Filed under: Mental health | Tags: fear, freedom, generalized anxiety disorder, pantophobia
I have recently become obsessed with the idea of ‘pantophobia’.
Pantophobia (sometimes called panophobia) is the fear of everything. ‘Panto’ is from the Greek to mean ‘all’.
In a recent post I included this picture.
This picture was originally featured in a book called ‘The physiognomy of mental diseases’ (1840) compiled by Alexander Morison. The picture was labelled with the following description:
“Portrait of a female in whom delusive fear of every object and person, pan[t]aphobia, keeps her in a state of perpetual distress.”
A ‘delusive’ fear of every object and person. The idea intrigued me. How is it possible to fear everything? A fear so total – a fear that includes objects, persons, animals, vegetation, earth. How can a phobia be sustained to all these elements all at the same time?
Pantophobia is not a term used nowadays, now we have generalised anxiety disorder. NHS direct describes generalised anxiety disorder (GAD) as thus:
GAD is a long-term condition which causes you to feel anxious about a wide range of situations and issues, rather than one specific event.
People with GAD feel anxious most days and often struggle to remember the last time they felt relaxed. GAD can cause both psychological (mental) and physical symptoms. These vary from person to person, but can include feeling irritable or worried and having trouble concentrating or sleeping.
GAD, like pantophobia, is a non-specific fear. What characterises pantophobia and GAD as pathological is their constant, never-ending nature. Pantophobia “keeps her in a state of perpetual distress”. GAD is diagnosed “when your worrying is uncontrollable”, and – because modern medicine requires time limits for determing the line between normality and abnormality – when “you have felt worried nearly every day for at least six months”.
This is a phobia that is not directed toward anything in particular but which may attach itself to any and numerous objects or elements haphazardly and inconsistently. This fear has no cause, no origin and no end.
Listening to a lecture by John Gray on the modern desire for immortality (again at the wondrous LSE) added a new dimension on the treatment and understanding of death and dying in modern society. Many scholars have written on the ‘sequestration‘ of death from modern life and the way mourning has becoming increasingly privatized. What was interesting in Gray’s analysis was his exploration of the rise and predominance of the theory of evolution in scientific thought and the role it played in repressing a more contingent and haphazard understanding of the universe. Evolution became associated with progress and improvement.
In an increasingly secular society, science acted in similar ways as religion by providing a narrative that endowed human lives with a larger meaning with laws and explanations that once again protected against disruptive notions such as no afterlife – eventhough this may have not been the original intention of Darwin et. al.
Meaning can be disrupted by the occurrence of events that appear illogical – bereavement or illness are commonplace examples. It is normal we are told to experience anxiety or fear following these events. But only as long as it is transitory. If we recover from illness, stop mourning and resolve our fears and anxieties – meaning is preserved. This is important because if we do not recover we remain in fear. We remain in meaninglessness, in a contingent universe where we have no control. If we return to what we were before, meaning is once again reinstated, it may even have been reinforced by the experience of meaninglessness.
It is possible to recover when the individual maintains that nothing is lost. If we believe that when others die we do not lose ourselves, we do not lose the other person either. Therefore, despite the fact humans die, WE, that is to say humankind, lives on.
But what if this disruption was not a transitory state but it was a perpetual and permanent condition of existence. Pantophobia is the perfect illustration of the meaninglessness that we try to escape from. Without meaning there is everything to fear. Without meaning everything is lost continually and without reason. There is no cause to pantophobia because it is not directed at anything. It cannot be redirected because it has no aim, it is at once all-encompassing and intangible – existing everywhere and nowhere.
Similiarly for GAD the NHS Direct website admits:
As with most conditions that affect mental health, the exact cause of generalised anxiety disorder (GAD) is not fully understood. Some people develop the condition for no apparent reason.
There is no cause but there are descriptions and definitions, and portraits that reveal a physiognomy, and CBT, and a plentitude of medications. There is a persistent striving to both define and remedy a phenomenon by means that are incapable of comprehending its dimensions. Like the picture above, these illustrations reflect only a poor fragment of what pantophobia is.
In 1840 diagnosis was conducted on the basis of physiognomy, on facial characteristics. Now we have lists of ambiguous symptoms and CBT that rearranges thoughts. The ultimate aim however has remained the same. Identification, categorization and treatment of an unknown and socially constructed problem that requires silencing in order for normal life to continue (that is to say, evolve).
