‘One day a week I’d sit in a café and write – it was a total pleasure’

How did your childhood make you who you are?
I feel really lucky to have felt very cared for in my childhood. Working with young people who have had a really difficult time has often made me realise how grateful I am for this. Growing up in the hippy town of Totnes in Devon was quite a creative place to be as well, and I think that helped me to be interested in both arts and sciences, and both mind and body. I went on to study psychology, philosophy and physiology at Oxford University, which was all about thinking about both mental and physical perspectives.

I was an only child, which I think made friendships very important to me too. Again, I feel lucky to have a fantastic family of friends and colleagues past and present, as well as my actual family. Although the book is all about how our childhoods make us who we are, I don’t think this is set in stone, and I think that the relationships we have throughout our lives continue to shape who we are.

Tell me about how you ended up working with young people and caregivers.
I didn’t always think I’d be a clinical psychologist. In fact I really didn’t know what I wanted to do at the end of my undergraduate degree. I moved to Paris in France for a year with a good friend and we had an amazing year of not knowing. We drank a lot of cheap rosé wine in the bar beneath our flat and I basically learnt French there. I was working teaching English to business people and small children (not at the same time) and that was the first time I’d worked with children. I really liked it, although I was terrible at getting them to behave).

When I came back to the UK I studied neuroscience for a year at the Institute of Psychiatry, and then I got a job as a research assistant. I still didn’t have a grand plan, but everything I ended up enjoying tended to be about people. When I was studying for my MSc I also had two part-time jobs with young people to help fund the course, one as an Explainer in the Science Museum children’s galleries and one as a tutor for teenagers struggling with A-level Psychology. I liked the way children and teenagers tend to just tell it as it is. They don’t sugar-coat things. If you’re boring them, they’ll yawn and wander off, so at least you know if you’re explaining things well or not.

I also had some work experience at the BBC at this point, working on Child of Our Time, the documentary series that’s all about child development, which again I loved.

And after that?
I got onto clinical training, and one of the great things about it is that you get six different placements in quite different services. My child and adolescent placements were where I felt the best fit, and my placement in an adolescent mental health ward really hooked me in, so when I qualified I got a post at one of the adolescent units in South London and Maudsley Foundation Trust, and worked in different adolescent inpatient settings for most of the next 10 years, with a brief break of a couple of years to work in an NHS expert witness team, again with children and families.

I still really like working with and thinking about children and young people, although I’ve expanded a bit now I’m not working in inpatient settings, and I also work with university students, foster carers and social workers.

So you still practise, and you’re increasingly combining that with writing?
Yes, I’m in a patchwork of different roles at the moment. I work for Action for Children with foster carers and social workers, I do a small amount of private practice with young adults, and I work for the British Association of Behavioural and Cognitive Psychotherapies as their senior clinical adviser which is a mix of strategy, policy, public engagement and communications. I try hard to guard time to write as well as I really enjoy it.

This is your first book. Have you found the writing process easy/enjoyable?
I absolutely loved it. I was working on an adolescent ward four days a week for most of the time I was writing it, and then one day a week I’d sit in a café and write – it was a total pleasure.

Who’s the book pitched at? What particular challenges did that bring?
The book is for a general lay audience. It’s not a parenting guide or an academic text, it’s a popular psychology book on the experiments I think are really juicy and that everyone could get something from. Everyone’s been a child, and there’s lots in child psychology that can help us understand ourselves as grown-ups, yet most people aren’t taught about the classic psychology experiments, unlike the way we are taught about classic physics studies like Newton’s apple or Archimedes’ bathtub. I wanted to explain child development and psychology in clearly accessible language for anyone interested in how they’ve become who they are, and also reassure people that although our childhoods are important, not everything is set in stone. That brings with it the challenge of trying to simplify jargon without being patronising or over-simplifying ideas, but I quite like to try and write in that way anyway. It’s felt challenging to market it in some ways because the potential audience is quite broad.

Why do you think it is that the ‘classic’ studies that cross into the mainstream don’t tend to be the ones on how we learn, how we grow close to those around us, how we become who we are?
It’s a really good question. I’m not sure, but maybe something about nuance. Often psychology studies like this tend to be less clear-cut than ‘x leads to y and we are certain about that’. In my mind that makes the subject all the more interesting, but it also makes it harder to explain and remember.

