Antoine Bourdelle’s Herakles the Archer (1909) captures the Stoic ideal: complete commitment to the action, complete detachment from the outcome.
By Dr Neel Burton — Psychiatrist, philosopher, and wine writer; Fellow of Green Templeton College, University of Oxford; author of over twenty books.
Whereas depression weighs upon life as it is, anxiety points towards the future: what might happen, what might go wrong, what might be expected of us.
Of course, some concern for the future is necessary. It motivates us to do what’s needed, pay our bills, and avoid danger. So the aim cannot be to abolish anxiety altogether—simply to prevent occasional alarm from becoming a permanent state.
Modern Life
The modern world makes this difficult because threats are seldom all-or-nothing. Our ancestors faced a predator, or did not. We have emails, deadlines, mortgages. And when we look on social media, we feel we are falling behind.
Because the pressure is diffuse and continuous, we internalise it. Eventually, nobody needs to chase us; we carry the pursuer in our head.
Once the pursuer is inside us, we try to outrun them by keeping busy. Activity gives us a sense of control, but often we are not addressing the anxiety so much as preventing ourselves from feeling it. We run faster and faster so that we never have to ask where we are going.
There is a Zen story about a horseman galloping down a path at speed. It seemed as if the rider was on some urgent and vital mission. “Where are you heading?” hollered a bystander. “I don’t know!” came the already distant reply, “Ask the horse!”
How to Reduce Anxiety
The first step, then, is to stop running and name the anxiety. A vague anxiety can fill the whole sky; a named fear becomes one object within it. Once identified, it can be worked with, accepted, or dismissed.
In particular, we can determine what part of the anxiety is actually within our control. The ancient Stoics emphasized this distinction between what is and is not in our control. What is not in our control must simply be let go.
The Stoics had this image of an archer. The archer does all he can to shoot accurately. But once the arrow leaves the bow, its fate is no longer within the archer’s control. So the right-thinking archer focuses on the action, not on its result—because the first is in his control, whereas the other is not.
When dealing with our anxiety, we should all become like the Stoic emperor Marcus Aurelius, who wrote, “Today I escaped anxiety. Or no, I discarded it, because it was within me, in my own perceptions—not outside.”
Before We Hurry to Silence It, We Should Listen to What It Has to Say
If depression is a journey, recovery cannot always mean returning to the starting place.
By Dr Neel Burton — Psychiatrist, philosopher, and wine writer; Fellow of Green Templeton College, University of Oxford; author of over twenty books.
Grief knows its object. Depression often does not. But that does not mean that depression is always meaningless suffering. Often, it is suffering whose meaning is asking to be discovered.
Still, we must be careful not to romanticise depression. Depression can be a disabling, even deadly, illness. Such depression requires urgent and intensive treatment. But neither should the most severe cases determine how we understand all depression.
Diagnosis
Today, in England, around one person in six is prescribed antidepressants. Numbers on this scale should make us ask: is this all mental illness, that is, a biological disorder of the brain, or is it also a problem with modern life?
If at least some depression arises from a problem of living, then the depression is pointing straight at the problem. By treating it as a biological disorder of the brain, we are hiding the problem and prolonging the pain. Our depression may be telling us, look, something here is seriously wrong, something here has to change, you can’t go on like this.
Treatment
Treatment cannot simply aim at silencing it. If a fire alarm is sounding, disabling the alarm may bring relief—but it does not put out the fire.
Instead, treatment should be more like an exploration and journey. Already in the thirteenth century, Dante gave us the right image. At the beginning of Inferno, he finds himself alone in a dark forest, having lost the straight path. The forest is dark and dangerous. Yet the only way out is through it.
If depression is a journey, recovery cannot always mean returning to the starting place. Because the starting place may have been the problem.
Depression can be an illness, but it can also be a form of intelligence. Before we hurry to silence it, we should listen to what it has to say.
By Dr Neel Burton — Psychiatrist, philosopher, and wine writer; Fellow of Green Templeton College, University of Oxford; author of over twenty books.
