Saturday Guardian: Susanna Rustin (Jun 10)

Saturday, 02 April 2011 15:40

"People don't suddenly become psychotic or depressed out of the blue, there's always a disaster that they suffer" 

'If you make happiness your goal, then you're not going to get to it," says psychologist Dorothy Rowe. "Philosophers have been saying it for thousands of years. The goal should be an interesting life."

Rowe has devoted her life to trying to help people free themselves from what she famously termed the "prison" of depression, to live that interesting life. In more than a dozen books, the self-help pioneer has set out what she believes are the obstacles that hold people back, and offered a recipe for, if not happiness, then a greater degree of satisfaction with their lot.

Drawing on her own life experience, including a miserable childhood and a marriage ended by her husband's infidelity, as well as her clinical work as an NHS psychologist, Rowe has developed a clear set of ideas about depression, and the best way to fix it. In the process, she has become something of a guru, with some admirers convinced that just reading her books is enough to bring about a transformation, even a cure.

Rowe believes talk of illness and cures is unsuitable. She prefers to speak of "mental distress", and rejects biological explanations for depression. "All the evidence has gone," she says, citing a recent study suggesting "life events" are what trigger depression in almost every case. "What we know now from research is that people don't suddenly become psychotic or depressed out of the blue, there's always a disaster that they suffer, and it's not always a disaster that other people can see is a disaster. It's a private personal one, but it always precedes depression, psychosis, obsession, mania, all of them."

At the heart of Rowe's thought is the idea that depression is a crisis in the relationship between the individual and the world. She believes that, as we grow up, we each develop a set of theories about how the world works. Many of these ideas remain private, though some may find shape in religious or political beliefs. But they are absolutely central to our understanding of ourselves and our lives. Depression is what happens when something challenges or upsets this worldview. "The reason people get into difficulties," Rowe says, "the kind of difficulties where they end up being a psychiatric patient, or difficulties like never being able to maintain a relationship, is that they believe that they are the way they see themselves, and the world is the way they see it."

Depression, according to Rowe, is essentially a defence against change, an emotional paralysis that afflicts us when we are unable to adapt. This insight came to her, she explains, as a result of the extended conversations she had with depressed patients while working in Lincolnshire in the 1970s, conversations conducted in defiance of the conventional wisdom of the time that what such people needed was drug treatment and, in extreme cases, electro-convulsive therapy (ECT).

"I realised that if you give somebody the opportunity to just sit and talk about themselves, and if you are interested in what they're saying, then over time you gradually build up a picture of how that person sees themselves and their world . . . So all I'd be doing, I'd be listening, we'd be talking, I would be there to offer alternative interpretations, to help the person see that whatever happens, we're free to interpret it in a multitude of different ways."

Rowe's early training in psychology was Freudian, and she has retained a strong sense of the importance of childhood events and relationships. Her early life, as "a country girl" in Newcastle on the east coast of Australia, was confusing and unhappy. She doesn't know if her mother really wanted children, but her father wanted a son. "He was very kind, but he hated any kind of trouble," she says. "As he got older he sort of withdrew, he just wanted a quiet life and would never intervene in anything that would get my mother going." Her elder sister, Rowe says, "was never on my side".

The family was dominated by her mother, whose fundamental dishonesty and insistence on her own point of view to the exclusion of all inconvenient facts drove Rowe herself to the brink of psychosis. "I know now that in my last year at school, had there been some kind of disaster in my life in that year, just a car accident or something like that, I wouldn't have been able to hold myself together . . . I'd have become very psychotic." In fact, nothing happened to tip the vulnerable teenager over the edge, and she left home to study for a degree in psychology 100 miles away in Sydney.

She became a teacher and began working as an educational psychologist, got married and had a son, Edward. Then she discovered that her husband, a lawyer, was having an affair. Partly out of respect for her adult son's feelings, Rowe has resisted writing in detail about her marriage, but in her new book, Why We Lie, she offers the story of the poet Cecil Day-Lewis, who was serially unfaithful to his wife Mary, as a kind of analogy. She suggests Mary was a substitute mother-figure for Day-Lewis, with the consequence that when she became pregnant, he felt betrayed. "He did what men like him always do in this situation. He had an affair."

