November 2009

The Archbishop of York, John Hapgood, once famously declared that ‘the lust for certainty was a sin.’  This statement was surprising, shocking even, coming from the second most important churchman in the country; a man who engaged with the ‘certainty’ of God. 

We live in an uncertain world.  We can never be sure of anything, truth, fact, reality, faith; they are all illusion.  Nothing is absolute; there are contexts, conditions, caveats and excuses.   Alter the perspective and the conclusion changes. We can never know the right course of action; all we can do is weigh things up and make a decision, that seems best at the time. 

From the dawn of civilization, people have needed to invent myths to explain the things they didn’t understand; day and night, the weather, the changing seasons, the migration of animals, the growth of crops, family relationships, love, anger, grief, madness. These ‘certainties’ were ascribed to the deities, who alone understood the ways of the world and  required appeasement.      

But man is restless and curious.  There have always been the neurotic ones, those who would challenge the elders and question the collective wisdom; the ones who noticed the missing stair in the double helix.

Man’s neurosis has made him successful. Curiosity has generated the knowledge that has turned men into Gods; Gods who knew how to grow their own food, create their own shelter, and migrate to every corner of the globe. The first revolution in human society, agriculture and the settled community, was followed some thousands of years later by the industrial revolution and the growth of massive cities, but now we have been taken over by the third wave; the electronic revolution, further disconnecting us from the tangible traditions of home and tribe. This new artificial world is based on belief and expectation.  Money, property, occupation, marriage, family can no longer be relied on. There is no absolute security.  What we regard as our wealth, our security, is more a matter of collective trust than any real commodity.  What sustains us as family and home is the faith that it is so. We are consoled by our illusions, up to a point.  

But there is a paradox; the more illusory and insecure our existence, the more we demand absolute certainties.  Our need for security permeates all aspects of our existence.  Daily administrative concerns domesticate an existential insecurity by providing the illusion of control. This is not so much a lust as a fundamental human need for shelter; what psychotherapists would term containment.  We need to know that our savings will be secure, that we will get effective treatment, that our children will get the best education, that we will be promoted, that our wife will love us forever.  These are our certainties. But all too often we worry about whether it will rain tomorrow, whether the rubbish will be collected, the mail delivered, the roads gritted.   We are panicked by a glitch on our computer,  enraged  by transport delays,  devastated by the loss of our mobile and tyrannized by regulation.   

To provide the reassurance to calm our fears, we demand more information.  We need to know what we can never know.  So we build glass and concrete temples dedicated to science, create multinational corporations to look after our money and service our existence and construct whole cities dedicated to treating the incurable, unexplained malaise of a society, that is sick with worry about being worried.  These are all illusions.  The reality, as we have seen all too clearly, is that our money can never be safe, the basic services, energy supplies, water, food, are finite, our shelter can be destroyed and life is an incurable illness.  But how desperately we need those illusions,         

In our uncertain, artificial world, try as we will to distinguish reality from fiction, truth from lies, right from wrong, the good from the bad, we fail. And this failure leads to regulation, because regulation provides the structural illusion of certainty. So we regulate every aspect of our existence – banks, hospitals, schools, transport and food.  So just as our ancestors never questioned their deities, so we put our trust in the God of  Science, the mysterious divination of evidence, the Rule of Law, the Oracle of Psychology, the Security of the Bank and The Power of Government.  Not to do so invites chaos or so we fear.  And our collective psyche abhors tension and chaos.    

We need to know where we stand, what will happen. So we look to our leaders to guide us.  Our politicians have to appear certain, lawyers trustworthy, businessmen reliable, doctors omniscient and efficient.  They all trade in absolute truths. We make Gods of them.  We have to believe that when our politicians tell us they will cut taxes, improve medical services, increase the state pension for old people and get us out of recession, that this will happen. But politicians are false gods. Certainty for a politician is at best what seems to be the optimal solution at the time and at worst sheer deceit and manipulation.  To be certain is to appear to have control and control is power.  And we need to know our leaders have the power to look after us. The media, the watchdog of an insecure public, demands certainty and will destroy those whose predictions fail to happen, whose promises are unfounded.      

It’s a game of pretence, a case of keeping one step ahead of disaster. Politicians are theatrical exponents of deception. Lawyers conjure truth out of doubt.  Businessman are skilled manipulators. Doctors trade in reassurance.   But they are only giving us what we want; the semblance of certainty in an uncertain world! 

Far be it from me, a lusty sinner, to take issue with the good archbishop, but I think that lust for certainty is less a sin and more a sign of insecurity.  Lust implies the need to own, to have power and control and that makes us feel secure.  It is what this desperate need leads on to, what it justifies, that are the sins; the deception, division and conflict, war, even murder. Doesn’t religion, in preaching a doctrine of certainty generate sin as much as any other conviction.  God save us from those who have conviction!         

Certainty forecloses discussion, precludes compromise, stifles creativity and promotes division. It inhabits a world that is split; right or wrong, black or white, good or bad.  The illusion of certainty  requires deception, suppression and secrecy.  It denies the real world and leads to conflict. There must be winners and losers.   

Uncertainty is freedom and life. We need to accept uncertainty if we are to understand the nature of things and change them.  Knowledge is not written in stone, but on shifting sand and the tide keeps coming in.  We should marvel at what we don’t know, engage with the fascinating complexity and the stimulus for understanding. Curiosity is one of the greatest joys of life. 

