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Susie Orbach: “Human beings are unbelievably adaptive”

The psychotherapist and author on the mental health crisis.

By Sophie McBain

Susie Orbach might be Britain’s best-known psychotherapist – she was Princess Diana’s shrink, she wrote Fat is a Feminist Issue (1978) – but to some of her patients, she’s just a “nice lady in Hampstead”, north London. She still sees around 18 people a week, from a diverse range of backgrounds, and adjusts her fees accordingly. Some have been patients for decades: once they discussed new parenthood, now they talk of grandchildren. She has forged a “profound form of intimacy” with them, though an unusual one, in which she is mostly the listener, the holder of stories: “We’ve grown old together.” 

Orbach is 74, spry and glamorous in a fitted black dress and jacket, lots of jewellery, and a floral scarf. She welcomed me into her home with a firm handshake (there is no talk of social distancing) and fizzed around her kitchen, which was bright and modern, boiling the kettle, grinding coffee beans, commiserating about the “bloody nightmare” of the pandemic. “Everything: the politics of it, the horror of it, the pain of my patients…” she said. “And I’m privileged! I’m hyper-privileged. I’ve got a great space, I’ve got really interesting work. There’s nothing to complain about, really. And yet it’s hell.” 

She spent lockdown in north London, where she lives alone. Her wife, the writer Jeanette Winterson, lives in the Cotswolds. Winterson has spoken about their arrangement in interviews (she says she likes to be by herself, while Orbach needs the “buzz” of London) but Orbach looked strained whenever I tried to ask about their relationship. Not long after she’d handed me a coffee and slid into a chair in front of me, she said, “I’m the least interesting thing about myself,” a line she’s used before, and a surprising admission from a therapist. 

What is more interesting, I think she’d argue, is the way she helped create a feminist approach to psychoanalysis, a means of understanding how politics shapes our inner worlds, and in 1976 founded the Women’s Therapy Centre in London to address this unmet need. What is more interesting is her pioneering work decoding women’s love/hate relationship with food, and the political and cultural pressures that alienate us from our appetites and our bodies. What is more interesting are the decades she has devoted, as a therapist, writer and activist, to trying to liberate people from the body-loathing that is expressed by disordered eating and rising rates of self-harm. 

When Orbach wrote Fat is a Feminist Issue, or “Fifi” as she calls the “anti-diet” book that made her famous, she wanted to change the world. Her ideas were inspired by the consciousness-raising groups she attended in New York, where she and fellow feminists puzzled over why they were all so discontented with their bodies. Why were they stuck on permanent diets that were doomed to failure? Why did they care so much? She observed how women used food – bingeing, purging, restricting – to try to cope with unresolved emotional conflicts, and believed some had an unconscious drive to become fat as a form of self-protection, to avert the male gaze. 

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She still receives frequent emails from women who just have come across “Fifi”, and finally feel understood. “It’s heart-breaking, but it’s lovely,” she said. Orbach had imagined by now we’d be comfortable in our own skins; it is “shocking” to her that the situation has only become more desperate. She began writing about anorexia in 1984: until then, it was virtually unheard of; now it’s a “bloody epidemic”. In our appearance-obsessed culture, the body-hatred that once mostly affected women is harming men and young children, too. She blames the government’s ill-conceived anti-obesity initiatives, the fast food and the diet industries, the mothers passing down troubled eating habits, the narrowing of beauty standards, the unrelenting pressure of social media, and the rise of plastic surgery. 

Orbach had learned to diet from her mother, who only ever ate chocolates in secret in the middle of the night; those groups she attended in New York helped her relearn her response to hunger. While writing Fifi she ate a lot of cheesecake, the kind of food forbidden to her as a child. Orbach’s mother, an American, had wanted to be a lawyer but taught English to refugees: she was “political but frustrated – my God!” Her father was a Labour MP. Orbach once said that growing up she was so miserable she didn’t even realise she was miserable; she felt “misunderstood” and “beleaguered”. At 15 she was expelled from the North London Collegiate School, where she had been on a scholarship, for getting pregnant. I tried to ask her about the pregnancy, the abortion. “It’s so irrelevant to me now, my life is so far away from that,” she said, waving her hands in the air as though shooing a fly. 

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But, I asked, isn’t this the kind of experience that politicises women? “I didn’t understand feminism as early as I should have,” she said. For a long while she saw what had happened to her as a personal injustice: how unfair it seemed that some girls could have lots of boyfriends while she was punished for going “all the way” with one. She finished school at Camden Girls, where she fell in with a crowd who saw themselves as “bohemian”; they aspired to be “sexy and interesting”, they campaigned for civil rights, protesting against apartheid in South Africa and the Vietnam War. 

