DOROTHY ROWE

Beyond Fear

20th Anniversary Edition

HARPER PERENNIAL London, New York, Toronto and Sydney

To my dear friends Helen, Galen, Marc and Naomi

Contents

Cover

Title Page

Dedication

Introduction

Fear and the Fear of Fear

1 The Nature of Fear

• Fight or Flight

• Unavoidable Conflicts

• Fear of Life and Death

• Fear of Not Being Good Enough

2 Understanding the Nature of Fear

• Brains and Minds

• Our Greatest Fear

• A Choice of Defences

3 Fear Denied

• Denying Fear as ‘Character’

• Denying Other People’s Pain

4 Learning How to Deny

• The Perils of Childhood

• The Perils of Sexuality

• Denying Who You Are

5 How Society Responds to Mental Distress

• What Has Stayed the Same?

• What Has Changed, and for the Better?

The Alternatives

6 Choosing a Defence

• Popular but Confusing Diagnoses

• Choosing a Desperate Defence

7 A Bodily Solution?

• Not Frightened, Just Ill

• From Fear to Illness

• Punishing the Body to Ease the Mind

8 Turning Fear into Depression

• The Story of Depression

• Public Discourse - Muddle and Confusion

• Do Pills Cure Depression?

• The Way Out of the Prison

9 Turning Fear into Anxiety, Panic and Phobias

• Panic and the Fear of Panic

• Relinquishing Panic, Phobias and Fear

10 Turning Fear into Mania

• The Manic Defence

• Finding Yourself

11 Turning Fear into Obsessions and Compulsions

• Doubt, Hate and the Denial of Feeling

• Gaining Freedom

12 Turning Fear into Schizophrenia

• An Idea Called Schizophrenia

• Are Drugs the Answer?

• Hearing Voices

• The Road to Recovery

13 Turning Fear into Courage

Notes

Books and Websites

Index

Acknowledgements

Copyright

About the Publisher

Introduction

Ideas about mental health and mental illness have changed over the last twenty years. Some old ideas like ‘chemical imbalance’ and ‘a gene for this and a gene for that’ linger on despite the fact that research has shown that these ideas are not hypotheses but myths. There is now a general acceptance of the idea that mental distress can be relieved by talking to a listener who has no vested interest in the situation which gave rise to the distress. The media take this idea for granted, but many members of the media fail to grasp what the talking therapies are, and speak of counselling as being a kind of unguent which is poured over some unfortunate person, as in ‘the victims were counselled’. No one would willingly talk to the media about being psychotic because the media, and many members of the public, still regard anyone diagnosed as schizophrenic as being a potential axe murderer. Yet prominent figures now speak openly of their depression, and pop stars seem to regard as obligatory a drug habit followed by a period in a fashionable psychiatric clinic. Politicians speak most sympathetically about the necessity for good mental health care, though the money for such a service rarely follows through. But, in all, when it comes to mental illness, everyone’s heart is in the right place.

Or is it? Despite all the changes for the better, the notion that madness is some strange thing that can fall upon an unwitting individual at any time is as strongly held as ever. The language in which we talk about madness might have changed, but the belief in that strange, wilful, sinister, mysterious force is still in the minds of most people, including the minds of those who ought to know better. To be seen to be mad is still regarded as being alien, no longer a full member of the human race. The Royal College of Psychiatrists and MIND, the National Association for Mental Health, have run a campaign aimed at removing the stigma of madness, or, in current terminology, ‘having a mental health problem’, while some sections of the media have a stylebook setting out what language may or may not be used (the Guardian stylebook bans ‘offensive and unacceptable terms such as “loony, nutter, psycho and schizo”’). However, little seems to have changed in private attitudes. Despite the courageous work by members of the user/survivor movement, the term ‘mental health problem’ is taking on all the negative connotations of ‘mentally ill’. Writing about the report issued by the National Institute for Clinical Excellence (NICE) following their study ‘Mental Health and the National Press’,¹ the journalist Lynne Eaton summed up NICE’s results with, ‘Some of the reports about people suffering mental illness, particularly news stories, contain a level of discrimination that would be deemed unacceptable for most other social groups (except, perhaps, Gypsies and asylum seekers).’²

In their report, NICE recommended that mental health professionals be prepared to inform the press about mental health issues. However, the language used by the majority of mental health professionals is itself suspect. In 1987, when the first edition of Beyond Fear was published, psychiatrists spoke of mental illness. In the intervening years the word ‘illness’ has disappeared from the diagnoses used by psychiatrists, though not from their general discourse, to be replaced by the word ‘disorder’. When I first came to England in 1968 and worked in psychiatric hospitals there were only five basic mental illnesses, namely, schizophrenia, manic-depression, anxiety and phobias, obsessions and compulsions, and depression. The behaviours associated with these diagnoses are very distinctive and found in all societies and throughout recorded history. Many of the psychiatrists I worked with had their own idiosyncratic diagnoses for people who could not be fitted into any of these categories. At Middlewood Hospital (a Sheffield psychiatric hospital now mercifully closed) a favourite diagnosis was ‘Irish’. Over the years the idiosyncratic diagnoses of American psychiatrists were pooled and the more popular ones were presented in what is now a vast tome, the Diagnostic and Statistical Manual (DSM - Revision IV) which covers all the ways we can behave when faced with a very difficult situation. We are all in the DSM, at least once. Psychiatrists have medicalized life, and, in so doing, joined forces with an international business comparable in size, wealth and power with the arms trade and the oil business - the pharmaceutical industry.

Psychiatric ideas of mental illness and mental disorder are based on ‘the oversimplified medical model that forms part of the culture of psychiatry, the “illness-treatment-recovery model”’ which the retired psychiatrist David Whitwell calls ‘naïve psychiatry’. This ‘focuses on short-term improvements in symptoms as a main target for intervention. Although its origins are over fifty years old, and it reflects an outdated concept of what it is to recover from mental illness, it is still very much in evidence.’ In his many years of work in acute psychiatry, David Whitwell came to see that, ‘The claims made by professors of psychopharmacology and the drug companies for their products were never fulfilled in practice. The new clever therapies never seemed to produce the transformations they promised. And as time went on I could see less and less value in the elaborate systems of diagnosis and classification that are so central to psychiatry… I became more aware of the power and effectiveness of the non-specific factors which help people recover.’³

‘Naïve psychiatry’ may still be flourishing but so is naïve psychology. If this psychology were water it wouldn’t wet the soles of your feet. When I read much of the work of my colleagues, whether academic papers in learned journals or self-help books for the general public, I get the feeling that most members of my profession have led extraordinarily sheltered lives, or perhaps in their teens they encountered life in all its crudity and messiness. Recoiling in horror, they comforted themselves with a fantasy of a pleasant, technicolour world where all problems are soluble. To maintain this fantasy into adulthood they had to ignore anything to do with politics. Traditionally, the British Psychological Society (BPS) has viewed politics as distasteful. More recently psychologists in the UK, along with those in the USA and Australia, have come to fear that any interest in the political aspects of their work could threaten their livelihood in a highly competitive market. Such timidity has led to the BPS’s professional journal, The Psychologist, reading like a high-school magazine written by diligent, unquestioning students. Psychologists feel sorry for their clients, but the way most of them talk about their clients, both publicly and privately, reveals that they do not see their clients as fellow adults but as wayward children whom they can teach to live in sensible ways. They present their advice to these children briskly and with authority because they feel it would lessen their standing in their profession and in the eyes of the public to admit to doubt and inadequacy. They seem to have no measure of how naïve they are.

There are those academic psychologists who live in a world of very long words, all of them abstract nouns. To them people are but containers for traits such as ‘sociability’, ‘religiosity’, ‘extraversion’ and ‘introversion’. (In much the same way naïve psychiatrists see people as mere containers for ‘depression’ or ‘schizophrenia’.) Psychologists discover these abstract nouns by giving groups of people questionnaires about what they do. Their answers are reduced to numbers, and these numbers are put through some statistical processes to see how the answers clump together in different groups. These groups are given abstract nouns as names, and these names are regarded as being ‘factors’ or ‘traits’ which explain why people behave as they do. Thus, these psychologists know that you don’t have dinner with your friends because you like to see them but because you have a trait of sociability. They have not noticed that two people can do exactly the same thing but for totally different reasons, and that it is our reasons which impel us into action.

