Not So Simple

It was a shock to the system, the day I started on a Psycho geriatric ward in the asylum I was to call home. I was nineteen, green as grass and shocked to see old, demented people left to scream and shit themselves.

In the midst of this horror, the regular staff could do no more than objectify these wretched beings as lunatics, doing otherwise would mean they drowned in the pool of human despair that they presided over.

So for the two months I was there, I got my head down and learned what I could of my trade, towed the line and pretended not to give a damn.

(I went back, ten years after the hospital closed and took this photo of the ward dormitory. You get the picture? More here.)

One ancient patient called Alice broke my heart. She had long white hair, a hook nose and skin so wizened it could have rustled like paper. She was a spot of a woman, perhaps four feet tall, but it was difficult to tell with any accuracy, as she spent her days bent over with her face no more than a foot from the floor.

She would shuffle from the moment she woke, mumbling and singing and examining the bottoms of doors with creaking arthritic fingers that shook with a tardive dyskinesic tremor caused by decades of sweet, cloying largactil.

You see, Alice had spent her entire adult life in the asylum. According to some of the older staff, Alice had been as mad as a fish.

One morning, as we were sat having a coffee break, Alice wandered up and came across my feet. She began to explore them with her trembling hands so I bent down to hold them and made eye contact with her. Given her posture, this was something she could rarely have experienced.

I don't remember saying anything to her, nor getting any response, but I'll never forget that she clambered up on to my lap, put her arms around my neck and nuzzled her face into my chest before falling asleep.

The sheer humanity of this gesture overwhelmed me. What responsibility had I for the childwoman in my arms? What responsibility had we - the givers and takers of humanity - to see that these people in our charge had needs other than physical? Yet to open ourselves up, face the brutal truth and to genuinely care could tear us to pieces.

Of course, like any good student, I retreated hastily to the office as soon as I could. What better way to make sense of Alice than four creaking volumes of manila psychiatric notes that went back to 1915?

I discovered that Alice had been given a myriad labels - Imbecile, Dementia Praecox, Mania to name but a few. Simple Schizophrenia had stuck with her since the 60's, until Alice was old enough for the Dementia label.

However, it was in the earliest volume that I discovered that Alice came to the asylum not because she was mad, but because she was "eccentric" and "rampantly promiscuous". From what I could garner, her parents despaired of their wayward daughter having fun with her new found womanhood and had her committed to the hospital.

So why, according to the old lags, had Alice had been so exquisitely insane? Perhaps going mad was the only sane response left to the young Alice, faced with the insane world that she found herself in.

My old demon

I've not been back to St Mary's hospital since the day it closed in 1994. I hate the place. Like any Victorian asylum its walls exude memories of abuse of the vulnerable. Spend long enough working in one of them and it'll get the better of you. Not places to hang around in.

Today I had some time to myself having dropped off the family at a kids party, so I decided to exorcise some old demons and revisit it. Of course I brought along my camera to record how the old asylum has gone to seed;


The back door to Ashley House, an Acute Admission ward and my first placement as an 18yr old student. I wrote about these experiences way back in March this year.


The Day Room in Ashley. I remember standing next to this very sink talking to Maureen (now deceased) who was suffering from tactile hallucinations of wires in her face. She seemed to be in a lot of pain as they held her mouth shut. Mind, I'll admit to being a little amused as she had to talk through tightly pursed lips. It made her look like a frog.


A spider's web across the window of Ashley House dining room.


Nature taking back what is rightfully hers.


Throughout the grounds of St Mary's you'll find these blue gazebos. They were the financial hubs of patients' lives. In the hospital real money was scarce and tobacco was the currency. I remember on at least three occasions catching female patients prostituting themselves in these huts for meagre payments of two or three fags. It was truly distressing to witness.

A rotting gazebo pillar.


The dormitory of ward two in the main hospital building. Notice the curtain runners delineating the bed spaces. This room slept thirty when I worked there. Before that, old staff told stories of putting patients to bed one at a time, then pushing their beds together so there was perhaps no more than three inches between them. That way each ward could sleep more than sixty patients. With three staff to care for them during the day. Ahh, the good old days eh?


The light dripping through Wd 2 day room windows. I wonder how many hours patients spent staring at these shadows.


Not a sign you'd see these days. Smoking was one of the few pleasures for staff as well as patients. Back when I smoked habitually I used them as a therapeutic tool. "Come on Dave, don't get angry, why don't we share a fag eh?". It frequently worked wonders.


The observation window of Wd 16 behind which staff would hide and peer at the mad people. Occasionally they would write something down to keep the management quiet.


A peer through a cracked door into a single 'bedroom'. Each ward had four or so of them. This is where patients were often 'constant obbed' if they were at risk or violent. So I use 'bedroom' in the loosest sense of the word. Perhaps a 'seclusion room' would be more fitting.

Never was I more demoralised when I was hauled into the manager's office one day for talking to a patient whilst constanting him.


It's kind of fitting really. The hospital was designed to keep people in. Now wood and nails are used to keep them out.


The cricket pavilion clock, now timeless without hands. During my years there I never saw this building, or its pitch used.


It's forever Christmas now on the roof of an old 'Back Ward'. A place where patients with no hope, or having become too ugly and demented, were secreted from the rest of the hospital populace, sometimes never to be seen again.


