The Examined Life: How We Lose and Find Ourselves, by Stephen Grosz

I read this book on the strength of its Guardian review, which described the stories in this collection as blurring the line between psychotherapeutic case studies and philosophical essays. The reviewer, Talitha Stevenson, remarks on the author's restraint and humility:  Some of the insights are his, and others belong wholly to the patients, but in either case,"Grosz writes with such artful self-effacement that his cases seem to speak for themselves."

Neurologist Oliver Sacks writes similar collections of case studies/essays, but he tends to focus on the more unusual and radical effects of brain injury, as in The Man Who Mistook His Wife for a Hat. When reading Sacks, we're tempted to say "Oh, thank the statistical gods, that's unlikely to be me!", whereas when reading Grosz, again and again I thought, "Yes, that could well be me."  And it was discomfiting to see my own psycho-snafus held up to me in the mirror of this book.

In his chapter titled "Confidence", Grosz examines the influence parents exert upon their small children. He notes that the contemporary tendency to dole out empty praise is as harmful as earlier generations' habit of spewing out thoughtless criticism. He cites a study which shows that children who are praised for trying hard outperform those who are praised for being clever or excellent. If you stop to think about it for a moment, this makes perfect sense:  Why would a child continue to try harder after hearing that he is brilliant, or he is the best at doing whatever it is?  Praise the child for his diligent effort, however, and he'll continue to strive.

As I read this chapter, I looked back on my own parents' child-rearing methods, which probably fell into the category of gentle but relentless criticism -- "Well, that's not bad, dear, but it could be much better..."  At 52, I feel quite sure that nothing I ever do will be good enough, no matter how hard I try. Yet I am equally sure that my parents felt that they consistently encouraged me to try harder by keeping the bar just out of reach.

So many adults feel the need to give children guidance, advice, lessons.  Grosz observes the work of an octogenarian child psychologist, Charlotte Stieglitz, who tends to avoid the subject of praise vs. criticism and simply spends time with children.

Unhurried, she talked to the child, but more importantly she observed, she listened. She was present. Being present builds a child's confidence because it lets the child know that she is worth thinking about. Without this, a child might come to believe that her activity is just a means to gain praise, rather than an end in itself. How can we expect a child to be attentive, if we've not been attentive to her?

If, as adults, we wind up in the psychotherapist's office, it's usually because we are in pain, and we want it stopped. Healers of all kinds, however, take their time before dispensing analgesics, because pain can be a valuable diagnostic tool. Grosz points out that patients who deny, mask or dull their own psychic pain will be unlikely to find its root cause. Like a leper whose nerve damage has left him numb, those of us who numb our emotional grief also run the risk of injuring ourselves further as a result.

In 1946, while working in a leprosy sanatorium, the physician Paul Brand discovered that the deformities of leprosy were not an intrinsic part of the disease, but rather a consequence of the progressive devastation of infection and injury, which occurred because the patient was unable to feel pain. In 1972, he wrote: "If I had one gift which I could give to people with leprosy, it would be the gift of pain." Matt [Grosz' young and self-destructive patient] suffered from a kind of psychological leprosy; unable to feel his emotional pain, he was forever in danger of permanently, maybe fatally, damaging himself.

Oddly, one of the chapters that jolted me most was "A Safe House", in which a middle-aged businessman spends much of his therapeutic time talking about his house in France. He tells Grosz that merely thinking about the house reassures him, gives him a sense of security. When the apocalypse strikes, when life in the UK becomes untenable, he shall retreat to his safe house in France. During meetings, or when he can't sleep, or when he recalls his very abusive and violent childhood, he withdraws into the house, thinking of potential renovations, redecorations, extensions he might do. He sketches floor plans, examines paint samples, details what is on each shelf in the pantry. Throughout the session, the man acknowledges that his house in France gives him comfort when life gets stressful, just as he had wished for an escape route when his mother had been viciously beating him when he was a boy. Overall, though, the session seems to be a calm and reflective one, not emotionally tumultuous. And then his hour is up.

"Mr Grosz?"
"Yes?"
"I don't really have a house in France. You do know that, don't you?"

