Cartoonist Darryl Cunningham has kindly agreed to be interviewed by the Frontier Psychiatrist blog.    Darryl has recently published his graphic novel ‘Psychiatric Tales‘, which I throughly recommend.  It was recently reviewed in the Observer and seems to be doing very well.  Darryl’s own blog is called Darryl Cunningham investigates.  See the end of this post for further links.

You’ve just had your graphic novel "Psychiatric Tales" published in the UK. Can you tell us about it?

Psychiatric Tales is a collection of eleven graphic stories about mental illness. Drawn in a stark black and white style, reminiscent of woodcuts. Subjects he book covers include schizophrenia, bi-polar disorder, depression, anti-social personality disorder, dementia, and self-harming. Psychiatric Tales is a book that attempts to demythologise mental illness. Forget what you’ve seen in movies or on TV. This book shows what the experience of mental illness actually is for both patients and the staff who treat them. Media representations of people who suffer mental illness tend to be appalling. We live in an age where racism and sexism is considered unacceptable. Yet the mentally ill are still thought fair game for ridicule and are subject to the worst kind of prejudice. The book is out in the UK from Blank Slate publishing. It will be published in the US by Bloomsbury early next year.

I’m aware that the subject matter of graphic novels has broadened a lot in recent years but psychiatry isn’t the most obvious topic.  Can you tell us about what lead you to the subject?

I worked as a health care worker on an acute psychiatric ward for many years, and throughout that time I kept a diary, thinking that the material might lend it self to a book. However I’ve always been a cartoonist, always drawn for pleasure and had a few things published in the 90s. It seemed natural to me to start drawing up these stories into comic strip form. It was when I began putting these chapters online, that I realised I had a success on my hands, due to the incredibly positive response I had from people.

What struck me whilst reading it was how suited the format was for exploring psychiatric issues in an unsensational but compelling way.  What do you think that the advantages of a graphic novel treatment are?

The comic strip form is very immediate. It’s an easy to read medium in which you can present a lot of information. It’s combination of words and pictures.

What could be more powerful than that? By the time you’ve decided not to read it, you’ve already read half of it. It’s a superb educational tool.

It’s clear that one of your aims with the book was to properly inform your readers about mental illnesses.  Why do you feel drawn to do this, and do you think that a book like this would have been useful to you whilst you were experiencing mental health problems of your own?

After a few years as a health care assistant, I decided that if I was going to drag myself out of the minimum wage trap and have any kind of a life, then I should become a trained psychiatric nurse. I had to do a year’s night course, at a local college, just to get the qualifications that would get me onto the nursing course in the first place. This I did alongside my health care job. I bit off far more than I could chew. Two years into the nursing course, and with only one year to go, I found that I could not continue. I began to struggle with terrible anxiety and depression. I had always suffered a certain amount of anxiety in the job, but I’d managed to deal with it. As the last year of the course began, I became completely overwhelmed with feelings of despair and hopelessness. Thoughts of death and suicide haunted me. I ran up huge debts, not caring whether I could pay them off or not. I had to leave the course. I’d invested so much time and effort into becoming a psychiatric nurse, but in the end it had all come to nothing. I was devastated. 

In the aftermath of all this, and while I was putting myself back together, I began to look again at much of the old comic strip work I’d done in the years prior to the nursing course. The internet had arrived by then and this gave me a direct line to a new and bigger audience. The story strips that had the largest impact were the ones written about my psychiatric ward experiences. These strips developed a life of their own, being picked up all over the internet, on sites such as Digg, Boing Boing, The Comics Reporter, and many others. This lead to Blank Slate offering to publish the stories. Well I didn’t have many strips done at this time. I hadn’t even looked at them for four years. So I began drawing more in order to have enough for a book. This process helped dig me out of depression and gave me a new direction and a future. I don’t know whether a book like Psychiatric Tales would have helped me much during my depression, but writing and drawing it certainly did.

Can you tell us about some of the reactions your book has received from service users?

I had an e-mail from a young man who intended to buy two copies of the book when it came out. One for his mother, and one for his step-father.
He wanted to show his family that the bipolar disorder he’d been diagnosed with, was a real illness, and that he needed their understanding not hostility. Lots of readers have told me that the book had moved them to tears. It’s very gratifying to have created something that has such a powerful effect.

You’ve worked in mental health care for long periods in the past – what was your experience of psychiatrists?

Good and bad. As a group psychiatrists are the same as everyone else.

I’ve met brilliant and effective psychiatrists, I’ve met arrogant psychiatrists, I’ve met useless psychiatrists, and I’ve even met psychiatrists who were clearly not well themselves.You seem to be broadly supportive of the treatments on offer, and those who are on both sides of the patient-healthcare professional divide. 

There are other people, some of whom read this site, whose experience of mental health services is quite negative.  What are your feelings about how we could improve what we do?

I’m so pro-psychiatry that I’m aware that I have a terrible bias towards it. So when psychiatry and mental health care is criticised I tend not to want to listen. We all have to be conscious of our bias and understand how our investment in the status quo might distort our thinking. It’s very human to be this way, but it doesn’t have to be so.

Service users would benefit greatly if those in the health care professions would listen more.

Some of readers of this blog won’t be too familiar with graphic novels, especially ones about mental health.  Can you recommend a few titles?

Recently there was a conference in London called Graphic Medicine, which looked at the ways in which the comic book narrative form could help both service users and professionals. There is a list on the site of medical themed graphic works.

 ***

Psychiatric Tales on Amazon. 

There are also samples of Darryl’s work on his blog and flickr page

Sample chapters from Psychiatric Tales:

Suicide

Schizophrenia

Last chapter

I’ve just been writing a review of the book Movies and mental illness 3 which will appear here as soon as it is published in print. It’s a handbook for anyone who wishes to use cinematic depiction of mental illness to teach and understand its presentation. It’s more of a textbook than something that can be read enjoyably cover to cover but nevertheless worth a look.

Practically any relevant major film, even one which only fleetingly depicts an altered mental state, is included.The dedication of the authors is such that they are not too proud to include some films which, although they illustrate psychopathology, are otherwise almost without artistic merit (although concerned readers will be glad to hear that Swept Away is not included)

Mental disorder has long been a compelling topic for filmmakers, as its depiction tends to deliver compelling personal struggles and exploits well established fears.  Unfortunately the treatment of mental disorder in film is often inaccurate and negative; dramatic films are primarily intended to entertain and as such they have little desire to stretch their audience and pander to popular stereotypes.  A reason to be concerned about this is that the pervasiveness of cinema means that for many people these narratives are their primary source of mental illness information.

