Protecting bodily autonomy

The overt promotion of discrimination against individuals for exercising their sovereign rights with respect to their health and the personal decision as to whether to consent to receive particular medical interventions has been of growing concern to me over the last 12 months. Additionally, in several countries around the world, the recent introduction of ubiquitous restrictive measures that excludes those who do not acquiesce to such interventions is wholly unethical. It is extremely disturbing that these illiberal measures—which are coercive, divisive, and effectively creating a health subclass—would even be entertained in free society and accepted by the wider public.

As a clinical psychotherapist, my values simply do not align with this mindset. I am opposed to the unethical practices of coercing others and to the loss of bodily autonomy1. By bodily autonomy, I am referring to the freedom to act upon choices which relate to the human body. I take a position that does not discriminate against individuals for the choices that they make.

People should not be subject to emotional blackmail (a form of psychological coercion) and shaming practices, especially by medical professionals and government officials. Crucially, it is a doctor’s duty of care to a patient to advise, explain and warn about a proposed intervention and its implications for a patient’s bodily integrity and health. Alarmingly, this crucial ethical practice is being undermined in lieu of practices that seek to promote an intervention that in many cases may not be in the best interests of the individual patient. Thus, it is imperative for individuals to make their own informed personal interpretation of the risks involved before agreeing to a medical intervention, for it is they who ultimately bears the consequences. It is precisely for this reason that informed consent and freedom of choice is absolutely sacrosanct.

Your body is your home. It is central to every aspect of your life, from being born, growing up, having children to becoming ill and dying. Hence, the choices a person makes about their body are not insignificant given the long-term consequences that are potentially involved in such decisions. Understandably then, the “principle of autonomy is an important foundational concept for the law of human rights, alongside principles of equality and dignity” (Wicks, 2016, p.6).

An intrinsic part of being human is the right to bodily integrity and autonomy—in other words, the right to take decisions about one’s own body. In Civil Liberties and Human Rights in England and Wales, David Feldman defines the right to bodily integrity as “a right to be free from physical interference”, and this “covers negative liberties: freedom from physical assaults, torture, medical or other experimentation, immunisation and compelled eugenic or social sterilization, and cruel or degrading treatment or punishment”2.

However, the universal acceptance of the principle of bodily autonomy is now being dangerously eroded through the coercive tactics that have been widely adopted to enforce a medical intervention that fosters discrimination and drives greater levels of segregation within society. It is such practices as these that are the greatest cause for concern, as history well demonstrates. Thus, I feel compelled at this point in time to openly state my position as someone who stands by their principles and values. I will not discriminate against someone and exclude them from society or treatment for exercising their right to bodily autonomy.

1 Wicks, E. (2016), The State and the Body: Legal Regulation of Bodily Autonomy, Bloomsbury Publishing

2 D. Feldman, Civil Liberties and Human Rights in England and Wales, 2nd ed. (Oxford, 2002), 241

Anxiety and the Covid-19 pandemic

Understandably, people are experiencing an increase in anxiety for various different reasons amid the current situation with Covid-19. These range from concerns about contracting the virus, particularly for those with underlying conditions, through to coping with being confined at home, which might in itself be difficult for some people and this could be for many different reasons. Beyond this, there are other significant pressures surrounding money, employment and education that might be affecting an individual’s level of stress and overall wellbeing. If you are self-employed or run an independent business, anxieties are sure to be growing in parallel with the gravity of the situation.

With these anxieties and the internal shifts that people are experiencing, finding ways to maintain a sense of equilibrium is increasingly difficult. Home circumstances can exacerbate the ability to take space and tensions can start to rise, or in contrast, others are faced with loneliness and isolation from connecting with people. The question then is how to lessen these potentially overwhelming feelings and find ways to support ourselves and others.

One of the most effective techniques in working with anxiety is to bring the attention to the ‘here and now’. Anxiety tends to be oriented toward the future – things that might happen or we fear will happen. The most effective way to lessen the effect of anxiety then is to bring the attention and focus back to the present moment. There are lots of exercises you can do to help draw you to the present, such as breathing deeply and counting the breath (inhale for 4-6 counts, exhale for 6-8). Elongating the exhalation is particularly important for calming the nervous system. Another is to walk mindfully around your living room, paying careful attention to each step, the sensation of your foot as it makes contact with the floor, what the floor feels like, the rhythm of your steps, the muscles in your calves as they contract and release and so on. I really like the 5-4-3-2-1 method which uses your senses – list 5 things you can hear, four things you can see, three things you can touch, two things you can smell and one thing you can taste or say one good thing about yourself.

It might be helpful to set some limits around news consumption for instance, and only check the news once per day for the headlines or important updates as a way to keep informed. If you find yourself compulsively checking or watching the news, this might serve to increase your sense of anxiety. It’s also incredibly important to try to maintain connections with loved ones and those who are sources of support. Reaching out and sharing difficult feelings with those you trust can be hugely uplifting and alleviating. But even having a coffee break with a colleague or friend via video chat will be beneficial.

