Archive for the ‘Books Films Television’ Category

Review of Schizophrenia: who cares?

Monday, December 20th, 2010

The travel writer Tim Salmon’s son, Jeremy, developed schizophrenia in the late 1980s.  This book is Salmon’s record and examination of the ‘strange voyage’ that has followed.  It’s a critical, challenging book, but very well written, and never bland.

Schizophrenia turns Salmon’s previously able son into a difficult, paranoid and sometimes violent young man.  He behaves in ‘ways that were strange and inexplicable beyond anything I had ever known, beyond anything I had the language to account for’.  Every aspect of his son’s life is affected, his paranoia making friendships hard and intimate relations more difficult still.  Salmon offers a personal carer’s view on the situation that has developed; the fear and despair he feels as a parent, the hopes, regularly dashed, that his son may eventually lead a more ‘normal’ life.

As the title suggests, a great deal of the book is devoted to examining Salmon’s pragmatic frustrations with the NHS and one is left with an impression that he wishes to inform but also to vent.  He is not always diplomatic in this regard, and this may explain why this book has not reached a particularly wide audience.  It’s not difficult to sympathize: the constant changes of NHS staff make relationships of trust with professionals hard to form; it takes three years – and a barrage of letters – for a care planning meeting to be held; Jeremy’s hostels are toxic and lonely.  Of one NHS employee he writes:

“He replied that he was going on a course and would no longer be involved in Jeremy’s care.  He had arrived on the scene in January of February, heard my concerns but kept me at arm’s length out of respect for client autonomy, unable without my son’s consent to disclose the time of meetings I had been attending for years, encouraged my son to go on a course which lead to my having to go to Toulouse to rescue him and now, in July, after a mere six months of involvement he was going off on a course and washing his hands of the whole business.  Par, one might say, for the course!”

Salmon is generous towards psychiatrists – whom he regards as ‘scientists, trained to look at evidence, identify facts and call them by their proper name’ – but sharp stones are aimed at managerial staff whom he considers to be often of low intellectual quality.  Salmon’s provocative stance is that their increased involvement in patient care has been associated with a shift of emphasis away from effectively treating and supporting those with mental disorder towards an unhelpful focus on ‘issues around mental health’ – ‘accommodating ethnic diversity, obsessive concerns about confidentiality and patients’ rights’.  He finds the accompanying terminology distasteful:

The current jargon – empowering, accessing, service-users, delivering services, service-providers, advocacy, client – implies at number of assumptions that in my view are inimical to the cause of the mentally ill.  First it implies a relation between the sick person and his healer that resembles that between the purchaser of a pound of peas and the shopkeeper more than that between what we used to call the patient and the doctor.  Second it seems to imply a sort of hostile intent on the part of the healer: that treatment whether clinical or otherwise is a sort of coercive intervention from which the ‘client’ needs protecting.  Third it implies that the sick person is a rational being capable of taking informed decisions about his own condition and treatment.

Also an anathema is the repositioning of mental health charities towards addressing all mental health problems, serious or not, and their focus on ‘stigma, fear and prejudice’ at the expense of practical help.  He considers talk of empowerment inappropriate for people with schizophrenia who ‘are not going to move on’ and who need ‘stability, security’ above all else.  The recovery model is dismissed as a fudge as, with this approach, ‘put crudely, you do not need to be well to be called well.’

Salmon’s ultimate conclusion is bleak:

He is difficult my son, it goes without saying, but what use is a system that in thirteen years has not been able to tackle any of his central needs, even the straightforward practical ones like benefits and prescriptions?

As well as offering a personal narrative on the effects of mental illness Schizophrenia: who cares is an uncompromising view of the shortcomings of mental health care in the UK today.  Although such a statement of doubt is valuable in itself, I would have welcomed a more fully developed argument on why the current narrative of recovery and empowerment has taken root.  The current ‘issues around mental health’ approach can be seen as a reaction to historical concerns regarding institutionalization of patients, exclusion of ethnic minorities, and abuse of human rights.  Whilst Salmon may believe that we’ve overshot with our concerns in this regard I doubt he would be in favour of a wholesale return to past practice.  Given his day job it is curious that he is not more sympathetic to the vulnerability of ethnic minorities and a general weakness of this book is Salmon’s generalizations which do not peer beyond his own cultural viewpoint or experiences – some people with schizophrenia can hope for a much better outcome than his son for instance.

