Never go to bed on an argument … and 19 other relationship ‘rules’ unpicked by experts

Is it wrong to flirt with other people? Do you have to agree on politics? And is it all about sex? Therapists examine the truths and myths of relationship lore - Joanna Moorhead in The Guardian

1 It’s not all about sex


TRUE “For most people, a satisfying sexual relationship is an important part of a good relationship,” says Susanna Abse, psychoanalytic therapist and author of Tell Me the Truth About Love: 13 Tales from Couple Therapy. “While sex may not be the most important thing, it’s certainly an indicator of chemistry, and it matters – especially at the start. Also, if you’re having bad sex with someone in the beginning, why would you want to carry on?”

2 Your partner should know what you feel/need

FALSE This is one of those saccharine myths we’ve been sold by romantic fairytales. However close you are to someone, says Joanna Harrison, divorce lawyer-turned-couples-therapist and author of Five Arguments All Couples (Need to) Have, you’ll never be able to second-guess them on everything. “And why would you want to? That would be boring. Also, people change; we’re all evolving.” What matters is that you each share what you’re feeling, you listen to one another, and you try to see things from your partner’s point of view.

3 No relationship can survive an affair

FALSE There are many kinds of affair, and this, says Abse, is key. “An affair can be an exit strategy, sure. But it can also be a protest – a way of bringing your partner’s attention to something that isn’t working for you in the relationship. If it’s that kind of affair, and you can work through why it happened with your partner, you can move on from it – providing apologies are given, reparations are made and forgiveness is forthcoming.”
If you’re having bad sex with someone in the beginning, why would you want to carry on?

4 A relationship is stronger if you share a bed

FALSE The important thing isn’t whether you share a bed – it’s talking about why if you don’t, says Harrison. “Whether it’s down to snoring or young kids, sleeping in separate beds reduces the intimate time you get together. So you need to discuss how you can compensate.” Make love on the sofa in the evening when the kids have gone to sleep. If snoring has driven you to separate rooms, at least have your morning tea in bed together.

5 Never go to bed on an argument

FALSE So often, says Terrence Real, family therapist and author of Us: Getting Past You and Me to Build a More Loving Relationship, rows happen because one or both partners have been drinking, or they’re not feeling good, or it’s late and you’re both tired. “What I say is: you’re not going to resolve anything tonight. Go to bed, and the next morning have a cup of tea together and talk it through.” All relationships are about the cycle of closeness, disruption and return to closeness. “Our culture worships the harmony phase, but a good relationship thrives on surviving the mess. The work of intimacy is the collision of imperfections, and how we manage those.”

6 It’s wrong to flirt with other people

TRUE You can be playful with someone, says Real, “but if you look into their eyes, there’s a difference between the shades being down – ‘shop closed’ – and the signal ‘come hither’. And if you’re using the sexual energy between you and someone else to feel excited, that’s like a mini-affair.” The rule is this, says Real: if your partner could hear you, and the way you’re speaking would upset them, it’s not OK.

7 People can’t change

FALSE. “I’m in the personality transplant business,” says Real. “Therapy is about understanding why we behave as we do, and making conscious decisions to change things in order to hang on to someone we care about.” Relate therapist Simone Bose, who runs her own practice, agrees that people can change, but they have to want to, and that means confronting aspects of themselves that might be uncomfortable or painful. “What’s hardest is overcoming the defensive mechanism you have as default,” she says.

  

8 Having arguments doesn’t have to be bad


TRUE If an argument escalates to violence or one partner feeling unsafe, that’s wrong, and you need expert help. But as you learn the landscape of your partner, says Harrison, arguments show you’re working each other out. “You’re finding out what your partner is passionate about, and sharing that. So these disagreements are full of useful information about what matters to each of you. If couples stop talking about what they care about, and sometimes arguing about it, they can start to feel disconnected.”