There are those clinical psychologists who aim to replace their client’s ‘dysfunctional cognitions’ with ‘functional cognitions’ which bear a remarkable similarity to their own eminently ‘functional cognitions’. Cognitive behavioural therapists who are in close contact with real life know quite well that there is no set of ideas or beliefs that will invariably lead to us being secure and happy, because all the interpretations we make of what is happening have both good and bad implications. For instance, seeing yourself as being competent has the good implication that you will be able to face new situations with confidence, but the bad implication that, seeing you as competent, people are less likely to help you. Naïve psychologists seem not to understand this. Psychologists who practise positive psychology, the psychology of happiness, advocate, amongst other things, that each day we should count our blessings. Psychologies magazine asked me to take part in a debate on happiness with Professor Christopher Peterson, an American psychologist well known for his work in positive psychology. The features editor of the magazine sent me an unedited copy of what Professor Peterson had written. He concluded his argument with,

Should we eradicate sadness from the world? Yes. This is not to say that we should eradicate challenge and difficulty, not that we could really do that. Challenge and difficulty are the stuff of life: they make innovation and accomplishment possible. But what we should do is to encourage people to respond to setbacks not with despair but with good cheer, hope and perseverance. Happiness makes this possible.

Should we pursue happiness? Yes.

This was written in August 2006 while world governments dithered over what, if anything, they should do to stop the death and destruction in Lebanon following the invasion by the Israeli army. It seems to be very naïve not to understand that there were many Lebanese and Israelis who were suffering the kind of losses which create a sadness that would stay with them till the end of their days. When we lose something which is an essential part of our being, be it a person, a home, a livelihood, or a future, we are left with an empty space inside us that no amount of blessings can ever fill.

Also in August 2006, an Austrian girl, Natascha Kampusch, who had been kidnapped when she was ten by a man, Wolfgang Priklopil, managed to escape after eight years’ captivity in a cellar under Priklopil’s house. This must have been a terrible experience, but worse was to come. According to those psychologists and psychiatrists who are experts on such things, at some point Natascha was struck by a terrible disease, Stockholm syndrome. This disease caused Natascha to sympathize with her captor.

Stockholm syndrome resides nowhere but in the minds of these psychologists and psychiatrists. They believe that diagnosing Natascha as having this illness shows that they are great experts. They also avoid having to explain to the public what happens to us all when we are imprisoned on our own for an indefinite period. We all need contact with other people just as much as we need food. Lacking contact with people, we become unable to distinguish our thoughts and feelings from what is going on around us. This is well known from the accounts of people who have spent long periods in solitary confinement and from sensory deprivation experiments. When we are starving we will take the vilest of nourishment, and, rather than be completely isolated, we will create a relationship with whoever is on offer, no matter how vile that person may be. Hostages like Brian Keenan and John McCarthy, who spent five years in captivity in Lebanon, much of that time on their own, have described this in detail. Psychologists who have studied how a baby forms a bond with a mothering adult have shown how the nature of the bond is very much determined by the way the mother responds to the child. Simply put, when the mother is unfailingly pleasant and kind, the child assumes that the mother will always be available and thus can bear being separated from her; when the mother is unfailingly unpleasant and unkind, the child forms only the slightest of bonds. When the mother alternates between being kind and pleasant and being unkind and unpleasant the child forms an anxious attachment to the mother, a bond which is very strong because, even though the child is frightened of her, he always hopes to be rewarded by her. To survive as a person Natascha had to form a relationship with Priklopil. Because he was sometimes kind and sometimes unkind Natascha became anxiously attached to him, and so she was distressed when she learned that he had killed himself. Placed in a similar situation, we all would have done much the same as Natascha, and none of us, including Natascha, would have been struck by the dreaded Stockholm syndrome.

Diagnoses like this put a security fence between the professional and the person who is suffering. It is the professional who is being kept safe from the horrors and the pain of real life while pretending to be an expert on people. Very little of the theory and practice of psychology and psychiatry relates to real, lived experience. Psychoanalysts have always tried to describe real, lived experience, but their desire to be special and different, as marked by their special language and by the difficulties in acquiring a ticket of entry to their group, has always overridden their desire to give a generally comprehensible account of what it is to live. Much the same can be said of the existential therapists. I have always tried to describe through the stories I tell what it is to be human, but I take things apart, while the great writers, artists and composers encompass life in all its complexity. Denis Noble, in his book The Music of Life, said of his colleagues, ‘Scientists and others tend to be quite fond of neat, clear-cut patterns. Nature is not. Nature is inherently messy… For some scientists reductionism functions as a security blanket. It avoids the need to ask too many questions, to stare into the abyss of uncertainty.’⁴

For most psychiatrists and psychologists, DSM diagnoses function as a security blanket, saving them from having to confront the messiness of life and its great uncertainties. Diagnoses also allow them to see other people, not as agents, but as puppets. The theories which picture people as puppets are about behaviour being the outcome of the actions of genes, biochemistry, disorders, traits, or the movements of the planets. Such theories are far removed from what we actually do. Neuroscientists have now put beyond doubt the fact that we cannot see reality directly but know only the constructions of our brain which come from our past experience. Developmental psychologists who understand this have applied this knowledge to their studies of babies and toddlers, and have shown that babies are born, not as passive puppets, but as agents, eager to make relationships and to act on their world.

Since no two people ever have the same experience, no two people ever see anything in exactly the same way. What determines our behaviour is not what happens to us but how we interpret what happens to us. In every moment of our life we are engaged in interpreting what is going on. We are, in effect, meaning-creating creatures. This is what it is to be human.

All the meanings we create form a kind of structure, and out of this structure comes our sense of being a person. Because we cannot see reality directly, every interpretation we make is a guess about what is going on. Thus, what we experience as ‘I’, ‘me’, ‘myself’ is a set of guesses about ourselves and our world. Our guesses are also predictions. When we find that our predictions are proving to be reasonably accurate we feel secure. However, the world can often surprise us, not always in pleasant ways, and when this happens some of our ideas fall apart. This is a very common experience. Unless we know that what we are experiencing is a necessary collapse of our ideas, we feel ourselves to be falling apart. If we are full of self-confidence we can say to ourselves, ‘I’ve got through things like this before and I’ll do so again,’ but, if we lack all self-confidence, we feel that our very self is crumbling, shattering, even disappearing. We feel a terror greater than our fear of death. Facing death, we can tell ourselves that some important part of ourselves will continue on, perhaps our soul or spirit, or the memories others have of us. Facing the annihilation of our sense of being a person, we feel that we are about to disappear like a wisp of smoke in the wind. In such terror we can resort to those desperate defences which psychiatrists call mental disorders. They are not illnesses but defences which serve to hold us together when we feel ourselves falling apart. We can relinquish these defences once we come to understand that what is falling apart is not our self but some of our ideas. These ideas must fall apart so we can build new ones that better reflect what is going on in our life. We are not puppets, victims of our genes, traits, or star signs, but agents, interpreting our world, making decisions and acting on our world.

If we do not value and accept ourselves, if we believe that our ideas about ourselves and our world are absolute truths, and if we try to force the world to be what we want it to be, we will be unhappy. If we value and accept ourselves, if we know that everything we know is but a set of ideas which we can choose to change, and that our ability to change the world in the way we want is extremely limited, we will be able to survive the worst that life can throw at us. There is a good chance that sometimes we will be happy.

Fear and the Fear of Fear

Chapter One The Nature of Fear

Fear comes to us in many guises. It can come as a shiver in the delight of anticipation; or as the drenching, overwhelming, annihilating terror known by the inadequate names of existential anxiety or dread. It can come suddenly, life-savingly, in situations of danger, when it is known purely as fear; or it can gnaw away endlessly with little apparent cause, and we call it anxiety; or it can come with a sense of having the eyes of the world upon us when we are naked and alone, and we call it shame; or it can loom darkly, threatening punishment, and we call it guilt.

Fear, like death, is the great unmentionable. We maintain a conspiracy of silence so as to pretend we are not afraid. In the aftermath of great physical danger or terrible disaster everyone claims that everyone was brave and no one panicked. In 1985, when I was living in Sheffield and writing this book, at nearby Manchester airport a British Airways plane loaded with holidaymakers caught fire as it was about to take off. Those passengers who survived spoke of terror and panic and the rush for the exits as smoke filled the rear of the plane, but they soon ceased to be reported in the newspapers as other people, important people who were not aboard the plane, made their statements commending the passengers for their bravery. These important people would have had us believe that everyone aboard that plane acted with courage and decorum. Yet would not anyone, trapped in the narrow space of a crowded plane, watching the flames and breathing the acrid smoke, feel afraid and try desperately to escape?