Prologue from the book

What’s in a name? Patient, survivor, client – Tim Salmon letter to The Psychiatrist 2010

All in the mind – Tim Salmon features 15 June 2010

Snow from Ebury Ward

Thursday, December 2nd, 2010

This poem accompanies an interview with Sarah Wardle, and is from her book A Knowable World

Snow from Ebury Ward

Each snowflake is a minute of detainment,
filing the air with falling measures of time,
not settling, but hitting the ground to melt,
like wasted hours, sectioned for losing one’s mind.
Sometimes the wind eddies the snowflakes upwards
and they take longer to sink, as moments stall,
like the sensation that time is going backwards,
that we’re forgotten and no hope’s left at all. 
But somewhere in me there is still delight
to see each snowflake, as in a Midland’s winter. 
And though down south it doesn’t stick, the sight
of snow in March give us a white Easter. 
By lunchtime there’s no trace, but half a day
has been ticked off the time I’ll spend away.

Interview with poet Sarah Wardle

Thursday, December 2nd, 2010

Sarah Wardle, poet and author of ‘A Knowable World’ recently came to speak at a conference I helped organise.  A Knowable World follow’s Sarah’s detainment in a Central London psychiatric hospital for over a year for manic episodes of bipolar disorder and it received positive reviews from both the British Journal of Psychiatry and the Guardian newspaper. I would also recommend it as her poems offer an eloquent glimpse of experiences that are relatively rarely documented.

Sarah has kindly allowed me to publish one of her poems to accompany this interview, which can be found in the post following this one.

 

Can you tell us about the circumstances which lead to you writing ‘A Knowable World’?

I had already had two collections published and in my third book wanted to chronicle time spent in hospital, much as Kate Clanchy chronicled pregnancy and childbirth in her third book, Newborn.

Were these poems written in the large part with events, or afterwards?

Apart from a few at the beginning and end, written before and after, most poems were written on the wards, for example one that begins, ‘The consultant psychiatrist is on the ward./ In his proximity all is hope with the world’.  Others were responses to the daily round of fire alarms and PRN, to snow seen on Easter Sunday from a ward window, or to a fellow patient’s suicide.  The opening poem describes the MRI scan that prompted a previous psychiatrist, Professor Basant Puri, to take me off medication and put me on fish oil.  The closing poem describes walking up Ben Nevis and celebrates being out in the open again.  Writing was a lifeline for me and I was heartened to receive in hospital acceptances from journals, such as The Times Literary Supplement, for poems written on the ward.

In his famous experiment Rosenhan reported the staff commenting on pseudo-patients’ ‘writing behaviour’.  Did the staff ever comment upon your writing? 

I wasn’t writing only poems.  I tried to write, not fight, my way out, for example, writing for tribunals and hearings.  I remember after writing a sonnet to the doctor, a nurse saying he would throw it away.

What was your aim with AKW – to inform, to record, to heal?  Your poems are often very personal, and are about events about which many people might prefer to get as little attention as possible; did you ever consider not publishing any of the poems?

Yes, my aims were exactly those – to inform, to record, to heal – for others as well as myself, and to make ‘a knowable world’ of such circumstances to those who may have little experience of them and may perhaps stigmatise people who have mental health difficulties.  Hopefully they will have appeal beyond their subject matter.  I have to say, as a writer, I write for the intrinsic pleasure and pastime of writing and this act of concentration helped me in hospital.  Because I value authenticity in writing, I did not self-censor.

 

I’m not generally a reader of poetry, but I was impressed by the emotional immediacy of your poems and their power to compel me to reconsider situations from an alternate viewpoint. Why do poems have this advantage over prose? ( I’m reminded of how Francis Bacon said he wanted to paint portraits: “Not an illustration of reality, but to create images which are a concentration of reality and shorthand of sensation” – perhaps poems are similar.)

Because poetry is midway between music and painting, it can deploy both sound and imagery to affect emotions and transmit truths in a more startling and defamiliarising way than prose. Iambic pentameter, the lifeblood of poetry in English, has a soothing beat and I was interested that when I had the MRI scan, I was told that parts of the brain responsible for music were highlighted, since, as it says in the opening poem, ‘I kept speaking poems I had written/ to myself, trapped inside that white coffin’.

 

Throughout the book there is a sense of your fighting against state systems of containment (the police, components of the mental health system etc.) which suggests a very negative experience – and it’s more than some people’s jobs are worth/to open a locked door or grant a wide berth (“Wild Card”) – but yet you are strongly drawn to the psychiatrist who is in charge of your care and also write of missing the ward when you are discharged. How do you reflect now on this apparent contradiction?

