Dr. Ajay Khandelwal Psychoanalytic Psychotherapy & Counselling near Southwark, South London & Marylebone, Central London

The Importance Of Altitude Sickness. Logo

The Importance of Altitude Sickness

What the Alps Taught Me About Life

I recently fulfilled an ambition to go skiing in the Italian Alps. In my enthusiasm I snuck off from my group in the first 10 minutes as I didn’t want to be stuck on the baby slopes doing what looked like really boring exercises. As a seasoned runner and cyclist I reckoned that skiing couldn’t be that difficult. You just sort of point yourself down the slope and go. Easy. No fevered pedalling, or lung busting leg action required. I’m sure I could do this asleep. Within 15 minutes of my first ever trip to a ski slope, I had ditched my instructor (sorry Massimo) and I found myself on a Red run. It looked steep, and everyone seemed to know what they were doing; everyone except me.

Now I was up there I couldn’t see anyway down except by skiing. I decided to give it a go. Reader, I got to the bottom. Was it pretty? No. Did I spend most of it crashing and lying forlornly in the snow trying to get my skis on and off? Yes. Did I lose any semblance of grace and dignity? I sure did. Still, I managed, through a series of “controlled” crashes, to get safely to the bottom. The next day, with my tail between my legs, I made the decision to join the group. Maybe, I grudgingly conceded, I did have something to learn. As a therapist maybe I should know better? Yes, sometimes you need a guide, especially on unfamiliar territory, to show you the way. Or to learn how to get from A to B more gracefully! Although I knew this intellectually, some over inflated part of me thought I could work it on my own. I’m sure you’ll be glad to know us therapists have our blind spots too! I had to get literally knocked down to the ground, repeatedly, in order to learn my lesson. As therapists we say this day in day out. Our patients come in and tell us the ego, the “I”, can master every situation. Yet, the “I” always bumps into more powerful forces – inner and outer- and usually gets a beating. The conscious mind generally gets too big for its boots. We usually need to listen to and enlist the unconscious to really grapple with the difficulties and risks of life.

Later in the day, after my lessons, when I was practicing on my own, I found myself in the wrong lift again. The wrong lift once I could explain away as an accident, but twice? This is what Freud might have called “repetition compulsion”, when we keep recreating a situation again and again, hoping that we can figure it out this time round. Usually, we don’t. And then we do it again. This process happens without our knowledge, driven by unconscious processes. I knew something wasn’t quite right when I got on this lift, I had a feeling in my stomach, but I couldn’t quite figure it out. I had a feeling of dread and was about to bail, but ended up getting on, overriding my instincts.

To confirm my worst fears he lift just kept going and going upwards. I felt a knot in my stomach. The guy next to me looked very intense. I had ended up on another Red Run. Not all Red Runs are the same. This Red run was really Red! Skiers jumped of the lift and floated and flitted like birds, turning and twisting and darting straight down the slope. This time I knew I was out of my league. I took off my skis, and found a small valley to the side of the carefully groomed piste, and carefully slid myself back to the flatter slopes. Various skiers stopped by to check I was ok. I said, “I’m not injured, just embarrassed…” Half an hour later I was back on more comfortable ground and I was able to put my skiis back on. Although this was a humiliation to my ego, I had surrendered and accepted defeat. A lucky escape.

Interestingly, I had found myself attracted to the higher slopes. I had been drawn to areas where I didn’t have the skills for. I somehow managed to “accidentally” repeat this. The second time, humbled and a little frightened, I had chosen to make a safe descent. On the last day I took the ski lift (without skis) up to the glacier. I was only able to go part way as I had missed the final lift cut off time. I was secretly relieved. I really didn’t want to go any higher. For some reason I felt nervous about going up to 3000 metres, even though I wasn’t skiing. When I returned to the hotel I remember feeling a little nauseous and unwell. I knew the signs of mild altitude sickness, which I seem to suffer from. It’s a useful warning signal from the body, telling I needed to get down from the mountains. So, every day, I had become more and more cautious. The unforgiving terrain had educated me.