Maintaining some kind of ‘normal’ routine each day can also be helpful as people function better when they feel they have some kind of structure in place. It also increases a sense of control during a time when things are feeling uncertain and maybe even out of control on some level. Be mindful though that it is nonetheless important to pay attention to feelings of fear and anxiety – they are important communications from within signalling to you that there is something going on that needs your attention. In this sense, I feel perhaps the most important thing any of us can do for ourselves and those we are close to at this time, is to seek to cultivate a stance of compassion and acceptance that this IS difficult and that your feelings are real and valid.

I believe the latter is crucial amid the prevailing stream on social media that it is selfish to complain about being confined or to experience difficult feelings when there are those risking their lives in certain fields. While we are of course eternally grateful for those who are keeping our fundamental and life saving services running, we must not lose sight of and squash the need to attend to those feelings that we fear might be unacceptable and the fact that they need to be given voice to as well.

Finally, we do not know what any one person’s individual circumstances or life experience has been and therefore, a situation such as this can evoke all sorts of complex feelings and behaviours. Our deeply embedded survival systems inevitably activate when there is a threat present, and we are dealing with a threat that we cannot see and so it is difficult to protect ourselves.

If you feel that speaking to a professional therapist might be helpful, many therapists, including myself, are now offering therapy online, and there is information about some of the other English-speaking support services in France on my links page here.

If you have any comments about what I’ve said or suggestions for other topics that you would like covered here, please drop me an email at sarah@headspace-therapy.com.

The Pain of Family Estrangement

“There must be room in love for hate.” — Molly Peacock

Definitions of estrangement vary, but at its most basic, estrangement can be understood as the breakdown of a relationship between family members. 

The experience of family estrangement is deeply personal, complex and unique, and there can often be a sense of secrecy and shame surrounding the experience. Individuals estranged from one or more family members, tend to feel the need to hide their situation from others, particularly in case of close family relationships such as parent-child estrangement.

Estrangement can be an intensely stigmatising process, with adult-children being condemned for estranging an ageing parent and similarly, a parent may be harshly judged for ostracising a child. Hence, disclosing their estrangement from members of their family is something that people usually go to great lengths to avoid.

However, the secrecy and silence surrounding the intense hurt of estrangement means there is a lack of support for those experiencing it, particularly within immediate social and wider support networks. Research indicates that family estrangement may not be such a rare occurrence as we might think and of course, estrangement is difficult to quantify since it tends to be such an isolating experience with individuals concealing or minimising their experience to others. 

Estrangement between a parent and a child can be seen as particularly acute, given the uniqueness of this relationship, and the parent-child bond is often socially perceived as permanent and therefore unbreakable. The relationship between a mother and child is arguably one of the most emotionally charged and therefore the most wounding when it breaks down.

Notwithstanding the reasons leading up to a family estrangement, there is an inevitable experience of loss. Often, the losses are multiple and may be felt at different levels by those that are estranged, and arguably the loss is more difficult to reconcile when the one that has been lost is still there. These losses can also extend across the generations involving siblings, cousins, aunts, uncles, grandparents and grandchildren. This loss has been referred to as ‘disenfranchised grief’ – a loss that cannot be openly mourned or acknowledged (Doka, 1989). This can leave the grieving person feeling inhibited from seeking and receiving support.

However alone someone might feel, seeking support from close friends where possible, or from an experienced psychotherapist who is independent from your circumstances, can offer a way to make sense of your experience and move forward.

References:

Doka, K.J. (1989) Disenfranchised grief. Jossey-Bass.

Expat Relationships : Keeping Your Relationship Healthy

“We are never so vulnerable as when we love.” — Sigmund Freud

Moving overseas is both exciting and anxiety provoking.

A move abroad at any time of life presents a considerable adjustment, with new surroundings to navigate, building friendships, perhaps another language to learn, finding out about cultural differences – the list goes on!

Couples and families move for many different reasons – career, lifestyle or something else entirely. However prepared you may or may not have felt, things can feel extremely challenging at times. It is during significant periods of change that we find intimate relationships tend to come under increased pressure. With our in-built need for security, stability and connection with others, these needs become amplified during periods of change.

Expat relationships

When partners have trouble responding lovingly and sensitively to one another during periods of increased pressure and changes in circumstances, feelings of disconnection can mount and couples can feel increasingly misunderstood and unsteady in their relationship. If this continues, over time, relationship problems can escalate – sometimes to the point where things feel lost or hopeless.

You have made a major life change and it is understandable things have impacted on your relationship – that is difficult for anyone. Big changes make us all feel vulnerable on some level and everyone responds to this differently. Some things that can help are to give yourself time, and to try to be understanding with yourself, and one another, about the challenges you have been experiencing.

Patience and consistency are key too – it can take some time to re-build your connection with one another. Relationships require energy, nurturing and patience to flourish – even more so during the most challenging and demanding periods, but of course, this is often when there are less internal resources available for one another.

Remind yourselves of all the good things about your partner – you might have lost sight of these recently! This is especially important if you find yourself in a negative and blaming pattern with one another. To get back into seeing one another more positively and warmly, try to remember what you love about your partner – what each person brings to the relationship and to value one another. Try to put your energy into seeing these special qualities in action and noticing them.

Or it may be that the time has come where you feel you need some support to help you get things back on track together. This is where some couples therapy can be of help, particularly when communication has become increasingly challenging. It can be difficult to take this step – some might feel they are admitting defeat. However, retrieving a relationship becomes harder the longer things go on unresolved.