Room 1a in the School of Nursing where I did the best part of my training. I usually sat in the far right corner. Many a fertile mind was deadened in St Mary's so it's nice to see that the school is now verdant.


So to the chapel, the spiritual centre of the hospital. I've never been inside I'll admit, but I chuckled at the graffiti - "May the force be with you."


The door to the student accommodation. I've never been so depressed than when I lived there. In fact, I told you about it when writing my top ten tracks. Number six I remember.


Above the door to the digs.


The outward facing dormitory of Maple End - another Acute Admission ward where I did my final three month management placement. I remember this room well, in fact it features in my first ever short story which I posted back in may this year.


This photo chills me to the core. The ECT suite was the only place in St Mary's that smelt like a real hospital. It was cleansed each day and reeked of detergent. I remember its bright fluorescent lights and spotless floors. ECT was still in regular use even back then. Whilst muscle relaxants dulled the patients' fits it was still an inexact science. Or perhaps our anesthetist was just incompetent. Anyway, I was witness to some horrific fits. Now, I'm ambivalent about ECT as I've seen it work wonders on desperately depressed patients. However, it's a barbaric treatment and it efficacy is still not fully understood.

To add to my disturbance, this used to be the psycho-surgery department where countless people were lobotomised. It is truly a house of horrors.


An oddly beautiful coat hanger sculpture in Wear Villa's toilet. This was a 'Rehabilitation' ward where patients were taught how to take their tablets like good people and shop for pot noodles.


A power switch in the Estates Department. Not a place I often frequented, save to drop of a faulty radio or lamp.


So finally to the morgue where many had died long before they'd even got there. I remember clearly these scuffed crosses in the paint on the inside of the window panes. I always felt that they cheapened the lives of the patients; graffiti symbols, made carelessly, reflecting the worthlessness of the bodies that lay within it.
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So, I've done it and finally gone back. I doubt I'll return.

Descartes' Skin

Last night I had nightmares of bloated, spiked animals with long legs. They crept slowly around my bed. Rather than let me see them, they lurked at the edge of darkness. Yet somehow I knew they had marsupial like joints and long forelegs that jutted out beyond their abdomens. Not pretty, I can tell you.

Being awake at the time was a bit of a bugger too.

You see, once in a while, usually when I'm over tired, I experience Hypnagogia. Which according to wikipedia is "vivid dream-like auditory, visual, or tactile sensations, which are often accompanied by sleep paralysis and experienced when falling asleep or waking up."

I experience mine about an hour after dropping off, just as I'm getting into a deep sleep. I wake up suddenly in the midst of a dream which carries on regardless in the real world. Sometimes I see beautiful geometric light shows. Most times however, I wake in a panic because there are beasties in the room with me. Imagine Naked Lunch, the David Cronenburg film. This is about as close as you'll get to seeing my dream-wake madness.

If I slept alone this wouldn't be an issue as my hypnagogia lasts only a few seconds. I'd be left with a thumping heart, adrenalin and sweats to work off. Nothing more sinister than that.

The problem is, I often wake up in Indiana Jones mode as my first instinct is to protect Miche. She's usually fast asleep beside me. In the time its took to realise I'm dreaming, I've screamed "MICHE, GET OUT!" and lunged at the creature to try and throttle it before it gets to the family.

The first few times this happened Miche crapped herself. Who wouldn't? Besides, the sight of my bare arse flaying round the room after shadows isn't particularly reassuring at the best of times.

Thankfully it's a very rare occurrence these days. Perhaps once or twice a year I get them. Miche has learned how to help me come round more quickly, and is always calm and motherly to me. There's nothing better than a cuddle to calm the Indie down.

Now, I've researched this phenomenon quite a bit, as you could probably imagine. Thankfully I've found that it's not some kind of psychosis. Neither is it pathologically sinister. It's just one of those things and more common than you might imagine. Mind, I do get odd looks sometimes when I tell people about them. Which is why I don't often tell people about them.

For all I'd rather not have these night terrors, I do think they've helped me in my work. I use them as a basis for imagining what it must be like to live with hallucinations. And I can tell you this; I have the highest admiration for anybody who has a real 'psychosis' who actually gets out of bed in the morning and tries to live an ordinary life.

I hate ants

Psychoanalysis appeals to my artistic sensibilities. With its repressed sexuality and subconscious yearnings we can transform any ordinary life into high art. We can ponder on the metaphorical meaning of behaviour and invent neo-classical narratives to romanticise almost any screwed up, wretched existence. And if you think Freud was odd, then just imagine the fun you can have applying the colourful fruitbattery of Melanie Klein's Projective Identification.

It's a shame that its utter bolloxs. Mind, projective identification does explain the current Middle East policies of the US & UK. An insane theory for insane action I suppose.

Anyway, there's three reasons why Psychoanalytical therapy is often long term;

1) Profit. What better way of achieving consumer 'lock in', than convincing the client he'll need therapy for the rest of his life?

2) Ego. The therapist gets to show off, and the client gets to self-congratulate / flagellate / stimulate...

3) It doesn't work. The client has to keep coming back, as he rarely gets any better by engaging in it. The therapist tells him that this is quite normal, as Psychoanalysis is a long term therapy.