9 The ‘one’ is out there somewhere

FALSE “This is demonstrably nonsense: you only have to look at the people who find love again after losing their partner,” says Real. “We tend to fall in love with a person who we subliminally believe is going to heal us, give us what we didn’t get in our early life. Relationships tend to replay situations we’ve been in before. We fall in love with what completes us, in other words. And it’s this feeling – that we ‘fit together’ – that makes us feel we’ve found ‘the one’.” A successful relationship comes down to rewriting the script, so you’re not playing out things that went wrong in the past.

10 Once a cheater, always a cheater

TRUE and FALSE What’s most interesting about cheating, says Real, isn’t why someone does it – that’s obvious (it’s exciting, it’s sexy, it’s a thrill). No: the interesting thing is why someone doesn’t do it. “Cheating is always selfish: it’s always about overriding what you should do. So if you’ve learned from it and moved on, then no, you won’t necessarily be a cheater again. But your partner might never feel 100% assured you won’t do it again. It’s important to understand that.”

11 Marriage is just a piece of paper

FALSE “The question I’d ask a couple,” says Real, “is: who is your community? Who is supporting you, and how have you signalled you need that support, that you value it for your relationship?” Few rituals are left in modern life, he says, and a marriage ceremony is one that includes others as well as the couple themselves. “There’s something transformative about it being an experience embedded in the community,” he says. “That’s why it mattered to fight for the legal right for gay couples to marry.”

12 If a relationship needs therapy, it’s too late

FALSE Individuals are complicated, and partners who love one another and can see there’s potential for an ongoing relationship can also see there are stumbling blocks, says Bose. Having therapy, especially quite early on in a relationship, can ensure they get across those hurdles without the relationship being damaged. On the other hand, she cautions against therapy that goes on and on. “Some couples are scared to leave – you’ve got to be able to carry on without that crutch.”

13 You should always own up if you cheat

TRUE and FALSE You should usually confess, but not always, says Abse. “If we’re talking about a one-night stand on a business trip, maybe it’s OK, and better not to share it with your partner. But if you’ve had a longer-term relationship with someone else and you never reveal it to your partner, you’re avoiding something. It’s going to leave you in a sad place because you’ll have lost that sense that you and your partner share your deepest feelings.”

14 You have to agree on politics

FALSE If politics matters deeply to you then yes, says Bose, you need to be aligned. But if it doesn’t, voting for different political parties probably won’t unseat your relationship to any extent. “Much more important is sharing the same values: what’s important to you, what you truly believe matters. If you don’t agree on values, it seeps into your everyday life and can affect your relationship at a very deep level.”

15 Relationship problems always come down to money or sex

FALSE “In fact, they always come down to one thing: communication,” says Harrison. “Money and sex are taboo subjects in many families, and we all bring our family baggage to any relationship. But the issues aren’t about these things per se, they’re about being able to talk about these things – and everything else that matters.”

16 It’s always obvious when a relationship is over

FALSE Even for an experienced therapist like Joanna Harrison, it’s often not clear whether a couple are going to make it through. “Individuals have different thresholds for what they can deal with in a relationship,” she says. “There are no absolutes, no moment where it has to be all over.”

17 You need to have lots in common

FALSE In fact, says Abse, unconsciously we’re looking for someone who has attributes we’re lacking – because being with them helps us to learn different ways, and to grow our characters. “So if you’re a shy kind of person, you might find yourself attracted to someone gregarious.” It also means you can rely on the other person for those things – it’s the yin/yang thing. “A relationship is often more interesting and dynamic where there are challenges and differences.”

18 You need regular date nights

FALSE It’s not date nights that matter, says Harrison, it’s time together. So you don’t have to spend money or go out or have a treat (though that might be lovely). The bit your relationship needs is time shared as a couple: snuggled together on the sofa watching TV or a walk in the park can be every bit as good as a pricey meal out.

19 A baby will jeopardise your relationship

TRUE It’s tempting to hope a child who shares your genes, who you created together, will bond you and keep your relationship going. But, says Abse, relationship satisfaction goes down in the early weeks, months and years after the arrival of a baby. “Having a baby changes everything – you can’t underestimate that. You lose freedom, you lose autonomy, you lose intimacy. It’s a really challenging time for a couple.”