Still, our culture often makes feel that we can do anything, and that we shouldn’t back down. In the last few days I read about a French woman and Polish man who ascended the very dangerous K2 mountain without oxygen. The Polish man died, and the French woman took her shoes off after hallucinations brought on by altitude sickness. She has been told by doctors that her hands and feet may have to be amputated due to frost bite. Even so, she said she would be back in the mountains, because, she said, “I need this.” The climber Beck Weathers, a very driven American doctor, said he used to climb to deal with a deep depression. The total dedication and obsession required to climb, combined with the physical exhaustion, seemed to cure him of his depression. 1/6 people who climb Everest don’t make it down alive. Nevertheless, he was a man possessed. It was only a near death experience, resulting his losing his hands, that he gave up climbing and found himself finally reunited with his family. Many psychoanalysts say it’s very important to accept our limits. In a culture that pushes us to extremes, it is very important to accept our vulnerabilities. It’s a lesson Beck Weathers has taken to heart: he no longer climbs, but is happier than he has ever been.

On the penultimate day in the hotel I got talking to a man who was a very experienced skier who enjoyed going off-piste, outside the prepared ski areas. I was impressed, but on the last day he went missing with his twelve year old daughter. We feared the worst. He last ski pass use had been at 10.30 am at 3000 metres at the top of a glacier. The one I had turned back from because I had missed the cut off time. He hadn’t been seen or heard from since. As night fell, the helicopters and search parties returned to base. No sign of him. No phone. No signal. No flares. Nothing at all. Everyone in the hotel was in total shock; no one could sleep. The next day he had still not been sighted. This was a tragedy, and his 10 year old daughter was alone in the hotel. At 9.30 just as I was leaving, there was news they had been found. They had got lost off the top of the glacier. Even with all that experience. They had then walked non stop for 16 hours through the night in order to stay warm and stave off sleep. They eventually found shelter, and were picked up at 9.30.

It was an incredible ending to what could have been a terrible misadventure. I wondered, what is it about getting “high”? It’s easy enough to get up there, but it’s hard to get down. Marie Louise Von Franz, the Jungian analyst worked with a lot of such cases. In her book, the Puer Aeternus, she recalls the case of young men who had trained themselves to sleep on mountains without any camping gear. The idea being that they didn’t want anything to weigh them down, either kit wise or psychologically. But mountains are extremely dangerous. They cut us down to size. The top of Everest, with its thin, lifeless air, is known as the death zone. People get up mountains, but sometimes they don’t get down. On a very minute scale, I experienced this over-inflation. Oblivious to the people being carted off the slopes in ski ambulances, I ended up on slopes that were beyond my ability. Similarly, my fellow guest, despite his decades of experience, had become disoriented off-piste, and without any back up plan. He was able to draw on inner resources, but it was very risky. Luckily, we avoided injury or worse, but both felt somewhat chastised in our different ways.

The body’s physical and psychological warning systems, such as altitude sickness, have an important role to play. Even though you can get medicine to rid yourself of altitude sickness, perhaps that is not always so wise? Watching the winter Olympics its easy to get carried away. However, if you watch an interview with any of those athletes, you’ll find that they are riddled with injuries; metal rods run through bodies; their bodies are broken and battered and they have spent months in hospitals and rehabs. Still, something keeps them going back. This knife-edge existence is extremely precarious. That is why the gods can live in Mount Olympus, but not humans. We can spend a few days at altitude, but then we need to come down to sea level. When we go up, we need to carry emergency supplies, whistles, flares, and plenty of humility, or we risk being thrown down the mountain. Addictions work in a similar way. It is maybe easy to get “high”; it seems like you can live up there forever; but then one wrong step; or just bad luck, and you find yourself caught up in avalanche. Von Franz warned of the dangers of over-inflation. It is very depressing to have to face our limitations and vulnerability. The Puer Aeturnus, wants to deny these limits. This works for a while, and can even be very heroic. But in the end the hero usually meets a grisly end. A life with no challenge or risk is dry and dull. But when a person only feels a alive when dicing with danger, that is another matter. My initiation to mountain sports has given me plenty of food for thought. The deeper I got into the skiing, the more aware of my limits I became. To be honest, I was glad to get back to earth, and place one foot in front of the other. On a more serious note, my fellow hotel guest, Gary Raine, appeared in an article in the Sun, and appeared grateful to have survived a very harrowing ordeal. The headline says, “they were lucky to be alive.” Sometimes, although very unpleasant, altitude sickness can be a life saver!


