Every year, nature quietly takes us through a moral lesson that has much to teach us about how we might relate to certain of the more dispiriting and despair-inducing moments in our own development. Beginning in mid-October in the northern hemisphere, the temperature drops, the nights draw in, the earth turns cold and hard, fog lies low over the land and rain drives hard across the austere, comatose grey-brown landscape. There is nothing immediate we can hope for; now we have nothing to do but wait, with resigned patience, until something better shows up.
Far more than we can generally accept, our minds too have cycles. We cannot be permanently fruitful or creative, excited or open. There are necessary times of retrenchment when, whatever we might desire, there seems no alternative but to stop. We can no longer be productive; we lose direction and inspiration. We are immovably numb and sterile.
It can be easy to panic: why should such a paralysed and detached mood have descended on our formerly lively minds? Where have all our ideas and hopes gone? What has happened to our previous animation and gladness?
We should at such times take reassurance from the late November landscape. Certainly things are lifeless, cold and in suspension. But this is not the end of the story; the earth is like this not as a destination but as a phase. The deadness is a prelude to new life; the fallow period is a guarantor of fecund days to come. All living organisms need to recharge themselves, old leaves have to give way, tired limbs must rest. The dance and ferment could not go on. It may look as if nothing at all is happening, as though this is a trance without purpose. Yet, deep underground, at this very moment, nutrients are being gathered, the groundwork for future ebullience and dynamism is being laid down, another summer is very slowly collecting its strength.
As nature seeks to tell us, we cannot permanently be in flower. We need moments of repose and confusion. There is nothing to fear. Things will re-emerge. We should make our peace with our own midwinters — and lean on nature’s wise accommodation to strengthen us in our pursuit of serenity and patience.
We would – of course – like any encounter with mental illness to be as brief as possible and, most importantly, to be isolated and singular. But the reality is that for many of us, the illness will threaten to return for visits throughout our lives, it will be a condition to which we will be permanently susceptible. So the challenge isn’t to learn to survive only a one-off crisis; it’s to set in place a framework that can help us to manage our fragility over the long-term. Some of the following moves, practical and psychological, suggest themselves:
Being ready for a return of the illness will help us to calibrate our expectations and render us appropriately patient and unfrightened in the face of relapses. We fell ill over many years – our whole childhood might have been the incubating laboratory – and it will therefore take us an age until we are impervious. We should expect to recover no more speedily than someone who has damaged a limb and probably a good deal more arduously, given how complicated a mind is next to a femur or a tendon.
We’ll need to monitor ourselves with special care, vigilant for signs of deterioration and vortices of despair. Our minds are prone to amnesia, we forget what we have learnt about ourselves and what has kept us steady. We may have worked out the basic structure of our illness in therapy. We might know that we are prone to self-sabotage, that we carry a trauma with us from the past, that we are inclined to destroy everything that is good about our lives and alienate those who want to care for us. But such knowledge will always be vulnerable to destructive impulses that can sweep away our patient intellectual labour and catapult us back into a state of helpless and frightened infancy. We should be ready to be submerged like this – and not experience our retreat as a humiliation, confident that ebbs and flows are normal and that we will be able to hold on to at least some of our gains.
Our minds don’t just need good lessons, they need to learn good habits, that is, they need to fashion routines in which helpful rituals, activities and ideas are repeated until they become second nature. Like someone learning a new language, we need to go over certain points again and again, rehearsing notions of self-love, self-forgiveness, kindness and self-acceptance on a daily basis. Things are so slow because we aren’t just trying to acquire intellectual concepts (something that might only need a minute), we’re trying to alter our personalities. It will be a life’s work.
We need to be rigorous with our patterns of thinking. We cannot afford to let our thoughts wander into any old section of the mind. There are thoughts that we need to nurture – about our worth, about our right to be, about the importance of keeping going, about self-forgiveness. And there are thoughts we should be ruthless in chasing out – about how some people are doing so much better than us, about how inadequate and pitiful we are, about what a disappointment we have turned out to be. The latter aren’t even ‘thoughts,’ they have no content to speak of, they cannot teach us anything new. They are really just instruments of torture and symptoms of a difficult past.
A Support Network
A decent social life isn’t, for the mentally fragile, a luxury or piece of entertainment. It is a resource to help us to stay alive. We need people to balance our minds when we are slipping. We need friends who will be soothing with our fears and not accuse us of self-indulgence or self-pity for the amount of time our illness has sequestered. It will help immensely if they have struggles of their own and if we can therefore meet as equal fellow ailing humans, as opposed to hierarchically separated doctors and patients. We’ll need ruthlessness in expunging certain other people from our diaries, people who harbour secret resentments against us, who are latently hostile to self-examination, who are scared of their own minds and project their fears onto us. A few hours with such types can throw a shadow over a whole day; their unsympathetic voices become lodged in our minds and feed our own ample stores of self-doubt. We shouldn’t hesitate to socially edit our lives in order to endure.
The impulse, when things are darkening, is to hide ourselves away and reduce communication. We are too ashamed to do anything else. We should fight the tendency and, precisely when we cannot bear to admit what we are going through, we should dare to take someone into our confidence. Silence is the primordial enemy. We have to fight a permanent feeling that we are too despicable to be looked after. We have to take a gamble on an always implausible idea: that we deserve kindness.
Love is ultimately what will get us through, not romantic love but sympathy, tolerance and patience. We’ll need to watch our tendencies to turn love down from an innate sense of unworthiness. We wouldn’t have become ill if it were entirely easy for us to accept the positive attention of others. We’ll have to thank those who are offering it and make them feel appreciated in return – and most of all, accept that our illness was from the outset rooted in a deficit of love and therefore that every encounter with the emotion will strengthen our recovery and help to keep the darkness at bay.
We would – ideally – of course prefer not to keep adding foreign chemicals to our minds. There are side effects and the eerie sense of not knowing exactly where our thoughts end and alien neurochemistry begins. But the ongoing medicines set up guardrails around the worst of our mental whirlpools. We may have to be protected on an ongoing basis from forces inside us that would prefer we didn’t exist.