If we are to live together in harmony, we need to acknowledge there are no absolute rights or wrongs; only what we decide is so. Everything has its contexts and conditions.  Laws are there to be broken if conditions dictate that is the greater good.     

But society has to deal in absolutes, otherwise there is no society.  And the bigger society is and the more complex, the more the individual needs to be regulated.  No man is an island … Society determines that we make decisions, obey conventions, laws, that our word is our bond.  Doubt and inconsistency could lead to chaos and disintegration.   But society is too large to trust or to understand. It is an artifice that must be accepted advisedly not absolutely.  .   

There is a third way; that is to acknowledge the necessary regulations of society while at the same time realizing and understanding the complexities and uncertainties of human existence.  (Give unto Caesar that which is Caesar’s ……….).  Decisions should not be imposed by obligation but arrived at by creative compromise.  Accept society’s necessary regulations, but retain the personal uncertainty, because it is out of uncertainty that we derive identity and meaning.   Too much regulation will breed fear and stifle life; too little threatens distintegration.  Decisiveness can lead to sin, but indecision may slide into chaos.  As ever, we need to find the golden mean

Day must follow night

and life will last forever,

but the watchman spins his coin

and the way it lands is never. 

The weather was a bit grim this morning; just off freezing and pouring in rain. I slipped on the mud and was soaked through in seconds, losing any insulation afforded by my leggings.  My hands soon felt like blocks of ice, but my back, which was covered with a winter running top and a light waterproof , remained dry and warm and I didn’t feel chilled.  I wasn’t even shivering, but this got me thinking exactley where we feel cold.  

I think we feel it at the back of our necks, across the shoulders and a few inches down the centre of our backs. I call it the shiver spot.  It’s where shivering seems to start.  Say you have washed in the open air or been for a swim in a cold river, and your teeth are chattering, if you pour hot water onto the shiver spot, or better still get somebody else to do it, then the chattering and shivering stops immediately.  The effect is still there if you pour warm water over your shoulders though less intense. 

But why is that?  What is special about that spot?  Well in animals it is the major subcutaneous site of brown fat, that particular type of metabolically active fat that generates heat in animals that live in temperate or cold zones. Brown adipose tissue (BAT for short) is well supplied with sympathetic nerves, which are activated by cold;  a   fall of temperature of the skin of the shiver spot of just a few degrees is enough to trigger an anticipatory thermogenic response that will prevent a drop in core temperature. This area has, as it were, a hot line to the brain. A drop in the temperature of the hands and the feet is not enough to cause a thermogenic response probably because this induces a local vasoconstriction that shunts blood away from the skin and returns it to the trunk via counter current heat exchange between the major arteries and veins in the centre of the limb. 

A fall in the temperature of the skin at the back of the neck is a much more immediate indicator of an imminent fall in core temperature because the back is more exposed – think of the way all mammals curl up in the cold.  Also that area at the back of the neck is close to blood vessels supplying that part of the brain stem that houses the life support systems of the body, so the temperature of this area must be maintained as a matter of necessity. 

But what about a rise in temperature? Does this area also stimulate heat loss?  I don’t think it does.  But if not, is there any sweat spot.  Might it be the mouth?  Foods that produce a sensation of heat in the mouth stimulate sweating immediately.  Does gustatory sweating have any role in temperature regulation?  Or is there another area?  Does anybody know?

For the last twenty years, we have been getting noticeably fatter.  Rates of obesity in America and Western Europe have more than doubled since the nineteen eighties.  And the problem shows no sign of diminishing. If trends continue, it has been estimated by 2050, one in two adults and one in four children will be obese with all the health risks that entails;  coronary heart disease, strokes, high blood pressure, diabetes, cancer, arthritis, gallstones, accidents and a profound reduction in life expectancy.  Alongside loneliness and depression, obesity is one of the three major public health issues of our time. 

So what is going on?  Weight gain is not a mystery.  Fat does not materialise out of nowhere. Obesity can only be explained in terms of an imbalance of energy consumption over energy expenditure. Fat people are eating too much and not exercising enough.  It’s all down, so cynics assert, to a combination of gluttony and sloth, a gross demonstration of moral failure.  But is that a fair indictment?  Some people may have a genetic tendency to put on weight; after all, the biggest risk factor for obesity is having parents who are overweight or obese.  The idea that a pre-history of starvation might have selected a thrifty gene was currency until very recently, through we now know that the way we conserve energy is under the control of several different genes.  

And there is also an environmental issue. The Foresight Report, published in 2007, declared that obesity is a normal response to an abnormal social environment. The watchword is convenience. People in the west are money rich and time poor.  There is always too much to do.  Time must not be wasted.  We eat fast food and get around in fast cars, trains and planes. Time spent on cooking, the cost of food, buying local food, growing our own food have all decreased.  Fewer people grow their own vegetables or buy local produce. We have become disconnected from food.production and preparation in the same way as we are uncoupled from the use of our own legs to get around. Fewer people are walking or cycling to work.  Children are taken to school by car. And fewer people engage in energetic sports or activities.  On the other hand, the availability of fast food outlets, low cost bistros and restaurants, food variety, food promotion and portion sizes have all increased alongside the ownership of cars and improvement in public transport.  In fact, less and less people need to go to work any more. They can just plug into their virtual Microsoft office and stay at home. We are rather like the cafeteria rats, who, when confined to their cages and fed a varied, appetizing diet in abundance, grow enormously fat.    