What was your favourite chapter to write and why?
I really enjoyed writing the chapter on identity, thinking about how we become who we are [you can find this on The Psychologist website]. I also enjoyed writing the chapter on attachment, and explaining how although today it seems really obvious that how we are cared for is crucial, not that long ago people saw love and affection as more the cherry on the cake and food and shelter as more crucial needs. I also enjoyed chapters which debunked myths to some degree, like the gender chapter and the one on siblings.

Did you learn much about development through the writing, or was it a case of marshalling all those years of study and experience and getting them on the page in the best way?
I had been teaching on and convening a module on child development for five years at the Anna Freud Centre, so I’d done a lot of the research that made the backbone of the book, but I still learnt loads as I interviewed experts and revisited the literature. Each time I teach or write about a topic I usually learn something new. Also things change as research gets renewed, for example the marshmallow test experiment, which I briefly mention in the book, has recently been revisited and reinterpreted.

I increasingly think that the best writing about psychology is actually about psychologists. Would you agree?
Hmm… I think I have a slightly different view. I do agree that the interface between the personal and professional is really interesting. Whatever job we do, we all bring our personal selves to it, and our professional roles also affect who we are personally, and that personal/professional boundary is really interesting to me.

But in terms of the best writing about psychology, I also really love reading about elegant experiments and clear theories. I think sometimes it’s tempting to believe in a theory because it has a charismatic person telling you about it, but really we need to clear that stuff out of the way and have a good look at the theory and the research behind it – really hold it up to the light and examine it for holes.

It’s interesting how, at the end of the book, you bring a theoretical understanding of development back to what therapies are on offer. Does your own approach as a clinical psychologist draw heavily on the influence of those early years?
I think a good assessment and formulation of difficulties needs to include some curiosity about early experiences, even if the treatment target isn’t necessarily on talking about that loads. Sometimes it is helpful to understand where things have come from, and that difficulties might be a result of a previously helpful reaction to a difficult experience or environment that isn’t now helpful. Sometimes understanding this can cause a shift in itself. Having said that, it depends what the problem is, what the model is you are using, and what clients want to work on as to how much that would be in the foreground of the therapy.

What next for you?
I feel like I should be able to say something really shiny here, like I’m about to finish another book and change career to be a tap dancer… but actually just more of the same really. I’m continually trying to have a good balance of clinical work, more academic-type work and more creative communication and engagement in what I do, so I’ll be carrying on with that juggling act, including more writing. I hope I’ll write another book at some point but at the moment there’s no firm plan. I’ll be sure to let The Psychologist know though!

- Dr Lucy Maddox is a consultant clinical psychologist, lecturer and writer.  

Who am I?

An exclusive chapter from Blueprint: How Our Childhood Makes Us Who We Are, by Lucy Maddox, published by Little Brown. 

The beginnings of identity

Draw a satisfyingly shiny blob of bright red lipstick on the nose of a child younger than eighteen months, and show them their reflection in a mirror, and they tend to reach out to touch the reflected red dot. Some of them even try to go behind the mirror, if it’s free-standing, to search for the other child with the silly red nose.

Beyond about eighteen months, children behave differently. They reach to touch their own nose instead. They understand that the image in the mirror shows a reflection, and that they must be the little clown.

How do we go from reaching for the stranger in the mirror to understanding that it’s us? And how do we go from there to being able to think about who we are and what we want to be? Identity is a slippery concept, and a very human thing to worry about. Who am I? What am I doing? What is the point of it all? These are excellent questions for rumination in a panic at 3 a.m., and they’ve also provided much material for philosophers, cognitive neuroscientists and psychologists, prompting a range of theories and experiments related to who we are and how we are able to think about this.

The ‘rouge-on-the-nose test’, with the lipstick-nosed babies, was first tried in 1972 by Beulah Amsterdam, who was copying similar experiments done in 1970 by Gordon Gallup with chimpanzees. Gallup anaesthetised chimpanzees and drew on their faces while they were asleep, an experiment that drunken students have been unwittingly emulating for decades. Researchers all over the world have used this test as an indicator of the first signs of a developing sense of identity, and it’s an easy one to try at home if you happen to have some lipstick and a roving toddler.

