Life Support

9 October 2020
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This week's guest blog comes from Dr. Adam Burley, Consultant Clinical Psychologist

"Breathe. Keep Breathing. I can't do this alone"


Most of us are expert at breathing. We have been doing it for so long and with such proficiency that we spend most of our time barely aware that we are even doing it. In, out, in out, in, out without a single thought or care. We rarely arrive at the end of the day congratulating ourselves on another twenty four hours of successful breathwork. Perhaps there is the odd moment when we choke on a piece of food where we come to realise with an ever-increasing sense of panic, just how fundamental breathing is to us, but typically it remains invisible, quietly keeping us alive.

Relationships are the psychological equivalent of breathing. From the first moments of our life, our psychological safety, development and existence is dependent upon the presence, quality and nature of the relationships we find ourselves in. Our relationships are not chosen by us, but they come to define us. If all goes well through those early experiences; if our needs are adequately met, and we feel safe and contained within them, then we may well go on to have a life where we can relate to some of our fellow human beings and through this continue to grow, develop and explore the world around us. And we may find that we can do this as easily as breathing – automatically and without any conscious effort. We will rarely arrive at the end of the day congratulating ourselves on another twenty four hours of successful relating, and we might even remain completely unaware that our mental health and wellbeing, as well as almost everything that we achieve in our lives, is governed by our capacity to form, develop and maintain relationships. When we occasionally choke, such as when an important relationship breaks down or someone close to us dies, we may come face to face with their importance, but typically we take our relating abilities completely for granted as they quietly keep us alive.

For those of us who find ourselves homeless, it is often the case that there has been a great deal of relational adversity in the earliest years of life. Trauma, neglect and abuse all occur within relationships, and can have profound impacts upon future human connection, particularly in the areas fundamental to relating such as trust, safety and dependency. And just as chronic choking in breathing can be life limiting, chronic choking in relationships can have similarly profound effects. Because while the more overt symptoms of these experiences such as drug use, poor mental health, and involvement with the criminal justice system, are easy to spot, the underlying relational experiences are less visible and therefore easy to miss. For example services often set themselves up, and even name themselves after symptoms, but because they are so often developed by people who have not had the sorts of relational experiences of those whom they aim to help, they are rarely designed in a way that takes account of difficulties in relating. They often operate under a never-articulated but ever-present assumption and requirement, that those making use of the service can trust in it and relate to its personnel in an anxiety free way. But of course some of those people who are in the greatest need of help are the very same people who have the greatest of reasons to trust in it the least. This can lead to discharge, banning, and other examples of relational breakdown between those in need and those trying to help.

My experience of working with support workers such as those at Cyrenians, is that they often labour under a fantasy that all the goodies are elsewhere, up in the specialist mental health services, or other parts of the NHS, and that their job is merely to facilitate connection to those goodies. In fact, they often preface what they do with, ‘I just...’, or ‘All I do is.....’, and then go on to describe what is the most fundamental and important part of all human activity; the provision of a stable, trustworthy and compassionate relationship. Because freed from the symptomatic and administrative tyranny that defines many healthcare services, they are actually able to be present in people’s lives as a committed, interested and dependable human being. And in doing so they truly are support workers. What I think is too often overlooked, and too little recognised, is that what they are actually supporting is life itself.