As a childhood asthma sufferer, I wondered if my illness was particularly weak since it seemed to follow colds that became respiratory infections—the asthma creeping in little by little. I held onto some glorified image of the authentic sufferer beset, like a flash of lightning, with the restriction of their breath. “Why couldn’t that have been my problem?” I often fantasized about a scene, as if in a movie, of a person who loses their breath like you lose your keys or wallet or favorite toy.

But asthma isn’t about a loss of breath, it’s a difficulty exhaling—refusing to give breath up. Asthmatics are caught at the midpoint between inhaling and exhaling. Something is restrained or constricted. While these images might be the product of a childish confusion about asthma and anaphylactic shock, the desire for such complete dissolution is diametrically opposed to how I was: composed and contained, even when ill. Proust’s secretary and housekeeper, Celeste Albaret, observed something similar in his asthma, noting “his exquisite elegance and that peculiar manner, a kind of restraint, which I later noticed in many asthmatics, as though he were husbanding his strength and his breath.”

Maybe I was impatient with the piecemeal restriction of my breath…or bored by it. The psychoanalyst in me now marvels at this fantastical scene of self-dissolution in the mind of a child. Perhaps I (or, the adults around me) needed to know more clearly what was in the process of slipping away? In one sense, the object of breathing is clearly air, but air isn’t slipping away for the asthmatic; the ability to regulate the rhythm of breathing is. When it comes to breathing, it turns out there is so much to know about what can get lost—our basic feeling of vitality, a sense of background rhythm, the bidirectional relationship between conscious and unconscious control, and indeed our relationship to air and the environment itself.

Freud once recounted the story of a patient’s hypochondriacal worries: “A woman suffered from attacks [of] obsessional brooding and speculating,” he wrote in 1895. “The theme of her worry was always a part or function of her body; for example, respiration: ‘Why must I breathe? Suppose I didn’t want to breathe?’ etc.” While Freud was interested in her symptomatic brooding about her body, I find the woman’s question stunning in its lucidity and subtle suicidality. Indeed, why must we breathe? What does wanting have to do with the functioning of my body? And if there is a connection—meaning my body isn’t simply a machine that works regardless of my will—what if I didn’t want to breathe?

What if I find you, world, just too suffocating? I think about how we’ve polluted our atmosphere (to say nothing of the seas and the land) and seem unable to stop. Over six million deaths a year can be attributed to particulate matter in the air. Less than a dozen countries meet standards for air quality set by the World Health Organization. Doesn’t an inquiry into environment, desire, and breathing feel indispensable? Why might we not want to breathe?

*

I’ve been working on a book about breathing. As I neared its end, I returned in my mind again and again to the British psychoanalyst Marion Milner’s long case study of a patient she called Susan in her book, The Hands of the Living God—a patient whose difficulties with breath brought Milner to reflect on the psychoanalysis of breathing. Milner was part of the middle group of psychoanalysts, somewhere between Anna Freud (Freud’s daughter) and Melanie Klein, the mother of object relations theory. She was also close with D.W. Winnicott, the beloved pediatrician and psychoanalyst who was interested in the trauma of birth and psychosomatic reactions in children. They were all holding Freud’s legacy, after the war and his exile in London.

Milner’s patient Susan describes a “loss of the background,” which also felt like a loss of her soul and breath, after she received electroconvulsive shock therapy in a psychiatric hospital following periods of depression. I remember watching this procedure with terror when I worked in an inpatient unit as a recent graduate. They still do this? I was told that it is one of the few treatments for chronic depression. I was told that it was less barbaric than it seemed. A chronically suicidal patient of mine demanded it—she wanted to wipe her mind and the hospital complied. Helpless, I watched as they put in a mouthguard, her body seizing under the currents. Afterwards, she liked speaking about the feeling of large lacunae in her mind, as if she’d eradicated something terrible. But her depressive feelings always returned with time, even if her memories didn’t.

Milner’s patient Susan, for her part, had a long history of trauma. But the electroshock therapy plunged her into a new state of derealization. She began analysis with Milner that would last 20 years. Little by little, Milner connected Susan’s “loss of the background” to her losing awareness of her body’s internal sensations, especially breathing, which was a constant focus for Susan. She couldn’t accept the fact that she breathed, didn’t want to be alone with her breath, and she sometimes felt phobic that she would start screaming. Surely an intimation of her death, Milner surmised.

Susan said she felt unborn and needed to create an environment for herself that she managed with diligent, even hypervigilant control. What, though, was the “background” she described? Milner found herself thinking often, as she listened to Susan, of D.H. Lawrence’s line about “the hands of the living god.” The phrase became, for her, a refrain humming like a musical backdrop in the case. When Susan told her about feeling “shot forward,” leaving her outside of her own eyes, or without the back of her head, Milner heard Lawrence’s words and understood them anew. The world was not outside of Susan. She was on the outside. The idea that some hands hold us—like a feeling of being part of the world, part of a social fabric that we are threaded into—is a background many of us take for granted. How can you gain ground for yourself when lost to an absent background, emerging from absence itself?

