Life of the mind: Acknowledging reality

October 13, 2016
Click here to read more from our November 2016 issue

My patient had a dream that turned out, she thought, to be a real memory. “I know you love dreams,” she laughed, glossy hair, shiny shoes, white teeth. I found it quite difficult not to cry as she spoke. That, I think, was her aim—project the sadness into me and then she can carry on pretending everything’s fine. This woman is beautiful, mid-twenties, successful. She delivers her material as though saying: “Pretty gripping stuff, eh? What do you make of that, oh therapist”?

“So, I was about two or three and I wanted my cereal out of this pink bowl with yellow flowers on it. I was a diva even then—always wanted that bowl. If I couldn’t have it I’d go nuts.” She mocked herself with a contemptuous tone. “Anyway, I was being such a monumental pain in the arse about it that my mum tipped the cereal and milk over my head and smashed my bowl on the floor.” She laughed now at the hilarity of this story until she noticed that I wasn’t laughing. “Oh, come on. I was being a nightmare. Actually, I told mum I’d remembered this and she said I was always pretty demanding as a child.”

I said it must have been frightening. She shrugged and shared another one of her mirthless laughs. “Well,” she said. “It’s all relative. But that was hardly the most frightening thing that happened at home.” She mentioned being repeatedly beaten in the car over her choice of music, pushed downstairs when she hadn’t tidied her room properly, being kicked on the sitting room floor and other violently abusive incidents she’d experienced as a child, but that she still considers normal or, worse, deserved.

So, here she is today, battling with depression and anxiety, sleeping very little, unable to understand the catastrophe of her relationships, so terrified of offending anyone that she goes miles out of her way to do favours for friends, acquaintances and strangers, making endless reparation for imaginary crimes with cupcakes and soup. Assuming that she has misunderstood something fundamental about the world, she is in therapy in an attempt to grasp what it is she is doing wrong—because she must be doing something wrong. After all, that’s what she’s always been told. Bad girl.

Another female patient lives thousands of miles away from friends and family, has no work, is desperately lonely and her husband is a bully. Should she, she wonders, take anti-depressants? There is something so fundamental to the background of women’s mental illness here—so often women in awful situations are pathologised or pathologise themselves and are pushed to treat their minds (“What’s wrong with you”?) instead of trying to change their lives. (See Lisa Appignanesi’s wonderful book on women and the mental health profession through history—Mad, Bad and Sad).

I quite often find myself thinking; “Well, anyone who had been through that would be disturbed. It would be amazing if you were any different.” My glamorous patient has no idea why she’s struggling when, given the grim reality of her childhood, it would be genuinely incredible if she wasn’t struggling. She is doing extremely well, considering.

Obviously, changing the current circumstances of our lives is possible (if extremely difficult) and changing the past is impossible, but there is still something important about acknowledging that so much of illness is a reaction to very real circumstance, past or present, rather than being somehow comparable to a virus picked up randomly on public transport. Therapy is often an exercise in acknowledging that the reality of life past or present is maddening.