September 2008

‘For the last week, the pain has been so bad, I have not even wanted to get dressed.    I’ve just sat in an arm chair, nursing a hot water bottle.  Eventually I could stand it no longer.  I went to see my doctor.  He said there was nothing wrong with me.  It was all in my mind.’ 


But the fact is that her mind was not where it was.  Although Susan’s pain was instigated by a catastrophic life event, her distress was all in her body.   It has left her mind months ago. 


After Geoff left home,  Susan experienced quite severe attacks of panic.  She went over the over the reasons in her mind.  Why hadn’t she seen it coming?  She knew he was friendly with Caroline, that they often stayed late to work on projects, but she never dreamt they would have an affair.  Besides, she’d always thought of Caroline as a good friend.  She constantly obsessed about what she would say to Caroline if she met her.  She wasn’t able to concentrate.  Her focus was interrupted by thoughts of Geoff .  She replayed their last meeting like a videotape in her mind.  Maybe she could have stopped him.  She shouldn’t have lost her temper.  He didn’t deserve that.  It stopped her sleeping.  She went off to sleep but woke at three o’clock consumed with thoughts and drenched in sweat. 


As the weeks turned into months and the panic and stress continued, she became ill.  She developed palpitations, felt faint, sick, had backache, pains in her shoulders, but the worst was the stomach pains that came on every time she tried to eat and soon were there all the time. 


Susan’s pain took all thought of Geoff and Caroline out of her mind.  It obsessed her, and became the focus of her anxiety.  So in a way the pain protected her from going mad from obsessing over what had happened.  It became a tangible focus of attention and a concrete means of resolution.  ‘If you have a pain, you take it to the doctor, who cures it.’ 



Susan’s trajectory from trauma to physical symptoms is not unusual.  The panics, flash backs, preoccupations and sleep disorders of Post Traumatic Stress Disorder have but a limited life span, provided people do not keep traumatising themselves by revisiting the site of the trauma.  After a few months, physical symptoms supervene, but these can become chronic, often unexplained, illnesses that last for years.  There is usually some identifiable event that precedes the onset of Chronic Fatigue Syndrome or Irritable Bowel Syndrome.  And people who have been involved in some shared trauma, like a flood, an earthquake , incarceration in a concentration camp, or extreme danger in war, tend to suffer from a disproportionate variety of unexplained symptoms many years later.  In 1976, Dr Finn Askevold published the results of a study of Norwegian merchant seamen, who had served on the convoys with the allies during World War 2.  Although they were not actively engaged in conflict, they were in constant danger of being sunk by aircraft or U boats.  Many had been rescued from ships that had been suck.  He found that thirty years later they suffered a disproportionate amount of illness: 90% suffered from extreme exhaustion, 80% were impotent, 75% experienced pains, 62% had dizziness and 50% had dyspepsia. .


But why does trauma go to the body?   Well, it’s always been there.  Stress does not only affect the mind, it affects the body as well.   The chronic stimulation of the sympathetic nervous system accelerates the heart, raises the blood pressure, tenses the back and shoulders, and wrenches the gut out of kilter, causing pain, bloating and bowel disturbance.  Physical pain has a tendency to occupy the mind.  If you have a toothache, all you can think about is the pain in your tooth. 


To use the metaphor from last weeks, blog,  Containing the emotional reactor going to sea with a tiger’,  it is like having a wounded tiger on board.  It is not thinking any more.  It is wounded and in pain.  Nothing else matters.  The pain takes over and commandeers all thought.  Whatever happened pales into insignificance.



This, however, is not some random selection of stress symptoms.  The body is governed by a mind that works in meaning and metaphor.  It selects the most appropriate area of bodily tension to represent the nature of the trauma and play out its purpose.  Decoding unexplained bodily can reveal what the illness means to the individual – the rumbling in the stomach – guilty secrets, the intolerable burden of backache,  the dreadful exhaustion of unwanted obligation,  the frustration of constipation, the distrust of food intolerance, the disempowerment of impotence.       


So the body will reveal what the trauma is like.  It acts it out, not only through symptoms of illness, but the way it holds itself,  the way it moves.  Body language is very revealing.  The postures of joy, sadness, shame and anger are instantly recognisable. The emotions are held in the body; they are located in physical attitudes.  Simulation of the posture of sadness traps somebody into that feeling.  It is impossible to feel joy.  Clumsiness reveals a mind out of control. 



There are natural experiments that help us understand how bodily symptoms can come to express unresolved torment.  Sometimes the symptoms of physical injury, childbirth, or infection fail to clear up.  They remain year in and year out, a persistent source of misery and desperation that takes over people’s lives.  For example, about 10% of people develop persistent pain and bowel upset after a bout of gastroenteritis.  Some years ago, we carried out a prospective study to investigate what factors led to symptom persistence.  Our results showed that the major factors were anxiety, depression and traumatic live events occurring at the time of the original infection.  Whatever happened became associated in the brain with the physical symptoms of gastroenteritis, which were recruited to represent what it meant.    


Neuronal connections work like paths in the forest.  Once a link is made, the traffic along it makes the path more clear and easy to follow.  Links between distress and physical symptoms seem to fit that metaphor very well.  The same route is taken time and again until something happens, life changes, whatever happened is no longer important, and then that path becomes overgrown.



But it’s not only in the brain that connections are made, it’s in the body as well.   Unexplained bodily illnesses are characterised by sensitivity, irritability and a mild inflammation.   Inflammation has been implicated in fibromyalgia, chronic fatigue syndrome, irritable bowel syndrome, the irritable bladder and many others.  Chronic stress tends to predispose to inflammation.  The sympathetic nervous system, reaching out to all parts of the body increases sensitivity and excites the immune system, while rendering it resistant to the anti-inflammatory action of the cortisol, the body’s natural steroid.  The reason that cortisol levels are often raised in depression and most unexplained illnesses is now regarded as an indication of cortisol resistance, like the high levels of insulin in type 2 diabetes. 