Now don't get me wrong. I firmly believe in the benefit of talking therapies. There's good evidence to show that Rogerian therapy (person centred counselling) and more specifically Cognitive Behavioural Therapy (CBT) can be of benefit to people in mental distress.

A brief course of CBT, coupled with some light physical exercise and Omega-3 fatty acids is as potent a treatment for mild to moderate depression as any anti-depressant pill. What I particularly like about CBT is how it can help teach Mindfulness. The same mindfulness incidentally, that Buddha discovered, long before Freud even noticed he fancied his mother.

CBT can help you to become aware of your own thoughts in real time - you become the observer. You can then monitor yourself for Automatic Negative Thoughts (ANTs) and then deal with them appropriately.

ANTs, like the little bastards in my front garden, get everywhere. I find them all the time in books, in friends, on the internet and in the mirror. This is what they look like;

Overgeneralisation: Coming to a general conclusion based on a single event or one piece of evidence. If something bad happens once, you expect it to happen again and again. Such thoughts often include the words “always” and “never”.

I forgot to finish that project on time. I never do things right.
He didn’t want to go out with me. I’ll always be lonely.

Filtering (Selective Abstraction): Concentrating on the negatives while ignoring the positives. Ignoring important information that contradicts your (negative) view of the situation.

I know he [my boss] said most of my submission was great but he also said there were a number of mistakes that had to be corrected…he must think I’m really hopeless.

All or Nothing Thinking (Dichotomous Reasoning): Thinking in black and white terms (e.g., things are right or wrong, good or bad). A tendency to view things at the extremes with no middle ground.

I made so many mistakes. If I can’t do it perfectly I might as well not bother. I won’t be able to get all of this done, so I may as well not start it.
This job is so bad…there’s nothing good about it at all.

Personalising: Taking responsibility for something that’s not your fault. Thinking that what people say or do is some kind of reaction to you, or is in some way related to you.

John’s in a terrible mood. It must have been something I did.
It’s obvious she doesn’t like me, otherwise she would’ve said hello.

Catastrophising: Overestimating the chances of disaster. Expecting something unbearable or intolerable to happen.

I’m going to make a fool of myself and people will laugh at me.
What if I haven’t turned the iron off and the house burns down.
If I don’t perform well, I’ll get the sack.

Emotional Reasoning: Mistaking feelings for facts. Negative things you feel about yourself are held to be true because they feel true.

I feel like a failure, therefore I am a failure.
I feel ugly, therefore I must be ugly.
I feel hopeless, therefore my situation must be hopeless.

Mind Reading: Making assumptions about other people’s thoughts, feelings and behaviours without checking the evidence.

John’s talking to Molly so he must like her more than me.
I could tell he thought I was stupid in the interview.

Fortune Telling Error: Anticipating an outcome and assuming your prediction is an established fact. These negative expectations can be self-fulfilling: predicting what we would do on the basis of past behaviour may prevent the possibility of change.

I’ve always been like this; I’ll never be able to change.
It’s not going to work out so there’s not much point even trying.
This relationship is sure to fail.

Should Statements: Using “should”, “ought”, or “must” statements can set up unrealistic expectations of yourself and others. It involves operating by rigid rules and not allowing for flexibility.

I shouldn't get angry.
People should be nice to me all the time.

Magnification/Minimisation: A tendency to exaggerate the importance of negative information or experiences, while trivialising or reducing the significance of positive ones.
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Watch out for the little buggers, they can really screw up your day.

Under Incubus

Number Six of my top ten, tells the story of my early experiences in Psychiatry. I will spill these beans, for what they're worth, another night.

Thinking about the post provoked a veritable brainstorm of memories and experiences. Amongst them was this. My first 'success story'. Now, I've dramatised it a good bit, and made myself quite the hero. You see the story, in my telling of it, becomes mine. So I shall do what I want with it, thank you very much.

That said, I hope that you like it. It's my longest blog post to date, so I hope it pleases you just enough to reach its conclusion.
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I know, half past one is too early to start drinking, but I’ve got nothing better to do these days. I’d polished the house into gleaming perfection before nine thirty this morning. What’s there left to do? Watch repeats of Emmerdale, or listen to the bleating smugness of Loose Women. Frankly I think I’ve done well waiting until now.

Anyway, on an afternoon like today it would be criminal not to enjoy a long drink or two in the garden. It’s looking wonderful. The sun plays in the foliage around our patio and a delicate breeze rustles the leaves of my favourite tree, Betula. I can’t hear the growl of the A1 either, which makes a change. The prevailing north wind normally tumbles the din and fumes right across the fields and over our garden wall.

Sitting down hasn’t come naturally to me. I’ve spent the best part of thirty years as a blur in the peripheral vision of my family. I would whisk up their detritus like a domesticated whirlwind, spinning off to deposit my spoils back into sock drawers and bookcases.

The gin helps though.

It didn’t really change when Thom, my eldest left for University. I still had enough to be doing with Lucy, who was in the midst of a belligerent adolescence.

Now the days just stumble past. I've still got my morning routine however, unchanged through the years. I’m up at seven, bringing tea (strong, no sugar, and a spit of milk) upstairs to leave on his bedside cabinet. I berate myself for leaving last nights dinner remains in piles on the kitchen top and get on with making order from the chaos my family are so expert at making. The problem is that I'm done by half past nine these days. There's just the two of us now, you see.