Sixteen years on and another, even more immense, tragedy occurred in New York on 11 September 2001. Across the world millions of people watched the television pictures of these events that day and over the next few days. We saw how again fear became the great unmentionable. When the two planes flew into the World Trade Center and the buildings collapsed, television crews filmed and interviewed some of the people who had escaped death. These people showed their fear and spoke about it, and such interviews were repeated in news bulletins later that day and evening, but by the next day such interviews had disappeared from our television screens. They were replaced by stories about the bravery of the firefighters and other rescue workers. The courage of the Mayor of New York, Rudy Giuliani, was praised, as was the courage of Americans generally. By then Americans had turned to patriotism and religion. The symbol of the USA, the Stars and Stripes, became a badge of courage and determination, while churches, synagogues and mosques were overflowing with worshippers. Americans were still afraid, very afraid, but this fear could not be mentioned.

The memory of such fear can stay with us for the rest of our lives, leaving us unable to enter any place which will remind us of our fear, or returning in dreams of terror when we find ourselves re-enacting, helplessly, the scenes where we once successfully escaped destruction. Some people, to give themselves freedom to go and do what they wish, put themselves through the painful process of therapy, in the hope that relearning a skill or talking about the events will remove the fear, and with that the shame of being afraid. Most people, however, adapt their lives to avoid certain situations and activities, by never entering an enclosed space or flying again, or they fog their sleeping brains with drugs to blot out dreams, or become what is known as ‘a light sleeper’, someone who is often awake while others sleep. They invent all sorts of excuses for not doing certain things - proneness to illness, or allergies, logical reasons for following one course of action rather than another - all to hide the fact that they are afraid. They must do this because they know, correctly, that to be afraid is to be scorned.

The fear we feel when faced with an external danger - fire or flood or a terrorist bomb - is bad enough, but what is far, far worse is the fear we feel when the danger is inside us. When the danger is outside us we know that at least some people will understand how we feel, but when the danger is inside us, when we live our lives in a sweat of anxiety, shame and guilt, we find ourselves in the greater peril that if we tell other people about our fear they will think that we are weak, or, worse, mad. So we take drugs to drown our fear and maintain the conspiracy of silence.

Edith was a very good woman who had devoted her life to others. She often acted as chauffeur for one of my clients, and while this client was talking to me Edith would visit some of the elderly patients in the hospital. One day she phoned me and asked whether, when she came the next day, she could have a quick word with me. I agreed, and so the next day she came into my room, apologizing for taking up my time and sitting nervously on the edge of her chair. What she wanted to know was whether she was going mad. The evidence that she might be was that she would often wake at 2 a.m. and lie worrying. The fear that pervaded her being manifested itself as the fear that no one would look after her when she was old. What if she became senile and incontinent, like the old women she visited on the psychiatric ward? She had done enough nursing to know that I could not truthfully say that her old age would not bring indignities and inadequacies, but there is one truth I could tell her.

Waking in the early hours of the morning in a sweat of terror is an extremely common experience. All across the country people are experiencing that terrible loneliness of being. They have woken suddenly to the greatest uncertainty a human being can know. There is no shape or structure to hold them. They are falling, dissolving; totally, paralysingly helpless without hope of recovery or of rescue. Sickening, powerful forces clutch at their hearts and stomachs. They gasp for breath as wave after wave of terror sweeps over them.

We all knew such terror when, as small children, we found ourselves in a situation which filled us with pain and helpless rage. We screamed in fear and in the hope that our good parents would rescue and comfort us. Now grown up, we know the extent of our loneliness and helplessness. Some of us wake, like Edith, completely alone. Some of us have another form sharing our bed, but it is effectively insensate, a log refusing to acknowledge our misery. Others of us, more fortunate, share our bed with a kindly person who switches on the light, makes us a cup of tea, and holds us close. Such love can make our terror recede like the tide, but, like the tide, it can return, and there is no good parent there to pick us up and cuddle us and assure us that the world is a safe place and there is no reason to be afraid. We are grown up now, and, try as we might to deny it, we know the loneliness of being. We long for good parents who will rescue and love us, but we know that there are no good parents and, while we might believe in God the Father, in these times of terror He is far away.

For some people the waves of terror and the sense of annihilation last for many minutes. Some people move very quickly to turn the terror into all kinds of manageable worries - manageable not because the worries are about problems which can be solved but because they turn a nameless terror into a named anxiety. Thoughts like ‘Who will look after me when I get old?’, ‘I can’t manage the tasks I have to do at work today’, ‘The lump on my groin is certain to be cancer’, ‘If my daughter goes to that school she’ll get mixed up in drugs’, ‘I won’t be able to meet this month’s bills’, ‘I should have done more for my parents before they died’ are indeed terrible, but they give a sense of structure and have a common, everyday meaning. With these common, everyday meanings we can pretend that the terror we felt did not happen, and that we belong to the everyday world.

However, not everyone can do this. For some people, lying there in the dark, the terror goes on and on. When Edith described to me how this happened to her she said, ‘It gets so bad I think I shall run outside the house in my nightie and stand in the middle of the road so I’ll get run over and that’ll stop it.’

‘Not in your street at 2 a.m. you won’t,’ I said, knowing how empty her town was at night. I went on to tell her that the terror she felt is called ‘existential angst’. She laughed at this ridiculously pretentious name. ‘I’ll remember that next time,’ she said, ‘I’ll lie there and think, “I’m experiencing existential angst.’“

I do hope she does, and finds her laughter in the midst of her terror. It would be so monstrously unfair if Edith followed the path of a woman whose inquest was reported in the paper recently. She was an elderly patient, not long discharged from a psychiatric hospital. A nurse told the coroner that she had looked in the patient’s room at midnight and seen her sound asleep. When she returned at 6 a.m. she found her floating in the bath. The coroner returned an open verdict. There was no mention of the terror which the poor woman could bring to an end only by filling the bath with water and, all alone, immersing herself in it. When fear is terrible, all we can do is run away.

Fight or Flight

Fear has a vital life-saving function. It is the means by which our body mobilizes itself to move swiftly and efficiently to protective action. When we interpret the situation we are in as dangerous, adrenaline, which is produced by the adrenal glands just above the kidneys, as well as at the ends of the neurones in the brain, is pumped into our system, thus causing our heart rate, blood pressure and blood sugar level to increase, and so preparing the body to fight or flee. If we act physically, by striking out at the source of the danger or by taking to our heels and running away, then we make use of our body’s preparations. But if we neither fight back nor run away we are left with the effects of these preparations and they can be most unpleasant.

Our heart beats fast and we feel shaky, sweaty and tingly. Some people experience severe headaches, some feel nauseous, some feel dizzy and close to fainting. Some people do faint. When these reactions occur in company, where we need to be calm and collected, we can feel very ashamed of ourselves. When they occur and we do not know why, we can feel frightened and so start on the sickening cycle of fearing fear itself.

Faced with an external danger, such as a man carrying a gun, or an oncoming monstrous tsunami, we can stand and fight or flee. However, sometimes the people around us will not let us do either. Children who are frightened of their parents or teachers may be prevented from either fighting to protect themselves or running away. Lacking the means to support themselves or their children, women may be unable to flee from husbands who frighten them. Needing to support their families, men may be unable to fight or flee from employers who frighten and mistreat them.

Thus it is very easy to find ourselves in a situation where we wish to fight or to flee but feel that we can do neither. Such a conflict leaves our mind in a turmoil and our body reacting appropriately to our reading of the situation (danger) and inappropriately to our reaction to our reading of the situation (neither fighting nor fleeing).

If we can make such a conflict explicit, by thinking about it very clearly and honestly and by discussing it with understanding friends and counsellors, then we can often find a way to solve the conflict or to live with it more easily. But if we dare not make the conflict explicit to others or even to ourselves, then we cannot resolve it and our misery goes on.

Shirley came to see me because she was nervous. She had given up driving because she was frightened she would have an accident and hurt someone.

‘I’m not worried about hurting myself. It’s other people that I worry about.’

She felt nervous when she had to go into a room where there were other people.

‘I worry that they’ll all look at me. Yet I like going out and having a social life. It’s just I sort of feel ashamed. I don’t know why. I do go out, like we go out for a drink, and I find my hands shaking.’

She said that what she wanted was to feel more confident.

‘I’ve never felt confident.’

Her brothers, all older than her, used to tell her that, as she was a girl, she could not play with them. At school her teachers told her that she was not bright.

‘I mightn’t be brainy but I’m intelligent. That’s what I’m always telling my husband. He treats me like I’m stupid and don’t know anything. But you can’t tell him. He’s one of those men who always have to be right. Don’t get me wrong, he’s a wonderful husband and thinks the world of me, but he does put me down.’