It would be completely compatible with what we know of the way the nervous system works to suggest that the inflammatory change may be activated only in those parts of the body that carry the memory and meaning of what has happened.



A body full of tension and pain all too readily becomes the enemy and may be attacked, by  anger, frustration, severe exercise, self harm and going to the doctor and requesting surgery to remove and offending organ or limb.  Too many surgical operations are still carried out to excise psychological wounds. 


But modern doctors are less likely to dismiss patients with, ‘it’s all in your mind’ or ‘it’s just psychosomatic’.  Most understand the essential connection between stress and illness and will often recommend counselling in addition to prescriptions that offer symptomatic relief.   Unfortunately, neither approach necessarily hits the spot.    


If  the body is expressing the tension, then it would to use the same route to relieve it.  Progressive muscular relaxation, deep breathing, yoga, meditation, Pilates, adjustments of posture through Tai Chi or Alexander technique, massage, reflexology, acupuncture or tapping on acupressure points as in ‘Emotional Freedom Technique’  all work to reduce the tension in the body.  Movement can shape body reaction.  Touch therapies can make contact with what is upsetting.  Song, drama therapy, running with others, playing games can instil a sense of companionship and belonging.   The confidence and relaxation instilled by techniques that work through the body loosen the preoccupation with the illness and will allow people to access and work through the feelings of what happened. 


Susan found talking profoundly disturbing.  Going over the circumstances of the collapse of her relationship with Geoff just traumatised her all over again. her therapist needs to be a safe presence, remain in the here and now, talk about feelings,  and employ touch, movement and posture to calm the mind and facilitate the necessary relaxation and confidence to  process what happened. 



Dance is the perfect medium to plot the trajectory of a love affair.  The choreography  expresses perfectly how erotic passion can so readily turn to aggression and finally indifference.  It demonstrates the fundamental animal nature of human intimacy.  All that is required is breathless voice-over of David Attenborough. 


In-i, currently playing at The National Theatre is a 70 minute performance spun around the theme of ‘falling in and out of love’.  It couples British-Asian dance wunderkind, Akram Khan with French actress, Juliet Binoche, star of Chocolat and The English Patient.  Starting with the pursuit by her and the seduction, it develops through simulated copulation to sleeplessness,  discordant toilet habits, disillusion, irritation, violence and abuse and finally indifference.  The dance is wonderful.  La Binoche matches Khan in a thrilling tour de force of athleticism and emotional power.  The monologues are by contrast unnecessary and embarrassing.  Khan is not an actor and it shows.  Binoche articulates the dreamy, vacant melancholy of every French love film you’ve ever seen.  Cue: David Attenborough. 


But why do so many love affairs seem to disintegrate into aggression and abuse?   



Falling in love is such a risky enterprise.  It exposes our mind, our body and our soul, which I take to be the core – the deepest, most personal meaning of our life – to invasion, exploitation and possibly damage by a stranger.  The possibility of hurt is enormous. 


What is still quaintly called ‘courtship’ breaks down psychological inhibitions though increasing bodily contact – from to holding hands, the first kiss, a fondling, intimate touching, stroking, rubbing, simulated sex and finally full intercourse.  On Monday I touched her on the ankle.  On Tuesday I touched her on the knee.  On Wednesday success, I lifted up her dress ……….   And all the time, the gentle talk, the reassurances, the promises, the staring into each others eyes, soft strokes and caresses, cuddles and kisses unzip our suspicion, unhook caution and arouse the desirous, not to say lustful and so needy animal that slumbers deep within all of us. 


Deep down, we all suffer from loneliness.  We start off connected to another being, but from then on, life is a sequence of ever more profound separations until the final reconciliation with the self.  Don’t we all, at the most profound level of our soul, want, for an all-too-brief, though everlasting moment to reconnect with that special person who we can trust with our life and will always be there for us.  This is such powerful stuff, so powerful that we would risk everything for it – and many do..   


And so dangerous.  When desire is aroused, it doesn’t think of consequences.  It doesn’t think.  When all critical faculties are unbuttoned and minds and bodies are laid wide open to  suggestion, we are all so vulnerable to exploitation, deception and betrayal, not to mention  injury, unwanted pregnancies and serious disease.  Isn’t it so ironic that our most serious diseases; AIDs, syphilis and cervical cancer are associated with unguarded and often promiscuous sexuality? 


How do you know whether he or she is sincere, genuine?  Do they mean what they say.  But once desire is aroused, it doesn’t care any more.  Suspicion is suspended.  Drunk on alcohol and lust,  goaded on by the mores of a narcissistic, pleasure seeking  society,  encouraged to join in the fun by friends, risky sex is not so much about love but about thrill, mutual exploitation, power and control.       


That’s ok, you might think, as long as both partners understand and buy into the game, but by sabotaging our natural defences, physical intimacy encourages an  emotional dependence.  People all too often get hurt.  There are sharks out there.  Philanderers and seductresses just love playing with fire.  They are drawn to it, hooked on it, but they are so dangerous.  With surgical precision, they open up the brains of their victims, releasing emotional reactions that could result in catastrophe.       



In yesterday’s post, ‘Containing the emotional reactor; going to sea with a tiger’,  I described how the emotional brain has two major components;  an emotional reactor (the amygdala and cingulate gyrus), lurking deep down in the part of the brain we share with other animals and the civilising emotional regulator (the dorsolateral orbitofrontal cortex) that has taken up residence in mezzazine of the skull, just behind the forehead and above the eyes, and keeps the reactor in check.  When the emotional regulators are taken out of the circuit and two emotional reactors are opened up by love making, then sparks can fly – one way or another.  It can be so romantic, so powerfully bonding, but it can also be terribly dangerous.  It’s like having two impassioned gorillas in a cage together; if they don’t make it, they will probably end up killing each other.  