This fast food, car based revolution has given licence for passive overconsumption and immobility. With too many opportunities to eat and less requirement for physical activity, people cannot help but gain weight, or so it seems.  Fast, convenience food is cheap and rich in fat.  Restaurants tend to serve big portions of high fat foods. And people tend to eat what is put on their plates. One experiment showed that when soup was presented in a bottomless, refillable bowl, people just kept eating.   Time that might be spent in physical activity is all too readily plundered by the computer and television.  The exhausted boredom, induced by the tedious combination of overstimulation and inertia can tend to cause people to seek solace in comfort eating. 

But if it was just the environment that was responsible for the obesity epidemic, then why aren’t we all fat.  80% of adults living in an obesogenic social environment are not obese and 40% are not even overweight. 

Take the French, for example; they traditionally eat a diet that is so high in cholesterol and fat and yet have less heart disease and obesity.  The most obvious explanation is  portion size.  Dr Paul Rozin in a recent article entitled ‘The Ecology of Eating’ showed that portion sizes for the same meals were 25% per cent larger in the United States than in France. Barbara Rolls showed that increasing portion sizes over the course of a week increased energy intake by 4,500 Cals, equivalent to 1.5 Kg of fat.  Increasing the consumption of fat resets physiological satiety mechanisms, so that more fat can be accommodated and people want to eat the same high fat meal again. People often notice a marked increase in appetite and weight after the annual Christmas blow-out.  The opposite works after starvation; fat receptors can be up or down-regulated. Exercise is good because it blunts this desensitisation and hunger.

The way food is served, the availability, variety, portion size and even the shape of plates all have a role in increasing intake.  We eat more when food is prepared by someone else. If we are eating with others, we tend to conform to the norm.  Food outlets tend to serve the most enormous portions.  They give too much choice and choice is inimicable to regulation.  When people are presented with a meal containing a variety of foods, they will eat much more than if they are given limitless quantities of the same food. 

So the answer to preventing obesity seems so easy.  If it is just a matter of the environment, then all you have to do is alter your personal environment.  Eat less,  cut down on portion sizes, choose low fat foods, don’t have seconds, don’t eat between meals, ration chocolate and alcohol, cook at home, only eat meat twice a week, cut down on butter, pastry, don’t rely on public transport so much, walk, cycle, take regular exercise. Take control of your life. Go on a diet.  Put yourself on an exercise regime.  About 70% of women and 30% of men claim to be on weight reducing diet. So why for most, doesn’t it work? 

Twenty years ago, the journalist, Geoffrey Cannon, published his eye catching title, ‘Dieting makes you fat’.  His thesis might be explained in part by the facts that it is fat people who tend to diet and it is very difficult to lose weight by dieting.  But there is another factor; if you deprive somebody of something you will increase the desire for it, and when they are let off the hook, they will rapidly eat more. Dieters tend to crave food and the foods they crave the most are those that they are trying to resist. 

Disinhibited eating is enhanced by the last supper effect (I’ll just have one more chocolate, then I’ll stop) and the what the hell effect, (oh, now I’ve had sticky toffee pudding, I may as well have another portion),  as well as by alcohol consumption,  eating alone, the behaviour of co-diner, and negative mood.  Dieting is more difficult when people are under an increased emotional load and feel brittle. The hedonic tendency to eat between meals might indicate an insecurity that demands satisfaction through the most basic source. Walking on the moors in late spring, I notice how lambs rush to their ewes to suckle as soon as I approach. Is that an example of the same insecurity?   

The overwhelming temptation to break one’s diet is an illustration of what psychologists call, ‘Wegeners White Bear Effect’.  The more you try to suppress any thoughts about something, the more you will tend to think about it, which results in a rebound in the behaviour you are trying to suppress.  Suppression can make people exquisitely sensitive to environmental cues.  The eponymous heroine in the novel,  Leila’s Feast, illustrates how starvation can make somebody very aware of food.  Leila wrote her cookery book while she was starving in a Japanese prisoner of war camp. A recent UK survey showed that people tended to think about eating 200 times a day.  This might suggest that they were exerting a tight control on their eating behaviour, which would just enhance the craving for food. 

You have to devote time and thought to cooking healthy meals. It takes too much work to exercise.  It’s all too hard, especially if you are doing it against such a resistance.  In the past, if we didn’t work, we would starve. Now our eating has become uncoupled from the production  and preparation of food. We don’t need to work to get our meals, so why should we?  If food is there, why not eat it?  So perhaps human nature hasn’t changed that much, we may have always tended to be lazy and greedy.

But this still doesn’t explain why we aren’t all fat.  Maybe it’s all down to the culture of eating.  The French eat less but spend more time eating.  They make more of an occasion out of eating; the ambience is different.  The French tend to eat together.  A meal serves more functions that just the supply of energy.  Eating is part of a whole sequence of social grooming.  Eating together with family and friends provides relaxation, companionship, comfort and reassurance. A family that eats together tends to stay together. One in five families in the UK sit down to eat together only once or less than once a week. Many people in the United States or in Britain eat alone and can miss out on the social benefits of mealtimes and so may consume extra large portions to compensate for a degree of social deprivation.

