Article
Culture
Film & TV
Psychology
5 min read

Who’s missing from Inside Out’s internal family?

Where Riley’s writers could go next.
Cartoon characters of emotions at a control desk.
Inside Riley's head.
Disney.

Once upon a time a man got angry. Then he got angry at himself for the fact that he got angry, which of course didn’t help. As the Buddhist monk Thich Nhat Hanh would say, “If we become angry at our anger, then we will have two angers at the same time.” Similarly, there was an occasion when he got really nervous that he might make a mess of giving a speech, and his nerves became so overwhelming that he delivered the speech badly. A self-fulfilling prophecy, one might say.  

These are not my examples; they are examples given by psychologist Richard Schwartz in his introduction to Internal Family Systems (IFS). This therapy (sometimes also called “parts therapy”) is a form of self-analysis in which participants learn to resist supressing or controlling their difficult thoughts or emotions, the different “parts” of their inner world, and instead adopt a posture of curiosity towards each of them. This posture allows people to be in a beneficial relationship to their emotional lives, rather than being ruled by them.  

Fundamentally, the relationship that emerges is one of compassion, understanding that our thoughts and emotions have a job to do, even the uncomfortable or shameful ones. So, anxiety, for example, guards us from committing social faux pas, whilst joy helps us to keep hold of a sense that life is ultimately worth the living, no matter how hard things get. Even sadness and grief, as much as we fear being overtaken by such emotions, have an important role to play, for example by helping us to define what things and people are most valuable and important to us. 

For those who haven’t seen the Inside Out films, the writers cleverly take this idea of the “internal family” of emotions and create five relatable characters that embody them – Joy, Fear, Sadness, Anger and Disgust. In the first film, we see how these characters interact inside the head of a little girl called Riley. They are helping her to hang on to her sense of self despite the upheaval she experiences in her outside world, when her family relocate to a new city, and she must settle in to a new home and school. In the sequel, we rejoin Riley as she enters the turmoil of puberty, and the five initial characters are abruptly forced to work alongside some new arrivals – the “teenage” crew of emotions: Anxiety, Ennui, Envy, and… the biggie… Embarrassment.  

This Self is transpersonal – it exceeds the boundaries of who we each are as an individual person and connects us to something large.

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When he first developed IFS in the 1980s, Richard Schwartz was, by his own confession, a committed atheist, with what he describes as “a distain for religion”. Schwartz writes of the frustration he felt at that time when several Christians got excited about IFS in its early stages of development. His peer, Robert Harris, even went so far as to publish a book that set out a Christian version of the therapy. Initially, Schwartz felt the biggie – embarrassment – that his therapy was being taken up by Christians. However, as time went on, and as much as Schwartz tried to push aside the spiritual dimension of IFS, he increasingly found that spirituality could not be eliminated from the picture: 

“As I used the model with clients through the eighties and nineties, increasingly they began having what can only be described as spiritual experiences. These vicarious encounters with the mystical profoundly affected my own spirituality and I became interested in Buddhism, Hinduism, Taoism, shamanism, Kabala – everything but Christianity.”

Over time, Schwartz’s antipathy to the relationship between IFS and Christianity began to wane. He saw how much he had been working on the basis of prejudice, limiting his own exploration of Christian ideas in response to some unhelpful encounters he’d had with a few heavy-handed fundamentalists. He made deliberate moves to engage with Christian dialogue partners across the breadth of the tradition and began to see how congruent IFS was with the teaching of Jesus. The posture of curious compassion towards oppressive and uncomfortable emotions that Schwartz was encouraging his clients to adopt was mirrored perfectly in the attitude that Jesus advocated towards “enemies” in the outside world: do not judge, instead seek to engage them with kindness, and work towards their healing.   

In recent decades, Schwartz has come to rethink IFS as an integration of psychology and spirituality, rather than as a form of psychotherapy. He speaks of “spirituality” as an innate essence at the core of each person, which he calls the “Self”, and acknowledges that many of his more religious students prefer to think of this essence as “the soul” or “Atman” (the eternal self within Hinduism). And, whilst he still describes himself as fundamentally agnostic and is wary of making his own definitive religious commitments, he has come to agree that this Self is transpersonal – it exceeds the boundaries of who we each are as an individual person and connects us to something larger.

Screenwriting for a popular audience of all-faiths-and-none, it is perhaps unsurprising that the makers of Inside Out have thus far eschewed the deep and fascinating spirituality of IFS. Riley’s “sense of self” is at the centre of both films, but the way it is depicted implies that it is something that only comes into being at birth and exists entirely to regulate Riley’s engagement with the outside world. So far, there has been no exploration of more existential questions such as faith and eternity. However, the concept of the film is so brilliant, and for a complex idea it is so well executed, that I am sure we can look forward to many more Inside Out films to come. If that is the case, then just as Schwartz found himself going on an unexpected journey of spiritual exploration, the writers of Riley’s may well find themselves doing the same. I, for one, look forward to finding out what Riley discovers.  

Article
Care
Culture
Mental Health
Trauma
5 min read

Stillness is not always peace: how wellness and illness intertwine in silence

Stillness invites clinical insight—and a deeper kind of presence

Helen is a registered nurse and freelance writer, writing for audiences ranging from the general public to practitioners and scientists.

A seated Celine Dion, leans forward, head to the side, holding a mic.
Celine Dion, stiff-person syndrome sufferer.
Celine Dion.