What do we lose by striving to resolve these conditions with superficial remedies? What do we lose by attempting to define the intangible and ambiguous in definite (medical, scientific, Western, etc, etc) narratives? In this narrative of progress, of self-improvement, of the continual desire for better; whose voices are being pathologised?; what are we labelling with medical diagnosis?
We do not have to continue the search for a better definition. We do not have to seek causes or identify symptoms. The alternative does not have to be a choice between pantophobia or happiness.
It is an alternative in which uncomfortable feelings, anxieties are embraced as valid and real alongside the spectrum of human emotions. It is an alternative which accepts the resistance of fears and anxieties to language, that accepts their intangibility. It is an alternative in which meaninglessness exists. An alternative which is not always full of aims or possesses a direction. It is an alternative in which we give up the idea we as humans have ultimate control of our own lives, and the lives of others.
The alternative may not be a comfortable one, it is not always a happy one. It does not promise a happy ending.
But if we live within our fears rather than attack them what other ways of being can we discover?
Perhaps something resembling freedom?
Filed under: Mental health | Tags: depression, melancholy, Wellcome Library, women
A wander into the Wellcome Library’s rather great archives uncovered these stirring images…
A portrait of “Georgina W.”. She was a domestic servant who had been admitted to the Royal Edinburgh Asylum, Morningside, in 1864, when she was aged twenty years. She was transferred in 1886 to the Craiglockhart Poorhouse, and the portrait was made when she was aged 46 years, in 1890.
“Portrait of a female in whom delusive fear of every object and person, pan[t]aphobia, keeps her in a state of perpetual distress. It is necessary to watch her closely to prevent her committing suicide”.
More details on the images here.
Filed under: Happiness | Tags: attention, behavioural economics, happiness, Howard Davies, LSE, Paul Dolan
This week I attended a lecture at the LSE entitled ‘Absolute beginners: Behavioural economics and human happiness‘ given with a certain car salesman charm by the slightly slimy Professor Paul Dolan. Thinking about it now I am not sure whether I have ever felt quite so alone as I did that Tuesday evening. As Howard Davies, who was chairing the event, cracked bad jokes and the numerous suited grey-haired or poncy-haired men around me guffawed in response I felt for the first time a deep soldarity with the unwashed dishevelled looking types at Goldsmiths, not to mention the reawakening of my contempt for Davies. But my discontent was something more than that. I will attempt to document here the distinct bad taste I was left with after my visit to LSE (a distaste caused only partially by my envy of the fancy interior of the New Academic Building).
Paul Dolan is an advisor to the current government and one of the Mindspace team that are responsible for introducing the idea of behavioural economics into policy. Dolan’s lecture encapsulated the recent themes and ideas that have been propagated recently; the role of nudges and incentives; the fact that people don’t do the ‘right’ things and the findings of positive psychology and the happiness ‘data’. He introduced a new theme as well however, namely the importance of attention in understanding individual behaviour. Essentially Dolan was arguing that where attention is drawn affects the judgements a person will make. When we are asked to reflect on something it becomes ruined, or becomes a distorted version of the ‘truth’. This causes problems and can explain why we are ‘prone’, in Dolan’s words, to making mistakes about happiness. This is because when we imagine the outcome of a decision, to give up smoking for example, it may seem hideous and frightening but afterwards Dolan says we realize the reality was not as bad. But we avoid making these ‘right’ choices because of what we imagine may happen.
Our attention is therefore is not allocated properly. Dolan goes further to state that attention is either voluntary or involuntary and that us humans are largely driven by involuntary attention. This involuntary attention is an unconscious response and outside of our control. Therefore when we make a decision we often think we construct a rationale before making a choice, but instead in Dolan’s opinion we make an unconscious decision and then rationalize afterward with an explanation that is actually at odds with the subconscious reasoning behind our choice. This subconscious decision is the ‘real’ behaviour as it were and Dolan et. al. (the government) are now trying to find ways to measure this ‘in the moment’ choice on deciding that what people say about their choices cannot be trusted.