She spoke of how important it was to her to be herself, to have a small job so she had some money of her own, and how annoyed she got with herself when she became too nervous to do the things that she wanted to do. Yet, when she spoke of being confident, there was some sense of reservation. She would not want to be totally confident.

Why was that? Well, a great deal is expected of totally confident people. People expect them to be able to cope with everything. Shirley’s problem was that if she became totally confident she would be asked to do things which she could not or would not do, and she did not want to say no to people.

‘I don’t like to upset people. I want to be liked.’

If Shirley’s problem had been simply that she lacked self-confidence, then she could have solved that problem by taking steps to increase her self-confidence, but if she also believed that if she was self-confident she would upset people and they would dislike her, she could not afford to become self-confident.

Unavoidable Conflicts

Shirley’s conflict is one which many people experience. We want to be ourselves, but we fear that if we do express our own wishes, needs and attitudes, then people will not like us. For some people being liked is not their top priority, but for many people it is a matter of life and death. More of this later. Here I want to point out that all of us, whatever we feel about being liked, are always involved in finding a balance somewhere between

If we live completely as an individual pursuing our own interests and taking no account of other people’s needs and wishes, we soon become extremely lonely. If we live completely on our own, lacking the checks and balances that other people place on our interpretation of what goes on in the world, we become an extremely idiosyncratic person whom other people regard as odd, even mad. On the other hand, if we merge ourselves completely with a group we cease to be the person we are. We become a nothing. Rather than face either of these fates we have to find a balance, day by day, between being an individual and maintaining relationships with other people.

In finding a practicable balance between being an individual and being a member of a group, you have to arrive at a balance between regarding yourself as

The more we regard ourselves as valueless and imperfect, the more we fear, hate and envy other people, the more we feel frightened of doing anything, and the more we fear the future. Regarding ourselves as bad brings a lot of troubles. Yet if we regard ourselves as perfect we delude ourselves and make it difficult for other people to get along with us. No one is perfect. We all make mistakes, get things wrong, irritate other people, and fail to make the most of our talents.

So we have to arrive at a realistic assessment of ourselves, with no false modesty, seeing ourselves as ordinary people, like all other people, yet at the same time as individuals who are valuable to ourselves and to other people, even though other people may not value us in the way that we want them to value us.

It can take us many years to arrive at an assessment of ourselves which provides a realistic and hopeful balance between imperfection and perfection. We can be plagued by doubt, confused by the conflicting demands that people make on us, and hurt by criticism. To find out who we are and how we should assess ourselves we need to explore, to meet new people, to try out new situations and to see how we feel and react to and deal with the strange and the new. But to do this, we need freedom, and to have freedom we have to give up security.

From the moment of our birth, we have to find a balance between

The more freedom we have, the less security. The more security, the less freedom. Total freedom means total uncertainty and great danger. Total security means total certainty and total hopelessness, for hope can only exist where there is uncertainty.

We all try to hold on to a measure of security. Most of us do this by having possessions (what is that line from a song - ‘Freedom’s just another word for nothing left to lose’?), just as most of us find security by keeping close to a group of people (why else would we put up with awful relatives?). Some people seek security not just in possessions and people but in a set of beliefs which makes everything that happens part of a pattern. The pattern may be in terms of heaven and hell, or Allah’s will, or karma, or fate, or a constellation of stars, or the eventual victory of the proletariat, but whatever the pattern is, it gives us a sense of fixity in what would otherwise seem to be a meaningless chaos.

However, while having a belief in some kind of grand design can give a sense of security, it can make the person who holds the belief feel hopeless. If the pattern of your life is already determined by God or by your stars, or by your genes, or by your parents, or by a series of rewards and punishments called conditioning, then there is nothing you can do to change it. You are helpless and hopeless.

On the other hand, if nothing is fixed, if anything can happen, at any time, then you have an infinite number of choices about what you do with your life. Such freedom can be exciting if you have lots of confidence in yourself, but if you do not, then such freedom is very scary. So, somehow, we all have to achieve a balance between

Along with the question of choice comes the question of responsibility. How much are we responsible for what happens? If we are just acting out a pattern which was determined and fixed in our stars or in our genes before we were born, then we are not responsible if we turn out to be murderers or thieves, and it is not our fault if our children turn out badly or millions of people starve. Such a release from responsibility can seem quite attractive, but, equally, if we are not responsible for when things turn out badly, we cannot take the credit for when they turn out well. You cannot take the credit when you become rich, famous and powerful, when your children lead happy, successful lives, and when you solve the problems of world hunger and nuclear war. So, being responsible does have its benefits.

But where does that responsibility end? You might be responsible for doing your work properly but are you responsible when the firm you work for goes bankrupt and you lose your job? You might be responsible for looking after your children, but are you responsible when your daughter’s marriage breaks up or your son gives up his job to go surfing in California? You might be responsible for organizing your finances so that you have some money to give the charities, but are you responsible for those world events which give rise to hunger, terrorism and war?

So we have to find a balance between being

Even though from the moment of birth we need other people, as small children we soon learn that other people can reject and punish us, and this can be very painful. We protect ourselves from this pain by becoming very careful in our relations with other people. We withdraw from them, and when we deal with them we put on some sort of social front. When I was researching for my book Friends and Enemies¹ I questioned a large number of people about the part friendship played in their lives. Many of these people spoke of how, while they valued their friends and dreaded loneliness, they feared being rejected or abandoned or betrayed by their friends. Being close to other people is risky, but then we also run the risk of loneliness.

So we have to find a balance between

Thus in these six vital aspects of our lives we are for ever trying to achieve a balance between two opposites. There is no textbook we can consult which will tell us what is the right balance, because what is right for one person is wrong for another. We cannot, when we are, say, fifteen, arrive at a set of balances which will suit us for the rest of our lives and stick with that, because what is a good balance at fifteen is not so good at twenty and quite disastrous at forty. So we have to keep trying to find the right balance, and we always run the risk of getting it wrong. We are always in the position of the juggler who is trying to keep eight oranges in the air while balancing on a ball which is on a chair which is resting on a plank which is supported by two rolling drums which are on a raft floating in deep water. Any minute, something could go wrong. It is no wonder that we often feel frightened.

We struggle on, meeting what seems an endless stream of difficulties and problems. When we encounter yet another setback, we often look at other people and see them being like those people in the television advertisements who are always beautiful, knowledgeable, organized, intelligent, happy, loved, admired and suffering no greater problems than choosing the right margarine and coping with the weather. Then we can feel just like Alice when she met a couple at a dinner party.

‘They’ve got three children,’ she told me, ‘and they’re all brilliant, marvellously musical, getting excellent degrees, entering wonderful careers. He’s done terribly well, she’s got this marvellous part-time job and she’s got paintings in this new exhibition. Everything that family does is just right. Urgh!’

It is hard not to feel envy for people whose lives seem to go along more easily, more successfully than ours. However, this is the price we pay for clinging to the hope that it is possible for us to find a way of life where we are happy, trouble free and never make a mess of things. Without this hope many of us would find life very difficult indeed. The alternative version of life, in which all of us suffer one way or another, have heavy burdens and often make a mess of things, can rob us of hope and make us feel very frightened.

Many of us, as we get older, come to agree with Samuel Johnson that ‘Human life is everywhere a state in which much is to be endured and little to be enjoyed’, and try to meet this view of life with courage and hope. However, those of us who have read about Johnson know that during his life he was often depressed and that he was always afraid of dying.

Fear of Life and Death

Most of us go through a large part of our lives not thinking about death. ‘When it comes, it comes,’ we say, and secretly think that it will not. Other people die in earthquakes or car accidents or of cancer or of old age, but not me. I am the exception. Then one day something happens and we know. Death means me.

Then all the careful security we have built up comes crashing down. We are all alone, without protection, open to great forces which we cannot and do not understand. We ask in our anguish, ‘Why me?’ ‘Why death?’ ‘Why life?’ ‘What is it all about?’ There are no satisfactory answers.

From the moral and religious education we received in childhood many of us drew the comforting conclusion ‘If I’m good nothing bad can happen to me or to my loved ones’. When death becomes imminent, or some other terrible disaster strikes, our belief in the protective power of virtue is swept away.

Rose’s lawyer asked me to prepare a report on how Rose had been affected by her accident. She was having difficulty in getting back to work.