20 You can have a good sex life for ever

FALSE Viagra has sold us this idea, says Abse, and sure, in theory there’s no reason why sex should ever stop. But in the real world, things are different. “I’m wary of putting pressure on older people,” she says. “The reality is, for most long-term couples, sex drops off after their 50s or 60s. Those who carry on usually shift from swinging from the chandeliers to a more gentle, slow sex that might not involve penetration. It can be very intimate, but not all couples want it.”

Who will apologise for plasma therapy? It was a disaster for Covid-19, govt hospitals knew

Hospitals shelved ICMR's reports that plasma therapy wasn't good. It was still rolled out, and people paid the price writes DR KABIR SARDANA in The Print



Plasma therapy was administered to Covid-19 patients during the second wave in India | Wikipedia


The closing pages of the 18th-century masterpiece fiction The Story of the Stone revealed the essence of the Tao’s message. In Lao Tzu’s words, it means that “Things are not as they seem, that the Eloquent may Stammer, that Perfection may seem Flawed, that Truth is Fiction, Fiction Truth.”

The truth is neither black nor white, it’s grey—the handling of the second wave of Covid-19 is a testimony to that fact.
Disaster that escaped public eye

In the midst of the second wave of Covid-19 with panic all around, a lot of therapeutic disasters were played out, and without a doubt, they were inspired by a lack of knowledge. Instead, they were fueled with a desire for one-upmanship and copycat fame. Some of the doctors unwittingly orchestrated this therapeutic mess. On one side, we had the armchair experts who were not running Covid-19 centres and had shut down their institutes. On the other, doctors in central government hospitals like the Ram Manohar Lohia Hospital in Delhi were running Out Patient Departments (OPDs) and wards. They were possibly following half-baked regimens with little proof, as there were lives at stake.

While some medications were possibly harmless and cheap like Ivermectin or HCQS, the others were ridiculously expensive, and no one was wiser about their efficacy. One of them was plasma therapy. Of course, the Indian medical system and healthcare did not have the time for a randomised trial to test a placebo. But the origin of the mess was thus created right here in the capital of the country.

One may ask—who would be the expert to decide on its efficacy? The clear answer is a clinician in a hospital, handling patients with an active plasma extraction centre. But what transpired is that a centre dedicated to liver care with nil experience in Covid-19 treatment proposed the idea that plasma might help. Then came the now-famous statement of Chief Minister Arvind Kejriwal, saying that Delhi opened the first plasma bank in the world. That set off a chain reaction, and within a few weeks, hospitals followed suit.

It wasn’t the solution

Plasma is a component of the blood that is believed to have antibodies to diseases. Here, it was believed that Covid-19 patients would benefit from such therapy. This was when even the use of Intravenous immunoglobulin (IV IgG), a related plasma-based therapy that had been available for years, wasn’t effective in most disorders. This was also when we all knew that the so-called antibody tests of Covid-19 patients are negative or low positive. In fact, what is even more comical is that the quantity of antibodies in plasma is probably too little to do anything. And the ultimate irony is that therapy works in isolation, but here we had a plethora of medicines being administered, and it was not possible to pinpoint what was working behind the treatment.

Plasma does not come cheap, as it has to be extracted from patients. Thanks to the CM calling for plasma donation with great zeal and fanfare, the concept spread like wildfire. Intermediaries and ‘scamsters’ came in, and patients paid lakhs to get treatment, that too with dubious efficacy. Most doctors were inundated with calls for plasma, and we didn’t know what and where to arrange it for so many patients.

I know of patients who sold their belongings and went broke, partly because of plasma therapy and of course, Remdesivir, which has now been yanked off from all the guidelines. One of the members of our department, who had recovered from Covid-19, needed to give plasma to her own grandfather. He was admitted to the hospital, administered plasma but to no avail.