In One Flew Over the Cuckoo’s Nest {I would recommend the film, the novel and also Tom Wolfe’s account of Ken Kesey’s Merry Pranksters} Jack Nicolson as Randal McMurphy takes on Nurse Ratched and the psychiatric establishment. 

In film this can apparently be traced back as far as 1909 with D W Griffith’s The Maniac Cook.  The Joker in The Dark Knight is an example as well as the Halloween films which feature an escaped psychiatric patient making mincemeat of attractive American teenagers.

The 1964 film Lilith stars Warren Beatty as a hospital therapist who is seduced by a psychiatric patient played by Jean Seberg.

This can be linked to work of RD Laing and Thomas Szasz.  King of Hearts (1966) and A Fine Madness (1966) are examples.

Here someone with mental disorder is depicted as self-centred, attention seeking and demanding.  In films like Annie Hall Woody Allen practically invented this.

These films treat people with mental illness as objects of amusement or derision for the entertainment of people who are ‘normal’.  Me, myself and Irene encourages us to laugh at someone with ‘advanced delusionary schizophrenia with narcissistic rage’.  Described here as ‘almost entirely devoid of accuracy, sensitivity and subtlety’.

Here the belief that a single traumatic event is the cause of mental illness is promoted.  In TheFisher King Robin Williams plays a former college professor who becomes homeless and psychotic after witnessing his wife being gunned down in a restaurant.

A widely held (but discredited) misconception that holds parents (mother most often) responsible for the development of serious mental disorder in their children.  When this theory was popular it was thought to be due to the double bind – opposing messages from a parent.  In Shine, a film about the life of pianist David Helfgott, the father is alternatively loving and hateful.

Harmless eccentricity is frequently labelled as mental illness and inappropriately treated.

One Flew Over the Cuckoo’s Nest is emblematic of this.  McMurphy appears to have no psychiatric disorder, but yet once he is in the psychiatric hospital he cannot escape.

Psychiatrist portrayals have been classified into three stereotypes.

‘Dr. Dippy’ is comic, crazy, and foolish.  This sort of practitioner lacks common sense, prefers bizarre treatments, but, ultimately, does no real harm.

‘Dr. Wonderful’ is warm, humane, caring, and much prefers the use of non-physical treatments.  Robin Williams’ character in Good Will Hunting is an example.

Hannibal Lecter is an example of a ‘Dr. Evil’ (no relation) tends to be cruel and sadistic in the use of coercive physical treatments.  He may not be immediately identifiable, hiding, perhaps, in the benevolent guise of someone else.

Further reading:

The Portrayal of psychiatry in recent film

Psychiatrists are being driven mad by their portrayal on screen – Independent 4 September 2000

Here is an uncharacteristically positive review for “Stiff: The curious lives of Human Cadavers” which I wrote for the StudentBMJ in 2004.  It is a very entertaining book, if you happen to find this sort of thing interesting.  You might just have enough time to buy it before Xmas if you are short of a present…

***

I have spent the past few years deeply embroiled in the study of how to prevent Londoners from dying. But I have never devoted much time to wondering what happens to their remains once they are actually dead. Nevertheless, human remains have something morbidly interesting about them, and this subject provides American journalist Mary Roach with more than enough material for her fascinating book.

Many people donate their bodies to science with the hope that in death they may help others to live more successfully, so conferring a kind of immortality. But beyond the donating of organs and dissection, a world of alternative fates exists for our earthly remains, and Roach guides us through a banquet of possibilities. A cadaver really is useful to research, like a person in many important respects—size, shape, tissue type—but totally without complaint as it unflinchingly researches car crash injuries or bullet wounds. As a result, cadavers have been used in the development of many of the surgical advances of the past century and continue to be used in training. Cadavers were used to research the Turin shroud, left out in the sun for forensic research, used to test France’s first guillotine, and provide valuable clues as to the causes of passenger aircraft disasters.

As the pages rack up, Roach widens her remit to issues relating to death and the dead and as she does takes the opportunity to draw on many amusing stories of quackery. One that I remember is that of the creative French doctor Jean Bapiste’s technique of rhythmic tongue pulling to emphatically establish death and of others’ attempts to weigh the body before and after death to determine the weight of the soul. Stiff also describes more recent attempts at head transplants and a Swedish movement to encourage the composting of human remains.

This subject could be very dull in the hands of many pathologists, but the non-medical Roach brings an impressive insight and, as a writer, has a witty and irreverent style. Stiff is informative, entertaining, and funny and as a result is a much more enjoyable read than your average popular science book.

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15% off solid color medical scrubs with code “solidfrontier”

Someone gave me this for my birthday.  I’d not heard of psychotherapist and novelist Irvin D. Yalom before, although apparently he’s quite popular, and sufficiently revered to merit the publication of a ‘Yalom reader’.  This is an accolade of which I can only dream, not least because I have never written a novel.

Lovers of psychoanalytical historical fiction need look no further.  The plot centres on Dr Josef Breuer, feted Viennese physician, mentor to the young Freud and his relationship with Friedrich Nietzsche, notable philosopher.  In the opening chapters Breuer is much troubled. Chiefly and inconveniently he is in love with a former patient, the famous Anna O, whose treatment in the real world has since been regarded as marking the inception of psychoanalysis.  Relations with his wife are correspondingly poor, but rather than tackle this he has thrown himself into his work.

Enter Lou Salomé, who requests a meeting with Breuer, stating no less than that the ‘future of German philosophy hangs in the balance’.  She fears that Nietzsche, with whom she has recently ended a relationship, may take his own life.  Feeling a responsibility to put matters right, she asks Breuer to meet Nietzsche but to conceal her involvement.  Breuer cannot resist her charms and agrees to help.

Nietzsche is plagued by a mystery illness, which regularly leaves him incapacitated.  He is prepared to allow Breuer address his physical concerns, but when Breuer suggests that Nietzsche’s problems might have a basis in his psyche, best addressed by in-depth conversation, he rejects the proposition.  Desperate to help him, Breuer then hatches a plan whereby he persuades Nietzsche into an unusual bargain: Nietzsche will be admitted to Breuer’s hospital where Breuer will treat his physical ailments.  In return Nietzsche will use his philosophical skills to ‘treat’ Breuer’s existential crisis.

