When I worked as a child psychotherapist in the Department of Child Psychiatry at Charing Cross Hospital in London, we developed a new method for interviewing new patients. Normally, in a medical context, you take a medical history when you meet the patient for the first time. In addition to that, we asked people to tell us the story of their relationship to help. In a way, it seems like a simple thing. It’s clear that we’ve spent our whole lives being helped in different ways, and yet we often don’t think about our relationship to the wish to be helped, the need to be helped and our capacity to bear being helped.

One of the striking things is that in order to be helped, you have to acknowledge there’s something you can’t do for yourself and there’s something you need somebody else for. These are two powerful and fundamentally formative experiences, because one of the ways of describing a life right from the beginning is in terms of dependence – that a baby is absolutely dependent on their family. And so you can think of a life as one in which one grows from a state of absolute dependence to relative independence.

The story we’re told officially is that we begin by being absolutely dependent. Then we have a long period in which we become more and more independent and then, when we’re old, we become dependent again. I think it’s probably truer to say that we’re always equally dependent throughout our lives, but in different ways. What dependence means is being able to acknowledge that I need other people in order to grow and develop. I can only live my life in a state of need and want. And what that means is something to do with what we call as adults “being helped”.

What interests me is to think about where the areas in our lives are where we can bear, enjoy and want to be helped, and where the areas in our lives are where we assume we can’t be helped or don’t want help. What are the fears about being helped? What are the drawbacks? What are the compromises? What are the self-portrayals in acknowledging there’s something you need help with and actually asking for it? These are quite profound questions because every time I ask somebody for something I’m acknowledging I don’t already have it. I’m acknowledging a lack of self-sufficiency, and that means having to face the fact that I need somebody who I can’t control. There’s something very daunting about that project. If I want to learn to play the piano, I will need a piano teacher. But I will also have to bear with the fact that my piano teacher will not be under remote control. I will not have them when I want them. I’ll have to negotiate an arrangement. On the one hand, this is straightforward and practical, but actually it’s much more difficult than it looks because what happens if I want a piano lesson when the piano teacher is not there? What happens if I don’t like my piano teacher? What happens if I begin to think I don’t want to learn to play the piano? You can see that I’m embroiled now in a network of difficulties about being helped.

Education is a very good example of helping and being helped because if we think of the preconditions for being educated, the student has to have a desire to learn. The question is, where does this desire come from? We may be told by our parents there are certain things we need to learn that the culture demands of us, and there may be other things that nobody’s told us that we should learn but that we are interested in. So from the student’s point of view, there’s the question of, what do I want to know? And the following questions of, who can teach me, who can help me? Pragmatically, all you need to do is get a teacher, but we know that teaching goes on in the medium of a relationship. In other words, I can’t be taught by everybody. So there’s something else here which you might call chemistry that makes the helping possible. I want to learn something, but then have to find somebody who I want to be taught by. Somebody who is sufficiently acceptable, lovable, likeable, admirable, such that I can let them teach me. 

A good analogy for this is a meal. If I’m hungry, I can just sit around daydreaming about my meal, but it won’t nourish me, of course. In order to have a nourishing meal, I have to enlist somebody else. Let’s imagine in this absurd way that I want a cheese sandwich. I have to find somebody who is willing to make me a cheese sandwich and, ideally, someone who would love to make me a cheese sandwich, so there is a real exchange. If we have cumulatively that experience, for example, of a mother who wants to make us the food we most want, then we will grow up assuming that if we want something, somebody will be interested in what we want. So if I want help with something, if I want to learn something, there will be somebody around who will have the desire to attend to my want. They may refuse me, they may frustrate me, but they’ll be interested. I know that if I want something, my want is a form of engagement with another person, and out of that want, which is like a medium of exchange, a relationship can occur. The fundamental thing about helping and being helped is that the medium of it is a relationship.

Helping and being helped informs almost all our forms of relating to other people. For example, in a sexual relationship or a love relationship, it’s not exactly that I’m being helped with my desire, but I’m engaging in a relationship in which I might discover my desire, or discover something about my desire, and also discover something about my interest in somebody else’s desire and their interest in mine.

I don’t want to be helped with sex, but it’s a version of wanting somebody to engage with my desire in a way that enlivens it, that makes it feel alive and not persecutory and not dangerous.

The Covid crisis exposes something very powerful about helping being helped. It exposes people’s understandable desperation when they are ill to both understand what they’re suffering from and to find somebody who can help them with their suffering. There’s also a political and economic element because we also have to wonder about the motives of the people who want to help us. On the one hand, we could think our politicians want to protect us, but our politicians might also want to make us well so we can go back to work and earn more money or consume more. What the Covid crisis puts into focus very powerfully is, what is real help? Am I really being helped when I’m being encouraged to socialise or when I’m encouraged to socially distance? In other words, is the project fundamentally economic? So, are the powers that be trying to create the conditions in which we can get back to profiteering and consuming as quickly as possible? Or is this a more benign project in which we are being looked after? It’s a fundamental question that comes from childhood, which is, are my parents on my side or are they exploiting me to do something of their own? So are our governments now helping us with what we’re suffering from or are they exploiting our suffering to do something to us?

Real help involves several things. One is a capacity to identify with the person who’s suffering. Not that you can feel what somebody else feels, but you can more or less imaginatively enter into what they’re suffering from. You can also be more or less imaginative in your understanding of their suffering, so that it can be interpreted in many ways. Real help is based fundamentally on care for another person, a capacity to make realistic promises to the other person and also an ability to bear somebody else’s suffering. The project is not simply to abolish somebody’s suffering because you can’t bear it; it’s the capacity to be able to enter into it and to contain it, to be able to listen to somebody’s account of what they’re suffering from.

