Get Well Soon

by Nick Duerden

  A leading British novelist, meanwhile, who had read many self-help books for research purposes, tells me that ‘so much of it is just a dreadful bag of charlatanry. Every day in every way I am getting better, they say. No you’re not. You’re dying. Every day you’re getting closer to your grave.’

  I reason that I may be more open to these books now that I am in a time of comparative need, and so I buy, and read, some of the most celebrated (and therefore pilloried) of them all: Dale Carnegie’s How to Win Friends and Influence People (1936), Norman Vincent Peale’s The Power of Positive Thinking (1953), M. Scott Peck’s The Road Less Travelled (1978), and Susan Jeffers’ Feel the Fear and Do It Anyway (1987). Each lecture on how to filter out the bad in favour of the good, how to take risks and run free, how to be, to breathe, to focus, not waver, not wallow, how to talk, and think, and listen, how to be good, how to love, and how to live in harmony, with spirituality or otherwise. The collective optimism on offer throughout these hundreds of pages is distilled into pure alcoholic potency that must speak terribly loudly to those who need direction, help, guidance. Each has been a totemic multi-million seller, and each has helped to spawn a genre that, by the early 21st century, has grown fat and bloated, and surely driven now by little more than cynical opportunism. We do not really need any more books with exclamation marks and bullet points essentially saying the same things only with different chapter titles, and yet still they come.

  Over the next few months, many people I encounter will recommend titles like Rhonda Byrne’s The Secret and Eckhart Tolle’s The Power of Now, lavender-scented self-empowerment tomes with shiny covers and instruction on how to live life, but my instinct remains a reliably blind one: yes, all such titles may be full of good, solid, sound sense, but the way in which such wisdom is dispensed lends it all an air, to me at least, of parody.

  And so I continue to find my literary sustenance elsewhere, with a steady diet of distinctly middle-aged memoirs that rhapsodise on decrepitude, illness, bereavement, misery and miserliness. Elena worries for me, convinced I should be reading happier books, but I argue that these are happy books, full of vivid life and bitter humour, and the most wonderful sense of optimism, albeit bruised and slightly dented. It’s an age thing, I tell her.

  Correspondingly, I begin increasingly to like music made by men with beards, and the jokes of comedians whose male pattern baldness gives them night sweats.

  Anna continues to drill down into my upbringing, encouraging me to explore the hurt I must have felt over my parents’ separation, and the role it foisted upon me, how sad it must have made me, how scared and angry. I can hear her frown when I tell her I always saw the end of their marriage as a purely positive thing. We were at least able to start afresh. Single-parent-family status moved us to the top of the council waiting list, and within a year we had left the ninth floor of our block of flats in favour of a newbuild house, with a bedroom each and even a small back garden. This was progress. Then came a washing machine, a second-hand car, a cat. I enjoyed school, had friends. Within those boundaries, life, so I had always thought, was good. No?

  ‘Can I point out the blindingly obvious to you?’ Anna says, interrupting my reverie. ‘You are now in a situation where you are out of control, losing your independence, where you are constantly frightened, and feel under threat. Does this remind you of anything? Your body is mimicking the exact situation you have been running away from all your life.’

  I ask her what I should do about it.

  ‘You don’t need to do anything about it. Just start by realising it, by acknowledging it. Basically, say to yourself: Oh yes, shit, that makes sense. And repeat it until you get it.’

  It seems that I have spent my life trying to protect myself from harm and hurt, from outside interference, from certain people and uncertain situations. This has left me with body armour that I have been lumbering around with, without my knowledge – until now.

  ‘Our bodies are very, very intelligent,’ says Anna. ‘Suits of armour are heavy. They drag you down, make you tired.’

  ‘But I don’t need the armour any more, do I?’

  ‘You’re right, you don’t. But there is a part of you that doesn’t realise this yet.’

  She says I should address my sub-personalities. ‘Do not disown the words protection, fear, armour. Our unconscious mind works symbolically. And can I remind you that it was you who first mentioned having a suit of armour?’

  She is right; I had. It just came out in response to one of her quickfire questions. I never even saw it coming.

  ‘That’s why it was in your subconscious mind, so trust it. I get it that it is confusing to you, and I don’t for a moment feel frustrated with you, but what we have to do now is find a way to work with your very powerful mind and, slightly, try to get your mind out of the way. We are defined not by our rational minds, but by our subconscious ones. Okay?’

  A few nights later, over a long post-dinner talk with Elena when we could have been watching television instead, she tries to shed light into my dim brain for me. I had been struggling with everything Anna had told me: its significance, and how to process it. Elena, all too evidently, has no such difficulty. She suggests that I am scared of being hurt because I have been hurt in the past. Even if I did not realise it, my parents’ separation, and the subsequent fallout, put me in a situation where I needed to be, and remain, strong in order to survive, to put up parameters which to me felt safe, and in which I could operate, and live. I have been doing as much ever since. Whenever something looks like it could hurt me, I remove myself from that situation swiftly, body armour on, barriers up.