A Quiet Life
We may – in our stronger moments – want to take on the world again and revive our largest ambitions. We should be careful of our motives. We don’t need to be extraordinary to deserve to be. We should see the glory and the grandeur that is present in an apparently modest destiny. We are good enough as we are. We don’t need huge sums of money or to be spoken of well by strangers. We need time to sort out of our minds and peace to stabilise our nerves. There must be free hours in which we can process our feelings, lying in bed or in the bath, soothing our frightened minds. We should take pride in our early nights and undramatic routines. These aren’t signs of passivity or tedium. What looks like a normal life on the outside is a singular achievement given what we are battling within.
There is no need for gravity. We can face down the illness by laughing heartily at its evils. We are mad and cracked – but luckily so are many others with whom we can wryly mock the absurdities of mental life. We shouldn’t, on top of everything else, accord our illness too much portentous respect.
Small and Big Wins
Many of the steps we take towards recovery could appear relatively small: a week in which we have not denigrated ourselves, a relationship in which we are allowing ourselves to to enjoy kindness, a peaceful sequence of evenings… The temptation might be to brush off these achievements a bit too lightly for our own good. Given what we may have gone through, these are milestones that deserve celebration and commemoration – so that we can notice how far we have come and gain strength from a glance back at the peaks and troughs of our mental lives.
We can think in this context of the work of the English walking artist Hamish Fulton. Fulton has spent his long career turning out large black and white photographs of places in the world where he has gone walking. Some of these walks have been epic in scale (whole weeks spent trekking across the Himalayas and the Andes), others have been more domestic (a few hours in the Welsh mountains). But Fulton always accompanies his images with solemn text, a written record of where he has been, how many miles he went and how long it took him. He arrests a moment that might ordinarily be lost and lends it weight and dignity. Through immaculate lettering and sober photography, Fulton is signalling to us how much a walk may – when fairly be viewed – be life-changing, and as worthy of commemoration as a battle or a premiership.
One could imagine performing a similar exercise of commemoration on the business of recovering from mental illness. Here too there are plenty of moments that are quietly extremely arduous and important – and that would warrant being frozen and highlighted. We could picture a vast photograph of an ordinary bath-tub to which a caption might say: ‘May 12th, evening, two hours of soaking, rethinking my relationship to what other people think.’ Or a picture of an armchair by a window: ‘September 3rd, an hour reflecting on my right to be free and content.’ A shot of an unmade bed at night might say: ‘An evening of self-forgiveness.’
We should be proud of ourselves for making it this far. It may have looked – at times – as if we never would. There might have been nights when we sincerely thought of taking our own lives. Somehow we held on, we reached out for help, we dared to tell someone else of our problems, we engaged our minds, we tried to piece together our histories and to plot a more endurable future – and we started reading about what might be up with us. We are still here, mentally ill no doubt at times, but more than ever committed to recovery, appreciative of the light, grateful for love, hungry for insight and keen to help anyone else whose plight we can recognise. We are not fully well, but we are on the mend and that, for now, is very much good enough.
Part of the reason why many of us have a tangled and unhelpful relationship to sleep can be traced back to the way we first learnt about the subject many years ago. Parents of small children tend to be very careful about bedtimes. They favour early nights, they give their babies plenty of naps throughout the day, they think a lot about black-out curtains, they are quick to diagnose many instances of bad temper as stemming from a background deficit of rest and while they may be indulgent in some areas, they are likely to be entirely implacable in any negotiation over routines: seven p.m. lights out, no ifs ands or buts.
None of this is remotely altruistic: tired small children are a nightmare to look after. Every reversal becomes a drama, every disappointment turns into a catastrophe and every excitement shifts into mania. A half-way decent adult existence is impossible alongside a tired child. Self-interest necessitates totalitarianism.
But while a draconian philosophy is useful in the early years, it can set up an awkward dynamic in an off-spring’s mind as adolescence sets in. Growing up and asserting one’s independence and individuality can then become associated with a newly defiant and cavalier approach to bedtimes. Not for a newly empowered young adult the strictures and denying rules of the past. Why bother to put the light out by ten or even midnight or one in the morning, given that one is so obviously no longer a toddler? Given that one has no more use of nappies, why would one need to worry that one was still finishing something on the computer as the first signs of dawn appeared in the eastern sky?
What is thereby missed is how much every adult shares in a young child’s sensitivity to a shortfall of sleep. Just like our younger selves, we do not have an impregnable command over a reasonable view of our own prospects or condition. There are many different ways of telling the story of our lives, ranging from an optimistic tale of progress mixed with noble defeats to a tragic narrative of thorough-going stupidity and unforgivable errors. What can determine the difference between madness and sanity may be nothing grander, but then again nothing more critical, than how long our minds have been allowed to lie on a pillow in the preceding hours.
It’s especially unfortunate that this connection is so easy to miss. No bells go off in our minds warning us that we are running low on nocturnal nectar; there are probably no parents around any more to nag us up to our rooms; plenty of well-meaning friends will invite us out for evenings that begin at nine p.m.; our screens never fail to have something new and interesting to tell us at every hour – and no stylish or authoritative figures in the public realm ever seem to urge us to turn in early or proudly show off their cautious bedtime routines. Being meticulous about sleep seems like something only a very dull and defeated person would care about.
As a result, we start to believe many dark things with doomful ease: that our relationship is over, that everyone hates us, that our lives are meaningless and that human existence is a cosmic joke ‘When we are tired, we are attacked by ideas we conquered long ago,’ knew Friedrich Nietzsche. We go mad from tiredness long before we notice the role of exhaustion in stealing our sanity.
We need to recover some of the wisdom of our early years. We may be a sizeable height, holding down an important job and capable of making impressive speeches, but where it counts in our resilience to emotional chaos, we are no more robust than a very young infant. Whenever we sense our spirits sinking and folly and anxiety pressing in on us, we should abandon all endeavours and head to the bedroom. We should be as proud of our regimented sleep patterns as we are about a neat house or a flourishing career.
