David Roth review of Judith Hoare, The Woman Who Cracked the Anxiety Code: The Extraordinary Life of Dr Claire Weekes

(Brunswick, Vic.: Scribe Publications, 2019), 416 pp., PB $39.99, ISBN 9781925713381

From 1962, Dr Claire Weekes’s self-help publications and recordings helped hundreds of thousands of people suffering from anxiety disorders. For many years, her ability to reach out to lay people in readable non-technical terms initially met with dismissal by the psychiatric profession in Australia but found more recognition by professionals in Britain, the United States and Canada. Yet her approach to cognitive behavioural therapy has slowly, if perhaps grudgingly, become accepted here and internationally, and indeed incorporated into some bibliotherapy programs recommended by medical professionals. Judith Hoare’s biography has rescued Weekes from an undeserved near oblivion by reminding us of her achievements. Hoare, a former senior editor at the Australian Financial Review, found that Weekes’s advice gave her relief from her own anxiety in her early career. She has given us an insight into Weekes’s many achievements, not only in the field of self-help, but also in biological science and music, and as a physician, presenting a warts-and-all account of her often-troubled domestic life. But the loyalty of her family and friends supported Weekes in her extraordinary dedication to the welfare of her worldwide ‘patients’, continuing well into her 80s, through letters, meetings and telephone calls at any time of the day or night.

The book frames Weekes’s earlier history as a long preamble, with many twists and turnings, to the main purpose of her life, her psychiatric vocation, which did not begin until her late 50s. Weekes’s intellectual gifts were recognised from her childhood. At the young age of 25, Weekes became the first woman to receive a doctorate of science at the University of Sydney. It was awarded for her original work on lizards that give live birth, rather than laying eggs. In a 1935 paper for the proceedings of the Zoological Society of London, Weekes showed that this viviparity was associated with high altitudes and suggested that it was caused by ‘cold interfering with development of the eggs in the nest’.¹ This article demonstrated a clarity of style and reasoning that would later attract many readers. Weekes’s studies had been interrupted for a time by a wrongful diagnosis of tuberculosis. Confined to a sanatorium, she began to suffer distressing symptoms of rapid heartbeat (tachycardia) that she was much later to identify as a ‘permanent state’ of anxiety. Hoare identifies these misfortunes as the inspiration for Weekes’s late-in-life psychiatric work. Weekes recovered, returning to the university to submit her thesis, and won a scholarship for further research in zoology at the University College, London (UCL).

Arriving in Britain in 1929, Weekes soon experienced a relapse of her anxiety symptoms. Reaching out in great distress to a war-veteran friend at UCL, fellow Australian Marcel Aurousseau, to whom she later became engaged, Weekes experienced an epiphany when her friend explained that all soldiers had ‘nerves’ in the trenches. She realised that it was the mind’s fear of fear that fed a vicious and self-reinforcing cycle of anxiety. Her breakthrough was realising that the cycle could be broken by accepting and understanding the fear so as to ‘float’ past it. Weekes was soon able to manage her panic attacks and continue her studies. Switching after her first year to the study of neurology under an expert on shell shock, Grafton Elliot Smith, Weekes gained further insight into the neurological basis of the fight-or-flight syndrome. From Hoare’s account, it seems that Weekes had closely studied Elliot Smith and T. H. Pear’s 1917 publication Shell Shock and Its Lessons.

Breaking off her engagement to Aurousseau, Weekes returned to Sydney in 1931 and resumed her old research position at the university. By 1933 she began vocal training at the New South Wales Conservatorium of Music. Her accompanist was a teacher at the ‘Con’, Bessie Coleman, who would become her lifelong close friend and constant companion. Abandoning her academic work in 1936, Weekes along with Coleman sought a musical career in Europe, combined with music tourism. Weekes was a fine singer, but soon realised that her voice was not up to professional standard. It was Coleman who had some success accompanying the famous soprano Elisabeth Schumann at a London recording session.

Returning to Australia in early 1937, Weekes had yet another career change. Drawing on her extensive travel experience, she established a travel bureau, advertising her services in various newspapers and via a regular weekly column on destinations in the Sydney Sunday Sun and Guardian from January 1938 to August 1939. She pitched her services towards the budget traveller. Ignoring the Nazi takeover of Austria in 1938, Weekes’s last four articles recommended Vienna as a suitable destination for sightseeing. War in Europe put an end to her business. In 1941 she enrolled in medicine at the University of Sydney and graduated as a medical doctor four years later at the age of 42. She began work as an intern at the university’s teaching hospital. By the late 1940s, Weekes established her own general practice in the beach suburb of Bondi.

According to Hoare, Weekes was unusually empathetic among doctors of the period to complaints of ‘nerves’. She had a gift for communicating with anxious patients in non-technical language. She gave them time and attention well beyond the conventions of the period, even inviting them into her home to the consternation of her family. Her work did not enrich her financially, as she never charged more than her fixed consultation fee. In another change of direction, Weekes qualified as a physician in 1955 and took up rooms in Macquarie Street, then the centre for specialist treatment in Sydney. There she soon acquired a reputation among patients and fellow doctors as the ‘go to’ person for ‘nervous complaints’ and psychosomatic illnesses. Weekes also learned from her patients, understanding that repetition and reinforcement were effective tools in breaking a cycle of fear.