Well, I have never literally fought anyone, in terms of punching, or kicking.  Growing up without siblings, I never learnt to fight.  I fought for my liberty by applying to tribunals and hearings and this very system is there so that you can be discharged earlier than your hospital care plan allows.  There is inherent struggle to the psychiatric patient’s position, since you find yourself detained in a challenging environment for the foreseeable future with little explanation of why you must be medicated against your will.

You don’t often glimpse your doctor on the ward, though the consultant allotted to me was more present than others, but when you do, the nursing staff and patients defer to him, plus he holds your release in his hands, so he can become a larger-than-life figure.  One sees policemen even more rarely, but it is a comfort when you do, because they come when you have called them for help, when you feel you are being mistreated.

I developed a crush, or transference, on the psychiatrist after I’d been A.W.O.L. and he mentioned a poem from my first book, called ‘Flight’.  I must have looked amazed he’d read it because his response to my expression was to cry and I was moved by his sympathy.

The patient may be discharged, as I was, to living alone and it is true that after a whole year of the camaraderie of fellow patients, one has to adjust to silence, but I have no doubt this is preferable.

 

At the Art of Psychiatry conference you were able to meet psychiatrists in an out-of-work context, so you’ve seen us at ‘work  and play’.  What do you think of us?

First, thank you again for inviting me to take part in the conference.  It was a very interesting day and the people I met were thoroughly pleasant. It was cathartic to be faced with a hall of people with sectioning powers and be treated as a working equal, not a ‘patient’.

 

Do you have any advice for the psychiatric profession?

As a lecturer I see a class of students, but try to get to know each one’s writing and themes and read and listen to them as individuals.  In this respect students are like patients and benefit from empathy and individual care.  I would recommend my consultant, Dr Ronnie Taylor, as an example of good practice in this regard.  Some doctors and nurses would do well to remember we are all patients of some specialism in the end.

Review of ‘Movies and Mental illness’

Tuesday, November 30th, 2010

My review of Movies and Mental Illness 3 has been published in the Journal of Mental Health (currently online, but it will be in the next print edition).  I have posted about psychiatry at the cinema previously. 

Unfortunately in order to get the review published I’ve had to sign over my copyright.  So the review is available here, but only to people with a login.  In summary this book exhaustively documents psychopathology as seen in cinema.  Major diagnoses get a chapter each where one film is studied in detail.  At the end of the book there is an appendix of films listed by disorder as well as an exhaustive index.  The authors are evangelical about films as a medium to teach psychopathology.  Personally I prefer documentary and literature.

Review of ‘Estates: An intimate history’

Thursday, October 21st, 2010

The Coalition Government is proposing that council houses ‘for life’ are to be phased out, with new tenancies being of fixed term and tenants being encouraged to find accommodation in the private sector when they are financially able.  No better time to review Estates: An Intimate History by Lynsey Hanley:

Council estates – very often large, indistinguishable blocks of housing found in inner cities and on the outskirts of towns – have become familiar features of the British landscape.  The social problems encountered on many of these estates have meant that, rather than realising the anticipated Bevanite socialist dream, ‘council estate’ has become shorthand for ‘proletarian hell’.

In this part history, part personal memoir journalist Lynsey Hanley looks at the UK’s social housing from both inside and out.  Hanley was born and raised on a Birmingham council estate and writes that this book is ‘an attempt to work out how much of the stubborn rigidity of the British class system is down to the fact that class is built into the physical landscape of the country’

Although ‘council housing’ is for many forever associated with unappealing tower blocks, subsidized rented homes were first built by philanthropists in the mid-nineteenth century.  The first ‘council estate’ was the Boundary Estate in Bethnal Green which replaced the notorious Old Nichol slum.  It was World War I which provided the impetus for the first large scale housing funding when Prime Minister David Lloyd George announcing that returning soldiers deserved ‘homes for heroes’.  This initiate was also aimed to at sidestepping a feared Bolshevik revolution.

Further building took place after the Second World War as four million houses had been destroyed or damaged beyond repair whist the UK population had increased by one million.  The acute housing shortage which followed engendered government targets of 300,000 new homes to be built each year during parts of the 1950 and 1960s.

Despite reports that the flat accommodation predominately provided proved unsuitable for families and communities alike, these homes were often erected quickly with previous high standards being disregarded.  That the burden of the consequences of this myopia fell directly onto the disadvantaged is a theme to which Hanley returns again and again.  Communities found it hard to establish themselves in the new estates, which were often placed outside towns with poor access to transport or amenities.  Occupants felt unable to police the anonymous stairways and walkways on which they lived and these became havens for antisocial behaviour.  The prosperity of many estates suffered as tenants were predominately employed in poorly paid jobs of the sort that have, with deindustrialization, become progressively more precarious.