People are at their most vulnerable when they are in love and especially if they have just made love.  They have let down their defences.  Deception or betrayal, the rejection by the person they trusted most in all the world, can then feel like a desecration of the soul.  They have been invaded, exploited, their life plundered of hopes, dreams, all the meaning they had invested in the relationship.  No wonder the person they loved to distraction suddenly becomes the one they hate to destruction.  They cannot cope with the sudden switch of emotion.  It’s a no-brainer!  The emotional reactor was already disconnected from any kind of regulation and has now gone critical.  It is out of control and will blow. Nothing can contain it.  Their only recourse is to protect themselves by attacking the person who has damaged them so much.  The capacity for serious injury or even murder is very great.  Police forces throughout the UK take domestic violence very seriously. 


In the kingdom of the animals, sex and violence frequently co-exist.  The mating rituals of many birds proceed through elaborately choreographed stages of aggression before the hurried fluttering anticlimax of cloacal apposition.  Cats are equipped with a barb on their penis that injures the female on withdrawal triggering ovulation and an abrupt burst of aggression, visually impaired bed bugs have penises sharpened to daggers, which they plunge into the abdominal cavities of their partners during passion.  Sado-masochism is a feature of human sexuality that is shared with the animals.  And when our thinking brain is disconnected we react like animals.  Domestic violence frequently takes place in the bedroom.      


True love never runs smoothly and untrue love never. That’s why extramarital affairs can be so distressing and damaging.  Courtship in human beings as in animals proceeds in a hesitant, two-steps-forward-one-or-two-steps-back manner.   Sometimes couples find it so difficult to trust each other than their relationship becomes less about love and more of a struggle for power and dominance.  Cycles of gratification and deprivation can then so easily lead to a kind of addiction as participants crave the fix that will alleviate their anxiety and restore calm. And if the addiction is not gratified, it is but a short step to abuse and violence.  


So safe sex doesn’t just mean wearing a condom.  There’s much more to it.  Safe sex  means doing it with a partner that you have known for some time and come to trust.  Anonymous sex, one night stands, sex disinhibited by drugs and alcohol is so risky.  The brain has gone.  There are no brakes.  Passion rules.  The participants don’t care; they just want thrills.  Safe sex means that if you are already angry or if you don’t really care for the other person, don’t even think of fucking.  With the regulator swamped or disconnected, the physicality could so easily turn to violence with the propensity for injury and serious emotional trauma.  People can be raped, injured and even killed.  It happens.  Just this week, the papers have been  carrying reports of the trial in Milan of three young people accused of murdering British student, Meredith Kercher during a drug-fuelled night of violence and debauchery.


I don’t know the figures or even whether they exist, but my experience with clients suggests to me that damaging and unhappy love affairs are more likely to result in post traumatic stress disorder (PTSD) than any other cause.  Rejection, abuse, violence, betrayal and deception to somebody who is rendered defenceless and exposed through sex is like murder of the soul.  Falling in love, investing all the meaning of your life in a person, who then attacks and betrays you, can literally blow your mind.     


Just look at the symptoms of people who fall ill because of love.  They are described endlessly is poems, literature, tragic opera.  They are listed in every love song that has ever been written.  ‘I can’t get you out of my mind’  is the refrain that Kylie Minogue sings over and over again – an modern ‘anthem for doomed youth’.  She has intrusive thoughts, flash backs, sleeplessness, anxiety, preoccupation, obsession – the lot – all features of  PTSD.   She needs help.  It has taken over her life. She can’t let go. She won’t let go.  She doesn’t want to forget.  The difficulty is that obsession seeks to justify, to explain, to forgive – anything just to keep the meaning alive, anything so she doesn’t have to face the awful loneliness of mortality again.  So she keeps singing about it.    



Lets’s face it.  Dancing is so much safer! 







In Jan Martel’s wonderful prize winning novel, The Life of Pi, Pi Patel, the eponymous hero, is shipwrecked in the Pacific and shares a lifeboat for 123 days with a fully grown adult Bengal tiger.  At first he is terrified and spends his time on a raft connected by long rope to the lifeboat, then as weeks go by he decides to train the tiger by a combination of punishment  and reward.  If the tiger transgresses into his territory, Pi blows his whistle loudly and rocks the boat to make the animal sick.  But he also keeps his charge well supplied with meat and fresh water.  Eventually he establishes dominance over the dangerous beast and can regulate its fear and aggression at will, but at the end of their journey the tiger just disappears into the Mexican jungle with never a backward glance.  It is a wild animal.


Martel gives such a wonderful practical description of how Pi and Richard Parker, for that was what the Tiger was called, managed to survive in a lifeboat on the Pacific Ocean for so long, that you could almost forget that it wasn’t true.  The book is an allegory, but for what? 


As I read it, it made me think of the relationship between the major components of the emotional brain; the primitive emotional reactor (amygdala and cingulate gyrus) – the  wild animal housed in the base of the skull and the emotional regulator or trainer (dorsolateral orbitofrontal cortex), situated in the mezzazine of the skull behind the forehead and above the eyes.  The amygdale reacts to threat or stress by generating fear or anger.  The orbitofrontal cortex puts this reaction into context with reference to its extensive database of previous emotional situations and selects the most appropriate and creative response to resolve it.   


When we are born, the regulator doesn’t exist.  The circuit board is there but it’s not wired up.  The emotional regulator develops out of experience and continues to rewire itself throughout life. 


Infants are like baby tigers, just a mass of very primitive reactions, hunger, discomfort, fear, anger.  Their response to all of these situations or events is to emit a penetrating alarm signal, which summons the parents to sort out the problem.  But with appropriate training using a combination of reward (smiles, enthusiasm) and prohibition (No!), the emotional circuitry of the orbito-frontal cortex becomes organised so that it is able to anticipate what might happen and keep the tiger in his lair beneath the tarpaulin.   