So is overeating related to deprivation?  It is well known that people who have been subjected to starvation tend to stockpile food, eat up every last morsel and overfeed their children. Population studies have shown a definite link between poverty and obesity, but not all poor people get fat. The historian, Peter Brears, suggested that working mothers lose the skill and the time to prepare meals and tend to rely more on convenience food, rich in fat. In the Foresight report the only group who are less likely to become obese are reasonably affluent women living in the south east of England who have the time to keep fit and choose healthy dietary options. 

But since mealtimes are a whole nurturing experience rather than just a nourishing experience, is eating a surrogate for other types of deprivation?  Does the loneliness and depression that is also so prevalent in the United States and Britain, make them more likely to turn to food for comfort and solace?  People who don’t actively engage in life get bored and eat to feed their interest and confidence rather than their body.  When I conducted psychological interviews on patients with morbid obesity, I uncovered a severe degree of loneliness, depression and emotional deprivation.  So is there a typical obese personality; insecure, needy, bored and chaotic, the sort of person who might tend to turn to drugs, alcohol, cigarettes, love and companionship as well as food to satisfy their compulsive needs?    When something happens, a person’s ability to regulate their food intake gets disturbed alongside regulation of other behaviours, sleep, mood and bowel habit, for example.  There are super-regulators, who intensify their control and tend to lose weight and others, who are perhaps more chaotic and needy, who become dysregulated and obese. So do food manufacturers and restauranteurs just supply what is needed so badly? 

A recent report suggested that the tendency of people to use food to satisfy their emotional needs may be gender specific. The psychologist, David Lewis, was recently reported as saying that when it comes to tongues, melting chocolate better than passionate kissing, at least for women. All men know that sex is better than chocolate; for women it’s the other way round..

So have psychological factors, such as life traumas, deprivation, need, loneliness and depression, which seem to have increased over the same period impacted with the environmental changes to create the current obesity epidemic?  And how much of a role  do genetic factors play?   

The current obesity epidemic is such a complex mix of mind, body and meaning with culture, history and development each playing their part. There is no easy explanation, though the interaction of the loneliness, boredom and insecurity of modern life with the abundance of cheap high energy foods and the reduced requirement for physical work seem to be essential drivers.

So how can we remain slim and healthy in an obesogenic environment?  Maybe the answer is to dare to stand out from the crowd and adopt an active, healthy and interesting life style where eating is not a predominant factor.  Children, who go on ‘fat camps’  lose weight as they gain in self esteem.  So the message is don’t rely on dieting; this is almost like treating deprivation with deprivation, but get out there, do things, be active, get involved and maybe, just maybe, you can allow your weight to look after itself.    

 This article was inspired by a lecture given by Andrew Hill,  Leeds Professor of Health Psychology, to the Guild of Food Writers at Artisan, the Booth’s bistro in Kendal on Friday 13th November, 2009.       

Mediobogdum!  What a name!  What a place!  Eleven months perched on a mountain at the edge of the empire  with nothing to do except watch the sheep and wait for those damned Brigantes to attack the fort again.  Why?  Why don’t we leave them to get on with it?  We’ll never beat them.  We can  burn their villages, kill their warriors and still they come!  And they don’t even fight like soldiers. They just appear out of the mist, set fire to our farms, steal a few sheep, trample the fields and vanish.  

And the weather, the accursed weather!  It has been raining for three days; not just a shower, but whole sheets, curtains, blankets of it, driving up from the sea, turning the ground to mud, running off the hillside in white torrents, creating  rivers of our roads. 

Nothing can be kept dry, the grain in the horrea has gone mouldy, the bedding is damp, there are even drops coming though the roof of the principia.  But at least we have the caldarium, one slight token of civilisation, though the other day the rain was so bad, the furnace went out. How can a Roman survive without hot water?  

And those Brigantes; they always chose the worst weather to launch another attack.  It’s as if they know how much we hate the wind and rain and that awful cold that grips your heart.  So we double the guard, sent out another patrol, chase shadows into the cloud.    

Why our glorious emperor, the illustrious Hadrian (may the Gods praise him!)  bothers with this barren place, I’ll never know!  He even built a wall across the whole country to protect perfidious Albion  from the Pictish barbarians in the far north!  Protect what?  There’s nothing of any value here, just a bit of lead and tin way down in the south.  Nothing grows; no grapes, no figs, no olives, not even any spices.  What passes for food is dull and tasteless;  porridge and warm mutton every day!  We can’t even get a tasty dormouse.  And there is no wine, just sour beer!  And those Britons are impossible; nothing but trouble ever since the dreadful queen of the Iceni had the temerity to sack Camulodunum.    

And to think we came all the way from Dalmatia for this!  Oh Dalmatia!  Those warm nights, the wine, the music, the restless warm sea and the women. Ah, the women!  But how could I know she was the consul’s woman?  She didn’t say, and she was so careless; he was bound to discover us.  I thought he was going to kill me, but he had a worse fate in store.  I and my men, my brave cohort, all five centuries of them, were banished to Britannia at the very ends of the world, where we cling with freezing fingers to this cold wet mountain, waiting for another futile attack!

He is the last off the train. He looks lost, wary, an alien from another world.  He stops,  picks up an object from the edge of a puddle, examines it and puts it in his pocket.  Everything about him is strange. He doesn’t so much walk but shuffle, keeping close to the wall, occasionally stopping in a vacant spot while he tries to work out what he is meant to be doing.  He seems uncoupled, unsure of himself.  He is not physically disabled as such, but he has lost the easy, fluid sense of being in the body, that facile connection between mind and limb. He shambles along the towpath to the terrace,  dominated by three rusting gasholders. He stares at them, transfixed. After a while, he turns away to the house behind him and knocks at the door.  The caretaker, Mrs Wilkinson, is expecting him.  She is brisk, business-like.  The rooms are bare, functional, brown and cream, with trestle tables and benches and a few exhausted arm chairs. The scattered collection of residents, dead souls, he calls them, are too drugged to speak, they just stare out at a senseless world with unseeing eyes.  .    

