Thursday 25 September 2008


How we are impacts 'pon who we are.

I didn't make this up, this statement was deduced by keener minds than mine. It's a concept that's gained credence over time and has been embraced in psychological therapies to effect change. Cognitive Behavioural Psychotherapy (CBT) has a rich evidence base showing that changes in behaviour and thoughts effect changes in our feelings and disposition. From being stressed when driving around a particular roundabout after a bad accident, from feeling panic when having to look after the grandchildren for a Saturday morning, from staying at home since you feel you're poor company instead of popping over to a friends for your usual Tuesday morning coffee and a natter, you work through CBT and move towards being able to manage these things. We're no longer anxious, or having panic attacks, or constricting our behavioural repetoire through thoughts of ourself/the world/others.

Thus, what we do has changed who we are.

This is a good thing. We can take positive action to make positive changes.

I was speaking with a lady from Sweden. Although this is anonymous, the number of Swedish ladies who have had this care will be modest, but her insight was such that I wished to share it. I spoke with her and she was more than happy for this to be shared here, so here goes. She had experienced a period of depression after her husband died which we managed with input from the CMHT and successfully improved things without medication. CBT over just a few sessions was very useful for her.

She has been well for a length of time so I visited her to review things, ensuring she wasn't being too brave (and wasn't depressed), that medication still wasn't necessary and whether discharge from our service should be entertained.

When I saw her in her home I was struck by how well she seemed. Often folk in my corner can be stoical, but struggling to manage beneath the veneer of coping. Not so here, she really was well. She wasn't as cheery as she felt she once was, still seeming a little weary, but was doing everything she used to, visiting friends, managing her garden every day which looked lush (the mixed sunshine and rain of this Summer helping make it a riot of colour), helping more frail neighbours with shopping, visiting a friend down South last week for a couple days, really doing well.

I talked through with her how life was for her now, how she'd been low in mood, how she'd recovered and what had been helpful in this process. Talking with friends and family had helped her, but what had been most useful was a CBT session with a CPN who had been promoting mindfulness and acceptance therapy ideas with her, to frame things she can't change in a fashion that she could accept and cope with.
This had switched on a lightbulb moment for her.

She was very animated and excited on telling me this, recounting how she'd had this conversation with the nurse. "I know this," she beamed, "this is how I am."
She explained that she had always felt you need a little of everything. She had experienced disbelief, she had felt wronged, she had felt sorrow, she had experienced warmth and friendship. "This is how it should be, this is how I am."
She explained to me how in Sweden they have a concept with they call Lagom, a word which has no direct equivalent in English. It's apparently used to mean things being in balance, good enough, sufficient, suitable, as it should be.

Rather than perfection, or excess (of wealth, success, happiness, anything), she espoused the view that "Lagom är bäst," meaning Lagom is best.

Having good and bad, but no excesses, wishing for things being just so, being simply appropriately good enough, is apparently a strongly rooted Swedish cultural value.


Here we are in our CMHT thinking we're being clever, when Sweden really did have it worked out ages ago. I always find myself taking something away from my contact with my patients but on this occasion I felt I'd learnt far more from her than she had from me.

Lagom, a simple, elegant and intuitively brilliant notion.


Elaine said...

Yes, it is good to recognise that there is no point in yearning after the unatainable as that can only cause unhappiness.

Does phlegmatic come close?


Catherine said...

The first word I thought of was "content" because for me it means "the perfect amount".

I liked this post, this introduction of a new word.

The Shrink said...

Indeed, I thought it was a brilliant word for a language to have!