by Tom Cutler
‘I’ve had what my wife thinks might have been a panic attack,’ I said, guardedly.
‘Are you an anxious person, would you say?’
I hadn’t really ever thought of myself as anxious — low mood, yes, but anxious people wrung their hands, jumped at noises, worried about everything, and suffered from what used to be called ‘their nerves’. I considered the idea. Maybe it would explain the constant tightness in my chest, the endless pacing up and down, my suppressed rage at a friend’s one-minute-late arrival for lunch.
‘I suppose I could be described as anxious, yes,’ I said, putting my answer in the passive voice so as to distance myself as far as possible from responsibility.
‘What makes you anxious?’
‘Being alive in the world,’ I replied. I got a genuine laugh in response. This is how I deflect threats, but I meant it. I’m sometimes accused of not taking things seriously. The opposite is true.
‘Does anything in particular make you anxious?’ asked Dr Sam.
‘Other people,’ I said.
No laugh. She was obviously rationed to one laugh per patient per appointment. Through the window I watched a small plane, which had just taken off from the airport, climbing silently over the river.
‘The ugly sisters of anxiety and depression are related,’ she explained, revolving a pencil between her fingers. ‘But they’re not the same thing. Panic attacks are a symptom of anxiety. They usually happen during the day, but they can also come at nighttime and wake you up. Because of the anxiety your brain is unusually alert, so it construes minor nocturnal changes in your body as signs of threat.’
The blue polymer mattress on which I’d been examined was covered with a sheet of papery material that had been creased as I got off it. I had a powerful urge to get up and smooth it out.
Dr Sam explained that there were things we could try for the low mood and the anxiety. There were antidepressants, but these might have side effects. We’d leave pills till we’d tried other options.
She looked at me over her glasses. ‘Do you know what cognitive behavioural therapy is?’
My heart sank. ‘Yes,’ I said. I knew CBT was a common and supposedly successful ‘talking therapy’.
‘Would you be willing to try that?’
I saw myself standing alone at the top of a hill, surveying a landscape of green meadows and chocolate-box cottages. Birds sang in the trees and dopamine flowed in tranquil streams, cheering the butterflies amongst the tussocks.
‘Would you be happy to try that?’ repeated Dr Sam.
I attempted to give the impression that I had been pondering the matter. ‘I’ll give it a go,’ I said. It seemed churlish to say no.
‘There is a waiting list of a few weeks to see a therapist, but I could refer you to an online CBT programme called SunBurst while you’re waiting to see a real live person. How does that sound?’
‘Online? It sounds implausible,’ I said ungratefully, ‘and commercial. But I’m miserable enough to try anything.’
And so I was sent on my way and told to stand by for news from the SunBurst people. I left the doctor’s and walked past the building-site where they are tearing down the hospital in which my son was born and putting up some new flats. I crossed the road by the old Red Lion, now a Tesco store with reversing lorries, and made my way back home along the edge of the park, where some children were chasing a pigeon with a bad foot.
I live in an old shipbuilding port on the south coast of England, and a sea fret was beginning to roll in over the town. Now and again, the low moan of a foghorn could be heard across the harbour. As I headed down towards the church at the end of my road, I noticed that the top of the tower was veiled in mist.
My way took me through the church yard, and I stopped as I sometimes do to look at the graves. I found myself at the burial place of Master Mariner Thomas Boyce, who died on 9 September 1881, aged 55. Disconcertingly, this was my own age. The grave was surmounted by an unusual stone. Carved into the shape of a pitched roof, it hugged the ground, its once bright masonry now grey and lichen-blotched. Twisted ropes snaked along its ridge and around the chiselled anchor that leant against its ‘gable end’. In lead:
ERECTED BY DANIEL DE PASS IN TESTIMONY OF HIS APPRECIATION OF THE UPRIGHT CHARACTER AND VALUED SERVICES OF CAPTAIN BOYCE DURING THE 33 YEARS HE WAS IN THE EMPLOY OF DE PASS & CO. OF CAPE TOWN.
