¹ https://www.inicea.fr/la-depression-chiffres-cles#chapitre

² Philippe Labro, “Tomber sept fois, se relever huit”, Folio, Paris, 2003, p. 37

³ https://www.inicea.fr/la-depression-chiffres-cles#chapitre

⁴ https://www.cambridge.org/core/journals/the-british-journal-of-psychiatry/article/antidepressants-on-trial-how-valid-is-the-evidence/E94E7663ACBC91A287A462E06B7B12EC

⁵ https://www.inicea.fr/la-depression-chiffres-cles#chapitre

⁶ Philippe Labro, “Tomber sept fois, se relever huit”, Folio, Paris, 2003, p. 178

⁷ ibid.

Cédric Bouët-Willaumez est psychothérapeute à Londres, exerçant en cabinet privé depuis plus de 20 ans. Vous pouvez le contacter pour prendre rendez-vous au +44 7876 035 119, ou en suivant ce lien.

1- What is social anxiety?

Most online and offline publications will define social anxiety as the excessive fear of social situations. People who have come to see me for help with this problem have also often described that they may feel discomfort in any social interaction, even if this is with “just the one person”. Because of this, I prefer to define social anxiety as the discomfort that relates to the experience of any relationship.

«In every contact, we communicate a bit of ourselves to the other, and the other is there to receive it, for better or for worse. In that respect, every social situation is significant, because it says something about us.»

2- Why does it happen?

We form our person and our character in the context relationships – to the family we were born in, to the community around us, to school, to our chosen communities of friends, spouses and children, to our communities at work. These relationships are not just a backdrop to our lives: by interacting within them, we evolve through them, and them through us.

It is perfectly healthy to feel a measure of trepidation in all forms of contact with other people, whether it is a brief exchange with a waiter, a discussion with a headmaster, or a presentation in front of the board of a company. After all, every personal contact, no matter how brief or apparently shallow, is an  experience that engages our person, consciously and unconsciously. In every contact, we communicate a bit of ourselves to the other, and the other is there to receive our communication, for better or for worse. In that regard, every social situation is significant because it says something about us.

«Psychotherapy, to be effective, must include two aspects at least: reflection on oneself and action on one’s environment.»

3- When does it become a problem?

However, for many, this creates a level of discomfort that can feel difficult to bear, which may lead some to assuming that all social contact will be painful, and therefore to avoiding certain social situations, and sometimes, most, if not all, social situations. This can be extremely distressing and debilitating.

4- Addressing the issue

It is my experience that psychotherapy, to be effective, must include two aspects at least: reflection on oneself and action on one’s environment. This is especially true when the concern that needs addressing is social anxiety. Action alone, which can be, for example, challenging one’s assumptions about other people’s thoughts about us and changing the way we interact with them, is not enough to create a deep-seated sense of safety in a social setting. Similarly, reflection alone will not help the person to “land” the insights acquired and create new and more helpful behaviours.

Therefore, I encourage my patients to:

• take a historical perspective on their experience of social interactions
• examine the feelings, thoughts and sensations that they associate with them
• get a deeper sense of who they are as a person, and what sort of social existence they are really meant to live
• observe in detail what they go through as they apply their insights and progressively approach life with others in different ways

The quote by St Francis of Assisi sums quite well my approach to helping people address their social anxiety, as it reflects its progressive nature and the surprises that can arise out of the process:

«Start by doing what’s necessary. Then do what’s possible; and suddenly you are doing the impossible»

Depression is the most prevalent of mental health problems. Studies have shown that it occurs in 1 in 10 adults or 10 per cent of the population in Britain at any one time. It is quite common to experience a depressive episode as a reaction to an event. It also happens that depression sets in “out of the blue”, and does not seem to go away by itself.

This experience can be deeply painful; poet John Keats wrote to a close friend: “I am in a temper that if I were under water, I would scarcely kick to come to the top”. It is part of life’s requirements that we should be able to tolerate periods of low mood, and it is to be expected that sometimes we find ourselves challenging the value of things and of life itself. If however we have an entrenched feeling of futility and find ourselves disempowered and persistently disengaged from life, this is probably something worth attending to.

In my experience it is possible to understand and successfully to address depression through the process of psychotherapy and counseling. Psychotherapist D.W. Winnicott (1958) wrote of John Keats that:

“[he] was someone who took the risk of feeling things deeply and of taking responsibility. […] If we look at depression this way, we can see that it is the really valuable people in the world who get depressed.”

These words remind us that the experience of depression should be respected in the process of psychotherapy. It is by working it through that its value ultimately appears, along with the fundamental qualities of the individual coming for help.  The goal of psychotherapy applied to depression is to allow insight to emerge and to use the therapeutic space as a “springboard” to reconnect with oneself, with others and with the world.

On 23 June 2016, a majority of the British electorate chose to leave the European Union. The economy and political landscape in Great Britain are changed dramatically, and beyond this, individuals can find themselves deeply affected.

One of my patients, an english man who has been seeing me for several years and has been thinking about bringing his therapy to a conclusion, told me after the results of the referendum: “I can’t make a decision either way at the moment, because with all the buzz about remaining and leaving, it’s hard to listen to my own mind”.

As therapists, we tend to look at our patients’ past to help them see how it shows up in the present. With the current events unfolding, we need to be very mindful of the effect that social movement and discourse can have on individuals.

“With all the buzz about remaining and leaving, it’s hard to listen to my own mind”.

This summary describes three effects of this crisis on the individual psyche.