From the house, it is only a short walk along the canal and over the railway bridge to where he used to live.  He returns there often, sidles through the gate into the yard, looks in through the window.  He sees himself as a boy, quiet and watchful.  They call him Dennis though his nickname is Spider, perhaps because he keeps a collection of flies, maybe because of his unusually long and slender limbs.  His mother shows him the spider’s silken egg sac and tells him that, having laid her eggs, the mother spider dies and abandons her children. Dennis thinks about this.  He sees his mother; slim, young,  beautiful but anxious. He sees his father, a jobbing plumber, truculent and quite handsome in a tired, careworn way.  His mother sends young Dennis off to The Dog and Beggar to tell his dad his supper is ready.  He sees his father at the bar, staring into his pint, his foot on the brass rail. He sees the loud, blowsy women in the snug. One catches him staring, pokes out her tongue and exposes a breast.  Later, he hears his parents arguing. 

According to Spider’s story, his father spends more time at the pub and becomes obsessed with Hilda who is loud, coarse and dangerous.  One night his mother follows them and surprises them in his shed on the allotment.  His furious father picks up a spade, bludgeons his mother to death and buries her body under the potato plants. Then he moves Hilda into the house, where she occupies the place of his mother, even to wearing her clothes, which stretch near to bursting to constrain her overripe sexuality. Spider regards them as murderers and plans his revenge   He creates a web of string, attaches the end to the gas oven and when his ‘mother’ comes home drunk again and collapses in the chair, he pulls the string and turns the gas on.  Later he sees his distraught father, sitting on the doorstep, cradling the dead body of his wife. He looks at the watchful spider with confusion and fear, ‘You’ve killed your mother, Dennis! Why?’       

This is another superbly directed film based on such a well observed and crafted novel by  Patrick McGrath.  It is such a convincing story that we at first fail to notice the inconsistencies. Why did nobody discover his real mother was dead?  Why was Hilda able to take her place, even wear her clothes, without attracting any suspicion?  Where did Dennis go for twenty years?  Did he really kill his ‘mother’ or was it Hilda? How did the woman who ran ‘the safe house’ become Hilda?  Why did Dennis enter her room and threaten her with a hammer? 

The skill of the book, so faithfully represented in the film, is the way it captures the web of delusion, compartmentalised by the wheels and spokes of Spider’s mind and dominated by the irreconcilable loving, cruel, soft, loud, lascivious and abandoning, mothers.  Dennis learns to adapt by splitting and segmenting his mind; the frightening world of delusion is in Spider’s lair at the very back of his mind while Dennis and Mr Cleg are able to exist albeit with difficulty at the front in the real world.  The danger is that Spider always threatens to emerge and enact his murderous intention.  In his isolation, Dennis cannot reconcile the good, albeit rather strict mother with the tart who goes to the pub, gets drunk and has sex with his hated father.  He wants to protect his love for the one and kill the other and all the time has a deep fear that he, like the other baby spiders, will be abandoned. 

McGrath enters the mind of the psychotic, the dream like way in which the events of the real world, the traumatic memory and unacceptable meaning interact to take control.  He imagines his father and Hilda taking over his mind, questioning and ridiculing his every utterance, so he no longer knows what’s real anymore and becomes a conduit for their guilt and anxiety.  ‘Dennis had to channel and absorb the poison and in the process was contaminated by it, it became a ghost, a dead thing, in short, it turned him bad.’  He becomes uncoupled, unsure of anything, yet construing meaning in everything, as he tries desperately to prevent the invasion of voices and hallucinations, ‘the terror of guilt that clicks and clacks around the back of my head like the teeth of a hound, like a cloud of chattering gnats.’  The madness of the pub just before closing time, the excitable, confusion of shouts, shrieks of laughter and snatches of song, becomes the chaos of his mind, though he gains some reassurance when the fog comes up from the river because in the fog, the blind, even the emotionally blind, can see clearly.

His landlady, Mrs Wilkinson,  is a projection of Hilda, the bad, tarty mother he despises, the one who got rid of the kind mother he loved.  She even has the same name. When Spider emerges, she has to be killed.  

Dennis is, of course mad, but not entirely.  There is method and logic to his madness, such as the psychiatrist R.D.Laing expressed in his book, ‘The Divided Self’, which he wrote at a time when his profession was becoming increasingly biological and deterministic and schizophrenia was being thought of as an inherited disorder, treatable with drugs. Laing, like McGrath, attempted to infiltrate and understand the mind of the schizophrenic, to engage with the disturbed personality therein and integrate it with the real world, but Laing was considered mad by many of his colleagues. Treatment with antipsychotic drugs may eliminate the social embarrassment by removing the certified insane to a place where they could be labeled, confined but at a cost of not being understood or re-integrated.   

Nowadays, we don’t talk so much about madness; we speak of mental illness.  And people with mental illness are only suitable cases for treatment if they are suffering and a danger to themselves or to others.  But that loses the essence of madness.    

