SUMMARY OF CONTENTS
THE SELF
The idea that we have a self is so obvious to most of us that the notion of questioning what a self might be seems absurd, except of course when we actually do and suddenly discover somewhat disconcertingly that we do not appear to know what it is at all. The Self Illusion a book written by Bruce Hood in 2011 exemplifies clearly the difficulties in determining how a self might be conceptualised.
Pragmatically though we might say that there are two aspects of self. There is a self that does things, a ‘doing’ self and a self that is, a ‘being’ self.This being self is who we actually are! We could call it our self as defined by our internal being. This is the self which is the entity that actually does everything that we do. It is that which senses everything that we sense. When we look it is that which sees. When you listen it is that which hears. When we speak it is that which speaks. If one asks the question as to who does what you do, then the I that emerges as the answer to the question is who this self is.
The self is what we define ourselves by. We create a conception we think as us and then we attach ourselves to that concept. We identify ourselves by our association with that concept and It becomes our prevailing identity.
We learn about our self in two main ways. The first is by our own experience. The other is by the experiences of others. Which one of these influences is dominant in our lives defines our character and its expression.
The idea that we have a self is so obvious to most of us that the notion of questioning what a self might be seems absurd, except of course when we actually do and suddenly discover somewhat disconcertingly that we do not appear to know what it is at all. The Self Illusion a book written by Bruce Hood in 2011 exemplifies clearly the difficulties in determining how a self might be conceptualised.
Pragmatically though we might say that there are two aspects of self. There is a self that does things, a ‘doing’ self and a self that is, a ‘being’ self.This being self is who we actually are! We could call it our self as defined by our internal being. This is the self which is the entity that actually does everything that we do. It is that which senses everything that we sense. When we look it is that which sees. When you listen it is that which hears. When we speak it is that which speaks. If one asks the question as to who does what you do, then the I that emerges as the answer to the question is who this self is.
The self is what we define ourselves by. We create a conception we think as us and then we attach ourselves to that concept. We identify ourselves by our association with that concept and It becomes our prevailing identity.
We learn about our self in two main ways. The first is by our own experience. The other is by the experiences of others. Which one of these influences is dominant in our lives defines our character and its expression.
SOCIETY / SOCIOLOGY
The self does not function in a vacuum. It functions in a context and that context is provided by the society within which an individual functions. Sociology studies the consequences of behaviours within the context of groups that we live in. Understanding the development structure and functioning of society is fundamental to negotiating an appropriate place for the individual in that society. Sociology is a social science concentrating on the behaviour of groups. Psychology is a social science concentrating on the behaviour of individuals.
SOCIETY / SOCIOLOGY
The self does not function in a vacuum. It functions in a context and that context is provided by the society within which an individual functions. Sociology studies the consequences of behaviours within the context of groups that we live in. Understanding the development structure and functioning of society is fundamental to negotiating an appropriate place for the individual in that society. Sociology is a social science concentrating on the behaviour of groups. Psychology is a social science concentrating on the behaviour of individuals.
ANXIETY
Everyone is by nature fearful. We are animals and there were always larger more dangerous animals that preyed on us. Through evolution we have developed innate mechanisms for sensing danger. Fear is our normal survival mechanism. It is an automatic emotion that is produced whenever we feel our survival is at risk. It is a primitive reaction which prepares you to do whatever you need to do to ensure that you do not become prey. We know intuitively that there are objects out there that we need to fear. This is a reaction that has kept us safe for millions of years.
Primitive humans just had fear. More evolved humans developed systems of awareness of these fears in order that we could perceive them more clearly and develop more effective behavioural safety mechanisms. This reaction of awareness of our fears is what we know as anxiety. In modern life anxiety and fear have become interchangeable. We experience fear and we feel anxiety.
Scientists inform us that having come down from the trees we started walking on two legs some four million years ago. Evolutionary science tells us that our higher cerebral brain functions began their development two million years ago. Over this period human brains have nearly doubled in size mainly due to the expansion of the frontal lobes the area of the brain most importantly responsible for cognition and awareness.