Apparently, the idea for a self-help book on ‘nerves’ came from a patient who suggested that it would save the effort of going over the same ground with each person. Based on Weekes’s 20 years of assistance to ‘anxiety’ patients, Self Help for Your Nerves, published in 1962, revealed her six-word remedy: Facing, Accepting, Floating, and Let Time Pass. ‘Floating’ would break the cycle of the body’s fight-or-flight response to fear. By not responding to the anxiety attack and not struggling against it, conscious reinforcement of the body’s automatic response to stress—rapid heartbeat and other painful sensations of fear—could be minimised or avoided and the cycle broken. The role of the nervous system was explained in clear and simple language. The reader was helped and not judged. There was a huge unmet demand for books of this kind. The book was a sales sensation in Australia and by 1964 there was a British edition.

But Weekes found few friends at first among psychiatrists or psychologists, who attacked her lack of professional qualifications in either field. She rejected Freudian psychoanalysis and resisted the medical profession’s enthusiastic embrace of psychoactive drugs and sedatives. Yet Weekes found supporters among the early adopters of what would later be called Cognitive Behavioural Therapy (CBT). Weekes went on to actively promote her book in Britain and the United States with television interviews and magazine articles. Her British publishers struggled to meet demand and by 1966 the US edition also attracted a huge readership. A further four self-help books followed.

But there were other reasons for the success of the books that Hoare could have mentioned. In an era well before patient communication was an integral part of medical training, doctors and psychiatrists were often judgemental and dismissive of patients with anxiety disorders. This attitude was perhaps exemplified by an event from Weekes’s student days when a doctor (her friend’s husband) refused to attend Weekes during an attack of panic-induced tachycardia. Before the establishment of universal health insurance, private medical or psychiatric help was well beyond the means of working-class people. State-run mental health clinics were often overloaded and were reluctant to treat patients who were not at risk to others or themselves. Another serious impediment to getting professional help was the social and economic stigma associated with mental disorders or ‘weakness’ of any kind. Weekes’s books (and later audio recordings) were a relatively cheap and private way for distressed people to get assistance. For those who had had unpleasant, confusing or judgemental experiences with medical professionals, the friendly and accessible style displayed in her magazine advice columns and book promotions provided a welcome and encouraging contrast.

Despite the public acclaim, professional recognition was slow to come. Some psychiatrists and psychologists recognised the effectiveness of Weekes’s techniques in the early 1960s, or had used similar methods themselves, but her books, and her avoidance of technical language, often met with patronising disapproval. While Professor Nick Haslam’s 2019 review of Hoare’s biography for Inside Story is on the whole sympathetic, he canvasses these criticisms. One charge was that Weekes’s books were viewed as ‘illegitimate’ because of her lack of formal psychiatric qualifications and her populist style. Haslam also claims that she refused to engage with the profession via scientific or professional publications. Moreover, he argues that the evidence that Weekes presented for the effectiveness of her bibliotherapy was scientifically ‘worthless’ because the abundance of favourable testimony was entirely self-selected. Finally, and perhaps contemptuously, Haslam argues that Weekes’s nomination for a Nobel Prize had an element of ‘pathos’ because she had published no scientific work on her treatments.²

These charges are not entirely accurate or fair. As Hoare explains at length, Weekes did engage with psychiatric professionals in the US and Britain privately, in television talk shows and at conferences. Haslam implicitly holds Weekes to the ‘gold standard’ of a randomised controlled trial (RCT) to establish effectiveness, but it is difficult to imagine how a sole practitioner without research resources or university backing could have run such expensive and time-consuming trials. It is also difficult to see how Weekes could have found suitable control subjects or placebo manuals, since she regarded non-treatment as unethical. Following up people who had bought her books, but had not presented for evaluation, was also problematic. A 2000 survey of self-help books for panic disorder by Per Carlbring and his associates, which included an examination of Self Help for Your Nerves, found that very few such books had been tested in RCTs. Despite this lack of testing, there had been a significant increase in the use of these books by psychiatrists in CBT therapy, both self-directed and therapist-directed. Clearly these therapists did not regard the treatments as ‘worthless’. As for Weekes’s alleged lack of professional publications on panic disorders, I would point to her articles on her treatments for agoraphobia in the British Medical Journal (1973) and the American Journal of Psychotherapy (1978).³ Her work has also been discussed by other specialists in a number of scientific papers. While Weekes did not have an extensive academic oeuvre, Haslam’s claim that she had published no scientific work at all at the time of her Nobel nomination is not correct.

Hoare does not explain why Weekes has been largely forgotten since her death in 1990. Nevertheless, Weekes’s books are still in print, available in electronic form and are recommended by some anxiety support groups. According to Wikipedia, about half of customer reviews say that the books have ‘saved lives’.⁴ The explanation for Weekes fading from public memory is straightforward. When she broke new ground in 1962, there were very few other players in the field. The hugely popular advice columns of the time addressed problems of phobias and anxieties, but they did not specialise in them. The success of Weekes’s works attracted competition and many other self-help books, of varying quality, appeared on the market. The use of these books were often integrated into professional treatments. At the same time, financial constraints on seeking professional help were eased to some extent with the advent of universal medical insurance. The stigma of anxiety disorders was gradually reduced as their true extent became recognised. Increasingly, better patient communication has become an integral component of medical training. These social and economic changes mean that present-day sufferers from anxiety have a far greater range of options than was available in 1962, and increasingly so since Weekes’s last book, The Latest Help for Your Nerves (1989). Her style is now thought to be outdated and Weekes has become lost in the crowd.

Hoare’s well-written and engaging biography has deservedly attracted much interest in Australia and internationally, and has rescued Weekes from unmerited obscurity.