But sometimes this training is imperfect – unbalanced.  If in the infant isn’t checked sufficiently and boundaries set, the orbitofrontal cortex is not sufficiently programmed to keep the reactor in check.  This can result in behaviour that is risky, impulsive,  thrill seeking, aggressive and doesn’t quite appreciate the consequences.  For an appropriate description of this see my blog on Captain Kirk flies too close to the sun (August 2nd) or  How do you solve a problem like Amy (August 1st).   But if on the other hand, there is too much restriction, this results in fear, repression and inhibition and a very restricted life.  See Narrative Therapy; changing life scripts (September 21st).             


But if this emotional collaboration is programmed well enough, if experience during childhood has provided sufficient containment plus the essential opportunity to explore and experiment for oneself, it will tame the animal within us.  It will equip us  to live productively and peacefully within society without over-reacting and causing damage.  But good-enough programming does not mean that we should all float around in hazy pink emotional cloud of peace and contentment, like the flower-power hippies of my not-so-misspent youth.  That would be so irritating!  No, there will be flash points. We are fundamentally animals.  There will be stimuli that cause the reactor to boil over, but engagement of the regulator will put things into context, consider the consequences, limit the reaction and channel the energy to creative resolution and activity. 


But if something happens that makes the tiger within us feel it is in mortal danger, then it can throw off the leash, disconnect from the regulator and will not re-engage until all the anger is spent and it feels safe again. There is no point in trying to reason with somebody who has lost it.  They can’t reason.  The rational part of their brain is off-line.  They are like children.  Not for nothing do we sometimes accuse people of behaving childishly.  They are.  All we can do is treat them as if they were a child;  hold them, sooth them, rock and stroke them until the terror has passed.  Can you imagine the umpire coming down off his chair and hugging McEnroe.  But that’s what he needed, because he was a toddler and ‘could not be serious’.     


Fear and anger are the same emotional response system.  People lose it when they feel terrified, out of control.  Alcohol increases the possibility of losing it, because it releases the reactor from inhibition.  Sleep deprivation,  an overwhelming sequence or combination of stressors, and inadequate containment during infancy, can also make this much more likely because these all sensitise the reactor, twisting the tail of the tiger in our lifeboat.  It is also much easier to lose it if your adversary is a stranger, such as a line court judge, or during road rage, battles between rival football fans or military conflict.  It is tempting to assume that the only way men could engage in hand to hand conflict, was by working themselves up into such a pitch of terror that it completely disconnected their thinking brain.  If they stopped to think, they would be dead.    .         


If, however, what happens is so outside one’s experience, so threatening to ones’ sense of reality, then the orbitofrontal cortex does not have the resources to put it into any kind of context.  In situations of severe trauma, such as rape, physical or sexual abuse, killing another person, an accident that threatens life, kidnapping, torture, being awake but paralysed during an operation, the unprocessed memory continues to excite the reactor as if it was still happening.  This induces such a prolonged and extreme state of emotional arousal, causing extreme irritability, panic, hypervigilance, sleeplessness, obsessive thoughts and flash backs.  These are the symptoms of Post Traumatic Stress Disorder (PTSD).  The tiger is on the rampage and the trainer is powerless to stop him.  


A wounded tiger is so dangerous.  It’s animal brain sees everything as a serious threat to its life and it overreacts.  Talking does not help.  You cannot reason with a wild animal. All you can do is to remove it to a safe place, allow it peace to rest and provide water and nourishment.  And with the tiger in your brain, you must first calm it down by being in a safe place with somebody you trust, by hugging, rocking, singing, holding, eye movement desensitisation, meditation or tranquillisers such as propranolol.   Only when calm is achieved, can you attempt to bring the regulator on line by focussing on how you are feeling now and what you can do to relieve tension.  Simply tapping on acupressure points (EFT) can be remarkably effective.  Music, writing down what happened, talking to somebody warm and soothing, whom you trust, while maintaining a state of relaxation, can all help to process what happened and let the tension go and with it the memory of what happened.   


Pi survived so long with Richard Parker because he was able to form a trusting bond with him. You have to learn to love your tiger especially when it threatens to misbehave.   

Rachel is 41 and has never really let herself enjoy life.  She is a risk taker, who can’t take the risk, a pleasure seeker, for whom pleasure feels very insecure – something is bound to go wrong.  She feels deeply but can never show her feelings.  She needs intimacy, but cannot let anybody close to her.  So her existence is orchestrated in a minor key.  She took a job that was dull and safe rather then challenging and interesting.  She was too scared to marry the man she fell in love with.  She never felt able to take on the responsibility of children.  Life has been a sequence of missed opportunities. She is a creative poet, but rarely reads her work in public and has never submitted it for publication.  She cannot let herself be free to express herself.  On the few occasions she has tried, a voice in her mind, perhaps an echo of her critical mother, would sneer, ‘Just who do you think you are?’  She constantly monitors her behaviour, censors every impulse. So she has never developed confidence is herself and she cannot trust people. Ever fearful of implied criticism, she feels worthless.    


So Rachel spends most of her time alone, preoccupied with her ailments.  She suspects she has a terminal illness that nobody can diagnose. She has.  It’s called melancholy.  She has starved herself of life and like Eeyore, the doleful donkey in Winnie the Pooh, has become a caricature of her own misery. 


So many of my patients come to see me because they are unhappy.  Why else would anybody wish to see a therapist?  They want to talk about it and some may want to feel better so much that they are willing to risk the change.      


Depression, which is the commonest illness in the western world is not just a disease of the mind or the brain, it is a depletion of the spirit – the meaning and purpose of life, an erosion of hope.  For the majority of depressed people, the changes in mood and brain chemistry occur as a result of what has happened to them.  It is crucial, therefore, to look for the causes of depression in a person’s individual narrative; their life script.     


Why do they tend to take the blame for everything?   Why are they so shy and scared of other people?  What has happened to make them feel so ashamed of themselves?  Why do they constantly compare themselves to others and feel inadequate?  Why do they always feel in the way?   Is it related to the way they were treated as a child or has something happened to shatter their confidence later in life?  Is their behaviour still relevant now?  


