Therapy and the broken man

Darryl was a difficult patient I had been treating for several years who illustrated the contemporary challenges of his ilk. A stocky man in his forties, he shuffled into each appointment with a walking stick. At first sight, the stick gave him a distinguished quality but then a trace of his bare belly beneath a T-shirt that never quite fit over his bulging gut became visible.

“How are you travelling, Darryl?” I’d ask.

“Yeah, alright,” he’d mumble. “Fucken insurance pissing me off as usual.”

Darryl was being funded through worker’s compensation after suffering a crush injury to his lower back while lifting crates in a factory. He underwent several operations of inserting plates to metal rods in his spine, to the point where scans of his spine resembled a construction site, but his pain and mobility showed few signs of improvement.

His employer kept him on performing light duties, which was essentially a euphemism for doing the most basic paperwork, but the factory shut down after the manufacturing shifted overseas. He was made redundant but continued to receive compensation payments while he looked for alternative work.

There is an important term in mental health therapy called transference, which refers to the reactions patients arouse in therapists. A good therapist is acutely aware and can counter and override such emotions but also consider them as information about how the patient might affect other people in his life.

My mix of mild disdain and sympathy was awoken each time Darryl visited. He was the epitome of the bogan, the kind of figure the middle classes were desperate not to be associated with, or have their own aspirations for Australian identity tarnished by.

Darryl often wore striped football shirts and a beanie to appointments, even during the height of summer. He said it was to cover an emerging bald spot. He was the only patient to give me a beer coaster as a Christmas present, which I treasure. He even had a name for his penis, which he not so imaginatively called Rod, a name that emerged in our sessions if sexual side effects were being discussed. It was one area of his life where he retained a sense of humour. His childhood memories involved his father taking him to the greyhound races. Darryl was able to give a vivid account of the trips, despite having few words for his emotions.

“The bookies were loud. They’d be screaming the odds before the bloody hare came out. I remember some dog called Leah Turd that won at odds of twenty to one. We won a motza and my dad bought me a massive tub of ice cream,” he said with a stealthy grin.

But Darryl’s father also suffered a work injury as a carpenter and turned to alcohol. He grew more violent and unable to suppress his rage, started beating his wife, Darryl’s mother, a resourceful woman who worked as an aged care nurse and eventually left her husband. Darryl and his younger sister lived with their mother.

Darryl had at least one good decade, when he was married with his first wife, had two young children and a traineeship leading to work with Telecom. He was proud of his time working with the company during the Sydney Olympics, but was made redundant soon after. The marriage ended and his children became more distant. He claimed he could never tell them that it was their mother who was unfaithful, instead unable to temper his anger through vengeful outbursts in the home. His mood only worsened when his factory job was also stymied, first through injury and then through outsourcing.

Now, in my rooms, he was a ball of suppressed rage, usually projected internally in the form of vague thoughts of harming himself, and made worse after he had consumed his evening round of five or six stubbies of beer. He once took an overdose of a prescribed tranquiliser after his new partner threatened to leave him, a prospect that was looking more imminent if he didn’t show some improvement.

“It helps me sleep,” he says, in reference to his drinking. “If I take more of those pain meds, I can’t shit no more.”

But despite his efforts to minimise his rage, it would surface at a range of inopportune times. He had been banned from his stepdaughter’s primary school for fighting with the teachers, once because he thought too many merit certificates were being handed out – “It makes the kids soft”– and another occasion for verbally abusing the middle-aged woman helping at the pedestrian crossing. “She should have let me cross,” he insisted. “There weren’t any fucken’ cars.”

When he drove, Darryl would regularly find himself in heated bouts of road rage, once limping out of his car to threaten another driver for tailing him too closely. He admitted to casually swerving in the direction of people he didn’t like the look of.

“I like to give ’em a scare, especially if they look a bit up themself.”

On the rare occasions he visited the local shops, he was livid at the demographic changes in the area, a place his extended family had resided in for several generations. So many black and Asian faces, too many fancy designer labels and too few people or organisations backing people like him.

“There’s outfits helping out refugees everywhere, on every bloody corner,” he railed. “They get extra money at school and everything.”

His sense of displacement was most tangibly felt through his regular tussles with the insurance company paying his benefits, attempting to have treatments approved and receive his regular allowance. His mental state was one of free-floating anger that latched to just about any aspect of his immediate environment and identified it as an enemy.

It is difficult not to see the fragmented rage of people like Darryl as being a fundamental factor in the rise of demigods such as Donald Trump, shock developments such as Brexit in Europe or the success and longevity of politicians like Pauline Hanson in Australia. They are the mirror image, the Newtonian reaction to the diffuse resentment of Islamic terrorism, full of dissatisfaction with the “system”, but without workable plans. They represent a pining for simpler, collective identities such as nationalism.