Underpinning our care should be modesty. While thinking through our problems is crucial to our health, to attempt to think without enough sleep is worse than not thinking at all. The thinking we do when tired is vindictive and sloppy. It misses important details, it gives the advantage over to our enemies, it hands victory to the evangelists of sadness. It isn’t a disrespect to the power of the mind to insist that we should not attempt to fire up this machine unless and until it has been adequately restored to health – like a powerful rocket or exquisite motorboat that one wouldn’t dare to activate unless we could be sure of a clear sky or a calm sea.
Understanding our vulnerability, we should never take seriously any worry that suddenly appears extremely pressing after ten in the evening. What we panic about in the early hours should automatically be discounted. No large conversation or argument should ever be undertaken past nine o’clock.
Being careful doesn’t just apply to the night. At varied points in the day, when we are overwhelmed, we should know to stop and hoist the white flag. It may look as if we should keep trying to fight our demons. In fact, we need to elide them with a nap. We may feel guilty, but it is lazier and more irresponsible to try to keep going than it is to know the game is up for now. There is never anything shameful in admitting one can’t cope. It’s this very knowledge that guarantees us a chance to fight another round soon. Many a crisis could have been avoided by a timely siesta.
When we lie in bed, it makes sense to think of ourselves as akin to a smaller, furry mammal, a rabbit or perhaps a squirrel. We should lift our knees up very close to our chests and pull the duvet over our heads. We might soak a whole patch of the pillow with our tears. We should – metaphorically – stroke our own weary foreheads as a loving adult might once have done. Grown-up life is intolerably hard and we should be allowed to know and lament this.
We shouldn’t feel weird in our weepy squirrel position. Other people go to immense lengths to hide that they do, or would like to do, the very same sort of thing. We need to know someone extremely well – better than we know 99% of humanity – before they will let us in on the scale of their despair and anxiety and their longings for a cosy, safe nook. It looks child-like but it is in fact the essence of adulthood to recognise, and give space for, one’s regressive tendencies.
What the curled squirrel position indicates is that not all mental problems can be solved by active reasoning. Not thinking consciously should also be deemed a part of the mind’s work. Being curled up in bed allows our minds to do a different sort of thinking, the sort that can take place when we are no longer impatiently looking for results, when the usual hectoring conscious self takes a break and lets the mind do what it will for a time. It is then, paradoxically, that certain richer, more creative ideas can have the peace and freedom to coalesce – as they may do when we are out for a walk in the countryside or idling while having a drink in a cafe. Thinking isn’t what we do best when it’s all we’re meant to do.
There remain plenty of reasons to live. We simply may not be able to see them until we have allowed ourselves the privilege of a weepy nap or a long night’s sleep.
A standard strategy, when we are physically unwell, is to head to the doctor, take a pill and then expect, in a short while, to feel a lot better. This recourse is so established, so practical and generally so successful, it is only natural if we were to try to replicate it in the mental field. Here too, when we are feeling ill, we may want to visit a doctor, take a pill and wait for our symptoms to disperse.
For most of the history of humanity, there was – aside from obviously fraudulent concoctions – nothing at all one could swallow when one was mentally afflicted. The full force of one’s sickness had to run unchecked; there would be uncontained sobbing, violence and despondency. It was said that the screams of the inmates of London’s Bethlem Royal Hospital, more popularly known as Bedlam, had the power to curdle the blood of listeners a mile away. There seemed little to do with mental sufferers other than place them in cells, tie them in chains and do one’s best to forget they existed.
Then, in 1950, Paul Charpentier, a French chemist working at Laboratoires Rhône-Poulenc, succeeded in synthesising a drug called 4560RP, later renamed chlorpromazine. When rats were injected with it, placed in a crowded cage and convulsed with electric shocks, they showed none of the expected alarm and frenzy, settling instead into a serene and indifferent mood. When given to humans, the drug had a similarly calming effect: American soldiers in the Korean war were able to walk into the battlefield with a fearlessness close to apathy. In hospitals, psychotic patients who were placed on the drug became sociable, unaggressive and ready to rejoin ordinary life. The world’s first antipsychotic drug was born. It would over the coming decades be followed by dozens more seemingly miraculous medicines, all of them playing – in ways that their creators did not and still do not entirely understand – with the brain’s receptors for dopamine, the hormone held to be responsible for excessive excitement and fear. Alongside these antipsychotics, there emerged a family of antidepressants, in particular those known as SSRIs, that could increase the brain’s levels of serotonin, the neurotransmitter and hormone associated with uplift, motivation and positive moods. The drugs were baptised with names that put language to ever more daunting uses: fluoxetine, citalopram, paroxetine, escitalopram, risperidone, quetiapine, aripiprazole. Whatever the particularities of each example, modern psychiatry ended up operating with two essential instruments: pills that could calm us down (reducing terror, paranoia, mania, disinhibition, insomnia and aggression) and pills that could lift us up (alleviating despair, moroseness and loss of meaning).
Thanks to these medicines, occupancy rates of psychiatric hospitals plummeted, decreasing by an estimated 80% in developed countries between 1955 and 1990. Illnesses that had been a near-death sentence a generation before could now be managed by swallowing one or two pills a day. It looked as if our unruly minds had finally been brought under control.
But these medicines did not meet with universal approval. All of them turned out to have serious physical side effects (being intermittently responsible for dramatic weight gain, diabetes, kidney malfunction and blood clots). However, the charge against them at a psychological level was more fundamental: that they did not and could never – on the basis of their approach – get to grips with the true causes of mental illness. At best, they could control certain appalling symptoms yet they were unable to grapple with what had led to them in the first place.
