David Zigmond Filament Publishing, 2021, PB, 104pp, £9.99, 978-1913192730
David Zigmond is a former GP, psychiatrist, psychotherapist, and political activist based in London. He writes prolifically and inspiringly on the perils of the industrialisation of health care, arguing that the increasing emphasis on procedures reduces human connection and depersonalises our interactions. He achieved more than his 5 minutes of fame in 2016, when his practice, based in St James Church in Bermondsey, was dramatically closed down following a visit from the Care Quality Commission, for noncompliance with current regulations.1
This brief and delightful book is the result of an invitation to discuss psychotherapy with a group of Jain Indians working mainly in the Antwerp diamond trade. Zigmond welcomes this invitation with open arms, and uses it as an opportunity to address two fundamental questions: Why are we gifted with reason yet cursed with restlessness? Why do we suffer and how do we heal?
Citing influences from Emile Durkheim to Yuval Noah Harari, he begins by rewriting the Christian creation myth. In place of original sin, he proposes that our problems arise from being gifted with a surfeit of brain capacity. With more capacity than we need for our physical survival and ability to procreate, we are seduced and tormented by our imaginations, by an inexhaustible interest in the other, in ‘what is not there’.
In contrast to all or almost all other sentient beings we are afflicted by four existential anxieties, of death, aloneness, insignificance, and meaninglessness. Denial of these fears, these absences, these ’vacuum phenomena’, leads to projection, hatred, and intolerance, whether of other groups or other individuals, and hence to abuse, homicide, and (if turned back on to self) to suicide. Human disease, in the form of anxiety, depression, psychosis, or addictions, is a response to these ‘not-theres’. And dis-ease all too easily lead to disease, for example, psychic stress causing acid indigestion and hence duodenal ulceration.
Comfort and healing are relational. They involve humanity, empathy, art, anything that allows creative engagement with our surplus brain activity. Psychotherapy enables us to endure and creatively encounter life problems, to increase our sense of agency. It may or may not involve a psychotherapist. Its essence is to convey the message ‘You are significant for me, so not alone.’ Psychotherapy has more nuance than religion in addressing our underling angst, since it has no need to involve mythical Others. While different therapeutic traditions may focus on thoughts, feelings, or body and behaviour, all work inductively, awakening a ‘human current’ for comfort, healing, and growth.
Zigmond complements his text with apposite illustrations from William Blake and Edward Munch among others, and concludes with Leonard Cohen’s advice to ‘Forget your perfect offering. There is a crack, a crack in everything. That’s how the light gets in.’ (Anthem, 1992).
Humanity’s Conundrum fizzes with exciting ideas. As a GP and former psychotherapist with a longstanding interest in mental health, I find it enormously appealing and invigorating, at a time when it is easy to become jaded and tired, to lose sight of the therapeutic purpose underlying all of our clinical encounters. In particular, I welcome the emphasis on the fundamental importance of existential anxiety.2
It’s not just the pressure of procedures that gets in the way. Our preoccupation with medical knowledge, with diagnosis and treatment, all too often leads us to depersonalise our patients. Whether intentionally or not, this enables us to ignore the reality of illness as a life-changing experience, leading our patients to articulate existential questions and experience existential uncertainty. Zigmond reminds us of our obligation to stop, to listen, and to respond.
- © British Journal of General Practice 2022