Trading fact for fame

Therefore, it is a must to understand the value of a placebo trial. Here, an identical-looking therapy is given to assess whether the active therapy—plasma, in this case—does anything substantial. A 30 per cent response rate is considered to be mostly placebo, or inactive, and that is the value of a placebo-controlled study.

There are numerous variables that determine the success of therapy in Covid-19, and assigning the credit to plasma showed a remarkable lack of foresight. At this juncture, the Indian Council of Medical Research (ICMR), in a multicentric study published in the British Medical Journal (BMJ), found that plasma wasn’t so good. But the public opinion swayed by the hospitals who pioneered the concept pilloried the paper and trashed it. Such was the distrust in our own country’s research that none wanted to get off the plasma bandwagon. Countless patients spent their life savings on what was a highly questionable therapy. And the charade continued till the second wave subsided.
The breakthrough

As always, we waited for a foreign journal to agree to a local finding, which was not surprising to a lot of us in the government hospitals. The landmark paper in the New England Journal of Medicine (NEJM) showed that there was “No significant differences in clinical status or overall mortality between patients treated with convalescent plasma and those who received placebo.” It has been cited 455 times since it was published in February 2021. The number exceeds the citations of any of the papers published by the ‘experts’ who rolled out an untried therapy on the nation.

To add insult to injury, a section of the print media, which studiously avoided criticising them because their publications were the benefactors of full pages advertisements on plasma banks. To make it worse, some of the names suggested for the Padma awards this year included the plasma therapy pioneers.

Who takes the responsibility?

In retrospect, what needs to be asked is—who will pay for the loss of life savings and the death of patients who were given plasma therapy? Who will fill in the gaps for the distrust in medical care? Will the experts apologise? Who will apologise for pillorying the ICMR’s report that could have nipped this in the bud? But no one really apologises for such things in India.

As Donald Keough said, “The truth is, we are not that dumb and we are not that smart.” The plasma blitzkrieg was neither dumb nor smart; it was callous, and someone should be paying for the negligence today or tomorrow.

Seven common myths about meditation

Julia Roberts learns how to meditate in the film Eat, Pray, Love. Photograph: Allstar/COLUMBIA PICTURES/Sportsphoto Ltd./Allstar

Catherine Wikholm in The Guardian

Meditation is becoming increasingly popular, and in recent years there have been calls for mindfulness (a meditative practice with Buddhist roots) to be more widely available on the NHS. Often promoted as a sure-fire way to reduce stress, it’s also being increasingly offered in schools, universities and businesses.

For the secularised mind, meditation fills a spiritual vacuum; it brings the hope of becoming a better, happier individual in a more peaceful world. However, the fact that meditation was primarily designed not to make us happier, but to destroy our sense of individual self – who we feel and think we are most of the time – is often overlooked in the science and media stories about it, which focus almost exclusively on the benefits practitioners can expect.

If you’re considering it, here are seven common beliefs about meditation that are not supported by scientific evidence.

Myth 1: Meditation never has adverse or negative effects. It will change you for the better (and only the better)

Fact 1: It’s easy to see why this myth might spring up. After all, sitting in silence and focusing on your breathing would seem like a fairly innocuous activity with little potential for harm. But when you consider how many of us, when worried or facing difficult circumstances, cope by keeping ourselves very busy and with little time to think, it isn’t that much of a surprise to find that sitting without distractions, with only ourselves, might lead to disturbing emotions rising to the surface.

However, many scientists have turned a blind eye to the potential unexpected or harmful consequences of meditation. With Transcendental Meditation, this is probably because many of those who have researched it have also been personally involved in the movement; with mindfulness, the reasons are less clear, because it is presented as a secular technique. Nevertheless, there is emerging scientific evidence from case studies, surveys of meditators’ experience and historical studies to show that meditation can be associated with stress, negative effectsand mental health problems. For example, one study found that mindfulness meditation led to increased cortisol, a biological marker of stress, despite the fact that participants subjectively reported feeling less stressed.