To be fair to psychiatry, even if this were true, it is no mean feat to be able to offer a person even a measure of control over their mental symptoms, given the horrors these tend to entail. Those of us who have known mental illness from close up would – at the height of our suffering – generally choose to be physically tortured rather than endure yet more of the abominations our minds can inflict on us. There are varieties of mental unwellness in which we are taken over by anxiety and foreboding – and paralysed by a sense that every minute is carrying us closer to an immense and unnameable catastrophe. We can no longer eat or speak, we may just have to lie in a ball crying, scratching ourselves and waiting for the axe to fall. There are states in which we wake up every morning with a conviction that we need to take an overdose in order to put to an end to the turmoil in our minds. There can be voices inside us that do not for one moment cease telling us that we are guilty, shameful and abhorrent beings. We may live in terror that we are about lose control or might already have done so. Our imaginations can be haunted by images of stabbing a child or tearing off our own finger nails. It can feel as if there is a monster inside us urging us to do appalling deeds and filling our consciousness with lacerating persecutory thoughts. We may feel our inner coherence dissolving and giving way to a maelstrom of aggression and paranoia. We may be so mysteriously sad that no pleasantry or act of kindness can distract us and all we wish to do is stare mutely out of the window and hope to be gone soon.
With the right pills to hand however, some of these nightmares can end. We may know our anxiety is still there but we are granted some distance from it, able to stare at it as if it were an enraged tiger in a zoo on the other side of a thick pane of glass. We may not lose sight of our despair and self-loathing but we can acquire an attitude of detachment in relation to it; it doesn’t matter quite so much that we are entirely awful and should be put down. We can park the idea for a morning in order to do some work or clean the house. We can put off thoughts of suicide until tomorrow. We don’t need to have a complete reckoning with our sadistic ideas at every moment. The crushing sadness can partially lift and we might have the energy for a conversation with a friend or a walk in the park. Only someone who hadn’t endured vicious mental suffering would dare to casually dismiss such psychiatric interventions as a mere plaster over a wound.
Nevertheless, most mental illness has a psychological history – and its hold on us will for the most part only properly weaken the more episodes of this painful history we can start to feel and make sense of. Pills may be able to change the background atmosphere of our minds, but our thoughts about ourselves need to be challenged and adjusted with conscious instruments if we are to get truly well. The genuine resolution of mental disturbance lies in our ability to think – think especially of our early childhoods and the key figures and events within it.
The unfortunate paradox is that illnesses of the mind generally effect precisely the instrument that we require in order to interpret our lives. It is our conscious reason that is both sick and desperately needed to do battle with despair and fear; it is reason that we need to locate persuasive grounds to keep living. This is where pills may usefully join up with psychotherapy to deliver a coherent solution. We might say that the supreme role of pills is to hold back panic and sadness just long enough that we can start to identify why we might want to continue living; they aren’t in themselves the cure, but they are at points the essential tools that can make therapy, and through it authentic healing, possible. They promise our minds the rest and safety they require to harness their own strengths.
One of the great contributing factors to mental illness is the idea that we should at all costs and and all times be well. We suffer far more than we should because of how long it can take many of us until we allow ourselves to fall properly and usefully ill.
For many years we may be able skilfully to evade our symptoms, pulling off an an accomplished impression of what counts – in our unobservant societies – as a healthy human. We may gain all the accoutrements of so-called success – love, a career, family, prestige – without anyone bothering to note the sickness behind our eyes. We may take care to fill our days with activity so that we can be guaranteed to have no time to address any of the sores that blister inside. We can rely on the extraordinary prestige of being busy to avoid the truly hard work of doing nothing – other than sit with our minds and their complicated sorrows. When pressures build, we may develop a raft of opaque physical ailments that baffle and excite the medical profession or we can acquire a paranoid world-view that identifies all our enemies with political and economic ideologies – rather than with anything psychological closer to home.
We may be deep into mid-life before the problems finally emerge with clarity. When they do, it is liable to be extremely inconvenient to those around us. We may be unable to get out of bed; we might say the same nonsensical sentence again and again. We might be still be in our pyjamas at midday and awake and wide-eyed at 2am. We might start crying at inopportune moments or shout angrily at people who had always relied on our docility.
Kind observers will say that we have had a turn, an episode or a breakdown. More impatient ones will remark that we have gone mad. The truth is that we may be closer to sanity than we have ever been, it’s just that proper self-awareness can often force us to walk through the door of seeming lunacy. Well-handled, a breakdown may be a prelude to a breakthrough. In order to rebuild our lives on firmer foundations, we may have to reckon with much that has not been properly addressed since the start: an unresolved sense of unworthiness, a fury at a neglectful care-giver, a terror around our sexuality…
In a crisis, our chances of getting better rely to a significant extent on having the right relationship to our illness; an attitude which is relatively unfrightened by our distress, which isn’t overly in love with the idea of seeming at all times ‘normal’, which can allow us to be deranged for a while in order one day to reach a more authentic kind of sanity.
It will help us immensely in this quest if the images of mental illness we can draw on at this time do not narrowly imply that our ailment is merely a freakish and pitiable possibility, if we can appeal to images that tease out the universal and dignified themes of our state, so that we do not – on top of every thing else – have to fear and hate ourselves for being unwell. We stand to heal a great deal faster if there are fewer associations like those created by Goya (of madness as the seventh circle of hell) and more of men and women a little like you and me, sitting on the sofa, able to combine our inner wretchedness with other, more temperate and attractive qualities – so that we remain every bit human, despite our terrifying convulsions, absences of mind, catastrophic forebodings and sense of despair.
Francisco Goya, Yard With Lunatics, 1794; Sylvia Plath, at home, 1962
It would help too if the places we were encouraged to visit when we were sick could have to them an architectural merit that would further enforce an impression that illness was compatible with grace, and that by addressing our mental problems we were not at the same time cutting ourselves off from humanity but simply acceding to a higher and richer variety of it.