1 – The disappearance of a safe and secure environment creates a void, which is filled with past memories

A Russian patient told me a few years ago about what he experienced when the Soviet Union was dissolved on Boxing Day 1991: “I woke up one morning, and my country had disappeared”. The European Union may still exist, but I have heard many other people voice a similar sentiment in respect of how they are perceiving its impending partial breakup.

The safe and secure environment that EU citizens have enjoyed up to now has changed dramatically. Another patient, a young french man, tells me: “I’ve studied in an international class from age 10, studied on an Erasmus programme, I’ve lived and worked here for five years and never asked myself any questions. It’s not just that the conditions of my stay here have changed: I feel like the foundations of my education and culture are challenged. What is going to become of my generation of young Europeans?”

“I chose to emigrate to the UK at 20, so I could take control of my own destiny, and here I am in the same situation again. I’m ten years old, my future has been robbed and I don’t know what to do”.

A vacuum has appeared in society because some of things that existed to ensure the safety of some of its constituents have disappeared. Memories of past experiences can then fill this vacuum. For example, people who, as children, have had to live through their parents’ separation, however amicable, will inevitably re-experience in the present some of the anxiety that comes with a challenge to the integrity of their family, or of their broader environment.

A polish woman, who fled communist Poland as a child in the early eighties, explains: “my parents kept their plan a secret, so that I wouldn’t give them away at school. I thought we were going on holidays in the Eastern bloc but, when we found ourselves in Stuttgart, they calmly told me we’d stay here to live, and that everything would be OK, which it wasn’t. I chose to emigrate to the UK at 20, so I could take control of my own destiny, and here I am in the same situation again. I’m ten years old, my future has been robbed and I don’t know what to do”.

2- A new vulnerability resonates with a vulnerability from the past

For a number of months, EU citizens have been called “Migrants”, and have found themselves conflated with the stream of refugees risking their lives in the mediterranean. The perspective of an effective withdrawal from the EU will also mean that this newly labelled population will be submitted to additional controls. Disempowered groups of citizens also find themselves likely to be used as collateral in withdrawal negotiations.

A country hitherto perceived as stable and nurturing for EU nationals is now acting like a volatile parent, making up rules as they go along. This is likely to resonate with past experiences of parental inconstance, and bring up ways of thinking and feeling that are closer to the experience of an infant rather than an adult. This is compounded by the increased feeling of powerlessness and dependence upon an external authority, which are also childhood experiences.

Any sweeping, black and white statements about “brexiters”, “remainers”, foreigners, governments etc. needs to be seen as a resurgence of an infantile way of experiencing relationships.

Infants slowly learn to handle ambivalence and complexity in their relationships. For them, it is not just puzzling that someone good could do a bad thing. It is literally un-thinkable. So, to manage the emotions linked to their mother, for example, they split her in their minds into an entirely good and entirely bad mother, which bear no relation to one another. It is the task of the mother to help her child merge the two mothers into one figure, that can be good and bad at the same time.

Any sweeping, black and white statements about “brexiters”, “remainers”, foreigners, governments etc. needs to be seen as a resurgence of an infantile way of experiencing relationships.

3- Beyond “Them and us”: grieving and re-engaging with the other

This infantile, binary organisation of the psyche and binary discourse, damages relationships. Boundaries, which were fluid and constantly negotiated within relationships of mutual curiosity, have crystallised into an uncomfortable “them and us”. Young and old, rich and poor, town and city, find themselves pitted against one another on either side of a suddenly concrete and frozen boundary.

EU citizens were part of an “us”, and now find that they are “them”. It is tempting to buy into this, especially since powers of adult judgement are being challenged by the regressive experience of vulnerability and dependency. So, it’s for us to do our best to remain intellectually and emotionally honest adults in the face of this experience, and to remind ourselves that they black and white world that has taken shape is a conceit that seeks to hide complexity and to attack our capacity to be in relationship with one another.

“we need to go beyond our regressive experience and actively grieve for our recent past if we are to develop peaceful relationships in good faith”.

Importantly, we also need to actively engage with our new situation. It is a case of grieving an old order of things and welcoming what is emergent. Psychiatrist Elizabeth Kubler-Ross (1969) understood that a grieving person will go through 5 stages: denial, anger, bargaining, depression and acceptance. It is easy to apply this model to post-referendum Britain:

• in denial, both EU and UK citizens feel nothing will change. The result is a narrow victory and does not mean anything. Sadiq Khan tells EU Londoners that they are welcome as before. People think there may be a second referendum, or that article 50 may never get triggered.
• In anger, hostility arises and the ‘”them and us” takes shape.
• At the stage of bargaining, we may feel that if we do certain things, everything will be as before. We will feel secure again, empowered and welcome. This is where people apply for passports, apply pressure on their MPs
• During the phase of depression, powerlessness and vulnerability consciously sink in.
• Acceptance is the time for an active engagement with the new situation.

As Jean-Paul Sartre illustrates in his 1944 play “No Exit”, bad faith is the reason why two consciousnesses cannot communicate. He adds later that this “incommunicability” is the source of all violence. It is this very bad faith that can prevent us from seeing that we are free to choose our positions, at a time when they seem dictated by the collective will, and which makes the Other disappear as a person to know intimately. It is also this same bad faith that fuels the first four stages of grief in Kubler-Ross’ model.

Therefore, we need to go beyond our regressive experience and actively grieve for our recent past if we are to develop peaceful relationships in good faith.