As our brains have grown they have developed a huge capacity for social learning, which almost certainly accelerated human advancement compared to other species. Learning comes not from personal experience alone. Learning comes most rapidly by watching and copying others. These social learning experiences have helped provoke the awakening of primal fears as well as helping to soothe them. If you see someone react with fear you do too. This explains social contagion which is the reason why anxiety spreads so quickly in a group. Our brains now have developed both intrinsic and socially learned reactions to fear.
Our enlarged frontal cortex gives us the dubious privilege of experiencing something and simultaneously being aware what we are experiencing. Our brains have the capacity now to produce an infinite number of fantasies. Our increasingly wild imaginations amplify our fears which become fantasies projected forwards into the future and backwards into the past. Catastrophic fears become inflated in direct relationship to our ability to indulge in hyper-charged fantasy. We have our dreams, but we have our horrors too.
Anxiety is generally divided into two components. The first component is awareness of the body’s physical reaction in response to fear. These experiences of palpitations, sweating, shaking, tremors, dizziness, feeling faint, nausea and diarrhoea are generally very unpleasant and frightening and can come on gradually or suddenly. The second component in anxiety is the awareness of this awareness. This produces recurringly intrusive thoughts and feelings of worry and apprehension. The thoughts become incessant as do the feelings that accompany them. Anxiety sufferers are tortured by these thoughts and feel trapped and helpless.
Most who have studied anxiety historically have related it to a condition that became known as neurosis now often referred to as anxiety-neurosis. Neurosis was a term coined by Dr William Cullen a professor of medicine in Edinburgh in 1769 who believed it to be a neurological disorder. He described it as “affections of sense and motion” depending on “a more general affection of the nervous system”. Over the next century the term became associated with a less serious milder affliction called ‘nervous sensibility’ and thought largely to be the result of an overactive imagination, hence taking on a pejorative tone. In 1811 a book written anonymously and called Sense and Sensibility portrayed two protagonists Elinor and Marianne Dashwood as representing sense and (nervous) sensibility respectively. Initially the author appeared to favour sense but as the work progressed interestingly began to waver in favour of sensibility. Freud nearly a century later moved neurosis into contemporary psychiatry making it a term for types of behaviour induced by unconscious psychological conflict and utilised in order to avoid the pain of anxiety. People began to understand finally what was so self-evident initially namely that anxiety neurosis was a disabling and very real condition.
Anxiety is a great mimic, a great pretender, a great liar and a grand manipulator. It creeps up behind you and before you know it you are overwhelmed and helplessly in its power. Many people are terrified of anxiety as they are only aware of it after it has taken over their lives. A patient once described his anxiety attacks to me as being his "Incredible Hulk". “Suddenly before I am aware of it my anxiety takes over. The blood-red anxiety demon, engulfs me with emotion. The emotion rushes into my body and I begin to swell uncontrollably. It rushes into my head. I cannot think clearly. I lose control of my emotions. I panic. I shout. I say embarrassing things. I get angry. I am suddenly this out-of-control monster. I think of warning people, “Don’t make me anxious! You won’t like me when I am anxious!” Before I know it though, the red monster is out in the room running amok. And then afterwards I am left to deal with what follows, the guilt, the destruction and then the insufferable shame and embarrassment. I slink away sheepishly into the night with my self-respect in shreds”.
When we are insufficiently involved in what we are doing in our life we begin to think excessively. Then we begin to trigger emotions with these thoughts. These emotions drive us into a spiral of further loosely connected thought patterns every thought amplifying the emotionality of the past thought leading to a greater stream of thoughts which in turn greatly increases the emotionality. Eventually as in acute anxiety this process raises the emotional tone to a level that we find difficult to tolerate. To protect itself the brain divides our consciousness into separate parts a process known as dissociation. Troublesome reality is conveniently locked away in the safe of unconsciousness. We can then abide in relative calmness. This contrived consciousness often exists in ignorance of the other. Denial of reality keeps one in a happy blissful state.