The best philosophical background against which to wrestle with mental unwellness would be one that conceived of the human animal as intrinsically rather than accidentally flawed, a philosophy that would resolutely reject the notion that we could ever be perfect and would instead welcome our griefs and our errors, our stumbles and our follies as no less a part of us than our triumphs and our intelligence. It is Japan’s Zen Buddhism that has historically perhaps best put forward such notions, with its bold declaration that life itself is suffering, and its veneration in the visual arts – and by extension in its psychology – of what is imperfect and un-glossy: rainy autumn evenings, sadness, moss covered roofs, stained wooden panels, tears and, most famously, misshapen and irregular pieces of pottery.
Life as fundamentally misshapen and imperfect, yet still dignified and graceful. Tea bowl, 17th century; in the collection of the Rijksmuseum, Amsterdam.
Against such a background, it becomes a great deal easier for us to accept ourselves in our unwell state. We feel less guilty that we are not at work and are not playing up to the roles demanded of us by responsible others. We can be less defensive and frightened, more inclined to seek out proper care – and more likely to recover properly in time.
With a philosophy of acceptance in mind, we can recognise that whatever the particularities of our crisis (which will naturally need to be investigated in due course), our pains fit into a broad picture of a crisis-prone human condition. No one is spared. No life can escape significant troubles. Everything is imperfect. We don’t have to know the details of someone’s life to be able to guess at the scale of the difficulties they too will have encountered. We have all been born to inadequate parents, our desires will always exceed reality, we will all make some appalling errors, we will hurt those we love and anger those with power over us, we will be anxious and confused, woeful and lost. We should accept both that we are profoundly unwell – and that our ailments are entirely normal.
Japanese philosophy has another lesson for us at this point: we will probably one day be fixed but there are likely to be substantial and ineradicable marks. And yet, these marks can be worn with pride and self-respect. According to Zen Buddhism’s tradition of kintsugi, an accidentally smashed bowl isn’t to be thrown away in embarrassment, its pieces can be carefully collected and reassembled with glue inflected with gold. The traces of repair are made obvious, celebrated and cherished, as if to suggest to us – as we bring a cup to our lips – that we do not have to give up on ourselves or be ashamed of our own brokenness.
Stoneware with clear, crackled glaze, gold lacquer repair; 17th century, Smithsonian Institution.
We can confront our illness without panic or fear, with a quiet intelligent sadness perhaps best captured by the word melancholy. If we were searching for a patron saint of such a melancholy relationship to mental difficulty, we could do worse than pick the Welsh artist Gwen John, who combined a brilliant career as a painter with moments of harrowing mental collapse – but remained all the while fundamentally on the side of life. From her self-portrait, John implies that she would understand whatever we might be going through, her eyes hint that she has been there too, that she could be our guide to the underworld of our minds – and that, however much we might hate ourselves at this moment, we deserve gentleness, patience and respect as we feel our way towards repair.
Gwen John, Self Portrait, 1902
When we are feeling well in our minds, we hardly notice that we might be harbouring in ourselves anything as formal or as dramatic-sounding as ‘reasons to live.’ We simply assume that we like life itself and that it must be natural and inevitable to do so. And yet a broad appetite for life is, on close inspection, never simply that; our apparently general buoyancy must covertly rest on a range of specific elements that, while we may not bother to itemise them, have their own and distinct identities nevertheless.
It’s only when a crisis hits and our mood starts to drop that we may for the first time start to feel, with acute sorrow, what these ‘reasons to live’ might have been all along; it’s as we lose our reasons that we understand them with uncommon clarity. We realise why we have for years bothered to rise out of bed with energy and relative good humour, put up with inconveniences, struggled to get ourselves across to others and looked forward to tomorrow – and wonder in dismay how we will from now on ever have the will and courage to continue.
Our engagement with life might have been bound up with, the enjoyment of work or of reputation, the companionship of a child or of a friend, the agility of our bodies or the creativity of our minds. Denied such advantages, we don’t merely miss out on an aspect of life, the whole of it loses its purpose. Secondary satisfactions – whether from a holiday or a book, a dinner with old acquaintances or a hobby – cannot compensate. The hedonic scaffolding of our lives disintegrates. We may not actively try to kill ourselves, but we can’t count as quite alive either. We are going through the motions; living corpses following a script drained of meaning.
When we say that someone has fallen mentally ill, what we are frequently pointing to is the loss of long-established reasons to remain alive. And so the task ahead is to make a series of interventions, as imaginative as they are kind, that could – somehow – return the unfortunate sufferer to a feeling of the value of their own survival.
This cannot, of course, ever simply be a matter of telling someone in pain what the answers are or of presenting them with a ready-made check list of options without any sincere or subtle connections with their own characters. It is at best cruel to tell an ailing person blithely to cheer up because the sun is shining and because they have enough money to feed themselves; it’s impossible to hector anyone back to health. If we are to recover a true taste for life, it can only be on the basis that others have been creative and accommodating enough to learn the particularities of our upsets and reversals and are armed with a sufficiently complicated grasp of how resistant our minds can be to the so-called obvious and convenient answers.
Awkwardly perhaps, we tend not to be able to heal on our own. In situations of true despair, our ability to think disintegrates (this is in large part what mental illness is) and so we need the minds of others to lend support to our native attempts to disentangle our confusion.
The process of dialogue, reflection and recuperation may be arduous but we can hang on to one essential and cheering thought: that no life, whatever the apparent obstacles, has to be extinguished. There are invariably ways for it to be rendered liveable again; there are always reasons to be found why a person, any person, might go on. What matters is the degree of perseverance, ingenuity and love we can bring to the task of reinvention and remodelling.
Most probably, the reasons why we might end up living will look very different after the crisis compared with what they were before. Like water that has been blocked, our ambitions and enthusiasms will need to seek alternative channels down which to flow. We might not be able to put our confidence in our old social circle or occupation, our partner or our way of thinking. We will have to create new stories about who we are and what counts. We may need to forgive ourselves for a fearsome degree of idiocy, give up on a need to feel exceptional, surrender worldly ambitions and cease once and for all to imagine that our minds could be as logical or as reliable as we had hoped. We may continue to live simply because every human deserves understanding – and because we are trying our best in the only way we know how.