Myth 2: Meditation can benefit everyone

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Fact 2: The idea that meditation is a cure-all for all lacks scientific basis. “One man’s meat is another man’s poison,” the psychologist Arnold Lazarus reminded us in his writings about meditation. Although there has been relatively little research into how individual circumstances – such as age, gender, or personality type – might play a role in the value of meditation, there is a growing awareness that meditation works differently for each individual.

For example, it may provide an effective stress-relief technique for individuals facing serious problems (such as being unemployed), but have little value for low-stressed individuals. Or it may benefit depressed individuals who suffered trauma and abuse in their childhood, but not other depressed people. There is also some evidence that – along with yoga – it can be of particular use to prisoners, for whom it improves psychological wellbeing and, perhaps more importantly, encourages better control over impulsivity. We shouldn’t be surprised about meditation having variable benefits from person to person. After all, the practice wasn’t intended to make us happier or less stressed, but to assist us in diving deep within and challenging who we believe we are.


Myth 3: If everyone meditated the world would be a much better place

Fact 3: All global religions share the belief that following their particular practices and ideals will make us better individuals. So far, there is no clear scientific evidence that meditation is more effective at making us, for example, more compassionate than other spiritual or psychological practices. Research on this topic has serious methodological and theoretical limitations and biases. Most of the studies have no adequate control groups and generally fail to assess the expectations of participants (ie, if we expect to benefit from something, we may be more likely to report benefits).

Myth 4: If you’re seeking personal change and growth, meditating is as efficient – or more – than having therapy

Fact 4: There is very little evidence that an eight-week mindfulness-based group programme has the same benefits as of being in conventional psychological therapy – most studies compare mindfulness to “treatment as usual” (such as seeing your GP), rather than one-to-one therapy. Although mindfulness interventions are group-based and most psychological therapy is conducted on a one-to-one basis, both approaches involve developing an increased awareness of our thoughts, emotions and way of relating to others. But the levels of awareness probably differ. A therapist can encourage us to examine conscious or unconscious patterns within ourselves, whereas these might be difficult to access in a one-size-fits-all group course, or if we were meditating on our own.

Myth 5: Meditation produces a unique state of consciousness that we can measure scientifically

FacebookTwitterPinterest Teachers and pupils practise meditation techniques at Bethnal Green Academy Photograph: Sean Smith for the Guardian

Fact 5: Meditation produces states of consciousness that we can indeed measure using various scientific instruments. However, the overall evidence is that these states are not physiologically unique. Furthermore, although different kinds of meditation may have diverse effects on consciousness (and on the brain), there is no scientific consensus about what these effects are.

Myth 6: We can practise meditation as a purely scientific technique with no religious or spiritual leanings

Fact 6: In principle, it’s perfectly possible to meditate and be uninterested in the spiritual background to the practice. However, research shows that meditation leads us to become more spiritual, and that this increase in spirituality is partly responsible for the practice’s positive effects. So, even if we set out to ignore meditation’s spiritual roots, those roots may nonetheless envelop us, to a greater or lesser degree. Overall, it is unclear whether secular models of mindfulness meditation are fully secular.

Myth 7: Science has unequivocally shown how meditation can change us and why

Fact 7: Meta-analyses show there is moderate evidence that meditation affects us in various ways, such as increasing positive emotions and reducing anxiety. However, it is less clear how powerful and long-lasting these changes are.

Some studies show that meditating can have a greater impact than physical relaxation, although other research using a placebo meditation contradicts this finding. We need better studies but, perhaps as important, we also need models that explain how meditation works. For example, with mindfulness-based cognitive therapy (MBCT), we still can’t be sure of the “active” ingredient. Is it the meditation itself that causes positive effects, or is it the fact that the participant learns to step back and become aware of his or her thoughts and feelings in a supportive group environment?

There simply is no cohesive, overarching attempt to describe the various psychobiological processes that meditation sets in motion. Unless we can clearly map the effects of meditation – both the positive and the negative – and identify the processes underpinning the practice, our scientific understanding of meditation is precarious and can easily lead to exaggeration and misinterpretation.