When our integrating functions are not working well dissociation becomes an everyday event. It occurs so often that most of us are unaware of it. Routinely anxiety sufferers will go into a kind of day-dream or reverie while wandering around the supermarket or having a shower. They don’t notice doing it. It is the reason why so many anxious people appear socially distant, uninvolved and in a world of their own. They really do live in a dissociated world different from the one shared by others.
AGNOSIA
Agnosia is a neurological term not found in general psychiatric usage. The word comes from the Greek ‘a’ meaning without and ‘gnosis’ meaning knowledge. The neurologist who coined this term in 1891 was a little-known Jewish neurologist from Austria known as Sigmund Freud. His main claim to fame at the time would have been that due to the racism inherent in Viennese and Austrian society he was barred from becoming a professor in Neurology and was consigned to the murky depths of a hitherto unknown psychiatric discipline called psycho-analysis.
Agnosia means not knowing and in a psychiatric context reflects in anxiety sufferers a degree of quasi-not knowing which is as fascinating as it is ubiquitous. Anxiety sufferers appear handicapped by an inability to comprehend the realities of life even in the presence of numerous of cognitive and emotional pointers. To simply label this as lacking in intellectual or emotional intelligence I believe is misleading given that anxiety sufferers in isolation are often hugely competent in both spheres. It is more accurate to suggest that fluctuating levels of anxiety restrict this cognitive and emotional competence in specific situations. It seems reasonable to propose that the difficulty lies in relating the two competencies of cognition and emotion and coming to what most people would consider reasonable conclusions. It is in establishing a balanced and effective relationship between cognition and emotion that they appear most at sea. This is reflected in their seeming difficulty in interpreting and understanding the meaning of inter-personal interactions and initiating appropriate inter-social behavioural actions. The problems appear to relate as much to faulty cognitive interpretation and lack of flexibility as much as emotional and social misfiring. The extent of this faulty mechanism however only becomes evident when anxiety levels are raised to a specific level. This explains why people with anxiety often suffer with such swings of performance almost entirely independent of actual ability.
Anxiety often exhibits itself in the social phobia that is so often passed off as being normal adolescent shyness and simply ignored. This can however leave people with a social incompetence that follows them doggedly through the rest of their life. The fact that no-one recognised it as a problem or bothered to help them leaves them at the mercy of an anxiety that is relentlessly present in every social moment. Those of us who have had the misfortune of attending boarding school might have keener recollections of what this is like. This is not however just an emotional failure although that aspect is most often the focus of intervention. What is ill appreciated is that not understanding social interaction is as much a cognitive failure as an emotional one. If you ask anyone with significant anxiety to explain cognitively what they fail to grasp, even highly intelligent and verbal people are at a loss to come up with any coherent theory or supposition. In other words they simply do not know. They are agnostic and what is more their demonstrated agnosticism is a hallmark of anxiety. Very few anxiety sufferers fail the test of agnosticism. On the other hand a great many people involved in the treatment of psychiatric patients fail the test of recognising agnosticism. One could almost argue it is a case of anxietism, an unconscious bias against the recognition of the ubiquitous handicaps that anxiety produces. Recognising how severe a handicap anxiety is to a sufferer is often a blind-spot to those who should see it most clearly. One could speculate that this may be because of an insufficient intimacy with their own experiences of anxiety. Quite often one suspects it is a function of an awareness significantly compromised by personal denial.
Agnosticism in anxiety is simply not knowing and consequently not understanding life experiences. Often though sufferers do not know that they do not know and equally often do not understand that they do not understand which in psychiatric terms represents a failure of insight. Perhaps though more accurately it is a simple lack of awareness of the depth of their agnosia and the profundity of its significance in directing their lives.
AGNOSIA
Agnosia is a neurological term not found in general psychiatric usage. The word comes from the Greek ‘a’ meaning without and ‘gnosis’ meaning knowledge. The neurologist who coined this term in 1891 was a little-known Jewish neurologist from Austria known as Sigmund Freud. His main claim to fame at the time would have been that due to the racism inherent in Viennese and Austrian society he was barred from becoming a professor in Neurology and was consigned to the murky depths of a hitherto unknown psychiatric discipline called psycho-analysis.
