Elizabeth Meakins: Tales From The Therapist's Couch

After he had children, the defences he had used to keep the world at bay began to splinter

The man in my consulting room struggles to explain why he has sought therapy. Everything, he tells me, feels swamped with uncertainty. A year ago, he'd felt sure-footed about who he was and where he was going. But over the past few months a terrible fog of depression has settled upon him. Nothing is as it was, and he no longer trusts his instincts to find a way forward. He has come to see me in the hope of recovering some clarity.

The man in my consulting room struggles to explain why he has sought therapy. Everything, he tells me, feels swamped with uncertainty. A year ago, he'd felt sure-footed about who he was and where he was going. But over the past few months a terrible fog of depression has settled upon him. Nothing is as it was, and he no longer trusts his instincts to find a way forward. He has come to see me in the hope of recovering some clarity.

I ask him to tell some details of his life story, and he starts with his most recent past. He is in his early thirties and has a wife and two small children. Although still legally married, they have been living apart for 10 months. The decision to separate was his. He is a writer, and since the birth of the children he found that the hurly-burly of domestic life savagely intruded on the conditions he needed for creative work. This issue began to fracture the marriage. His wife felt that his demand for solitary retreat was unreasonable, while he felt increasingly allergic to any noise or interruption from family life.

So, about a year ago, his mind became set and with new resolve he announced his decision to move out. He told his wife he had no choice, and linking himself to a long line of artists who disengaged from the chaotic demands of life, he quoted DH Lawrence: "Some men live by this unremitting inwardness, no matter what the rest of the world does. They must not let the rush of the world's outwardness sweep them away: or if they are swept away they must struggle back..."

The initial result was huge relief and a release of creative energy. But a few months down the line this energy drained away. The pages before him remained empty of new thought. And into that emptiness seeped the fog of uncertainty and depression.

So what was happening? And why? "There is so much mediocrity around," he tells me, with slight contempt. "Creative people are just not understood." A painful sense of loneliness seeps through this defensiveness. At one point, the words "retreating in the face of pain" float into my thoughts. I think they come from the psychoanalyst Betty Joseph. Whatever their origin, they feel apt. I share them with my patient because they crystallise the issue he badly needs to address: is his withdrawal essentially constructive or destructive?

The answer begins to emerge as we explore his childhood. Both his parents were highly creative and brought him up with a strong sense of the need to value one's inner life. His mother was a painter, his father a writer. Both worked from home, and my patient always got the sense that the outside world was unable to nurture or respect what really matters in life.

As a teenager, he was sent to a progressive school where he discovered a talent for writing. This became a valuable way to express what felt vital and authentic. But, while the written word could hold and show aspects of himself that felt sincere, he found it painfully difficult to spontaneously communicate this self to the human world of social relationships. Writing became a welcome escape. Over time, as he gathered some success, it was more and more possible to justify this retreat in the name of a creative vocation.

His marriage was fairly happy, but after the birth of his children the defences he had always maintained to hold the world at bay began to splinter. And the inner distress that resulted felt unbearable. And so the day came when he packed his bags and departed from the invading fracas.

So, as his fertility of thought turned to futility and despair, what was psyche saying? Surely the message from the unconscious is loud and clear: retreating in the face of pain may be necessary, but only ever as a temporary measure. As Jung was fond of saying: "reculer pour mieux sauter" - move back in order to better jump forward.

Learning how to embrace the human chaos he longed to avoid was the only way out of his psychic sterility. There would probably always be something of an uneasy alliance between participation and isolation in his life, but, as Freud wrote, mental health is dependent upon both creative work and human relationship. And escaping into the world of work in order to avoid difficulties with the human factor is bound to bring some form of comeuppance.

Elizabeth Meakins is a psychoanalytic psychotherapist in private practice. None of the above clinical details refer to specific individual cases

elizabeth.meakins@blueyonder.co.uk