Image courtesy of Serge Bertasius Photography at

Image courtesy of Serge Bertasius Photography at

This article focuses on a specific area of human action; our ability to manage our experiences and in particular our mental health. It will explore how the words and ideas we use to describe aspects of our experience affect our ability to manage ourselves.

Surveys of the prevalence of psychological problems suggest that high percentages of people experience significant psychological distress. This is often blamed on the pace of modern life, and the lack of appropriate and accessible services is frequently mentioned as a factor. In this article I want to explore the possibility that the way we have come to describe these difficult psychological experiences makes it harder for us to understand and manage these experiences. I will suggest that this is a major reason why so many people have psychological problems.

I will approach this issue by first considering experiences which we describe in terms of our actions. When we think of everyday activities such as reading, cooking, gardening, playing sport we see all these activities as the person doing something. We tend to focus on the physical action involved in these tasks but we also recognise the importance of the thinking we are doing at the time. We recognise the importance of learning how to do them and of concentration when we are performing them. We know that to develop knowledge and skill we need to practice and build habits so that we can perform aspects of the actions, including the thinking, automatically.

So when we describe these everyday activities we see them as actions we are performing but we also implicitly recognise that our thinking lies behind our actions. This thinking includes wanting certain outcomes, having an understanding of how things work, being able to predict how things will turn out, and making judgements and choices. We can regard this thinking as inner action as it is an intrinsic part of us doing any activity, even if it less obvious than our outward physical actions.

In activities such as doing a crossword, solving a puzzle, designing something, planning a project the thinking takes centre stage. It is, again, an intrinsic part of the activity. From these considerations we can see that we should regard thinking as a form of action; thinking is action that takes place in the privacy of our minds.

Turning to our psychological experiences we can apply a similar analysis to our everyday worries. If we see a friend is worried or anxious and we try to help we will say things like; “It won’t happen.” “Don’t worry.” “Try not to think like that.” “It will be OK.” “It won’t be that bad.”

By advising our friend in these ways we are clearly recognising that what makes the person worried is what they are thinking. We know this is something they are doing and that it is the source of their distress. Our efforts are aimed at encouraging them not to carry on doing it. In particular, we are encouraging them not to predict that things will go wrong and we are also challenging the way they are making possible outcomes seem so bad. We intuitively know that anxiety is a form of action characterised by predicting something and not wanting that thing to come about.

So we see everyday worry or anxiety as something we are doing, as a form of inner action. It is important to note here that while anxiety may be driven by the way we are predicting and not wanting certain outcomes it is also a physical process that can involve sensations. Even everyday worries sometimes produce strong sensations; eg exams, interviews, driving tests, bungee jumps, competing, performing. We see these sensations as understandable given the situation the person is facing and so we see the sensation as connected to the thinking they are doing.

However, under certain circumstances we disconnect sensations from the thinking behind them. We no longer focus on the thinking the person is doing but instead ask them to describe their sensations. But we go further and describe these sensations not as sensations but as symptoms. When we do this we are seeing anxiety quite differently. Here we are meeting inner action’s first enemy, the ugly sister thingification or reification, (ie the process of describing an action or process as if it were a real thing).

Turning sensations into symptoms suggests they are symptoms of something. We no longer direct our attention to what the person is doing in their thinking but to the idea that there might be something causing their symptoms; there might be something that the person is suffering from. Sensations that can only arise as part of our thinking become seen as problematic symptoms of something wrong with the person. By doing this we create the possibility of conditions, disorders, even mental illnesses. Possibilities that need to be identified and named. In this way all manner of natural sensations and combinations of sensations end up being given diagnoses. There is an ever-growing list of such diagnoses. So by the simple thingification of sensations into symptoms we fill our imaginations with a host of possible conditions, disorders and illnesses. These immediately and automatically feel like realities; realities that are loaded with concern and even fear, not only for those in distress but for those who are afraid that one day they might be.

When does this category flip from anxiety as inner action to anxiety as disorder take place? Is there some obvious and supportable logic or science to it? I have already given examples that show that this flip does not occur simply on the basis of the intensity of the sensations. This is true for high levels of anxiety that are relatively short lived and which can easily be associated with something the person is understandably worried about. However, when the sensations last longer than expected or occur when there is no obvious, understandable connection with outside situations then the category flip is likely to occur.

At first sight this might seem absolutely reasonable. However, the important words in the paragraph above are; obvious, understandable and expected. All of them depend on someone making judgements; judgements about what counts as obvious, understandable and expected. But, for example, we need to ask: Who is doing the expecting and what expectations do they have about how people should feel and can feel? What models and social norms are they using to judge whether the person’s experience is understandable? This applies both to the outside observer and the distressed person themselves. They are both making important judgements against a set of assumed social norms and expectations.