We are social animals.  We all need to feel we belong – to feel comfortable with ourselves in the company of others.  If we are feeling ashamed, guilty, insecure or inadequate,  it can affect the way others treat us and unerringly bring about what we are most frightened of, inviting a spiral of inadequacy, rejection and depression.  So fear of abandonment and isolation can cause us to behave in a needy way, causing others to feel obligated.  If we are so obsessed with our own inadequacies, then people perceive us as a burden.  If we can’t trust others and are closed and secretive, they will not trust us.  If we feel in the way and are constantly making excuses for ourselves, then we put demands on others to rescue us.  If we are too aware of the unfairness in life, then our grievances will irritate others.  If we become too assertive of our own rights, then others will feel ignored and rejected.  If we are so preoccupied with our own misery,  we will take others’ behaviour personally. If we are always questioning another’s love for us, they will begin to question it too.  If we envy another’s success,  then they may feel they have to demean themselves to be in our company.  To cure our depression, we need to escape from our own morbid  obsession with ourselves.  We need to change the script.   


Traditional healers, such as the Sangoma in South Africa are story tellers.  They heal by enacting a new script, a script for change.  Stories carry meaning.  They can make people feel better.  If something they feel guilty or ashamed of can be explained in ways they can understand,  then they can forgive and forget and move on with resolve not to make the same mistakes again.   Psychotherapists also need to be interpreters and tellers of stories.  They need to understand the meaning behind the depression and  help their clients change it.  In order to do that, they must conduct sufficient analysis for their client to appreciate fully the narrative that they illness is expressing.  Then the two of them need to edit the script in a way that makes sense and offers a credible route for healing to take place.


Change occurs slowly and starts with a change in attitude; a redrafting of the life script.  As well as providing an acceptable understanding for perceived misdemeanours,  the altered life script might include emphasising areas of life where people have a role, a purpose,  where they can rediscover a sense of value.  It might suggest enterprises that can inspire, ways of being creative, opportunities to become more interested in others while not minding too much how they are perceived.  In these ways and many others people can stop the morbid self destruction and dare to embrace life.  This is not a catch all formula for change.  The script has to be authentic, to relate to their own history, but presented in a  more hopeful manner that draws strength from their experience and brings out the best of their personal resources of family, work and interests.


Rachel has starved herself of life, because she has feared her mother’s critical envy.  But her mother died some years ago.  In reality, there is nothing to fear except the fear that is in her head.  She now has an opportunity to change the story.      

As the heavy chords build in tragic volume, the curtains part, revealing a vast landscape of empty fields lit by a lowering sun.  A row of broken fence posts, like derelict pilings on a beach, occupy the middle distance.  A man, about 40, bare-headed and wearing the open neck shirt, tattered waistcoat and baggy sand-coloured trousers of an intellectual farmer – an incomer – stares out, his face half lit by the sun.   He picks up some chaff,  and in a gesture of despair tosses it away.   He pulls a book from his pocket, sits on a stump and reads.  The music dies away.  A bird sings. 


Another person enters.  A stocky, bald headed man, dressed in a tweed hunting suit.    He cradles a shot gun in the crook of his right arm, a game bag hangs from his shoulder.  He tiptoes up to his unsuspecting partner,  a mischievous smile spreading across his rubicund face, and discharges his weapon.     


The problem is that people can’t leave Ivanov alone.  Borkin, his partner, saddled to a man who has lost motivation, tries to shock him into action, enthuse him with his ideas.  The doctor, another idealist, wants to find the better man inside.  His old friend Lebedev, offers him money.  Anna, his wife, and Sasha, his friends daughter, want to rescue him with their love.  But trying to rescue Ivanov from his disillusion is like trying to feed an anorectic, or offer a hotel room to an artist in a garret.  The more people try to help, the more miserable he becomes.  Their well meaning kindness depletes him of any residual autonomy and meaning.  Ivanov is the only person who can save himself. 


Ivanov was Anton Chekhov’s first major play.  It was written in 1887, when he was just 27, and training to be a doctor.  He was never happy with it and revised it at least once.  The production at the Royal Court has been revised yet again, this time by Tom Stoppard. 


It is a play about disillusion and despair.  Nikolei Ivanov is not just in debt, he has not just fallen out of love, he has lost the meaning and the purpose in his life.  He is in despair.  He was once such an idealist.  He went to the university. He had progressive ideas.  He was going to revolutionise farming, reorganise the ancient feudal system of labour, change things.  And now, after 10 years later, and in his early forties, he has been defeated.  But the land was relentless, hard, unforgiving.  Its vastness, its sheer inertia, drained his spirit.  The crops failed again, he got into debt. He became too tired to try any more.  He lost hope.  Kenneth Branagh plays Ivanov with consummate insight.  He brings us right up to the crumbling edge of despair without sliding off  into melodrama. 


Falling in love with Anna might have rescued Nikolei from his creeping disillusion.  Anna believed in him.  Infected with his enthusiasm,  she left her culture, lost connection with her parents to marry Ivanov and join him in his vision.  She continued to believe in him when he was losing belief in himself,  but lacking the diversion of new life that children might have brought, she has become an effete, fragile shadow of herself, slowly dying of tuberculosis.  Ivanov has also become sick;   sick of farming, sick of Anna, sick of himself.  Bored by his work, accused by his wife’s illness and needing to escape the oppression of his home, he spends his evenings at his friend’s house, drinking, playing cards and flirting, but it is like an addiction – the more he does it, the more he despises himself.   


Ivanov is a study in destructive narcissism. He wallows in self pity.  He has lost the grandiose meanings in his life and he has nothing left.  So like an unhappy child, he mopes around infecting everybody with his misery.  But he is an attractive man – people are drawn to him.  Sasha, young and romantic, needing to escape the stifling confines of an unhappy provincial home, plans to save Ivanov from himself.  She explains how some women find meaning in life by saving an unhappy man in the futile expectation they will gain their love and gratitude.  But is Sasha too much like Ivanov – a partner in depression.  Does she also find some perverse meaning in misery?   