Britain's first state-certified sex coach

Unlike conventional sex therapists - who talk to clients having sexual problems and give them advice on how to overcome them - sex coaching can take place in the bedroom

Sarah Morrison in The Independent

 

Sunday, 13 January 2013

Jane walked up and down the street outside what looked like a nondescript house in north London three times before she summoned up the courage to ring the doorbell. The 51-year-old was about to have her first session with Britain's - and indeed one of the world's - first state-certified sex coaches. She was overwhelmed with nerves.

Unlike conventional sex therapists - who talk to clients having sexual problems and give them advice on how to overcome them in their own homes - sex coaching can take place in the bedroom. Its benefits can include anything from achieving better orgasms to simply feeling more comfortable naked with a partner. They can use a range of techniques: talk, role-play or intimate physical approaches like touching or massage.

Until now, this sector has been largely unregulated, and understandably scepticism has run high. But experts talk of a "booming industry" that is moving out of the shadows and into the mainstream. California has become the first state worldwide to certify sex coaches, but it is Britons who are its very first graduates. Jane's instructor, Mike Lousada, is so committed to the regulation of the sector that he is launching the first professional body for the industry across Europe later this year.

Lousada, 45, moved from the corporate world into sex coaching as a way do something "more meaningful" in his life. With his own hang-ups and "shame around the body," he became trained as a counsellor, and graduated from the Advanced Study of Human Sexuality last month as a sex coach. He now charges £80 an hour for talking therapy, and £120 for physical work, which includes genital massage, but can include having intercourse with a client. This would be in very rare cases; say to overcome a situation where a woman wanted, but wasn't able to, have penetrative sex.

Lousada calls his work "sex positive," differing from sex therapy which "arises from the point of view that something's wrong that needs to be fixed." He insists his services, often used by women who have been abused in some way in the past, is "boundaried" and run with a "strict code of ethics." He added: "'I'm showing people how to connect their bodies with someone else's. We are taught at school about pregnancy and sexual disease, but not about pleasure."

There are no recorded figures for the number of sex coaches in Britain, but one of the world's pioneering sex coaches, Dr Patti Britton, found there are at least 80 worldwide, when she conducted the first international survey last year.

Namita Caen, 46, from London, is another state-certified sex coach, working in California. She says interest in her services, which focus on talk, are on the increase as they become "legitimised": "Attitudes are totally changing; People are dying to share what's happening in their relationship".

Jane agrees. She had been living an asexual life for almost thirty years when she decided to take up sessions with Lousada. She said she chose to see a sex coach over a sex therapist, because her "issues were around discovering who [she] was as a sexual woman - in relationship to another." Engaging in talk sessions and intimate massage with Lousada, she said she is now "more comfortable with men" and able to "look in the mirror and see a sexy woman" again.

She added: "I find it fascinating that in the UK 'sex coaches' generally have the unfounded reputation of being some sort of prostitutes by another name - exploiting men and women who are either bored and rich or vulnerable and stupid. Mike's work provided me with a safe supportive environment where I could explore my sexuality as a woman and address the issues and hurts of the past."

The Department of Health advises that "people visit their GP if they are experiencing a sexual health problem" and some therapists have voiced suspicion of coaches lacking their accreditation. But Lousada hopes to change this. His professional body will be launched in the next few months: "Sex coaching is becoming a new profession. We need to have a code of ethics, a disciplinary code, and standards, in order to do this work safely."