What, I wondered, had the upright Thomas Boyce known of anxiety?
I wandered home, shut the door, and hung up my coat. I noticed that my bloated feeling had faded away. It had been worrying me for days but now it was gone. I thought about Dr Sam and her diagnosis. Was there something in it? In this age of instant news and instant noodles, so-called ‘talking therapy’ was surely nothing but the latest flavour of the month, wasn’t it? It wouldn’t help me to find out what was really needling me, would it? It was going to be a waste of everybody’s time. After the excitements of the night it all seemed a bit of a let-down.
But without my knowing it, something had already started to happen. Before long, a new light would be faded up on the dark backstage of my character and, with a bit of help, I would come to see that my panic attack had been long primed to explode. I was going to uncover the mystery of just what it was that for years had been souring my relationships; getting me into scrapes; winding my spring.
I put the kettle on.
*
Days passed; the sun came out; the rain came down. I remained steadily grey. Every morning I brushed my teeth. Every evening I brushed them again. Up and down. Up and down. Every Tuesday the bell ringers practised: a soothing sound. Lea was busy at work. Now and again I caught her looking at me. While I was waiting to hear from SunBurst I thought I would walk along to the library and read up on anxiety.
The word itself has been around since the early sixteenth century, but its use in English has become steadily more common since the 1960s. It comes from the Latin anxius (choke) and is related to angere (to torment), which is a parent also to ‘anger’, ‘anguish’, and ‘angst’, three other emotions with which I was familiar.
The definition of ‘anxiety’ in Oxford’s online dictionary is, ‘A feeling of worry, nervousness, or unease, typically about an imminent event or something with an uncertain outcome.’ If this was true, it wasn’t quite what I had. My unease was with me from the moment I woke up. There was no imminent event with an uncertain outcome. It was chronic.
Psychiatrists see anxiety as a nervous disorder characterised by excessive apprehension — not so much a condition in itself as a symptom of several other ailments. It comes in a variety of flavours, each of which expresses the feelings of inner turmoil in a different way. I flipped through the list I had made.
First on the cards was post-traumatic stress disorder. PTSD arises after a person has experienced a very frightening or dangerous crisis, such as a bad car crash, a violent personal attack, or military combat. This didn’t sound like me.
Next was a common form of anxiety called social anxiety disorder, or ‘social phobia’. A dread of social situations, more pronounced than shyness, it is an intense irrational fear of mixing with people or even of speaking on the phone. This struck a chord. I recalled something that I had forgotten from my early years, when I worked in publishing.
From time to time as a young man, while making a routine phone call to a print supplier, I would suddenly be struck dumb, unable to get out any sound beyond a croak. Frightened and embarrassed, I would replace the receiver and sit quiet for a few minutes to allow my trembling to subside. I couldn’t understand what was going on. The people I was speaking to were friendly, and in the unwritten social hierarchy of business relationships when I said ‘Jump!’ they were supposed to ask ‘How high?’ It was just that, for a reason I couldn’t grasp, I sometimes found the experience of speaking to them on the phone grossly threatening. It always came out of the blue and it was alway
s inexplicable and alarming. Once I had recovered from each puzzling episode, however, I paid it little attention, and over time I allowed myself to ‘forget’ that anything had ever happened.
For as long as I could recall, parties had also been difficult for me, provoking silent dread days ahead. I vividly remember at my own seventh birthday party watching the other children playing games and having fun, while I stood uncomprehending and resentful at the edge, with an invisible forcefield somehow separating me from them, unable to break in.
By the time I was being invited to parties during my teenage years — an infrequent occurrence — I had learned to pre-medicate myself with alcohol. I knew that a bottle of beer fifteen minutes before any kind of social gathering was enough to blunt the fear and make me more able to join in. Two bottles was even better.
In 2016, a team from University Hospital in Basel decided to test what everybody thought they already knew: that booze is a good social lubricant. They gave sixty healthy men and women a glass of beer each, either alcoholic or non-alcoholic. Then they waited. After a while, they administered mood and empathy tests to both groups.