Empathy is, in a sense, the opposite of anger. In anger, we are imprisoned in ourselves and unable to see another person’s perspective. We see in people only what they have done to us. With empathy, we reach out to the other and try to see the world through their eyes.
But if we take this reaching out too far and begin to merge with them, it can become a problem. The suffering of our patients can become both corrupting and exhausting.
Sympathy vs Empathy
The danger becomes clearer if we distinguish between sympathy and empathy. If a friend has lost a parent, and I say, “I’m sorry,” that’s sympathy—which is simple concern for another person’s suffering. If I imagine what that loss feels like from within my friend’s world, that’s empathy.
The power—and the danger—of empathy lies in its particularity. It’s not merely a matter of imagining myself in someone else’s situation. I must imagine myself as them, in that situation. I need to understand who they are, where they have come from, and where they are trying to go. As John Steinbeck wrote, ‘It means very little to know that a million Chinese are starving unless you know one Chinese who is starving.’
Why Empathy Must Remain at One Remove
Yet, to imagine myself in someone else’s shoes is not to become that person. Empathy must remain at one remove. That distance enables me to think objectively and be of help. After all, if I drown alongside a drowning person, I can hardly pull them out of the water.
If that boundary collapses, empathy can corrupt as well as exhaust us. It can lead us to favour the person before us over the many people we cannot see. And, as empathic distress, it can lead to compassion fatigue and burnout.
Regulating empathy, therefore, is not callousness but the condition of effective care.
Doctors who understand their patients without being engulfed by them are not only more effective but more fulfilled in their work.
Ultimately, the doctor’s task is not to carry the patient’s pain, but to stand close enough to understand it—and far away enough to help.
Psychiatry derives from the Greek psyche (butterfly or soul) and iatros (healing), and means ‘healing of the soul’. In Greek myth, Psyche’s lover was none other than Eros.
By Dr Neel Burton — Psychiatrist, philosopher, and wine writer; Fellow of Green Templeton College, University of Oxford; author of over twenty books.
In my experience, most medical students enjoy learning about mental illness and talking to mentally ill people, who often have a refreshing knack for saying things exactly how they are. In a fit of inspiration, some students—particularly the more intelligent, creative, or quirky ones—confide that psychiatry is the only specialty that gives them the time and material to think about themselves, other people, and life in general.
They also like the lifestyle (in the UK): an hour for each patient, ‘special interest’ days, protected time for teaching, light on calls from home, and guaranteed career progression. In medicine they might triage yet another anonymous case of asthma, chest pain, or pulmonary oedema. In surgery they might do knee replacement upon knee replacement, up until the day they retire or collapse. But in psychiatry there can be no factory line, no standard procedure, and no mindless protocol: each patient is unique, and each patient has something unique to return to the psychiatrist.
I often come across those same students again, months or sometimes years later. After the smiles and the niceties, it transpires that they are no longer so interested in psychiatry. So what happened?
The students are never too sure, but I think I have an idea.
When I was a medical student in London, an American firm offered me a highly paid job as a strategy consultant in their Paris office, opposite the British embassy and the Elysée Palace. So I gladly left medicine and the many inconveniences of working in (and increasingly ‘for’) the National Health Service.
I had a great time in Paris, but the job itself turned out to be more about dealing with personality disorders than about having brilliant ideas. I quit after six months and freelanced as an English tutor to high-flying executives, bankers, venture capitalists, and that sort.
As my clients already spoke working English and merely wanted to improve their fluency, all I had to do was to make conversation with them. My lessons often turned into something akin to psychotherapy, as I realised that I could make them open their hearts and minds simply by listening to them. Although they seemed to have everything in life, they were deeply unhappy, and had rarely stopped to ask themselves why.
I wanted to find out why, so I decided to return to the UK, do my house jobs (internships), and specialise in psychiatry. I had always been far too ‘ambitious’ to consider psychiatry, but by then it had become abundantly clear that I didn’t want to pursue a career that didn’t allow me to think and feel, and to relate to others and to the world in a genuine and meaningful way. There are not many such jobs, but psychiatry—along with general practice, teaching, academia, and the clergy—is certainly one of them, and even, arguably, their archetypal form.
