'I don't want to talk about it'

Martin Deeson first saw a therapist when the drugs and booze could no longer ease the pain. But, like many men, he found that the real challenge came when he had to confront his feelings
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At first glance, comedy and therapy could make awkward bedfellows. After all, one is often about tears and the other is about laughter. With the exception of Frasier (which is really about self-help radio and being a pretentious urbanite), the odd Woody Allen gag and a few clichéd scenes in movies where the bearded, pipe-smoking Eastern European asks, 'Unt how do you feel about your muzzer?', there has been little sustained comedic involvement with the world of psychiatry of a sort that has given any insight into what goes on behind the closed doors of the therapists' rooms.

At first glance, comedy and therapy could make awkward bedfellows. After all, one is often about tears and the other is about laughter. With the exception of Frasier (which is really about self-help radio and being a pretentious urbanite), the odd Woody Allen gag and a few clichéd scenes in movies where the bearded, pipe-smoking Eastern European asks, 'Unt how do you feel about your muzzer?', there has been little sustained comedic involvement with the world of psychiatry of a sort that has given any insight into what goes on behind the closed doors of the therapists' rooms.

As a veteran of four different couches during the past 15 years, the whole therapeutic situation - the 50-minute "hour", the turning of every patient statement into a therapist question (Patient: "I feel depressed." Therapist: "Hmm... so, you say you feel depressed?") and the fact that all therapists have been in therapy (and are, therefore, sometimes slightly strange people) - has always seemed like it was crying out for really good comedy.

With Help - the new BBC comedy written by and starring Chris Langham (as Peter, the slightly out-of-control therapist) and Paul Whitehouse (as every one of his 25 patients) there is finally a masterful dissection of the humour and tragedy to be found in this most bizarre of relationships - and all hail them (and director Declan Lowney - of Father Ted and Cold Feet fame) for bringing comedy about the "talking cure" to the little screen. Never mind Changing Rooms - this is changing humans.

Therapy is, of course, no laughing matter. Well, let me rephrase that: therapy is traditionally no laughing matter to the middle-class masses who make up the majority of its clientele and practitioners. The process is, for anyone who's been in it, often hilarious and often very, very painful. As one of the characters in Whitehouse and Langham's new show says: "This isn't therapy, it's bloody carnage."

What Help does brilliantly (no doubt informed by Whitehouse's own voyage from plasterer to comedian - and, as he has revealed recently, via some time on the couch himself) is to show that therapy doesn't have to be the preserve of the self-pitying, the self-obsessed and the middle classes: that therapy is, at its core, a tool used to help people in pain who are in danger of inflicting their suffering on the innocents around them.

What it also shows is that men are often quite reluctant patients. Dr David Purves, the principle lecturer in counselling and psychology at London Metropolitan University, says most men won't go into therapy until they have a significant problem - and usually that problem comes because the coping strategies they have been using (be they exercise, working or drinking) have become a problem in themselves.

I went into therapy in my twenties, because I had problems with addiction, sadness, miserableness and incapacity. I didn't go into it because I had too much cash to spend and a vague interest in finding out "who I was". I never wanted to know who I was, until the dead weight of what they call "a dysfunctional childhood" (a hateful phrase) meant that I couldn't function every day. This wasn't self discovery; this was survival instinct. It was therapy or "dial-a-rope".

A friend once said he knew he needed therapy when he woke up crying every morning. I've never found myself in quite that drastic circumstance, but I do think that therapy is something you do when you are desperate, and is not for the merely curious. My first contact with the world of therapy was one session conducted on the 24th floor of a mid-town skyscraper in New York in 1991. The therapist told me that I was self-medicating heavily with booze and drugs, and that if I wanted to sort myself out, I should return to England and re-unite with the daughter whose birth seemed to have brought on a breakdown that had been waiting to happen. She was right.

On my return to London, I started seeing a group therapist for the crippling depression that would stop me getting up for days. I found the twice-weekly, early morning sessions excruciatingly embarrassing - not least because I was convinced I was the only sane person in the room - but perhaps if I'd stuck with it, I would have realised that I wasn't. I quit after nine months.