Babies all develop at slightly different speeds, but in general the youngest that babies start to point towards their own nose when confronted with the rouge test is about fifteen months. By eighteen to twenty-four months most eighteen-to-twenty-month-old children start to use their own name, and the children who point towards their own nose also tend to use more personal pronouns, referring to themselves as ‘I’. It seems that the rouge-on-the-nose test might be tapping into more than just an awareness of how a mirror works: rather a growing awareness of ourselves, a self-consciousness in the very basic sense of the word.

What is identity?

The idea of identity is massive, and often nebulous: ‘who one is, what one values, and one’s future life course’, is how James Marcia, a renowned identity theorist, once described it. Not much, then. Some components of our identity are there from birth, though not necessarily unchangeable: our biological sex, our eye colour . . . Other aspects we decide later: our political preferences and favourite foods. Identity is multi-faceted, involving internal and external characteristics. We need to recognise that we are separate from other people, and be conscious that we can act in the world and influence it, which in turn affects how others might describe us. But identity also involves being able to think about our internal world, to have a sense of what we desire, prefer, believe and value.

Why is it important?

Identity is rich fodder for all the psychotherapies in their different ways, and for good reason. Thinking about who we are might feel like navel-gazing, but not knowing who we are can be profoundly destabilising. We all have times when we might feel less clear about what it is we are doing in our life, but this can also be a major side-effect of mental-health problems.

Consider Mark, a teenage boy who loves to play basketball, who plays in a band with his friends, who dreams of being famous. He also hears voices. They started a year or so ago and have got steadily worse, getting in the way of his concentration at school, making him feel irritated and on edge, saying things that make him feel sad. He had to defer his first GCSE exams, and he’s not sure if he’ll be able to take the rest. His sense of who he is has been blown apart by his diagnosis of psychosis. He doesn’t want to think about it like that; it makes him feel worse. It makes him feel like one of those people they write about in the papers: someone dangerous. He doesn’t feel dangerous: he feels really scared.

For Mark, he hasn’t yet had enough experiences of success to feel he has a reliable narrative of who he is. While experiencing mental-health problems at any point is potentially destabilising and distressing, for younger people it has even more potential to knock their sense of who they are. If Mark had started hearing voices ten years later, after having already passed all his exams and obtained a record deal, he would have a different sense of self to fall back on, and with which to make sense of his experiences.

While even when we are adults our lives can always travel forward in many different ways, if we have fewer personal successes and experiences we can remind ourselves of, then anything which shakes our sense of who we are can potentially have a bigger impact. As a child and teenager we have certainly had less chance to explore the possibilities of who we are. Big life events, in particular physical or mental illness, can have a big effect on how we see ourselves, especially when we are too young to have an established personal story.

Developing identity

How do we get to this sense of who we are? How do we go from being babies – bundles of desires and frustrations – to grown-ups with at least some sense that we can choose, change, direct where we are going?

Developmental psychologists have tended to cluster aspects of identity into self as subject, and self as object. Self as subject means understanding ourselves as someone who can know things and act in the world: the main character of our own plot. It involves having a sense of personal agency or capability, a sense of distinctness from others, a sense of continuity of self, and a sense of self-awareness.

Self as object is how someone else might describe us, if they were watching our story unfolding. This includes a sense of how we would describe our own attributes and roles, a sense of who we are in terms of physical and psychological characteristics. How would your best friend describe you, if they were sitting here now?

Our knowledge of who we are as subject or actor develops before our ability to describe ourselves as an object, or as seen by someone else. Before we can know what we are like or how someone else might see us, we first have to know that we exist at all. As young infants, we develop our sensory capabilities, our motor skills and our ability to influence the world around us, including other people. If we think about the development of what we can see and hear, and what we can do with our bodies, we can imagine how developing an ability to grab things that we want, or observe the world more clearly, might impact on how we understand who we are. A sense of ourselves as a separate person able to act in and on the world develops first, followed by a growing understanding of what we are like and what we are good at.

If you had to describe yourself in five words which words would you pick? Take a moment to think about it. Chances are your responses will be pretty sophisticated. It’s likely you will have thought about something to do with your character or personality. When children are asked this question their response tends to vary predictably, depending on what age they are. Pre-school children tend to talk about characteristics you can see. They might mention hair colour, pets, or behaviours they have learned to do, like counting. Their tendency is to talk about concrete physical things or clear behaviours, not psychological tendencies: ‘I have a cat’, for example, or, ‘I have green eyes’, or, ‘I can say my alphabet.’