In short, I wanted to get paid to talk to people, read books, and study life—and it felt like robbery.
The following year while going about my house jobs I put up with all sorts of abuse from my colleagues in medicine and surgery. One of the other house officers (interns), by then a good buddy, took me aside one day and said with an alcoholic mixture of concern and disdain: ‘Why do you want to go into psychiatry? You’re a good doctor. Can’t you see you’re wasting your talents?’
It became very clear, first, that the stigma that people with a mental disorder are made to feel also extends to the doctors who look after them; and, second, that this stigma emanates most strongly from the medical profession itself, mired as it is in middle-class preoccupations and prejudices and, as a whole, far too grounded in neurosis not to be terrified of psychosis.
Of course, it is simply not true that psychiatry is ‘a waste of talent’. The term ‘psychiatry’ was first used in 1808, in a paper by Johann Christian Reil. Reil argued for the urgent creation of a medical specialty to be called ‘psychiatry’, and contended that only the cream of physicians would have the qualities required to join it. Psychiatrists needed to have not only an understanding of the body, but also proper learning and culture.
Indeed, a psychiatrist can change a person’s entire outlook with a single sentence, so long as he can find the right words at the right time. No protocols, no high-tech equipment or expensive drugs, no pain or side-effects, and no complications or follow-up.
Now that is talent, and one so great that I can only ever aim at it. And each time I fail, I always have medicine to fall back upon.
By Dr Neel Burton — Psychiatrist, philosopher, and wine writer; Fellow of Green Templeton College, University of Oxford; author of over twenty books.
‘Hypersanity’ is not a common or accepted term. But neither did I make it up. I first came across the concept while training in psychiatry, in The Politics of Experience and the Bird of Paradise (1967) by RD Laing. In this book, the Scottish psychiatrist presented ‘madness’ as a voyage of discovery that could open out onto a free state of higher consciousness, or hypersanity. For Laing, the descent into madness could lead to a reckoning, to an awakening, to ‘break-through’ rather than ‘breakdown’.
A few months later, I read CG Jung’s autobiography, Memories, Dreams, Reflections (1962), which provided a vivid case in point. In 1913, on the eve of the Great War, Jung broke off his close friendship with Sigmund Freud, and spent the next few years in a troubled state of mind that led him to a ‘confrontation with the unconscious’.
As Europe tore itself apart, Jung gained first-hand experience of psychotic material in which he found ‘the matrix of a mythopoeic imagination which has vanished from our rational age’. Like Gilgamesh, Odysseus, Heracles, Orpheus and Aeneas before him, Jung travelled deep down into an underworld where he conversed with Salome, a young woman, and with Philemon, an old man with a white beard, the wings of a kingfisher and the horns of a bull. Although Salome and Philemon were products of Jung’s unconscious, they had lives of their own and said things that he had not previously thought. In Philemon, Jung had at long last found the father-figure that both Freud and his own father had failed to be. More than that, Philemon was a guru, and prefigured what Jung himself was later to become: the wise old man of Zürich. As the war burnt out, Jung re-emerged into sanity, and considered that he had found in his madness ‘the prima materia for a lifetime’s work’.
The Laingian concept of hypersanity, though modern, has ancient roots. Once, upon being asked to name the most beautiful of all things, Diogenes the Cynic (412-323 BCE) replied parrhesia, which in Ancient Greek means something like ‘uninhibited thought’, ‘free speech’, or ‘full expression’. Diogenes used to stroll around Athens in broad daylight brandishing a lit lamp. Whenever curious people stopped to ask what he was doing, he would reply: ‘I am just looking for a human being’ – thereby insinuating that the people of Athens were not living up to, or even much aware of, their full human potential.