Agnosia means not knowing and in a psychiatric context reflects in anxiety sufferers a degree of quasi-not knowing which is as fascinating as it is ubiquitous. Anxiety sufferers appear handicapped by an inability to comprehend the realities of life even in the presence of numerous of cognitive and emotional pointers. To simply label this as lacking in intellectual or emotional intelligence I believe is misleading given that anxiety sufferers in isolation are often hugely competent in both spheres. It is more accurate to suggest that fluctuating levels of anxiety restrict this cognitive and emotional competence in specific situations. It seems reasonable to propose that the difficulty lies in relating the two competencies of cognition and emotion and coming to what most people would consider reasonable conclusions. It is in establishing a balanced and effective relationship between cognition and emotion that they appear most at sea. This is reflected in their seeming difficulty in interpreting and understanding the meaning of inter-personal interactions and initiating appropriate inter-social behavioural actions. The problems appear to relate as much to faulty cognitive interpretation and lack of flexibility as much as emotional and social misfiring. The extent of this faulty mechanism however only becomes evident when anxiety levels are raised to a specific level. This explains why people with anxiety often suffer with such swings of performance almost entirely independent of actual ability.
Anxiety often exhibits itself in the social phobia that is so often passed off as being normal adolescent shyness and simply ignored. This can however leave people with a social incompetence that follows them doggedly through the rest of their life. The fact that no-one recognised it as a problem or bothered to help them leaves them at the mercy of an anxiety that is relentlessly present in every social moment. Those of us who have had the misfortune of attending boarding school might have keener recollections of what this is like. This is not however just an emotional failure although that aspect is most often the focus of intervention. What is ill appreciated is that not understanding social interaction is as much a cognitive failure as an emotional one. If you ask anyone with significant anxiety to explain cognitively what they fail to grasp, even highly intelligent and verbal people are at a loss to come up with any coherent theory or supposition. In other words they simply do not know. They are agnostic and what is more their demonstrated agnosticism is a hallmark of anxiety. Very few anxiety sufferers fail the test of agnosticism. On the other hand a great many people involved in the treatment of psychiatric patients fail the test of recognising agnosticism. One could almost argue it is a case of anxietism, an unconscious bias against the recognition of the ubiquitous handicaps that anxiety produces. Recognising how severe a handicap anxiety is to a sufferer is often a blind-spot to those who should see it most clearly. One could speculate that this may be because of an insufficient intimacy with their own experiences of anxiety. Quite often one suspects it is a function of an awareness significantly compromised by personal denial.
Agnosticism in anxiety is simply not knowing and consequently not understanding life experiences. Often though sufferers do not know that they do not know and equally often do not understand that they do not understand which in psychiatric terms represents a failure of insight. Perhaps though more accurately it is a simple lack of awareness of the depth of their agnosia and the profundity of its significance in directing their lives.
TWO BRAINS / TWO VIEWS
In general in the western inspired world we tend to follow a model of interaction that is mainly cognitive, logical, rational and coherent. In reality this model only works some of the time. This is because it is a unitarily biased theory not in accord with the actual functioning of our brain. It is a fantasy created by one part of the brain. The fact that we have other parts of our brain giving us quite different messages have within this framework largely been ignored. One only has to have a quick scan of global events today to discover how out of touch such a rationalistic view is.
Neuroscientists might argue about the reasons behind this but the reality of human life is that we have different often conflicting views on almost everything we say or do. We arbitrarily choose one path all the time agonising about an alternative path. We always have two views. We often deny this reality as it helps reduce our anxiety in relation to this inherent confusion.
This is partly a function of our enlarged frontal lobes which allows us to perceive what we perceive and therefore have confounding views about it. We want to eat sweet things but we don’t want to put on weight. Which path should we choose? To eat or not to eat is certainly a question.
Neuroscience has moved away from specific functions being attributed to definitive brain areas. We now talk about different brain systems interacting with each other. This sounds at one level like we are making significant headway. One could with justification suggest that these systems of the brain compete with each other for attention and that these competing systems give us conflicting views on everything we do. We then make a choice based on a long line of predisposing elements including genetics, environmental factors and socio-cultural influences. Two views of necessity produce conflict and that conflict is the origin of anxiety. Anxiety by definition wants a singular simple view not a complexly nuanced one, not because this represents truth but because it is a convenient way of avoiding psychological pain. Most commonly in anxiety as in war truth is the first casualty.
