The Romantic Patient

I read yesterday that Frederic Chopin never died, he simply became music. This idea, almost as beautiful and romantic as his own music, has been playing on my mind.

Many critiques write that Chopin’s music does not tell a story. I believe they are woefully wrong. Much as we experience tens and hundreds of emotions, the music of Chopin reflects these emotions. Each and every note is its own small lake under a clear night’s sky. Yet this night’s sky is clear of any human pollution or industry. It is simple and pure – a direct insight into the soul of another.

I believe Chopin used the piano to transfer his streams of thoughts and feelings into physicality by using the right hand to stream conscious thought and the left to stream that which is unconscious.

Take a nocturne (https://www.youtube.com/watch?v=WJ8RVjm49hE).

The right hand is the most prominent. It is the part that lightly takes your attention, and trails in chromatic notes that fall close to the previous notes, just as one thought is derived from the last.

The left hand is quieter, yet you can always vaguely hear it. If you concentrate, you can sometimes work out its content. This is the same as unconscious thought. It is always in the back of your mind, mostly ignored.

For Chopin, the unconscious was a background, maybe even a support, to his trail of thought. Just as conscious thoughts can be derived from the unconscious, the melody in the right hand is vaguely mimicked or represented in the left, whether it is a harmonising complement or a chord showing the emotions that each thought might induce.

The many minor keys Chopin used are commonly known to suggest a feeling of sadness. This is by no means a coincidence; Chopin was notoriously moody, and is often thought to have struggled with depression. Negative thoughts and emotions would of course translate to minor keys. Many sources have suggested that Chopin also may have suffered from bipolar disorder. Perhaps this might explain the structure of his waltzes (https://www.youtube.com/watch?v=hOcryGEw1NY); a short slow part followed by a contrasting staccato faster section, both somehow hauntingly sad. The sections are repeated over and over, with little in between the moods.

In his famous ‘Fantasie Impromtu’ (https://www.youtube.com/watch?v=B-HosIOod_A), Chopin undercuts triplets in the right hand with quavers (quarter notes) in the left hand. Both hands are played immensely fast and it is often confusing to determine what one should listen to, both not truly sounding like a true melody. I believe this to also represent the romantic author’s despairing mind. Both his conscious and unconscious are confused strains of half thoughts, both struggling for attention in their own way, both need attention in their own way so they can become untangled and become once again a true melody. Chopin once said that simplicity is the final achievement. I wonder if he was longing for an end from his depressed thoughts: could the refuge he was so longingly seeking be happiness or death?

I imagine, for a number of reasons, that Frederic composed his first ballade (https://www.youtube.com/watch?v=Ce8p0VcTbuA) to represent a cycle of psychotic episodes. There are three stages within a psychotic episode – a prodrome phase, an acute phase, and a recovery.  The prodrome phase is often the longest phase lasting up to a year of small repeated symptoms that vary from person to person; these interfere with daily life but do not completely take over. This is represented by the repeated phrases in the first two minutes of the piece.  This is followed by the acute phase, a time that is completely disorganised and distressing for the individual, quite often leading to delusions and hallucinations. This is represented in minutes 2-3. After this comes the recovery phase, in which the person is left with a couple of symptoms but, overall, this section is said to feel like breathing the outside fresh air after being stuck in the same room for weeks on end. This is represented from minutes 3-4. Chopin repeats the whole cycle starting with the same notes as in the first minute.

Chopin’s first ballade was the favourite of many, including himself. He wrote to Schubert that he held it to his heart most dearly out of all his pieces. Could this be because it represented such a crucial time for his health?

For a moment, let us believe this theory to be entirely truthful. To me, it is utterly heart-breaking to understand how much suffering a person has gone through. It feels as though he was crying out for help his whole life – people heard him and appreciated a reflection of the experience, but no one helped him. He just carried on making music as a way of transferring his emotions and feelings from his own body.

So maybe it’s true, Chopin never really died. His thoughts and feelings live through us when we experience his music. We are given a precious taste of what he once felt.

Is being cold good for us?

I hate the cold.

I hate how one experience can make you so uncomfortable, irritable, and introverted at the same time. I hate how one experience can make you shut down as if someone has flipped your power switch, or tremble so much that you feel like you’re about to start an earthquake all by yourself. I hate how, dressed up to the point you become a ball of cotton and woven material, you can barely see or hear anything from outside of the cavern of clothes you have draped around your forgotten figure.

