The Chaos Train

An article by Eliza Burdon.

I had a client recently (Eliza) who started to talk about the experience of panic as a seemingly uncontrollable journey. I liked that idea very much and we started to call it The Chaos Train. I asked her to write an article about it as it seemed such a useful idea.

The train stops at stations on its journey to the hub. Along the way it picks up passengers and freight, (burdens to take to the hub) as each hub is reached the burdens are delivered and the result of them expressed. In the case of this particular Chaos Train they are panic, anxiety and sadness.

I think the fascinating insight Eliza had was that it all felt really chaotic and out of control. Of course it feels like that because it is panic but it is not as chaotic as it feels. The train has to stop at the stations on the way to the hub and pick up burdens otherwise there is nothing to take to the hub and nothing to be expressed. By making choices and deliberately not stopping at the stations on the route Eliza places a structure on her sense of chaos. She fights the darkness and despair and she makes a journey she wants to make not the default journey her Chaos Train may make if left to its own devices. Here is Eliza’s article.

The Chaos Train

All aboard the Chaos Train, final destination Anxiety. All change for Sadness and Depression.

Living in a continuous state of anxiety is chaotic. Panic is predictably unpredictable. We seem to have no idea of when it will strike and yet somehow it is always a certainty that it will. When the panic finally loosens its grip on us, whether that means a panic attack has passed or a stressful phase has ended, we can’t find a reason for it happening in the first place. Our minds will tell us there is no reason, leading us to simply “accept” how chaotic and unpredictable our anxiety is. We lose faith in our bodies and lose sight of how we’re ever going to get better because we can’t ever establish a reason for our behaviours.


As you pass through the stations you pick up baggage.

As you pass through the stations you pick up baggage.

The truth is it’s not all that chaotic. Anxiety and the resulting sadness and depression comes as the final culmination of a series of bad behaviours and disordered thinking. The chaos we feel we’re living in is a symptom of our anxiety taking hold of our lives, and accepting that it is that way allows it to act up if and when it pleases. Last time you did this was a Friday and today is a Tuesday? Here’s a panic attack for you. Last time you were here you wore red and now you’re wearing blue? Panic attack for you. Nothing seems all that different? Have a panic attack anyway. Your anxious mind can sense any difference in a situation, and all the chaotic steps you’ve taken to allow anxiety into your life add together to produce what feels like a very unpredictable fear response to just about anything. Yet, in reality, it is entirely predictable, it’s going to happen because you’ve accepted the idea that it’s out of your own control.

The Chaos Train is the journey you take to those major hubs, Anxiety and Depression. At each stop on the way you collect more and more behaviours and beliefs that lead to full blown anxiety disorders and predictably unpredictable panic. Each one is an essential element, they work together to seize control of your mind and create chaos.

It looks a little like this, though each persons individual stops may differ.

Other stops could include inflexibility, a lack of willingness to try things out of your comfort zone or things which are not part of your usual routine will lead to anxiety and panic. Similarly being concerned that other people will judge you. Catastrophising is a major cause of both anxiety and sadness. Catastrophising means allowing your thoughts to run away from you, and believing in only the worst case scenarios. This could be that you won’t be able to cope and you’ll have a panic attack, or that you’ll never get better.

It’s simple to build up to the “Hubs”, a series of faulty thoughts and feelings of being out of control leads to panic fairly quickly. On the other hand, breaking it back down isn’t quite so easy. It’s a slow moving train back to where you started. The best way to approach it is to break it down, cutting one station out at a time. For example, if you can combat catastrophising, you’re less likely to believe in the worst case scenario becoming a reality. With a little more faith, seeing events more realistically instead of living in a fantasy world where everything goes wrong, you would be opened up to a whole new level of freedom. In the same way, combating each station on the Chaos Train journey one step at a time, picking up a little less baggage at each stop, your anxiety would have so much less control over you, and in that, the chaos would dissolve.

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Psychologist vs Psychiatrist – What’s the difference

November 8, 2013 by  
Filed under Psychology

Psychologist vs Psychiatrist – What’s the difference? This is something I am often asked to explain so it seems sensible to set out some of the key differences for you here.

But first:-

The old joke goes

What’s the difference between a psychiatrist and a psychologist? Answer: about £100,000 per year.

Psychologist vs Psychiatrist: What is a Psychologist?

Chartered Psychologists have completed an undergraduate degree in psychology and then completed at least a further postgraduate degree that constitutes their clinical training (usually a doctorate).

Psychologist vs Psychiatrist: What is a Psychiatrist?

By contrast, a psychiatrist has undergone medical training and is first qualified as a medical doctor. They then go on to specialise in psychiatry and eventually become qualified to practice.

Both professions are sensitive to the complex origins of mental health problems although it is also the case that the emphasis in training is different between these professions.

