Maybe it's because my mother is from London, but I have always felt a certain type of kinship with the Royal Family. I remember getting up super early in the morning to watch the wedding of Kate -- the Princess of Wales -- and William, having Yorkshire Gold tea and scones with the one other British family in our town.
Fast forward to a couple of weeks ago, when Kate sat in front of the earliest spring flowers, looked straight into the blackness of the camera's lens, and shocked the world with news of her cancer. I watched her affix a smile to her face. I watched the staccato movements of her hands. I watched her eyes say something different than her carefully parsed words.
Out of all of the many reactions I had -- sadness, surprise, worry -- what I found myself wishing for most was that she could just shut the lens down and no longer have the attention of the world on her. (I recognize the irony -- and my ambivalence -- about writing an article on just this topic at all.) In other words, I wished that she might have the sanctity of space. A wholly private space, separate from what the world wants from her, which is self-packaged for public consumption, wrapped in a neat bow.
To be clear, I have never met Kate, and I have no opinion regarding her mental health. And yet, her story resonated in part because of the work I do as a women's mental health psychiatrist. It was not that long ago that one of my most stable patients,* a mother of two young sons, whom I thought I was following just for mild adult ADHD, saw her doctor for persistent abdominal pain and was told she had stage IV colon cancer. Our sessions frequently began to center on dealing with this new diagnosis. Along with coping with serious medical illness, the mental load of being a parent with cancer is immense.
According to Cindy Moore, PhD, a clinical psychologist and director of the Marjorie E. Korff Parenting At a Challenging Time (PACT) Program at the Massachusetts General Cancer Center, "Parents (of children and adolescents) are even more vulnerable than other adults with cancer to depression, and medically ill parents may also feel less efficacious and satisfied in their roles as parents as a result of changes in their physical, cognitive and emotional functioning."
With my patient, I witnessed the shock, the sense of trying to enter a whole new reality. Wondering what to tell her children -- and how much. Wondering how much of their lives she will get to see. Wondering what to prioritize -- should she work? Can she work? What does she do with the degree of undetermined time she has left? How do you make sense of knowing what has come out of left field, knowing that it is impossible to turn back time?
All of these changes mean you must leave the room of the life you had before and enter a new one. Somehow you must become a new self -- a self you would have never wished for. The author , who has had cancer since her early adulthood, , "Though the word may suggest otherwise, recovery is not about salvaging the old at all. It's about accepting that you must forsake a familiar self forever, in favor of one that is being newly born. It is an act of brute, terrifying discovery."
In Kate's case, she doesn't even get to own herself fully. That was obvious with the relentless, public from public life, the intrusions into her , and the many opinions . According to in the New York Times, as a royal, "her body is under inspection because it belongs to her nation, and to its future."
Can you imagine living in a world where even your body doesn't belong to you? (Well, yes, we can. Any person who might get pregnant in certain states knows that feeling -- the idea that our bodies don't, in fact, belong to us.) The word privacy comes from the Latin , defined as "set apart (from what is public), belonging to oneself (not to the state)." Everyone -- even Kate -- needs the sanctity of a private space, beyond what the state wants and takes from us.
To traverse that gap between selves, you need that private, closed space. It goes beyond just medical privacy, although that's important of course. I often say to the residents I supervise that no one should become a psychiatrist unless they are really, really good at keeping secrets. That level of privacy is crucial, because what fills that closed space are the hardest things. Things that fill us with fear. Things that fill us with shame. Things that fill us with craving, despite the self-destructive pull. Things that make you have no idea who you are anymore. When you can't believe this is now your life, that you must be dreaming -- but it is, and you aren't.
You need space to be able to sit with what feels too hard. You need to know that you won't walk down the street and find out that your story has become everyone else's to own.
In psychotherapy, the sanctity of space is part of what we commonly refer to as a frame, a concept popularized most by . A frame describes the parameters of how psychotherapy will happen, rather than what is talked about. On a certain level, you can think of a frame as logistics: how often the meetings will occur, or whether it is in person or on Zoom. One of the core pieces of the frame is confidentiality, the sine qua non of therapy.
But the meaning of the frame goes deeper than that. Having a frame means having a space that's just for you. Having a frame is the same thing as having a right to the privacy of your body. If we keep the door open all the time (or, in Kate's case, the door is constantly being flung open), we are vulnerable to the distortions and projections and gaslighting and ulterior motives that come rushing in. You realize that some people want your door opened for reasons that have nothing to do with you. You lose the ability to understand your own narrative -- much less to shape it.
True well-being, including good mental health and physical healing, starts with having a closed space that's just for you. Especially in a world that claims to have ownership of a piece, or all, of you. You still get to own that closed door. You get to own the frame. You get to know where you begin and where you end. You start to remember who you are, by defining who you aren't. If I were to wish for anything for Kate as she traverses this new world, it's that she has the sanctity of a space that she, alone, owns.
*Details of this case have been changed to protect patient confidentiality.
Lucy Hutner, MD, is a board-certified psychiatrist specializing in women's mental health and adult psychopharmacology and psychotherapy.