You may be able to imagine my sheer irritation as I learnt that coldness is somehow in fashion. It seems ironic that something that we wrestle with, struggle against, even introduce it into our negative lexicon, can be of benefit to us. Honestly, it baffles me.

Yet, here we are. Primitive theories of scientists, research at their tails, are slowly starting to recognise the many uses that the low temperatures we try so hard to eradicate with our central heating and triple-glazed windows are actually useful in a clutter of weird and wonderful ways that even I, sat here in a bundle of blankets in March, might be able to appreciate.

According to some scientists, cryotherapy (that is, the use of freezing temperatures in treatment) can temporarily relieve the symptoms of anxiety and depression. First of all, let’s not get carried away. No one, and I mean no one, will exclaim with joy on learning that they will be freezing for the next five minutes. Supposedly, the calming effects of the coldness for a few minutes should be felt for the rest of the day. Perhaps this is due to something I like to call the ‘re-set effect’. If you’ve struggled with an addiction, anxiety, or depression in the past, you may have an inkling about the tangled thoughts I’m trying to separate here.

Many people, myself included, tend to overthink or stress about one thing so much that it gets pretty overwhelming. To get over these difficult few minutes, it is useful to shock your body, bringing yourself out of the panic with a good jolt. I think the anti-anxiety/depression effects of cryotherapy stem from this; your body turns away from the mind, instead fixating on survival. This helps your breathing, your heartbeat, and your muscles to go much faster, and then slower once you become warmer. This is much the same principle as clenching all your muscles for ten seconds in meditation to make sure that they all relax afterwards. Paradoxical? Maybe. Logical? Possibly.

The major benefit of cryotherapy is its ability to reduce swelling. Everyone knows – if you hit your head, put ice on it. This is because the low temperature reduces inflammation, which, in turn, has a larger effect on you than you might think. Long-term inflammation can contribute to diseases such as Arthritis, Dementia, Multiple Sclerosis, and even cancer. If inflammation is reduced, logic would determine that the risks of these diseases is decreased.

The signs seem to suggest that being cold once in a while is almost too important to ignore, and this is only the tip of the iceberg; the number of hypotheses of the uses of cryotherapy on the internet are virtually inexhaustible.

So what I’m really trying to say is, next time it snows, and you want to go sledging or skiing, do your health a favour – go naked.

An Armour of Guilt

Guilt is one of the most common negative feelings that people experience. Yet, it seems so little understood.

Evolutionarily, why is it that we feel guilty?

What true benefit does it bring to us?

Why do we experience feelings of guilt even at times where we may not bear any logical responsibility?

And what is it that drives guilt to scar so viscously into our minds that it has a permanent negative effect on our day-to-day lives?

Let us begin with evolution. We know, courtesy of John Nash, that humans will always strive for what is best for our community, or group of people that we consider close to us, in order to benefit ourselves. Perhaps, guilt is our minds’ way of telling us that we should look out more for others in our group? For example, you pull a sicky at work, but it means your co-workers have to do double the work for the day. You subsequently feel guilty because of this. Now you feel guilty, because you haven’t strived for what is best for the group (i.e. your co-workers)?

The experience of guilt always follows from one’s idea of negatively impacting other people. This correlates with the ‘Game theory’ approach to guilt; guilt is always to do with the best interests of the group in question. It also answers the question of why guilt troubles in our minds so long as to permanently affect our day-to-day lives.

This idea may bring us peace when trying to derive the logic behind the inherent emotion, however, it doesn’t quite explain how we feel guilt at times when pure reason points otherwise. Turn your attention to survivor’s guilt. There is a fire. You live, but your friend dies. You had nothing to do with the fire starting – it may have even be the cause of your late friend. Yet, many people in this situation have found themselves crippled with guilt.

To overcome this somewhat baffling barrier, our solution may have to be delving into a philosophical realm. This suggestion assumes that we, as humans, inherently and unconsciously believe that nothing happens to us when we die. Therefore, when someone is dead, they are completely and utterly helpless, unable to move, think, feel, or interact. Of course, we know their body is still in the physical realm. They are not able to touch, but are able to be touched – able to be thought about, but not think about others – able to be felt about, but not able to feel themselves. This seems like the very definition of helplessness. Those who are not able to move, think, feel as well as ourselves include babies and those with disabilities. To babies and people with disabilities, we feel some sort of obligation to help – a responsibility if you will. On an aeroplane emergency, parents are expected to help their children. People in wheelchairs are helped out of burning buildings. Going back to the hypothetical situation, you have survived and your friend, who now seems completely helpless, has died. It seems as though you have recently gained responsibility for your friend. Logically, is this your fault? Of course not. Were they your responsibility? Of course not. However, it would seem that you left a helpless person in a burning building to die.

