Darian Leader is a man you turn to during a crisis. As a practising psychoanalyst in London, he, of course, tends to both the sudden and prolonged suffering of his clients, but as an author, his books offer a lasting comfort to readers and patients alike. Endorsing his Strictly Bipolar, two-time Booker-winning author Hilary Mantel wrote, “A contribution to a debate, but it could also change lives.” While Leader is obviously feted, it is his palpable empathy that has marked his reputation and bibliography.
His books such as The New Black: Mourning, Melancholia and Depression and Hands: What to Do with Them—and Why have now taken on new meaning. At a time when news headlines disguise trauma as cold numbers, and experts ask us to wash our hands every time we touch a surface, Leader offers insights that help us make sense of life and death. What is Madness?, arguably his seminal work, draws a careful distinction between “being mad” and “going mad”. So, as the world seems to be going mad with worry, we called Leader in the hope that he’d give our fears a rationale and our suffering a narrative.
During a pandemic, when a patient being wheeled in with COVID symptoms is more likely to be viewed as a possible corpse than a human being with an individual story, do you think there’s any space for psychoanalysis or psychoanalysts such as yourself to intervene or help?
In terms of critical care, I think other people have got more to say than psychoanalysts. These could be medical professionals, journalists, social theorists or philosophers. They must, of course, all recognise the importance of not forgetting the human dimension — that cases entering the hospital or cases that end up dead are not just numbers and statistics. They represent human lives with families, and that dimension should never be forgotten. I don’t think there’s room for a specifically analytic input there, although, obviously, psychoanalysis has got a few things to say about the psychology of people’s reactions to the pandemic, the fear of infection and so on.
In Why Do People Get Ill?, a book you co-authored with science historian David Corfield, you make the claim that physical illness can sometimes be the manifestation of an individual’s mental state. These days, we often hear that the coronavirus affects us all equally. Can this claim be true?
I don’t think it does affect everyone equally because most of the studies that have appeared so far show that socio-economic variables are clearly important. If you live with your family members in a closed space, there is obviously a greater likelihood that the infection will spread, just as socio-economic conditions generally correlate with health outcomes. Though there are some well-publicised cases of privileged elites contracting coronavirus, the broad statistical evidence so far indicates that the socio-economically underprivileged are disadvantaged.
With lockdowns and the insistence on self-isolation, we’re hearing several people describe loneliness as suffering. In the end, do you think this isolation might prove bearable, or is it what you once called a “nightmare of loneliness”?
Loneliness doesn’t always depend on the physical presence of others. That’s a common misconception. Someone can feel lonely when they’re with their families, with their friends, in crowds when they are surrounded by people. Loneliness is an internal state that can be present regardless of things outside you. Many studies of the elderly have claimed that what matters more than regular contact with people in their homes is the knowledge that someone is there if they need them.
I see a lot of people during the lockdown finding isolation more positive than negative in the sense that they want to have space of their own. Again, the socio-economic factors have to be recognised here. For most people in the world, a lockdown doesn’t mean being on your own because you are in a small place with a lot of other people. You might be living in one room with your family or people that you work with, so it’s only a privilege for some to be able to retreat. In terms of my practice, though, a lot of people say they find the lockdown a great relief.
Anxiety, you have written, is now a well-packaged illness. “The imperative to remove anxiety,” you say, “may do more harm than good.” Sudden unemployment, however, seems to have resulted in loss that has left many worried. Can such anxiety pose a danger to mental health?
The effects of this pandemic are tremendously massive and no doubt will continue to be massive for a long time. And it’s obviously important to recognise the effects of suddenly not being able to provide for oneself or one’s loved ones. These things can, of course, impact one’s material and mental health in every sense of the word. If you find that your identity and capacity as a wage-earner is suddenly abolished overnight, the question then is not just of one’s self-image, it’s also a question of one’s function in relation to one’s family network, one’s loved ones and dependants.
One of the things that a lot of analysts and therapists have seen so far in the pandemic is that at the beginning there were waves of anxiety in people—short, punctual moments of intense anxiety. Then we found that the patients who had been anxious prior to the pandemic were now more stable, whereas the people who had less overt anxiety had become more anxious. One reason to explain the first of those factors might be that anxiety today has a concrete thing to fix on—the presence of a virus. All anxiety can now be transformed into one concrete fear of a nameable, tangible object.
Shortly after India went into lockdown, the Indian Psychiatry Society suggested that India’s mentally ill population had grown by 20%. Since one out of five Indians has already been assumed mentally ill by the WHO, this figure seems alarming. Do you feel we must view such statistics with suspicion?