The risk is that the listener can’t bear the story and wants to fob the person off prematurely with a drug or a treatment, whereas actually it might require a good deal of patient listening. There are limited human resources, but the quality of a society depends upon the relationship to the most vulnerable people in that society.

A lot of people have been left feeling radically unprotected in this Covid crisis, partly inevitably, because there are limited resources, but partly because people have been very selective about who’s been treatable. Clearly, it’s much better to be rich with Covid than to be poor. Clearly, it’s much better to be white with Covid than Black. All these differential variables have to be included in the total picture. Otherwise, in this case, the virus simply becomes politics by other means. It simply becomes another way of continuing the fundamental exploitation of the culture.

The power question in terms of helping and being helped is central. Put in psychoanalytic language, how can we avoid having sadomasochistic relationships? What I mean by that is, how can we avoid a person making themselves feel strong by making somebody else feel weak? One of the preconditions for genuine help is that there would be no bullying, that there would be no domination, no need for the patient to submit. One of the fundamental questions that helping and being helped raises is, what is power? And how is power going to be used? As a doctor, you have an immense amount of power, but you might have so much power that the patient is too frightened to speak freely because they depend upon the doctor’s willingness to help. We’re always going to be caught up in this question of what I am allowed to say while having the relationship I need with a person who can help me. The problem is free speech and being helped don’t tend to go very easily together.

One of the useful things about being a psychoanalyst is that precisely these questions of power and authority can be addressed in the room between the two people. One of the things I try to do, and it sounds rather paradoxical, is being useful and helpful, but I’m also addressing the question of why the person believes me. In other words, what are the preconditions for somebody agreeing to take my words seriously? When somebody comes for psychoanalysis, one of the things they’re coming to understand is their relationship to authority because they’ve grown up with the very powerful words of their parents. Clearly, one of the ways we look after our parents is by believing what they say, but we are predisposed to be credulous. So the question you can address repeatedly in psychoanalysis is, how do I know who can help me? How do I know who simply wants to exploit me as opposed to help me?

For example, I might think I know, as an analyst, what it is to be kind to somebody. But actually, I need to find out what it would be to be kind for them. What’s their version of kindness? Because the risk is that I, as the analyst, believe I know what’s good for them. One of the things we try and work out is insofar as the patient believes that I know what’s good for them, why they believe this doesn’t mean they’re always wrong. But the question is, what makes somebody believe that they can trust somebody? It’s fundamentally about trust, and that means entrusting yourself to somebody such that they will not exploit you or bully you or humiliate you. That’s always the question in any relationship. How do you prevent help from being intrinsically humiliating?

The question of rejecting helping and being helped is very interesting. You can’t generalise, but I might refuse to help somebody either sadistically – because I want them to suffer – or I might feel that in helping them, I might be robbing them of their competence so that I might be assuming an inadequacy in them which may not exist. I may, in the nicest possible way, encourage them to do for themselves the thing they need help with.

If I refuse to be helped, that’s because somewhere there’s a fear that I might become dependent on the person who I need help from. It’s almost as though the background belief or the unconscious assumption is I could become addicted to or enslaved by the person who can help me. So it’s much better if I can avoid the need to be helped at all. I live as if I need very little help, I live as if I can do most things for myself, and that’s like an unconscious reassurance that I won’t be reduced to some craven, desperate figure.

Why are people so frightened of each other and why is there so little sense of solidarity in most of the societies we know? I believe this is partly to do with capitalism, as in an ethos that encourages competition rather than collaboration, and it encourages a world of winners and losers. It seems to me that that ethos is cruel and exploitative. We’re not going to change the world and end capitalism tomorrow, but in terms of our everyday life as individuals, it seems to me there are very simple things that matter. For example, being reminded of the pleasures of being kind and of the effect on us when people are kind to us. This seems to be a very simple and fundamental thing. Also, it would seem to me that a better society would bring people who would be more capable of listening to each other rather than coming up with solutions immediately. There would be free speech, but also free listening. People would be capable of and wanting to listen to each other. There’d be different kinds of conversation. But once helping and being helped enters into the world of competition, it’s a non-starter. The best thing we do is look after each other. It’s the only thing worth doing. And the question is, why isn’t that appealing enough?

Good things are done charitably. Also, charitable work is partly a conscience appeaser because I think it’s obvious that there is something terrible going on in the world we’re living in. Homelessness, for example. Imagine a day of a homeless person. We know it in a way that’s become a terrible cliché, that there are lots of people in the world who are virtually starving. We know that the distribution of wealth in the culture is startlingly inequitable. The question is how we can go on bearing, knowing these things and carrying on as we are. One of the most shocking things about us, as creatures, is that we can adapt to anything. We can live perfectly plausible lives stepping over homeless people in the street. At one level this is startling, that we actually have the capacity to do this, because it makes you wonder how much you have to inure yourself in order to survive in these societies. My assumption would be you have to numb yourself to a great deal, that you can only live in these capitalist cultures in a state of heightened anaesthesia.

This is the point that the structural inequality in the helping predicament is exactly what needs to be addressed for the help to be real. Even describing it like this loads the dice, because you could say we’re all equally in need of help and, although the help may be different, we’re all equally unaware of what it is we need and want. We are all in need of conversations and relationships which enable us to know these things. But I think that the place to start is to redescribe help such that the structural inequality is not the prominent preoccupation. In other words, that dependence can be a mutual pleasure rather than a form of domination.