The Global Wellness Institute defines wellness as the active pursuit of activities, choices and lifestyles that lead to a state of holistic health. It includes rest and rejuvenation, through mindfulness, meditation and sleep. As a care home nurse, I am intrigued by the subject of stillness – for patient and nurse - in the pursuit of wellness, and as a sign of illness.  

There’s a lot of stillness in illness - from the dense paralysis that can follow stroke or spinal cord injury, to the subtle weakness or stiffness in an arm that might signal the onset of motor neurone disease. Over half of people with Parkinson’s experience ‘freezing’, feeling as if their feet are momentarily glued to the ground. Freezing is also a feature of stiff-person syndrome – the auto-immune neurological condition powerfully documented by Celine Dion in her film I Am. In so-called stone-man syndrome, muscle tissue is replaced by bone, an immobile ‘second skeleton’. 

The stillest still is seen in death itself. I’ve stood still with spouses and sons as their loved ones breathe their last. Alone, I’ve watched the hush between heartbeats until there exists only stillness beside sorrow. It’s a stillness like no other, when breath becomes still air, and the only movement is through a window opened to let air in, and souls out, in time-honoured nursing tradition. 

In memory of babies born still, a public education and awareness campaign has been launched in the US. “Stillness is an illness” calls for families and healthcare providers to take seriously altered foetal movement in pregnancy, which is reported by 50 per cent of mothers who experience stillbirth. Stillbirth is a tragedy insufficiently addressed in global agendas, policies, and funded programmes, according to the World Health Organization. Mothers in sub-Saharan Africa and Southern Asia are at highest risk, with nearly 1.5 million stillbirths in these regions in 2021. 

Sometimes stillness manifests in more muted ways. When dementia robs the recall of person, place and time, residents no longer lift their head in response to their name, nor appear at their chosen place at the breakfast table in the morning. Television presenter Fiona Phillips describes the late stages of dementia for her mother, when she “spent whole chunks of time just sitting and staring ahead, only able to give out a series of sounds.” In care home nursing, I have brought stillness to an agitated mind. Therapeutic touch has relieved tension; creative activities have reduced restless pacing up and down. Music, movement, and medication can also calm a troubled mind. 

In the further pursuit of patient wellness, the nurse may need to be still. The “CAREFUL” observation tool has been developed in nursing homes, in which the nurse sits still and discreetly watches a resident for a period of time, assessing their activities and interactions, working out what brings wellbeing, or ill-being, for that individual; residents in this case being our best teachers. Other times in dementia care, the nurse is still as they patiently wait for a resident to explore, enquiring into self-made mysteries solvable only by themselves, examining everything from door handles to another resident’s buttons; or to slowly finish a meal, their swallow also affected by the disease.  

Punctuating any frantic nursing shift are other moments of necessary stillness as the nurse performs intricate procedures, carefully inserting catheters, delicately taking blood from fragile veins, or applying prolonged pressure to stem bleeding caused by a catheter during cardiac stenting. In the operating theatre, the scrub nurse stands still awaiting a surgeon’s call; the “honor walk” or walk of respect is a ceremonial procession in which healthcare staff line the corridor, in silent tribute, as a brain-dead patient is taken to theatre for organ donation. 

There’s a different stillness sought in nursing, and elsewhere, which runs very deep. Described by missionary and author Elisabeth Elliot as a “perfect stillness…a great gift”, it is, in her words, “not superficial, a mere absence of fidgeting or talking.  It is a deliberate and quiet attentiveness—receptive, alert, ready”. It’s an expectant stillness in which we “put ourselves firmly and determinedly in God’s presence, saying ‘I’m here, Lord.  I’m listening’.” Writing for the Christian Medical Fellowship, nurse Sherin describes such a seeking during a stressful shift. “Overwhelmed, I stepped away to find a quiet place. I ended up in a washroom. It wasn’t ideal, but there I cried out to God, asking for courage, peace, patience, and above all, love for that patient.” And her prayer was answered. “That, to me, was the quiet, powerful presence of Christ,” she writes. 

Her role model was Jesus himself who often stepped away to be still, to seek spiritual sustenance. Just before he fed the five thousand, Jesus said to his tired and hungry disciples, “Come with me by yourselves to a quiet place and get some rest.” When grieving the execution of John the Baptist, he withdrew by boat privately to a solitary place; and in the hours before his arrest, Jesus withdrew about a stone’s throw from his disciples, knelt down and prayed. An angel from heaven appeared to him, and strengthened him. We too are invited, in the book of Psalms, to “Be still and know God” when hard pressed and weary. Here, the words “be still” derive from the Hebrew rapha which means “to be weak, to let go, to release”, or simply to surrender. It’s a theme repeated in many of the great Christian hymns, hinting at an expectant, sustaining stillness, invoking God’s promise of His presence in that stillness. Little-known hymnwriter Katharina von Schlegel, writing in the eighteenth century, captures it perfectly. 

Be still, my soul! the Lord is on your side; 
Bear patiently the cross of grief or pain; 
Leave to your God to order and provide; 
In ev'ry change he faithful will remain. 
Be still, my soul! your best, your heav’nly friend 
Thru' thorny ways leads to a joyful end. 

I’ve sought this stillness, and it’s brought me wellness. It’s the reason why, despite some difficult days, I am a nurse. Still. 

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