via The Age
On October 23, 1977, a diminutive Australian stepped onto the stage in New York. The audience saw an elderly woman whose regular uniform was a tweed skirt, twinset, spectacles, and sensible brown lace-up shoes with low heels. Her dark hair was permed and for adornment, she wore a string of pearls. At the age of 74, Dr Claire Weekes was the guest speaker at the 18th Annual Fall Conference of the Association for the Advancement of Psychotherapy. She was an unusual choice for this gathering, as she ranked as an unqualified outsider.
However, Weekes had one measurable claim to fame: her books on anxiety were a global sensation, hitting the bestseller lists in the US and the UK from the early 1960s onwards. She’d found a popular audience by identifying and describing the havoc nervous illness could create, and explaining and treating it in a fresh way. Weekes had been invited to address this professional association despite divided opinion over her approach. Many psychiatrists had heard of her methods from their patients, and a number accepted that some patients they had treated unsuccessfully had read her books and felt, if not entirely cured, then on the way to recovery.
While her audience saw a populist, Weekes started life as a scholar, an evolutionary scientist. In 1930 she made history as the first woman to gain a doctorate of science at the University of Sydney, and also won the university medal in zoology. By then she already had an international reputation in her field, which lives as vigorously today in academic circles as her work on nerves thrives in the popular market.
In 1945, she qualified as a medical doctor, eventually becoming a specialist general physician dealing with difficult-to-diagnose cases. She then hurdled what was then the highest bar in medicine, being selected as a fellow of the Royal Australasian College of Physicians. Her medical peers recognised what went unappreciated by her New York audience: Weekes was a scientist and a doctor who had mastered an understanding of the nervous system.
Yet on the podium in New York, Weekes inspired no awe and many in the audience dismissed her as offering nothing more than the equivalent of grandmotherly advice. She was the author of self-help books, not a psychiatrist, and she was in huge demand in the media. Her fame invited critical attention to her lack of specialist credentials, which was enough to wound her reputation in her own profession.
The psychiatrists in the New York audience fell into one of two schools. They were either psychoanalysts, who followed the techniques of Sigmund Freud and his intellectual descendants, or cognitive behaviourists, who worked on changing habits of thought and associated behaviours. Weekes’ approach could not have been further from that of Freud. Referring to the legendary psychiatrist’s pioneering technique of interrogating his patients while they were prone, Weekes boasted of being “one of the first to deal a blow at the old Viennese couch technique. I led them out of the consulting room, into the world where they were to live successfully.” She was equally critical of attempts by the behaviourists to “desensitise” their patients using relaxation techniques.
She understood that trying to teach a patient to relax in the face of phobia or panic was not only counterproductive but an almost impossible mission. Instead, she argued that by fully experiencing the panic, the individual learnt it was possible to “pass through” to the other side. Their nervous system needed to be reordered, which they could learn to do themselves. They didn’t then need a shepherd or psychiatrist.
“To recover, they must know how to face, accept and go through panic until it no longer matters …” Weekes said. “Recovery is in their own hands, not in drugs, not in avoidance of panic, not in ‘getting used to’ difficult situations, nor in desensitisation by suggestion. Permanent recovery lies in the patient’s ability to know how to accept the panic until he no longer fears it.”
The New York audience made her acutely aware of their disdain. They looked at their watches and talked among themselves, and the famous South African psychiatrist Dr Joseph Wolpe tore her to pieces after she dared challenge an approach to treatment that he favoured. At least one psychiatrist in the audience appreciated her pioneering work, however. Dr Manuel Zane, who ran a New York clinic for anxiety and phobia, had firsthand experience of the success of her method, even with intractable cases.
“The remarkable thing was that patients came to me talking about her,” Zane wrote in a nomination he made for Weekes for a Nobel Prize in the late 1980s. “That was the difference between Weekes and other professionals. She was coming to us from where the patient is, and not from our top, where we were telling patients what it’s all about, why they are the way they are.” Weekes also offered something unique to the field: hope.
Years later, Weekes chided another professional audience. “I am aware that many therapists believe there is no permanent cure for nervous illness. When I was on the radio some years ago in New York with a physician and a psychiatrist, the psychiatrist corrected me when I used the word ‘cure’ and said, ‘You mean remission, don’t you, Dr Weekes? We never speak of curing nervous illness!’ I told her that I had cured far too many nervously ill people to be afraid to use the word.”