I knew that this empty nest was coming. My body warned me about it in its final throws of menopause. All it would let me think about for a while was babies. At night I'd dream of them floating and fluttering in me. During the day I could conjure up the milky wet odour of cradle cap on a whim. My stomach would wrench whenever I heard one cry on the TV.

I even asked David one night, without the slightest hint of irony, whether we should have another one. He let out one of his barking laughs, the kind that can silence a restaurant before realising I was serious.

“Dawn, come on sweetness.” He'd said leaning over to me. His face, now craggy still had that teak, solid kindness that I’d fallen in love with so long ago.

“We're in our fifties. Could you imagine what it'd be like having another Lucy when we're seventy?”


He had a point I suppose.

It didn't stop me spending the rest of the evening blubbing under Betula.

Have I already mentioned my tree? I still have the label from when she was a sapling fresh from the garden centre. Apparently the “Downy Birch is a fast growing small tree that prefers moist ground. It can grow up to five meters in seven years.” David bought me her in an effort to apologise.

That was twenty three years ago. The day I was committed;

Late in pregnancy with Thom I was supposed to be blooming; all glistening hair and good skin. My reality was quite different.

It had started innocuously, with a faint tingling of doubt in my chest. However, it became pervasive enough that I began to worry about everything. My abilities to be a mother, how I kept the house, if I could get to the shops and pretty much everything else.

I dismissed it as hormonal daftness at first. But the doubt grew and grew until it stopped everything. Rather than get to the butchers I'd not bother at all. It was too hard to make a meal for myself, so I would go without. Giving in to it spent less of the energy that I had precious little of.

It took me a while to grasp the root cause of it. When I did, it was like a bleak epiphany. I went crashing through my past like an elephant on a rampage. Battered and gouged I ended up slammed against the door behind which I'd locked my Secret for so long.

You see, being pregnant had awoken an old demon in me. It had festered quietly for years. Angered by being denied it lurked, clinging like a monkey onto my back. After I'd opened the door to the secret, it became so bloated that I could hardly move, save to breathe.

It was like each day its fingers gripped deeper and deeper into the skin of my back. I imagined its neck twisting around my shoulders, its fetid mouth suckling from my breast. Voraciously it would drink at my spirit.

David knew nothing of this demon and knew nothing of my Secret. All he saw was me curled up on the sofa. Each evening he would return from work and sit by me. I can remember him stroking my hair. He'd implore me to get up and eat something. For hours he would sit with his warm hands on my stretched stomach feeling his child move, frightened of the effect my sabbatical from sanity was having on his unborn son.

As the days went by his requests became more and more muffled, like he was talking through pillows. Until one day I stopped dead. This was the day that my demon had grown so large that it engulfed me in its belly folds. I hung there, foetus within foetus, stinking amongst its effluent, immobile.

David came home that silent night, to discover me on the hall floor. He had to force the front door open. I was a dead weight, crumpled behind it since he’d left for work in the morning.

I can remember being dragged into the lounge. I saw his face, usually kind and gentle, pulsing red with terrified rage. My thoughts moved so slowly, they like continents. His fury just blurred past me. I hardly noticed being slapped.

I watched the back of his shoes as he stormed from our house. He'd left mud on the carpet.

I don’t know long I lay there, head on the floor. But it was long enough for David to drive into town, request that a psychiatrist see me and bring me back Betula whom he’d bought to apologise, not for hitting me, but for having me committed to Grove End.

David and Dr Hines (as I would later come to know him) lifted me off the floor and into a chair. In front of me was my new tree, skinny like a gymnast in her brown plastic pot. There was something attractive about her. David knew I loved my garden, but there was something specific that drew me to her. Perhaps it was her asymmetry. She had two good branches that stood proud and a third, runt branch that poked stubbornly towards to floor.

David and the doctor were talking behind me.

“I’m concerned for your wife’s well being and that of your child.” Dr Hines told David. “However, I’m unable to treat her catatonia whilst she remains pregnant…”

And so it was that I found myself on Grove End. Acute psychiatric admission ward for the troubled. Having had Thom torn out of me the day before by a surgeon, I lay limp and inert.

After the Cesarean Thom had been placed gently on my chest by a midwife.

Stroking my hair she whispered quietly in my ear “You have a boy.”

I knew that he was on me. I should have been in the midst of a wonderful, spiritual moment. But my secret held me fast. I felt no joy, sadness or guilt. No glimmer of awakening or maternal stirring to drag me from my stupor. So Thom was taken away from me, the Stone Mother, to be nursed as an orphan until I recovered.

Perhaps in these more modern times David would have taken Thom home with him. But neither of us had any close family to help, so perhaps not.

I was detained at the pleasure of Dr Hines for some three months. During which time only one person other than David attempted to make any human contact with me. He was Daniel, the Student Nurse.

He was a slight boy, with long lank hair tied into a ponytail. There were still wisps of puberty about him but he possessed a stillness and an inner calm that was beyond his years. I found him soothing.

Each morning he would sit down next to me and take my hands in his. Sometimes he would talk quietly, and I would listen. He would bend low so our eyes met and he would tell me about the sky and how fast the clouds were blowing across it or the colour of the leaves as they blew from the trees. Other days we would just sit in silence, together.