Definitely. It’s not like so-called “mental illness” is suddenly more frequent. It’s a question of visibility. Let’s say you have managed to maintain some kind of equilibrium in your life through things that might not attract a lot of attention—walks you take every day, or even trivial, fleeting interactions with local shopkeepers. If all these different things that people construct to give them stability are removed, the person is often left with a kind of vortex of uncertainty. All their classical defensive structures that they have spent years or decades building up are no longer available because of restrictions placed on movement and activity. That means that the compensations will be more frequent and more visible. Also, of course, being suddenly trapped in your home with other people can trigger a lot of problems. It can be very distressing if, suddenly, a lot of people find that their personal space has been removed.
In your book, Hands, you ask, “What if rather than focusing on the new promises or discontents of contemporary civilisation, we see today’s changes as first and foremost changes in what human beings do with their hands?” What do you make of us washing our hands constantly now?
One of the things that has become documented public knowledge post the pandemic is not just the need to wash our hands, but also a warning about the number of times people touch their bodies every day. For adults, that number is in the thousands. It shows there are clear links between the way in which we inhabit the body and the way in which we touch its surface. It’s been talked about over the years, but it’s only now that we’re seeing the perpetual touching of the surface of the human body as a rather interesting fact of human behaviour. Once you tell people not to do that or to try and reduce its frequency, they start to become more aware of it and might find reducing it more difficult.
You’ve just talked about how we touch our own bodies, but social distancing has also made the touch of other human beings an impossibility for many. What effects might this have?
This is an incredibly important aspect of the pandemic. It has been pointed out a few times, but not something that has been as central to media coverage as it ought to be. The very first entrance to human life is through touch when a baby is born. Touch has also always been seen as one of the most important markers of the exit from life, too. Ideally, a loved one holding the hand of someone passing away. That happens much less frequently than we think, but this is perhaps incredibly important for us to at least try to ensure. Obviously, critical care units and care homes are now finding this more and more difficult. Protocols against infection have effectively made it impossible for a loved one to be present, holding the hand or touching the body of someone dying. It seems important to me that we try and invent ways to allow some kind of touch to take place. It’s interesting that Switzerland has recently argued it is detrimental to the health of the elderly to be deprived of the touch of their young grandchildren, so they’ve started encouraging brief contact with grandchildren for them.
In an article for The Guardian, you’d written, “The imperative is to live longer, to be healthier, so that death almost becomes a mistake to be avoided.” Has the pandemic frustrated that imperative?
What we’re seeing now is something opposite. In Hands, for instance, I contrast two conceptions of life—the biological and emotional. The biological emphasis is on maintaining health. The aim of life is to be alive. You could spend your whole life exercising, eating blueberries, doing whatever you can to prolong your life, but by doing that, you might be cancelling out what others think is a fuller life, one that isn’t governed by a regime to make life longer. The pandemic has placed a premium on the biological conservation of human life, but as I have heard from a lot of my patients, including the elderly ones, there are things in this world much worse than death. That’s one reason why people kill themselves. Not being able to say goodbye to your loved ones, for instance, is for some people a fate far worse than death. They might even want to risk holding the hand of a dying parent rather than hope they avoid the spread of infection. You have to think—how does dying in isolation render the life of someone? Also, how does that death render the lives of those they are leaving behind? How will they continue living if they feel they haven’t said goodbye in a warm or even a dignified way?
Reading The New Black, one can’t help but reconsider one’s view of depression, but it also makes you revise your view of death. As we start measuring our mortality by looking at death count tickers, do you feel terms like “mourning” and “melancholia” will better explain our sadness?
If understood as complex phenomena and processes, I think those terms are still very accurate. But I think what we’re seeing now is a reduction of death to statistics and numbers. That’s certainly been a part of human civilisation in the past 130-140 years, yes, but given the way things are being presented on a daily basis by the media, I think it’s very important to have that counterbalanced by the story of the individual. Every news item that tells how many thousands of people have died should also focus on at least one individual’s story, so that people don’t forget that dimension of particularity.
In your new book, Why Can’t We Sleep?, you write, “Your insomnia is caused less by your worries than by the fact that your mattress is not gold standard.” Does that claim hold in a pandemic?
In the book, I am criticising the advertising practises of the mattress industry, which remove the dimensions of human pain and socio-economic distress. If someone is now lying awake at night, worrying about becoming ill with the virus or about their parents and elderly relatives, wouldn’t it seem like an anomaly to know that this person has had a lovely night’s sleep? We can ask another question: Why do we expect people to sleep well, given the difficulties facing the world’s population?
You’ve written extensively about art. Can art, do you think, help alleviate our personal and collective suffering?
Art and culture are woven into the way human beings respond to catastrophe, and it’s absolutely crucial to not forget that fact. When people are starting the long and difficult process of mourning, of trying to process their tragic losses, art can be a great inspiration in helping to get that mourning process started. It helps to have an exposure to how other people have managed to create something out of their own losses and pain. Artists, writers and creative people often show off their efforts in the public arena. While it’s essential to then separate that from the medical side of the pandemic, we must also give it a central place, showing people how to try to create from the process of loss.