Is the uncertainty of modern life causing more IBS?
It is late Saturday afternoon, the setting sun is shining across the loch and a fire is glowing in the grate. It feels very peaceful. We have stopped over at the Taycreggan Hotel on our way back from our retreat on the Scottish Island of Mull. I am catching up on the news via the internet. It is the familiar litany of industrial failure, political corruption, historical sexual abuse, another school shooting in America, never-ending war in the middle east, military build up by Russia and China, another shocking revelation about the American President, a further setback in our negotiations with the EU and the biggest threat of all, the potentially disastrous effect of climate change, which threatens everything we take for granted; food, energy, water and our homes and environment.
I have never known the world feel so insecure, but then I have been lucky to live my life through the longest person of peacetime and domestic security, Britain has ever known. I was born in 1945. Britain had won the war, with a little help from the Americans. The ensuing Labour government introduced The Welfare State and the National Health Service. Despite the disintegration of The British Empire to just a few red dots in the ocean, in 1964, prime minister Harold Macmillan could tell us, with a reasonably straight face, that ‘we had never had it so good’. Britain, or so we all believed, was still Great, leading the world in science, medicine and the arts. We may have undergone a bit of a dip in the nineteen seventies, but then, safe in the handbag of Mrs Thatcher, it seemed that we were doing rather well. We were one of the five richest economies and had a seat at the top table of international affairs. While part of the European Union, we still had a considerable degree of influence and autonomy.
The recent political and economic instability highlights the degree to which uncertainty can challenge our sense of identity. It calls into question the values, assumptions and beliefs that many of us accreted and embodied throughout our lives, leaving us feeling insecure and predisposed to ill health. The rural poet, John Clare must have felt much the same when the village, in which he grew up and lived all his life, was divided up by enclosures. He became ill and never really recovered. Who was he if the very environment he so strongly identified with was not there any more? My patients describe the same sense of dysphoria after a collapse of a relationship, loss of a job, parental illness, children leaving home, but now, it seems, they also suffer from the fundamental issues that threaten all of our security, notably Trumpism, Brexit and climate change.
In a recent article in The Guardian, psychoanalyst Susie Orbach wrote that Brexit is an assault on our sense of self, our community and our identity. The system, we have lived under for so long, has, like a fractured family, disintegrated and we too experience a sense of alienation. Politicians and the media manipulate us by fear. We realise that the people who represent us, our surrogate parents, are unreliable. Those whom we loved to criticise, have now split up. Instead of being able to take them for granted, we blame and mourn them. And all the while, an irresponsible media, intent on creating division whatever the cost, stirs up a state of paranoia.
Certainty and stability underpin healthy development. When we were very young, we were totally dependant on our ‘mother figure’. That bond was so intimate, that Donald Winnicott wrote, ‘there is no such thing as a baby’; there is just the union between the mother and her infant – they are essentially a single item. We needed our mother to be consistent and reliable; failure to respond to our distress calls would be like the archetype of anxiety and we would grow up with a fundamental lack of trust.
As we grew up and began to explore our environment, this core relationship was attenuated, but we still needed to know that our family was there and could be accessed when our security was threatened. We had a home to go to. Later, we made our own home, populating it with our partner, children, friends, colleagues, and acquaintances.
The idea of home is not just a container for family, it also encompasses the town we live in, the school and university we went to, our occupation, our country and more fundamental concepts like the weather and the natural environment – in other words everything that is familiar and we identify with. All of these contribute to the person we are and give meaning to our life. So any disruption in any of them can come to feel just as threatening and insecure as disruption in the family. This may feel much worse and cause exacerbations of illness in people scarred by familial trauma in their youth and childhood. As I have described many times in this blog, uncertainty may rekindle gut feelings of previous insecurity and bring on symptoms of IBS and other unexplained illnesses. Could this suggest that the recent ‘epidemic’ of unexplained mental and physical illnesses might be related to the insecurities and uncertainties of our current existence?
No matter how it came about, illness is itself a major cause of uncertainty and insecurity. If the reactions of our mind and body are unpredictable and let us down, we may live our lives in fear of what will happen next. This is particularly so if the illness is socially embarrassing, like episodic vomiting or incontinence of urine and faeces.
If anxiety is caused by uncertainty, then depression is caused by seeming inevitability that our needs may ever be satisfied – the hopelessness of it all. Emotional tension, just like many bodily states , temperature, appetite, pain, discomfort, obeys homeostatic principles; the body tries to return the system or feeling to a state of rest. So uncertainty
Installation in Folkstone UK by artist, Nathan Coley
would by necessity tend to make us try to relieve it by dealing with what has happened or moving to a place where things are much more stable. ‘Heaven is a place where nothing happens’. The problem arises when uncertainty has been implanted as an implicit memory by needs that could not be met very early in life or a later trauma that could never be dealt with. Then the aim of therapy must be to replace the implicit memory of illness with understanding, resilience and a sense of ‘learned wellness’. But then, we are such a perverse species. Who would ever want to live in a place where nothing ever happens?’
The Sensitive Gut 