This week I left The IBS Network. I had been involved with the charity for 25 years as medical adviser, editor of Gut Reaction, volunteer CEO and chair of trustees. I had seen it through bad times and better. And like a marriage, the organisation and I had become part of each other. But with the charity buoyant, a competent team of office staff in place and supported by a dedicated board of trustees and an enthusiastic cohort of advisers, it was time to hand over and leave.
This year’s Christmas party was also my leaving do. I took the opportunity to thank the sfaff, trustees and volunteers for their dedication to the charity over many years, to praise their success and to encourage the patients and health care professionals on the advisory board to continue to support what is a vital service for many people with IBS. Everybody then did a turn; recited a poem, brought a game, performed a party trick or sang a song. It was amazing how on my last day, I found out so much more about the people I had worked with for years. We all seemed very happy. It was a good ending!
This got me thinking about endings; how important it is to end without the burden of unresolved issues and how rarely that occurs. So many of the people I see in my clinic have been traumatised by bad endings: love affairs that have not worked out, marriages that have failed, estrangement from children, dismissal from their job with no clear explanation, the sudden death of a parent.
Endings are also beginnings. They represent a test of our self confidence and resilience. Can we bear to leave and start again? Do we feel confident enough to choose? Or do we just wait for the choice to make itself and feel weakened by our lack of resolve or victimised by a situation that was not of our choosing? Can we cope when unexpected change happens?
We learn to cope with endings from very early in life. Growing-up presents a graded sequence of separations. When we are born, we are still so attached to our mother that there is little gap between us. She feeds us, keeps us warm and comfortable, soothes us when we are upset and calms us when we are too excited. And so, little by little, through the emotional connection of gaze, tone of voice, demonstration and guidance, she teaches us how to negotiate the landscape of life ourselves. Being left to play alone, staying with grandparents, going to school, sleepovers and holidays with friends, leaving home to go to Uni, finding a job, trying out relationships, getting married, moving house; these are all exercises in separation – endings and beginnings. The more successfully we negotiate the earliest separations, the better we cope with change and trauma later in life.
The psychologist, Mary Ainsworth, developed what she called The Strange Situation Procedure, to demonstrate how different infants cope with separation. In this model, mother leaves her infant playing, then a stranger comes in, then the stranger leaves and mother returns, then the stranger returns with mother in the room. She showed three different styles of attachment. Infants with secure attachment are distressed when mother leaves, avoids the stranger but continues to play, but are positive and happy when their mother returns, continue to play when the stranger returns but use their mother as a secure base. Infants with an avoidant attachment pattern do not appear to notice their parent leaving, continue to focus on their play when the stranger enters the room and show no communication when their mother returns. Infants with an ambivalent, insecure attachment, are intensely distressed when their mother leaves the room, become quite fearful of the stranger, and run to their mother when she returns but resists contact. Ainsworth concluded that these patterns relate to the nature and quality of parenting. Securely attached infants have parents who respond appropriately to their needs. The parents of avoidant infants tend to ignore them, whereas parents of infants with an ambivalent pattern of attachment tend to show an inconsistent and inappropriate parental response. Insecure attachments are likely to cause tension and illness during separations later in life.
But does that mean we are inevitably programmed by our upbringing to react to adversity and loss with emotional tension and illness. Is an avoidant pattern of attachment more likely to lead to withdrawal and the symptoms that represent that, such as fatigue, constipation or anorexia. Does a more ambivalent pattern of attachment lead to high anxiety and disorders of sensitivity? This would seem to make sense – we are all influenced by what happened early in life. Nevertheless it rather denies the ability of any of us to change the way we react.
So it is not just our parents, who are the problem. Some are born with an irritable nervous system and many more have it knocked out of kilter by the blows of circumstance. Trauma later in life can severely affect our ability to cope with even minor changes. Conversely, the experience of a loving secure relationship or an effective long term therapy can render a person much more resilient.
And no matter your life experience, if endings have to occur as they inevitably will, it is critically important to make sure that, if circumstances allow it, they are negotiated and planned for. So how can you end and stay well. Here are a few pointers.
Change is the essence of life. It will inevitably result in separation, but it will also result in new opportunities. So take charge, set forth with a light step and a song in your heart and approach the opportunities of the future with anticipation. That way your IBS will not spoil it for you.
I am looking forward to the opportunity to develop my writing and to travel. Life experience follows a bell shaped distribution curve. The seventies offer the same freedoms as teenage, but with experience to do it better.