It was a provocative claim, but one that sat on an unshakeable foundation. Weekes’ work anticipated advances made decades later in both neurology and psychiatry, and her approach, akin to modern psychology’s Acceptance and Commitment Therapy (ACT), has been vindicated. She changed the way anxiety was understood and treated, yet her huge global footprint is invisible, and her achievement remains largely unrecognised by professionals.
Hazel Claire Weekes was born in 1903 into a modest middle-class Sydney home. Her father, Ralph, was a musician, and this clever eldest daughter of four children was the favourite of her mother Fan, a preference all too obvious to Weekes’ two brothers and younger sister. Fiercely proud of this child, who showed early scholarly success, Fan determined to see her daughter fulfil her promise. So off Weekes went to Sydney University, securing her first-class honours degree in science and university medal.
In 1928, at the age of 25, she identified a new challenge: a Rockefeller Fellowship, with which she planned to further her evolutionary studies in England after completing her PhD. But before she got there, she lost her footing and found herself in freefall. It started with a sore throat, followed by a botched operation on septic tonsils resulting in a haemorrhage.
“I’d had severely infected tonsils. I’d eaten very little for months and had lost two stone,” she said years later in an interview with the BBC. For a small, slightly built woman, 13 kilograms was a significant weight loss. In her weakened state, she experienced heart palpitations and was referred to a Sydney specialist she knew as a “famous cardiologist”, who gave her injections of calcium, which had little or no effect.
Fragile, emaciated, and with a racing heart, Weekes was a puzzle to her local doctor, who finally, with scant evidence, made a monumental diagnosis. He concluded she had contracted the dreaded disease of the day, tuberculosis. “I thought I was dying,” she recalled in a letter to a friend. “I was sent away to the country and I was told that I must make no effort, not even to pull a blind down.” Tuberculosis invoked the terror of the Black Plague of earlier years; the public response to it was a preview of that to the HIV/AIDS epidemic to come generations later.
Her studies were put on hold, and the young woman who hated being alone was packed off to the Waterfall State Sanatorium, 38 kilometres south of the Sydney CBD. Here there was no occupation and no one to keep Weekes company in the face of the death and dying around her. Her heart continued to race. “I was more or less confined to lying on the couch, with nothing much to do, and six months on my hands. So that I knew what it was to become introverted, worried,” she said of that period.
The sanatorium was the perfect petri dish for a fear that would grip and not let go. Yet Weekes was one of the lucky ones, for, after six months, the doors of the sanatorium swung open. The doctors concluded a mistake had been made; that she’d been wrongly diagnosed. Far from being relieved, Weekes felt immeasurably worse. Now she was convinced that she had a serious heart complaint as the tachycardia, or racing heart, was unceasing. Once outside the sanatorium, she was terrified and overwhelmed.
“I can remember, I had lost all confidence in what I could do, because I’d been told, ‘You mustn’t do this, you mustn’t do that!’ I remember walking out alone and thinking, ‘I wonder if I can walk as far as the corner of that street?’ I remember being aware of every footstep I took, and wondering how much faith I could still have in my body to get there,” she said in a media interview years later.
Rather than immediately returning to university, she chose to recuperate in “the country” with a female friend who was married to a doctor. Weekes hoped for some advice on her heart problems, but instead, found more medical incompetence.
“My heart would palpitate if I woke up at night, just the shock of waking up would make it accelerate. I can remember very clearly how, one night, I called out to her when my heart was beating fiercely and thought my last gasp was coming. Her husband, the doctor, said, ‘No. I won’t go to help her. She’ll think she’s worse than she really is!’”
The doctor was right in one respect. There was nothing wrong with Weekes’ heart. She was to live for another six decades. However, something important had gone unexplained. It was fear that was managing her heartbeat, and, without knowing this, she was trapped in a vicious cycle. It would be years before she cracked the anxiety code.
In 1929, aged 26 and not long out of the sanatorium, an unsteady Weekes boarded a Dutch liner. With a professional record that eluded most men of her generation, and the backing of eminent scientists in her field, she was finally heading to England on that Rockefeller scholarship, bound for University College London, where she would continue her studies in evolution.
The rhythm and vibrations of the ship helped camouflage the movements in her body, and she regained composure for the first time in two years. Yet on stepping ashore, a rapidly beating heart reclaimed her. The return of her symptoms was devastating. At night, she would just be dropping off to sleep when she’d wake with a start. “Then I would sit up for hours for fear that I would die if I lay down.” There was no way out. Newly arrived in London but close to collapse, she felt keenly the paradox of her situation. “I had everything to live for and I knew it. I had achieved so much, the whole of life lay before me, but I was incapacitated.”