After being exiled from his native Sinope for having defaced its coinage, Diogenes emigrated to Athens, took up the life of a beggar, and made it his mission to deface – metaphorically this time – the coinage of custom and convention that was, he maintained, the false currency of morality. He disdained the need for conventional shelter or any other such ‘dainties’, and elected to live in a storage jar (pithos) and survive on a diet of onions. Diogenes proved to the later satisfaction of the Stoics that happiness has nothing whatsoever to do with a person’s material circumstances, and held that human beings had much to learn from studying the simplicity and artlessness of dogs, which, unlike human beings, had not complicated every simple gift of the gods.
The term ‘cynic’ derives from the Greek kynikos, which is the adjective of kyon or ‘dog’. Once, upon being challenged for masturbating in the marketplace, Diogenes regretted that it was not as easy to relieve hunger by rubbing an empty stomach. When asked, on another occasion, where he came from, he replied: ‘I am a citizen of the world’ (cosmopolites), a radical claim at the time, and the first recorded use of the term ‘cosmopolitan’. As he approached death, Diogenes asked for his mortal remains to be thrown outside the city walls for wild animals to feast upon. After his death in the city of Corinth, the Corinthians erected to his glory a pillar surmounted by a dog of Parian marble.
Jung and Diogenes came across as insane by the standards of their day. But both men had a depth and acuteness of vision that their contemporaries lacked, and that enabled them to see through their facades of ‘sanity’. Both psychosis and hypersanity place us outside society, making us seem ‘mad’ to the mainstream. Both states attract a heady mixture of fear and fascination. But whereas mental disorder is distressing and disabling, hypersanity is liberating and empowering.
After reading The Politics of Experience, the concept of hypersanity stuck in my mind, not least as something that I might aspire to for myself. But if there is such a thing as hypersanity, the implication is that mere sanity is not all it’s cracked up to be, a state of dormancy and dullness with less vital potential even than madness. This, I think, is most apparent in people’s frequently suboptimal – if not frankly inappropriate – responses, both verbal and behavioural, to the world around them. As Laing puts it:
The condition of alienation, of being asleep, of being unconscious, of being out of one’s mind, is the condition of the normal man. Society highly values its normal man. It educates children to lose themselves and to become absurd, and thus to be normal. Normal men have killed perhaps 100,000,000 of their fellow normal men in the last 50 years.
Many ‘normal’ people suffer from not being hypersane: they have a restricted worldview, confused priorities, and are wracked by stress, anxiety and self-deception. As a result, they sometimes do dangerous things, and become fanatics or fascists or otherwise destructive (or not constructive) people. In contrast, hypersane people are calm, contained and constructive. It is not just that the ‘sane’ are irrational but that they lack scope and range, as though they’ve grown into the prisoners of their arbitrary lives, locked up in their own dark and narrow subjectivity. Unable to take leave of their selves, they hardly look around them, barely see beauty and possibility, rarely contemplate the bigger picture – and all, ultimately, for fear of losing their selves, of breaking down, of going mad, using one form of extreme subjectivity to defend against another, as life – mysterious, magical life – slips through their fingers.
Hypersanity is not simply a matter of intelligence. Intelligence can make us more ingenious in defending our prejudices and rationalising our desires. Hypersanity requires something more: the ability to step outside ourselves, to see our lives in proportion, and to question the assumptions that we were weaned on.
We could all go mad, in a way we already are, minus the promise. But what if there were another route to hypersanity, one that, compared with madness, was less fearsome, less dangerous, and less damaging? What if, as well as a backdoor way, there were also a royal road strewn with sweet-scented petals?
In fact, the ancient philosophers cleared several such paths. Socrates sought to free himself from false opinion through relentless questioning; Diogenes, from convention through radical simplicity; the Stoics, from destructive emotion through reason and perspective. In India, the Buddha went further still, seeking liberation from the attachments and illusions of the self. I’m busy recovering them all.
Besides Jung, are there any modern examples of hypersanity? Those who escaped from Plato’s cave of shadows were reluctant to crawl back down and involve themselves in the affairs of men, and most hypersane people, rather than courting the limelight, might prefer to hide out in their back gardens. Perhaps, then, we should not expect the hypersane to be famous, or even conspicuous. To recognise them by worldly achievement would be to judge them by the very standards they have transcended.
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