Ivanov does not need rescue; he needs to be helped to discover his own salvation.  His friends’ well meaning interventions merely trap him in the web of his own self disgust and the more he wriggles the more he is entrapped.  The end is inevitable.  It was clear by the interval that this play would not end well.  It doesn’t, Anna dies, Ivanov agrees to marry Sasha but on the day of the wedding, trapped on all sides, he shoots himself. 


I wonder what provoked Anton Chekhov to write such a dark play about disillusion.  Was he also becoming ground down with the overwhelming sickness and misery he witnessed everyday as a doctor in provincial Russia.  Did he disocover in writing short stories and plays, a creative escape from his own boredom?  Disillusion is layered heavily in this production.  Although it centres around Ivanov’s predicament,  other characters add resonance.  Lebedev has sold his soul by marrying a rich woman, he doesn’t love.  The old Count refuses the temptation to do the same by trading his title for cash.  The young doctor is furious with Ivanov for destroying his faith in human nature.  Borkin is perhaps the only character who refuses to let go of his grand ideas,  but he cuts a rather ludicrous figure in Stoppard’s translation.      


If we accept that men tend more to inhabit a world of ideas and ambition,  Ivanov’s might be seen as a masculine route to disillusion and misery.  Relationships are more important to women and therefore their disillusion is more likely to be with people rather than ideas.  Anna went into decline when she no longer believed in the love of her husband, whereas Sasha’s albeit unrequited love for Ivanov was sufficient motivation for personal development. 


Although Ivanov is a period drama set in the dying years of the Tsarist Russia, its message is perhaps more relevant to our current age.   Depression, the commonest illness in western countries, is not so much a disease of the brain of even a specific mental disorder, it is a depletion of meaning or purpose, a weariness of life.  Our narcissistic culture encourages enormous expectations, but unless one can find the self belief to realise the opportunities, the sense of failure can be quite devastating.  The person sitting behind me commented loudly that all Ivanov needed was a good dose of prozac.  I doubt that would have done the trick. 


Ivanov is playing at the newly refurbished Wyndham’s Theatre until November.  Go and see it. 



I’d read the reviews. Francis Bacon, they proclaimed, the most important British artist of the 20th century.  Surely not!  The distorted faces, the slabs of human meat, the shameful crouching nudes are there to shock, not to illuminate or educate, certainly not to inspire.  So I anticipated the seventy canvases displayed at the Tate Britain with some degree of trepidation.  Would I think that Francis Bacon is a great artist?  Would he shed light on human experience? 


To my surprise, the answer to both of these questions was yes. There is no make believe with Francis Bacon.  He strips away the protective façade of pretence and exposes the basic raw meat of life – the loneliness and the terror, the shame and guilt, the absolute futility of it all. 


His images haunt in a way that few artists manage.  Even Edvard Munch seems tame beside Bacon.  The pope, in his cape, terrified by the loneliness of his eminence, screams silently in his transparent box,  the horror of crucifixion is portrayed in flesh flayed to the bone, the suggestion of violence in his sinister crouching nudes both thrills and shocks,  his lover, Peter Dyer, dies, bent double on a toilet, vomiting into the sink,  and Bacon exits to his own death, a strange fluid deformed creature  oozing through the door into the black void.  


Bacon strips life down to the meat and the bone and leaves us to cope with the horror of it.  This is literally ‘a side of Bacon’  He has created an art form out of his own terror and self loathing.  He is said to have experienced deep feelings of guilt over his masochistic homosexuality.  Equally at home with the aristocracy and the criminal gay fraternity, he once described his life as lived between the gutter and the Ritz.    His lovers were taken from the sweepings of the London social floor.  In them he found the belief that coloured his art – that life was indeed as brutal as it seemed but that brutality had a beauty all of its own – the beauty of a wound.    


Bacon’s art emanates from a deeply traumatic childhood.  He was born in Dublin of English parents, who came to hate each other.  His violent father, an officer in the colonial service who became a trainer of race horses, used to get the grooms to beat young Francis. Bacon used his art to make sense of his trauma.   If he could  express it in a concrete form, then he could perhaps gain mastery over it – and by so doing, distance himself from it, leaving his comfortable art-going public to experience the terror and desolation instead.  Bacon literally rubs our noses in it.  ‘Champagne for my real friends; real pain for my sham friends,’ he once wrote. 


Bacon was fortunate.  He found his creative expression.  He transformed the guilt and shame of his sordid life style into a kind of fame.  If it were not for this outlet, his disgust would have surely overwhelmed him in a self-annihilating chaos of drugs, alcohol, debauchery and depression.   


Bacon is a great because he, like no other artist, had the sheer guts to expose what it is to be human.  We all cover this up with layer upon layer of meaning,  but this is just a delusion.  Strip it away and underneath it is just, meat, terror and total isolation. ‘Birth, and copulation and death’, wrote T.S. Eliot (Sweeney Agonistes, p 131). ‘That’s all the facts, when you come to brass tacks.’

She’s sexy, she’s sassy, she’s funny, she’s tough and she’s totally committed;  Sarah Palin is one hell of a woman.  I’ve just watched the whole of her speech on You Tube and I think I’m in love with her.  What an inspiring performance!  It had the rhetoric of a preacher, the timing of an actor.  Her joke about hockey moms being like pit bulls with lipstick may not be the most amusing,  but the delivery was perfect.  And she was so brave!  She stood up on an empty stage in front of millions of people; poised, eloquent and totally confident.    