Despite the Left building its foundations on the valorisation of the working class throughout the twentieth century, it has now abandoned them to some degree, leaving them free to hold some of the most conservative social views of any group, particularly around race.

Debates around racism are an area where the nose-turning sneering at the working classes is most palpable. The representations of people attending patriotic protests are an obvious example. The protesters are depicted in tattooed, pierced splendour holding angry signs at racist rallies. An accusation of racism is often veiled class sneering using Muslims and other ethnic groups as cover, evidence of French philosopher Pascal Druckner’s observation that multiculturalism was sometimes the racism of the anti- racists.

What progressive groups sometimes fail to realise is that by their outward expressions of concern for ethnic groups, and thereby separating themselves from the crass and unsophisticated people who don’t express adequate sympathy, progressives are effectively clearing a space for themselves to enjoy the advantages of white privilege.

Patients like Darryl, while an isolated case study, illustrate that no collective group or organisation, other than perhaps the football leagues, is actively representing the white working class. Race-based politics have helped entrench the resentment, for it has given the working class permission to view themselves as an aggrieved, racial group left out in the cold.

Men like Darryl may present to me because they are also the group least likely to manage the gender transition that is necessary for all men in response to changing sexual norms. There is a much greater expectation for all men to be available emotionally to their partners and children not to mention undertake more housework.

Yet most feminist groups and even the psychiatric classification system don’t easily incorporate rage as a legitimate expression of emotional distress because there is a belief that it will diminish accountability, particularly in areas such a domestic violence. But as psychiatric patients presenting before the law demonstrate, a more nuanced view that incorporates both responsibility and therapy is possible.

As someone from a very different ethnic background to patients like Darryl, examining racial resentments is of particular interest. Those who express anti-immigration views will often express admiration and affection for authority figures of ethnicity in their lives, such as their family doctor for example, but simultaneously harbour anger to migrants in general.

After the shock of the Brexit outcome in Britain there was a swathe of studies attempting to make links to a wider worldview that supporters may have held, all in a desperate clamour to understand the seemingly inexplicable. A common overlap for supporters was broader authoritarian views, notably predicted by support for the death penalty.

As a psychiatrist, such a turn towards authoritarian certainty makes me think of the place of fathers in my patients’ lives. I find it instructive that the handful of my patients with strong ties to anti-immigration groups inevitably had limited or ambivalent links with their father. Darryl did not have any organised links with racist groups but held similar views.

But another patient of mine, Drago, developed strong links to a group similar to Reclaim Australia, wanting to end Muslim immigration. He was a tall, lanky man raised by a devoted single mother. He pined for his Serbian father who lived interstate with a new partner. Drago was referred to me from a disability employment agency because he couldn’t hold down a job due to his problems tolerating any kind of frustration. His frustration automatically spilled over into rage rendering him incapable of handling interactions with authority and negotiating with co- workers, a requirement of any workplace. His employment kept getting terminated.

When I asked Drago about hobbies and interests, I discovered he had formed a group with some local friends which they coined the “Slavic brotherhood”. His friends and the other members of the group were all raised with little or no presence of a biological father. Did they not notice this overlap, I asked? Drago shrugged and agreed it was something that brought them together, but didn’t think it was a big deal.

It is difficult not to see the rise of anti-elite, strongman political figures like Trump as a symbolic yearning for a generation of men derived from the highest proportion of fatherless households in modern history. Without a clear acknowledgement of this deficit or an appropriate channelling into alternative forms of collective identity, such groups will actively look to assert their group identity through outlets of resentment and authoritarian certainty such as anti-immigration organisations.

Conservative thinker Reihan Salam writes of an “asymmetrical multiculturalism” whereby minorities are actively encouraged to celebrate their identity and defend their interests while the majority are discouraged from doing it. Outward displays of Italian, Indian or Muslim pride are fine, but if the same occurs for Anglo-Saxons it’s regarded as a definite no-no. When whites with many generations of ties wave the national flag or sing the anthem too spiritedly, the fear is that it de-legitimises or dilutes the Australian-ness of other groups.

Salam believes that due to the white majority being denied the option of celebrating their ethnic heritage, they’re reduced to championing ideological causes like free speech and the rule of law, stripped of any cultural content. These are notably worthy goals, but as debates around the Racial Discrimination Act in Australia illustrate, they are also indicative of a suppressed nationalism without alternative outlets.

In his book Angry White Men, American sociologist Michael Kimmel coins the term “aggrieved entitlement” as a way of describing the losses felt by the white working class, particularly around their power as males in the household, the dilution of their political power in the face of demographic shifts towards ethnic groups and their economic disempowerment in the face of globalisation. He visits characters such as neo-Nazis, wife beaters and angry divorcees to make his point. Kimmel argues such men are failing to make the adjustment to a world where they must be equals instead of the stars of history’s arc where they were placed upon a pedestal.

