Also, we moved to Brisbane, and then my anxiety improved a little. I went on medication at that point, and I think that did help me.
Ross:
Medication has played a useful role?
Mary:
I felt like it helped me function in short-term bursts, but that was it. I don’t think it necessarily helped with therapy. On medication I could do stuff, but it wasn’t actually progressing anywhere if that makes sense.
Ross:
Yes, I see what you mean. In all the therapy that you’ve had, and you’ve had a lot with various people, what do you think have been the most effective components? What procedures or tasks have most moved you forward?
Mary:
To be honest, for me, the very first thing was talking to someone who wasn’t an idiot.
Ross:
Right.
Mary:
It was so important to talk to someone who understood what they were talking about. Mostly I’ve felt that mental health professionals didn’t actually understand what was going on with me at all. And then they’d fumble around and try to get me to do exposure and it was all too extreme. It was all too traumatising.
Ross:
I see.
Mary:
I did learn about breathing from some early psychologists. And about not fearing sensations — learning the difference between sensations and symptoms. I think all of this was really helpful for my panic disorder because it meant that when I had a panic attack I could control my symptoms. One psychologist got me to deliberately hyperventilate through a straw and spin around so that I got used to bodily sensations. That was helpful.
Ross:
Getting exposed to the interoceptive cues — the body cues — and realising that nothing bad happened when you had those sensations.
Mary:
Yes. Yes. I did find that useful. But none of that really helped my OCD, which I have always seen as the biggest problem. Before you, no one really helped with the OCD or understood it even, I think. They didn’t seem to understand how to use exposure to get me to confront my fears. I remember one psychologist saying ‘your fear is death, and I can’t expose you to death, so I can’t use behaviour therapy’. I was shocked. Too few professionals seem to understand OCD.
Ross:
That’s really interesting. You met with a lot of people who didn’t seem to understand the problems you had and were, in your view, fumbling around a little.
Mary:
You know what? I also think that a lot of professionals that I worked with had their own death fears. I think this is a big issue — I think it’s another reason people avoid working directly on the death fears of their patients. I realised that I was dealing with fearful human beings trying to tell me not to be fearful. I thought, ‘How is that helpful?’
Ross:
I understand why that would make it hard to listen, and perhaps to trust. Yes, that makes a lot of sense. Mary, I’d like to change topics again and ask you about your feelings toward death. When you think about death, what emotions arise in you? What emotions arise in you at the thought of your own death?
Mary:
Sadness. Just sadness. No (Mary paused), maybe angry as well. (Mary paused again). I don’t know. All of the negative emotions. (Mary paused again). I think about the experience of death and the realisation that I’m dying and leaving people I love. And then I think about death on a spiritual level — of the universality of it all and what might happen afterwards, which makes me angry.
Ross:
In what way?
Mary:
Like, why the fuck? Like, for what point did any of this happen? Like, if we are some kind of spiritual being in the universe, why do we exist? Like, what? I just want some kind of answer, I guess. I feel like maybe that’s in death, but I don’t want to die.
Ross:
What do you think will happen to you as you physically die, and once you’re physically dead?
Mary:
I don’t know. I think death itself … It’s interesting because the way I picture it is absurd and isn’t how it’s going to happen, which is like the realisation of death, like the thoughts of knowing you’re dying. But that’s not how shit happens. It just fucking happens and then you’re dead. I often think about it in slow motion. I see myself from the outside — closing my eyes and seeing my partner Michael for the last time or realising that it’s all done. And then I believe that you probably wake up and do it all over again. I don’t know. I think I don’t tend to believe that this is it. So I do have some kind of sense of continuity.
Ross:
Expecting something beyond this?
Mary:
Not necessarily in consciousness. Maybe I mean a sense of the connectivity of the world — an experience of your consciousness dissipating and you no longer feel like you’re an individual, you feel peace with everything and everything that exists. Maybe that sense of oneness.
Ross:
I think I understand. Do you expect some ongoing sensory experience? Some ongoing awareness?
Mary:
I think so. But I also have a fear of that change of awareness, rather than there just being nothing.
Ross:
Can I ask you what relationship you see between fears of death across your life and your experience of everyday living? Is it an extremely tight relationship? Has fear of death been the ultimate driver of most of your 25 years of living? Or has it been a smaller part of your life?
Mary:
I think my relationship with fear of death has changed in the last few years — since beginning treatment with you, Ross, and also in finding more of a purpose. But before that, it was my world. Everything was about distracting myself from death, staying safe from death, and avoiding it, avoiding even saying the word ‘death’. Everything was about closing the blinkers and not focusing on it, or alternatively, obsessively thinking about it. I spent years obsessively thinking about death and exploring it thoroughly and then trying to avoid it altogether in any way that I possibly could.
Ross:
So once it was your world, but these days it’s not as dominant. You said that since entering an effective therapeutic relationship, things have changed. But you said that finding more purpose has helped you. That’s very interesting because you mentioned feeling purposeful in the teenage years in which you were free of anxiety. Can you tell me more about what makes life purposeful or meaningful right now?
Mary:
Multiple things. I have an increased sense of the possibility of leaving a legacy, I think. The idea of working towards something for life to be meaningful resonates with me right now. But I also get meaning and purpose by genuinely enjoying what I’m doing — enjoying life and the experiences around me.
These days I also believe that even negative experiences are worthwhile — they are still experiences. I’m caring less about survival. I’m less insular and less protective of myself — I’m caring more about others. I’m trying to focus on others and that definitely helps. The more I think of others; the less death seems to worry me. I have always thought that I would find the answer to life in other people. That has been a recurring thought of mine, and something that I tried to seek out at various points in my life. I have always sought out people