Another theory I have to do with survivor’s guilt revolves around defence mechanisms. It is known in psychology that people have constructs of common events around which are woven the subtle fibres of specific events and memories. These can easily be contorted and twisted. After all, each time you remember an event, you are only remembering the last time you remembered it. If your mind can contort the memory to make you believe that you could have saved your friend from the fire, then you will believe that you will not lose any more friends in fires, which will mean you won’t feel the same grief you have done for your friend, as you believe you will be able to save the next friend that finds themselves in a fire.

I believe this is an important time to note the curiosity of grief and how it might play a role in survivor’s guilt. It could be the case that our analysis has dived too deep too quickly. We should at least toy with the idea that guilt may not entirely be the right word altogether. After all, medical students are increasingly encouraged to think about differential diagnoses before coming to a conclusion about a patient’s condition. Perhaps, survivor’s guilt is a manifestation of pure grief, in a different form. Grief has been known to implant physically and emotionally in a variety of ways, including hallucinations, depression, anxiety, and psychosomatic pain. Could it be that one’s grief is so incomprehensibly overwhelming and so undesirably intolerable, that one must split the grief into different sections, to make it easier for the individual to deal with? By assuming responsibility of your late friend in the fire, you divide the grief between that for your friend, and that for a part of you that you believed to be a good person who would help a friend in need. In doing this, you sacrifice your morality for your state of mind, believing it easier to cope with two smaller parts of grief than one larger one.

It is a common belief in psychology, that understanding more about yourself will bring you more peace. On the whole, I agree. Coming to terms and feeling at ease with anything holds a prerequisite of understanding the thing itself. I’m sure, one day, I will find out if this truly applies to a deep-set, stomach-curdling survivor’s guilt. For some reason, I have my doubts.

Love’s Executioner

This chapter left me feeling significantly uneasy. It revolves around the psychotherapy sessions of a 70-year-old lady called Thelma and the therapist, Irvin Yalom. Thelma has an obsessive love for an ex-therapist to which she hasn’t talked for 8 years. She has since descended into a depression deeper than any psycho-therapeutic medication, and has come to the therapist as a last ditch attempt to savour the last chapter of her life.

At first, it seemed as though the ex-therapist had been exploiting the deep insight he had gained into Thelma’s life and taking advantage of this, yet it turned out that her love was sadly unrequited after a three-way session with the ex-therapist, Irvin and Thelma. Thelma eventually stopped seeing the therapist, leaving us unconvinced of the effect the sessions may have had on her.

Currently, I’m not entirely sure why the chapter made me feel so strongly. Half way through the chapter, I felt nothing of this magnitude. Perhaps the effect is due to the large effect that psychotherapy seemed to have on the patient, or more likely perhaps on the therapist, who was disturbingly honest about how attached he got to the case. As a medical student who has had a slow and steady, unconscious until recently, increasing interest in the field of psychology, it stung me deeper than I would have liked that this could be similar to the career I may choose. The thought of paying attention to my mental throughout my whole life seems somewhat daunting. On the other hand, thinking consciously about this puts me at a better ease, as I have learnt that, to be truly happy, one must always pay attention to their feelings, thoughts, and our minds relationship with our body, other people, and the world around us.

It seems rather intimidating to plan to undertake a career with which the most experienced psychiatrists are still wrestling (and sometimes losing). If an enjoyable and blissful life is my primary target, does this mean I should abandon hope for a career in psychiatry in pursuit of a career that leaves my mind untouched? Or should I instead infer the opposite from my findings, and lead myself into the largely unknown territory in the hope that it may bring myself and those around me a sense of stability and tranquillity?

I have long since believed that the teenage years are those of particular difficulty (an opinion to which many people will, I’m sure, testify). However, when I read around the life of a seventy-year-old woman with crippling, major, long-term depression, I am forced to take a stance that each section of life is neither hard nor easy. Each person has their own reality, and it is our job to find this reality, and come to terms with it. If this means my reality is to lead a life of constant anxiety, then so be it. If it means that I may soon ‘grow out of’ this phase I find myself in, then so be it.

This post is an analysis of the first chapter of ‘Love’s Executioner’ by Irvin D. Yalom. The chapter is called Love’s Executioner.

https://www.yalom.com/loves-executioner