After dropping out of university in London, Orbach enrolled at the City University of New York (CUNY) aged 21 and found her home in the women’s movement. At the consciousness-raising workshops and in the legal campaign work she engaged in, Orbach began to connect the dots. “Feminism saved me,” she said. “It saved my whole generation, really.” They weren’t going to be like their mothers – trapped, bored, isolated and ashamed of their hunger. 

When the Women’s Studies programme at CUNY became beset by infighting, Orbach developed an interest in how misogyny can be internalised; she would later co-write a book analysing how the conflicts that arose from challenging the patriarchy poisoned women’s friendships. She began to study psychoanalysis, “which was so misogynistic at that time it was ridiculous!”, but which offered a methodology for thinking about how we become who we are. If women were to change the world, they would need to change themselves, too – or at a minimum, understand how patriarchal norms could become imprinted on the subconscious, shaping their emotional lives. 

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Orbach didn’t know, at first, that she’d be a good therapist – how could you? The first place she worked was the New York probation service, with trans people caught up in the criminal justice system who were offered regular therapy in place of a custodial sentence. “The therapist who supervised me was in shock that I was good!” she told me. 

She has written several books trying to demystify what happens between analyst and patient, and worked on a BBC Radio 4 programme, In Therapy, in which she would recreate a session, but with improvising actors rather than real patients. The programme is slow-moving yet gripping, and sometimes excruciatingly awkward. Long silences go unfilled. In one episode, a patient tells Orbach that he is madly in love with her, and she responds first with a therapist’s “Mmm-hmm”, and then, “Look, it’s important what you’ve said…” Orbach hadn’t been expecting the actor’s confession (“I wanted to kill the director!” she laughed) but on the radio she seemed unfazed. In person she is the same, warm but brisk. When she said she had struggled even to read the newspaper during lockdown, I found myself telling her I had been so emotional after my first child was born that I read nothing for six months, and she snapped to attention. “Well, of course not! Sorry! It’s the most incredible thing!” she said of being a new mother, in a tone I can best describe as assertive empathy. 

Orbach has found that, in the five decades since she started training as a psychotherapist, most people have woken up to the importance of feelings, but few have become more emotionally literate. They still struggle to relate to other people’s emotional disclosures: “If somebody has a miscarriage, do you cross the street, or say something stupid like ‘Oh, better luck next time’ or do you, and without wanting to sound too British Airways…”  she dropped her voice, so that it was gentle and tentative: “say: ‘That’s so difficult.’ Can you say something real? I don’t think we’re there yet.” 

Photo by Alice Zoo

The morning we met, Prince Harry had spoken in an interview of wanting to “break the cycle” of “pain and suffering” in his family in the way he brought up his own children. Orbach, who was hounded by the press after Princess Diana’s death but has never broken her professional confidentiality, didn’t want to talk in detail about the interview. “I kind of know too much about it,” she said, though she did feel “he’s on to something”.  There’s also an element of what he said that’s close to universal: “I think every generation wants to make its own mark on its children,” she said. Orbach has two children from her previous marriage to the psychotherapist Joseph Schwartz. “I made my children different the same way my parents being leftists had made me different: ‘There’s no such thing as God,’ my parents would say; and I’d say, ‘What did you feel?’” She always encouraged her children to reflect on their emotions. 

The Women’s Therapy Centre closed in 2019, for lack of funding. Orbach was frustrated with the psychoanalytic establishment for not fighting harder for NHS money; Britain’s health service now favours more structured, short-term talking therapies such as cognitive behavioural therapy – which lends itself more readily to metrics and evaluation. The goals of psychoanalysis are more personal and open-ended. Orbach sometimes quotes Sigmund Freud, who wrote that the purpose of therapy was to transform hysteria into ordinary unhappiness. I thought of her as a teenager, and of so many teenagers, who are unable to recognise their own misery, and wondered what “ordinary unhappiness” even means. “There are sorrows and anguishes, and things we can’t do anything about except tolerate and feel them. I don’t think that limits happiness,” Orbach said. “Happiness is not a synthetic concoction: it does have to come out of tolerating difficulty.” 

I asked what she thought the psychological impact of the pandemic might be. Is it, as the leading psychiatrist Adrian James has argued, the biggest hit to mental health since the Second World War? Orbach said she worried for young people, who have been robbed of the richness of social interaction just as they are grappling with fundamental questions of identity. How do you become a grown-up? How do you have an impact on the world? She was concerned that lockdown isolation has been “diminishing” for teenagers. “But the long-term effects? I just really don’t know. The thing about being a psychoanalyst is that you can talk about the present, you can talk about the past, but you’re not a futurologist. Psychologists think they are, but I’m not,” she said. “And human beings are unbelievably adaptive.”