Madness is part of the human condition.  We are all capable of going mad and indeed do so from time to time.  We all have our limits and circumstances can push us over the top. Madness is losing touch with the real world, as defined as the belief structure shared by the majority of people in the same culture.  Religious beliefs might be considered collective delusions, but since they are shared within their own culture,  Christians, Moslems, Buddhists, Sikhs and Hindus would not be considered mad, though Jedis and Christian Scientists might.  Highly creative people; artists, poets, composers, scientists, might be considered mad – their beliefs are highly idiosyncratic, but we recognize them as important and interesting and we support and value their ‘difference’.

Madness is a state of mind in which delusions can take control.  People often talk about being madly in love when they inhabit the wonderful world of make believe they each create. And if and when paranoid delusions surface to torture us, we can all be insanely jealous, crazed with guilt, deranged by suspicion, estranged with loneliness and driven mad with grief.  These are all human traits.  At those times we need a safe guiding to hand to reintegrate our thinking with that of our family, society and culture.

 The situation with Spider is a little different. He has a well established recess in the back of his mind, that is seriously deluded and dangerous.  If he is to be helped to integrate his split mind, it  is important to understand the familial roots of his madness while at the same time creating a safe house where his persecuted arachnid perceptions can be tamed, and accommodated alongside the functionality of Dennis.  But what chance of that within a divisive society, paranoid with risk?

When her husband, Max, is appointed director of an asylum in Essex, Stella is not overjoyed.  She is bored; ‘dying of chronic neglect’.  She resents the restrictions of her position and the limited perspectives of the other wives.  To relieve the monotony, she develops an attraction to Edgar, a handsome and charismatic inmate, a one-time sculptor who is assigned to duties in her garden.  They fall in love.  When she learns from ‘her friend’, the senior psychiatrist Dr Cleave, that he has brutally killed his wife in a fit of jealousy, she is in too far in to pull back.  Nearly discovered in Stella’s bedroom, Edgar steals Max’s clothes and flees the asylum in the boot of her mother-in-law’s car. After a while, Stella abandons her family and joins him to live in a derelict warehouse in East London. At first, all goes well. Stella claims she is happier there than she has ever been. But Edgars dark side emerges; he becomes jealous that she is encouraging the attentions of Nick, his assistant.  He beats her up.  She is rescued and returns to her husband, who has been ‘relieved’ of his post in Essex and taken another position in North Wales.  Edgar discovers where she is and comes for her, but the police have followed him and he is arrested and sent back to the asylum again.  Stella, distraught and preoccupied, fails to respond when her 10 year old son, Charlie, drowns in a lake while out on a field trip in her care.  She is certified and locked up in the same asylum, also as a patient of Dr Cleave.   

But the urbane Cleave has other designs on Stella.  Some months later, when Stella appears on the route to recovery, Dr Cleave suggests an ‘arrangement’ whereby Stella is released but lives with Cleave as his wife. He takes her up to the clock tower and proposes, but not before he has informed her that Edgar is back in the institution and they might meet at the annual ball. At the last minute, Cleave prevents the meeting. Edgar does not go to the ball.  Stella walks away and kills herself by jumping off the tower.

This gothic tale of erotic obsession and possession is shocking in its intensity and apart from the last twist, Cleave’s proposal, its credibility.  Patrick McGrath, whose father was once medical superintendant of Broadmoor, is the master of dark suspense. In prose of steely control, he captures the reckless dangers of falling in love for those who have little self control. We observe with horror how Stella and Edgar become possessed by a magnetism that is bound to destroy them and the lives of those connected to them, yet we sit in hypnotic trance, watching the plot work its inexorably deviant route to an inevitable conclusion. 

When Stella refuses to answer Cleaves question about love, he comments;  ‘There’s no defining it then.  No discussion possible?  It springs to life.  It cannot be ignored and it tears people’s lives apart.  But we can’t say more.  It just is.’ 

But doomed love affairs have a structure, a sequence which with some variations, they all conform to.  First, there is the recognition, the look. ‘I feel that you are the one I have wanted all of my life.’  

Then, the identification; the lovers let each other into their imagination, become part of each other. ‘Powerless to control the hunger they had for each other, their bodies flaring at the slightest contact, they lose any independent will and can only live for the time they can become one again; body mind and soul.’  

Next, the relationship develops a structure, they make assignations. Pragmatic thoughts are never far from the thoughts of the secret lover, but for a single purpose. 

But there are complications; there are always complications, but as Stella fears, it may be the very constraints of their situation that drives their passion, the excitement and danger, the effect it would have if it were known, the dreadful risk to another’s happiness. That’s the awful power, the evil, dark side of love.  And when all is known, disillusion sets in with the cold test of reality.  Familiarity, uncertainty, squalor gnaw into passion and blight the fruits of love. Jealousy, the paranoid anger generated by a terror of abandonment, destroys it. Edgar would kill Stella to keep her. And Stella cannot live without him. The conclusion is inescapable.      

So is falling in love a form of madness?  It seems so. The obsession, the compulsion, the delusion, the despair are all make believe; a dangerous departure from the normal rationality of human behaviour. And yet its a magic that so many of us want to experience just once in our lives. But we must contain it otherwise it will overwhelm us.    

Edgar, Stella, Max and Cleave are all in their own ways, mad with love.  Their innocent victim, Charlie, is dead. 