I rarely thought about Thom.

Over time I found myself looking forward to Daniel’s visits, even though I was always mute and unresponsive when he came. He was solid and trustworthy like David, but yet delicate enough to hold my fragile world together long enough so that I might reach out of myself and make eye contact with him.

One day he didn’t arrive until late afternoon. I’d not long come round from Electro Convulsive Therapy and my head still ticked and buzzed. As usual for the hours following ECT I felt a bit brighter and was sitting up in my bed, sipping a cup of tea given to me by the silent Staff Nurse who stank of fags.

When I saw Daniel enter the dormitory a jolt of happiness and relief made me blurt out “Hello Daniel!”

He stopped dead in his tracks when he heard me, obviously taken aback. I smiled timidly at him. He regarded me for a moment, my first words hanging in the air between us before he smiled back.

“Hi Dawn, you’re looking well.” He commented as he sat down next to my bed.

And so we talked with each other for the first time. I was stiff and clumsy at first, unfamiliar with my voice but I quickly gathered pace. Daniel listened, calm and collected. With nods, frowns and smiles he teased out my story like it was spiders silk.

I told him of falling in love with David when I was sixteen. I told him how we gave in to each other on a ripe summer night in the fields behind my house. And I told him how I hid the sickness from my mother and him, and how I avoided both of them for weeks as my stomach stretched. I told him that David could never have known because he was still a child himself. I would have broken and lost him had he known.

I told him how I ran away to Edinburgh to give birth, alone and terrified in a damp bedsit and how I wept and wept at how beautiful she was, my little girl.

I told him how weak I was from the birth, and how we both starved and froze for two weeks whilst I struggled to decide what to do.

I told Daniel how I left her, my baby, on the steps of the Royal Hospital wrapped in my coat. And I told him how my spirit was torn and mangled as I ran away from her, choking on my bile.

In sharing this story I felt my beast wither and deflate a little, loosening its burden from my frame. I promised Daniel that I would tell David and Dr Hines. He felt that I needed to share and offload some more.

I chose instead, to live with the guilt of lying to him. This private confession had been enough to start my recovery. I had no urge to infect David with my guilt so that we might wallow together under its dead weight.

I’ve continued to carry it on my back, and will do so for the rest of my life, but from that day onwards I’ve been able to starve it of attention. In remembering Daniel, and how he helped me tell my story, the beast clings to my back, cowed and submissive.

Since then Betula, my tree has grown into a beautifully, verdant specimen. Even with her thickened and gnarled runt branch pointing down to the earth she is stunning. During the time she’s grown David and I have had our ups and downs, both ordinary and extraordinary. But we’ve nurtured our children to adulthood and saved enough to live a modestly comfortable retirement.

Now that Lucy’s left home however, I’ve had too much time for myself. Time enough to ruminate and allow the beast to be fed again. I’m not strong enough now to carry it, should it get any larger.

So it’s time to exorcise it and cut it from my back. Time now to do something before it suffocates me again. Perhaps I’m drunk, the bottle of gin looks considerably emptier than it did an hour ago. I don’t care though, something has to be done.

David’s tools are in the back of the garage. It smells damp and unfamiliar in here. I find the biggest saw he has hung up on the rack by the dusty window. I take it and stride out into the sun.

It takes me a good half hour to saw through Betula’s runt branch. I’m dirty and sweating from the exertion. The palm of my right hand has reddened and blistered from gripping the saw so hard.

When I finally cut through the branch it fell to the left, scraping the inside of my thigh causing blood to pour down my leg. No time to dress the wound though.

Spade, I forgot to get the spade. Back to the garage. I find it quickly, where I left it yesterday. Two short planks of wood catch my eye on the shelf above. Perfect. I take them with me too.

It’s hard work digging the tough soil behind the hedge. It’s full of clay and stones. I get on my knees and dig some of them out by hand.

By the time I’ve dug a hole wide and deep enough I’m covered in mud and grime. I’m sweating and the blood has caked hard on my legs.

I drag the branch, bouncing down the patio steps and gouge it over the lawn. I tip it into the hole with a sense of grim satisfaction.

It takes less effort to bury it and I’m done just as David arrives home from golf.

I watch David survey the scene as he gets out of the car. A deep frown furrows his face. He looks first at Betula, noticing immediately how the light shines differently on the patio. He sees his saw on top of the pile of sawdust and follows the gouge along the lawn to the hedge behind which I’m standing.

I watch him walk towards me. I feel oddly calm, resigned even. He gets a shock when he walks through the arch.

It takes him a second or two to absorb what he sees; his wife bloodied and torn, dripping with sweat and stood over a makeshift grave.

He snaps back into life, runs up and holds me by the top of my arms.

“Dawn, what in the world has happened? Are you alright?” He asks.

I wait for a moment, looking into his eyes and remembering our lives together. Remembering how long he’s lived in ignorance, and how long I’ve lived with the Secret.

“She died you know.” I say to David,

“Who did?” He asks, looking nervously at the grave.

“Our first child, on the steps of the hospital”

“Dawn, what are you on about?”

“It was the middle of winter, no baby could survive all night wrapped in a thin coat like that.”

“David, we need to talk....”

