Health: Tales from the Therapist's Couch

"MOST OF the time I feel full of needless worry. Then every now and again there are these extraordinary moments of feeling utterly connected to life, and I'm filled with a tremendous sense of thankfulness. Which is what happened the other week. But how sad that it took a tragedy like that to temporarily set me free from myself."

The tragedy that the woman above was referring to was that of the Asian tsunami. Like millions of others, she was deeply moved by the scale of human suffering and longed to do something to help. What puzzled and slightly concerned her about her response, however, was that the tables were unexpectedly turned, and rather than being the one who helped, the tsunami tragedy seemed to have inadvertently helped her. Deeply moved as she watched the scale of human suffering unfold, she felt herself becoming freed from a habit of anxiety that had thwarted so much of her life.

For several days after the tragedy she continued to feel uncharacteristically alive to herself and the world around her. Within this time she spontaneously wrote to a couple of friends. They were, as she put it, "letters of thankfulness...the tsunami somehow enabled me to step out of my usual worrying self for a short time, and feel extraordinarily glad to have life and friendship. I suddenly felt the need to share that with my closest friends."

Weeks later, the usual mantle of anxiety has to some degree returned. But, like the Ancient Mariner, my patient now has a clear memory of what it feels like to be "set free" from inner conflict. And, like the Ancient Mariner, she desperately needs to tell and re-tell her story in order to find a way of learning from it. How, she asks me, can she rid herself of unnecessary worry and embrace life with the fullness she has known but too rarely felt? "It was as if I could fleetingly merge without fear into the world, until the old bugbear of anxiety made me once again retreat."

For some time, my therapeutic work with this woman had been focusing upon the possible causes of her anxiety, which seeped into every nook and cranny of her life. She remembers as a child feeling anxious without cause, and recalled numerous instances of always feeling fearful about the future. Her parents had always tried to reassure her, teasing her gently about being such a worrier, and she was always made to feel that it was her problem and hers alone.

Now, as an adult, she was able to recognise with hindsight that anxiety had been pretty much part of the wallpaper at home. Her mother had quietly suffered from several phobias, which worsened as she grew older. And whilst her father's symptoms of anxiety were less overt, he was, my patient remembered, full of apprehension and caution. Most importantly of all, what was never openly talked about in the home was the unthinkable suffering that my patient's parents had both endured during the Holocaust. They had never talked openly to their daughter about the terrors they had lived through, and she was only now beginning to understand her own anxiety as deeply connected to their unspoken fears.

When my patient began therapy she wanted two things from it. The first was to locate the causes of what Freud would have called her "free floating anxiety". The second was to develop practical tools to help her fight this anxiety with, so that it was within her own power to challenge the habit of a lifetime. Psychoanalytic theory offers excellent tools for digging up and deciphering the different causes and kinds of anxiety. But it often seems to fight shy of advocating any simple but practical self-help methods along the lines that my patient is asking for.

There are a few exceptions. The psychoanalyst Marion Milner, who for years battled with her own ingrained habits of distracting anxieties, wrote about the method of refocusing she discovered, which enabled her to shift from "narrow" to "wide" attention. When she achieved this, her world became flooded with meaning: "only a tiny act of will was necessary to change the face of the world, to make boredom and weariness blossom into immeasurable contentment."

Today, many would describe Milner's technique as a form of prayer, or meditation. I don't think it matters what language defines such a discipline. Surely the important thing is that any approach which offers a practical way of learning how to shift anxiety should be harnessed to psychological understanding. Both approaches are aiming to increase the amount of control we have over whether we emotionally retreat from or embrace our worlds. And both seem inseparable, because sometimes knowledge alone is simply not enough.

elizabeth.meakins@blueyonder.co.uk

Elizabeth Meakins is a psychoanalytic psychotherapist in private practice. None of the clinical material above refers to specific cases