Yalom has hit on an interesting conceit which sustains itself nicely until the end of the novel.  The dialogue between Breuer and Nietzsche is particularly well executed.  On the other hand I found Yalom’s writing style, with his liberal use of exclamation marks, somewhat irritating.  The protagonists are caricatures as Nietzsche is cast as a brooding intellectual and Breuer as a workaholic physician whose weakness for attractive females is difficult to believe.  The ending is a little too neat and Freud, who pops up on a number of occasions, appears to have been included for the sake of completeness as he has very little to do with the actual proceedings.

Also on the BMJ’s doc2doc

Christopher Crook who wrote the extract in the previous post answers my questions

How did you come to write the novel?

It was about being my own boss more than anything, being in full control of something without risk of interruption or distraction. I knew I had lots of points I wanted to make and the only way to put them all together was to write a book. Also, I’d been dabbling rather half-heartedly with journalism but I knew this was something i could do whole-heartedly.

The novel appears to have a lot of autobiographical content.  Do you feel able to tell us a bit about your experiences?

At the start one of my main motives for writing the book was so that I could finally draw a line under some difficult and painful experiences – and most importantly – a feeling of injustice. Nothing keeps you awake at night more than that, I find. I begin the novel with an alternative glossary of psychological medicine in which I describe what all the drugs really do rather than what they are supposed to do. I wanted the whole novel to work like that. I wanted it to be a complete re-writing of an accepted version of events: what really happened. So, no, I don’t really want to talk about my experiences – read the book instead!

What made you decide to write a novel, rather than say a biographical piece?

The more I wrote the more I realised I could remain true to what I wanted to say without necessarily describing real events. This became very liberating. However, I had a problem in that I wanted the reader to see that truth is stranger than fiction so it was important the reader realised most of the events I described actually happened. Now I just call it an unreliable memoir. I’ve learnt no memory is accurate. Why we remember or think we remember certain events became more important than the accuracy of the memory.

Do you think writing fiction is a good way to come to terms with difficult things from the past?

If you mean writing fiction about things in the past you want to move on from, then yes and no. I want to be able to communicate my thoughts and ideas. I think it would be hugely gratifying for me to know that I have been able to do that. That is why I write. But I have chosen to write about a subject that risks dragging me back to my past. Whilst I have done this because I think I can write confidently and, hopefully, well about it, I’m not sure I can say I have truly come to terms with anything as that to me means moving on from it which I cannot say I’ve done or benefited from. It feels like the opposite sometimes – like I’ve been poisoned by my writing. But now I might as well be talking about the process of trying to get a book published…  It’s emotionally destabilising whatever you’re writing about.

What do you think that the themes of the novel are?

It’s about interference and specifically interference posing as concern. I think it’s one of the first things that makes anyone truly livid – when a teacher you despise, and you know wants to undermine you, tells you they are concerned about you. I think a lot of teachers fear their pupils being more intelligent that they are and so learn to use certain tricks to avoid ever dropping their guard or giving too much of themselves away. These are tricks I have seen displayed by senior psychiatrists trying to keep their wards in order. Basically we are taking about bullies working in institutions where their behaviour is not challenged because people have become desensitised to it. Bullies who say it’s all for your own good and prescribe drugs that give you parkinsonian side effects. It’s a nightmare scenario: concern from the source of the problem. An abusive teacher who no-one recognises as being abusive. It makes you question your sanity.

And they have the language, the jargon, to back up their claims when all they are really doing is a pretty lame impression of a cult leader – telling the relatives of a concerned patient to forget all they know and listen to him instead because he has the answers. It’s totally implausible and it’s actually why there is this huge stigma attached to mental illness. It’s not because Joe Public is unsympathetic to people having a hard time. It’s because most people are naturally suspicious of a psychiatrist with a never-ending list of made up mental illnessess telling the relatives of a loved one that they’ve been ill all along and they have to take drugs that are like slow death, leaving you unable to function as normal, robbing you of your self esteem and then taking ten years off your life.

You relate what appear to be very difficult experiences with psychiatrists in the book.  What’s your attitude to mental health services now?  What do you think we are getting wrong?

I find that difficult to answer. They are getting nothing right. I speak as a victim of torture. I’m not exaggerating. I was locked up and told to ’sit still’ then given a poison that made it impossible to sit still.

How do you feel about your mental health now?  Do you still have any contact with psychiatrists?

Sometimes I diagnose myself as miserable, sometimes happy.

I think for as long as psychiatirsts dispense neuroleptic drugs – and many do nothing but -  I don’t want to know. We’re talking about drugs that turn people into desperate individuals who lose control of their bodies and then their grip on reality. It’s the same horror story written by psychiatrists over and over again. And they are supported by a bunch of people and charities who do nothing to change the system becasue nobody really knows what they are doing. There are no experts working in psychiatry because it is not a science. It’s just guess work and a branch of medicine that’s open to massive abuses.

How would you tackle the problem of mental illness in our communities? Do you think that it’s ever reasonable to treat someone against their will?

It doesn’t invalidate my criticisms of the current system if I can’t come up with an alternative that can be implemented straight away. It took centuries to get rid of the death penalty in this country. I think it will take a similar length of time to change psychiatry. However when the death penalty was finally gotten rid people stopped getting put to death. The positive effects were instant. That could happen in psychiatry. Abandon the medical model, cut ties with the drug companies, start again, re-define so-called mental illness.

There’s always prison if someone has committed a crime and they need to be treated against their will.
If someone’s only crime is self-neglect, and they have come to the attention of the services, and it’s decided they need treatment against their will, then one would hope all other options have been explored first.

Quite unexpectedly, a few weeks ago I was contacted by an author about novel that he’d written and for which he was looking for a publisher.  I couldn’t help at all, but he sent me a chapter anyway and he’s agreed to let me post it below.  It’s visceral stuff, and  a valuable counter viewpoint for anyone – like me – who’s ever worked in an inpatient ward and been party to people being treated against their wishes.

The novel is called Memory, loss and possession of all the facts and it’s written by Christopher Crook.  He’s keen for his novel to reach an audience and also to hear people’s reactions to what he’s written.  You can leave a comment below, or if you wish you can contact him directly via me.

This chapter was originally called ‘Duel’ because it’s about a power struggle between a patient and his psychiatrist.  It’s not exactly a fair fight though. I wanted to show how the patient’s mental health deteriorates the longer he is treated because, in essence, he is not being treated at all, he is being tortured. So he ends up much more frightened and ‘ill’ at the end of the chapter than he was at the start.  This extract takes place about two thirds of the way through the novel at a point where the narrator is in an impossible situation because he must go along with a system he doesn’t trust – and why he doesn’t trust it becomes apparent.