A psychologist will usually take a psychological view of problem origins and therefore psychologists offer psychological solutions to problems like depression and anxiety. These days the most common treatment strategy is likely to be cognitive-behavioural therapy (CBT). It is an effective and relatively short  term treatment and patients often like the experience of understanding their own thought processes and learning how to make them more useful.

In general psychiatrists have been trained to place more emphasis on the genetic and biological basis of mental health problems and therefore usually offer a pharmacological treatment for them. Psychiatrists also commonly refer to psychologists to provide CBT therapy in addition to drugs or instead of them.

I have now answered the question I set myself without, I hope, upsetting too many people by misrepresenting them.

I hope you can now see that broadly psychologists and psychiatrists have differing views of how mental health problems are created, maintained and what constitutes treatment for them. We often have somewhat contradictory theories of mental health problems. A good example is depression.

Psychologist vs Psychiatrist: What causes depression?

The most complete answer will probably include a multitude of possible things, genetics may play a role for some people, social settings may be important, employment, relationships, adverse life events or trauma and sometimes there does not seem to be any reason that can be found.

Psychologist vs Psychiatrist: The real differences between psychiatry and psychology

This is where the differences between psychiatry and psychology kicks in and can affect the patient. I have never seen a depressed person, in my clinic, who did not appear to be overly negative (compared to the average) about their history, life chances, and their potential future. I know this because in therapy I hear it.

I consider this overt negativity a facet of their overall psychology being expressed. The beliefs they have about themselves, the world and their future are a window to how they think about themselves and their capabilities.  I consider this to be the stuff of psychology.

When these overtly negative beliefs are challenged and changed (because they are always inaccurate) the patient’s mood lifts, they feel better and they go back to their normal life.  Therefore I see depression as a predominantly psychological problem that responds well to a psychological treatment.

I have seen this hundreds of times over the years, the research on CBT and depression confirms this and I have received many emails from patients thanking me for helping them get their life back on track.

Psychologist vs Psychiatrist: The psychiatric view of depression

I don’t want to mis-represent psychiatrists but in general they will tend to accept the view that mental health problems are largely caused by genetic or biological processes gone wrong. Why else would they prescribe a pharmacological solution?

Antidepressant meds cannot change a personally held belief but it can lessen the impact of that belief and that seems to me to be the sum total of the effectiveness of antidepressants.

Psychologist vs Psychiatrist: Symptoms and Problems

Perhaps psychiatrists help manage symptoms while psychologists help resolve underlying problems.

Maybe the outcome of treatment from psychology and psychiatry look similar but the focus is different.

The trouble is that in the topsy turvey world of medical interventions for psychological problems most treatments are medical in nature (drugs) and relatively few are psychological although there is something of a change occurring albeit a modest one.

Psychologist vs Psychiatrist: My View

If the entire system worked well that would be okay. But I have several criticisms I would like to express.

Dr Purves leads CBT Therapy
The common mental health problems like the depressive disorders and the anxiety disorders are overwhelmingly treated with pharmacological medications and yet these problems continue to increase.

Furthermore once antidepressant medication is stopped relapse rates are high. In fact anti-depressants give no protection against further occurrence of depression and some commentators consider that anti depressants make relapse more likely. In practice this often necessitates someone being on an antidepressant for many years if not their whole lifetime.

Hence my view that antidepressants and anxiolytics treat the symptoms of a mental health problem but not the problem itself, once the symptom relief is stopped the problem is prone to re-emerge (sometimes worse than before).

The biological explanations for why mental health problems arise has little evidence to support it and little to recommend it. And yet ‘patients’ often report they have been told they have ‘a chemical imbalance in the brain’. When in reality they don’t because the ‘chemical imbalance’ story is just that, a story! So, despite the vast commercial and research effort in trying to find them, biological explanations are as rare and as valuable as dragons eggs.

Psychological therapies, on the other hand, are the most effective treatments for psychological problems. Treatments like Cognitive behaviour therapy (CBT) give good treatment outcomes and give enhanced protection against relapse. Hence they are recommended as the first line of treatment for the depressive disorders and the anxiety disorders.

Psychologist vs Psychiatrist: Medical treatments

Why are medical treatments still used for depression and anxiety?

Pharmacological treatments manage the symptoms of depression and anxiety without the sufferer having to do anything other than take the pill and tolerate the side effects. For many people this is all they want or can tolerate. A treatment like CBT takes some time and effort and costs much more than a medication. Furthermore CBT is considered to be an effortful therapy and not everyone has the resources to put effort into their own treatment, or even wants to. Not everyone can find a good therapist and not everyone has the funds for private therapy. In many parts of the world CBT is very scarce.

Psychologist vs Psychiatrist: In Conclusion

So there remains the need for both psychologists and psychiatrists. I will just say that I have seen quite a few people, over the years, whose lives appear to have been blighted by long term use of psychiatrist prescribed medications and I think that is a terrible thing.