Unlike Mary, however, Rowe did not wait for her husband to leave. She ended the marriage and, in 1968, decided to move to England. One of her correspondents had advised her there were jobs, so she signed up for a PhD at Sheffield University.

Now 79, Rowe lives alone in a quiet garden flat in Highbury, north London. She chooses her words carefully, and speaks in a distinctive hushed voice. She has recently had cataracts removed from both eyes, and is finding her improved vision a revelation. Lung disease during childhood went untreated ("the only thing my mother ever did about it was criticise me for coughing and say I was lazy"), and Rowe has suffered from bronchiectasis all her life. The illness, which requires her to spend time each day clearing fluid from her lungs, is a mild form of cystic fibrosis, and she recently suffered a severe attack. But she looks well.

"Loneliness is easy when you live on your own because there's always something you can do," she says. "My loneliest time was when I was married because I was trapped there. And I was lonely as a child but I could always go to the bush or the beach and just think about things."

Rowe's son lives in Australia. He remains the most important person in her life, and she moved to London partly to make it easier to meet when he travels to Europe. Her relationship with her elder sister remains strained. "When I encounter women whose sisters are their best friends, I am so tremendously envious, because that must be really, really nice, but that's not my experience," she says. Marriage, she decided, was "worth trying only once".

Instead, Rowe built her new life around her work. She arrived in the UK just as the NHS was beginning to invest in psychological therapies, and in 1972 was invited to set up a new department of clinical psychology in Lincolnshire. She describes it as a period of remarkable freedom. "Nobody supervised me," she says. "It was really a matter of having the time to sit and listen to the person. That's very difficult for psychologists nowadays because they've got managers and they're told, 'you can see people only for six sessions or 12 sessions'."

Jeremy Haldstead, a former colleague of Rowe's and a consultant clinical psychologist, says she "is a person full of knowledge and understanding. She has a lot of the generic qualities of a good therapist. I've had many conversations with her over the years and she will hold on to large quantities of whatever it is you happen to have said. Not everybody has the capacity to do that within a conversation."

In 1978 Rowe published her first book, The Experience of Depression (since reissued as Choosing Not Losing). In the subsequent decade she published half a dozen books and adopted the more explicitly self-help approach that would make her well-known. In books such as Depression: The Way Out of Your Prison and Beyond Fear, she offered advice to her readers in the second person ("Thinking that you will be helping your family by killing yourself can seem to be very virtuous, but it is not"), rather than simply describing clinical work, and recast depression as a personal challenge that could be overcome without professional help.

Writer Tim Lott, who suffered a severe depressive episode in his 30s and was successfully treated with anti-depressants, is one of those who believes Rowe's books can help depressed people to get better. Having been told by doctors when he was ill to disregard his dark thoughts as symptoms of his low mood, he was amazed to find Rowe took the opposite view: his feelings were the product of his thought processes, so his thoughts were worthy of close attention. He had been "quite hardcore on the idea that depression was a physical illness", he says, but became attracted by Rowe's framing of it as an existential problem. As he puts it: "Life can be shit, horrible things do happen at random to innocent people, and our mental defences can make things worse."

But while titles such as The Successful Self, Wanting Everything andDorothy's Rowe's Guide to Life placed Rowe in the vanguard of the expanding self-help industry, Lott believes "the way she's labelled a self-help guru does her a great disservice". She remains a champion of the original self-help idea, "the notion that the experts are rubbish and we can do this ourselves", but in conversation and in print she is more thoughtful and more political than much of the faux-spiritual, money-seeking advice that saturates the "self-help" market. Her previous book was a serious examination of sibling relationships, while Why We Lie is a wide ranging discussion of the uses of dishonesty in public and private life.