Emma is a PhD student in her 20s who is suffering a deep depression. Grosz repeatedly asks her how she feels about this or that and is struck that she always responds by telling him what her father or her boyfriend, Mark, thinks about the matter. This exchange could easily have happened between Mr. Grosz and me. Like Emma's, my father was forever telling me what I should and shouldn't feel or think. What I did feel or think was either wrong or immaterial, so I lost sight of it altogether. Emma is obviously in the same boat.

"The conversation with my dad was like the conversation with Mark -- both were telling me what I really feel, or should feel." Emma said that she didn't understand how people knew what they really felt. "Most of the time, I don't know what I feel. I figure out what I should feel and then just act that way."

As he listens to a patient who talks herself out of every intimate relationship, Grosz is reminded of Ebenezer Scrooge.  (I love the idea of a Dickens character as a psychotherapeutic anti-hero.)  But it's true -- Scrooge cannot bear the thought that love ends. Actually, Scrooge finds any loss unpalatable. But protecting himself against losses has a steep cost.

Scrooge spends his evenings comforting himself; as he reads his deposit book, he thinks to himself, "You see? No losses, only gains." Ultimately, Scrooge changes because the ghosts unpick his delusion that you can live a life without loss. They undo his delusion by haunting Scrooge with the losses he has already experienced, the losses now being endured around him, and the inevitable loss of his own life and possessions.

Why do we stay in toxic relationships? Often for the same reason that we stay in any number of other unhealthy situations -- we are averse to change. Grosz cites a woman who had worked on a high floor in the World Trade Center on September 11, 2001.  After seeing the plane crash into the neighbouring tower, Ms. Panigrosso grabbed her purse and ran down the stairs.  Other colleagues stayed at their desks, and one actually returned to the office to retrieve her daughter's baby pictures, which she'd left in her desk. None of them survived.

In Marissa Panigrosso's office, as in many of the other offices in the World Trade Center, people did not panic or rush to leave."That struck me as very odd," Marissa said. "I said to my friend, 'Why is everyone standing around?'" What struck Marissa Panigrosso as odd is, in fact, the rule. Research has shown that, when a fire alarm rings, people do not act immediately. They talk to each other, and they try to work out what is going on. They stand around.

I read this account and shuddered. Having been badly burnt as a teen-ager, I do not stand around when I smell smoke or hear a fire alarm. I don't ask my neighbours if they know what's going on; I don't wonder if it might be a false alarm. I don't worry about what people might think of me as I exit the building as hastily as I can. This, however, seems to be a result of my own previous trauma. Ms. Panigrosso and I appear to be in the minority when it comes to emergency evacuations.

And research has shown, again and again, that when we do move, we follow old habits. We don't trust emergency exits. We almost always try to exit a room through the same door we entered. Forensic reconstruction after a famous restaurant fire in the Beverly Hills Supper Club in Kentucky confirmed that many of the victims sought to pay before leaving, and so died in a queue. After twenty-five years as a psychoanalyst, I can't say that this surprises me. We resist change.

But what about life situations that are only figuratively engulfed in flames? Do I move as purposefully toward the emergency exits? Do I even know where they are? Or do I loiter about my desk, wondering if it might be a false alarm, or if the firemen will extinguish it, solving the problem for me?  I've been in both personal relationships and work environments that were essentially on fire, and what did I do? Dithered, hung around, hoped things would magically clear up on their own. Grosz has two clients in destructive circumstances, and they too are paralysed.

For Mark A. and Juliet B. the fire alarm is ringing. Both are anxious about their situations. Both want change. If not, why tell a psychoanalyst? But they are standing around, waiting -- for what?

In my case, my own psychotherapist put this very question to me some years ago, noting that my life was indeed on fire: "What are you waiting for?"  The answer came to me instantly.  I was waiting for someone to give me either permission or orders to exit, or to make the necessary change. Just as people who are near death may hang on until a loved one assures him that it's okay to let go, I was waiting for someone else to give me the signal. My therapist's question prompted me to give myself permission.

Grosz speaks of the myriad external distractions we employ to avoid confronting our internal malaise. One patient comes to her sessions and tells him that she is very upset about a natural disaster here, a war there, and a long list of social ills right in her neighbourhood. I wondered what this woman was doing in the therapist's office -- after all, isn't it perfectly normal to be upset about the woes of the world? Part of Grosz' skill, however, is seeing through what his patients present as the problem.  Elizabeth's wars and disasters were nothing more than red herrings.

