INTRODUCTION
Shudosho means "learning the way" a concept created by a man in 15th century Japan called Zeami Motokiyo, considered the father of classical Japanese dance drama known as Noh. Zeami developed and theorised classical Noh rescuing it from less savoury aspects of its origins and turning it into the sophisticated tradition that we know today. For him mutuality of existence meant that individual skills needed to be harmonised in relation to the group dynamic. He was the first to emphasise the pivotal relationship between the performer and observing audience. This balance between the individual and society perfectly mirrors the reality of life. I have conceptualised Shudosho as the drama inherent in the ongoing dance between our selves and the society within which we are embedded. This dance-drama is enacted within an environment that fluctuates relentlessly between the predictable and the unpredictable both elements simultaneously involving aspects of safety and security as well as danger and vulnerability. This juxtaposition leads to confusion when the fantasied excitement and stimulation of danger becomes perceived as more attractive and seductive than the pursuit of stability.The particular drama of the dance between our selves and society is at the heart of where anxiety originates in most human lives.
Our brains are biologically and socially evolved to scan our surrounding environment constantly for danger. The stress of this process is what we experience as anxiety. The extent to which our brains have been sensitised to danger or fear of danger will determine how much anxiety will be generated and how it will affect us. Anxiety tints and distorts the view through the lens by which we perceive our lives and the world around us. The extent of this distortion will determine just how accurately or inaccurately we see reality and how much we will understand it. This in turn determines how effective we are in being able to solve the problems inevitably thrown up by life. It is a truism to say we can only solve a problem if we see that it exists.
Robert was led into my office by a nurse who guided him into the chair opposite me. It was only when I gazed directly into his face that I realised that his eyes were completely shut. He could not see. He was blind. On my very first day of psychiatry I had begun my journey into the curious and fascinating realms of anxiety and the different ways it presents. I did not know then but was later to discover that I would never escape from its clutches.
Robert’s story was perhaps not quite as unusual as one might initially think. He was a respectable bank manager who had worked long hours at his job at the bank. He was always punctual and generally respected although some of his workers thought he was a little surly. He had got to the retirement age of sixty-five years, been presented with his gold watch for excellent service to the bank, and retired to his house in the English countryside which he shared with his wife of 35 years. Eileen was a caring person who knew that Robert was not a very social person and would be a little lost without his long hours at the bank. She had therefore taken him under her wing organising a round of social gatherings and other retirement activities which she did with characteristic verve and aplomb. After about six months of this happy and enthusiastic existence her husband found himself having increasing difficulty keeping his eyes open and in the last two months or so his eyes had completely shut. No one could discover why this had occurred. After a couple of months of hospitalisation and seemingly endless investigation he had been referred to us to see if we could help.
Robert, I was to discover was at heart a gentle and introverted soul who it seems used to retreat into long solitary hours at the bank to escape from his wife’s attention as well as her hectic and extroverted social activity. His job at the bank allowed him legitimate absence from the bulk of these social encounters and gave him a sense of peace. Then his job ended. He was ejected from the calmness and control of the bank into the chaotic world, the social domain of Eileen. Initially he attempted to keep up with her but with time his resolve failed him and he began to wilt. He began to believe that he was clearly being pathetic and he felt inadequate. Mysteriously at that point his eyes began to close and he began to live in a world of darkness. His isolation had returned.
In our sessions together a picture slowly began to emerge. Here was a man who in effect could simply no longer stand the sight of his wife. His difficulty was that he truly loved his wife. This was directly in conflict with the fact that he simultaneously could not stand seeing her for the additional eight hours per day that his retirement had presented him with. It was a dilemma that over the weeks that followed Robert and I worked through in daily sessions. At the end of that time we found a way together that helped him to move forward. His eyes began to flicker and then opened. Somewhat miraculously they then stayed open. He had perhaps begun to see a way to a brighter future. In his conversations with me some change had occurred that had stimulated the beginnings of the resolution of the conflicts he had been experiencing. Robert left hospital clearly a man ready to look anxiety in the face.
I saw many such patients with ongoing psychological conflicts that had stopped them walking, talking, leaving their homes or in general terms living. Graham was a forty-five year old man who for twenty-five years had never been able to look at his reflected image. In that time he had never looked in a mirror. If you can understand how many times a day we look at our reflected selves in lifts, shop windows, in pubs (where there is often a mirror above the bar) and of course in our bathrooms one gets some idea of how difficult it must have been to live like that for so long. Graham spent some weeks in hospital under my care and during our time together he and I spoke at length about his life and how it had developed. Together we indulged ourselves in chats which I videotaped. We went on walks together and enjoyed lunches at the local shopping centre. Even today it still surprises me that when one walks into a shopping centre one finds reflected images of oneself at almost every turn. Full length mirrors are commonplace as are reflective windows. At the end of our time together Graham found himself quite happily preening himself in front of full length mirrors in the middle of shopping centres. We did this together much to the obvious amusement of the other shoppers who stared at us curiously mystified at the behaviour of these strange people. It eventually transpired that the source of Graham’s difficulties arose from unresolved feelings of inadequacy a result of a deformed foot that he had as a child. His subsequent experiences at school due to this handicap exacerbated his difficulties. Interestingly as an adult he had never considered it. Once he had consciously and openly finally confronted this anxiety he was freed to engage in an unfettered life, a normal life one might say. He could do what most of us would not even give a moment’s thought to. He could walk freely into his nearest shopping centre.
I have had the privilege of working with scores of fascinating patients like Robert and Graham over more than twenty-five years treating anxiety and its related conditions. They however give a sense of why my interest in anxiety began. Their stories also explain the fascination of this type of work. Many of the patients I have seen have been treated with combinations of psychological and pharmacological therapies. I think of myself nevertheless as a psychiatrist who is primarily a psychotherapist. In other words I believe that the power that lies in the relationship between the therapist and the patient is the greatest of all healing forces.Therein lies the magic of psychotherapy.