The potency of this experience would inform her advice, many years later, to patients and readers.
She knew the return of fear carried with it real despair, the death of the hope so badly needed but impossible to secure. In her books, she had a typically practical word to describe this state: simply, a “setback”. It was not defeat, she counselled, but was to be embraced as an opportunity to practise.
Stress, fear and panic could return, but it was possible to learn how to ride the terrifying waves back to the shoreline. In this way, what she would later call “the habit of fear” could be broken. Not long after she began working in her University College lab, a friend came to visit. Beyond dissembling, her first words to him were: “Oh, I can’t take this any longer. I’ve had it!” When told of her racing heart and indescribable distress, far from being surprised or concerned, he shrugged.
“That is nothing,” he said. “Those are only the symptoms of nerves. We all had those in the [World War I] trenches.” He told Weekes that her heart continued to race because she was frightened of it. It was programmed by her fear. This made immediate sense. “All the time I have been doing this to myself?” she asked. “He said ‘yes’ and laughed,” she would later recount.
His words spoke to the scientist in Weekes. War offered empirical examples: men got scared, their hearts raced, and they often continued to race after the threat had passed. Her friend, decorated for bravery in the savage battle of the Somme, had noticed that he and his fellow soldiers had become distressed by their racing hearts, which further aroused and primed them for panic. Yet there was nothing wrong with their hearts. They were consumed with a fear that felt overwhelming in the body, so the mind concluded something was terribly wrong and continued to feed the fear.
Fear could not be extinguished by the rational brain. Thinking inevitably lost the battle to feeling. Weekes’ substantial cognitive abilities, which delivered scholarships, awards and opportunities, were sidelined by an all-consuming dread. It was this feeling she was desperate to extinguish, this feeling against which she fought so futilely, this feeling that was accompanied by racing panicked thoughts.
The discovery that she’d been frightened of fear itself was a profound revelation. Weekes was shocked that not one of the handful of doctors and specialists she’d consulted had explained how fear could have such a deranging effect on the body. She immediately grasped the point that she needed to stop fighting the fear, an instinctive response yet counterproductive. There was no benefit gained by striving, trying to think rationally, or attempting to exercise willpower. She later reported it as the breakthrough insight.
“After my friend told me the cause, I just lay as calmly as I could, ‘Okay, I’ll just go to sleep, palpitating if necessary.’ ” When she ceased engaging so intensely with her symptoms, her heartbeat returned to normal. “The whole thing cleared up,” as she put it. Once she understood “fear” was bluffing her, she decided to ignore the messenger. She accepted the palpitations instead of fighting them. No battle, no fighting. The keyword was “acceptance”.
The turnaround was swift. If Weekes had been devastated by her lack of understanding of what ailed her, she now felt exhilarated, liberated by an explanation from what had been incomprehensible suffering. With this new understanding, she regained control. Her friend had planted the seed for the bestselling books that Weekes would eventually write, but years of professional medical experience were needed to shape this single brilliant insight of acceptance into a comprehensive understanding of the anxiety state.
Weekes’ own distress, which had so piqued her interest in “nerves”, was to find its professional purpose back in Sydney, when she began practising as a doctor, first in Bondi and then as a specialist general physician in Macquarie Street. Here she learnt that panic and anxiety played a medley of dissonant bodily tunes, from breathing, swallowing and digestive difficulties to headaches, dizziness and muscle fatigue among many others.
Now other doctors began to refer their difficult cases to her. With the support of her partner, the accomplished pianist Elizabeth (Beth) Coleman, and her mother Fan, she had unlimited time and sympathy for anxious patients. Determined not to be like the doctor who had long ago failed to ease her own suffering by explaining the effects of fear on mind and body, her dedication to those she deemed nervously ill went far beyond any normal professional boundary. She even invited some of them to live in her home, to better help their recovery.
Weekes knew the effect anxiety had on the body, later describing in her books “the whiplash of panic” and the “electrifying quality of sensitised panic” to communicate to a non-sufferer the way in which continued distress prepared the body to ever more swiftly respond. The nervous system became primed to experience anxiety more quickly and savagely than ever. It had become “sensitised”, and understanding this process was the key to recovery. Desensitisation would follow as a natural consequence. That is, there was no need to practise becoming desensitised to whatever was particularly feared.