***

Extract from Memory, loss and possession of all the facts

A fish tank, ping-pong and a trolley of pills told me I was trapped again. I could have been miles from civilization stuck up on the fifth floor of a dirty block of hollowed-out concrete, crammed to the limit and doomed like a prison ship on its way to an unknown penal colony, sinking. “Not fit for dogs!” someone shouted.  The only way down was in the lift and the way to the lift was locked. Large, glossy pills invaded my body and took possession of it like a poison. It was Haldol® thwack and it hurt. My neck stiffened and my face began to twitch. I couldn’t settle so I stood up, sat down again, stood up, sat down again, then rocked back and forth to try and ignore unpredictable waves of discomfort that swept through me. My limbs jerked spasmodically. I couldn’t piss without leaning over the toilet, hands pressing the wall, concentrating hard. I got angrier, louder, hyper, as control of my body was wrestled from me. But to the doctors and nurses this was just my condition. A patient asked me what colour my drugs were then looked at me with pity as if he knew I’d been singled out for special punishment.

At ten every evening six days out of seven came a call for medication from a nurse who liked to work by night. She thought it gave her patients something to rely on, a sense of continuity, someone to wish them sweet dreams. She was a former nun from Ireland who looked like she boiled babies in her spare time. I told her the drugs weren’t working so she offered me more, saying in a creepy, whispery voice it was a tranquilliser that would help me find peace with myself. She was the stranger pushing sweets I’d been warned about at school; only she pushed Catholicism as well. A junior nurse without the authority to hand out sweets from the kiosk saw how agitated the Haldol® thedevilsinsideyou was making me and asked the nun why she didn’t give me some Restoril® toogoodforyou instead. He wasn’t there for long.

Sleep was a monumental struggle. Plastic curtains yanked noisily across bendy rails split territory between four of us. A chorus of intimidating nocturnal murmurings reverberated around the room, as I lay rigid, drugs and fear again. Early dawn came as a relief and was my cue to move to the common room. If I was lucky it would be empty and I could watch aeroplanes fly past in the distance, leaving smooth trails stretching from one side of the window to the other. When I stood closer I saw London and roads that used to be my playground as a student, now closed to me because I was considered too mentally ill to walk down them.

Weekly consultations with Lisserman were meant to be a chance to speak my mind. So I filled them with pleas to be taken off the medication. Then he picked bi polar affective disorder off the menu for me. “In other words?” I said.

“Manic depression,” he replied, and his long, spidery limbs were flung into a thoughtful pose, his skinny face too pleased with itself. Nonsense, I thought, but I let him choose my dish for the day because it meant serving me Lithane getfatandloseyourmemory with reduced Haldol ®kryptonite and any reduction in that was a relief.

Lisserman got friendlier, but only if I went along with what he was saying, and that got harder to do when one dreary afternoon a mysterious hard-faced butch woman turned up and sat with him. She only spoke to confirm everything Lisserman said, but she claimed to have arrived at all the same conclusions from a slightly different angle and used more esoteric psychiatric language that sounded endlessly rehearsed.

“What’s the point of you?” I said.

She paused, evaded my question and stated: “Chris, you are currently in the elated…”

“Elated! I’m just trying to amuse myself because you lot are so humourless.”

“…. phase of your manic cycle, you show no sign of the psycho motor retardation that is consistent with the depressive phase of your illness, but you must understand you will not feel like this for long. Your mood will dip. This is why you should take your medication. It is for your own benefit. It stabilises your mood.”

“So what phase am I in right now? The psycho motor fuel injection phase?”

She turned to Dr Lisserman who said: “We think you’re not fully aware how you appear to others.”
“How do you want me to be?”

“We want you to be yourself.”

“But you just said I’m a psycho motor retard. I don’t want to be a psycho motor retard.”

“Look Chris,” said the butch woman, “stop making things more complicated. You have a condition, and to help yourself you have to take medication that controls that condition. It’s not rocket science.”

“Ha! You’re bloody well right. It’s not even science.”

As the two of them exchanged glances I realised the in-built logic to their partnership was that in an uncertain business, two corresponding views were far more credible than one. I took a deep breath ready to fire my thoughts at will, hoping somehow that the heat of my emotions would incinerate my opponents and I’d be left to sweep their ashes off the floor: “You’re always saying that you’re trying to help me and that this is all for my good but the funny thing is you’re actually doing the opposite, all you’re doing is bullying me, and denying me ownership of my feelings. For god’s sake stop telling me what you think I think! Basically once I’ve agreed to give up my thoughts and feelings, once you’ve broken my will and I’ve submitted to your greater knowledge – which amounts to deciding what drugs to give me and reeling of some bullshit to justify it – once I’ve accepted all that, and your version of events, I’m cured and you’ll let me out. But until then you’ll keep me here because your professional reputation depends on you being right when being right is just you deciding something and then sticking to it. There is no right or wrong in this game but if you admitted that your job would change and you might even have to do some real thinking. This isn’t about helping people. It’s just about confining and medicating them. There’s nothing more to your job than the simple exercise of power. That’s all it is! I was educated to avoid the likes of you, not have you try and control me.”

“I think you need to control yourself,” Lisserman said.

“I’m not some kid who was told he’d never amount to anything, got hooked on glue then got told he was ill all along and not just illiterate, you know. You can’t manipulate me. I’m not 2D, I’m at least 3D.”

“Riiight… You’re not helping yourself, you know.”

“Yes I am. Your office, it goes beyond the walls of this room doesn’t it? The ward is your office. Mental hospitals are offices where people are processed!”

“Okaaay…”

“And what is she doing here?” I said pointing at the butch women. “Are you lovers or do you just need all the friends you can get? And another thing, why does the bacon here smell of fish? What’s that about?”

“Riiight… I think it’s time we finished off. We’ve achieved all we can for now.”

“Oh go fuck yourselves, or each other. Fucking failed medics.”

I could only be polite up to a point. I mean it’s not like it was a job interview. These people were my tormenters; they’d taken away my liberty. What did they expect? I thought I knew their game, but I thought they probably thought they knew I thought I knew too, and if they thought that they probably didn’t like it, especially if I was actually right and they knew in their hearts, if they still had them, that everything they said was total shit. So when Lisserman said I’d been outrageous I apologised and was on my best behaviour again.