Effective action in life however requires accurate perception of reality combined with clear understanding of personal and social bias skewing this perception. Understanding the reality of how our brains function means recognition that our brains are often unhelpful in our deliberations given they give us confounding viewpoints. A world-famous professor of psychiatry once said to me, “Remember only one thing. Do not believe what you think”. In other words what your brain tells you is one point of view but there are many others. One of them may represent the truth. In fact however it may not...and so we end up back where we started..in the world of agnosia.
THE HISTORICAL BUDDHA
As a result of my work in psychiatry combined with my endeavours in Thailand I have naturally developed an interest in Buddhism. To be fair there probably are very few psychotherapists in the world who do not have at least a passing acquaintance with Buddhist philosophy.
To a psychiatrist particularly and in medicine generally history is the fundamental building block of clinical practice. A patient’s history is what diagnosis and treatment is based upon. Without a history there is in fact no medicine. Having said that we live in an increasingly ahistoric age. Once the world was flat. Today increasingly we have no history. We have a present and we have a fantasied technological future. But we have no history or certainly any history of relevance. The past is truly dodo-like.
As a psychiatrist this I refuse to believe. Understanding something of our historical past we begin to understand our present and are able to an extent begin to contemplate realistically what the future might involve. Looking at Buddha's history might help us come to know something of what the real man thought and felt when he produced the most effective therapy for anxiety that the world has ever known. Two thousand five hundred years later it remains as a mode of treatment unsurpassed.
An entirely relevant criticism would be that any history of Buddha the actual man has to be clouded in a great deal of mythological speculation. This is undoubtedly true. I believe nevertheless that whatever information we can glean about him is going to be of some use in assessment of his actual life and work. The basis of karma is that nothing comes from nothing and that is something I am particularly prepared to believe more so perhaps because it is my own personal experience of life.
As a result of my work in psychiatry combined with my endeavours in Thailand I have naturally developed an interest in Buddhism. To be fair there probably are very few psychotherapists in the world who do not have at least a passing acquaintance with Buddhist philosophy.
To a psychiatrist particularly and in medicine generally history is the fundamental building block of clinical practice. A patient’s history is what diagnosis and treatment is based upon. Without a history there is in fact no medicine. Having said that we live in an increasingly ahistoric age. Once the world was flat. Today increasingly we have no history. We have a present and we have a fantasied technological future. But we have no history or certainly any history of relevance. The past is truly dodo-like.
As a psychiatrist this I refuse to believe. Understanding something of our historical past we begin to understand our present and are able to an extent begin to contemplate realistically what the future might involve. Looking at Buddha's history might help us come to know something of what the real man thought and felt when he produced the most effective therapy for anxiety that the world has ever known. Two thousand five hundred years later it remains as a mode of treatment unsurpassed.
An entirely relevant criticism would be that any history of Buddha the actual man has to be clouded in a great deal of mythological speculation. This is undoubtedly true. I believe nevertheless that whatever information we can glean about him is going to be of some use in assessment of his actual life and work. The basis of karma is that nothing comes from nothing and that is something I am particularly prepared to believe more so perhaps because it is my own personal experience of life.
GAUTAMA BUDDHA AND NEUROSIS
The history of Gautama as far as we can ascertain it with any certainty gives a significant amount of admittedly indirect evidence of a man riven by internal psychological conflict, anxiety and obsessional perfectionism. Within the context of neurotic anxiety as defined by Freud he would certainly have been diagnosed as such. It is difficult to argue against the fact that most psychiatrists if presented by a person exhibiting his symptoms today would diagnose that person as having an anxiety disorder. He would also be considered as showing signs and symptoms of dysthymia and obsessionality. One could speculate theoretically that had he been in a position to be treated by contemporary psychiatry perhaps Buddhism would never have eventuated.
