Thoughts as I cycle: fear, uncertainty and doubt (FUD)

This one came into focus yesterday, around the time the hymn came to my mind as I felt the challenge of that “3km at 6%” and wondered whether I can make it to Santiago, and recognised that I’ve pretty much abandoned the idea I had had of getting on beyond Santiago, to Finisterre and back.  The phrase that came to my mind was “FUD” and interestingly I associated it with the bombing in what I was thinking of as “the first Iraq war”.  My mind has been making a mess of things with that as I’m conflating “FUD”, which I know well from its IT roots: you make the customer stick with what you want them to stick by sowing FUD about alternatives.  I’m muddling it with “shock and awe”, and that’s from the “second Gulf war” (N.B. to self: it’s “Gulf war” not “Iraq war”.)  It’s been odd sorting this out with the help of Wikipedia as it’s brought back two searing memories.  Let’s follow those as I think I should trust these processes.

The first can be dated precisely to 17/1/1991 so I was a bit under seven years into psychiatry.  I and my partner for some years had separated and I was living in a shared house with a number of (basically lovely) medical students.  I had worked late as was usual> academic work.  I think I came into the house in the early hours of the morning or very late evening and a number of the students and friends of theirs were glued to the TV in the shared sitting room and said “we’re at war” or something pretty similar.  I had heard nothing of this and watched in complete horror the start of that news coverage that got it named the “first video games war”: bombs raining down as if they were fireworks.  Remote footage as guided bombs were aimed into targets and the black and white explosions that marked that footage.  I remember standing there for ages feeling almost unable to speak, almost unable to think, though I was thinking, and one thought was that the students didn’t like it either, but their reaction was younger than mine, without the same gut wrenching horror at the death that was being caused and at the sense of the inevitability that much, much more death would inexorably follow.  As it did.

The other is equally easy to date: 9/11/2001.  I was working in Rampton by then and as I left my office, then outside the secure perimeter, someone said something that I caught as “a plane has flown into the Twin Towers”.  I was preoccupied with the clinical work I had to do (though I confess now that I can’t remember what that was at all) and my silent reaction was that it wasn’t important compared to the challenge of working in Rampton and trying to understand the contorted problems it contained, both the patients, and the rejection of them and what they had done by wider society. That probably sounds mad but I had linked what I heard with memories of an American who had once landed a microlight plane in Moscow.  I thought it would be something of that size or not much bigger and nothing in the tone of voice in which the person had spoken conveyed anything serious and I now realise she, one of the superb secretarial staff as I remember it, was completely stunned having already heard the severity of things on the radio report.

I got back a few hours later and people had found a TV and set it up in the waiting room in the administrative area and were watching the horrifying pictures, running and re-running, of the collisions, of the people jumping.  It was the second time in my life I was frozen and again thinking of the lives cut short, but this time I had very little sense of the wave or horror that would follow.

These are pretty horrifying images but I know they do link with something that is a niggle, or more, contributing to this pilgrimage and very much connected with my clinical work and ending it.

These were dramatic moments but humans do horrible things to other humans, and to the planet and its so many other species, all the time.  That’s us.  I honestly think that not acknowledging this is utterly mad and utterly unhelpful.

So where do these memories connect with “FUD”?  Well, the recollections arose out of it but I think they’re mostly about “F”: Fear. What had triggered the FUD thoughts was recognising the previous few days had been unhelpfully blighted, no, that’s too strong, plagued, by “D”: Doubt and the recognition that I’ve never been a very confident person, that I always doubt myself and my right to impinge, to be around and that I have often dealt with that, certainly from teens, earlier I think, by trying to be good at something and demostrably useful at it.  I knew that some of this time out is needed for me to cope with not being able any more to do that with the idea that I’m good at clinical work, that I do some good through it.  I think that handling the new doubts about whether I’d make it to Santiago (so what if I don’t?) was, is, a key part of this challenge but that I want to come out of this opportunity to reflect, to mark the change in my life, not just continuing to deal with self-doubt by trying to give myself some proofs of worth by work.

It’s not easy to change who you are and the habits of, well perhaps as much as all my 59 years so I know this is something I’ll be working on for a year or two of the “continuing (internal) pilgrimage” when i get back.  What struck me was that it might be useful to distinguish between F, U and D.

I am putting some self-doubt as central here but the two burned in memories, of the first Gulf war as it opened and impinged in Tooting in South London, and 9/11 as it impinged in the curious retreat in rural, agricultural, Nottinghamshire that is Rampton are partly about F: utter, gut twisting fear.  But they’re also about U and its dangerous opposite: certainty.  I was certain as I watched things in Tooting of the further horror to come, as I watched some of 9/11 (very little: I couldn’t bear it for long and turned away to do something, however small, useful) I didn’t have the same premonitory certainty but the horrible certainty that so many people who had woken up that morning with no sense it was their last, were now dead and some had held hands and jumped together with that certainty that death was their only outcome.

It struck me, toiling up that hill, that I have spent a lot of my life dealing with U: I love statistics and the principled management of uncertainty which is the heart of good statistics.  Good statistical methods help us think about U, they don’t give us certainties.  If we could get away with the prevailing ideas that statistical methods give us “proof” in medicine we’d be a lot safer.  I’m particularly fascinated by and have contributed, a tiny bit, to “psychometrics”, the particular set of methods, usually but not always statistical, that help us manage usefully our uncertainties about what any communication from another human being means.  Those are all very stereotypically masculine domains (though not, of course, in any way restricted to men, just typical ways men in our current, Western, culture, like to handle our uncertainties, and, to some extent our doubts and self-doubts.

One release of stopping clinical work, partial but I’m going for it with probably excessive zeal, is that I would not have shared some of these thoughts publicly previously as I think there’s a real way in which clients, patients, finding and reading such things, would lose some really important freedoms to believe things about the person of this clinician in whom they are trusting so much.  It’s partial as some of that freedom not to be burdened by this stuff about me is probably helpful for some years after therapy work finishes, if not for ever.  I’m taking a punt on (a) it taking some considerable time before clients I finished with very recently might find this and (b) others being ready enough, as I think the recent finishers will be by the time they, perhaps, find this.

However, it’s a sort of release to share these things.  I’ve always been uneasy about the idea, the certainty in some quarters, that therapists should be very opaque: it has felt not principled but self-protective and dishonest.  However, I don’t think there are easy answers.

I’m going to be pondering the separating of F, U and D more in the remaining week or so, but, I hope, for some years to come.

There’s a link here to “He who would valiant be”, actually, such a slew of links that it’s not so surprising that the words and tune followed soon after “FUD” as I pumped the pedals and groaned, but that’s meat for the days and years ahead!  I’ll try to get a quick positive post up here now to follow this to underline that this is not all doom and gloom: it’s really not, it’s about moving on, whether inching across the map of Northern Spain, or just in the multidimensional mess of my mind and my connections with others and my embeddedness in our cultures.