Rose said to me, ‘The car pulled out of the driveway and hit me as I was cycling past. My bike was caught under the front of the car and I was pushed across the road. I could see the lights of other cars coming towards me. I remembered how, when I was eight, we left our beautiful home in the country and moved to London. And then I thought, “I won’t have any more holidays.” I ended up in the gutter on the other side of the road. A man came to pick me up and I thought he was the driver of the car. I gave him a mouthful. I was angry and then I found that he wasn’t the driver… I feel so guilty about all of this, putting all you people to so much trouble. You’ve got people who need your help far more than I do. I’m all right, really, just my back’s a little sore and I get a bit weepy now and then. I usen’t to be like that. Always self-controlled, really. Now I think, why me? Why do I go on living and those babies die?’

Rose was not all right. She was shaken to the very core and guilty that she was alive. That sounds crazy, but it is what many people think when they have survived a terrible disaster. ‘Survivors’ guilt’ is now a common term, derived from studies of the people who survived the concentration camps of the Second World War, or Hiroshima and Nagasaki (the hibakusha), or the fighting in the Vietnam War.² Such people feel, not joy at being alive, but fear, fear that they have done something wrong, for they ought to have died like their companions, fear that they have been given something they do not deserve and that they will be punished for holding on to it or that it will be suddenly taken away from them. They may have survived, but death as retribution is imminent.

Rose’s question ‘Why me?’ was that of an ordinary woman nearing sixty who had worked diligently all her life, looking after her family, being competent in her office work, enjoying a quiet life in a country town, never expecting that her life would have any other significance than the pattern of the lives of her family and friends.

Then suddenly she was flung, not just across a road in the path of oncoming cars, but into the vast mysterious universe of being. Why me? In all this vastness, why me? Alone in all that vastness, she trembles with fear. Has she been saved for some purpose? Is there some pattern, some Grand Design, in which she has to play a significant role? If there is, why is she, an ordinary woman, chosen to play it? Will something be asked of her that she cannot perform, where she will fail and be punished for her failure? Has the Grand Designer got it wrong? Was she saved by mistake? Has she been given something that she doesn’t deserve? Should she be dead, and some little baby, now dead, be alive? Or is there no design, just a random universe where some people live and others die, with no justice or fairness or reward for goodness and punishment for badness? Just randomness, chance without significance, life without meaning? Is ‘Why me?’ a question flung at the stars, and the stars shine coldly back with no answer?

To contemplate the significance of one’s life against the limitlessness of space and the infinity of time is to create a powerful sense of awe and dread. Sometimes this is a very sensible thing to do. It certainly helps in keeping a sense of proportion about our own anxieties and ambitions, but at other times such a contemplation brings a sense of powerlessness and insignificance which can be quite overwhelming.

We all first had this experience when we were children and learning about space and time. By then we had all come across death through the demise of grandparents or pets, or stories on television, or simply the unspoken threat of death in the instruction ‘Be careful crossing the road’. As young children we puzzled over the problem of what death is and we arrived at an answer.

Over the centuries of human life, death has been given many meanings. Yet in all, such explanations fall into two categories. Death is either the end of the person’s identity or it is a doorway into another life. ‘Another life’ can be described in a multitude of ways, but whatever the description given, it implies that some significant part of the person goes on existing after death.

The curious part of arriving at an answer to the question ‘What will happen to me when I die?’ is that even though we may use scientific methods in seeking an answer (‘Has anyone come back from death to tell us about it?’ ‘Are there such things as ghosts?’ ‘How many people could fit in heaven?’) the answer we arrive at is in terms of meaning. We discover a meaning for death which then gives meaning to our life. We say, ‘There has to be something after this. Otherwise, what’s the point?’ or ‘This life’s all we’ve got. It doesn’t make sense, the idea of an afterlife.’

In giving death a meaning, the end of identity or the doorway to another life, we fix the purpose of our life.

If death is the end of your life, then to be able to accept your death you have to live your life in a way that you feel is satisfactory. There are a multitude of ways of seeing life as satisfactory - by becoming rich, or famous, or having a good marriage, or having children, or having done most of the things you wanted to do, or just getting by without too much trouble.

If you see death as the end of life and find yourself failing to make your life satisfactory in the way that you want it to be, you feel fear. Death looms menacingly, you see time running out, and you feel the pain and guilt we all feel when we know that we have wasted our talents and thrown away our opportunities.

If you see death as a doorway to another life you are immediately confronted with the problem of justice. If the afterlife means that there is the possibility of going somewhere better than this present world with its troubles and pain, then our likely questions are ‘Does everyone go there? Is it fair that everyone goes somewhere better irrespective of the kinds of lives they lead? Should Hitler enjoy the same kind of afterlife as Mother Teresa?’ The answer that most people give to these questions is no. So the idea of an afterlife, whatever form it takes, contains some notion of justice. If you see your life as a doorway to another life you then feel that you have to achieve a certain standard of goodness and excellence which will allow you entry to a better life. When you see yourself as failing to meet the standards and rules of life beyond death’s doorway, you feel great fear.³

Seeing death as the end of existence or seeing it as a doorway to another life are ways of trying to understand, not just our own life, but our life in relation to space and time. When we contemplate the vastness of the ocean or the immensity of the heavens, we feel great awe, a mixture of respect, fear and incomprehension. To reduce our fear and increase our understanding, we develop theories to explain, in the words of the Hitchhiker’s Guide to the Galaxy, ‘Life, the universe and everything’.⁴

Some of us frame our explanation in scientific terms, and are left with puzzling things like curved space, a flat universe, black holes, and the question of whether there is life in other parts of the universe. A scientific description of life, the universe and everything is just as strange as a metaphysical or magical description. It gives rise to many fantasies, as the popularity of science fiction shows. In the end, a scientific explanation of life gives neither comfort nor security. To hold such beliefs and not be afraid requires courage and the ability to tolerate much uncertainty.

Not everyone can manage this, and so they turn to metaphysical or magical beliefs in order to find greater comfort and security. The scientific view of life and the universe sees us humans as just a small part of a vast complexity which will go on being itself with no more special regard for human life than it has for asteroids, atoms and the fifth dimension. Metaphysical and magical views of life place human beings at the centre of the universe where everything that happens relates to us and where we can influence vast forces and powers by our prayers, rituals and virtues.

Holding beliefs which place us at the centre of the universe under the control of a beneficent power can create a sense of security, and increased pride and self-confidence. Knowing that God loves you, or that your ancestors are watching over you, or that you are party to the forces of goodness which rule the world, can make day-to-day living simple and secure. However, the trouble is that everything in life has both good and bad implications. You win a lot of money in a lottery, which is good, and then all your impecunious, greedy relatives want to share your good fortune, which is bad. As an adolescent you look forward to being an independent adult, which is good, but as an independent adult you will have no one to look after you, and that can be quite bad. In the same way, our beliefs about the nature of life and death, whatever they may be, have good and bad implications. To rest secure in God’s love, or in the approbation of our ancestors, or in the power of the forces of goodness, we have to live our lives following certain rules, and if we fail to follow those rules then we are in great danger. The power which we perceived as protecting us can be turned against us and can threaten us with death and damnation.

In a group discussion about the experience of depression one woman described how when she was badly depressed she would wake during the night with the conviction that she should check whether her children were safe in their beds. She would get out of her bed to do this, but as she entered the hallway, all familiarity vanished and she found herself faced with a vast black hole. She was sure that if she took a step forward she would plunge into the hole, so she would stand there frozen with terror. The group discussed this in terms of how easy it is in the dark to lose contact with the most familiar of surroundings, and how the image of being depressed (frequently expressed as falling down into a bottomless pit) is experienced as something real and palpable. The woman listened to this and then said, ‘I think that your feelings summon up powers - good powers or evil powers - out there. If you feel terrible, inside you, then you somehow draw this terrible blackness towards you. If you feel good and happy, then you draw this goodness out there to you.’

This woman’s belief in supernatural powers was a comfort to her when she was happy, because happiness, she believed, attracted the benevolent power, but her belief also harmed her because when she was depressed she felt that she attracted the malevolent power.

We may try to deal with our fear of death by imagining that it will not occur for a long, long time. But if that is the case we have to travel through old age to meet death, and the prospect of old age can be full of terrors. No one likes the idea of becoming deaf, weak sighted, forgetful, frail and incontinent. No one wants to be treated like a foolish child by patronizing doctors and nurses and disrespectful relatives. Yet that is the fate which awaits many of us, and no matter what plans we may make to avert such a fate - by looking after our health, or making financial provision for a place in a superior nursing home, or threatening our relatives with guilt and retribution if they do not look after us properly - we can still be frightened.

Sometimes our fear of old age is more than just a fear of the practical problems it creates. Sometimes there is a magical dimension to our ideas about youth and old age.