This isn’t to say that pre-school children can’t reflect to some degree on what they are like psychologically. Many experiments with children yield richer results when an effort is made to make the verbal load in the experiment smaller – that is, to say things more simply, and give clearer options. Given some help to understand and think about it, pre-school children are capable of stating preferences which reflect their personalities – but it’s not what they naturally go for when asked about themselves. R. A. Eder and colleagues gave children a forced-choice task, asking them to choose between statements like ‘It’s more fun to do things with other people than by myself ’ and ‘It’s more fun to do things by myself than with other people.’ Pre-school children gave consistent responses to repeated questions like this, suggesting they weren’t just picking options at random.

In middle childhood we start to get a bit more naturally reflective. We tend to use more trait-based words like ‘helpful’ or ‘naughty’. At this age we tend to relate our character to other people as well, either by describing how well liked we are – ‘I have lots of friends’ – or by comparing ourselves to other people in our family or in our class: ‘I’m more hard-working than Tom’, and ‘I’m louder than Jay.’

As teenagers we get even more sophisticated. Values, political and religious views, abstract ideas about what we believe in: these things start to be part of the discussion. As adolescents we are able to think about how we might be different in different social contexts as well: ‘I’m loud when I’m with my family, but when I’m with my friends I’m one of the shyer ones.’ This sort of difference in who we are and how we behave can be really confusing, especially for young adolescents.

Adolescence has long been labelled as a period of identity development. Erik Erikson, an identity theorist and developmental psychologist with a psychoanalytic background and a name like a Swedish pop star, came up with an overarching theory of how we all develop throughout our lives. His model suggests that we move through a series of life stages, each one involving a crisis between two states of being that needs to be resolved before we can move on to the next. Erikson was the first person to use the term ‘identity crisis’, a term we now all use fairly flippantly. Erikson was referring to the crisis between identity and identity confusion that he thought occurred for all adolescents. According to Erikson, as adolescents we are supposed to be figuring out what is unique about ourselves in order to be able to choose our roles in life.

Identity in relationships

‘Success’ in working out who we are is also supposed to be associated with intimate romantic relationships later on. Not having a clear idea of who we are is thought to make it harder to sustain a close relationship with someone else. In a line reminiscent of a Spice Girls lyric, Erikson wrote that ‘the condition of twoness is that one must first become oneself’.

Is this true? Do we need a strong sense of who we are in order to be able to have an intimate relationship? Wim Beyers and Inge Seiffge-Krenke from Germany carried out a study looking at this in 2010. They followed nearly a hundred adolescents, fifty-two girls and forty-one boys, over ten years, giving them questionnaires and interviewing them to measure their sense of self and their attitudes to intimate relationships. They started at age fifteen and followed up at age twenty-five.

The questionnaire which measured sense of self in the fifteen-year-olds was the Washington University Sentence Completion Test, which has a series of sentence beginnings which participants complete: for example, ‘When I am criticised . . .’ and, ‘My mother . . .’ These get coded according to how much they relate to a very self-oriented attitude, or whether they begin to take into account other people’s viewpoints more, which the authors think suggests a stronger sense of self. The Network Relationship Inventory, the questionnaire that measured attitudes towards intimacy at fifteen, asked questions such as how much secrets were shared with a trusted other. Ten years later, the participants were interviewed and rated on how coherent a sense of identity they had, and how much they were able to be intimate with, committed to, but also respectful of their partner’s autonomy.

The researchers found that scores on sense of self at age fifteen strongly predicted intimacy in relationships ten years later. Individuals with weaker scores on sense of self either didn’t have enduring romantic relationships, had more superficial romantic relationships which didn’t involve much emotional intimacy, or were in what the authors referred to as ‘merged’ relationships, where they compensated for anxiety about the relationship by being overly close but couldn’t really say what they felt.

This is only one study, but it echoes other findings, and it uses a nice follow-up design. It makes sense that the stronger our sense of self, the more able we might be to have a truly intimate relationship, where we are able to say what we really mean, and also tolerate hearing what the other person has to say without our sense of who we are crumbling around us. It seems to support Erikson’s idea that developing a sense of identity lets us get closer to other people.

Identity or intimacy: which comes first?

To play devil’s advocate, does identity really come first? It’s likely to be much easier to develop a sense of who we are if we have first experienced a good enough intimate relationship with our initial caregivers. Everything suggests that we are set up to develop a more reflective, coherent sense of who we are when we have had early caregiving that is stable, reliable and emotionally responsive. In order to develop a sense of self we are helped by having a more secure early experience of being held in mind. Intimacy and identity might help each other to develop.