In the 1980s Thatcherite reforms meant that those living in council houses were able to purchase their previously rented properties.  Although popular, this has reduced the housing stock available for councils and by Hanley’s reckoning has further marginalizing those unable to step onto the housing ladder.  Such is the continuing unmet demand for social housing that some councils have actually begun to buy back council homes.

Hanley’s anger that we have created ‘single class concentration camps’ is thus set out; the difficulties in escaping such confines are illustrated by her own experience.  Poor schools situated on council estates have low expectations of their pupils and some of the worst exam results in the country.  In addition there are less tangible barriers to social inclusion or, as Hanley describes (and borrowing a phrase from reunified Germany) a ‘wall in the head’.

Most social housing is now not actually owned by councils and much of what is now built are mixed developments of social and private housing.  Hanley concludes by relating her own experience of purchasing a council home in East London and her subsequent attempt, as part of a committee of residents, to have the estate redeveloped into something more suitable.  Her vision is proper housing for all, with social housing ‘less distinguishable from private housing in order to give those who rent a more equal chance in life to those who buy’.

Hanley’s answer to her own question is ‘yes’; council housing has made class segregation worse and whilst many people have a surfeit of choice in their lives, a minority have none.  Although Estates often falls foul of making the similar point again and again, she has nevertheless succeeded in making the subject of social housing compelling.

***

Here’s an interesting paragraph from the book about mental health:

Although many people manage to hold themselves together and even thrive in the single class environment of a council estate, hidden damage is caused by many factors.  First, there is the simple knowledge that you are surrounded by poor people – poor who have drawn the short straw in life and can see no obvious way of lengthening it.  The fact that you are living in a place populated almost exclusively by the poor makes those who are less poor unlikely to enter the area unless they have to, further entrenching its isolation and the stigma of living there.  That isolation in turn limits the aspiration of those poor people by presenting few clear alternatives to the lives being lived around them.  If those lives seem mad and chaotic, that madness and chaos will spread to those who are the most susceptible.  So it spirals down.  The sense that you are fettered by circumstances beyond your control – lack of money, a house that you have not chosen to live in, noisy and antisocial neighbours – will, if left unchecked, inevitably lead to depression and general poor health.  …. In American housing projects, the ‘ghetto miasma’ that is said to cast a pall over the lives of the (overwhelmingly black) poor lifts miraculously from anyone who is moved out of them to single family homes on the edge of the countryside.

 

Folie à deux? “Madness in the fast lane”

Tuesday, October 12th, 2010

Last month’s BBC documentary ‘Madness in the fast lane‘ has just come to my attention.   It tells the story of Ursula and Sabina Eriksson, two Swedish twins, who were captured on camera as they ran into the traffic on the M6 – apparently without motivation.  One spent months in hospital, whilst the other was released from police custody and subsequent events lead to a murder trial.

Unfortunate title aside, the twin’s behaviour appears to have been the result of an episode of folie à deux so is of interest to students of mental disorder.

The documentary is available on YouTube – you’ve got to sign in

 

Folie à deux

Shared delusional disorder was first described in 1860 by Jules Baillarger, who called the syndrome folie à communiqué.  It was later described by Charles Lasègue and Jules Falret, who coined  ‘folie à deux’ in 1877. Other names, including shared psychotic disorder, shared delusional disorder, and induced psychotic disorder, have also been suggested.

In folie à deux, one individual develops a delusional belief in the context of a close relationship with another person who already has an established delusional idea. The key features of the disorder are the unquestioning acceptance of the other individual’s delusional beliefs and the temporal sequence of development of the disorder, with one of the individuals having an earlier onset.   Although shared psychotic disorder usually involves two individuals, it may involve more than two individuals, including entire family units.  The delusion resolves in the second person on separation.

Acute polymorphic psychotic disorder

This is a diagnostic category from ICD-10 and is found under the category of ‘Acute and transient psychotic disorder’ (F23).  It is further subdivided into acute polymorphic psychotic disorder without symptoms of schizophrenia (F23.0) and acute polymorphic psychotic disorder with symptoms of schizophrenia (F23.1).

Acute psychotic disorders are characterized by one or a combination of acute onset of delusions, hallucinations or incomprehensible or incoherent speech.   Acute polymorphic psychotic disorder is a variant where symptoms change rapidly in both type and intensity from day to day or within the same day.  The episode remits completely with no residual symptoms and are not due to substance use.