What I find strange about this is less the verity of the argument concerning the process of decision-making but the usage of the subconscious in the understanding. Again the paradox emerges where on the one hand we see individual responses taken at face value in happiness studies (which inform a lot of this behaviour economics thinking), and the proliferation and championing of cognitive behavioural therapy, which rejects psychoanalysis and the subconscious and maintains a superficial understanding of the human psyche, and on the other an embracing of the role of the subconscious in decision-making. Now this selective usage of the subconscious is nothing new. We only need to think back to the ways in which Freud’s ideas were picked up and then utilized by heads of marketing and advertising and politicians (as illustrated so brilliantly by Adam Curtis in the Century of the Self). Both then and now the ideas were taken not for the emancipatory tool they had the possibility of being but as a new technique to manipulate the masses. The aim of exploring subconscious drives is not to understand where they come from, what they do, how they are constructed, but rather to find out how these involuntary attentions can be redirected. Yet something far more pernicious is occuring now for these actions are being spoken out in public. As Dolan spoke about the aims to re-orientate our desires a packed lecture (people had to be turned away) applauded – whereas I felt we had officially reached the End Times. For now this manipulation is being undertaken under the guise of ‘for your happiness’ or to increase your well-being. Happiness is beyond reproach, an unquestionably good endeavour, right?
But scratch a little beneath the surface and it is not hard to discover the foundations of this happiness agenda – simply economics. Unhappy people are expensive and they increase unemployment. This is the reason behind IAPT (Improving Access to Psychological Therapies) which emerged following the finding that countries with high GDP aren’t necessarily happier. The move in positive psychology appeared as a happy coincidence as suddenly all this data emerged to say that what people think they want (money) doesn’t make them happy. IAPT with its deliverance of nationwide time-efficient CBT was then created in order to remedy the increasing depression rates that now were a cause not of lack of wealth or socio-economic status but simply maladaptive thinking. This was also a convenient solution for the government as it would resolve the problem of unemployment and demands on health services without having to change the structures of an unequal society.
This is even more apparent in the new developments in IAPT where clients/patients are provided with employment advisors. The intention has never been so clear, a report declares unemployment makes people depressed so therefore lets get them back into work asap. But what about considering why people may become ‘depressed’ when they are unemployed? Because they live in a society with a high precedence and value on being employed and a disgust of those who do not work perhaps? Even the language – you are ‘un’ employed, you are defined positively or negatively by employment, to have a job is not be ‘un’ leisurely for example.
So whether it is to get us to get a job, or give up smoking or recycle more the strategies used by the government are designed to reorient our thoughts not only on a conscious level but also it would seem now on a subconscious level.
This new approach is once again reshaping the common conception of subjectivity. There has been a move from taking an individuals account or reporting of their own lives without question, and holding up the subjective account as the most valuable claim on experience, to claiming that what people say they want is at odds with their true desires. In the hands of politicians this seems a troubling situation as the presupposition that there is a ‘true’ unconscious drive behind our each choice or act, and further that our drives are always bad or deviant or uncontrollable, grants the powers-that-be the permission to harness this abnormality and remould it towards the ‘appropriate’ goals that suit their ends, i.e. creating an easily malleable population.
Conscious thoughts are undermined or are viewed as unnecessary in this understanding of the subject. When we are consumed by something or pay it too much attention we are allowing thoughts to take on different proportions or more importance than should be attributed to them. This is also classic CBT speak, in which thoughts are labelled irrational or logical. Depression for example is a result of a consumed mind according to Dolan. A mind consumed with depression leads to poor judgement, as do wandering minds. A recent study in Science claimed ‘ a wandering mind is an unhappy mind’. The article presented research that claimed the people reported to be less happy when they were thinking about things other than what they were doing in the present. Instead of considering the fleeting, contingency of thoughts or the importance of uncomfortable thoughts, thinking at all, other than about the act you are undertaking is apparently problematic because it may produce a feeling of being less than ecstatic.
Too much thinking is a bad thing. It would be best it seems to now stop thinking altogether and just let the government through its nudges and incentives do it for you.
P.S. Dear Howard Davies if you are still Director of LSE/alive in three years time please find it in your heart to forget the bellend comment above and please, please, please give me a lecturing post, regards.
It was when a friend suggested I take up knitting that I wondered how I had sunk so low. The suggestion was well intentioned; an attempt to make me feel better, to help me overcome my respective problem(s). Yet such an idea left me feeling a great deal of inadequacy. As my friend was providing me with these suggestions – knitting, jogging, all things I would never consider – I questioned why I lacked the ability to resolve my various unnamed ‘problems’ by undertaking these simple activities. I had planned to write a critique of the popularity of mindfulness describing it as a form of brainwashing, but as I considered the part I played in the construction of my own difficulties I questioned whether I could even attempt to criticize something that perhaps I should be undertaking myself.