The psychoanalyst and writer Adam Phillips says of Milner that she “very much believes…in the relinquishment of identity. Of people…blending and getting mixed up and so on.” This mixing and entanglement are part of the background’s “undifferentiated sea” of sensations. But this wasn’t fusion for Milner. Rather, it was a world of infinite intensities that need not separate themselves out. We can be held or wrapped in these sensations. And we can emerge from them—all the more so, Milner believes, if we let go of our identity and learn to live in a breath-like fluctuation between self and world.

*

“I think the thing about Marion that most got to me,” says Phillips, “was her belief that psychoanalysis was really about a capacity for absorption, that what people were suffering from was an inhibition about absorption.” Milner explodes any idea of life as progressive individuation. Instead, Phillips surprisingly says, she points to a very old sense for the commonwealth. Intimacy is about our constitutional and unending dependance. Independence was “the suppressed madness of sane men,” Milner wrote. She thought, rather, that we’d do well to take more in, be more absorbed in one another. Inhale each other.

How difficult the intimacy of sharing is for us—sharing space, air, a body, money, memories, even images. Susan shared over 400 drawings over the course of her psychoanalysis. Both analyst and patient were artists. Milner was so disturbed by one of Susan’s first drawings that she returned to look at it again and again—a figure of a woman who seemed to be holding a baby, but on closer inspection looked more like she was holding herself. It was as if her whole body emerged from this enigmatic grasping of nothing. Or like the figure might be holding on before collapsing in on herself. But no hands were visible.

The Lacanian psychoanalyst and writer Darian Leader, in his book, Why Do We Get Ill?, notes that our distress needs the minimal idea of an addressee. “Could this be why asthma sufferers fare better if they are encouraged to write about their troubling experiences?” It would not seem unreasonable, he concludes, that the abolition of human dialog has an effect on immune functioning. Perhaps the overactive immune functioning of asthmatics, to say nothing of so many chronic conditions, is a call to the other—for the hands of a living god.

The word environment, as in “holding environment,” was made prominent by Winnicott while working with patients in the aftermath of World War II. Winnicott’s idea is still surprising: a person feeling stark differentiation from their environment, he argued, is the result of environmental failure. This is why Winnicott calls the absorption of a baby and a mother “an environment.” As we separate from a child, we gently relinquish them to their environment or world where they can carry on being. Susan’s need for what Milner called a “self-created environment” was a replacement for this failure of holding.

The word environment certainly has different connotations now. Environmental catastrophe is a new reality—we feel deep alienation from the environment or can rejoin it perhaps solely in the form of a feeling for catastrophe. The philosopher Peter Sloterdijk surmises that our environment has been increasingly thrust from background into foreground as we have destroyed it. In becoming an object, air invites more and more militaristic and technological control. Indeed, we are living in an era in which we have violently taken over the air. This amounts to an absolute loss of environment. We now must explain with urgency this environment that is already lost to us before its real loss.

Isn’t this set of contemporary thoughts prophesied by Milner’s work with Susan? We too cannot accept that we breathe. We too have been convulsed and derealized by the pace of climate change, violence against bodies and breath, and the attack on our commons. How can we emerge from an absent background? Or, as Judith Butler titled her pandemic work—What World is This?

*

One day while painting a landscape, Milner said she wanted more of a relaxed mood and tried some breathing exercises. She was surprised by how vivid the outer world became, and mused on how attention to inner sensations could make one more deeply related to the outside. Why was breathing the nodal point in this process? She noticed that instead of imposing a rhythm, counting as one is often instructed to do, she could let breathing take on its own rhythm: “let it flow at its own speed, waiting for the turn of the tide both at the top and the bottom of the swing.”

Breathing was like surfing, riding these waves, or waiting for the wave to arrive. Hardest was to let the new breath come all on its own, braving the fear that it might not come at all, which was the price to pay for the feeling of relaxation. She wondered if we are close to our instincts, close to how they compose our singular rhythms and style. Breath work not only breaks down false organizations; it changes our compliant adaptations to the demands of the world. Even more difficult still because this means temporary chaos is caused in the process.

Milner’s breathwork followed Winnicott’s ideas in his celebrated paper The Capacity to be Alone. The importance of orgasm for Winnicott was not merely the heightened pleasure it brings with another, but also the solitary relaxation in their company afterwards, when one can wait for the natural return of tension. We can get closer to a moment of wanting again, or having an idea, in this space of relaxation. What arises in those rare intimate moments of solitude and satisfaction? What “smile of being in your breath,” to quote the poet St. John Perse.