Her speech was so well crafted.  First she made a direct appeal to the emotions by introducing her family.  Her smiling husband, Todd, is a fisherman and champion snowmobiler,  ’We met in high school and he’s still my guy, after 20 years.’  They have five children; Track, her eldest, a soldier about to be sent to Iraq,  Bristol, 5 months pregnant and due to get married to her body friend,  Willow, Piper and little Trig, who has Down’s Syndrome.  Then she talked about her career as Mayor of Wasilla and then Governor of Alaska.  She described how she cut the expenses of the governor’s office, the Lear jet, the chef, the chauffeur, and diverted the money to the people.  She told how she broke up the oil company’s monopoly’s, stopped congress spending money on a bridge to nowhere,  ‘Thanks but no thanks!’,  and encouraged more drilling for oil on Alaska’s north slope. 


She compared her ‘lack of experience’ with Obama’s,  ‘Well, I guess you could say I too am a kind of community organiser, but at least I have responsibilities.’  The point went home.  She continued to portray the democrat candidate as an appeaser, a negotiator, more interested in his own self image than the American people.  ‘He’s drafted two books of memoirs but not a single piece of legislation.’ 


I couldn’t have believed could have upstaged Obama after his performance last week, but she did it – ‘even without the Styrofoam Greek pillars.’  The message hit home;  Barack Obama is more aware of his place in history than leading the American people. 


‘The world is a threatening place right now,’ she went on.  ‘Russia has invaded Georgia, Al-Qaeda are planning more attacks on America.  What America needs is a leader.  And there’s only one man who has the experience, the courage and the determination.’   She delivered a powerful, resounding endorsement of Senator John S. McCain, describing his heroism as a prisoner of war in Hanoi, and his determination to be a maverick in the senate, fighting for what he believed was best for America.  But when McCain appeared at the end of her speech, he looked a bit like Mr Magoo, ‘Duh, was that about me?’


Nevertheless, Sarah Palin may have won him the election, but let’s make no bones about it, if she has, it will be Sarah Palin who is running the country.  McCain is 72 and well, he looks and moves, he thinks and speaks like grandpa!  He has had heart trouble.  Even if he survives for a second term, will he be physically and mentally able to lead the country?  He is already no match for Obama in a televised debate, but Palin is.  Palin has the balls and the energy to make a very effective President.    


But I am worried about this gun-toting, tough-talking small-town housewife turned Governor of Alaska.   She appears to see threat everywhere.  Maybe being sandwiched between Canada and Russia gives her that perspective, but is America really on a war footing?  Dick Cheney is currently on a tour of the independent states bordering Russia.  He has been trying to persuade Georgia to join NATO.  America has agreed with Poland to install a missile defence system on their territory.  The language between America and Russia is becoming ever more bellicose.  Vladimir Putin has interpreted America’s provocative actions as a politically motivated manoeuvre to favour the republican candidate.  I must say that seems an entirely reasonable assumption.  And haven’t the Americans forgotten that it was Georgia who first invaded South Ossetia? 


Palin criticises Obama for wanting to talk to Russia, to understand Al-Qaeda, to negotiate with Iran.  ‘There is one word that the democrat candidate never mentions except when he talking about his own election and that word is victory!’   Obama comes across a shrewd, but tough negotiator.  Palin just seems dangerous. Which of the two would make the world a safer place? 


No, Mrs Palin, this is not the time for tough action.  America is not at war, and to behave like the bully in the playground and threaten to beat everybody up can only foment resentment and onflict.  The world is nervous.  We need a steady had on the tiller.    Europeans look to America to use their power and influence to create a stable collaboration with Russia, China and the Gulf States that will encourage a focus on the major global issues that affect us all, like climate change, recession and terrorism.  Obama is our man.  His ability to weigh up complicated situations and his multiracial credentials make him the perfect choice – not some gun(g)-ho hockey mom from red-neck Alaska .    


Let’s not forget,  Iraq was an enormous error.  Saddam was undoubtedly a tyrant, but perhaps Iraq got the leader it deserved and should have been allowed to sort their own problems out.   My deep concern is that part of America, the small town, rural,  I’ll-not-let–go-of–my–gun-until–you- prise-my-cold-dead–fingers-from-the-trigger part,  might just get the leader they deserve. And heaven help the rest of us.     


Mrs Palin, you are a beautiful, inspiring woman, you gave everyone there in Minnesota a wonderful night, but I fear your need to be adored makes you provocative and so-o-o-o dangerous!  

It had reached that stage of the evening when the food and wine had done their work and the guests felt relaxed enough to share confidences.  Harold MacMillan turned to  Madame De Gaulle, who was seated to his left and said. ‘Madame, you and M’sier le president have lived such an interesting life, is there anything else you could possibly wish for.  Madame thought for a moment, seemed to find what she was searching for and replied, ‘A penis’.  Macmillan coughed, harrumphed, searched his memory for something Sigmund Freud might have written,  ‘Yes, yes, hrrrmmph ….’  But before he could embarrass himself any further, the President leant across and said, ‘What madame means is ‘appiness’.  


But what is happiness?  What do we know about it?  it seems that as soon as we try to define it, to pin it down, it escapes in paradox.         


Happiness is a state of mind – a feeling of peace, contentment, freedom, but it is also a trait, a state of being that is informed by what has happened in the past. 


Happiness is a social construct – a feeling of connection, a sense of belonging, being valued for ourselves?  But happiness is also about the capacity to be alone, the confidence that if things go wrong, we can manage.  


Happiness is having the confidence to take risks, to try things out, having the freedom to play, to be creative, to laugh and enjoy ourselves.  But it is also a capacity to tolerate reflection, quiet introspection, to feel a sense of peace and  hope.    


Oh, to hell with it all.  Happiness is feeling good about ourselves and that, of course, has many facets.  


So how can we feel good about ourselves?  The nearest I can get to it is to quote the concept first coined by the paediatrician and psychoanalyst, Donald Winnicott, ‘The capacity to be alone in the company of others.’ This implies the self confidence to express ourselves, to be accepted for who we are and to exist contentedly with our family, friends, colleagues and the wider social network.  We need to feel happy in our own skin before we can find long lasting happiness with others. 