  But then I became ill, and couldn’t seem to recover. This was not part of my script, and so I panicked and had to realign the parameters. This is why I fairly quickly adapted to it, and learned how to survive in this new, compromised state. I could now exist at home, and be at least a present father to my daughters, and I could still work. For this I was grateful. But over everything else, I developed a heightened fear. I could not allow myself to be compromised further, and so I closed the door, both metaphorically and literally, in order to protect myself. Which is how I ended up stuck, which is why any activity outside those parameters left me flooded with anxiety and fatigue.

  It is this, then, that I need to learn to manage.

  ‘From a psychotherapeutic point of view,’ Anna says later, ‘the level at which you disconnected from your fears as a child is quite impressive. You did it very effectively. You parcelled it away so much so that it took really quite a lot to engage you with the fact of what is still there. You became ill, and something in you snapped. No longer could you override that fear. We need to now re-engage with that fear in order to work with it, to let it go. The disconnecting which you have done so well in the past is no longer working for you now. You have to stop disconnecting. You have to engage with it.’

  Anna is happy, and I am relieved. We can move forward now. The next time we speak, she tells me we are in a process of recalibration. It might be slow, even dispiriting at times, and I will have to be patient with it, but I will get there. We speak once a week, then once every two weeks, an hour each time, then half an hour. When she tells me she is soon to go on maternity leave, I am in a way relieved. At first I had relied on our sessions, but as they progressed I had become increasingly aware that we were talking in circles, about the same things over and over again, and I no longer feel I need to hear it again. Her maternity leave offers a natural conclusion.

  She suggests that a course in cognitive behavioural therapy might be useful. CBT teaches patients how to observe their thoughts and beliefs, and also how to develop the skills to influence subsequent mood and behaviour. When somebody falls into a negative pattern of belief, they can be taught to change their reaction to it, to lessen it, make it less harmful. It has proved very effective among people with fatigue, but also with depression, anxiety, phobias.

  CBT is offered at the clinic, but at the usual fee, and I
have long ago stopped being able to afford the clinic’s fees. No matter, Anna says, because I will qualify to get the treatment on the NHS. Of this she sounds entirely confident. She wishes me well, and says: ‘You tend not to recognise stress very well in yourself, I don’t think. You normalise it. You need to learn to recognise now when you are in stress, and also when you are in a healing state. It is being in a healing state that you have to maintain. That’s the only glitch now, if you like. Otherwise, you are extraordinarily normal, and I hope you will be happy to hear that.’

  ‘That’s fine by me,’ I tell her.

  She says one last thing. ‘I have never come across anyone who hasn’t gone through what you are going through right now on their route to ultimate recovery. You would have to be Superman not to encounter stumbling blocks along the way, but, trust me, you will be able to cope with whatever you’ve got coming up.’

  Though I don’t know it yet, it turns out she’s right.

  Part Two

  CURE . . . ?

  Ten

  We decide to go on holiday, Elena’s say-so. She is convinced it will do me, us, good, our first holiday in two years, and a chance for me to travel further than the front gate, or the nearest Costa. Google estimates a five-hour car journey, but Google does not bank on a traffic accident just outside Paris, nor on the unexpected early death of Elena’s iPhone battery, and with it the only satellite navigation system we have. This results in many wrong turns in what must be France’s flattest, most unremarkable region. There are few signposts, and little to tell us where we are.

  We arrive 11 hours after we had set off, all of us tired and exhausted, legitimately so. The owners have been sat in the garden with the keys waiting for us for hours, they say. Before they leave for Paris, they tell us that the small outdoor swimming pool is closed until August (it’s June now), and that a storm is coming. Adieu.

  The storm arrives within the hour, and the temperature plummets 10 degrees overnight. We wake up the morning after to find we really are in the middle of nowhere, but something inexplicable (to me) has occurred: for the first time in a long time, I awake without fatigue. It is as if, away from home, where I have built up such a store of bad memories, the maladaptive stress response has nothing to clutch onto, no negative connotations associated with the place. I still feel consciously fearful of overdoing it, but my subconscious knows better, and my anxiety loses its capital A. I wonder, only half-jokingly, whether it is possible to live on holiday, to never go home again.

  When we return to London a week later, I make an appointment with the GP to request a referral to the local CBT clinic. The doctor looks from my notes to me with an unreadable expression on her face, asks me rote questions to which I offer my rote answers, and tells me that I shall be contacted in due course, ‘to see whether you qualify’.

  A few weeks later, the call comes. I speak with a lady called Phyllis, and we chat in a way that seems to me informal and friendly. At some point I say something that makes her laugh, a high, lucid giggle that is infectious. As we end the call, I find myself hoping that she will be my therapist.

  Two weeks later, I receive a letter. It says that, regrettably, I do not qualify for CBT on the NHS. I call Phyllis to ask why, and she explains that I had not shown sufficient signs of depression during the initial consultation. Quantifiable levels of depression are required in order to qualify, she says.

  Phyllis is apologetic and empathetic. In her opinion, she confides, she agrees that CBT would indeed benefit me, but she says that NHS guidelines are there to be adhered to. The questions she had asked me two weeks back are the same for everyone – it is a standard form – with not much room, she suggests, for individual expression.

