Holding What We Fear

Matthew Maxwell’s How to Hold a Cockroach: A Book for Those who are Free and Don’t Know It begins with a deceptively small problem. A cockroach. Unpleasant. Startling. An insect, easily dismissed as trivial, becomes the object through which the narrator begins to examine something much larger: the mental scripts that shape how we move through the world. The book is about the stories we tell ourselves and the ways those stories can both protect us and cause us suffering.

After an encounter with a cockroach, the man investigates his assumptions about the creature. Rather than trying to eliminate fear, aversion, or pain, he turns toward them. He then begins to investigate the assumptions he has carried for much of his life about himself, about other people, about love, about his own thoughts and notices how often these interpretations have gone unquestioned. Many of them formed for understandable reasons. But over time, they also narrowed his emotional range and limited his capacity to be present with his own experience.

The cockroach becomes a stand-in for anything small yet intolerable, anything that triggers immediate avoidance. What the book makes clear is that the problem is not the discomfort itself, but the meaning layered onto it. The sensation and the story are not the same thing, even though they often arrive fused together. When that fusion goes unnoticed, suffering tends to expand.

This framework has particular resonance in the context of medical stress and trauma, where meaning-making is often an immediate necessity. Illness forces interpretation. A diagnosis, a symptom flare, a surgical complication, each invites questions that demand answers, even when none are available. Why did this happen? What does it mean about my body, my future, my worth? How should I live now?

For many patients, the experience of being in a body that requires constant attention introduces a steady stream of new “cockroaches.” Physical sensations that cannot be ignored. Uncertainty that resists resolution. A loss of control that no amount of vigilance can fully correct. Alongside the practical disruptions of illness comes an existential reckoning: goals are reevaluated, identities shift, and values are renegotiated, sometimes voluntarily, often not.

Maxwell’s book does not minimize this confrontation. In fact, it moves directly toward it. As the narrative progresses, the lens widens from everyday discomforts to the one experience that underlies them all: mortality. The presence of a medical stressor brings death out of abstraction and into the foreground. The illusion that suffering can be permanently outpaced by effort or optimization begins to falter.

What How to Hold a Cockroach offers that pain is real and unavoidable. Suffering, however, is not inevitable. This distinction is delicate and easily misunderstood. It is not a claim that distress reflects personal failure, nor that patients are responsible for their pain. Rather, it is an invitation to notice how tightly one is holding the interpretations that accompany experience.

The choice Maxwell describes is not whether pain exists, but how it is held. Whether sensations are allowed to be sensations, emotions allowed to be emotions, or whether they are immediately absorbed into a story about danger, defectiveness, or loss. When fear, grief, anger, and bodily sensation are seen clearly as facets of a larger whole, something shifts. The experience does not disappear, but it becomes more spacious.

This process is about integration. The book repeatedly returns to the idea that freedom comes not from rejecting parts of experience, but from breaking them down, examining them honestly, and then reintegrating them without allowing any single narrative to dominate. Compassion, in this framing, is not an affective state so much as a way of relating to what arises.

Although the book centers on personal inquiry, its implications extend beyond the individual. Patients are not the only ones carrying scripts into medical encounters. Health care professionals bring their own small, often unexamined assumptions about uncertainty, suffering, emotional expression, and what it means to help. These scripts tend to surface in the impulse to fix rather than sit with distress, to reassure before understanding, to steer conversations away from emotions that do not resolve. Like the cockroach, these reactions are easy to dismiss as insignificant, yet they shape what becomes possible in the room. When they go unnoticed, they can foreclose patients’ opportunities to process their experience. When they are recognized and held differently, they can create space for it.

In its final movement, How to Hold a Cockroach returns to mortality. Acknowledging death does not diminish life; it clarifies it. For patients living with illness, this perspective can feel both destabilizing and grounding. Death is coming, but not necessarily today. Life is constrained, but not gone. The question becomes how to live alongside discomfort without allowing it to dictate every choice.

The act of holding, as Maxwell describes it, is a form of engagement. We get to choose to stay present with what is uncomfortable rather than turning away or being overtaken by it. For those navigating illness, and for those who care for them, this stance offers a different kind of hope. Not the promise that suffering can be avoided, but the possibility that it can be carried with more freedom, more compassion, and more grace.

In the end, the cockroach is still there. So is the body. So is uncertainty. What changes is the relationship to them. In that shift, something vital opens up: the ability to live more fully in the life that remains, even in the presence of what we fear.