If there is any advantage to going through a mental crisis of the worst kind, it is that – on the other side of it – we will have ended up choosing life rather than merely assuming it to be the unremarkable norm. We, the ones who have crawled back from the darkness, may be disadvantaged in a hundred ways, but at least we will have had to find, rather than assumed or inherited, some reasons why we are here. Every day we continue will be a day earned back from death and our satisfactions will be all the more more intense and our gratitude more profound for having been consciously arrived at.
The challenge from the present sickness can be mapped out in its essential form: one day to reach a small but robust and persuasive list of reasons to continue to be.
One of the tedious aspects of having problems with our minds is that we need to take more of an interest in how they work than untroubled people do: we have to become mind mechanics because something is hurting inside.
A particularly noxious problem that afflicts many of us is that we are almost permanently anxious, self-critical, self-hating and afflicted by a sense that we don’t deserve to exist. We are definitely not good enough. Ever.
Psychology points us to a part of the mind termed our conscience, a faculty that keeps an eye on how well we are doing in relation to duty, to the demands of the world and to the regulation of our desires and appetites. Our conscience monitors how much effort we are putting into our work, our ratio of relaxed rest to anxious labour and our degree of sensuous indulgence. It’s our conscience that tells us when we’ve probably done enough gaming, dating or eating.
However useful this function may sound, for many of us, our conscience has grown very unbalanced. Rather than occasionally gently nudging us towards virtue, it is permanently screaming, denigrating and attacking us for perceived failings: it tells us that nothing we do is ever good enough, that we have no right to take a holiday let alone an afternoon off, that we have no business relaxing or enjoying ourselves – and that the worst is coming to us because of our sinful nature. Anxiety and self-contempt are our default states.
It was Freud’s simple but brilliant insight that our conscience is formed out of the residue of the voices of our parents, in particular (usually) of our fathers. Freud called the conscience the ‘superego’, and proposed that it continues to speak within our minds as our father figures once spoke to us.
For the lucky ones among us, we had reasonable father figures and therefore our consciences are broadly benign. If we fail today, we can try again next time. If we’re unpopular, we can be valuable anyway. We deserve a rest. Sex is allowed. Treats are part of life. We can do nothing for a while. We’re OK as we are.
But for others among us, our conscience rehearses the worst lines of punitive parental archetypes. When things go wrong, we swiftly conclude that it might be better if we killed ourselves.
One of the steps we can take towards greater mental health is to realise, properly realise, that this drama is going on inside us. It sounds strange to say, given the significance, but usually, we have no clue; the self-criticism has become too familiar to be noticeable, it’s just how things are and who we are. We can’t draw a distinction between the fierce inner critic and any other part of us.
A crucial first move is therefore to learn to put some distance between ourselves and our conscience. We should see our conscience as a character. We should tell ourselves: I have a punishing inner critic and it’s very unfair to me, it’s even trying to kill me. It is speaking to me, within me, but it isn’t all I am: it’s someone I sucked in from childhood and might learn to expel from my mind in time.
We can then start to question the critic. Is it really fair to say that our lives are wholly worthless? We’ve messed up for sure, but do we really deserve no compassion and no forgiveness? Is nothing about us in any way good? Would we ever think of treating a friend (or even an enemy) the way we’re treating ourselves?
We had no choice about who we had to listen to when we were little, but we do now have agency. We can retrain our minds, by getting better spotting how they were indoctrinated in the first place. We have picked up some extremely cruel and questionable habits. No one needs to be hounded by a sense that they are excrement; this feeling has a past and it doesn’t have to be the future.
To retrain ourselves, we need other people: people who can love us and fill our minds with other kinder perspectives. We need to dare to lean on them (not an easy move for people who feel undeserving in the first place) and ask for their help in taming the nasty sound-track inside. We should stop trying to be brave about the inner attacks we host. We might explicitly say to others: ‘you are here to help me with my inner critic, and to give me new perspectives on my self-punishment and despair.’ We should at times get incensed that we have to live with such a critic, and question why our first impulse is so often to forgive the critic and the parental figure who inspired it and blame ourselves for our stupidity.
We need to feel sorry for ourselves and annoyed with those who didn’t know how to show us tenderness. Of course we occasionally need to upbraid ourselves and try harder; but the real achievement is to know how to remain gently and generously on our own side.
It’s peculiar to think that there might be a word like ‘misanthropy’ in our language: ‘a dislike of humankind.’ For a phenomenon to become a word, it needs a sufficient number of people to identify with it; it has to be an idea that we recognise in ourselves and others and then want to name and, in some cases, wear with pride.
That we have such a stark and straightforward word in so many languages suggests that, whatever our apparent allegiance to our species, it isn’t very uncommon for a human being to look at who we are collectively – what we get up to, how we behave, how our thoughts run – and in the end want to give up at the sight of our limitless violence, wickedness and folly and wish that we had never evolved, homo sapiens having ultimately proved an unending and undignified plague upon the earth whose reign should end without regret.
Misanthropy isn’t bias or prejudice or snobbery. The misanthrope isn’t singling out or prioritising any one group. They’re treating everyone equally, even themselves. They’ve just reached the unfashionable view that we are a disgrace; that we don’t deserve life. It is a supreme movement of the imagination: to be human and yet to settle on the considered judgement that humans might be a cosmic error, a moral mistake.
What thoughts underpin the misanthrope’s convictions? What is so appalling about us? A true list would be very, very long; a beginning might look like this:
– We are ineradicably violent. We keep justifying our recourse to brutality through an appeal to a higher goal (we are fighting for a little while for the sake of the motherland, for justice, for God) but so regularly and gleefully do we erupt into cruelty that something more basic seems to be at play: we are violent because we have an ingrained taste for blood, we destroy because without a chance of a rampage, we would be bored, because it’s in the end a lot of fun to fight.
– We are unavailingly vindictive. Someone does us wrong, but rather than being spurred on to a little more tolerance and humanity, our wounds charge us up to smite others back with even greater force the moment we have the chance. An eye for an eye is for weaklings; we’d rather just kill outright when it’s our turn.