Sylvia came to see me distraught after her husband of fourteen years had left her for another woman. All her conversation was about him. If her description of him was in any way accurate I would not have given him houseroom, but Sylvia desperately wanted him back.

They had met and married when she was thirty-four and he was twenty. I asked her what had made her fall in love with him.

‘Chemical reaction. He made me feel so good. Young. Some women don’t get older, do they? Like in those films, you’ve seen them, haven’t you, where there’s this woman and she’s young and very beautiful but really she’s hundreds of years old, and then something happens and she gets old, real old, suddenly, and her body starts to break up, ugh, it’s horrible, and she just crumbles up and her body sort of falls in on itself.’

If this is what she feared old age would be, then it was no wonder that she wanted to hang on to a man who had the power to preserve her, even though he did beat her when he got angry.

When I was researching for my book Time on Our Side⁵ I asked a large number of people how they felt about time passing and growing old. All agreed that growing old was frightening, but what made growing old an experience to be feared was different for each person and related to how they saw themselves. Those who had built their identity on achievement feared the time when they could achieve nothing. Those who had built their identity on being needed by others feared being of no use. Those who had built their identity on their sexual attractiveness or sexual prowess feared the fading of their beauty or their loss of vigour.

What people saw as the beginning of the descent into old age depended on how old each person was. People in their twenties saw thirty as the peak of their life, and after that was nothing but decrepitude and decay. People in their thirties saw forty as the turning point, people in their forties saw fifty as the turning point, and so on. I have now turned seventy. Old age, I know, starts at eighty.

Old age does have some actual deficits. Being ill in whatever form is no fun, and we live in a society where old people are not valued, except by politicians when they need the pensioners’ vote, but most of our fears about growing old arise from our ideas about old age. Fearing being ill or losing our physical and mental capacities is bad enough, but if we add to those fears our own prejudices about old people, if we see old people as being ugly, stupid and of no importance, then old age becomes something we dread. However, we are free to change our ideas and thus reduce our fears.

Those of us who enjoy a relatively serene old age have certainly changed our ideas. When we were young many things mattered enormously to us. Now we know how little really matters, but we concentrate on that little which is of immense importance to us, be it those we love, or music, or stories as told on radio, television or film, or simply our garden.

The serenity I enjoy can be interrupted when a chronic lung disease, bronchiectasis, a legacy from childhood, flares up and brings me low. Then I feel frightened, but at the same time I am ruthless in a way I was not when younger in protecting myself from too many demands on my strength. I can achieve this easily because one of the ideas I have discarded is that I must work hard to be good, because no matter how good I am it is never enough. Now, if occasionally I am good, it is solely because it pleases me to be so.

Fear of Not Being Good Enough

When we came into the world as babies we were quite pleased with ourselves and did whatever we wanted to do. We slept when we were sleepy, cried when we were hungry or uncomfortable, and, when offered a nipple, sucked only if we wanted to suck. We had no notion of good or bad. We just were. Then society stepped in and said, ‘This won’t do. You are not satisfactory as you are. You have to be different.’

This all came as a terrible shock to us. We discovered that we were not masters of our own universe. There were greater powers out there and they were insisting that we had to be what they wanted us to be. We had to eat when they wanted and not just when we were hungry. We had to empty our bowels and bladder at the time and place they wanted and not just when we felt the need. We resented this interference, but we knew that the powers that demanded this from us were also the people on whom we depended for survival, and so we acquiesced. We became obedient, and, even more than that, we accepted our family’s definition of us as not being good enough and needing to improve.

Having accepted this as a child, we moved into adult life fearing that we were still not good enough and ready to react with shame and guilt whenever some parental figure chided us for not doing well enough. The editor of Good Housekeeping saw nothing wrong with writing, ‘The other visual treat is the second in our series of Norman Parkinson spectaculars photographed in Tobago. This time it’s summer evening clothes - silky, slinky, sexy numbers. The models look wonderful, very Fifties, very Parkinson and should inspire many of us to take stock and try a little harder.’⁶ This was written in 1985, but women’s magazines have not changed, except to increase the range of matters in which women must try harder. It is not enough for a woman to look beautiful and wear beautiful clothes. She must also have a successful career, have a great social life, and be the perfect mother, cook and lover. Women readers react by making an even greater effort to lose weight or else sink deeper into a feeling of inadequacy and despair.

Men do not escape this sorry state of forever trying to do better to justify one’s existence. They have, in some way, to ‘make it’, and when they do not, or when what they have ‘made’ is taken away from them, they become very frightened. Some young men set themselves the goal of having ‘made it’ by the time they are thirty, and so, if they fail, enter their thirty-first year in a state of rage and despair. Others set the vital age at forty, and when the failure to be rich and famous combines with a lessening of sexual performance, they sink into depression, or seek denial in alcohol or in the arms of a much younger woman. Forty is indeed a dangerous age.⁷

When we were small babies we had no concept of ourselves as separate entities. We were contiguous with the rest of our world, which presented itself to us as a continuously changing phantasmagoria. Then, by about eight months, most of us made that curious transition to the belief that what we saw was not a display of an infinite range of spectacles, coming fresh to our eyes every moment, but a limited range of spectacles which came and went and then returned. We acquired the understanding that we did not have an infinite number of mothers but just one who came and went and then returned and who was somewhere else when we could not see her. When a favourite toy disappeared, we had some idea of where to look to see it reappear. Making things disappear and reappear became a great delight as we rejoiced in our power to control our universe. We were not always successful at this. Sometimes Mother disappeared and did not reappear, no matter how hard we tried to get her back.

With the belief that objects go on existing even if they are out of sight came the understanding that if objects do this, then it is worth the bother of having some sign that stands for them when they are out of sight. There is no point in having a system of signs if there is an infinite number of things in our universe and their appearance is never repeated, but if events are repeatable then we may as well have some sort of language which we can use in reference to them. So babies who acquire ‘object permanence’, as Piaget called it, go on to acquire language.

As we went through this extraordinary process, something which seems to be to a large extent peculiar to the human species, we were learning that our world consisted not just of ourselves but of ourselves and other objects. Some of these objects were very important to us, especially our mother, in whose warm and loving gaze we bathed in ease and delight. Then one day, when we were absorbed in some activity, we discovered this loving gaze had vanished and had been replaced by something cold and rejecting. Suddenly we were wrested out of the state of being ourselves and we became an object in another person’s eyes, an object of disgust and contempt. We were exposed, vulnerable and frightened. We had discovered shame.

Few of us can remember our first experience of shame, but we know when a small child has discovered it. The child ceases to be frank and open in all situations and to all people. He squirms and hides his face. If he does not look, then perhaps no one will look at him.

Experiences of shame which end with affirmations of love and reconciliation - a good cuddle - can be extremely helpful to the small child who is in the process of creating his sense of being a person, but when there are too many such experiences, or when such experiences never end with affirmations of love and reconciliation, the child can be left with the belief that he is, in his very essence, bad and unacceptable. Shame is about our identity, what kind of person we are, and when we are small and having the world defined for us by our parents, then if we are shown over and over again that we are unacceptable, that we should be ashamed of ourselves, we come to believe that this is one of the facts of the universe, as immutable and unchangeable as the pattern of night and day. As we get older such a belief about ourselves can be confirmed again and again by other events.

Margaret could not bear to be touched. She could not bear to be alone, but when she was with people she could not bear them to come too close. When she first came to see me she told me that she knew she was a bad person. She had known this ever since she was a small child. She knew that she was bad through and through. She spoke of herself as a child without any sympathy or concern, because, as she told me when I asked, she did not deserve any. She said that as a child she had done something terrible but she would not tell me what it was. It was so bad that the children in her street had been forbidden to play with her. If she told me what it was I would see how bad she was and then I would not want to have anything to do with her.

This was the theme of our meetings, every fortnight for more than two years. She would sit, head down, saying nothing, or speaking so softly that I could not hear what she was saying. She wore glasses which darkened in the light, but when I eventually challenged her on this she changed them to lighter ones so I could at least see where she was looking.

Again and again she would say, ‘If you knew what I was like you wouldn’t want to know me.’ Sometimes I would mock her gently, saying, ‘That’s right, I’d throw you out - tell you never to darken my door again.’ But most times I would say, ‘That’s just how you feel about yourself.’

For the first year she resisted fiercely my idea that no one is intrinsically bad but that we can learn through what happens to us to experience ourselves as bad. Then she started to experiment with this idea. She would say to me, ‘I say to myself, “Margaret, you’re all right,” but it doesn’t work.’