And I have seen many more whose use of antidepressants appears to be on a life-long trajectory.

It makes me wonder if we, as a society, have put too much faith in modern medicine to provide medical treatments for what are essentially psychological problems.

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Alexithymia – Can you describe your emotions?

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I recently went to North Canada where I carried out a bit of work with something called Alexithymia.

Alexithymia is basically an inability or difficulty in describing and understanding emotions.

I’d like to share more about this work with you in this video. Alternatively you can read the text below the film.


Transcript of the video

Hi, I’m standing here in the middle of a frozen lake in Canada. It’s a beautiful day. The sun is shining and it’s only about minus 10 so it’s a great day to be on the ice. I’m just going to go over to that island, sit down and tell you a little bit about why I’m making this film.

Well, I’ve come over to the island and I’ve found a nice little spot with some shade so that I’m able to film.

While I’m here in Northern Canada and one of the things I’m doing is a little bit of work with something called Alexithymia.

What is Alexithymia?

Alexithymia is basically an inability or difficulty in describing and understanding emotions. And it also has a certain, what you might call an externally oriented thinking style, in that it tends to be quite concrete thinking processes.

Often people with Alexithymia might be very successful because they’re very focused on tasks.  They’re very able to carry things through to completion and not get distracted by fantasy or wild imaginings.

The thing about Alexithymia, though, is that it’s a fairly stable personality trait, or so we believe, and therefore it’s going to continue.



On one end we have Alexithymia which makes it difficult to recognise and describe emotions and on the other end we have excessive description and recognition of emotions. Someone at the other end of the spectrum would probably be highly anxious and they would recognise that they’re highly anxious and that makes it difficult to live.

Someone on the Alexithymic end has all of the physiology and all of the biological processes that go along with anxiety and stress etc but they don’t tend to recognise it so consequently they can’t do anything about it. Their body therefore experiences the hypertension, the elevated blood pressure, all of the stomach upset that goes with stress and anxiety. But they don’t recognise it as an emotional problem and consequently they interpret these emotional signals as a medical problem.

Tests and more tests

This means that they very often spend a lot of time pursuing their doctor and getting the doctor to do lots of medical and physical checks and that can, if you take it to the extreme, push doctors to do all sorts of weird surgical interventions. The thing is none of that is very useful because it’s not a medical problem, it’s a psychological problem.

Alexithymia is correlated with lots of other problems which are often considered to be quite mysterious by the medical professionals such as irritable bowel syndrome, fibromyalgia, migraine, headache and even depression.


So I’m here in Northern Canada and I don’t expect to see any bears or other wild animals creeping up on me but it’s always worth looking around from time to time to be sure because I’m in a completely different environment from my normal comfort zone which is my office in Reading.

The filters I would usually use to clean out every day experiences have been cleansed. The filters or the doors to my perception have been opened so now I’m seeing things that I wouldn’t normally see. I’m paying attention to things that I wouldn’t normally pay attention to.

The emotional experience of everyday life is like that. You get used to filtering out stuff and not paying attention to stuff. You get used to accepting whatever happens as being the norm.

What we need to do sometimes is just refresh those filters just to say, ‘Let me just pay attention to what’s actually happening in my life.’

Understanding your emotions

If you’re feeling not quite right and you have something that’s not quite right in your body or you have something that’s not quite right in the circumstances of your life then just try to refresh your filters and see if there’s anything that can be done to increase your vocabulary about the emotional experiences that you’re having.

Take the challenge

Let me offer a little challenge to you… 

Do you feel that you can adequately describe your emotional experiences to the people that are close to you so that they can adequately enough understand where you’re coming from so they can feel a sense of empathy?

If you can do that then you probably have a good vocabulary for your emotional world.

If you can’t do that or people complain that you don’t share enough of your emotional experiences then you might potentially have what we might think of as an inadequate vocabulary to describe your emotional experiences and that would be something that you need to rectify.

In the end you can only understand what you have language for. If you don’t have language for your emotional world then it’s hard for you to understand it. It’s hard for the people that are close to you to understand it, share it with you and help you process it.


Increasing your vocabulary

So, I’m in a new place and I’m learning a new language. I’m learning about snow and snow showing and cross country skiing, and wild animals that walk around in the snow. I’m looking at tracks and learning the difference between a fox and a racoon. I’m learning a new language.

We always need to increase our vocabulary. That’s true of our emotional vocabulary. Stick with what you’ve got if it works but if it doesn’t work lets learn some new words to describe, understand and process our emotional world.

Thanks for taking the time to watch and listen. I’m Dr David Purves in Northern Canada on a frozen lake.

How can you increase your emotional vocabulary?

CBT therapy and Mood Control are excellent ways of helping you to develop the language of emotions.

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