The results were interesting. The desire to be with others in a happy, chatty, and open environment was greater in the alcohol group than in the non-alcohol group, but the effect was stronger in those who had shown higher social inhibitions to start off with. The alcohol drinkers were also quicker than the non-alcohol drinkers to recognise happiness among a variety of facial expressions, and they displayed more emotional empathy, particularly if they had shown less of it at the beginning.
These findings might explain why many anxious people drink alcohol, and why so many of them get into trouble with it.
Alcohol is a depressant which, paradoxically, makes you more lively and less anxious. But though it can oil the social wheels, it is a hard drug to manage because as well as relaxing your nerves it will also depress your vigilance so that you end up having too much. The American humorist James Thurber put it in a nutshell: ‘One is all right, two is too many, three is not enough.’
I mentally ticked the social anxiety box. This one was spot on. They were talking about me.
Another common complaint on the list was generalised anxiety disorder (GAD). GAD sufferers have an imbalance of mood regulators such as adrenaline and serotonin. They are anxious most of the time about a whole range of things, and often cannot remember when they last felt relaxed. Restless and worrisome, they suffer insomnia and palpitations. Should one anxiety pass, another is likely to take its place.
Here again was a condition I recognised.
All this was quite a surprise, not to say a revelation. Within a short time I had gone from being a man who was feeling a bit low, who believed anxiety to be a complaint of the fey, jumpy, and nervous, to being a classic case, having not one but two of the items on the menu.
Generalised anxiety disorder was, I learned, more likely to occur in those who have a close relative with the same thing, and this made me think. I wondered whether the anxiety, which I now recognised as a longstanding part of my makeup, might be inherited.
I thought about my parents and remembered my father at the seaside, when I was a boy. He would stand at the water’s edge as his children splashed about, watching us like a lifeguard. Every now and then he would shout an angry warning about the deadly dangers all around us. He was incredibly tense. At night if anyone got up to use the loo he would call out ‘Who’s that?!’, and walking across a bridge over the bypass his heart would race so much that he was prescribed pills. When my mother recently forgot to ring him from a family do that she had driven to, he paced up and down, beside himself with vague terror.
My mother herself is a tremendously anxious woman who will tremble and cry if one of her grown-up children is a few minutes late for a lunch appointment. I recall her telling me that the overwhelming atmosphere in her household as she was growing up was one of anxiety, which emanated, she said, from her own mother.
I don’t remember my grandmother as anxious. A Victorian lady of rather censorious demeanour, she seemed merely dour, terse, and aloof. Little did I then know that this is just how many people see me. Maybe it was in the genes.
There was plenty to get through on the subject of anxiety, but after a couple of weeks of hard graft I found myself a sort of amateur expert and felt I could hold my own when the cognitive behaviour therapy people got in touch.
I had no idea that I was barking up the wrong tree.
*
I was sitting at my desk when the phone rang. I have an office in the attic where I do my writing, and after my morning walk I ‘commute’ upstairs at about eight thirty. I am a disciplined writer, but I like the taut urgency of the deadline as it ratchets a notch nearer each day. Douglas Adams, who wrote The Hitchhiker’s Guide to the Galaxy, said he loved deadlines — he liked the whooshing noise they made as they flew past. That’s not me. I am conscientious. I never deliver late. It is part of my stickler personality.
I had been constructing a paragraph about the Turin Erotic Papyrus, a thousand-year-old illustrated document depicting some Ancient Egyptian men and women having a bit of an orgy. Apart from the drawings of their admirable gymnastics, the orgy scene contains many illustrations of musical instruments and, tellingly, wine vessels. It seemed to me that the way I was using alcohol to relax my stressful inhibitions before and during social occasions — the booze-and-schmooze idea — was not new. The Erotic Papyrus showed that the story of wine, women, and song was as old — older — than the pyramids.
