thing, with the exception of the artificial stimulation of emotion in reality TV shows!

But, he also cautions against those who assume it always IS the right approach to bare the suffering soul:

Is avoiding talking about feelings always wrong? I do not think that one can or should make such a categorical statement. So much depends on the context and the person, not to mention their relationships with family and close friends and on timing

Focusing on a wide range of traumatic single events – Marzillier in this book is exploring the kind of ‘out of a moderately clear blue sky’ unexpected and traumatic event, rather than, say the trauma of repeated brutal events from early childhood – the author looks both at the unpredictable horrors caused by acts of deliberate chosen malevolence, and the impersonal ‘being in the wrong place at the wrong time’ of major accidents like train crashes due to mechanical failures. Marzillier was, for many years, employed by Thames Valley Police, working with those who have to deal with traumatic events, which arise out of the nature of their work – police, firefighters, army personnel, ambulance personnel. The professionals have to maintain a distance from their own natural ‘alert! Danger! I am under threat! autonomic nervous system response of flight, fight, freeze or dissociation which is our physiological survival response. The fact that they are trained to do this, and have techniques to use, cannot ever completely over-ride that ancient animal response, and this kind of ‘trauma is my 9-5, day in-day out worker’ may well find health problems which arise out of the continual overriding of the normal response to danger – get out of here!

How people feel and behave once they are out of danger and the traumatic event is over is a product of the intensity of the experience itself, the nature of the person and the context – that is, what their life is after the event

As in his previous book, what most blazes out, necessarily and importantly, is Marzillier’s artistry, his compassion, his flexibility and his open-ness to meet each individual he interviews for this book, making space for a joint exploration of their stories. Time and again he cautions against the single fix-it approach to PTSD – and, indeed, to the single, fashionable diagnosis of the condition. There may be other mental and emotional health issues experienced by someone who has been in a ‘traumatic’ situation, and other approaches, other diagnoses may need to be made. Don’t jump to a PTSD conclusion, he cautions.

It is a mistake to sweep all post-trauma psychological reactions into one simple category, or to assume that if someone shows PTSD symptoms then nothing needs to be done but treat the person’s PTSD

At the heart of this book, is the often stated central idea that whatever ‘the diagnosis’ says, that it is a unique individual with all their individual personality, history, belief systems and social networks who is receiving the diagnosis, and there CAN be no ‘one way’ of treatment. As in Gossamer Thread, Marzillier stresses it is the relationship between practitioner/clinician and patient/client which actually matters MORE than any ‘specific’ method. Sure, the practitioner must have relevant skills which can work in this field, and preferably, the flexibility and skill to acknowledge that ‘their’ skillset may not be the right one for THIS client at this point. Marzillier even acknowledges that treatment approaches which lie outside his particular belief system and training, DO work for some people, – with the right practitioner. He is extremely open-minded, whilst being at the same time, a scientist by training.

This book has a lot, highly relevant, to say to both the clinical psychologist and the ‘energy worker’ working in this field.

It is a marvellous book, serious, analytical, warm, open minded and hearted – and, always important, beautifully written, and authentic – he has allowed the individual voices of the many people he interviewed in this book – those who had experienced events, and been diagnosed with PTSD – to recount their stories, and the different treatments and outcomes. These are not, in the main, ‘his clients or former clients’ . They are people who chose to respond to a general request made ‘public’ when he was planning on writing a book on this subject.

To Hell and Back Amazon UK
To Hell and Back Amazon USA

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John Marzillier – The Gossamer Thread: My Life As A Psychotherapist

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Book Review, CBT, John Marzillier, Psychological Therapies, Psychotherapy, The Gossamer Thread: My Life As A Psychotherapist

The Gossamer Thread and The Boundless Ocean

I thoroughly appreciated John Marzillier’s wonderful book on psychological therapy, as the reading of it caused deep reflection which led me into many fields. Not least of which is the whole relationship we have with the reflective activity of reading itself. Doors open, horizons widen, intense emotional experiences and thoughtful, reasoned self-questioning occurs; ideas become developed or discarded; change happens.

I most value those books, fiction or non-fiction, which take me into these areas.

Marzillier’s beautifully titled book explores his own development in the field of psychological therapy, and the development of particular therapeutic approaches, as much as it also explores his successful or less than successful experiences with clients, suitably anonymised, and often with stories changed, to also protect the confidential integrity of the client’s story, in case a former client reads and thinks ‘that is me!’

John Marzillier almost stumbled into clinical work by default, beginning to work using behavioural techniques – a very reductive, lab-rat approach (or so it seems to this reader) in the late 60s and early 70s. The model, it seems, was heavily based on physiology and learned behaviours, biased towards large scale statistical ‘objective’ scientific studies, and drew much of its methodology from observed animal behaviour. However, Marzillier was beginning to feel uneasy, as ’something’ was missing in this approach, and almost by instinct he found himself, through a more dynamic engaged relationship with individual clients, drawn to exploring thought processes and even gaining curiosity about ‘back stories’

In fact, he was moving closer to embracing the role of the relationship between client and practitioner as integral to treatment. The ‘relational field’ approach though was still in the future for his work. This is a concept central within psychotherapeutic and psychoanalytical approaches, but was barely engaged with by the more ‘impartial’ scientific observational ideology of the behavioural approach.

He began to formally train in a then new discipline, cognitive therapy, examining the internal thought processes, the scripts and dialogues which run through our heads. Cognitive therapy of course, in tandem with the earlier behavioural approach, became mainstream as Cognitive Behavioural Therapy (CBT)

My sense, reading this book is that perhaps Marzillier was always as much an artist as a scientist, and therefore, by his own nature, more likely to find that any approach which has fairly set protocols, and a fairly rigid methodology might quickly begin to seem as if it were missing something. It seems to me that no one method or approach, in this field, is ever going to be successful with all people, at all times. What the left brain approach lacks is the imaginative gestalt, the whole-person poetry of the various strands of ‘relational’ right brain methods. Science versus art of psyche.

Marzillier ended up having a kind of revelation, listening to a lecture given by Dorothy Rowe, well-known for her work in the field of depression, about the centrality of core belief and how it can become entwined with one’s very identity. A belief may be useful or destructive, but even a self-destructive and painful core belief can provide the security of comfort – a reinforcements of the sense of self. To LOSE, for example, the certainly that life is meaningless or you yourself are worthless and bad things happen to you because you are worthless can be a frightening change too far – though a belief may or may not be a helpful one to an individual,  – and may or may not be right, it is YOURS. We all struggle with complex responses to being WRONG

His process of progression from scientific certainty, where the steps are known, and the methods can be approached sequentially, so that the method, not the person employing the method ‘makes’ the cure, eventually led him to the uncharted, waters of the mysterious ‘unknown’ of other, and the personal, uncertain route of that more narrative, right brain approach. I had a sense of the psychodynamic psychotherapist (a further training in this followed) like a boat in the middle of an ocean, lacking a map, with destination unknown, steering by instinct, feeling, sense, gut reaction on a journey of trust with his client. This sort of work comes closer to the relationships we have with ‘the others that are not self’ as we move through life. There are forms and structures, rough maps and sketched instructions which guide us, but the relationship between self and any other is something like a dance, which though the steps may be known, veers off into something jazzy, freeform, improvisational. Things may go horribly wrong, and the dancers fall over, step on each others’ toes – but they may also get to a dazzling, inventive, dynamic place with their dance.

Later, his journey takes him into analysis, to experience the procedure from the other side. He is as thoughtful about himself as an analysand, as he is about his patients, teasing out his sense of the process, and his resistance

As Marzillian points out, there are difficulties in psychoanalysis being properly verified by the statistical tools – because it is not dealing in certainties, but in ambiguities – the subjectivity of the practitioner is always within the encounter. There is not a set protocol of method, session to session, with set aims and objectives. This is the very real challenge of that therapy. It seems to me that IF the practitioner is both skilful, and congruent , on some deep level, with the client, the work can be amazing, profound, transformational. It is about much more than the client being free of the ‘symptom’ which brought them into treatment, and about much more than the client being ‘made well’ by the method – or by the therapist using ‘the method’. Instead, there is the possibility of (like with any authentic human encounter), both participants stepping into ‘meaning’ An epiphany of sorts, if you will. The big problem of course, is that it always beset around by those IFS.

Like that other wonderful writer in this field – the humanistic, existentialist psychotherapist Irvin D Yalom, Marzillier is steeped with a sense of art, awareness of metaphor, the poetic. He often illustrates by using literary allusion – literature is indeed a potent source helping us to understand the depth and vitality of human experience.

Marzillier also writes not only with warmth, clarity and authenticity – but with a fine sense of the absurd humour that is to be found in even the most serious places.

What is also utterly compelling about this journey Marzillier takes the reader through, is that he is a man who accepts the confusions, the hesitations, the contradictions within any ‘method’ No wonder he embarked on so many trainings, with that recognition that any one party line is too reductive and fixed to capture human exchanges in all their complexity

Or, as he more cogently puts it

If I have learned anything from a lifetime career as a psychotherapist, it is that there is no universal truth, that everyone is different, and that you, the reader, should take what I or anyone else tells you about psychotherapy with a large pinch of salt

The Gossamer Thread Amazon UK
The Gossamer Thread Amazon USA