Relax is a funny word. I will always remember a patient of mine who painted the word on a canvas and hung it across from his bed. It practically persecuted him. An impossible injunction—relax! Waves of tension spasmed through his body staring at this word. Maybe, I wondered to myself, it’s the most hypocritical thing someone can say. One cannot be told to relax. Relaxation cannot be forced. The only thing possible is to make space for it through some other means. My patient was designing something he called webs of connection. I heard my name. Maybe I even heard the ethos of my name—Webster, weaver.

Awareness of the external world, says Milner, is a creative process. At the extreme point of relaxation, we melt into the background. We reemerge and discover shapes or figures anew, heightening our capacity for attention, and giving us a renewed sense of our self in space. The philosopher Jean-Luc Nancy was fond of Freud’s scribble, collected from a notebook in 1938, that said “psyche is extended; knows nothing about it.” By psyche, Nancy says, Freud means soma-psyche which extends forever outwards. We all need a sense of place, home, space.

We now live with a global sense of the world, billions of bodies that have never been felt, billions of images that have never been seen. “Crowds, piles, melees, bundles, columns, troops, swarms, armies, bands, stampedes, panics, tiers, processions, collisions, massacres, mass graves, communions, dispersions, a sur-plus, always an overflowing of bodies, all at one and the same time, compacted in masses and pulverizing dispersals,” writes Nancy. Our contemporary environment presses in on us while ever more is lost to us. We are supposed to find a way to enter this? Take a place there? This necessary task is an incurable and ordinary madness, Nancy argues.

Milner believed we can create holding environments beginning with breath. She said she was surprised by how little attention psychoanalysis paid to the state of enjoyment and relaxation that breathing can bring. In fact, Wilhelm Reich, another of Freud’s disciples, was the only one she could find who spoke of the feeling of warmth that can spread through the body. Behind so much talk of auto-eroticism and narcissism, there is an attempt to reach a beneficent self-enjoyment that is an investment in the whole body (and not just sexual organs). It is not a rejection of the outer world (as narcissism is) but in fact our entry point to it. Vital.

“Milner doesn't want to save us,” Phillips writes in his introduction to The Hands of the Living God. “But she does want to warn us away from…the knowledge that comes from the part of myself that lives as if I am a self-invented, self-sufficient, omniscient, independent, free-standing figure.” What value does this unknowing breathing have in a world with such pressing problems, seducing us with the lure of self-sufficiency? What use can breathing be in a world with a decreasing supply of breathable air, in a world of terror from the air, to quote Sloterdijk? I hear my critics—a 20-year treatment? I feel the weakness of psychoanalysis. I feel as if we must sing with what tatters of breath we have left, as the narrator of The Magic Mountain says on the eve of World War I.

*

This idea of spirit or breath is close to the psychoanalytic idea of desire as what insists in a body—like toddlers insisting on their every thought and whim. As my daughter says, “again again, gain, gain.” I must resist the urge to silence this insistence and listen or contain it with a creative displacement. I search for the way to hold it and her for a time. The basic psychoanalytic dictum is that every world we are born into must repress some part of our desires; leaving it requires that we try to hear what hasn’t been heard or given a place. This is about a lost background to what has been thought or allowed to exist. Breathing is thus listening to our soul.

The philosopher Emmanuel Levinas, in conversation with my friend the psychoanalyst and artist Bracha L. Ettinger, says: “In the future, there they are; my possibilities and my impossibilities. And my death is there as well. And time is there: in what is possible, in what is no longer possible, and in the unforgettable. Time, our time, is already the breath of a human being in respect to another human being. Our time is the breath of the spirit.”

Catastrophic time is time without time. Time is now screen time. Breathless time. If thinking about breathing is to do anything, perhaps it will give us back what time we have, a space to take place in a body. You can’t really have anything else. Is it any wonder we’ve returned to breathing cures? 

Distressed the other evening after being reprimanded, my daughter started shaking and repeating, “I’m tired, I’m tired,” tears falling down her flushed cheeks. I held her tightly until her body relaxed. I tell her she’s tired to explain states of unravel as the time to sleep draws near. But she wasn’t tired this time, she was hurt. Maybe she was tired of me, which she doesn’t yet know how to say. Such is our absorption.

We must begin again (again gain) developing our background awareness, as Milner called it. Attention, Simon Weil said, is prayer; the soul turning towards God. Milner is close to this thought. She said attention was first breathing, later the creation of an outside. I’ve so wanted to be outside, to be again in the air. I live inside with so many to help them get there. To vary the Freudian cliché, to help turn hysterical misery into the commonwealth of human unhappiness.

Psychoanalysis doesn’t have to be so prudish with its sensibility that the truth hurts—it does. And that breathing is simply the illusion of unity—illusion has its value, and it isn’t only oneness. There isn’t one truth or one illusion. There are many truths, and infinite pleasures too. I think this is the wealth in the common, the wealth in an attention to breath. In the background of this commonwealth of unhappiness, then, there is always the possibility of reinventing the fugitive—but always primary—enjoyment of everything we can do with breath in a body. Until our last. ♦