My musing was cut short by the jangling of the phone.
‘Hello?!’
‘Is that Mr Thomas Cutler?’
Nobody calls me Thomas except my mother.
‘Who’s calling?’ I asked.
‘This is Paul Hattman … From Talk the Talk, the talking therapies service.’
It all came back to me: they had sent me an anonymous-looking letter a couple of days before, saying that I should expect a phone call, and stressing the care they took to protect clients’ privacy. It all seemed a bit cloak-and-dagger, and I wasn’t sure either, feeling the way I did, that ‘client’ was the right word. But I decided to be friendly.
‘Oh yes,’ I said, ‘I was expecting your call.’
Paul said that he was an ‘assistant trainee psychological wellbeing practitioner’. It sounded a bit of a mouthful. Was he qualified in anything, I wondered, and what did he actually do?
The way it worked, Paul explained, was that he would go through a questionnaire with me over the phone and would then pass on my responses to SunBurst. Before long I would be contacted by somebody who would explain how the cognitive behaviour therapy exercises on the website should be done and would then respond online to the ‘diary’ comments I would be making.
‘Okay,’ I said, ‘Shoot!’
I don’t know why I said ‘shoot’. Perhaps I thought it made me sound more dynamic than I felt.
Paul asked me several questions, which he was plainly reading off a list. There is a sort of fuzziness to communication when somebody is doing something else while you talk to them. I guessed Paul was keying my answers into some sort of online form. In the end he said he would sum up our discussion in a letter, and rang off.
The next couple of days continued as normal. It was a bitterly cold January and we were getting through the logs at a galloping rate. I was still waking early.
One morning, I looked down into the street from my office window. The pavement was silky with frost and a small icicle hung from the pediment over the door of Captain Henry Roberts’ former house, opposite. I imagined the handsome Roberts in his periwig and fancy breeches, meeting my gaze from his window, across the years. He had sailed on the HMS Discovery, making maps for Captain Cook, and died in the West Indies in 1796 after getting yellow fever. Like all of us, he had his problems. He was at the mercy of his anguish, his h
eartache, and the thousand natural shocks that flesh is heir to. Wasn’t I making too much of things? Shouldn’t I pull myself together?
The sound of the whistling postman snapped me out of it. Amongst the unasked-for catalogues was a letter from Paul ‘summarising’ our phone conversation. We had agreed, he said, that I ‘would benefit from an initial intervention of computerised cognitive behavioural work on SunBurst’. This surprised me.
‘We did not agree this,’ I replied in a letter. ‘Far from agreeing that I would benefit from CBT, I remain open-mindedly sceptical, which I regard as the rational way to approach anything untried, and something which may fail, and which does fail in some cases, though not in others.’
Pedantic as usual. I didn’t want to sound contrary, but we were off to a bad start. In any event, I got no reply to my letter. But I did soon get an email from someone called lulu.pickering at SunBurst explaining how their website worked and telling me to do a couple of exercises. Lulu would check in to the site a few days later, and weekly thereafter, guiding me through the online CBT forest.
The SunBurst site was busy and bright, illustrated with potato-print pictograms of men and women. Some of them had brown skin, others had white skin. On the ‘What we do’ page was a short introduction. This is what it said:
Our user-friendly flexible-access solution-delivery platform comprises a library of interactive empowering programs offering supportive feedback for a diverse range of mental and behavioural health issues. Exploratory and nonlinear, our unique care-path insight and motivational content, including mood charting and interactive journaling, facilitates enhanced engagement and effective service-user retention and completion.
Pardon? Why did I feel I was being done over by a high-pressure salesman?
On the rest of the site there were various sections with headings like, ‘Understanding Feelings’ and ‘What’s Your Thinking Style?’ Over the next two or three weeks I logged on and went through some of the pages. It was a mixture of Grandma’s old-time common sense, fatuous multiple-choice quizzes, and what I will term, for fear of sounding ruder, ‘undiluted moonshine’. One inanity, plucked at random, read: