A few nights ago, as I arrived at a book launch, an acquaintance – a woman I don’t know well – came over and chose to remind me of an incident that apparently took place over twenty years ago.

According to her, Martin Amis and I were in a restaurant called China White and were involved in some heated debate or argument. Supposedly, she felt compelled to sit down between us and mediate.

On hearing this story, I attempted to remonstrate with her. Not only had I never been to China White, but I never argued with Martin Amis, whom I barely knew. But she was having none of it. This memory of hers definitely happened, she remembered it vividly, and it had come back to her now, at this party, with me in a wheelchair, she bending over to remind me.

In the days since, I have considered this baffling encounter and her memory, wondering what it was she remembered and why she recounted this nonsense at all. Maybe she got me muddled up with Salman Rushdie, although I don’t in fact resemble him.

My acquaintance had been enthusiastic about this anecdote, which obviously meant something to her, and on the night I gave up trying to disillusion her with what I considered to be the truth.

There is, of course, the possibility that it may have happened and that I had forgotten it. We are both older people now; our memories are fallible and stretch back decades. Who can know exactly what happened, how events unfolded many years ago, who is to arbitrate?

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On Saturday mornings, I like to go to the farmer’s market with Isabella, my ex-partner Tracey and our twin sons. Last weekend, as the five of us approached Gails at the end of my road, we ran into my long-time psychoanalyst, who was on his way to his barber.

I’ve been talking with him for thirty years, but have barely seen his face; during my sessions, when I used to go to his office, I would lie on the couch and he would sit behind me, in classic Freudian fashion. Since my accident, I speak to him on the phone.

So bumping into him on the street, and feeling obliged to introduce him to my family, characters I have discussed with him in some detail over a long period of time, was discombobulating. He was of course charming and polite. Carlo told me I went bright red, which is quite a feat for a brown-skinned, if not swarthy man.

In an earlier dispatch, which was also published in Shattered, I wrote about my relationship with my analyst, which I will quote here:

I began my analysis in the early nineties, when I was in my late thirties, with a Freudian analyst who was not much older than me, though inevitably, in the transference, I considered him to be far more knowledgeable, intelligent and omniscient than I could ever be. But he was very good at his job.

I had a lot to talk about and found that I looked forward to the sessions, which were twice a week. I took to lying down on the couch with enthusiasm. I didn’t want to look at him; I wanted to dream and think. There was a lot of silence, which I was not intimidated by. I had no desire to babble. I found the interregnums to be a very practical and useful tool, as Freud has suggested it might be. In the silence, a lot is happening; you are not paralysed but thinking; a number of ideas and images will emerge in the period, which will be sorted through until you find something that must be exposed to the light.

Some people worry that therapy will somehow halt the creative process; they suggest that when talking through your issues, you will somehow evacuate them, and will therefore have nothing to write about. That was never a worry for me, it never happened. I found at the end of each session I wanted to write a diary entry, that I would go through the dream interpretations provided in the analysis. This I found fertile for my work because the analyst – if we were having a good session - would say things that I could never have conceived myself. He would make connections which would surprise me, and which would prove generative.

This isn’t to say that the sessions were all play. During those years, I went through some painful experiences when I was at a loss and depressed. But the analysis kept everything moving. When it works, it doesn’t allow you to linger in any particular state of mind. It moves things along, despite the darkness. There is no doubt, however, that psychoanalysis is both a quick and a slow cure. Sometimes during a session you might come to realise some idiotic repetition that you’ve been living in for most of your life. Something like this could become clear to you, and in that moment you would never wish to make the same mistake again. And while it might be a banal thing, it may have taken you years to come to this recognition. On the other hand, there are other understandings and changes which may take years for you to recognise, things that you cannot possibly bring yourself to do or say, even though to others they may seem simple. Which is why, as I say, psychoanalysis can work both slowly and suddenly.

Psychoanalysis is not a cure-all. It doesn’t suit everyone, and it might be difficult to find an analyst that suits you. I didn’t shop around for my analyst; he was recommended by a friend, I just went to see him, he was starting out and had a space. The moment I left my first session, I thought, this is for me; I want to do this, and I did it, and I’ve never regretted the amount of time and money it has cost me. It is certainly expensive. The French psychoanalyst Lacan certainly wanted it to be expensive. He believed the more you paid, the more it hurts, the more you’d get out of it. There had to be a cost. He didn’t want you lying on the couch for months talking crap and being evasive. If he thought you were doing that he’d cut short the session and invite you to leave. This method really hurried things along, but he was, despite these strange habits, a brilliant listener. In contrast, my analyst is a Freudian, and I wouldn’t want to visit a Lacanian, but I have many Lacanian friends. I like knowing how long my session will be, and that this is my apportioned time slot. This means that I can lie down and say what I like, or say nothing if I want. In one session, I remember, I spent the whole session describing a long dream I had had, and when I got to the end, with about thirty seconds to go, I asked my analyst what he thought it meant. “That is the story of your life,” he said.

I know my analyst has many writers on his books, since he is a considerable writer himself. And I know that his patients continue to see him for many years. These particular analyst/patient relationships has lasted longer than many marriages, or other relationships. So this is an odd experiment. You could say that he and I are experimenting together. What happens if you extend an analysis over thirty years? What kind of analysis is this? And what is going on between analyst and patient?

Probably my analyst knows me better than anyone else knows me. I’ve spent more time with him than I ever did with my parents, a thought that always makes me laugh, because we are still talking about them. I wouldn’t say that my analyst and friends; I don’t want to be his friend, and I never ask him about himself or his opinions on football or politics. Sometimes we do discuss literary topics and we have had long talks about Kafka, Dostoevsky and Proust, for instance. Sometimes these discussions are illuminating, and other times I know he knows that I am avoiding some important issue by chattering on about The Trial or Metamorphosis. There are some topics, and very boring ones, where we have got stuck, sometimes for months on end, and I have felt dead at the end of the sessions, as if I have been trying to bury him under my depression. He once said to me, “I am very tenacious. I will never give up.” I found this uplifting, despite the darkness of this particular period. But it does move on, though it might take a long time, perhaps a year or so.

For many years I had an ambient depression, a kind of gloom, which analysis helped me discover was related to my fear of superceding my father. I realised I was impeding my possible pleasures as a way of protecting my father from my joy and successful creativity. Depression, along with bouts of intense anxiety, a kind of buzzing in the body, made me want to run away from myself.

But anxiety – if you can bear it, rather than seeking to eliminate it - can function as a threshold, beyond which there are revelations about the self that can be achieved. Rather than pathologizing our anxiety, seeing it as a symptom to be dismissed, we should look at what it points to. It might indicate that you are on the verge of excitement or discovery.

Freud suggest that our fears and our anxieties protect us from the fulfilment of forbidden desire. What we fear is not danger but excitement. Anxiety itself provides safety and stores the past, giving you a sense of security, becoming the one place in a person’s life meaning never develops. A symptom, in this view, represents possible self-knowledge that has stopped functioning as insight. Only in analysis might you come to see this about yourself.

Gavin Francis, GP and writer, wrote an interesting piece in the Guardian this week about overdiagnosis and anxiety. I quote from him here:

In mental illness, symptoms don’t point to causes: one person may have withdrawn to their bed, unable to leave the house, because of a paralysing crash in their mood, while another might have withdrawn because of terror over what lay beyond their front door. One person could have developed anorexia because of obsession over food or thinness, while another developed it because a traumatic, abusive childhood left a legacy of need to control what goes in and out of the body.

The best psychiatry focuses on strengths rather than weaknesses. I have come to appreciate more fully how just a little of some traits such as obsessiveness or elation or rumination can be helpful, while an excess usually ends up being harmful. A little anxiety is a good thing – it keeps us safe – but if it starts to take over, we need to find ways to hold it in check.

Someone with a tendency to elation and disinhibition can be a boon for any community – we need some rule-breakers and utopian dreamers, who believe themselves to be capable of anything. But when those feelings tip over into mania, it wrecks families, friendships and livelihoods. A pupil with a label of ADHD might challenge a teacher trying to control a boisterous classroom, but the energy, enthusiasm and multitasking associated with such tendencies can, in other contexts, be a blessing. And what is low mood except the excruciating awareness that life could and indeed should feel better than it does? Every mental health problem I see in clinic has at its core a tendency that, in a more measured dose, or different setting, could contribute to human wellbeing rather than detract from it.

If we were able to hold the labels more lightly, aware of the human tendencies they oversimplify, would we be able to create a society more accepting of difference? Might it be less stigmatising, and also more hopeful, and more open to recovery? With each of my patients, I try to figure out what works best for them to be unfragile – to bend and roll with life’s challenges, rather than be shattered by them. Our minds are not brittle or rigid, but dynamic and responsive, creative and adaptive. Change is not only possible for the mind, it is inevitable, and part of its very nature. To reverse the mental-illness epidemic we need less rigid classification, and more curiosity and kindness, humility and hope.

Bumping into my analyst in the street was uncanny. He knows me well, and I know little about him, nor do I want to. In a sense, he is like an invisible man, a kind of ghost, but at the same time, substantial and forthright in his opinions.

Standing there with him, before my family, members of which represent different epochs of my life, all together now and relatively harmonious, I felt compelled to acknowledge something. A considerable portion of this success belongs to my work with him.

I am rolling down the Shepherd’s Bush Road when I glance into the window of the charity shop where I used to pick up books and other bric-a-brac. I haven’t been inside since my accident, as the books are too high up and I can no longer read hard copies.

Moving closer, I notice several classy Paul Smith dress shoes in attractive colours, as well as some Dr. Martens in a highly decorative pattern. For a moment I think they are to my taste, and that I might pop in and try them on.

Then it dawns on me that they are, in fact, my shoes, donated by my wife. She has, with my permission, been clearing out stuff I can no longer use, as my feet are now swollen and I wear softer, larger, more comfortable skateboarding kicks.

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To be an artist is to be locked into a devotion. David Hockney or Lucian Freud were always working – Hockney still is. It is compulsive, and what is it for? The artists I know are consumed by what they do, and are too interested in the questions art asks of us to relax. None of this is to do with money, but with preoccupation, which constitutes an artist’s sanity and whole being.

Most people discover their vocation—whether it be playing the guitar, painting, writing or gardening—at an early age. It really sticks, and they spend the remainder of their lives exploring their talent.

From a certain point of view, it’s clearly a lovely thing to find something you can dedicate yourself to, that you are good at, and which brings others pleasure. But at the same time, you might wonder whether such a dedication is a narrowing of one’s world, a closing down of other things. For me, as a teenager, deciding to become a writer secured some kind of safety and made a future.

My father was disciplined. He woke up early every day to write before going to his job. He also wrote at weekends. He believed that becoming a published writer would fulfil him and make him happy. Though none of his books were published, his effort was heroic, and he continued to work on stories, most of which were set in India. Dad once said that he continued without giving up, day after day, despite being sick, because it was an example to me of what it is to persist. And yet, I wonder today whether persisting is futile, a waste of time, even an idiocy. If he had taken the time, he might have found better things to do.

But it is true: you can’t develop or grow as an artist without putting the hours in. Mostly, what you are discovering during these hours is what your subject matter might be; the situations and characters that best express your view of the world. And so, daily discipline, the art of returning again and again to your desk—refining, exploring, and wondering who the hell you are—is the basis of becoming an artist.

Sometimes—indeed, a lot of times—you really don’t want to work, preferring to gossip, go for a walk, or shop, anything being preferable to the hard work of creating something new. But you also know that artistic work shouldn’t be easy. It can’t be a breeze; there has to be a tension between what you want to say and what you are able to say. The truth is always just beyond you, out of reach, which is why you start again the next time.

Discipline keeps you out of trouble, but even as I write this, I find myself arguing with the idea of discipline, which implies something compulsory, as if you are in the army, being yelled at, rather than voluntarily attempting the difficult, mostly unsatisfying task of art-making.

Before my accident, I wasn’t writing so much—just little literary essays, which appeared in my two collections, Love & Hate and What Happened?, most of which came out of my reading: the reissuing by Penguin of Georges Simenon’s work, including the Maigret series, which resulted in my essay about his wonderful novel, The Train. I became fascinated by his romans durs—bleak noirs—set in rainy landscapes with desperate people trying to find love or concealing the fact that they are killers. I like to write about what I am reading, but I never imagined there would be a huge audience for this stuff.

I was with Isabella; being with her, and seeing where conversation took us, was more important than making up stories. In the afternoons, I was busy with the kids and the dog. As a writer, I had run out of gas—what was there left to say? And, after all, a lot of artists use their dedication as a way of not engaging with others, of opting out of their responsibilities. But, after my accident, at Christmas 2022, writing came back with considerable force. I felt an almost teenage enthusiasm, or desperation even, to write again, to explain my position, and to talk about what had happened to me.

As you get older, you lose interest in things that once fascinated you. In my case: sex, sport, music, and, for a period, literature—although I have now returned to it as a reader.

(Books I have admired recently: Bret Easton Ellis’s Shards; Saba Sams’s Gunk; Intermezzo by Sally Rooney; Perfection by Vincenzo Latronico; All Fours by Miranda July; the Werner Herzog autobiography Every Man for Himself and God Against All; Keith McNally’s autobiography I Regret Almost Everything; and Fundamentally by Nussaibah Younis, to name a few.)

Perhaps this shedding of interests is part of the aging process and your movement towards death. You certainly lose your ambition, and there is less that you want, except the company and conversation of others, which is something I still crave and enjoy.

Advising my students, I tell them to do a bit every day, to keep the discipline up, and to teach themselves to write freely, whatever mood they are in. You can’t wait for the inclination to take you. Show up at your desk—wait, smoke or drink something if you have to, look out the window—and begin to fashion ideas into some kind of form.

You will be surprised by what your imagination exposes; how far it can take you from what you consider your ‘normal’ self, pushing you into areas you never thought possible.

My friend Peter has prostate cancer; his wife has lung cancer. John has throat cancer and is receiving chemotherapy. Marianne has bowel cancer and is undergoing immunotherapy. Isaac has prostate cancer, urinates all the time, and screams as he does so. Arthur’s prostate cancer has returned, and Amir’s cancer is spreading to his spine.

My former girlfriend Victoria has dementia and cannot speak or walk. We recently learned that her younger sister has the same condition. Bruno came around the other day; I hadn’t seen him for two years. He was shaking and speaking in non sequiturs. “He’s another goner,” I thought. “He’ll be gone before me.”

It’s a toss-up as to who will be attending whose funeral. At the last one, I turned to my good friend Stephen and said, “It’s hardly worth our while going home.”

I am, of course, tetraplegic, but I have a number of other ailments that must be taken seriously. I am seeing a dermatologist for a worrying spot on my forehead. Next is a visit to the eye clinic because my diabetes can cause macular degeneration—did I mention I have diabetes?—and an appointment with a podiatrist for a blackened toenail, the least of my problems.

Remarking on his imminent death, the late Christopher Hitchens said: “I do not especially like the idea that one day I shall be tapped on the shoulder and informed not that the party is over but that it is most assuredly going on—only henceforth in my absence.”

When you get to seventy, it’s not that the party is going on in your absence but that it is emptying out. You may wander onto the dance floor and find no one you recognize—or no one at all.

“All day, all night the body intervenes,” writes Virginia Woolf in On Being Ill. “The creature within can only gaze through the pane—smudged or rosy; it cannot separate off from the body.”

Last night, I was awake at two with a blocked catheter and then again at five with spasms that kept me awake for another hour. I live in a constant state of emergency, never far from the local A&E, where I have been twice in the last month.

When I go to sleep, inevitably I worry that I will be up in a couple of hours needing medical intervention. I can’t relax; the body does intervene. One day, I will go to the hospital and won’t return—having either fallen into a coma or had a heart attack. These fears haunt me.

This is an intolerable situation for Isabella, who sometimes is awake all night—or for days on end.

Edward Said's concept of late style challenges the idea that age brings serenity and resolution. He argues that late works often embody intransigence, difficulty, and unresolved contradiction. Said's own experience with illness, as documented in his memoir Out of Place, offers a moving example of how adversity can fuel creativity. Written during periods of treatment for leukemia, the narrative is marked by a sense of exile and displacement—a deeper engagement with the realities of illness and death.

Born between 1945 and 1965, my generation probably had the best of it—with the welfare state, the Sixties, feminism, the gay movement, and civil rights among other radical social changes. Possibly, we were the most fortunate generation of all time. Now we’re dying off.

We had contempt for those older than us—believing that no one over forty had any juice in them—but my contemporaries are still creative, intelligent, innovative, and even visionary while besieged by shattering infirmities.

Think of great octogenarians who have produced—and are still producing—significant work: Martin Scorsese, Bob Dylan, Louise Bourgeois...

Tracey Emin's work has profoundly evolved in response to her experiences with illness—particularly her battle with bladder cancer in 2020. Her recent exhibition I Followed You to the End serves as a visual memoir documenting the physical aspects of her illness—becoming a powerful conduit for processing trauma and transforming pain into collective understanding.

Yesterday afternoon, I went to North London for my weekly hydrotherapy session. I am on new medication that means I have less control over my bowel movements. I walked several laps of the pool—the only place where I can currently stand up unaided—and as I was being hoisted out, I defecated in front of four strangers.

Most people—including my younger self—would find such an event catastrophically embarrassing. But for me now, it was almost an irrelevant inconvenience. My carer cleaned me up with quiet efficiency, and I went home for a meeting with a director.

Bodily intrusions abound—but good days can be plucked from the abyss of decay. The trick is to assimilate your symptoms: converting them into advantages, making something of them.

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I told Carlo I wanted to write about beefs - disputes, differences and conflicts. Carlo liked the idea and urged me to think about my own history; of significant arguments with women, friends or others.

Of course, I recalled many, but couldn’t land on anything representative. And there are beefs which must remain private. I told my son that I do not consider myself a person particularly drawn to conflict. At this, Carlo laughed, having been privy to many bust-ups with waiters, friends, doormen, taxi drivers, various children and indeed members of the public. I have also served a six-month suspension from a Oxfam bookshop after a run-in with the manager.

My picture of myself clearly didn’t align with Carlo’s. Despite this inability to come up with anything personal, I insisted that this subject was important, that conflict is essential to successful relationships.

Clashes begin in childhood. It is only when the child says “no” rather than “yes” to the parents that she begins to become independent. If a child refuses to go to school there will be friction. But this is also an important moment. To know your parents, you must discover their limits, their breaking points, what they will tolerate. Do they beat you, shout, or carry you to school? In a similar way, as an adult, you cannot know another person without taking them on.

People’s lives are a series of beefs; it is impossible to live without them. The question, then, is not how to eliminate conflict—this is the fantasy of the autocrat and the withdrawn depressive—but how to engage in them, using them as a form of knowledge.

Since my accident in December 2022, my wife and I have entered a new world of conflicts and differences. As I’m now tetraplegic and dependent on her, anything can be a subject of dispute. When she’s feeding me, I can accuse her of putting too much or too little food on the fork, or it may be too hot or too cold. We argue about minor things like this endlessly.

Despite being together for ten years, these conflicts have added complexity to our relationship. And although we would prefer not to be in this situation, there’s a new richness and depth to our interactions, as we are forced to get to know each other in different ways. This can be liberating and destructive; above all, it is a form of connection.

The psychoanalyst Adam Phillips observes that the desire for “happiness” through non-conflict is a form of cynicism—a refusal to engage with the other person. Frustration, Phillips argues, is a version of authenticity. The beef reveals what the other person is made of.

Conflict is the basis of culture. Every book, play, film, and indeed much of social media is concerned with warring factions. We are fascinated by how others resolve disputes or sustain them.

The psychoanalyst Donald Winnicott argued that for a person to become real to us we must first, in a sense, try to destroy them. And we do this by entering into a conflict. If the other does not retaliate or collapse, then can we truly use and love them. The destruction is not literal; it is psychological. It is the testing of boundaries. To be is to differ.

However, some people may be afraid that their anger or verbal violence is too dangerous. They may feel guilty for arguing with or attacking the other person. So rather than engaging in the beef, in order to know the other’s truth, they may withdraw in order not to suffer from the guilt that the dispute may stimulate.

The child may have the experience of upsetting the parent and feeling that they may have in fact destroyed something in them. This would make them cautious, fearing that they will lose the person they are most dependent on. Which is why having a weak parent - one you could easily destroy - could make you fearful and neurotic. You may feel that your very existence is violent. The child would rather become self-destructive – perhaps engaging in self-harm, which is violence against another on oneself - since this feels safer.

There are some people for whom fighting is life itself. They create conflicts where none exist, loving difference and their own aggression. They want to be in opposition, defining themselves by their antagonism. For these people, the absence of conflict is a form of death. But there is also the opposite type: those who flee from conflict at all costs, who confuse peace with harmony. Both are refusing to engage with the other.

There are at least two ways to be exposed in a romantic relationship: through sex and argumentation. In both, you are seeking the other’s vulnerability, attempting to penetrate their defences and see where they will go emotionally. You are extracting something from the other, an exposure of their unconscious.

Arguing can be erotic. It can be sexy. The tension of a dispute can create an intensity that civility cannot match. This is why couples often fight in order to have make-up sex. The fighting is the erotic build-up. The tension must be created and sustained before it can be released.

When we socialise, we are met with others’ masks. We trade pleasantries. But in a moment of anger or sexuality, the mask slips. The other person betrays themselves, losing control. Jokes slip out, vulnerability spills over.

In the middle of a shouting match, you believe you are describing the other person—”You’re selfish, you never listen, you always have to be right”—when in fact you are issuing a kind of inadvertent autobiography - projection. The quarrel becomes an improvised monologue about your disavowed traits, fears, and grievances.

Argument offers an opportunity, allowing someone to say intolerable things about themselves while believing they are talking about the other. This is why fights can leave one feeling oddly lighter or cleansed; the rage has functioned as a crude form of confession. The danger, of course, is that projection disfigures the other person—turning them into a dumping ground for one’s internal rubbish. The scene of conflict is a theatre where the self, unable to bear its own contradictions, donates them to the other. With the racist, it’s clear that what is attributed to the other - greed, laziness, over-sexualisation - is a rejected or idealised picture of oneself.

In William Blake’s The Marriage of Heaven and Hell, he wrote “Without Contraries is no progression.” To stay in a relationship, or a friendship, or even a functioning democracy, is to keep discovering how much disagreement we can bear without retaliating or killing the other person. This can be a form of intimacy, as powerful as love.

‘You don’t know what worse luck your bad luck saved you from’, wrote Cormac McCarthy in No Country for Old Men.

We all have bad luck. Sometimes, bad luck seems to be the only luck around. But this was the worst bad-luck day of my life.

Sitting at Isabella’s table in her living room in Rome, I felt faint. Leaning forward to get some blood into my head, I passed out, and then, apparently, stood up, called for Isabella, who was in the shower, and fell flat on my face, breaking my neck, rendering me tetraplegic.

The doctor told me that if I had been fifteen years younger, or if I had fallen in a slightly different way, I would have suffered nothing more than a bruised face. It was just bad luck, he said.

You are lucky, or unlucky, to have been born into a certain time or place, with parents of a particular temperament. On the luck-scale, these are your lottery tickets, and they can be either a gift or a curse, depending on how you use them.

I was born lucky: healthy, with stable, loving parents, in a comfortable south London suburb in the mid-1950s, an epoch of rising living standards, free education and health care, with the revolutionary prospects of the sixties on their way. On the other hand, I was a mixed-race kid riddled with anxiety, and the career prospects of my contemporaries and me were limited to physical labour and minor civil service jobs. But some of us would escape through Pop: fashion, music, photography and writing.

‘The Owl of Minerva flies at dusk’, wrote Hegel, meaning we can only make sense of historical events retrospectively. This is true when trying to understand our lives – allocating either good or bad luck to certain significant events.

There are at least two types of luck: foundational and situational. The former is when and where you are born, the temperament of your parents, and indeed what you look like. The latter refers to those pivotal, coincidental moments that can change the course of your life in an instant. Aristotle tells us that luck is, firstly, beyond our control; secondly, contingent; and thirdly, that it matters in being either good or bad for you.

Sartre famously said that we are ‘thrown into the world’ without purpose or choice. Yet, successful people almost always suggest that the constraints of their childhood allowed them to develop the precise tools they needed to flourish. The dyslexic becomes the visual thinker. The person without resources becomes the strategist. Being mixed-race at that time furnished me with original material. Only those whose particular misfortune happened to align with a viable skill survive to tell the story. Bad luck becoming good luck is about the retroactive rewriting of what the luck meant. Your bad luck is your material; your symptom can be your escape.

For the most part, luck is not something that happens to you in isolation. Rather, it’s something that happens through other people. Chance encounters: the luck of having a good teacher or of running into someone at a party who becomes your spouse. You might say that other people make your luck, either being good or bad for you. Most, over a period of time, are a mixture of both.

The year I was in hospital, I spent a lot of time around people who suffered life-changing bad luck, not the kind you can reformulate into any kind of advantage. On the luck-scale, these are on the extreme end of misfortune, next to death. In a previous dispatch entitled The Hospital of Accidents, I wrote of these subjects:

‘There are injured surfers; there are many cyclists, some of them very young; there are motorcyclists; there are car accident victims; there are two men in here who had disasters on trampolines. Swimming pools are dangerous, particularly if they are emptied overnight, which someone on this ward failed to notice. And there are many people who have fallen down the stairs. You are lucky to survive going up to bed each night.’

For these unfortunate people, their bad luck may never be converted into good luck. As trauma, it cannot be symbolised or integrated into a life story. There is no coming back from certain kinds of bad luck—suffering so total it destroys the capacity to want redemption. It can’t render you stronger; it simply unmakes you—so you are neither dead nor alive.

I could have died that day, the day of my accident. So you might say there was some good luck, or, I had the best luck of all. My accident was a kind of second birth, a forced beginning. I didn’t choose it, but it was the condition of what came next: this writing, my book, the ever-growing community of people reading and sending in their stories. So luck, or bad luck, is just chance plus our agency. I am seventy-one and still writing, which you might say is the luckiest luck of all.

On Saturday mornings, I like to go to the farmer’s market with Isabella, my ex-partner Tracey and our twin sons. Last weekend, as the five of us approached Gails at the end of my road, we ran into my long-time psychoanalyst, who was on his way to his barber.

I’ve been talking with him for thirty years, but have barely seen his face; during my sessions, when I used to go to his office, I would lie on the couch and he would sit behind me, in classic Freudian fashion. Since my accident, I speak to him on the phone.

So bumping into him on the street, and feeling obliged to introduce him to my family, characters I have discussed with him in some detail over a long period of time, was discombobulating. He was of course charming and polite. Carlo told me I went bright red, which is quite a feat for a brown-skinned, if not swarthy man.

In an earlier dispatch, which was also published in Shattered, I wrote about my relationship with my analyst, which I will quote here:

I began my analysis in the early nineties, when I was in my late thirties, with a Freudian analyst who was not much older than me, though inevitably, in the transference, I considered him to be far more knowledgeable, intelligent and omniscient than I could ever be. But he was very good at his job.

I had a lot to talk about and found that I looked forward to the sessions, which were twice a week. I took to lying down on the couch with enthusiasm. I didn’t want to look at him; I wanted to dream and think. There was a lot of silence, which I was not intimidated by. I had no desire to babble. I found the interregnums to be a very practical and useful tool, as Freud has suggested it might be. In the silence, a lot is happening; you are not paralysed but thinking; a number of ideas and images will emerge in the period, which will be sorted through until you find something that must be exposed to the light.

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‘You don’t know what worse luck your bad luck saved you from’, wrote Cormac McCarthy in No Country for Old Men.

We all have bad luck. Sometimes, bad luck seems to be the only luck around. But this was the worst bad-luck day of my life.

Sitting at Isabella’s table in her living room in Rome, I felt faint. Leaning forward to get some blood into my head, I passed out, and then, apparently, stood up, called for Isabella, who was in the shower, and fell flat on my face, breaking my neck, rendering me tetraplegic.

The doctor told me that if I had been fifteen years younger, or if I had fallen in a slightly different way, I would have suffered nothing more than a bruised face. It was just bad luck, he said.

You are lucky, or unlucky, to have been born into a certain time or place, with parents of a particular temperament. On the luck-scale, these are your lottery tickets, and they can be either a gift or a curse, depending on how you use them.

I was born lucky: healthy, with stable, loving parents, in a comfortable south London suburb in the mid-1950s, an epoch of rising living standards, free education and health care, with the revolutionary prospects of the sixties on their way. On the other hand, I was a mixed-race kid riddled with anxiety, and the career prospects of my contemporaries and me were limited to physical labour and minor civil service jobs. But some of us would escape through Pop: fashion, music, photography and writing.

‘The Owl of Minerva flies at dusk’, wrote Hegel, meaning we can only make sense of historical events retrospectively. This is true when trying to understand our lives – allocating either good or bad luck to certain significant events.

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As a young man, I was enthusiastic about the contemporary philosophy existentialism, where writers as diverse as R.D Laing, Beckett, Kafka and Camus were often collected together in anthologies.

As a perennially-depressed teenager, I can recall reading part of an essay by Camus from The Myth of Sisyphus. The rolling of that fucking rock up and down forever – a metaphor for the futility of existence – appealed to me, particularly at school in a rough comprehensive.

But what shocked me, as far as I can remember, was Camus' writing about suicide, where he says, 'There is but one truly serious philosophical problem, and that is suicide. Judging whether life is or is not worth living amounts to answering the fundamental question of philosophy.'

Despite growing up in Bromley, I did in fact quite like living, and was planning, at the time, to bounce right out of the suburbs and into the future, where I would become a famous writer and have lots of sex.

Many years later, after my accident in December 2022, and paralysed in hospital in Rome, I wondered whether this half-life was worth living. My suffering and grief was immense. It overwhelmed me. How could it not? Would death have been preferable? Could I live with a catheter, the pain in my bladder, my inability to use my hands, the suffering I caused my family and Isabella, the intense difficulty and strain of the rest of my life? Do I still feel the same way now?

When I moved to the Santa Lucia, a comfortable rehab just outside Rome, and, later, when I came back to London, I began to see more people. Many friends turned up to visit, to sit at the end of my bed, and have conversations. I'd forget my predicament and was able to leave myself behind. I guess this is the point of other people; to become absorbed in them, in what they are saying; to laugh and think, enjoying their existence and their love for you. A lot of what we do – reading, listening to music, swimming, sport, whatever – is an attempt to escape our self-disgust and contempt, to allow others to elevate our mood.

In a North London rehab, I became friends with Jon, a philosophy lecturer on my ward. In his early thirties, he had suffered a terrible accident which left him paralysed from the chest down. In contrast, I was seventy and had lived most of my life in a fairly healthy state, while he was still a young man who had lost everything, rarely had visitors, and couldn't, at that time, return to his job or apartment.

He wanted to die, and we would sit in our wheelchairs in the corridor discussing the ethics of suicide, as well as its practicalities, and indeed how impossible it is to kill yourself in hospital, particularly if you can't use your hands.

He wished he had died during his rock-climbing accident, and regretted continuing in this abysmal state, which involved so much loneliness and grief. I encouraged him not to rush into suicide, since he might cheer up in the future, and renew himself, despite everything, discovering reasons to live. He doubted that, but in fact wrote to me not long ago saying he no longer wished to die. He was getting on with things that he found relatively fulfilling.

The child psychoanalyst Donald Winnicott said somewhere that when he encountered a suicidal patient, he would want to know whether there was a good reason for this wish; was it, for instance, a rational response to the lived-experience of the patient?

A good reason for wanting to die would be a burden of psychic suffering that rendered existence so unbearable that on balance, one would rather be absent. Who could blame any individual whose anguish was so great and without reprieve that oblivion, which is inevitable anyway, was preferable?

Recently, a friend suggested that instead of greeting each other with the usual 'Hello, how are you?' we should say, 'Where does it hurt today?'
This made me laugh, as it identifies something that we older people talk about - even before we mention Donald Trump - which is the parlous state of our bodies; where exactly the cancer has penetrated, how far it has got, and what treatment we are receiving, and so on.

So whether one wishes to continue living in these circumstances, or would rather do away with oneself, getting the whole squalid process over, is a live question, and not just a matter for abstract debate.

Suicide is, in many ways, an abhorrent act, which can seem like an attack not only on your own body, but on your family and friends, those who care for you to live. But when you get older, and in certain circumstances, it can seem like a rational move; there are some things that one just doesn't want to go through in order to croak on for a few more months or weeks, barely alive, a body being devoured by fate.

Sometimes I wake up in the morning with a sigh on realising that I can no longer use my hands; my right is more or less entirely useless, and my left, I can move only a little, but certainly can't grip a pen or even a glass.

But later in the day, when I finally get moving, and see Isabella and Carlo, and begin to enjoy laughing with them, I realise I am happy to be alive, which is enough for the time being.

This trite phrase 'happy to be alive' means a lot to me; a modicum of pleasure, a moment of relief, an entertaining conversation, and you are back in the world. That might be the difference when it comes to deciding whether one wants to go on.

One afternoon in the early 90s, I found myself face down on the pavement outside the Whitechapel Mosque in the East End, with a cut on my forehead.

Most Sundays, at that time, I visited the mosque to hear the speakers who would opine on a variety of juicy subjects: homosexuality, geopolitics, marriage, the government, perfume, and so on. Some of these speakers were wildly entertaining in their absurdity: marching up and down, declaiming at enormous length - Trumpian in their free-associative excess. I was writing my second novel, The Black Album, and this was material I knew I could use.

Head down, scribbling copious notes, I didn’t notice the two large bearded men approaching me. ‘You’re a friend of Salman Rushdie’ one of them said as they grabbed me by an arm each, carrying me to the exit and throwing me out into the street.

Not only was it humiliating, but the situation was becoming dangerous, particularly after what happened to Rushdie. I already knew that these people were fervent and didn’t like being disagreed with. But at that time, it was essential for me to get out of my study and bear witness to what was going on in the Islamic community.

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For my birthday, a friend bought me an expensive piece of hardware: an exoskeleton called a Hypershell — a device that attaches to your waist and legs, forcing them forward. The machine is operated through an app, stimulating your legs so that you can walk farther and take longer steps.

Designed for hikers and climbers, this device is intended to help them travel longer distances. Apparently, it is not designed for disabled people. But now, once a week, with its help, I walk up and down either my garden or front room on a Zimmer frame, wearing the Hypershell, accompanied by my three physiotherapists — one on each leg, and one at the front. My aim, when the weather warms up, is to walk to the end of my street.

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It is 1964 and my father is up a ladder in a secondhand bookshop on the Charing Cross Road. This is how we'd spend our Saturdays, hunting for old stuff: philosophy, psychology, fiction and politics.

My father, an Indian, was also looking for something in Buddhist and Taoist texts that would give him, as he put it, 'direction in life', which his parents had failed to engender in him.

Years later, without knowing it, I found myself following him. I too would scour bookshops in London, and later in New York and Canada, where I was teaching, searching for works of literature, or for books on psychology, where I might find the key to some kind of liberation.

After I left home, I was aware there was something lacking in me. Something was wrong, I wasn't who I wanted to be. I knew I had to become a different kind of person. My life became consumed by this quest for 'self-improvement'.

We boomers always wanted to be new people, free from the constraints of our conservative parents: we would open our minds with drugs, experiment with our sexuality, make new kinds of families, and be innovative with our work.

Today, self-improvement means redesigning yourself for an already existing system; smoothing off your rough edges so you can find employment and then rent a flat. Self-help gurus and influencers prey on people's insecurities. They have the answers for how to live, what to buy, and how to master your neuroses and become a super-capitalist.

In our world of inestimable choice, who doesn't want guidance? For at least the first eighteen years of our lives, we live in a regime where we are guided by others' ideals, our parents and our teachers. But who can prepare you for the world as it is?

In Woody Allen's wonderful "Play It Again, Sam" (1972), the protagonist, played by Woody himself, is in constant conversation with an imagined Humphrey Bogart, dressed in the famous raincoat and hat.

A cross between a mentor and therapist, the Bogart character consoles and advises Woody on how to deal with the women in his life. In our imaginary, our heroes are those who appear to have escaped the manacles of their history. They are free and powerful.

However, there is always a conflict between the collective, equal society we desire, and our beguilement by those who break with convention.

Heroes matter because they map possibility. Musicians like David Bowie and Bob Marley weren't just artists—they were insurgents who redefined identity and resistance. You might say that our characters begin when we start to esteem others, beyond the parent paradigm.

The political right's rebirth hinges on its ability to channel a primal human desire: the yearning for self-improvement and heroic individualism.

While the left fixates on systemic equity, the right speaks to personal ambition, offering a vision of success rooted in autonomy, resilience, and self-creation.

They promise that through sheer will, one can transcend limitations, a narrative the right weaponises against the left's collectivist ethos.

Consider gym culture: a microcosm of right-wing ideology. Fitness regimes valorise discipline, competition, and physical mastery—traits coded as masculine and tribal. It's no coincidence that today's tech bros and libertarians are beefed up and into martial arts.

On the other hand, for the younger generation—the first generation in centuries not to be wealthier than their parents—the gym represents a place of self-determination and overcoming.

The right have stolen the left's charisma, its revolutionary fervour. For the twentieth century—from Lenin and Trotsky, to Che Guevara and Castro—the left were the leaders in radical optimism. These outsiders were hip innovators, who would destroy existing structures and make a new future.

Conservatism once meant the preservation of the past. But now the right are the new revolutionaries; punks who hate tradition, ripping up the present and starting again. It would be considered farcical if it weren't so tragic.

I collect and have read dozens of writing manuals, which I find both stimulating and pointless. And I have read some self-help books, in particular Robert Greene's entertaining manuals on Power, Seduction and War, which assume that others are only competitors and not collaborators.

What kind of person would you be if you read nothing but self-help books? You might gain some discipline, but you'd have no knowledge.

Self-improvement is a trap; the idea should be to leave yourself behind. What is required is not more of yourself, but less—to live outwards rather than inwards. You might have noticed that I have fallen into the trap myself, of giving advice on how to live.

The people I am most impressed by—and whom I try to surround myself with—are drastically uninterested in themselves, and lacking in narcissism. They are full of stories, anecdotes and gossip, finding wonder in what is around them. Big talkers, they want to impress on you something they've seen or heard, invigorating you with their energy.

This is why I find it so unusual that the famous narcissists of today hold the public in thrall, since they are so boring. They only have one story, and it's inevitably self-aggrandising. Narcissists are vulnerable and afraid of disappearing, constantly needing validation.

Looking back at those Saturdays in the bookshops, with Dad up a ladder searching for ideas, I realise now he was attempting to commune with the most serious thinkers. Today's ladders lead to masterclasses, online courses and viral success stories.

We've replaced the search for knowledge with the pursuit of metric-driven self-optimisation. The power of the narcissist is always based on exclusion, oppression and humiliation, sucking the life out of others and using it for their enhancement.

I can’t remember the last time I ejaculated. But there would have been a last time, and I wouldn’t have known it was the last time. I guess you’ll never know with anything when the last time will be: the last cigarette, your last kiss, a last look at your children’s faces.

I have been thinking a lot about the end of my sexuality, how it feels and what it means. At times, it seems insignificant when it comes to dealing with everything else we have to worry about in this house. But losing one’s sexuality is a unique, if not unparalleled loss, since libido – particularly if you come from the boomer generation – was a dominant figure in the cultural, political and social life of my time.

Fortunately, I haven’t seen my cock for some time, but I feel it being washed by my carers in the morning. I suspect it is a shrivelled mushroom in a mass of thin grey hair.

My cock took me into all kinds of unexpected and often farcical situations, leading me to meet new people and to explore others’ minds and lifestyles. Luckily, I didn’t have my accident until I was in my late sixties, and so lived most of my life ignorantly innocent, with no idea of what losses were ahead of me.

As I lie in bed at night and think of my friends and how they are beginning to suffer new maladies, dying off and getting sicker, I think about the women I’ve known.

Despite the forfeiture of my sexuality, I still have erotic dreams and even fantasies, which can seem, at times, to be like a plague, something I can’t escape. When insomniac and in pain from my catheter, I see images and scenes, wishing I had had more fun with my cock when I still had it. I am reminded of a wonderful John Cheever short story in which the protagonist, an aging poet, is harassed and assaulted by sexual thoughts and images.

Recently, I was reading The Confessions of Samuel Pepys, a new addition to his exhilarating diaries and scurrilous adventures, with freshly translated material. This edition mostly concerns his cock, and the numerous women he pursues, harasses and even rapes. He barely records what each woman is like; they are merely instruments, and he tells us only whether they touched what he calls ‘his thing’ or not. He is a fascinating diarist and always good fun to read, but his sexual adventures are repetitive, as if he were viewing his sexuality as something to evacuate, rather than that which might bring him closer to knowing someone, enjoying them in their singularity.

I never thought of sexuality as being an end in itself, but as a journey into intimacy with another person; a way of knowing them, or getting close to them, of being with them in a heightened way. It was never a matter of numbers.

Loving women, their presence, their speech and their bodies; being enthralled by their hands, the way they touch their hair and the way they move and dress, I haven’t lost that appreciation. I can still enjoy it as a form of curiosity. And the world is still full of sexual wonder, if not of accomplishment. My mode is voyeuristic now, a love of looking.

As I wrote in a previous blog, Fuck More: The Impotence Men:

My contemporaries speak of how liberating it is being - as several of them have put it - unchained from the lunatic that is their libido. There is relief: they are no longer being driven into mad scenes by an irrational master buried inside them. You might even say they have entered a new age of serenity and peace.

When your sexuality dies, it doesn’t follow that you lose interest in everything. Freud’s notion of sexuality being at the centre of the human dynamic feels far less relevant and interesting as you get older. A libido can become more scattered and invested in other things. Who knows where it might take you? At this point, life becomes an experiment once more.

As well as my internal, pornographic cinema, these restless nights are spoiled also by shame. I dwell on many missed opportunities, cruelties, numerous embarrassments and fuck-ups, while wondering what use this self-reproach serves. Perhaps only Donald Trump lies in bed thinking of his triumphs. The rest of us, no matter how successful, muse on our failings and regrets.

I live in an age of death and illness - it is all around. Recently a friend wrote a long, moving and upsetting letter about his dementia and how it is beginning to take him down. Another friend has discovered that his cancer has spread into his back and bones. Every day there is new bad news.

But despite our human fate, and the reality of war and disease, it is crucial that we keep the idea of pleasure in circulation. We are desiring animals who arouse one another through speech and touch. Our pleasures support our activity and imagination. Play sustains our lightness and curiosity; it is itself a therapy. And so we must, until the end, insist on our appetites and delights.

Dusty pink plastic flowers and two bizarre fountains which drip over the pavement. From here, where I sit outside in my wheelchair – the restaurant is inaccessible, having a large step – I can see inside where there are onyx tables, a large water feature with liquid running down a huge panel, and a mostly Asian clientele eating eagerly. The ceiling is extraordinary and well worth a look, if you have time on your hands in Shepherd’s Bush. You will see, if you raise your head, a large number of black and white metal doves, framed by garlands of orange artificial flowers. This has become our Sistine Chapel.

My wife discovered this restaurant recently after becoming disillusioned with the Indian in Shepherd’s Bush market, whose wife’s prawn curry we admired, but they only provided it on Fridays, which is when I go to my hydro.

This Pakistani restaurant has been quite a find, particularly now I like to eat Pakistani food every evening. The place has a large menu, and since we are pescetarian our favourites are prawn and fish curry; we also like their spicy tarka dal as well as their matar paneer. They do a fine black dal which is as good as Dishoom’s but half the price. The service, however, can be a little wayward; they tend to forget things or have to be reminded two or three times of your order. Their response is always a boilerplate “fifteen minutes”, which is usually longer than any fifteen minutes I’ve been acquainted with. But they usually give us a box of too-sweet rice pudding as recompense.

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I told Carlo I wanted to write about beefs - disputes, differences and conflicts. Carlo liked the idea and urged me to think about my own history; of significant arguments with women, friends or others.

Of course, I recalled many, but couldn’t land on anything representative. And there are beefs which must remain private. I told my son that I do not consider myself a person particularly drawn to conflict. At this, Carlo laughed, having been privy to many bust-ups with waiters, friends, doormen, taxi drivers, various children and indeed members of the public. I have also served a six-month suspension from a Oxfam bookshop after a run-in with the manager.

My picture of myself clearly didn’t align with Carlo’s. Despite this inability to come up with anything personal, I insisted that this subject was important, that conflict is essential to successful relationships.

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Yesterday, Isabella and I went down to Hammersmith to give notice of our forthcoming marriage, a legal requirement, where we were separated and asked a series of questions to ensure that we actually knew each other and had, indeed, met before.

Seated in a tiny, airless room, confronted by an earnest bureaucrat behind a glass partition, I was asked an easy question to kick things off: “What is your prospective wife’s date of birth?” I had no idea and replied, “I have three children, and I don’t know their dates of birth either.”

Next, they asked, “What is her phone number?” Again, I shook my head in despair. Her email? Not a clue. They asked for her full name. I sighed, “I never asked.”

Finally, they handed me a sheet of paper and a pen and asked me to sign the document. My head sank. “I’m paraplegic; I can’t use my hands.”

The following day, recounting this tribulation to Carlo, it occurred to us that we should write a self-help book. But instead of the usual instruction about achievement and success, its topic would be failure: the often unrecognised pleasure of letting yourself and others down, and what fun it is to fuck things up.

Most of us have already practised this form of passive-aggressive resistance, usually with our parents, partners, or while in bad jobs. The point of our new book would be to encourage more failure—this underestimated indulgence—seeing it as a form of triumph.

I was a librarian at school. It was a good gig because when it was cold, you didn’t have to go outside. A book that made a strong impression on me one lunchtime was Alan Sillitoe’s The Loneliness of the Long Distance Runner.

In a foot race, the protagonist, Colin Smith, a long-distance runner in juvenile detention, deliberately stops just before the finish line, allowing his rival to win. This is an act of defiance against the authorities. By losing the race, Smith asserts his independence and rejects the governor’s values, remaining true to himself.

As human beings, we have no choice but to work in teams; we are as dependent on others as they are on us. We are therefore in a delicious position to fail them and cause suffering. Our failure would be their failure. Telling your father that you’ve flunked your exams, are no longer pursuing a law degree, and have decided to become an experimental electronic musician can be a compelling source of jouissance. Life is filled with these moments—expectations not met, hopes dashed if not destroyed—and we should learn to savour them.

You will never, I hope, forget the times you have let down a sexual partner, leaving yourself embarrassed and ashamed, and them unsatisfied and frustrated, if not furious. These memories will come back to you years later as blissful recollections, as victories to bask in.

In China, “lying flat” is a form of protest where young people reject the relentless pressures of work, competition, and consumerism by opting out of the rat race and activity, simply “lying flat” in bed all day.

The philosopher Slavoj Žižek describes this as “Bartleby politics,” after the titular character of Herman Melville’s short masterpiece Bartleby, the Scrivener: A Story of Wall Street. Bartleby’s defining characteristic emerges when he begins to respond to requests to work with the phrase, “I would prefer not to.”

This docile defiance escalates until he stops performing tasks, refuses to leave the office, and ultimately declines all offers of help or employment.

If achieving expertise in any field requires 10,000 hours of practice, those who spend all their lives watching porn and playing video games are already some of failure’s highest achievers. These heroes require our acknowledgment, succour, and welfare handouts.

Entire businesses, if not institutions, are fired by the fuel of failure: the psychotherapy industry, for instance, is propped up by losers interminably complaining on a couch about their lack and their losses. The comedy trade, from Charlie Chaplin to the BBC’s Alma’s Not Normal, is a litany of mortification, falling over, and general idiocy. The German word schadenfreude—pleasure in others’ misfortune—is, of course, a form of projection, allowing us to enjoy our own inadequacy on the site of others.

America is a case in point. Under Biden, the economy was humming along, unemployment was low, as was inflation; the country was relatively peaceable, and the billionaire class were richer than ever before. Everything was almost all right. Appointing Trump, a failure in every aspect of his business life—a man clearly an idiot—proves the glorious human instinct for failure hasn’t diminished, but is alive in the most successful country in history.

The film Amadeus brilliantly centres not on Mozart but on his rival Salieri, whose sense of failure embodies the universal fear that no matter how hard we strive, there will always be someone more talented, more beloved, or more successful than ourselves.

Some of the world’s greatest works are about losers. To pick a few: Shakespeare’s Hamlet, Notes from Underground by Fyodor Dostoevsky, A Fan’s Notes by Frederick Exley, Oblomov by Ivan Goncharov, or indeed Salinger’s The Catcher in the Rye.