Given that anxiety disorders probably in reality affect something like one in three people in the current era it is a particularly common disorder. It therefore is probably not saying much to speculate that Gautama was also a sufferer. The fact that we might question it relates more to an idealisation of Gautama rather than anything to do with actual historical reality.
The stigmatisation of psychiatric illnesses makes us reluctant to accept that psychiatric disorders really do affect so many of those living around us now in the present as well as those who lived in the past. Psychiatric disorders have always been around. They have greatly influenced the lives of humans both heroic and prosaic throughout the seemingly timeless eternity that represents our consciousness of human existence.
The history of Gautama as far as we can ascertain it with any certainty gives a significant amount of admittedly indirect evidence of a man riven by internal psychological conflict, anxiety and obsessional perfectionism. Within the context of neurotic anxiety as defined by Freud he would certainly have been diagnosed as such. It is difficult to argue against the fact that most psychiatrists if presented by a person exhibiting his symptoms today would diagnose that person as having an anxiety disorder. He would also be considered as showing signs and symptoms of dysthymia and obsessionality. One could speculate theoretically that had he been in a position to be treated by contemporary psychiatry perhaps Buddhism would never have eventuated.
Given that anxiety disorders probably in reality affect something like one in three people in the current era it is a particularly common disorder. It therefore is probably not saying much to speculate that Gautama was also a sufferer. The fact that we might question it relates more to an idealisation of Gautama rather than anything to do with actual historical reality.
The stigmatisation of psychiatric illnesses makes us reluctant to accept that psychiatric disorders really do affect so many of those living around us now in the present as well as those who lived in the past. Psychiatric disorders have always been around. They have greatly influenced the lives of humans both heroic and prosaic throughout the seemingly timeless eternity that represents our consciousness of human existence.
AUTHENTICITY
A shaky foundation is one of the primary reasons that anxiety becomes a permanent inhabitant of the psychological home one calls self. Authenticity is one of the main building blocks holding up the foundations of the self. Take it away and we get what psychiatrists would term vulnerability.
Authenticity in the anxious mind relates to truth and by this I mean a truth that one can depend and rely upon, not one that is evanescent and malleable. Too many of us have lived with malleable and changeable truth. Such shifting sands are no place for psychological stability. This is not a reliable basis for the development of trust and security in one’s own self or in selves of others in society.
Early attachment is also a fundamental building block in the foundation of self. Absence of secure attachment is probably the most fundamental pathological element of dysfunctional anxiety.
In consideration of the treatment of anxiety re-stabilisation of these foundational elements is a necessity, a sine qua non without which balanced and peaceful existence is simply not possible. Rebuilding and restructuring some of these foundations is where therapy must begin.
Living an authentic existence life helps in the development of a foundation for a meaningful life. Upon this a more secure form of self can be developed. This will be a self that can be trusted. It is a self in which one can have faith. Ultimately this is a way that leads to a greater prevalence of peace tranquillity and balance in a life authentically lived.
A shaky foundation is one of the primary reasons that anxiety becomes a permanent inhabitant of the psychological home one calls self. Authenticity is one of the main building blocks holding up the foundations of the self. Take it away and we get what psychiatrists would term vulnerability.
Authenticity in the anxious mind relates to truth and by this I mean a truth that one can depend and rely upon, not one that is evanescent and malleable. Too many of us have lived with malleable and changeable truth. Such shifting sands are no place for psychological stability. This is not a reliable basis for the development of trust and security in one’s own self or in selves of others in society.
Early attachment is also a fundamental building block in the foundation of self. Absence of secure attachment is probably the most fundamental pathological element of dysfunctional anxiety.
In consideration of the treatment of anxiety re-stabilisation of these foundational elements is a necessity, a sine qua non without which balanced and peaceful existence is simply not possible. Rebuilding and restructuring some of these foundations is where therapy must begin.
Living an authentic existence life helps in the development of a foundation for a meaningful life. Upon this a more secure form of self can be developed. This will be a self that can be trusted. It is a self in which one can have faith. Ultimately this is a way that leads to a greater prevalence of peace tranquillity and balance in a life authentically lived.