– We are immeasurably self-righteous. A part of our mind is constantly spinning a story about why it’s right for us to do what we do – and erasing the slightest doubts as to actions or any possible need for self-examination or apology. It’s always the others’ fault, there’s always a reason why we don’t need to say sorry; why we are victims rather than perpetrators. Placed end to end, our moments of guilt and atonement might amount to no more than half an hour across a lifetime. We are shameless.
– We are fatefully inaccurate in who we punish. We are hurting, but the person who hurt us isn’t in the room, or we can’t get to them, so we redirect our rage onto the closest available defenceless target. We kick the dog on a grand, planetary scale.
– We do eventually learn and improve. There’s a higher chance of having good sense after some decades on the planet, but there are always newer, hungrier, more ferocious types coming on the scene, ready to refuel humanity’s reserves of vehemence and savagery. We can’t hold on to our insights; the wisdom painfully built up through wars, divorces and squabbles gets reliably erased every few years. We return back to primal rage with every generation. Our knives get sharper and our weapons keener, but moral progress eludes; the gap between our power and our acumen widens ineluctably. We’re as dumb as we ever were.
– We’re entirely uncurious as to why people we dislike made mistakes. We gain far too much pleasure from calling them evil. We adore never for a moment having to imagine that they too might simply be worried or sad or operating under compulsions they regret. We thrive on a sense of our rectitude.
– We are jealous of all the perceived advantages of others; but rather than admit to our feelings of inadequacy and impotence, we turn our sorrow into fervour. We attempt to destroy those who unwittingly humiliated us. We turn our feelings of smallness into sulfurous cruelty.
– We loathe compromise. We only want purity. We can’t accept that something might be ‘good enough’ or that that progress might come slowly. We’d rather burn the whole house down now than patiently fix a wall.
– We find gratitude intolerably boring; we’re sick of having to appreciate what we have. Grievance is so much more interesting.
– We can’t laugh because we don’t, despite everything, find ourselves ridiculous. We hire professional comedians, as though finding ourselves stupid were a possibility someone else had to explore for us.
– We’re obsessed by justice; we think so little of kindness. Justice means giving people what they are owed; kindness – a far more important quality – means giving someone something they’re not owed, but desperately need anyway. It means knowing how to be merciful.
Misanthropists love people of course – or they did once upon a time. What high hopes one has to have started with in order to end up feeling so sad at the state of our species. How much one would need to love humanity in order to conclude that we’re a cosmic error. Misanthropes aren’t mean: they’re just casting around for a few solid reasons to keep faith with the human experiment. And, for the moment at least, they’re struggling.
When we think of what it means to feel mentally well, we often picture exuberance or excitement. But what really defines our optimal moments is that they are ones in which we are able to feel stable – that is, to take things in our stride and to be neither weary nor fearful, bored nor manic. The goal of psychological life could be said to be stability.
It’s unfortunate therefore how rarely we pay close attention to our levels of stability. We seldom directly interrogate ourselves as to the steadiness of our state of mind – and so allow our moods to yoyo and veer, swinging between extremes without studying what activities, people, places and thoughts have the power to push us beyond our limits.
It is in this context that we might lean on one of the most useful and simple concepts in modern psychology, the idea of the window of tolerance. This proposes that all of us have parameters within which we can operate comfortably, with a sense of competence and security, adequacy and spiritedness. Challenges may come our way, but we can engage with them collectedly; they aren’t going to be the end of us and everything we care for. We might feel tired, but we know how to offer ourselves the rest and calm we require to recover. Something or someone is proving very frustrating, but we don’t veer into rage – animated by a terror that everything is falling apart. We can pull a wry smile and forge on. We are under pressure, but we don’t have an impression of being persecuted. There’s some gossip circulating about us, but we’ll get on top of it mentally and find strategies to cope. We’d like to have achieved more but we aren’t going to tear ourselves apart. We might be in high spirits but we don’t slip over into risky ebullience. Our moods are ebbing and flowing within a sustainable range. We are – as the psychologists would say – living safely within our window of competence.
We could picture a dial within the dashboard of our minds a little like an airplane’s altitude indicator, where our mood moves up and down between two lines indicating our safe parameters. Above the top line lies everything that feels overwhelming: this is where we slip into terror, hypervigilance, mania, guilt or shame. And below the bottom line lies everything that renders us uncomfortably numb: states of debilitating loneliness, boredom, deadness and alienation.
If we are fortunate, our moods will deflect sustainably between the two lines, sometimes coming a little close to overwhelming, sometimes near to numbness, but always remaining within a harmonious window. But for many of us, one way to conceive of our troubles is that we are continually, in one way or another, smashing through the mental window – without even necessarily being aware of the zigzagging involved. The morning might start well but by midday, something has triggered a breach and we are soon in a zone of high anxiety and self-persecution – which is then followed, a few hours later, by mute sensations of loneliness and despair. We feel tossed from one extreme to another. Life is an uncomfortable storm.
Remaining within our window of tolerance is a skill – and those of us who find it easy to be there probably learnt the art of self-regulation in childhood, by having been closely coached by a loving adult. This person (who would themselves have know how to remain within their window) will have been on hand at moments when we felt terrified and would have known how to make the world feel manageable again. We would have trusted them, and they would have helped us to deal, with incipient feelings of shame or guilt. They would have sensed when it was getting too much and we were exhausted or needed to be held calmly for a while. Likewise, they would picked up on our feelings of numbness when suppressed anger or self-hatred were blocking our ability to be authentic and purposeful.
Luckily, even if we lacked such a person, the skill can be learnt. The first step is to get a picture of the window of tolerance in our minds and to develop the habit of looking at it constantly, much as a good pilot will keep their altitude indicator always in view. We should learn to determine at all points of the day what sort of direction our mood is heading in – and when we sense that we are on a slightly overly-aggressive trajectory towards the top or bottom borders, at the earliest moment, should take light aversive action, as though we were playing a particular kind of psychological video game.