So instead of structured exposure to fears, she prescribed total acceptance of the fear as the way out of distress and panic. The problem was inside, not outside. To address it required total acceptance of what felt unacceptable. For it was exactly this fighting against tension, fear, anxiety and panic that perpetuated the problem. Weekes’ treatment protocol was just six words: face, accept, float, let time pass. It was not designed to eradicate all the stresses of life, but to enable people to find their own way out of distress. It was, she would later say, simple but not always easy. Her point was that it worked.
Weekes put her success as a doctor down to her scientific training, telling the BBC years later that it allowed her to see the trunk of the tree, rather than being distracted by the leaves. She had a gift for discerning the relationship between the mind and the body – what was clinical illness and what were symptoms driven by fear and anxiety. Understanding fear and its relationship to physical illness had become a mission.
Such was her success that throughout the 1950s, people were referred to her from across the nation.
She came to believe she had something unique to offer the huge, unmet market for effective treatment for severe anxiety. In 1962, she wrote the prosaically titled Self-Help for Your Nerves, and by the time she was standing on the podium in New York 15 years later, there had been two more books, which were prominently displayed in airports and translated into at least eight languages.
Two more were to follow in the next decade. She later explained to an American doctor that, instead of writing research papers, she had seen “the need was so great” that she went directly to the people.
The books were slim volumes that explained the nervous system and how it could go awry, how the mind and body were interconnected in arousal, and the trouble this could cause. Yet the clarity of work that drove the books’ runaway success also repelled professional recognition. Self-help was not yet a genre that inspired psychiatrists’ attention or respect. In a field more familiar with failure, and one riven with division, Weekes achieved success and as psychoanalysts struggled to prove that their methods worked, Weekes had the numbers running in her favour. People bought her books and queued to thank her for “saving” their lives. She was writing about “them”, and they often chose a religious metaphor to express their gratitude: the books were their “bible”.
Weekes died in 1990, aged 87. Along the way, she’d hurdled a series of different careers – evolutionary scientist, travel writer, singing coach, GP – and it was a lifetime of scholarship and deep experience of the anxiety state, as well as exceptional communications skills, that delivered the books that saved lives, and changed history.
People as diverse as 1960s housewives, the daughter of Richard Nixon’s drug czar, a British television producer, the late poet Les Murray, the singer Clare Bowditch, the famous US environmental activist Erin Brockovich, even prisoners have benefited from her work. The eminent anxiety specialist David Barlow, professor emeritus of psychology and psychiatry at Boston University, confirms she “created a treatment protocol to the unending benefit of tens of millions of patients over the years”.
It was her training as a scientist and a doctor that enabled Weekes to understand the nervous system and explain it in a way that is state-of-the-art today, although many mental health professionals are unaware of the debt they have to a woman whose work was discovered by a wide, thankful suffering public.
Her face, accept, float, let time pass method was based on a biological understanding of fear. Today, psychologists use a version of her method; neuroscientists study the interaction between different fear circuits in the brain and many psychiatrists are revising the mind-body connection that was the hallmark of her work. “Acceptance” is the treatment du jour, and many mental health professionals explain fear in the same way she did all those years ago, when she identified how the body’s simple alarm system, the unconscious fight-or-flight system – which she called first fear – could be distressingly perpetuated by what she called “second fear” which kicked off a vicious “fear-adrenalin-fear cycle”, as she called it.
Weekes was chagrined by the professional resistance she faced over decades as it so starkly contrasted with her huge success in the marketplace, where she met intense, continuing gratitude. When she spoke on US television networks, switchboards were overwhelmed, and in England in the 1980s, the BBC post office could not handle the avalanche of letters that followed her appearance in an interview series on daytime television. The broadcaster was forced to rent extra space and employ outworkers to handle the mail.
Over time, the professionals were educated by their patients who had found her work so useful, and some leaders in the field, such as England’s renowned anxiety expert, Dr Isaac Marks, and Albert Ellis, considered one of the originators of the so-called cognitive revolution in psychology, came to understand the power of her books. Yet her loyal audience never needed persuading and her enduring public value is easy to identify to this day.
Her books are still being read and a social media foreign to her continues to share her work. If history has forgotten Weekes, her public remembers. In 2014, when US magazine The Atlantic invited readers to respond with tips on anxiety, just three writers were cited and their books listed. One of these was Self-Help for Your Nerves, or, as it was retitled for the US market, Hope and Help for Your Nerves. It had been written over half a century before, and Dr Claire Weekes had been dead for almost 25 years.
This is an edited extract from The Woman Who Cracked the Anxiety Code: the Extraordinary Life of Dr Claire Weekes by Judith Hoare (Scribe, $40), out October 1.