More and more people, some of them bright-eyed, enthusiastic students in fashionable rags, turned up for my consultations. I always chose the chair that gave me the most commanding position in the room. Once I moved my chair next to Lisserman’s and tried to engage him in a double act: “Who are you, Dr Who am I, The unravelling psychiatrist?” As I tried to undermine him with quips and interjections, nothing offensive, just light-hearted banter, everyone thought it was hilarious that manic depression could be such fun. The more I made people laugh, the more I judged the meetings a success. Tantalisingly I was offered weekend leave.

When I left the ward to stay with Melissa my first impulse was to throw away the Haldol® letmego. Even in reduced amounts it was intolerable. Melissa felt responsible for me and advised against it but she had no idea how tense and distracted the drugs were making me feel. They were a way of keeping my body prisoner even though I’d left prison for the weekend, a psychiatric version of tagging, a constant physical torment to remind me of my tormentors.

Drugs meant to calm me, prescribed to those thought to be a danger to themselves, made me so restless I kept wondering off, running around, falling over, hurting myself, accident prone like Frank Spencer, but not funny. And when everyone else slept off the Saturday night before, I was a deranged Alsatian chasing my tail, deaf to the order: Sit! So it was no surprise Melissa found it hard to help or relate to me. We used to take illegal drugs that made us feel closer to each other. Now I took drugs licensed by the government and pushed by my psychiatrist that made us feel like strangers. Sex was impossible. My body just wouldn’t do what I wanted it to. Had someone decided I had no right to such simple pleasures?

At father’s new house I was pleased to take full advantage of his large garden and galloped around it hoping if I exhausted myself I might finally relax. I tripped and suddenly my entire body was griped by spasms. Then as I bent forward and tried to get up, my spine and shoulders stiffened and froze. Melissa moved me onto my side when I realised I’d forgotten my side-effect drugs. I was manoeuvred into father’s car and rushed back to hospital where a nurse reacted incredulously to what had happened before reluctantly giving me the drugs I needed to counter the effects of the drugs someone I didn’t like or trust said I needed, but I didn’t want.

Week after week, same time, same office, same walls, same chairs, Lisserman said I was making progress, but little else. On the ward I talked continuously, hoping patients would warm to me, hoping to please everyone, often doing the opposite. A scowling racist threw a plate of chicken remains my way when he heard me say that, generally, black people make better athletes. Then someone who claimed to have played a monster in Doctor Who spat at me because I said Peter Davidson was an underrated doctor. Better even, in some respects, than Tom Baker.

There was friendship too though, of sorts. A bewildered Croatian spoke no English except one phrase I taught him which, in a place that always felt on the brink of anarchy, was more apt that any other: “Don’t panic!” A mysterious visitor offered to translate for us so I told him he was a big friendly giant. His face lit up, and to show me his gratitude he gave me a fireman’s lift that made me feel giddy and elated.

A well-meaning Welshman offered to be my bodyguard. He was struggling with a catastrophic loss of self-esteem having just been dismissed from the army. He insisted that every time we spoke we salute each other first and promised me a career in the RAF when I left. Maybe he thought I was already a space cadet so must have an aptitude for flying.

“What the fuck?” was almost all an agitated Noel Gallagher look-alike ever said. He punched me when I told him not to look back in anger but apologised later and gave me a Masonic handshake. Captain Jean Luc Picard was accidentally beamed into the hospital and was unable to beam out again. Resisting the Borg collective was futile but we had some fun trying.

With nothing to do but wait for an unspecified point in time when someone might decide I had a right to live my life again, storytelling was necessary to stay sane. But it made some think I was insane, and that’s what I eventually became: a pacing tiger caged in a zoo, driven mad by lack of stimulation and counterproductive tranquillisers not fit for human or cat. Why not look at London through a different window for a change. Smoke a different brand of cigarette. Drink tea not coffee. Coffee not tea. Hot chocolate instead. Nothing at all. Everything at once. Walk down the corridor. Walk up the corridor. Walk in a circle. Walk on the spot. Complain to a nurse. Get wound up. Get ground down. Hang around. Piss about. Get punched by Noel Gallagher again. Cry. Queue for breakfast. Queue for lunch. Avoid dinner. Listen to the radio. Turn the dial. Turn on the TV. Switch it over. Switch it off. Switch it on again. Wonder why there was a compass painted onto the floor. Stare at it. Stand at its exact centre. Spin around till I felt dizzy and sick, every single fucking day.

All patients were automatic members of the smoking club, except Jean Luc who said fags were Borg mind control. We met daily and, in smaller clusters, nightly, to share complaints and compare pills. They warned me to be careful what I said to staff, especially the baby-boiling nun: tacit acknowledgement that the nurses had great influence. They were power brokers between patients and their psychiatrists. Against advice I constantly fought with them, questioned their judgment and tried to second-guess them, but I never got anywhere because… I was a patient. So I started to think I was being converted to some perverse religion the basis of which was admitting I was powerless, not in the face of god, but of my psychiatrist. I was worse than a criminal because I’d got myself locked up without ever even having the character or courage to commit a crime. There was only one possible conclusion: This hospital was being run by a time-honoured alliance of Roman Catholics and Nazis. And then I realised, no wonder so many psychiatric patients develop a Christ complex, a system that makes people feel persecuted without them ever having done anything wrong creates them.

Still I had no idea when any of this was going to come to an end, which was torture in itself. I wanted answers so when my next consultation came around I invited Melissa along. Her presence only irritated Lisserman as he carried on and on patronisingly repeating I was making good progress, but refused to be drawn on when he intended to lift my section and let me out. “It’s irrelevant,” he said.

“But you’ll make me feel instantly better if you tell me when,” I said distressed.

“You need the time to make a full recovery,” he said, “and I’m confident you will.”

So how come he was doing everything he could to make me crazy or mad or angry or sad or ill, as he liked to put it? I used to pretend to be ill to get off school. Maybe this was some kind of belated comeuppance. My social worker, ever keen to have her say, recommended I have less contact with Melissa because she was making me confused.

And then I was surprised to be told I was “nearly there.” My care group, which comprised Lisserman, the butch woman, my key nurse, my social worker, the baby boiling nun, a magician, Richard and Judy, a cat and the kitchen sink, were due to meet shortly to discuss a supported hostel I could move to. Hearing this I very nearly cancelled my managers hearing the next day – my chance to prove that my detention was unlawful. But I had some points I wanted to make, first of which was where was the logic in scheduling these hearings so many months in advance that by the time they come around patients have either been released or are in a much worse mental state than when they arrived. I remembered Amelia’s tribunal that she won. It must have been so sweet to see her psychiatrist’s authority overruled. So I went ahead with it, I was even looking forward to it. Mother joined me, that way if it all went wrong she’d be there to fight my corner, or at least try to.