Is identity that stable?

Erikson’s big theory of a series of crises does have a reassuring air of living a life like a level-based computer game – levelling up after each crisis is resolved, even if a series of inevitable crises sounds a bit stressful. But it definitely has its flaws, too, and Erikson himself acknowledged and re-worked it towards the end of his career. A major problem is whether the development of a sense of our identity really is this simple. Do we all end up with a coherent sense of self that we develop as a teenager and that then remains constant? If my identity had been formed by the time I was seventeen then I would still be a vegetarian, I would be both less careful and less confident, and I would be more open to wearing black lipstick.

James Marcia built on Erikson’s theory of identity development, but questioned the idea of a stable identity. He thought our sense of identity continually changes through our whole life, or gets ‘re-formulated’. Although it might be important to have a clear idea of who we are as we transition to adulthood, this is still subject to getting knocked about a bit, and it can change, sometimes radically.

Marcia’s way of explaining identity development uses two dimensions: exploration and commitment. He thought that our identity status fell somewhere along each of these dimensions: the extent to which we have explored, questioned, thought about who we are and what we stand for, and the extent to which we have committed to one particular version of ourselves.

He uses four categories: identity diffusion, moratorium, identity foreclosure and identity achievement. Obviously one of these options sounds much better than the others, and I think it’s fair to say Marcia felt that identity achievement was where we wanted to end up. He had a more flexible view of how we get there than Erikson’s original ideas, though, and he allowed for us to cycle in and out of our ‘achieved’ identity.

The four different categories fall at different points along the two dimensions. Identity diffusion refers to low exploration and low commitment –a person, for example, who has not explored very many possibilities related to who they might be, but who has also not really committed strongly to any sense of what their values are. For instance, they might be non-committal about what their views are on politics, but from a standpoint of not really bothering to read the papers or talk to their friends about it at all.

Moratorium represents a large amount of exploration and low commitment: a period in our lives where we might be trying a lot of things out but not feeling fixed on any of them. Trying out lots of different types of music, or lots of different sorts of fashions, might be a good example of this: one weekend a goth, the next into hip hop.

Identity foreclosure is having a high level of commitment to a certain sense of identity, but without having explored many other options – maybe just going along with our family’s view of who we should be. Being totally sure of a political standpoint, for example, without having found anything out about other perspectives; or having a strong narrative of there being a certain way to do things as a family, without ever having tried anything different: ‘We don’t like to travel too far afield on holiday – that’s just how we like it.’

Finally, identity achievement is coming from a position where several options have been explored, but there is also a strong sense that certain values and beliefs have been stuck to. ‘I tried working privately, but it just didn’t suit me: I like working in teams more, and I really believe in public healthcare, even if it’s more stressful and worse paid.’

Questions that researchers used from the earlier studies on identity achievement tended to cover occupation, religion and political beliefs, for example:

How willing do you think you’d be to give up your job/religion/political ideology if something better came along?

Example classifications of the answers were:

Identity diffusion: Oh, sure. If something better came along, I’d change just like that.

Moratorium: I guess if I knew for sure I could answer that better. It would have to be something in the general area.

Identity foreclosure: Not very willing. It’s what I’ve always wanted to do. The folks are happy with it, and so am I.

Identity achievement: Well, I might, but I doubt it. I can’t see what ‘something better’ would be.

Later writings, by Jane Kroger in 2007, described identity achievement as ‘elusive’, with only half of adolescents in most samples reaching what Marcia would classify as ‘identity achievement’. Whether or not we agree that we reach a sense of identity in our teens, Marcia thinks this sense is still elusive in adult life. Marcia thought that as adults we flip between moratorium and achievement, with major life events tipping us off-balance, but then a sense of identity being reconstructed. He thinks many different events have the potential to tip us off-centre, even if we have a strong sense of who we are.

Can happy events knock our sense of self?

According to Marcia, the events that make us question who we are don’t have to be crises like a mental-health difficulty or a major loss. He thought ‘disequilibrating events’ were anything unsettling, and that any of these can knock our sense of equilibrium about who we are. These events can be positive things, too, like falling in love or changing career path: things that might make us happy, but can also unsettle our sense of who we are.