Red lorry, yellow lorry

I cut my first psychiatric tooth at St Mary's Hospital, in 1994 (eek). I was fresh from college and full of naive, brittle theories on the nature of man. I was convinced that madness and suffering could be tamed, through the use of empirical knowledge and liberal application of PRN.

In my first ward round, on my first clinical placement, I sat watching a patient being interviewed by the 'Multi-Disciplinary Team' (MDT). It consisted of the Ward Manager, Social Worker, Clinical Psychologist, Staff Nurse, House Officer and the esteemed Psychiatrist. And lil ol' me, of course.

The patient, a small, bearded man, had been led into the inquisition by a nursing assistant. His terror, at being under such scrutiny was plain to see. He shook and lurched his way to the far end of the room, where the last remaining seat had been reserved for him. As he sat, I realised that us 'professionals' had all chosen the high chairs. His, was more of a lounger. So, once down, he was lower than the rest of us. How apt.

In what was rather like a lawyers cross examination, the psychiatrist poked and prodded the mans psyche. With a flourish to the jury, he exposed this man for what he was; utterly, and absolutely crazy.

He was quite mad indeed. He heard voices and believed he was an SAS commander, on a mission to infiltrate the communists running the hospital. He received his orders through codes sent via breakfast TV. He could also command animals to do his bidding.

I'd never seen anything quite like it before.

"Thank you Mr Smith", Psy said, "This has been very useful, if you could have a seat in the day room, I'll be right with you".

And so Mr Smith left the court room.

I half expected the room to explode in raucous laughter, once the door had closed behind him. However, the MDT just sat for a while in quiet contemplation. The Psychiatrist broke the silence;

"Well, I'm afraid I'm going to need to recalibrate our oddometer."

The rest of the team nodded sagely, whilst I stared at him, somewhat bemused.

"So, where would you place him, on this new scale?" The Staff Nurse asked, with a serious look on her face.

Psy considered this for a bit, then announced, "Probably between Red Lorry and Bag of Fish."

Some nice breasts there, Melanie

There's a big group hug going on at Digg right now, as circa 2,400 geeks agree that being intelligent is damned hard. Apparently being bright makes you unhappy. Some might call it an emo circle-jerk.

Now, of course this is a load of old bunkum. There's no clear correlation between high intelligence and depression as far as I'm aware. In fact, it's been shown that having a high intellect can reduce the likelihood of suicide.

I (and probably you) know many 'intelligent' (I) people we consider to be happy (H). Equally, we know 'less intelligent' (D) people who are unhappy (U). There are two more combinations left of course; I/U & D/H. See, I can use algebra. 'Cos I'm clevor, me.

That said, I think there may be a kernel of truth in the proposition.

Assuming that intelligence isn't simply IQ, I've the good fortune of knowing some immensely gifted people. What I admire most about them is the way they occupy the 'Depressive Position'.

Now, bear with me whilst I explore what this term means. For those of you uninitiated to psychodynamics, hold on tight, because it gets a bit freaky.

Melanie Klein, a Freudian psychoanalyst, first described the Depressive Position in her work with very young children.

The child, in Klein's argument, engages in 'phantasies' wherein the mother's 'good' breast is idealized and loved, while the mother's 'bad' breast is attacked and devoured. The split between the satisfactory 'good' breast and the frustrating 'bad breast' is the child's first step into its 'I' prison - the breast is the first object the child experiences outside of itself. For the child, the good and bad breasts are not seen as belonging to a whole mother. Instead, they are experienced as separate objects.

Why would a child do this? Well, "splitting" enables the infant to ward off anxiety by experiencing the loving breast singularly, and completely separate from the hated, persecutory breast. The good breast is then 100% good. Life in this position is a simple flip between all bad and all good; Black and white. Klein called this the "paranoid-schizoid position". (I doubt she'd have named it that today.)

At some point within the first year of life, the infant comes to see its mother as a whole object, and, with this new perceptual ability, it comes to the horrifying recognition that the "good" and "bad" breast co-exist with the whole mother. The infant is grief-stricken by the recognition that, all along, it had been attacking the "good" breast along with the "bad" breast.

With this realisation, "the infant suffers extreme feelings of grief, guilt and fear of loss, and, as a result, seeks to make reparation for her/his damages to what once was the idealized, good breast. In exchange for this bitter realization, the infant's anxieties lose in strength; objects become both less idealized and less terrifying, and the ego becomes more unified. All this is interconnected with the growing perception of reality and adaptation to it."

So, if we think of the breast as metaphorically representing wholeness; good, bad and all the grey in between, then this realisation is the first experience of ambivalence for the infant.

Now of course, all of this is utter bollocks. We must not forget that Melanie was the product of an unwanted birth - her parents showed her little affection. Her much loved elder sister died when Klein was four, and she was made to feel responsible for her brother’s death.

You could say that she had some "issues".

That said, her theories have some use when applied to object relations theory, and in particular the dynamics of groups. In the interests of brevity, I'll not touch on projective identification and other Kleinien mental gymnastics. This is a gross simplification of her ideas;

Groups of people occupying the Paranoid-Schizoid Position tend to view other groups as all bad or all good. Politicians capitalise on this each day.

Groups of people that inhabit the Depressed Position tend to view things in shades of grey. They're less inclined to blame, and tend to see both sides of an argument. They can hold an idea that they don't argee with, in the group mind, for the purposes of exploration. You could call this a 'grown up' approach.