She found our sessions together very painful. Silences forced her to writhe in embarrassment and say, ‘I don’t know what to say.’ If I had to travel it caused her tremendous anxiety. When I discovered that she was one of those worriers who believe that worrying about something prevents it happening, I would ask her to be sure to worry about me when I was away and I would be sure to be safe. Postcards from me in faraway places with the message ‘Keep worrying’ would make her laugh, but still she worried that I might leave her.

One day Margaret risked telling her friend Sue about a childish misdemeanour about which she was very ashamed. Sue surprised her by not rejecting her. Margaret told Sue how her schoolfriend Betty had given her twopence to mind but she had spent it. Once she had told Sue about this, and how ashamed she had been when her act had been discovered, she found that the memory of this deed and the shame which accompanied it were not so painful.

Now she wanted to risk telling me about the greatest crime, the most shameful, terrible deed. But this was not easy. She looked at the clock and said, ‘It’s time to go.’ It was lunch-time, when I had planned to do some shopping, but I sat still and silent. Such a moment for Margaret might never come again.

Head down, speaking softly, with many hesitations, she said, ‘We lived on the corner, the end of the terrace. Then there was Shirley and Peter, then Betty and her brothers, then Carol and Mary and Ann - they were Betty’s cousins - and then the Smiths, and then my grandmother’s house, at the other end of the terrace. We all used to play together. They all went to the Protestant school and I went to the Catholic school. At school my best friend was Bernadette. I thought she was my best friend. She had a boyfriend, Barry, and I thought I’d like to have a boyfriend, but there wasn’t anyone, only Paul, and he was awful. I didn’t like him at all. He lived in a big house. We used to go there. He used to do things to me. I didn’t like it but I let him. He said I’d like it but I didn’t. We weren’t the only ones, all of them did it - together - all of them.’

She remembered all their names. A roll-call of former playmates.

There was one boy, George, he used to tease me, and I didn’t like it. I told Paul and he said he’d get George. He did, he got him, he tied him up and he did terrible things to him. I watched him - I didn’t stop him - and afterwards, when George’s parents found out, and the police came, I saw George’s mother put her arms around him, and I thought, ‘My mother won’t do that to me.’ When I got home, and the police took me home, my mother did put her arms around me, but I knew she didn’t mean it. There was a policewoman and she took me and asked me lots of questions. She asked me who else did it, and I knew they all did but I couldn’t say. She went on and on at me and I had to give her one name. I told her Betty and then they went to see her. Then we had to go up to the police station and there was this policeman there and he told me I was wicked. And afterwards, the parents, they wouldn’t let their children play with me. Betty could play with them but I couldn’t. I’d go and watch them, but I couldn’t play with them. Sometimes Bernadette would let me play with her and her sisters, but if anyone came I had to hide. And if I had to go down the street to my grandmother’s, they’d all call out to me, say things to me, it was terrible. They never played with me, not ever again. And they told other people about me. When I went to secondary school, some of the boys from the boys’ high school knew, and they’d say things. That’s why, when I left, I went right away. But I’m always frightened they’ll find out where I am and they’ll tell people and I’ll lose my job and nobody will talk to me.

She was crying. I gave her a tissue and said, ‘That’s the saddest story I’ve ever heard. That poor little girl.’

Margaret did not believe me. For her the shame was never ending.

But the pain for Margaret was not simply the shame she continued to feel for a misdemeanour the like of which many children at that age commit. If it is not sexual exploration it is stealing, or joy-riding, or, more dangerously, glue-sniffing. It would be a rare adult who could put their hand on their heart and swear that between the age of six and sixteen they had never broken the law or transgressed the moral code. For Margaret there was a greater problem.

One day she took me to task for never using her name when I was talking to her. I had to admit this. My style was never to use the name of the person I was talking to except when I wanted to attract their attention. I apologized to Margaret, and asked her why it was important that I use her name.

She said that it showed that I had not forgotten it and thus had not forgotten her. She told me how she felt that when she vanished from a person’s sight she vanished from that person’s memory. Whenever she returned to work she was surprised to find that the people there remembered her.

I said, ‘I always remember who you are when you arrive,’ and she responded, ‘That’s because you’ve written it in your diary.’

It was not just that she believed she was so insignificant that people did not remember her. Behind her anxiety was the fear that if everyone forgot her then her existence would cease. Most of the time she knew that believing that she existed only because other people thought of her and that she could vanish at any time was nonsense, but being left alone and forgotten was a fate she dreaded. Shame may have made her want to hide away, but shame also gave her the feeling that other people were observing her, and their gaze meant that she continued to exist. Shame strengthened her sense of existence and so she dared not relinquish it.⁸

In 1985 I wrote this story in the present tense. Now it must be told in the past tense, because for many years Margaret has led a happy life. She now has her own home and a loving partner, and she travels extensively worldwide. I have told the story of how she took charge of her life and changed in my book Breaking the Bonds.⁹

Many of us define ourselves in terms of our sense of guilt. A feeling of impending punishment can hang over us, like a Damoclean sword, ready to smite us for deeds done or which we have failed to do. While shame relates to our identity, the person that we are, and guilt to what we do, we can come to believe that everything we do is wrong and that we can never do anything properly, so that a sense of guilt, a pervasive sense of fear, can absorb our being to the extent that it becomes one of the structures by which we define ourselves. If we did not feel guilty we would not know what to do. As Constance once said to me, ‘I was born guilty’.

Some children acquire this sense of guilt when they come to feel that it was their fault that their mother died or their parents split up, even though these events occurred when the children were far too young to understand them. Most of us acquired our sense of guilt when, as small children, we found ourselves locked in combat with a parent over where and when we should defecate, or whether and what we would eat, or because our parent was punishing us and we did not understand why. We defended ourselves with anger and protest against a parent whom we saw as interfering and unjust. However, we could not win the battle and bring it to an end. We went on battling, and, as we did, we recognized that the situation was becoming increasingly dangerous. We felt very keenly that our parent was wicked to do this, but if that were so it meant that the person on whom we depended was wicked. This was terrible. We had to find some way of making ourselves safe.

Our solution was to accept our parent’s definition of the situation. Power is always about who does the defining and who accepts the definitions. So we acquiesced. We decided that we were wrong to see the situation as ‘I am being unfairly punished by my wicked parent’. The correct way to define the situation was ‘I am bad and am being justly punished by my good parent’, which was how our parent saw it.

This acceptance of our parent’s definition may have extricated us from that dangerous situation, but the price we paid was a lifelong sense of guilt. The sins of commission and omission became an integral part of our relationships with others and, knowing our badness, we have to strive to be good. Or else what will happen to us if we are not good? We shall be punished and abandoned.

This, as small children, is what we feared most of all, that our parents would abandon us and leave us alone, weak and defenceless in an alien world. We had learned what this was like when we were abandoned in our cot through a long, dark night and no one came to comfort us, or our mother left us with strangers and did not return for a long time. We heard the threat of abandonment when our parents told us of bad children being sent to children’s homes or of parents being driven to leave or even to die by their children’s wickedness. The most loving of parents can say in a moment of exasperation, ‘I can’t stand you a moment longer,’ or ‘You’ll be the death of me.’

Threats of abandonment do not diminish as a child gets older. A friend told me how, when he was nine and causing his mother some bother, she had packed a bag with his clothes and ordered him out of the house. He spent the day sitting at the front gate, hoping to be let back in again and promising to be very good. He is a man of unsurpassed goodness.

The fear of abandonment can underlie the whole of our experience of our existence, and because it is always there, allowing no contrast with periods without it, we do not conceptualize it clearly and consciously. Thus we do not ask why we have this fear now and whence it came.

Lorna had a nasty, life-threatening disease, cystic fibrosis, but she showed that by bravely and sensibly following a strict health regime this disease need not cut short one’s life nor prevent one from leading an ordinary existence. She had had to give up her work as a nurse but she had a loving, supportive husband, a wonderful daughter, a pleasant home, and a strong Christian faith which assured her that there was no reason to fear death. She could not understand why she should wake during the night consumed with panic, nor why a black depression should immobilize her in a way that her illness never did.

Nor could she understand why her GP wanted her to talk to me. But she dutifully came along, and discovered that talking to me gave her something important that was missing from her life. At home she was addressed as wife, mother, daughter, daughter in-law. Nobody talked to her. Now she had found someone who talked to her as her.

