In the opening chapter of How We Break, a book exploring the many ways that humans can reach breaking point, the psychologist Vincent Deary introduces Sami, a South Indian man who was sexually abused by other men from the age of seven. One of his abusers would give him a hand-carved animal after every encounter, and Sami eventually amassed a whole wooden zoo, which he played with for hours each day. Then his family moved house, and the zoo disappeared. How could Sami ever explain to his family the depth and complexity of his feelings about these toys? It was, Deary writes, Sami’s first experience of a profound loneliness that would remain with him.
This vignette sets the tone for the book, which is evocative, unsettling, emotionally complex and quite strange. Sami reappears in subsequent chapters. We next meet him as a zero-hours health worker who must stay up all night to watch over a suicidal patient who keeps trying to throw himself out of the window. Even when the patient falls asleep, Sami must remain on high alert. During a brief break he is reprimanded by an officious colleague for attempting to take a coffee with him out of the staff kitchen, and to avoid conflict – after all, he has no job security – Sami pours his coffee down the sink before returning to his post. Who is Sami, the reader begins to wonder, and why is Deary telling us so much about him? Is he OK?
Eventually we learn that Sami is a former boyfriend. Their relationship was passionate and volatile, which is what broke them up. “You will miss the drama,” Sami told him. Deary, who frequently addresses the reader directly, asking questions such as “How about you, my unknown friend?”, at one point addresses Sami instead. “So no, Sami, I don’t miss the drama, but I sometimes miss you,” he writes, and reading this I felt compromised, like I’d heard something I shouldn’t have or accidentally walked in on someone naked.
How We Break blends memoir with self-help, science and philosophy, and it resists easy categorisation or summation. Deary’s writing is wise and compassionate, sometimes florid and always interesting – few writers could jump so nimbly between Proust and RuPaul, neuroscience and the occult. The book explores and deconstructs the factors that can break or weaken our spirit, such as being a misfit, being overworked or living according to punishing or self-limiting standards. It is the second book of a trilogy entitled How to Live. His first book, How We Are (2014), divided critics, as this unusual book is likely to do – but I loved the exhilarating oddness of it.
Deary writes that sometime after How We Are was published, he himself “broke”, but on this subject he remains vague. His approach to understanding psychological stress and mental breakdown is shaped more by his professional experience. He writes of his work with throat cancer patients who can no longer enjoy food; old people who have fallen and are scared to walk; and his role at the UK’s first “transdiagnostic” fatigue clinic, which treats people who are experiencing crushing fatigue and exhaustion for a range of reasons, from cancer to depression. Transdiagnostic approaches offer a promising alternative, or complement, to how we conventionally think of mental illness, by focusing on the mechanisms – such as rumination (dwelling obsessively on a negative thought) or memory distortions – that are common to a range of emotional problems.
Deary depends heavily on detailed case-studies because he believes medicine is shifting away from relying on large data sets towards “idiographic” research that homes in on a small number of individuals, and that the future may lie in personalised medicine and precision psychiatry. Our emotional problems are as unique and complex as we are, Deary argues, but the underlying processes are the same. “Our best defence against the turbulence of life is not self-transformation but self-knowledge and self-acceptance,” he writes, and throughout the book he invites readers to consider how his discussion relates to their own life.
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He begins by exploring how we are shaped by our early childhoods, observing that we often apportion too much blame or credit to parents: the wider culture and environment into which we are born, our schooling and our first encounters with peers can be formative too. Life may be easier for those who naturally fit in, whereas “misfits are given back to themselves as work”: from an early age those who are awkward or different must learn to manage the difficult emotions that come with social isolation or rejection. He stood out from his peers in a working-class Scottish community, as someone queer, with a posh accent and a mother with outsized ambitions for her children, who took them to museums and the theatre and filled the house with books. His classmates called him “Concorde”, but his large nose is now more likely to be seen as distinguished, and his mother’s efforts were rewarded – Deary and his siblings enjoyed professional success and escaped their childhood poverty. In other words, our perceived strengths and weaknesses, our successes and failures, cannot really be understood without reference to our surroundings.
Deary hopes that once people understand how little control they have over the kind of person they are, they will learn to unburden themselves from both credit and blame. This isn’t only about the luck of whether you were born rich or poor, safe and loved or desperately insecure. Our talents, personality, or tendency towards mental illness are partly the result of genetics and reflect what the philosopher Thomas Nagel calls “constitutive luck”, the luck of being the kind of person one is.
Reading Deary, one begins to wonder how we developed such a simplified, inflated, harmful view of the self: consider how many popular psychology and self-help books advance a single explanation for our problems or act as though we can change our lives through hard work and will alone. Deary instead borrows concepts from physics and engineering to examine how a variety of life “stressors” (stress-causing situations) can interact. He believes it makes no sense to think of something such as “willpower” as simply a personal attribute, when so many external factors influence our capacity to resist temptation.
Each person’s struggles are very different and so readers might find different sections of How We Break more resonant than others. Those prone to rumination and self-criticism will be interested in Deary’s discussion of inner monologues. “Perhaps the oddest, most problematic and yet rarely remarked upon feature of human existence [is that] we have a relationship with our self… we are capable of self-aversion, self-criticism, self-contempt, self-harm, self-destruction…” he writes. While many forms of therapy aim at helping us change the story we tell about ourselves, Deary sees merit in acceptance and commitment therapy (ACT), which instead encourages us to change our relationship with the story.
ACT suggests that high self-esteem is as problematic as low self-esteem: the trick is to step away from our inner critic, to acknowledge that in our lives we are neither the narrator nor the story. “If we imagine our lifetime of ego-driven melodrama and its narration as the play, then the Self is the theatre,” Deary writes. “The work of well-being then is not to change the play but to be the theatre, to disidentify with the ego and be your Self.” This way of thinking aligns with Buddhist philosophy, as well as much neuroscience. I personally am about as likely to succeed at “being the theatre” as I am to grow wings, but even a subtle shift in perspective can have a dramatic impact and Deary’s is the rare book that helps you see the world a little differently. In any case, he is too subtle a thinker simply to conclude that the answer to overcoming suffering is to achieve a kind self-transcendence, to let our feelings float by like clouds.
He writes that he once came close to this state on a ten-day silent retreat. He realised there that if he disengaged from his wants and desires: “I would want nothing, I would fear nothing, I would be free. Ah, but where’s the pleasure in that?”
How We Break: Navigating the Wear and Tear of Living
Allen Lane, 304pp, £25
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This article appears in the 10 Jan 2024 issue of the New Statesman, The Year of Voting Dangerously