  Then she says something unexpected. How about we go through them again, now, and you reconsider your answers?

  I am not sure what she is suggesting here, but it seems clear enough that I should answer them differently – in effect, make myself sound more distraught, less level-headed, and not even attempt to prompt that infectious giggle of hers.

  A little bemused, I say okay.

  Though I cannot quite confess to feeling suicidal, I do my best to tweak my answers accordingly, and try to convey what is an undeniable truth: I am unwell. I am miserable about it. I need help.

  Our call ends, and she sounds optimistic. ‘Great, thanks, I’ll be in touch.’

  She calls back a day later. Good news and bad, she says. Her boss still feels I do not fully qualify but agrees that certainly some sort of NHS-funded assistance is warranted in a case such as mine. What I do qualify for, then, is a few one-to-one self-help sessions with a counsellor, dispensed around CBT principles. But it is not to be confused with CBT, because it isn’t, strictly speaking, CBT. It’s more helping you to help yourself, through suggestion.

  This isn’t quite what I had requested, of course, and not what had been recommended to me by Anna, but it will have to do.

  I thank her, with sincerity.

  My first appointment is in three months’ time. ‘It’s a long waiting list, sorry.’

  The health clinic is a short bicycle ride from home. A short bike ride is something I can now manage, but not without a certain amount of mental preparation – and, if I’m honest, a helpless case of nerves that prompt an unhelpful spike in cortisol. My appointment is for 9.30 in the morning, and as I make my way there, my cloudy breath reminding me that winter is coming, I feel a mixture of excitement and trepidation.

  It is a small, squat building located to the north of my neighbourhood, nearer the park, where there are Italian delicatessens, independent coffee shops and houses with bigger extensions. I am buzzed in, and walk upstairs to find two other people in the waiting room, a motorcycle courier in his 30s with Slavic cheekbones, and a young woman in her early 20s, her eyes shielded by a curtain of strawberry blonde hair. There is no eye contact between any of us, and I instinctively take the seat furthest away from either of them, next to an overgrown potted plant. I am given a pen and a form to fill in, which asks me whether I am depressed, suicidal, avoiding social situations. I chance a look up at the man and the woman, and realise they are answering the same questions themselves. As I find myself ticking No, I cannot help but wonder whether they might be ticking Yes.

  Moments later, I am being led down a carpeted corridor by a woman whose official title here may or may not be ‘caseworker’. She leads me to a corner room that hasn’t seen redecoration in decades, and encourages me to sit. There are two low chairs arranged around an even lower coffee table, upon which is a box of tissues. I sit, and the woman smiles at me and tells me her name: Claire.

  I recount my story, bored by now of my own words but at the same time invigorated, because I am hopeful that this time it may produce different results, that this new person opposite me – Claire, who is French, a few years younger than me, and radiating an almost maternal kindness (though I don’t know it now, she is in the early stages of her first pregnancy) – might just be the person to make me well again. Her accent is ravishing.

  She begins by telling me that I will be allotted between six and eight sessions, once a week, where we will discuss not so much my recovery as my attitude towards it. Because my condition is still so unchanging, so tedious in its repetitive nature, I readily accept the offer to talk to somebody about it. At home, I must be boring Elena senseless; the opportunity to bore somebody else holds much appeal.

  However, I quickly become aware that this is not the form of treatment Anna had recommended at all, not even close. Though the sessions may be guided by the principles of CBT, Claire talks much more like the self-help books I recently read, albeit with less evangelism. In comparison with the sessions with Anna, the discussions I have here feel like a distinct step back, a waste of taxpayers’ money. There is none of that forward-motion dynamism I had become used to at the clinic. Claire focuses on the management of my expectations. She says that what I am going through right now is a kind of post-traumatic stress, that
the experience has changed my life completely, and so of course I am going to be anxious about it, and fearful. Who, in my situation, wouldn’t be?

  But there is hope, she says. She tells me that I do not present to her as other chronic fatigue cases (this may have been because I don’t have actual chronic fatigue, though I still don’t know that yet) and that this is to my benefit. She says that I speak with strength and conviction, that I walk from the waiting room to the consultation room quickly, often ahead of her. To her, I seem confident and capable. Her other patients, she says, are different. It is as if there is a cloud above them; you can almost see the fatigue. You can see they are depressed. Not so with me.

  Each week we talk about the week before, the progress made in my thinking patterns, the need to focus on the positive and the improvements, and not the negative because the negative will only hold me back. About the frequency of the symptoms themselves, and the occasional gravity of them, she doesn’t know what to say, nor why they are so persistent. She tells me to be positive, above all else be positive. It is all a bit comfort blanket, this, leaving me with a nice, warm feeling, but it is gentle, and gentle right now feels ineffectual and frustrating. I do not want to tread water, I want to plunge forward. After the sixth session, she asks if I would like to continue to eight, and I tell her no.

  The last time I see her, shortly before she goes on maternity leave, she tells me that, all things considered, my life sounds pretty good.