As thinking is inner action the outside observer does not have direct access to what the distressed person is thinking. Furthermore, because thinking is such a complex, multi-layered and automatic activity, even the distressed person may not be able to give an account of their thinking. Neither of them have the information that allows them to see the natural connection between the thinking and the sensations. Furthermore, if they are focused on symptoms rather than sensations they are unlikely to do the difficult work of trying to elucidate the thinking the person is doing. If either of them pay any attention to the person’s thinking it is likely they will only regard any thoughts that come to light as more symptoms rather than as actions the person is unwittingly performing.

The thingification of sensations into symptoms is the enemy of inner action. The fact that it has become so well established in the culture means neither the distressed person nor the observer takes seriously the idea that thinking is a form of action which inevitably includes sensations. Most importantly it prevents the distressed person from seeing any link between their inner action and the sensations they naturally experience as a result. By doing this it fundamentally undermines their self-understanding and their potential for self-reliance. It turns a difficult experience into a problem they cannot solve.

At this point we can ask: Is it really possible that an anxiety problem is an action or set of actions? At first sight this might seem like a ludicrous question as it suggests a way of thinking about anxiety problems that has become counter to the usual way of thinking of these experiences as conditions, disorders and illnesses. However, to take the question seriously we need stop and ask what a person is likely to be thinking when they are anxious for extended periods in unexpected ways. What inner actions are they performing?

In spite of the fact that the question may initially appear ludicrous we know it is quite likely that some of the person’s thinking is concerned with why they feel the way they do. They are quite likely asking; “What is wrong with me? Why do I feel like this? Is there something in my past, some trauma or difficult experience that I have not dealt with properly? Have I always been like it really? Have I simply been hiding it or managing to control it?” They are likely to spend significant energy trawling through their pasts in an attempt to answer these questions. They are also likely to be very concerned with the question; “What should I do to stop feeling like this? Should I avoid any situations that make me feel like this? Will I always be like it? What would other people think of me if they really knew what I am like? How bad will it get? Am I actually going mad?”

These are just some of the thoughts that distressed people have. Do these thoughts matter? Should we regard them as the person doing something? Are they going to affect how the person feels? These thoughts all flow with an internal logic from the assumption that the person is suffering from something, ie directly from the thingification of sensations into symptoms. However, if we take them seriously as inner action we can see that they can create intense distress. They are confusing because the person cannot usually come up with clear answers. They are frightening because they raise all sorts of doubts and fears about the person and their future. As such these thoughts have the potential to account for a great deal of the person’s distress.

What then of action’s other ugly sister; commodification? Commodification is the transformation of ideas or other entities into a product or service.

Now it is clear that the two ugly sisters are closely linked conceptually; thingification leads seamlessly to the need for a service or product that solves the problem created by the thingification. The person cut off from a recognition of the importance of their inner action is not only distressed and confused but they become dependent on others to provide a service to help or cure them. Many people who experience anxiety problems will say they are “willing to try anything”. They seek help often without any idea of what sort of help they need. This is a measure of their desperation and of the helplessness induced by the two ugly sisters.

Once thingification has described a person’s experience as a problem and thus created a need, the commodifiers set to work. What they must do is create a rationale that the links the way they choose to describe the person’s experience with the product or service they can offer. In the area of mental health this is not difficult since there are a variety of ways in which experiences can be described; ways that to the lay person appear plausible. As a result there is a vast range of conditions, therapies and treatments ‘on the market’.

The two ugly sisters are the enemies of action; enemies of the simple way in which we could understand ourselves and be more self-reliant. I am not for one moment suggesting that such self-understanding and self-reliance is easy and I should make it clear that I am not trying in any way to minimise the intensity of the distress we are capable of experiencing. However, I am suggesting that the intensity of distress we experience arises out of the category flip from sensation to symptom. This category flip occurs because of the abandonment of the everyday understanding that sensations are an intrinsic part of the actions we perform in our thinking. The more we lose this everyday understanding then more of us will experience psychological problems. It follows from this argument that the more we focus on such ideas as the pace and stresses of modern life as the reason for the high incidence of mental health problems and the more we argue for more services, the more people will ‘suffer from’ psychological problems.

In The Origin of Anxieties I have written in more detail about how the ideas in this article can be used to understand so-called anxiety problems and how we can re-establish the connection between our thinking as inner action and the sensations we will naturally experience as a result of this thinking. This way of thinking puts us firmly back at the heart of our experiences. It can give us the understanding and power to help ourselves even if at times we need the support and help of others.

Charles Merrett

About Charles Merrett

I have worked as a Clinical Psychologist for 38 years. In spite of this two of my daughters are now qualified Clinical Psychologists. I have worked in a variety of settings in the NHS, with a number of companies, a university health centre, in health education, with self-help groups. I also act as an expert witness. My main interest is in the words and ideas available to us to describe distress and how these can adversely shape our experience.