The Examined Life: How We Lose and Find Ourselves

"Grosz is such a beautiful writer. He creates these tiny vignettes. All the stories are short, you just get a little portrait of somebody, with a growing understanding, and invariably a bit of insight at the end. It provides answers more than some of the other books I’ve chosen. One example is the story of a man who compulsively tells lies. Grosz is trying to figure out how the man could possibly benefit from this. He traces it back to a point when he was a child and used to wet his bed. His mother used to clean up after him, they didn’t tell anyone and they shared this lie together. Then the boy’s mother died. In telling lies as an adult and forcing others to collude in them, Grosz concludes that his patient is unconsciously trying to recreate the bond he once had with his mother. You just think wow, that makes so much sense. I found it an incredibly wise and insightful book. My sister read it and she said it changed the way she praised her children. Grosz describes how he worries when he hears people praising his own children, because he knows that some sorts of praise are not beneficial. If you praise someone for being good at something, it makes them try less hard the next time and they worry about not being good in the future. Whereas if you praise them for hard work, it encourages them to work harder and improve on what they have done. The stories are very relatable. I love the case of the man who used to retreat into daydreams about his house in France. I do that. Sometimes if I want to relax I imagine that I’ve fixed everything in my house, and wouldn’t it be lovely if I could convert something into something else. And so many of the chapters end in a pithy moment where you go ohhh, the house wasn’t real in this particular story! He’s been daydreaming about a house that wasn’t real. We can all imagine doing that. Absolutely. I think about this all the time. When you know someone who behaves in a way that seems objectionable to you – constantly tells you pathological lies, for example – you have a particular disregard for that person. Perhaps if we understood what was at the root of people’s behaviour, we would all be much more sympathetic to each other. I think that to be a good doctor, and a good patient, always requires an acceptance of ambiguity. I’ve certainly encountered that in my practice. Some people feel like they’re not going to get 100% better unless they have an ironclad answer that is completely proven and incontrovertible. But, unfortunately, in the field of medicine, ambiguity exists and uncertainty exists. When I treat people with the same disease half of them will get better and half of them won’t, and I don’t know which half it will be. You can torture yourself by worrying about ambiguities and uncertainties or you can accept things and move forward. This is what I try to think about with my patients with psychosomatic disorders. I say, listen, if you’ve got no better answer, can you take this one for the moment and see how it benefits you? And if it doesn’t benefit you we’ll try something else. I think sometimes you just have to accept things and see how they help you. That is what I wanted to change entirely by writing this book. When I tell somebody that their seizures are dissociative rather than being due to epilepsy, they often get very upset. And I think that’s understandable, because people see things like dissociative seizures as not real. They immediately apply words like there’s nothing wrong with me after all, or there’s nothing wrong with you after all. Whereas the point is that if someone is having seizures or headaches or stomach pain, it doesn’t matter what the cause is, there is something wrong with them. I think part of the reason people respond this way to psychosomatic disorders is because they believe it suggests a volitional component. People think that if your seizures are psychological then, to some extent, it’s deliberate and you could stop if you wanted to. That makes people very dismissive of these disorders. But I always say to my patients if I were anxious or frightened now and my heart was going at 150 beats per minute, you wouldn’t say stop it, or you’re doing it on purpose. You would understand that my heart is reacting that way for physiological reasons that I can’t control. I think there’s also a judgment people make that the pain you get from something psychological is less painful than the pain you get from cancer or a pulled muscle. Whereas actually the pain is every bit as real and can be just as painful if not more painful. Severity of pain doesn’t necessarily reflect a disease process. These symptoms are sometimes more disabling and more difficult to treat than other disorders. It’s hard to say at the moment. When I talk about psychosomatic illness at festivals or conferences, people are really relating to the idea. The minute you start talking about it, people realise they’ve had it. Not necessarily to the degree where they become disabled, but we’ve all experienced it. I describe in my book how I injured my foot and it took ages to recover. I know it was because I was worried about it, paying attention to it. I’m also beginning to get referrals. People are coming to me saying I think I have this, which is not something that ever happened before, so that’s brilliant. So I certainly feel that there is some raised awareness. But whether that is going to go even remotely far enough, I’m not sure at all. I’d like to see changes in how doctors are trained. When I qualified in neurology, I was suddenly encountering these patients in huge numbers and I felt ill-equipped to do anything. Why? If this is a no secret to anyone and a large part of every doctor’s practice, why wasn’t I taught how to manage these problems? As a neurologist, you are taught to look for neurological disease. But a third of people you see will not have a neurological disease and you are not taught what to do when you encounter them. You’re essentially taught that they are not your responsibility and you must send them somewhere else, but where? I think we have to address that problem in medical school. Ultimately, though, I think we need a broader shift in attitudes across society. If you knew a colleague was off work with seizures or in a wheelchair and you thought it was because they had multiple sclerosis but then you discovered it was actually psychological, would you see them differently? Would you have less sympathy? We need to realize that different sorts of disabilities deserve the same respect."