In these respects, I aspire to sit in the Depressive Position. I aspire to have the beginners mind.

Like bible mythology, psychoanalytical theory must now be thought of as metaphor. In our brave new, cognitively behavioural world, it no longer sits upon its throne of truth.

It's a good thing I suppose. Psychoanalysis does make you talk a lot of crap.

Despite all my rage, I'm still just a rat in a cage...

In the 1970's Bruce Alexander challenged the dominant understanding of drug addiction. Previous to his research, it had been widely accepted that availability of drugs was the root cause of addiction in our communities. As drugs become more available, we become addicted to them at an increasing rate. Therefore, if drugs were ubiquitous, we'd be a nation of addicts.

This theory had been confirmed in studies of rat behaviour. They went something like this;

Give a rat two choices - 1: Push a lever for a drink of water or, 2: Push a lever for a shot of Morphine.

Unsurprisingly, the rats got themselves stoned. Over and over again. Some of them got so wasted, they ceased to eat or drink. They even started listening to the Velvet Underground. Some of them died.

This proved that mammals, given the opportunity, will spontaneously become addicted to psychotropic substances. They will become so dependent on them, that they will cease to become productive organisms.

Alexander highlighted a flaw in these ideas. He argued that if you put a man in a tiny cage and make him live his whole life in it, it would be a near certainty that he'd choose to get out of his head on smack. What else has he to live for? Alexander thought that this is no different for rats.

So he made the Rat Park. A rat utopia. It was big, interesting and comfortable. Food was readily available, and the rats had ample space to form social relationships. When Morphine was made available to these rats, they chose not to use it.

Even when a rat was put in a cage and forced to become a junkie, when it returned to Rat Park it spontaneously withdrew from opiates. With very few observable withdrawal effects incidentally.

Now, we need to be careful in drawing any firm conclusions from his research, but it does pose some interesting questions about human behaviour.

Do we take drugs simply because they're there? Or do we take drugs for more complex reasons? And if we ever create our utopia, will we still use them?

Personally, I think that Alexander's ideas can be expanded beyond the realm of drug abuse;

For many, daily existence lacks any real meaning and purpose. Many live within a "mindless routine....[their purpose is to] produce the greatest quantity of widgets on the assembly line". It's little wonder then, that they return home to seek out the most soporific diversion available. Diversions such as soap operas, reality TV shows, junk food and pornography.

In a way, this mindless consumption gets us stoned. Like heroin, one-way entertainment wraps us up in a comfort blanket of thoughtlessness. Thinking is the last thing we want to do when we live in restricted cages. Ignorance is bliss.

Unlike Alexander's rats however, we're the architects of our prisons. We can choose to inject the hypnotic, each time we press the next channel button, or we can choose to make something.

This I think, is at the root of human spirituality; The need to make things. The need to be creative and express ourselves is cruicial to our wellbeing. One-way entertainment that's designed to stifle thought, strips these urges from us. It deadens something fundamental in us.

Few of us are talented artists. But all of us can make stuff;

We can make;

• dinner
• time
• love
• someone laugh
• someone think
• an idea
• a phone call
• a heart race
• a move
• a choice

The opportunities our new, read-write web gives us are limitless. For those of you who surf using only your mouse, look down at your keyboards and start to make something...

A Morality of Madness

Before 1974, the Diagnostic and Statistical Manual of Mental Disorders (DSM) listed homosexuality as a mental disorder. The psychiatrists who collated the book, considerd it a disease, complete with symptomology. Something that could be diagnosed, treat and cured.

Things of course, have moved on. Now in its fourth iteration, DSM IV no longer lists homosexuality as a disorder. It does however, list the following; Fetishism, Gender Identity Disorder, Hypoactive sexual desire disorder (not Hyperactive), Kleptomania, Voyeurism, and my personal favourite - Frotterurism. This is a sexual 'disorder' involving rubbing against another person to achieve sexual arousal or even orgasm, discreetly and without being discovered, typically in a public place.

It strikes me that a diagnosis of the above requires as much moral judgement on the part of the Psychiatrist as it does clinical expertise.

It dosen't stop with sexual deviancy either. It gets into the meat and bones of our identities. 'Schizoid Personality Disorder' for example, presents in the following manner;


A pervasive pattern of detachment from social relationships and a restricted range of expression of emotions in interpersonal settings, beginning by early adulthood and present in a variety of contexts, as indicated by four (or more) of the following:

1. neither desires nor enjoys close relationships, including being part of a family
2. almost always chooses solitary activities
3. has little, if any, interest in having sexual experiences with another person
4. takes pleasure in few, if any, activities
5. lacks close friends or confidants other than first-degree relatives
6. appears indifferent to the praise or criticism of others
7. shows emotional coldness, detachment, or flattened affectivity

Other than sexual indifference, this sounds like a good few teenagers that I know. Should we be thinking of adolescence as a disorder then?

I wonder if the authors of DSM IV understood the awesome power of words. The power of labels. A tag beggining with Schizo, affixed to a young person, can ruin their life. For some, it's a death sentence. Words can indeed kill.

What's this got to do with spirituality then?

Well, for all its quantitative posturings, Psychiatry remains an art, not a science. Don't let anyone tell you otherwise. And art of course, is a metaphorical exploration of the human condition. An exploration of human spirit.