Kimmel’s analysis applies one of the most common accusations leftists make of conservatives: that they lack empathy for disadvantaged groups. By continuing to view working or underclass men through the lens of gender or race and not through class or economic entity, it seems that resentments will only be further inflamed and the whittling away of the foundations of the historical Left will continue unabated.

Scottish novelist Andrew O’Hagan in a 2009 George Orwell lecture argued that the English working class is dead, its traditions and values replaced by sentimentality and the illusory promise of credit cards and celebrity. Unlike the Scots and the Irish, who were an innate community held together by songs and speeches about themselves, said O’Hagan, “the English were something else: a riot of individualism, with no sense of common purpose or collective volition as a tribe”.

It is possible that Australians exist somewhere in between, with some overlaps with the Scots and Irish in developing a tribal, lighthearted oppositional identity to the English motherland but also exhibiting a greater individualism borne from a stronger cultural influence from America. But with the decline of unions and manufacturing across the Western world, it is difficult to see what traditions, habits and speech bind this amorphous group.

As economic entities the white working class have much in common with newly arrived immigrants, but it is rare that they have the same drive and desperation to rise up the social ladder. The working class is perhaps now a holding bay for those transitioning to the middle class, with a portion falling through the cracks to take their place in the entrenched, welfare-dependent underclass.

When supporters of Brexit in England were interviewed, along with views tending to the authoritarian, a common theme was they no longer felt they belonged in the communities they lived in. There were tinges of racism in these stories, with tales of walking to the shops and only hearing Polish or Romanian and no longer recognising others on the street or of shopkeepers calling them by their first name. There is a nostalgia for the past in such stories that borders on delusional, but they are nevertheless the lived experience of many.

Interviews with Londoners who supported Brexit conducted by the BBC illustrated how people celebrated the difference and enjoyed the vitality diversity and migration brought. And the same interviews showed these people were happy to co-exist in separate communities rather than pine for some kind of greater intermingling reminiscent of the past.

Patients like Darryl expressed similar views to the Brexit supporters. Darryl walked to the local shopping centre and became incensed that he felt like a member of a minority group in the place where he had lived for generations. He noticed signs and organisations advocating for newly arrived immigrant groups such as asylum seekers. Any sense of being part of a collective was limited to buying his Lotto ticket or watching his football team on the weekend. Given Darryl’s considerable psychological frailties, he was not indicative of the majority. Most people are adapting, but his inner concerns were pointers to wider trends in dissatisfaction among his demographic group.

British sociologist Will Davies writes that the Brexit campaign slogan “Take Back Control” was ingenious at both a psychological and political level exactly because of the way people like Darryl felt. Their inner experience was one of what is known in psychology as “learned helplessness”, where you felt like you were a rickety boat being thrown around in choppy waters. This diagnosis has traditionally been applied to survivors of trauma, particularly women subjected to long-term domestic violence. But in politics as used by Trump, the UK Leave campaign and to some extent Pauline Hanson, the slogan spoke directly to the feeling of inadequacy and embarrassment felt by the white, working class man, and magnified by the class sneering endemic among the inner-city bourgeois. As Davies writes, what such voters crave more than anything else is “the dignity of being self-sufficient, not necessarily in a neo-liberal sense, but certainly in a communal, familial and fraternal sense”.

I used to have a view that attempting to engage with patients like Drago and Darryl with a strong psychological angle, attempting to help them gain insight into their coping deficits was doomed to failure, that they were not psychologically minded. But experience has taught me otherwise, that men of limited education, few words and diminished resources were in fact capable of engaging in individual analysis. This did not replace the wider dimension of their position. As American poet Adrienne Rich wrote, “the moment when a feeling enters the body is political”. Changes in political economy had affected the working man disproportionately, but the wider project of helping them gain a greater mastery of their emotions and, in turn, their lives, was a worthy social goal. They were reminiscent of the individual versus society being a more relevant struggle for most than that of labour versus capital.

Unfortunately I was not able to keep Drago in any kind of therapy, but the disability agency informed me that the addition of a medication that helped reduce his impulsivity and increase his tolerance towards frustration allowed him to hold down a job in a car wash. Sure, it wasn’t a dream job, but it gave him some structure and purpose. I doubt he took much notice of my interpretations around his fatherlessness, but I’m confident his anger towards racial groups was tempered once he was able to maintain some kind of employment.

Darryl on the other hand was a difficult but eventual success story. Instead of projecting his rage outwards he was able to see that his own failures of communication and regulating mood were major contributors to why his life had gone the way it had. The moral, individual dimension of his problems became more apparent, mediated through the secular process of therapy and psychiatric medications. He managed to keep his new partner, just, and he had initiated contact with his children after many years.

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