Founder Member of the Guild of Psychotherapists, Camilla Bosanquet, on the beginnings

Camilla Bosanquet Recollects the Early Days of the Guild
My background
I trained as a doctor and worked in medical practice for a time. After the birth of my third child I had a depressive breakdown, which I found terrifying. This was in 1950 and no one seemed to know anything about psychotherapy. This made it much worse. Finally I was admitted to the Bethlem Maudsley hospital where they did understand and I gradually got better. I was luckily taken on as the training patient of a young registrar who was training at the SAP. Much later I myself trained at the SAP and became a member. I also trained as a psychiatrist and worked at the old world local mental hospital where I was trying to look after more than 200 patients. At the same time I would drive to London to see my two analytic patients three times a week. My aim since then has been to try and help people avoid such terrifying breakdowns and somehow make a bridge between the two kinds of treatment.
The Guild
The Guild was Peter Lomas’ brainchild. He had trained at the Institute of Psychoanalysis and left it because he felt it dehumanised people. He would look at you with horror if you talked of ‘technique’. He wanted to start a training which did not dehumanise the trainees. He and John Payne and Ben Churchill would discuss the birth of this brainchild as they walked on the South Downs. At this time John was in charge of the psychotherapy at the London School of Economics and I worked with him part-time. He invited me to join in with the creation of this new training which I willingly did.
I liked the sound of it and I hoped it might play some part in bridging the gap between analysis and psychiatry. I invited Joe Redfearn, an SAP member, to join us. He too liked the sound of the Guild’s aims and particularly that trainees were considered as responsible people and not infantilised. John Heaton and Peter Barham also joined us. It was Ben Churchill who suggested the name ‘Guild of Psychotherapists’. We all felt this was appropriate because we thought of psychotherapy as a craft and learning this craft as a form of apprenticeship.

The Guild founders - Peter Lomas, Dr John Payne, Ben Churchill, Joe Redfearn, John Heaton, Peter Barham, and Camilla Bosanquet (above)
When in 1974 we first opened our doors to applicants for training we had to reject some who appeared to be attracted primarily by what they saw as the anti-establishment aspects of the Guild and to have closed minds. Others were more promising. At first the training was a bit chaotic. We were influenced by the de-schooling ideas of Ivan Illich and there was no formal teaching. Seminars were taken mainly by the founder members and covered only the subjects which they and the trainees thought were most important. It was left to the trainees to do the basic reading. It wasn’t always clear who was teaching who and the trainees sometimes felt they were training the trainers.
At the end of the first year the trainees sent an angry letter complaining about the teaching and saying they were not getting their money’s worth. It became clear that we needed more structure and boundaries. Peter Lomas did not agree with this; he felt we were becoming too orthodox and conventional. He resigned and the remaining founder members drew up a constitution and set up a more formal programme of teaching.
John Payne became a very good chairman. It was to be a pluralistic training, not following in the steps of just one authority. Students were encouraged to think for themselves, to critically evaluate traditions and ideas, and be open to new ideas. The relationship between therapist and patient was regarded as central. Perhaps teaching was the wrong word in training. It was more a question of dialogue and discussion. Trainees were required to be with an approved therapist for a minimum of two sessions a week. In selecting candidates for training, experience and personal qualities were regarded as more important than academic or other qualifications.
It was stressed that Guild members should be proud to call themselves psychotherapists and not feel they were inferior to analysts or psychoanalysts, although the definitions of these terms have changed since the Guild was set up and will probably continue to change. Since retirement I have read with interest the news from the Guild. Naturally there have been disputes and difficulties but it still seems to have a lively, critical and creative approach to psychotherapy. I particularly like its encouragement of discussions about cultural, race and gender issues, and its openness to other disciplines and areas of culture such as art and drama.
Camilla Bosanquet
March 2017

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