In a world obsessed with winning, the true rebels are those who find joy in losing. So don’t let the fear of disaster ruin your life; embrace it fully and throw yourself into every available calamity and misadventure. I am taking it for granted that my forthcoming marriage will be an utter catastrophe. Remember, success is fleeting, while failure is perennial—our enduring, constant companion.

I have been given new meds for my bladder which have had unexpected side effects. Hallucinations, in other words; waking dreams where I know where I am, yet at the same time, I am enveloped in an uncanny, semi-realistic trip. My eyes are open, I’m at home, but unable to shake off the vivid delirium.

I am living in the basement of my house as a spider in a web, clinging to a dusty beam. Upstairs, my wife is living with her new husband. I crawl across the ceiling, listening to their footsteps, laughter and voices, attempting to work out what they are doing. For a moment, I have a visual through the floorboards, and so can see the husband is smartly dressed in a suit and tie. He is a book illustrator and his work is modern and stylish. A clever man. The other thing to note is that the pages of his books are blank. They might be notebooks.

I, the spider, dance across the floorboards, attempting to work out what it is the couple are doing up there. I try to communicate; I want them to know of my existence, that I am still alive, even in this new form. I envy their life but cannot join it.

This dream goes on for a long time, and I find that I am crying out in my sleep. Isabella has to rush down two or three times to find out if I am okay. I tell her I’m asleep.

The drug in question is Mirabegron. A Google search informs us that the possible side effects might include dizziness, constipation and nausea, all of which I have enjoyed, but there is no mention of spider metamorphoses.

Recently, I have had several horrific, waking dreams of this nature. I have since come off these meds, but the hallucinations have made me think about the nature of dreams and what you do with them. Do you tell your dreams to your partner, family or friends? Is anyone interested? What tools might we use to decipher them?

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How would you like it if one day a stranger came to live in your house?

Every three weeks, my carers have to change, since they are on duty 24/7. The other day, a nice Nigerian woman came to work here. She was eating in the kitchen when she overheard a conversation I was having with my gossipy, entertaining physiotherapist. As she was stretching me, we were discussing how you might know whether you are a 'top' or 'bottom' – a distinction I have only recently heard about. We then discussed the master and servant relationship in regard to BDSM, which she is teaching me about, a woman who likes to party.

Later that afternoon, when Isabella and I were out, we received a text from the new carer saying that she had packed up her things and left for good, claiming that my earlier 'sex conversation', though it was private, had upset her.

Later that day, she was replaced by a sweet woman, who turned up in full Muslim robes. She was competent and keen to learn, except later in the day when I required refreshing with a strong Bloody Mary, she refused to make it, citing religious objections.

She left for another job a few days later and was replaced by a charming South American woman, who, at all times, wore huge artificial eyelashes, even in the middle of the night. Behind them, I noticed, she wore green coloured contact lenses. Although she was good at her job, she spoke little English, which can be frustrating when trying to discuss a blocked catheter, or how I like my coffee.

We've had only one white British carer, who we liked, though she did have the tendency to pull up a chair and join in conversations with family and friends. We got along well, until one day, when Carlo and I were working in the morning, she told us she was going to the fishmongers, but in fact had packed up her things and we never saw her again. We never found out why.

So, how would it feel if a stranger came to live with you - not for a few days, or even a couple of months, but for the rest of your life?

They would be absolutely necessary for your existence, doing things that no one in your family, or your spouse, could possibly do. Washing you, relieving your bowels with their hands, fetching food and drink, taking you for a walk, and spending much of the day and, at times, part of the night with you.

It would be a heroic achievement to remain good-tempered, polite and decent with this stranger, despite their quirks and personal eccentricities, or even their values, which might be different to yours. They could, for instance, have religious views, whether Muslim or Christian, and might be easily offended by the way you speak, despite having made a decision to live and work in a stranger's house. You would, I think, have to be a tolerant character to want to do this job.

What would it be like to be in their position, living with a family where you are both needed and burdensome? They don't like your cooking, you can't prepare meat because of their vegetarianism, and you disapprove of their drinking, smoking, and crude conversations.

I am no saint. I can be bad-tempered and frustrated, in a rage about my condition, but I do my best not to be too crazy. On the other hand, I am who I am, this is my house, and I have suffered this severe traumatic injury that has left me pissed off.

If you get close up to anyone, particularly a stranger, the chances are you will find them not only peculiar, but mad, as proximity to any person will prove.

As a child, you are flung into a family, with grandparents, parents and siblings. If you are to survive, you will have to adapt in order to get what you need, which is love. You will have to modify your speech and behaviour in order to please these people and keep their possible hostility at bay. Finally, when you are able to leave home, you can make your life as you like it, on your terms, if you are lucky. But, as you age, you may have an accident or illness, and find yourself in something of an infantile position again, where you will have to adapt to the needs of others, having become entirely dependant.

I want to be a better person. Isabella says I should try harder and moderate my tone, but enough bad shit has happened already without me having to radically remake myself, curbing my worst impulses, or my best.

I've already been remade. Am I someone else now, or the same idiot I have always been, but with the added friction of a stranger? There was one carer, right at the beginning, who explained that she wasn't in fact working for me, but was actually in the service of God. I had to apologise for my bohemian behaviour, but she soon left. There are many lessons here that I must learn, but do I want to be a 'better' person, or is that just a pointless concession?

Outside of the home, in the workplace, we are in a constant state of necessary adaptation. Our families, although replete with their own compromises, should be a refuge from professional obligations, where we can be at our most free and relaxed. Now, I must learn to live with people who are employed to look after me. In this careful choreography of specialised care, I find myself mourning not just independence, but the privacy of home, which has been lost for good.

Here we go again. Carlo opens the computer, goes to Word and a blank page pops up. He turns to me and says “What now?”

My mind is as blank as the page in front of us. I say, “It always starts like this.”

I guess by now, it is a matter of trust and experience. We know we have nothing to say at the moment, but we do know that once we start arguing and discussing, something will emerge - but what exactly, we have no idea.

You are not a machine. It would be a mistake to believe that you can continuously renew yourself. It might be an idea to take a break for some time, for weeks, even months, until something substantial begins to stir. No artist is consistently creative. Why would they be? Good ideas come unbidden and you might need to wait, to think about other things, ruminate. You are not a machine.

It is a fallacy that you should be able to continuously produce new work. The Pakistani psychoanalyst Masud Khan, who edited Donald Winnicott’s masterpiece Playing and Reality, explored the concept of ‘lying fallow’ in his 1983 essay “Hidden Selves.” He describes ‘lying fallow’ as a state of mind that enables genuine creativity, as opposed to pseudo activity. The term itself is taken from agricultural terminology – where the fallow ground is ploughed but left uncropped – to allow for genuine regeneration. He does not endorse inertia or listless vacancy, but an active state of receptive awareness.

Khan observed that modern technical cultures have created “a colossal trade in organising people’s leisure,” filling every stillness with ready-made distractions. This represents “the omnipresent fallacy of our age that all life should be fun and that all time should be made available to enjoy this fun,” resulting in apathy, discontent and neurosis. The capacity to lie fallow proves “that a person can be with himself unpurposefully” a radical act in our productivity-obsessed culture.

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