Next, in the mid Nineties, I had my longest single run with a therapist - two years, once a week, one on one with a nice woman in Victoria. This two years broke the back of my depression - mainly by acknowledging that my parents were deeply damaged people and that they had done a good job of passing it on. This gave me the knowledge to "break the chain", as we say (there was also a lot of cushion-beating to release anger), but her persistent insistence that the level of abuse in our childhood home was, in fact, criminal led to some pretty dark nights of the soul-searching during the next five cocaine-fuelled years.

Then eight years later, in 2004, I found myself once again slipping into the old, black cloud, and my GP prescribed eight sessions of cognitive behavioural therapy (CBT) with a gifted, young man in Hampstead. This was far and away the best therapy I have had - and it was on the NHS - and (combined with reading CBT books) equipped me with excellent skills for avoiding the cloud. I would recommend CBT to anyone. After all my years on the couch, I finally discovered something that could have saved me many hours and much pain: that it's best to leave the past where it is and to concentrate on living now, which is exactly what CBT does. Repression isn't always a bad thing.

While in conventional therapy, I felt that the process was akin to picking at a scab. The short-term benefit of recovering memories and facing up to repressed feelings was just that, short term. In the long term, it left me feeling no better on a day-to-day basis and although it was helpful to realise that my out-of-control feelings had a real source in real events (albeit a long time ago), the remaining feeling (after I left this form of therapy) was one of fear: what else was there in the past to be dug up and how was I supposed to cope with the information that had been recovered?

In the end, I concluded that childhood-based therapy was better at discovering the roots of problems, and creating new ones, than it was at facilitating living. CBT was the opposite. "Let's keep focused on the present," my CBT therapist would say whenever I tried to refer back to my childhood. This refusal to go digging meant that the sessions were invariably uplifting, rather than traumatic, and that I left the short course of sessions with new ways of thinking to avoid depression and self-medication, instead of the horrible feelings that accompanied previous therapy of: "Oh my God, what have I dug up today and what more is there to come?"

In retrospect, that's probably a very male reaction to the problem of painful memories. Perhaps more than with women, it seems almost a reflexive response of men to try to bury their problems, bad memories and awkward thoughts under a sea of booze, work or denial - whereas the talking at the heart of the "talking cure" perhaps comes more naturally to women.

Purves says men are much more behaviourally motivated than women and so when a man has a problem, he is more likely to do something that makes him feel good, whereas a woman will more likely talk or think about the problem, turning it over and over. Both strategies bring on their own problems: a man who is seeking to feel good through sex, exercise or self-medication will go and seek therapy when the behaviour itself has become a problem. A woman will go when the constant worrying about a problem has developed into anxiety.

"Men try harder to ignore their problems, and are less likely to talk about them," says Purves. "Women tend to talk and think about their issues, and so tend to reach higher anxiety problems by recycling them."

Purves also points out a fact easily forgotten when so much media discussion of mental health appears under the headline fact that men - particularly young men - have higher suicide rates than women. "Women have been proven over and again to be twice as likely to develop mental health problems than men, right across the board," he says. "Women also attempt suicide far more than men. The difference is that men tend to be successful attempters - they use methods such as hanging or jumping which have a far higher fatality rate than some of the methods (such as overdosing) more generally used by women."

A by-product of this gender difference is that for many men who end up on the therapists couch, the initial stages of therapy can be a bit slower. This is because, in the words of Dr Purves, "some men deny that they have any psychology". This means that in the earliest stages, it often takes longer for the therapist to get to the underlying issues of a man's situation. "Although," says Purves, "in the long run, after a course of anything from 12 to 20 sessions of CBT, both groups have similarly high success rates."

Perhaps the largest single remaining gender difference in men and women's experience of therapy is that there is still some stigma attached to seeking therapy - and more among men than among women - but far less than there was 15 years ago when I first went.

And so, after three courses of therapy, what have I learnt? Well, the main thing is that you are never "cured". You take away tools from the therapist's room to help yourself. But if you have demons, they will resurface in periods of stress, and so it is better, for me, to see therapy as an ongoing process that never really ends... and it certainly doesn't stop when you leave the therapist's room for the last time.

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