We talked about many things - the worry of her illness, the peculiarities of the medical profession, the responsibilities she carried for her family because she had always been the ‘sensible, well-organized, reliable one’. We talked a great deal about her need to do everything perfectly. Visitors had to be entertained with hot meals and home-made cakes. The garden must be trim and neat, the house immaculate. ‘I wouldn’t dream of going out and leaving the washing up not done or a bed unmade,’ she said.

I argued that she should let visitors fend for themselves and that housework should be kept to a minimum so that she had time and energy to do things which she found interesting and pleasant. At first she was doubtful, but one morning she told me, with triumph and laughter, ‘I went to church on Sunday without making the bed first but I closed the curtains so the neighbours couldn’t see.’

Why did she set herself such high standards and always strive to meet them? True, she had a mother who always expected her daughter to be perfect and a credit to her, but why had she accepted the enormous demands that her mother made on her?

One day, when she was telling me how fiercely she resisted going into hospital whenever her illness produced some complication, and how miserable she felt when she was there, she mentioned going into hospital when she was a child. I asked her about this and she described how she had been sent to a hospital when she was about seven. It was housed in a castle and run with military efficiency. Parents were not allowed to visit and children had to do what they were told. They had to be neat and tidy, obedient and reliable, and there were punishments if they were not. When her parents left her there she dared not cry because her mother disapproved of tears. She thought that she might never see her parents again, but when, at last, after many months, she did go home, she worried that she might be sent away again, to be abandoned and alone. So she tried very hard to be good.

Until we talked about these events in her childhood and uncovered the meaning they had for her, Lorna had not seen the connection between these childhood experiences and her drive for perfection, her fear of hospitals and the terrible panics which came whenever she felt that she was completely and absolutely alone. Buried farther was her anger towards her parents, who had abandoned her in the hospital, and towards her family, who expected her to give up being herself and to be what they wanted her to be. She had not acknowledged this anger, lest it burst forth and her family, who would not tolerate anger, reject her.

In the womb we were securely held. Being born brings us the first experience of being abandoned. We are no longer confined within secure limits, and instead a limitless world stretches around us. This uncertainty is frightening but necessary. All through our lives we cannot change anything about ourselves unless we go through a period of uncertainty. If we are wise we teach ourselves to tolerate the uncertainty of change, but, even as we do this, we retain the longing for the comfort and security of being securely held.

The ways in which this need can be met range from being physically held to knowing ourselves to be an accepted and loved member of our group. Important though this need is to all of us, there is no word for it in English. The closest word is ‘dependence’, from the Latin ‘to hang from’, but in our society to be dependent is not an admirable quality. Only weak, despicable people are dependent; strong, admirable people are independent. So we have to keep hidden our longing to be held secure in loving arms.

Not so in Japan. The Japanese language contains an important word, amae, which has the root ‘sweet’.¹⁰ Sweet it is to rest secure in loving arms. Sweet it is to amaeru, to presume upon the secure and indulgent love given by another person. It is that sense of snuggling up, of coming home, not to shouts and yells and coldness and criticism, but to welcome, allowed to be yourself and knowing that the people around you accept you as you are. The toddler who climbs on to an adult’s lap, confident of a cuddle, the teenager who throws his dirty football shorts on the bathroom floor, confident that they will reappear in his drawer, clean and pressed, the wife who snuggles up to her husband in bed and confidently places her cold feet on his - all amaeru. We all long to amaeru, but so often we cannot do this. Sometimes we have no one to hold us, and sometimes the people who hold us do so too tightly and threaten to smother us.

Adults who care for babies need to find a balance between keeping the baby securely held and allowing the baby the freedom to stretch, kick and act upon the environment by exploring it. In western Europe until the eighteenth or nineteenth centuries and to this day in eastern Europe, babies were wrapped tightly from birth in swaddling sheets to form a rigid bundle and left tightly held, but not in human arms, for the first six to eight months of their life. The theory behind swaddling was, according to the historian Lloyd de Mause, ‘If it [the baby] were left free it would scratch its eyes out, tear its ears off, break its legs, distort its bones, be terrified at the sight of its own limbs, and even crawl on all fours like an animal.’¹¹

Nowadays good mothering practice includes both tucking the baby securely in a cot or carrying him in a sling held firmly against the adult’s body and freeing the baby from all physical restraints in a warm, safe environment. These two kinds of condition are necessary for the baby, not just to encourage physical growth and health but to help him develop as a person who can tolerate the closeness of being in a secure group and the uncertainty of being an individual acting upon the world.

Unfortunately, some parents believe that they must teach the baby that they and not the baby are in charge, and so they do not respond to cries of hunger or distress. Some parents are too tired, or too busy, or too depressed to play with or talk to the baby. To learn, to develop our intelligence, we need to be able to act upon the world. Doing this, we develop the idea that ‘I am the kind of person who can act successfully upon the world’.

The idea ‘I am the kind of person who can act successfully upon the world’ is one of the possibilities that can be contained in an individual’s sense of being a person. If I asked you, ‘Who are you?’, you could list your gender, your age, nationality, religion, race, occupation and family connections. If I asked you, ‘What kind of a person are you?’, you could list your virtues and vices, strengths and weaknesses, alliances and enmities, your interests, wishes, needs, passions and beliefs, and all the things you know about yourself but find hard to put into mere words, but everything that you could tell me about yourself is made up of ideas. The sum total of these ideas is you, what you call I, me, myself. There is no little you sitting inside you, adding to and maintaining this sum total of ideas. You are your sum total of ideas, or what I call your meaning structure, because this sum total of ideas has a structure where every part is connected to every other part.

Your meaning structure is not a static structure but a feedback process in constant movement. Nowadays we are all familiar with feedback processes in objects like refrigerators and heating systems. Many refrigerators freeze and defrost themselves, and many heating systems change themselves with changes in outside temperature. There is no little engineer sitting in your refrigerator or heating system pressing the right buttons as needed. The process processes itself. It is the same with you. Denis Noble, Emeritus Professor of Cardiovascular Physiology at Oxford University, calls the self ‘an integrative process’.¹² If you happen to speak Japanese or Korean you will have no difficulty in understanding this because, as Denis Noble said, ‘What these languages do is to emphasise the “doing-ness” of things, the processes that occur, that is, the verb rather than the subject who is the possessor of the being-ness or doing-ness.’ If Descartes had been Japanese or Korean he would not have said ‘cogito ergo sum’, ‘I think, therefore I am’, but ‘thinking, therefore being’.¹³

Thinking of yourself as an active process can be somewhat disturbing, but think about it a bit more. Isn’t that how you experience yourself, with thoughts that come and go, memories bobbing to the surface, along with ideas, images, wishes and needs? The feedback in your process operates all the time as you see the results of what you have done, and you modify what you do next time. The process which is you reflects upon itself and so it can change. If you had been born with a bit of your brain marked ME, a bit that just sits there unchanging, you would have been stuck with you for the rest of your life.

Feedback processes like those in our refrigerator and heating system and in us, our meaning structure which gives us a sense of being a person, do not operate in a vacuum. These three kinds of processes operate in relation to their environment. Deprive us of our environment, and our sense of being a person begins to disintegrate. Sensory-deprivation experiments, where an individual is deprived of sight, sound, movement, smell and touch, have shown that, under these conditions, people begin to lose the ability to distinguish what is around them from what is inside them, their thoughts and feelings. These become increasingly bizarre. There is no lack of evidence of what happens to babies and children who are deprived of loving care, while all gaolers know that the quickest way to break the toughest man is to put him in solitary confinement for an indefinite period.

Our meaning structure starts to take shape while we are still in the womb, where babies hear sounds and experience pleasure and pain. A newborn baby looks around at the world with intense interest, and so his meaning structure grows and changes. Our meaning structure grows out of the functioning of our brain, and so, like all living things, its first purpose is to stay alive.

‘Staying alive’ for a meaning structure means staying as one coherent whole. The aim of all the functions of the meaning structure is to keep the structure whole and not let it fall apart. If the meaning structure starts to fall apart the sense of being a person will start to dissipate. We experience this whenever we discover that we are mistaken in our judgement. Mislaying our house keys makes us anxious; discovering that the world is not what we thought it was can threaten to annihilate us as a person. Whenever we discover that we have made a serious error of judgement - say, that the person we loved has abandoned or betrayed us, or that being a good person does not protect us from disaster - we feel ourselves to be shattering, crumbling, even disappearing, and with this comes the greatest terror, the fear that we shall be annihilated as a person.

Our sense of being a person is our meaning structure, and this meaning structure grows out of the functioning of the brain. While we are far from understanding just how brain and mind are linked, our increasing knowledge of how the brain functions shows that there can be no scientific doubt that the brain and mind are one.

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