Mindfulness is currently the popular answer to achieving a sense of well-being. Even the Guardian with its ‘Start Happy‘ campaign is producing mindfulness podcasts and tips on how to incorporate mindfulness in your life. Mindfulness, is in essence a form of meditation. It is as the many new proponents claim, a way to slow down and take a moment out from the fast paced lives we are apparently all consumed in and acknowledge our thoughts, our bodies, our emotions. The mindfulness approach can assist in cultivating an objective stance to our thoughts, identifying the irrational thoughts from the rational which can help ease anxiety and stress.
Anxiety is viewed as an increasing concern blighting the population. Anxiety, a response to danger, has become a futile emotion in our contemporary lives where (generally speaking) there is little threat of danger. Anxiety is only experienced as a result of imagined threats rather than being a reasonable reaction. Mindfulness is thus considered a useful technique for anxious, stressed souls, allowing them to acknowledge the unreality of their thoughts.
Yet mindfulness soon begins to wade muddy waters. Mindfulness, similarly to cognitive behavioural therapy posits that all thoughts are just thoughts. Though if we say thoughts are just thoughts what are we saying? Thoughts do not do things? Thoughts are somehow not true? Or less true than a reality we can see and touch? If a thought is not acted upon, spoken, performed, does it not matter/exist in the same way? Further to be mindful is to recognize thoughts without judgement, yet it also involves the ability to be judicious in distinguishing between distorted thoughts and logical thoughts. But by which criteria are we judging the rationality of these thoughts?
This is a question of abnormality or normality, a question determined by the criterion established by the particular historical and social epoch in which we live. It is the societal discourses and norms that deem behaviours and thoughts as abnormal or pathological; a thought can not be inherently “wrong”. These behaviours and thoughts I have always contended would be better considered simply as part of the human condition, and not something that requires a resolution.
Whether it be mindfulness or knitting I have always considered these suggestions as a way to escape, as opposed to exploring problems. Furthermore my feelings of frustration at being given these suggestions is the implied comment of, ‘Look at all these things you can do, you have no excuse!’. The onus is always on the individual, on the individual’s actions and behaviours and incorrect thoughts. But what if the fault is not with individual but with a society that frames their behaviours as illogical. What if anxiety was not an imaginary, useless pattern of behaviour but it was a form of resistance against some deeper discontent. Anxiety may be the symptom for an issue that can not be belittled or avoided but seeks understanding.
In principle meditation allows this exploration. I would also agree to an extent mindfulness is proposing this, particularly through the idea of decentring the self. Decentring the self in mindfulness practice enables the development of an objective perspective on ones own life. Yet would it not be best to reject objectivity and subjectivity in the process of decentralization. Decentring the self is a critical standpoint. A vigilance. It allows enquiry. It is a coming undone. It is an uncomfortable and an unhappy process – even proponents of mindfulness I am sure would agree with me on this point.
If we develop vigilance to our own thoughts and tendencies and explore their origins, many things can emerge. Mindfulness and cognitive behavioural therapy seem to assume a superficial understanding of the human psyche paying little attention to the concept of the subconscious. But how can we interpret the rationality of the ingrained nature of memories, or of our often bizarre and mysterious dreams? These cannot be glossed over by changing behaviours or smothered with new thoughts. These quick-fix methods argue they are evidence based but as the rates of depression, anxiety and stress increase it is hard to see whether the effectiveness of these approaches are sustainable.
In some respects this is beside the point for the problem is not the apparent increase of these disorders but the categorizing (and creation) of these disorders. In mindfulness we can only learn how to accept things as they are but not question them. Until we realize ‘no recovery’ as a possibility – and not only as another strategy on the road to recovery – but as an absolute outcome, we risk fostering a false ideal of happiness. As Jacques Lacan stated in discussion of the therapy situation:
To make oneself the guarantor of the possibility that a subject will in some way be able to find happiness even in analysis is a form a fraud. (The ethics of psychoanalysis, 1992, p303)
Perhaps we will always hope for and desire happiness, but we must also accept our possible failure in the pursuit. The obligation to recover, to be well, to be happy, is the normative framework in contemporary society but it has come at the expense of the possibility of alternative ways. The question is not whether one sees the glass half full or half empty, but to reject having to choose one possibility that destroys the possibility of the other.
Instead if we accept the possibility of both, a possibility that is not necessarily always equal but contingent and haphazard, we can start to embrace the significance of irrational thoughts; of anxiety with no direct aim; of uncontrollable emotions; of mourning that goes on and on. With no quick fixes, no guarantees and without berating ourselves for failing or for our inadequacies, perhaps we can begin to explore ourselves and others; form resistance; find other ways of being, and realize knitting will not assist in the continual striving to transcend the double-bind.