So happiness depends on how others treat us and on whether we can feel accepted for who we are.  It is a social construct.  Even the tyrant can feel happiness when he is supported and adored by others, though his is a fragile contentment that does not allow him to relax his defences for too long.  And anybody can feel deeply unhappy if he is ostracised, even wrongfully, for some perceived misdemeanour. We are social animals.  Without the companionship and support of others we become apathetic and ill.  


But happiness is more than how we are treated in the here and now, it is a more enduring quality, an attitude to life.  I know it is fashionable to regard everything as inherited,  but I can’t believe that applies to happiness. Neither do I think it is some God-given quality.  The 80-year-old comedian,  Ken Dodd calls happiness, ‘the greatest gift that I possess’, but he isn’t a person I would immediately regard as contented.  If a capacity for happiness is bestowed on us by anybody, it is our parents.   


A safe and loving environment that encourages children to be curious and explore but prohibits behaviour that may cause us or others harm sets them up for contentment.   If our parents are too strict, their children grow up feeling they are in some way bad and that may compromise their confidence for the rest of their lives.  On the other hand, spoiling a child by parenting that is too liberal or too conditional may lead to an over-weaning confidence, which is out of kilter with the rest of the world.  Such children soon learn that the world does not always react as their parents did. Honesty may be regarded as naivety, hard work is too often taken for granted, being pretty or  cute may encourage envy or exploitation.  Unless modified by life experience, conditional or liberal love can all too often lead to disappointment and unhappiness by incurring society’s disapproval and sanction.     


But life lasts a long time and change is always possible.  A good marriage,  a successful career,  the love of one’s children and the admiration and regard of friends can build self confidence and trust.  And if one aspect of life is good, the chances are that confidence will spread and influence other aspects too. 


So happiness can be instilled in us from our parents, can be learnt by experience later in life or we can just get lucky.    


But perhaps the nub, the crux of happiness is living an authentic life.  This goes back to the notion of being yourself in the company of others – being true to oneself and others and caring for others as you would to yourself. 


There are few of us who can put their hands on their hearts and say truthfully ‘I have always been authentic.’  The best most of us can say is ‘I have tried to live a good life – the intention was there, but I haven’t always succeeded. I have learnt from the experience and will be more authentic in the future.’  While not unequivocal happiness, this is at least work in progress.    


But if authenticity is the key, how could any politician or even any politicians wife, let alone President and Madame de Gaulle ever achieve happiness?  

Sunday was the last day of the Grand Annual Country Fair at Chatsworth and it rained, not just a fine drizzle but a downpour, that cascaded off the entrances to the  marquees, tumbled merrily down the helter-skelter and created lakes of the arenas.   


The weather had threatened to drown out the event.  The Ferrets stopped racing when their tunnels flooded.  The Tigers Freefall team got lost somewhere in the clouds.  The 50 balloons never took off at all, and when the aerobatics duo appeared out of the grey to risk their lives in rolling loops, barrel rolls, knife edge spins,  nobody cared.  Stallholders occupied the hours before they could pack up, staring disconsolately out from beneath dripping banners advertising The Countryside Alliance, Mike Dunn, Liberal Democrat MEP,  The Domestic Fowl Trust and Don Philpot, Daughter and Granddaughter, purveyor of gents moleskins and quilted handknit sweaters.  Only the Buxton Mountain Rescue were truly in their element. 


With paths becoming rivers of mud, fairgoers pulled peaked caps and Arkuba bush hats over their eyes and crowded tweed elbow to tweed elbow into steamy marquees, where they ate sausage rolls and prepared to be fascinated by the fabric sculptures and demonstrations of magic knives.


At least the dogs had fun.  The gundogs swum industriously back and forth across to the island where they searched with tongue-lolling enthusiasm for the cylindrical blue bags of bait that were hidden in the grass. And Cyril the Squirrel’s racing terriers were driven to a state of manic excitement by the conditions, though the final race disintegrated into chaos when all the dogs in the park joined in a frenzy of splashing, yapping and scampering, as the lure was propelled first one way and then  the other by Cyril, frantically hand pedalling an upturned bicycle wheel.  The terriers with their short legs could turn on a sixpence,  but the greyhounds overshot by miles and were last seen heading for the park gates and the larger collies, poodles and retrievers bounded along anywhere just enjoying the fun.



The Chatsworth fair celebrates the other side of Britain, the country side, where weather is a given and people just carry on.  So, in a grassy arena,  desolate except for groups of supporters on shooting sticks, the carriage drivers sat proud and erect awaiting their turns, while water dripped off their bowler hats, soaked into tweed and cavalry twill and ran off polished leather and white foam dropped from the champing muzzles of glistening black ponies.  At the other end of the showground, the Scottish dancers had donned capes and  continued to splash daintily in the mud to the dying skirl of the pipes. 


It was late in the afternoon with the weather fully established that the band of the Royal Welsh Guards entered the grand ring, splashing in step.  They had also put on  black capes, which with their dark helmets, made them look like the Derbyshire police force of 1901, out to sort out a spot of bother in t’park.  In a manoeuvre that looked more like synchronised swimming, they formed themselves into a semi-circle in front of the few faithful in the grandstand.  The Archdeacon of Chesterfield, summoned by the tempest, entered, wearing a creamy white woollen cassock, his face hidden under the large black umbrella which was held aloft by his assistant, the Reader of Edensor.  The thunder tumbled overhead on cue, as, with vowels like sodden fruit cake amplified over the hiss of falling water, he suggested with a somewhat forced ecclesiastical jollity, that the band play ‘All things bright and beautiful’.  I felt thankful it wasn’t  ‘For those in peril on the sea’.  The water had got into the tubas and made the drumskins flaccid, but within the grandstand beneath the celestial artillery and the rain-gun rattle of corrugated iron,  a few doughty Christian soldiers warbled on to save the Empire.