Jane's name has been changed

Having cancer is an education, and this is what I have learned

Illness introduced me to a beautiful network of dependence – and a struggle for autonomy I can't win on my own

• 
• • Mike Marqusee
  • guardian.co.uk, Tuesday 26 July 2011 22.00 BST
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The discipline of nursing converts science into care. Photograph: Bert Hardy/Getty Images
Now entering my fifth year of living with multiple myeloma, a haematological cancer, I reflect back on a roller-coaster ride of symptoms, treatments and side effects. Whatever else this experience has been, it's been an education. But what exactly have I learned? To begin with, that any glib answer to the question misses the core of the experience – the complex dialectic of being ill, which is a social as well as physical condition. For me the experience has led to a heightened awareness of both our intricate dependence on others and our deep-seated need for independence. Sitting with my IV drip, I like to think about all the human labour and ingenuity that come together in this medical moment. I could dedicate the rest of my life to this exercise and still not complete the inventory. The first circle of dependence is immediate and sometimes intimate. Partners, friends, doctors, nurses, cleaners, porters. Beyond them is a vast network of people I never see: pathologists, pharmacists, IT engineers, appointments managers. Everyone who has anything to do with maintaining the supply of medications or the functioning of equipment or getting me to and from hospital. Everyone who makes sure the lights are on and the building safe. The whole intricate ballet that is a functioning hospital. One misstep, and the whole breaks down, with potentially dire consequences. Beyond that, I'm dependent on a long history of scientific development to which individuals and institutions in many countries have contributed. From the British chemist Bence Jones identifying the protein associated with multiple myeloma in the 1840s to the pathologist and one-time film star Justine Wanger developing the IV drip in the 1930s; from the first experiments with chemotherapy (a byproduct of chemical warfare) in the 1940s, through the protracted struggle to master the art of toxicity (a dialectic of creation and destruction, if there ever was one), to the discovery of proteasome inhibitors in the 1990s and the creation of new "targeted therapies", like the one I'm currently receiving. Without innumerable advances in immunology, biochemistry, chemical engineering, statistics and metallurgy, to name but a few, I wouldn't be where I am now – in fact I wouldn't be at all. The drip flowing into my vein is drawn from a river with innumerable tributaries. It is an entirely rational, intelligible process but no less miraculous for that. And it's not just a story of science. Alongside that – and necessary to it – is the long history of the hospital, of the discipline of nursing, of the social developments that made it possible to convert raw science into practical care. I'm acutely conscious of how dependent I am on those who built and sustained the NHS – including, pre-eminently, generations of labour movement activists and socialists. And as I sit with my IV drip, I'm mindful of those in government and business who would smash the delicate mechanism of the hospital and shatter the network of dependence that sustains me. I'm being kept alive by the contributions of so many currents of human labour, thought, struggle, desire, imagination. By the whole Enlightenment tradition, but not only that: by older traditions of care, solidarity, mutuality, of respect for human life and compassion for human suffering. The harnessing of science, technology and advanced forms of organisation and information to compassionate ends is by no means automatic. It leans on and is only made possible by the conflict-riddled history of ethical and political development. Beautiful as it is, this network of dependence is also frightening. Restrictions in capacity and mobility are hugely frustrating, and relying on others to supplement them is not a straightforward business – for patient or carer. I often feel I'm engaged in a never-ending battle for autonomy. I fight it out in relation to institutions, experts, medications, means of mobility, forms of diet. Not to mention the vital effort to live a life beyond illness, to hold on to that kernel of freedom that makes you who you are. Paradoxically the struggle for autonomy is one you can't win on your own. You need allies, and part of being a carer is being an ally, not a nursemaid or controller. Independence is the stuff of life. But you can achieve it only through dependence on others, past and present. That's a truth driven home to the cancer patient but applicable to all of us. Illness is not an ideology-free zone. Certainly not for the government, which aims to divide sufferers into acute cases deserving of support, and less acute ones that must be forced back into the labour market, where our only function will be to undercut wages. This is one reason why resistance to the attacks on benefits for the disabled ought to be a central plank of the anti-cuts movement. The crisis facing the ill is an extreme form of the crisis facing the majority of the populace. We don't want charity – the form of dependence that makes independence impossible – but rights, and the resources to exercise those rights. Speaking for myself, taking part in anti-cuts activity is some of the best therapy available, an unashamed acknowledgement of social dependence and at the same time a declaration of political-spiritual independence.