Rowe describes herself as having embarked on a "long quest to educate journalists" in the 1970s, and says that back then the reporters she spoke to would be amazed when she suggested childhood experiences could affect us later on. She was part of a generation of professionals who proposed a revolution in parenting, arguing against old-fashioned techniques in favour of a much greater effort to see the world from a child's point of view.

Alessandra Lemma, head of psychology at the Tavistock NHS Trust in London, believes Rowe's gift for communication has been her most lasting contribution. "When she started writing, she would have been one of the first people trying to popularise psychology - and by popularising it you raise awareness," she says. "She stands for a capacity to translate complex psychology into something more accessible. Being out there in the media is important."

Within psychology, Rowe identifies herself with a small band of fellow professionals, known as "personal construct psychologists", whose most important idea, based on the work of George Kelly, is that we construct our own meanings in the world, in our lives and families, a theory she believes sits well with recent discoveries in neuroscience. While broadly in line with mainstream cognitive psychology, her approach is more open-ended and she has been critical of the government's preferred model of cognitive behavioural therapy (CBT) as a "quick fix".

Her early writings show her chafing against the grids and charts used by clinicians to make their diagnoses, and she says what she learned as an undergraduate "had no relevance to human life whatsoever". Recently, she wrote that she could not be considered a "proper psychologist" as she was too aware of the "curious mystery" of life.

This insistence on the validity of subjective experience, as well as her conviction that a person's childhood and early relationships may hold crucial keys to their present distress, in some ways place Rowe closer to psychoanalytic thinkers, and she shares with psychoanalysts dating back to Freud a huge interest in literature. She and psychologist friends love to sit around after dinner plotting a syllabus built entirely on literature. Edmund Gosse's Father and Son is her favourite book.

But her view of emotional life and the function of psychotherapy stops well short of the idea essential to psychoanalysis that there is a dimension of the human mind that is hidden from conscious thought. When Rowe refers to the "unconscious", she is careful to explain she does not mean the cauldron of secrets Freud envisaged, but a kind of storage facility for thoughts there isn't space for nearer the top. In some ways, she thinks, a therapist is like a friend, "in the sense that you're always concerned about the other person and you get to know them really well".

While she remains doubtful about evidence of a biological basis for depression, Rowe thinks of herself as a scientist, and suggests hopefully that the vast gulf between scientific understanding of the brain and ideas about the mind is narrowing. This idea finds some support among scientists, many of whom now share the view that depression is a complex outcome of nature and nurture. Dr Carmine Pariante, reader in biological psychiatry at King's College London, says the "psychological versus biological dichotomy doesn't really exist . . . in the overwhelming majority of cases there is at least an environmental component".

Rowe does not necessarily seek agreement with fellow professionals, preferring to remain an outsider. Her website attacks "the bamboozling lies that mental health experts and politicians tells us", while in a recent edition of Beyond Fear she criticised psychiatrists, psychologists and psychoanalysts in the space of a few pages.

Provocatively, she has stuck to her line that "you have to be a good person to get depressed", arguing recently that it is the determination to be perfect that causes difficulties for many high-profile people. But lest she be accused of moralising Rowe insists the case against lies that she presents in her new book is not about being a better person, because "you can tell the truth in a very vicious way, can't you?"

At school in Australia, Rowe was "often in trouble for writing about things I wasn't supposed to, like politics. I wasn't supposed to know that Shelley had quite strong political views and wrote political poems". Why We Lie, a polemic that includes Rowe's views on climate change and the global credit crisis, seems like her answer to some of the world's problems. Psychology, for Rowe, is the science of living in the real world, and she has thrown off all caution to declare what she believes to be the truth about everything.

But the book has a more personal meaning as well. For Rowe, the origin of untruth was her mother. "In calling me a liar my mother was being as destructive to me as she would have been had she attempted to murder me," she writes. On one occasion her mother threatened to kill them both. Like her life, Dorothy Rowe's new book is a tale of survival.

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