Illusion and Reality: The Meaning of Anxiety

by David Smail

This work challenges the notion that anxiety and depression amount to a mental illness denoting that something is wrong with the individual sufferer. Instead, anxiety and depression are described as perfectly rational responses to difficulties in the sufferer's world, experienced subjectively by that person. An essential contrast is drawn between objective conceptions of normality (what reality ought to be as per commercial and other objectifying sources) and the reality of the individual's subjective experience of the world (abuse, unemployment, and so on). Chapters include tackling the myth of normality; examining shyness; and analysing the way in which assumptions behind the use of language can foster anxiety and depression. The book's primary purpose is to explain the meaning of anxiety as experienced by the sufferer. These insights also lead to a view, by way of secondary purpose, that the role of the therapist is not in 'curing' the individual, but rather to negotiate demystification and to provide insight into the effects of the problems in the sufferer's world, based on the sufferer and the therapist's shared subjective understanding.

Genres: Psychology, Nonfiction, Mental Health

192 pages, Kindle Edition

First published July 1, 1984

Reviews

[Chris Tempel · Rating 3 out of 5]

Pretty decent book of the blind spots of therapy and psych-whatever from a longtime NHS (UK) clinical psychologist. To generalize: for Smail, anxiety and depression are symptoms of a need for nurturing in a culture that is good at pretending to give love but really manages to maintain you as a sort of machine, and treats distressing symptoms as physical when they are anything but. The creation of the consumer in our great metropolises makes people idealize objects. those that glimpse how fragile and difficult their relationships are from time to time typically develop anxiety and depression. Even those that avow to get away from this existence exhibit the dominant ways of thinking: idealizations, fantasies, delusions, and so forth are likely to be uncorrected or are secrets guarded tightly from a world based on the image of togetherness. For a depressed person everything has cracks, and it's all a big exhausting performance outside as well as inside.

Smail says that the only route to subjectivity and integrity for all of us, not only those with anxiety and depression, is painful, isolating and alienating, and it will take a lifetime. The last two chapters are devoted to this but I'll try to summarize: 1) do not shame yourself for any "failure" that allows you to cope with society, you do what you do for perfectly fine reasons even if they are considered abnormal (or "mentally ill", a term he abhors), and 2) start to see what you can actually do. as in, you are not a work in progress and there are things you can affect individually as well as collectively. You do not need other people's consent to do what you will have to do time and time again if you choose this, which is stand up for your own experiences even when they are by definition unprovable or even beyond language, when they beyond fashionable politics, in a society that controls using both rhetoric and image.

The role of the therapists in this is to clarify things, and give support and resources. This to me includes truths that allow people to cope.

[Ryan · Rating 3 out of 5]

this book is basically a manifesto for the thorough application of common sense to psychology, with an existentialist bent. very anti-method, extremely critical of medical psychiatry, behaviorism, psychodynamic depth psychology, and pretty much everything else in academia. to smail, dominant forms of psychological help are either too mechanistic (psychiatry) or (as with therapy) they adopt a kind of pseudo-scientific bad faith about what they really are: the commodification of love in response to its scarcity in modern society (much like prostitution is the commodification of sexual favors). a little too rant-y, but it's hard to complain too much when you're convinced by most everything he says.

the positive thesis, more or less:

"Psychological help, then, is gained by those who seek it first and foremost in the context of a relationship in which they are undeceived about the nature and significance of a real, often complex and possibly insolubly difficult, painful predicament or set of circumstances, and encouraged to confront bodily those aspects of the predicament which admit of any possibility of change. In essence this procedure is a moral, not a technical undertaking, since at every point it necessitates judgements' being made by both therapist and patient about what is right and what is good for either or both to do, not only in the immediate therapeutic setting, but also in the wider social context (particularly, of course, that of the patient)." (140)

[Peter · Rating 5 out of 5]

A quite terrifying, but critically important book for anyone who wishes to greater understand the underlying causes of the now epidemic levels of 'mental illness'. Smail challenges psychology and psychologists' role in 'fixing' people displaying mental health problems, so they are best able to continue operating in our present society. Conversely, it is the latter which Smail claims is the cause of our suffering, our symptoms merely a 'rational' response to an irrational and pathological social system.