The DSM IV manual comes with a health warning - The application of these diagnostic criteria must only be made by people with the appropriate training and expertise.

Perhaps, if DSM IV was written in Latin, the judgements Psychiatry makes about people would be accepted even more as an absolute moral authority.

Countless copies of DSM IV have been made over the years. Rather than on a printing press, I imagine hundreds of aspiring psychiatrists, hunched over desks, lit by candle light carefully copying the DSM criteria onto parchment.

More on this another night.

Want to know more right now? You could do no worse than starting with Thomas Szasz.

Interdependence

There's an obsession currently amongst mental health & social services in the UK about independence. The term is handed down to us by our government to be used as a mantra.

We're charged to ensure that;

"services help maintain the independence of the individual by giving them greater choice and control over the way in which their needs are met;"

Well, aren't we all nice people? We're "Giving them greater choice and control..."?

I know I'm being flippant. In truth I support a lot of the current developments in health & social care. However, I'm left with a nagging feeling that we've missed the point somehow about independence.

I'm involved in a bit of research at the moment consulting with people who have 'severe and enduring' mental health problems. Our focus is finding out what people identify as contributing to their well-being and recovery.

Perhaps unspirisingly the main emergent theme is positive relationships; Ones that have hope and optimism at their core. These are established predictors for well-being and recovery (though I'm not so clear whether they represent a causation or a correlation), so I doubt I'll get my PHD through it.

Nonetheless I think it highlights the significance of interdependence as opposed to Independence.

The last thing I'd want to be is independent in the purest sense. What a bleak, lonely existence it would be living 'independently' in my own flat, unreliant on anybody to meet my needs.

As it is I'm dependent on so many people. In particular I'm dependant on Miche (my beloved), not least to stop my head disappearing up my own arse.

Point to point

The other day I talked about my existential leanings and thus the tendency to view our universe as being ultimately pointless. I also explored, albeit clumsily, how we may be predisposed to crave meaning in our lives. So much so that we invent gods to meet this need. And finally I thought about how now, more than ever, our society could be in need of a god.

To me, the fact that we could need a god is patently absurd. But Viktor Frankl was right when he observed that we're living in a world so easy and so vacuous that we no longer experience any fundamental struggle in our lifes. Concequently many of us lack purpose. Frankl argued that this is evident in boredom. (Not something I've experienced in years. I'd like to give it a go for a short while, it sounds quite relaxing).

He felt that boredom was endemic in our society, evident through mindless consumption of cheap TV, gambling and voter apathy at elections. However, much of his writing was based on his experiences of the US culture. He was much more famous than he was here in Europe. Even though he was Austrian.

Frankl was a psychiatrist, and a student of Freuds. Incidentally, he was excluded from Freuds learned circle because of his open disagreement with his theories.

Frankl proposed that Freuds 'Pleasure Principle', in which our Id demands us to take care of needs immediately and is then suppressed by our egos' misses the point.

He also argued against Adlers theories (another prominent neo-Freudian) that an individuals freedom of choice is the fundamental urge.

He summed this up rather nicely when he wrote "Actually, pleasure is not the goal of human striving but rather a by-product of the fulfilment of such striving; and 'power' is not an end but a means to an end. Thus, the 'pleasure principle' school mistakes a side effect for the goal, while the 'will to power' school mistakes a means for the end"

I find his ideas very attractive as they help me square the circle between the pointlessness of existance and the irrepressable, opposite notion, that there has to be some purpose, some meaning to it all.

I guess that our purpose should be to get our heads down and work hard to make our collective lives a little bit better, one small step at a time. We should also measure our success, not against our bank balance but against how fulfilled we feel in our work and relationships with others.

After all "being human always points, and is directed, to something, or someone, other than oneself - be it a meaning to fulfill or another human being to encounter...The more one forgets himself - by giving himself to a cause to service, or another person to love - the more human he is...", Frankl.

So, it could be argued the needs of the individual are indivisible from the needs of society. Perhaps the root of our westernised plight is the central placement of the individual in our culture.

So why does this lift my spirit?

Well, this post is hopefully the second of many on this theme where my ideas may become clearer, to both you and I ;-) . But simply, I find the idea that our place in the universe can only be found in relation to others uplifting.

So if collectively we can have a meaning, it becomes immaterial then, that the universe dosen't care.

Introductions

I guess I'm struggling in the same way that many do do define and understand what keeps us well spiritually. I'm also not sure if we should even bother to try. Does it make sense to differentiate spiritual wellbeing from just general wellbeing? That of being content, happy, sad, anxious or depressed; and even being physically well, secure and loved.

I hope to use this blog to try to understand this subject a bit better. In real life I work as a mental health professional. In this 'trade' there is an obsession currently about Spirituality and its place in a persons mental health. A lot of people talk and write about it. It is a requirement that we 'assess' somebodys spirituality in the same way we would assess someones mood or behaviour. Predicatably, we all struggle with this. Over and over again I see 'spiritual assessments' revert to typecasts such as the religion a person belongs to (but rarely how or if these religious beleifs influence day to day living) and wishes upon death.

I've so many questions to think about. Perhaps you, the reader can help me and post your thoughts I feelings to me on this blog?