For this manoeuvre, we need to start to notice what in our way of life threatens – often insidiously – to send us out of the window of tolerance – and everything that we know can bring us back into it. Through a lot of self-observation and introspection, we might realise – for example – that spending too much time on social media, seeing a particularly competitive acquaintance, visiting a demanding family member, dating new people, attending parties, drinking, watching pornography, interacting with a certain colleague are all at risk of sending us beyond our window – and should therefore be undertaken only with the greatest care and in limited doses. At the same time, we should observe and cultivate everything with the power to bring us back into our window: long hot baths, early bedtimes, sexual moderation, reading history books, astronomy, conversations with a therapist, walks in nature, light meals, Stoic philosophy, a lot of time on our own with a diary and a trusted kind friend who knows about suffering. Remaining vigilant about our course through the window of tolerance might require us to be rather firm with ourselves and others. At points, we might need to moderate our people-pleasing impulses in the name of saving our own minds.
We might also start to tune into the windows of tolerance of those around us. We might stop trying to have certain difficult conversations with people when they are obviously far too in breach of their limits to listen to us and we might feel more compassion for people who aren’t simply ‘evil’ or ‘mad’, but are temporarily, for reasons we can guess at, operating in the far extremes of their windows. We need to keep this dial on the emotional dashboard of humanity always in our sights – and do everything we can to stay artfully within its safe parameters.
The modern world purports to respect both introverts and their opposites but in practice, the action, the rewards and the glamour are all precisely designed to synchronise with the talents and sensibilities of those in the extroverted camp. To have any chance of seeming normal or achieving success, one must pull off a range of feats to which extroverts seem inherently well suited: impress strangers, attend conferences, make speeches, outshine competitors, manage people, join in with prevailing enthusiasms, reflect public opinion, socialise, travel a lot, go out often and date widely.
It can take a very long time before we realise that – however much we might hope for this to be otherwise – this is not in fact us at all. For our part, we happen to get very worried before going to parties, we have felt close to death before giving speeches, any kind of social occasion perturbs us heavily, we’re left extremely jittery by encounters with news and social media, we start to feel sick if we haven’t had the chance to sit on our own and process our thoughts for a few hours every day, new places (especially bedrooms) worry us hugely, we’re very awkward about having to be responsible for anyone at work and we are extremely wary of jolliness or demonstrations of group fervour of any kind. We don’t actively hate hugs but our bodies do stiffen when someone rushes forward to embrace us (we may be working on this).
Conversely, we adore staying at home, we’d be quite happy spending a whole weekend (or even a few years) in our own company with some books and a laptop, we only properly like about three people in the world, we love exploring different rooms in our minds, we are reassured by friends who know how to confess their vulnerability and anxiety, we’d like never to have to go to a party again, we almost never complain that things are too quiet and we love peaceful landscapes and uneventful days. We quite like flowers too.
All of this can bring intense suspicion to bear on us in the modern world. Why are we so timid? Why can’t we sing along with everyone else? Why aren’t we coming out to celebrate? We conclude that we are weird and possibly ill long before we can accept that we may just be very different.
To be an introvert is to be constantly impacted by undercurrents and hidden electricity in situations that others will miss. What can make a party or a company meeting so exhausting for us is that we aren’t merely expressing our thoughts and chatting, we’ll wonder what everyone has made of what we’ve just said, we’ll suspect that we have failed to understand an important dynamic, we’ll be struck by a peculiar possible hostility from someone in the corner, we’ll worry that our face has stuck in an unfortunate, gormless position. We are – when called upon – canny observers of the human comedy, but minute by minute, we are also hellishly and exhaustingly self-conscious.
We are equally vulnerable to whatever we read on screen. We can’t just take in an aggressive email and move on. The viciousness exhibited online shatters our fragile confidence in humanity. We ruminate on things we have read. We long for connection but relationships are a minefield, especially at the start. What do they really think of us? Are we allowed to express desire for them? Are they disgusted by us? No wonder we prefer to stay home with a book. We want there to be less because what there is impacts us so hard. We can’t understand how anyone should be able to sleep – and we rarely do in any unbroken way.
It sounds difficult, but an introverted life can also be a very grateful and rich life. We need so much less in order to have enough. We don’t require noise and attention. We don’t care where the giant party is. We just want to potter around in our boring clothes, chat to the few people we feel comfortable with, take walks and lie in the bath a lot. There can be so much in things if we let them resonate properly. How much we’ve already seen; how many journeys we’ve already been on; how much we’ve already read; what tumults we’ve already been through. We don’t really need more. An introvert is someone prepared to properly take on board what an event or another person is – all that is daunting, powerful, resonant, beautiful or terrifying in experience. In this sense, small children are natural introverts. When a stranger comes into the room, they instinctively and wisely turn to nestle in the bosom of their caregiver; and who can blame them, given how huge this new person is and how odd they sound and how much they want to go straight into a conversation, instead of spying warily for a while, as would feel so much more natural. These children also don’t need too much stimulation from outside: playing with the lid of a cardboard box for a while is fascinating. You can have a lot of fun gazing at rain drops chasing each other down the window. You can lie on the floor in your bedroom and draw one version of a tree after another and you don’t even notice it’s already bathtime. And you get exhausted easily: an hour at a lively birthday party and it’s imperative to go straight home for a nap.
Recognising our introverted nature is not merely a piece of poetic self-knowledge. It belongs to our mental health – for failing to make the correct accommodation with our introversion is a fast route to overload and ensuing anxiety and paranoia. What we term a breakdown is often simply an introverted mind crying out for greater peace, rest, self-compassion and harmony. Experienced introverts therefore realise a need to push against the extroverted agenda. Their sanity relies on being able to cleave to the insular routines they need. We have at least got a vocabulary for explaining the structure of our personalities to others. The next step will be to learn how to honour it – and properly allow people to lead the quieter lives their temperaments crave and deserve.