Edgar has been institutionalised for committing the kind of horrific act that threatens the stability of the social order; he has killed and mutilated his wife. He continues to believe he was justified in doing so and is sufficiently charming and plausible for Stella to identify with his sense of grievance and injustice.  He occupies a no-mans land where the making of art and the maintenance of sanity had a precise and delicate relationship. Disturbance in one would create a dysfunction and breakdown in the other.  The very nature of the work, the long periods of isolation followed by the public display, the admiration so intricately balanced with the risk of rejection, all conspire to create unnaturally intense relationships with friends and sexual partners   But like many artists, he has the soft core of a child, a touchy, clingy child. Any expression of distress from Stella, he receives as imminent desertion.  So when disillusion occurs as it inevitably will, the sense of betrayal is profound and murderous.

And what of  Stella?  Fragile, impetuous, and spoilt, with a provocative and dangerous beauty, she is the hysterical focus, where sanity and madness elide with each other in  dramatic gestures and impetuous acts. For the first time in her life, she desires somebody with all a physical and emotional intensity that overwhelms her; she abandons herself, mind body and soul to her passion.  But Stella has met her match, a man with all the darkness and passion that she possesses and less of the control.  She accepts him without reserve, ignores all the warning signs. She has to. To love him conditionally would have implied criticism.  It simply doesn’t arise.  So she surrenders her whole being to him; is possessed by the thought of him.  She has no will, no choice, and without him, no life!  She just lives in and for the moment of her madness.        

Max, the husband, continues to function, but he is burdened down with what has happened.  He loses all spontaneity and humour and responds to the pathology he observes everyday on the wards with a sensitivity that does not allow separation.  The line between sickness and sanity is blurred and Christ-like, he suffers for all humanity.  He can never again be refreshed, he loses weight and begins to read philosophy.

And what do we make of the mysterious Dr Cleave?.  Why does he issue his shocking proposal to Stella?  He is not a man of passion (or if he is, he keeps it very hidden).  Does he not realize the impropriety of his behaviour?  Does he not appreciate the danger it has for his patient?  He is an intelligent man, but is he playing a game of power and control, seeking to break the will of Stella as well as Edgar?  Is he a kind of crazed despot, who gets a detached satisfaction from the possession of another’s soul?  The lasting horror of this story is not the inevitable death of Stella, but the way that Cleave changes from the harmless and interesting yet compassionate psychiatrist into a sinister psychopath who has engineered the conditions for the tragedy for his own omnipotent purpose.  

‘I have resumed my habit of returning to the office in the evening.  The police were most accommodating, and I now possess all the drawings he made of her in the studio, and also the sketch done in the vegetable garden.  They are curiously tentative in outline and feature, and as a result have a sort of softness to the eye, what the Italians call morbidezza. I also have the head. I have had it fired and cast in black bronze.  I keep it in a drawer in my desk.  He worked so obsessively on it, those last days before he left Horsey Street, and so he worked it down, that it became slender and tiny in the end, no bigger than my hand; but it is her.  I often take it out, over the course of the day, and admire it. So you see, I do have my Stella after all.

And I still, of course, have him.’

How much of what we call love is possession?

 Asylum was first published in 1995.  It is still in print and was made into a film featuring Natasha Richardson as Stella and Ian Mackellan as Cleave.  

Armies pursued each other around Europe; soldiers, little better than animals laid waste the countryside, taking what they wanted, burning, raping, killing, no longer knowing, if they ever did, the reason why.  It had been a good war for Mother Courage, for a time. She became a camp follower, trailing the armies, selling food, blankets, clothing, brandy and even ammunition, changing allegiances when it was expedient to do so, always keeping one step ahead of the game. Her sons were killed; one was too crafty, another too honest.  Her daughter saw it all but couldn’t speak. She was cut and raped. But she beat the drum and paid the price. And Courage survived for want of anything better.  

The talk over the long breakfast table at 22 York Street was about other wars; Iraq, Afghanistan, Zimbabwe; brutal, unwinnable, neverending wars.  There have been 250 major wars since the end of the second world war and over 23 million people have been killed. But why? Who really understands why we are fighting in Afghanistan or why we really went to war in Iraq?  Bush’s war against terrorism is a tautology. War against terrorism is like war against war!  It doesn’t make any sense.  And there are no winners in this war. It’s war for the sake of war; completely futile. Nobody gains the moral high ground. We were shocked by the atrocities committed by our boys (and girls) at Abu Graib prison, but why? Of course our troops would commit atrocities as much as the enemy.  It has always been so.  Frightened people do the most awful things.  And war degrades humanity; murder, theft, rape and destruction becomes a way of life.  Soldiers become inured to feeling. It’s dog eat dog.  When the Duke of Wellington inspected his troops in the Peninsular War, he was heard to comment,  ‘I don’t know what they do to the enemy, but by God, they terrify me.  But it’s not only the enemy that is injured, mutilated and killed, it’s innocent civilians as well.  And there are always people like Mother Courage, ready to make a quick buck out of it all.    

The attendant at Anish Kapoor’s exhibition, a young man from Bosnia, said that many people had been offended.  Every twenty seconds, a cannot shoots a pellet of soft red wax across the room through an archway to splatter against the war of the next room.  Kapoor claims not to have any preconception of the meaning of his work, but you really don’t have to be Sigmund Freud to understand how it uses sexual metaphor to explore he brutality of war.  The large erect penis shooting its bloody  ejaculate through the doorway, stains the virgin-pure white walls of the Royal Academy, leaving a large crimson mark, that resembles brutalized female genitalia. Blood stained labia enclose the gaping wound like a scream, and the matter that slithers from that gruesome gash forms a mound, which winds like a crimson glacier, from the dead, white, empty womb. It is a shocking, yet compelling image.  The twenty minute beat of the cannon will continue until January.  By that time the Academy will be awash with blood. 