Falling in love is a really interesting one. Have you ever had that sensation of feeling out of touch with yourself when you start to find yourself very attracted to someone else? Schools of thought on falling in love cluster into those who think it is so destabilising that it’s more like having an addiction, and those who think it’s a valuable experience that helps us to develop a richer sense of ourselves. In reality it’s probably both, and Marcia’s theory allows for this. A happy event, but one that promotes change, so it’s both disturbing and fulfilling.

Much of this literature assumes that having a relatively stable identity and a long-term relationship are the optimum ways to live a life. Of course, there are lots of people who don’t want to have just one intimate relationship, and who want to experiment more with who they are in life. Does this mean they don’t achieve identity development? Again, Marcia leaves room for this, and his idea of cycling between moratorium and achievement (or MAMA as he calls it) is a more fluid way of thinking about who we are. It’s a bit more hopeful when things go wrong as well. For Mark, a teenager with psychosis, perhaps his psychosis is a period of crisis which prompts moratorium, but this doesn’t prevent him reaching a sense of identity achievement.

Identity and brain

Identity is such a complex concept you’d think it would be hard to find a clear brain area that relates to its development.

This hasn’t stopped scientists from trying, and finding some promising leads. The main brain structures implicated in the development of our sense of self are called the cortical midline structures. These are in the middle of the brain, clustered around the corpus callosum, the inverted-banana-shaped structure that runs from front to back between the two hemispheres of our brain.

The most common way of looking for the brain regions involved has been functional magnetic resonance imaging (fMRI), a brain-scanning technique which can measure brain activity with relatively good spatial and temporal resolution while we are lying in a brain scanner doing tasks.

Lisette Van der Meer and colleagues reviewed the adult imaging studies done up to 2010 and analysed them together. They compared the brain scans of people who were lying in the scanner thinking about something related to themselves, with baseline scans of people not thinking about anything in particular. Then they compared brain scans of adults who were asked to think about characteristics of themselves (self-reflection), with brain scans of people thinking about characteristics of other people (other reflection). They pinpointed one main brain area that differed when we think about ourselves instead of someone else. This was the ventral medial prefrontal cortex, part of those cortical midline structures. They concluded that it is this bit of the brain that is involved in reflecting on ourselves.

But when children and teenagers are put in the brain scanner and compared on similar tasks, the results are slightly different from the adult findings. For example, when nine-to-eleven-year-olds are asked to rate themselves on how good they are with friends and at school, and then asked to rate Harry Potter on the same things, several parts of the brain are more active during the self-reflection task, and they aren’t the same region as in the adult brains above. By contrast, adults asked to do the Harry Potter experiment did show more activation in the ventral medial prefrontal cortex in relation to thinking about themselves, just like the adults in the studies reviewed by Van der Meer.

This suggests that children and teenagers might be thinking about themselves in a different way to adults, literally using a different area of their brain. One thing the authors of the Harry Potter experiment suggest is that children and teenagers might have more of a social idea of their identity, so thinking about things to do with their own skills might require the brain areas involved in processing information to do with other people. Maybe as teenagers what we think of who we are is more intertwined with how we think other people see us. This would fit with the idea of a developing self-identity that is more socially malleable when we are teenagers. One of the nice things about getting older is that feeling of, ‘Well, this is who I am: take it or leave it.’ Perhaps the different brain-scan patterns show us this in action.

Ultimately this is still at the stage of conjecture, though, and we still know very little about how the landscape of the brain promotes our understanding of who we are. It’s unlikely we are going to find one part of our brain which is responsible for our sense of self: it’s much more likely to be a network of areas which is involved, including those in the adult and child brain scans described above, but probably also some others too, not only within the cortical midline structures.

Who is that in the mirror?

Next time you look in the mirror or catch a glimpse of your reflection on the Tube, give a moment’s pause to consider how sophisticated this moment of cognition is. You know the reflection is you, you probably have some value judgements about how you look related to how you want to present yourself to others, you have some idea of how you look now in relation to how you used to look when you were younger.

And you have a sense of being able to act in the world to change how you look, what you do, even to some extent who you are. To some degree we are all constantly developing our own identity through what we choose to focus on thinking about, what we choose to do, and how we choose to look. That we can think about all this gives us a uniquely human perspective, which sometimes leads to painful dilemmas and those middle-of-the-night crises, but also gives us the chance to really choose whatever for us is ‘a life well lived’.