***

In front of three female hospital managers who looked like bread baking spinsters from a forgotten Shropshire village, and in her favourite kinky boots again, my social worker read from my revised patient notes. Now they covered events stretching back 18 months. She dredged up me crossing the railway line on my way back from Ireland. I groaned inside. Had I mentioned it to her at some point? Had someone told her? It was part of the trail I’d left, evidence against me. She said I’d put myself in danger. True enough. But she said I’d thrown myself onto the line. The truth is I’d crossed the line carefully after I thought I heard a gunshot. In my mind it was an act of self-preservation, not self-destruction. Anyway, why was this relevant now? Typical of her simple, tabloid mind, I thought. She’s trying to give others the bleakest possible impression of my condition, to consolidate my psychiatrist’s position no matter what, and make everyone think, mother included, that her lot are the only people on earth who know what’s best for me. Like some balmy cult taking me hostage, or being trapped in the belly of a whale.

Far from saying I was nearly there, Lisserman told the hospital managers I was seriously ill, a danger to myself, and in need of constant monitoring in hospital. Then he said something that really made my blood boil:

“It should be noted that Chris had a sister who…”

“How dare you mention her, she’s got nothing to do with this.”

“… I, we believe Chris is showing symptoms that are consistent with a schizophrenic related illness. Chris had a sister who was schizophrenic and killed herself by hanging. We believe there is a reasonable chance Chris could do the same.”

“What? Hang on a minute; you’ve never said that before… What the hell are you playing at?  Do you not realise your lot did that to her? You gave her nothing to hope for. You made her feel worthless…and now you’re doing the same to me…you’re killing me softly with your drugs. Anyway I thought you said I was bi polar something or other. How can you call me something when you’re not even sure what that something is? You’re making it up as you go along! You’re improvising! You’re all actors! Stick to the fucking script!”

“Chris has been refusing to take his medication. Medication that we believe is essential to control his condition.”

“What! Your potions are poison and your diagnosis is crap. I’ve been told I’m so many different things I might as well be called Gemini and treated by Mystic Meg! At least she’d give me something to look forward to.”

“Chris’s mood swings have also given us cause for concern. His thoughts are confused much of the time and we believe he has little insight into his condition. He cannot look after himself without at least first admitting that, like his sister, he has a very serious illness.”

Shaking with anger and incredulity I snapped: “What? Are you suggesting that I somehow inherited this…this whatever it is?! Listen to me you bastard. You…you like to claim mental illness is genetic and physiological because then it’s easier to treat… with your wretched pills. Something wrong with my brain chemistry is there? I’m not mad, I’m just mad at you! I’m not even ill, you just say ill because it makes your job easier. You know nothing about mental illness or me and what the hell gives you the right to say what’s best for someone? Your lot put my sister in a godforsaken place like here…just like here…against her will where…where she was raped…and…and…you did that for her own protection! Was being raped part of her illness? Did she imagine that? She thought she’d be killed eventually and with damn good reason. So she finished herself off and got one up on you! If only you were just a pathetic fraud and small-time criminal in a suit. But you’re not, you’re so much worse than that…you’re twisted, evil…you’ve got blood on your hands… Who the fuck do you think you are? The world is full of wankers like you who make it impossible for nice people to live in it. You’re the fucking psycho…you, you fucking murdering cock-faced cock. I know, why not measure my head! See if you can determine what’s wrong with me from that. Where’s your fucking conscience, you fucking Nazi?”

Once again he turned to his colleagues who were all agreed that my outburst was a perfect example of my condition. I wanted to rip his face off. Had I tried, I’d have only had violent added to schizophrenic or whatever they imagined I was that week. Betrayed, sobbing with rage and gasping for air I couldn’t compose myself.

“I’ll get my revenge, Lisserman, and it’ll be served with your cold brain!”

I stormed out and headed for the common room cursing him for all to hear. Mother came chasing after me. Other patients asked what was going on, intrigued by the drama. “Those sick bastards, where do they get off? They fuck their children up, that’s how they learn their profession. Yes, that’s it! They practice on their children. They analyse them to death until everything’s their fault. They’re doing it to me and they did it to Amelia… Who on earth are these people to me? How has it come to this?” Mother held my arm and tried to calm me. She was as surprised by Lisserman’s blatant U-turn as I was but what could she do, he’d usurped her. The psychiatric system, with all its breathtaking inconsistencies, had me manacled.

“A royal pardon, that’s what we deserve, nothing less!” I said suddenly composed. “Now you’re being mad,” mother replied.

“What’s mad about wanting an apology? Who will ever be held to account for what happened to Amelia?” There was a long pause when a patient wearing a KLF t-shirt offered me a cigarette from a blank, white packet.

“What are these?” I said.

“They’re death cigarettes,” he said, “50p for twenty.” I took one, and sucking hard it felt like a knife plunging into my throat.

“Smile, you’re on candid camera,” he said.

Mother persuaded me to return to the hearing. When I did I was told my exit was most irregular and could count against me. I tried to calm myself and told the three witches, one of whom seemed sympathetic, another indifferent, another hostile – that I’d been assaulted twice on the ward by another patient and I felt unsafe. This, at least, could not be disputed. My social worker returned to my notes that, like a jigsaw hastily thrown together, now included misinformation about Melissa and miscellaneous comments I’d made about my parents. No mention was made of my favourite pop group or sexual position. Powerless and humiliated I left the room and this time didn’t return, leaving mother to record my fate. The managers voted two to one that my section should stay in place. But much to Lisserman’s annoyance they decided I should be moved as soon as possible to another hospital where I felt safer.

***

My care meeting never happened. I think they thought my care irrelevant after the hearing. I thought its cancellation was punishment for challenging Lisserman’s authority, yet more punishment casually handed out, salt in wound. With nothing left to lose I fell back on the only weapon available to me: words. Perhaps this was how my great, great grandfather felt as a Protestant preacher in a Catholic country. Isolated but driven. God forbid, perhaps this was my spiritual home.

So I defied the sedatives they gave me in the evening and planned an all-night sermon. My aim: martyrdom. My subject: psychiatrists are, amongst other despicable things, legalised drug pushers who hide behind a mask of bogus scientific credibility, hijack language, make it slippery, then use it as an instrument of oppression. I improvised around song lyrics that suggested themselves to me. They were lyrics that said more about my life, about any life, than any of the nonsense my shrink said. It didn’t matter others had said it before me. So what? It wasn’t about being original. I was just the messenger proving beyond all doubt that there was glorious truth shining out of virtually every song ever written. Words and music that had always been a defence against the banality of the world had become a defence against its total cruelty.