Fiona Shaw is brilliant as the feisty, calculating, yet  indomitable Mother Courage; a woman with balls!   The play, like war itself, is unrelenting in its dark brutality, the music by Duke Special and his band, a thumping accompaniment.  It is wonderful performance that shocks and disturbs.  Anish Kapoor’s exhibition is at The Royal Academy until January.  It is art on a big scale, shocking and impressive.  22 York Street is in Alastair Sawday’s book.  It provides an interesting and enjoyable stay just off Baker Street and within easy access to the west end. The long curved breakfast table with abundant coffee and a variety of fruits, cereals, croissants, pastries and preserves, is conducive to conversation.  By yourself in London?  What a good way to start the day, even if all the talk is about war!       

Good actors, declared Sir Richard Eyre, speaking last week at The Guild of Psychotherapists’ annual public lecture, have to be possessed by the characters they are playing.  They have to immerse themselves in their world, feel what it is like to be them, experience the passion and then act it out.  But it is impossible for an actor to experience the same degree of emotion every night.  They would be emotionally and physically shattered by it. Having just seen Fiona Shaw in a matinee of Brecht’s, Mother Courage, I observed how much that performance had taken out of her, but as the run continues, she like all good actors will distance herself from it; express the passion but not be overwhelmed by it.  Judi Dench, according to Eyre, exhibits the perfect balance. She allows herself to become possessed by the role but maintains an observing eye.  Actors are people who imitate others. ‘ They are great pretenders’,  Sir Richard declared, expert at the arts of deception and seduction, but they have live in the real world too. 

Sir Richard summed up the qualities of good actors.  They must be conscious of themselves but not self conscious.  They must be narcissistic on stage, but humble off it. They must live the role but then forget it.  They must have a perfect balance of good sense and warmth, rationalism and emotion.  They must captivate their audience, but then become anonymous. They must create empathy in people’s minds and leave.  They should feel the part, but never try to go beyond the feeling.

Courage is essential to a good actor, death to a bad one.  Actors must present a buoyancy of spirit even though their heart may be breaking.  Eyre described finding Ralph Richardson looking glum after rehearsal.  When asked why, he  replied ‘Oh dear boy, I just learnt today that my brother has burnt to death, but’, he added thoughtfully, ‘there’s one consolation; it can’t happen again.’ 

Actors must learn to contain their emotions, avoid being too worried about their performance, work as a team but never imagine they are the play. That’s a route that runs close to madness. The psychotic actor, can imagine that they are the stage, upon which others play out their emotions.   

It seems to me that acting is not too different to psychotherapy.  The effective  psychotherapist enters the clients world sufficiently to set up a confident and trusting therapeutic relationship  They have to understand, empathise and be compassionate, yet maintain a detachment. It’s a delicate balance that cannot be prescribed, only felt. The quality of any therapy depends on the quality of that engagement. Like the actor in relationship with the character, the therapist must maintain an observing, intelligent mind. They must not descend into their client’s abyss, they must remain on the brink, in communication, connected, yet able to see the possibilities of freedom. There is no redemption, no rescue, if both get lost.

But doesn’t the same principle apply to all relationships?  We are, after all, social creatures. We need to engage with other people but we must not become them.  We bring our independent selves to any relationship, creating the possibility of insight, growth and the joy of discovery. Merger may seem like stability, security, but it’s stagnation.  We should not seek to confine others with bonds of obligation and dependancy. 

But what of falling in love; that wonderful delusion of discovering ourselves in the other?  Therein lies the seeds of madness; the suspension of reality in the service of the dreadful seduction of the feeling.  People can fall in love with falling in love and often do. They can become completely lost in the abyss unless they maintain the observing eye of the director that can see how the play could work out. But what would happen if they fell in love with the director?     

And what about actors who play the same character for years on the radio or in television soap operas?  Norman Painting, who played Phil Archer, died last week aged 86. Three days previously, he had recorded another episode for November. He had said he wanted to die in the role. So had he become Phil Archer?  Therapy too can go on forever. The patient may get out of the abyss into the therapist’s safe house, only to find herself unable to leave. Many couples persuade themselves and others that they are in love forever. So why can this seem so boring?  Have I just become an old cynic?      

Afterwards, finding Sir Richard alone with a glass of wine, I explored the idea that  directors combine characteristics of both therapists and actors.  They work with the company as well as the play, coaxing the correcting nuance out of the actors, calming their insecurities, interpreting plot and character.  In this God-like status, I added, warming to my argument, was there not a danger that they could become the stage, upon which others play out their emotions, like the charismatic conductor of a symphony orchestra?  

Perhaps I had gone too far. Eyre looked alarmed. He replied, somewhat huffily, that he never analysed what he was doing; it was intuitive.  In any case, the director is not the stage. The plays the stage.  A-ah!  I could have pursued this, but at that point, some ‘lovies’ came to the rescue and I departed, stage left!

Sir Thomas Beecham was immensely narcissistic, but he recognized the knowledge and talent of his musicians and did not attempted to impose his will  on the orchestra, merely guide it.