After about six months, Elizabeth confided that the first thing she felt in the morning was "a depressed, choking anxiety". She woke frightened, sometimes shivering with fear, until she remembered a problem, some urgent situation that required her to get out of bed and face the day. There are various ways to circumvent depressed, anxious feelings. It's not uncommon, for example, to exploit sexual fantasies, or to use hypochondriacal worries. Elizabeth employed her disasters to calm herself -- they were her tranquilliser ...

It's also not uncommon to use some large-scale calamity, or someone else's personal disaster -- the newspapers are full of both -- to distract oneself from one's own destructive impulses, and I soon noticed this tendency in Elizabeth ...

But we can sometimes exploit a disaster to block internal change. Like Elizabeth, we can take on a catastrophe to stop ourselves feeling and thinking -- and to avoid responsibility for our own intimate acts of destruction.

We've all been cornered at a party, feigning interest in the fluctuations of east Asian currencies or a re-hash of last weekend's cricket game, praying that the speaker will need to refill her glass or his plate very soon. In one chapter, Grosz describes a patient whose dullness does not reflect a stagnant life -- it's something quite different, and I'll never look at a tedious person in the same way again.

Graham C. was boring. One night, his girlfriend, an economist who worked in the City, told him so. They had just had a dinner party, during which she'd watched him, again and again, thoroughly bore the person he was talking to. "Can't you tell when someone goes dead behind the eyes?" she asked. Then she broke up with him. A few weeks later, the senior partner at Graham's law firm called Graham into his office. He told him that his work was fine, and that he appreciated the long hours he was putting in. But he warned Graham that the clients weren't taking to him. If Graham wanted to make partner, clients would need to feel a loyalty to him; they should want to call him with their problems. Graham saw the future he'd imagined for himself slipping away. Worried and depressed, he came to see me. For the first few months of his analysis, Graham bored me too ...

Graham's being boring was aggressive -- it was a way of controlling, and excluding, others: a way of being seen, but not seeing.

Grosz gives a chapter to one of his long-time friends, Tom, who accepted Grosz' referral to another therapist, Dr. A. When they meet for coffee, Tom relates what his therapy has revealed to him.

"... if you're frightened of being criticised, you're probably pretty critical. And what a surprise -- it turns out that I'm a critical person. It turns out that when I'm not finding fault with myself, I keep busy reproaching others. I won't bore you with the one thousand and one things that are wrong with the decor in Dr A.'s office -- or with Dr A. herself. You can imagine." Tom leaned forward and put his hands on the table. "Do you know the word captious?"

I had a good laugh at this, both because I've had a very similar realisation about myself, and because that very word -- captious -- is all but stalking me in my reading, as if mocking me. Tom goes on to share another belief that I've harboured all my life, despite the fact that I have no evidence to back it up.

" ... there's still part of me that wants to believe that if I stay nice and clean, and work really hard, and I'm a big success, I'll be protected from depression and anxiety."

The problem with being captious, of course, is just that:  You are always finding fault, both with yourself and others, but usually more the former.

Tom's minutiae-- the smell of his sweat, the mud on his shoes; how opposite this view of himself from my own picture of this big, gentle, civilised man. I thought about his fear that if he was known, if he was seen as he believes he truly is, he would be found dirty, broken. And being dirty and broken -- how could he love, or be loved?

I mentioned to a friend that I was reading this book and that I found it very sensitive and insightful. I admire how Grosz helps his patients see what lies hidden beneath their ordinary coping mechanisms. My friend replied, "Well, yes... but what does he say about changing one's behaviour? It's one thing to understand what caused the problem, but does he say  anything about fixing it?"

I paused and thought.  "No. No, he doesn't." But does that diminish the value of the book? I would say not. Perhaps that would be a different book, or a sequel. Diagnosing the root cause of a problem is of course the first step, an indispensable step, and the insights that Grosz relates in The Examined Life are valuable as they stand. Changes or solutions may or may not follow. For myself, I know that I'm now more likely to make important changes in my life without waiting for someone else to grant me permission or encourage me to do so, and for that, I thank my therapist. On the other hand, knowing that I would be much happier if I curtailed my constant stream of self-criticism hasn't actually done much to curb it. The case studies in The Examined Life, however, encourage me to look at my own idiosyncrasies and upsets, and then to look, with gentler inner eyes, more deeply beneath them.