So “talk, talk, all you do to me is talk, talk,” led seamlessly into, “say, say, say what you want,” which at some point evolved into a rhyme of my own,” you tell us we’re mad, that we’re not quite right and you give us pills to stop the fright, but the pills turn day into night and everything you say is trite,” which lead to a chant of: “psychiatry is the enemy of the imagination,” which reminded me of a newspaper ad, “are you shamed by your English, doctor?” which was answered by a burst of Oasis, “all you people right here right now. Do you know what I mean?” Then why not add some Happy Mondays, it could have been written about Lisserman, “he’ll stamp on your fire, he’ll change your desire, don’t you know he can make you forget you’re a man,” or even better, some Depeche Mode, it could have been written about me, “you’ll see your problems multiplied if you continually decide to faithfully pursue the policy of truth. Never again is what you swore the time before,” or best of all, some Stone Roses, it could have been written about Amelia with the express purpose of pissing off the baby boiling nun, “let me put you in the picture let me show you what I mean. The messiah is my sister ain’t no king man she’s my queen. I had a dream I’d seen the light don’t put it out ‘cause she’s alright yeah she’s my sister.”

Never pausing, that would be failure, my game of psychiatric Just a Minute lasted four hundred and eighty. Sometimes sense turned to nonsense, the jukebox broke down and my monologue deteriorated into simple word association, but that was partly the idea. There was still method in everything I said and it was never long before nonsense turned to sense again. My audience came and went, drifting in and out of bed, between unconscious and conscious in a twilight world that was neither. Noel Gallagher came close to my face, said: “What the fuck?” again but didn’t punch me.

“Leave me alone,” I said, “I’m doing this for all of us.”

It was a gruelling but cathartic process by which I exercised my right to say whatever I damn well liked, however provocative. I knew that nothing I said would come anywhere near to being as morally reprehensible and downright unlawful as was locking up an innocent man and force-feeding him poisonous drugs. “Now that’s what I call mental!” I yelled. In the morning I called for Lisserman to be overthrown and imprisoned in the Tower of London then roared so loud I felt my body weaken:

“Oh fuck it! Face the music, Lisserman! I’m not going to take this shit any longer. C’mon! Come and ‘av a go if you think you’re hard enough!” I dropped to the floor, the friendly Croatian helped me up, gave me a cigarette, a gold medal in mental hospital terms, and said: “No panic.” Exhausted I turned the radio on. Don’t speak was playing.

Ward round wasn’t due till later in the week but that afternoon I was summoned to see Lisserman. The atmosphere in the room was arctic. It was no place for Mary, Mary quite contrary. He was brusque and unfeeling, spoke at me not to me and just ignored me when I tried to speak. He said I’d relapsed and that my Haldol® pleasegodno was to be increased to a dosage that far exceeded anything I’d had before and, as I could not be trusted, it would be injected. I knew he knew this was the last thing I wanted. “What are you putting into me? What is this Haldol® Why is it called that? Is it…is it so recipients think they’re the last person alive on a spacecraft to Jupiter that’s been taken over by a computer. It feels like it!” I shouted pointlessly. Then I tried to say I’d not relapsed, if anything I’d had a relapse, if that’s how he wanted to describe it, induced by events at the managers hearing, but he crushed my resistance with ease.

The meeting was brief but brutally efficient, a swift, deadly rebuke. And why was the butch woman sat next to him saying nothing with her back to me the entire time? What sort of twisted mind games were they playing? Everything changed; the threat was unimaginable and overwhelming. Dispatched from his office I found myself in Hell’s holding bay where insecurity had escalated to the point everyone was acting as if they had a gun pointed at them. Dizzying terror had spread across the ward like a virus. Elderly, previously calm patients were sobbing and others that only minutes past had been lively and cheerful were frantically, desperately trying to reassure each other that everything was okay.

The psycho was doing it to all of us because I’d actually succeeded in making him think I was trying to start a revolt. He was using all his powers to raise the stakes, turn the known into the unknown, turn back time and instil the fear of god into his bleating, useless flock. It was off the Richter scale. “Bastards!” someone shouted. “They’re trying to scare us because they feel threatened and jealous.”

Wordless, unfamiliar nurse giants in white coats appeared and patrolled the ward. I went looking for Jean Luc, but he along with others had beamed out. They’d been voluntary patients all along. They must have realised their error and scarpered after receiving some coded warning that an army of feeling-deniers was on its way. I couldn’t cope with the fear. Had world war three just been declared? Had the Japanese infiltrated psychiatry? Was this payback for Hiroshima?

Suddenly a friendly nurse turned up from nowhere and led me towards the door reminding me that because of my hearing I was being moved to a hospital more suited to my needs. The friendly Croatian saw me being escorted and begged something I couldn’t understand. “No panic,” I said as the lift doors slid closed. Outside I saw an ambulance parked, ready to take me away from somewhere I’d been taken. My relief turned back to anxiety. The way out was a garbage chute, and what the fuck did a hospital more suited to my needs mean?

© Christopher Crook 2009

Also published on doc2doc on 17 November 2009

That the play 4.48 Psychosis has a strong theme of mental disintegration was obvious to me from the moment I walked into the Young Vic theatre and heard a fragment of a conversation taking place to my left.  ‘…I self diagnosed…’  4.48 is celebrated playwright Sarah Kane’s final work, performed for the first time only after her death in 1999 when at age 28 she hanged herself in Kings College Hospital.  Previous to this she had twice been a voluntary patient at the Maudsley, seemingly overwhelmed by depression.

Kane’s final piece is an angry, fragmentary work.  It makes no attempt at plot or character and was written without any direction as how many actors were intended to voice the play.  When first performed in 2000 at the Royal Court Theatre, two women and one woman performed the work.  The current Young Vic production, directed by Christian Benedetti, instead presents a monologue delivered by a single actress.

If I say that 4.48 Psychosis is reminiscent of Beckett visits the psychiatric hospital delivered by the character from Munch’s The Scream this may give an indication of what the experience is like.  Harsh lighting, shouting, snippets of conversation, and sentences without syntax expressed themes of pain, unrequited love, and intentions of suicide.  Conversations with psychiatrists feature prominently, whom Kane appears to have both needed and despised.

Not then the sort of thing you’re meant to actually ‘enjoy’ and with no dramatic arc the mind easily wanders to consider the relationship between Kane’s writing and her accompanying real life story.  Is this actually a play or, given the circumstances surrounding it, really a dramatized suicide note?  The play then suffers but is lent a greater relevance by the fate of its creator.

4.48 Psychosis at the Young Vic

There is I think an episode of Inspector Morse when Morse, whose investigation has conveniently developed to involve an alluring female psychoanalyst, is told by her ‘I’d love to get you on my couch’.  Not like that of course, and such a clichéd line embodies why treatment of the mind can be so fascinating.  It’s a chance to ask questions that would usually be considered rude, and to peer into people’s psyche, so far as they’ll let you. 

Such curiosity, combined with a dollop of the bizarre is amply sated by Alex Boese’s book Elephants on Acid and other Bizarre Experiments.  Here hoax aficionado Boese covers a wide range of scientific enquiry all of which has been published in scientific journals.  Some of it comprises a freaky sideshow but most of the experiments – despite their boldness – have actually represented a leap in our understanding of the human condition.  It’s predictably psychology heavy; Milgram’s grisly experiments in obedience lead him to conclude ‘if a system of death camps set up…of the sort we had seen in Nazi Germany, one would be able to find sufficient personnel for those camps in any medium-sized American town’.  Meanwhile his erstwhile school classmate Zimbardo was the instigator of the infamous Stanford experiment, were mild mannered college students rapidly lost themselves in their adopted social roles.  Festinger tested his ideas on cognitive dissonance by infiltrating a cult that believed in the imminent end of the world. 

Also mentioned are ultimately unsuccessful efforts to get dogs, having seen a bookcase fall on their master, to seek help; the title tale of the consequences of injecting an elephant with LSD, the effects on cockroaches on racing in front of their peers and the effects of LSD on the terminally ill.  It’s all told with a jaunty lilt and, unlike a lot of books I review here, is easily read on the bus.

In 1986 whilst working for the now ex-newspaper Today, journalist Alastair Campbell suffered a mental breakdown.  This would have remained a relatively private affair, but Campbell’s subsequent role as Tony Blair’s right hand man has meant that it has since become the second most famous mental health breakdown by a figure in current British public life*.  But there’s a happy ending: twenty-three years later, Campbell has not only become an extremely prominent public figure but has recently won the Mind Champion award for his work to reduce stigma surrounding mental health problems.  As well as representing the anti-mental health stigma campaign Time to Change, his contribution has included the BBC2 documentary ‘Cracking up’, and the novel ‘All in the Mind’.  Accounts of Mr Campell’s breakdown can be found on the internet, of which Wikipedia, One in Four magazine and a Ruby Wax interview provide four viewpoints.

For my part, and as part of my ongoing project to read every book about mental health ever written, I have just finished Mr Campbell’s abovementioned novel ‘All in the Mind’.  A curious book, and mostly dreadful, it takes place over three days in the life of reputable psychiatrist Professor Martin Sturrock.  Although highly regarded by his patients and colleagues, protagonist Sturrock is a man on the verge of a crisis, his mood nosediving and no less in need than his patients; his personal life is a mess; he is distant from his children, semi-estranged from his wife/in love with a patient and has a penchant for visiting prostitutes.

Besides breathing and standing up straight, Sturrock’s psychiatric work is the only thing he seems to be able to do to his own satisfaction.  Perhaps because of this he feels toward his patients a great responsibility and he is reluctant to cancel their appointments under any circumstances.  The book opens with Sturrock fretting over the consultations he has that day with five people whose own stories are subsequently woven amongst that of Sturrock’s throughout the book: a disfigured young lady, a mood disordered young man, a former victim of sex trafficking, an alcoholic cabinet minister and a straying husband.   Outside these consultations Sturrock’s boundaries with his patients are blurred and during them his methods unorthodox, with his enthusiasm for dream interpretation and conspiracy to mislead a patient’s wife examples.  Sturrock’s patients take his sessions very much to heart, and his sage pronouncements and homework assignments – which they are expected to email to him the night before their appointments – dominate their lives.

Occasionally All in the Mind’s simple tales of the woe are rather touching and the plot as a conceit is not a terrible one, but the central problem is that Campbell’s prose basically lacks the dexterity to convincingly render his characters’ mental states on the page and more than once the writing was so leaden that I wondered whether a blood vessel might burst in my eye.  A brilliant study of depression this is not, despite Campbell’s first hand experience. Furthermore, although it would be a mistake to come down on a work of fiction too hard for lack of verisimilitude, I do wonder whether Campbell has talked to a psychiatrist about what the job is actually like; Sturrock’s enmeshment with his patients is never criticised and his clinical unorthodoxy never acknowledged, the narrative being purely concerned with the tale of an excellent psychiatrist whose deftness with patients contrasts his own inner turmoil.  Campbell even goes so far as to suggest that psychiatrists have mind reading powers:

She would tell herself he was the psychiatrist not her.  He was the one who understood the human mind, not her

***PLOT SPOILER: do not read on if you intend to read this book***

As it informs the experience of the rest of the book I cannot but mention the ending.  During the closing chapters Sturrock’s depression takes a sudden, and frankly unlikely, turn for the worse and a florid psychosis leads to his death as he steps in front of a lorry.  Campbell then uses this tragedy to set up a mawkish and contrived ending, as before he dies Sturrock sends a text message to his wife asking that the patients about which we have read should make speeches at his funeral.  They duly do, and the church is unexpectedly full of people Sturrock has formerly treated, all wiping tears from their eyes.

The coffin was carried out.  Hundreds of mourners, many in tears rose to their feet as Mrs Sturrock and her family filed out behind it: pew upon pew of flawed people come to bid farewell to a man who healed many of them; who preached forgiveness, but could not forgive himself

Oh dear.  Campbell is a novelist only for the most undemanding reader.  He clearly feels grateful for the help he has received in the past, but I fear this is not the way to show it.

Other reviews:

Byron Rogers The mannekins don’t walk The Spectator 12 November 2008
Peter Kemp All in the Mind review Times Online November 2nd 2008
Sahmeer Rahmi All in the Mind review Telegraph 6 November 2008
Derek Draper Inside the sick world of the spin doctor Guardian 9 November 2008 – a notably more positive review than the rest, from the former labour insider turned psychotherapist before he revisited disgrace.
There was a positive review in the British Journal of Psychiatry (paywall)

*Can you guess which the best known one is?