The diagnostic guidelines are influenced by several historical syndromes including bouffée délirante (literally a ‘puff of madness’).  The syndrome was introduced by Valentin Magnan (1835–1916) and Paul-Maurice Legrain (1860–1939) in 1895 as caused by ‘degeneration’, a 19th-century view that attributed mental illness to the spread of modern civilization and urban life.

Interview with Darryl Cunningham, author of ‘Psychiatric Tales’

Sunday, August 8th, 2010

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

Psychiatry at the movies

Saturday, July 24th, 2010





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)

The depiction of mental illness in film

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.

Cinematic stereotypes of mental illness:

Patient as rebellious free spirit

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. 

Patient as homicidal maniac

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.

Patient as seductress

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

Patient as enlightened member of society

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

 Patient as narcissistic parasite

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

Patient as zoo specimen

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’.

Some dominant themes concerning mental illness:

Presumption of traumatic aetiology

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.

Schizophrenogenic parent

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.

Psychiatrists:

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:

Psychiatry in the cinema

The Portrayal of psychiatry in recent film

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

Interview with Iain McGilchrist

Thursday, February 4th, 2010

master cover

It’s interview week here at Frontier Psychiatrist and I’m very excited that Dr Iain McGilchrist has agreed to be featured on this website.  Dr McGilchrist is a psychiatrist with an unusual background as, before he turned his attentions to psychiatry, his first career was in the academic study of literature.  He has recently published ‘The Master and his Emissary’ a book which posits that the division of the brain into two hemispheres is essential to human existence, making possible incompatible versions of the world, with quite different priorities and values.

If readers would like to find out more about Dr McGilchrist’s ideas then the introduction of the book is available for download from his website.  He has also published an essay in the Wall Street Journal: The Battle of the Brain: The mind’s great conflict spills over onto the world stage

You’ve had a very varied career, most notably starting off as a scholar of English literature before training as a doctor and then as a psychiatrist. What was the motivation behind your change of tack?

Much as I loved working with literature, I began to see that the explicit approach to a work of art, which the critical process demanded, was inherently unsatisfactory. It substituted something abstract, cerebral and generalised for an entity the whole purpose of which was to lead us in the opposite direction.  The encounter between the work of art – the poem or whatever – and ourselves was not like dealing with an object, more like the encounter of two people, each unique, each embodied, each an indissoluble whole that could be only mis-represented by examining its parts.  The value of the work of art depended on things that were radically altered by their context, which were implicit, and had to remain implicit, if they were not to lose their power.  The relationship between mental experience and the physical fact of our own embodied selves seemed to be central to this conundrum, and I studied what the philosophers had to say about the so-called ‘mind-body problem’.  Eventually it became clear to me that they were themselves too prone to deal with this fundamental fact of existence in an abstract, decontextualised, disembodied fashion, and I thought I ought to train in medicine and find out for myself, in a more embodied way, what it was like when things went wrong with people’s brains and bodies, and how that affected their minds.  So I wrote a book about my concerns, called Against Criticism, and went off to study medicine.  Then after a brief spell of  neurology, I went to the Maudsley to train as a psychiatrist.

How has a training in literary scholarship informed your practice as a psychiatrist?

You might expect me to say that perhaps the reading of great novels and so forth has influenced the way I think about disease and death.  Maybe it has, but if so it is at a level beneath my awareness – implicitly, one might say, rather than explicitly.  What I would say, though, is that having a training in the humanities in general makes a vast difference to how we see what it is we are looking at when we approach the human being, the human body.  Many medics, whether they are aware of it or not, accept unquestioningly the scientific model of the body as a machine.  I say ‘scientific’, but of course the paradox is that in physics a far more sophisticated understanding of what matter is has been forced on its practitioners, with the result that their universe is far less mechanical than that of biological scientists, who remain becalmed in the untroubled waters of Victorian scientific materialism.

Medicine could be seen as a branch of psychiatry, and psychiatry as a branch of philosophy.  Philosophically speaking, many medics are quite unreflective.  I think that the Americans have got it right in making medicine a second degree.  Of course at the simplest level, it allows people time to mature, and to make sure they have made the right decision – some doctors I have encountered clearly didn’t.  But, even more important, it permits a period of intellectual exploration and questioning, before getting stuck into a medical degree, with its overwhelming demands for rote learning and the acquisition of information, largely without time to question.  As a result the fundamental questions don’t get asked by those who actually have the experience – the questions are left to philosophical outsiders.  It is no kind of piety to say that, hard as we work for it, the experience we have as physicians of the mind and body is vastly precious, a real privilege that the others, the professional philosophers, can only imagine, and we must never lose the ability to stand back and look at what it all tells us in the broadest possible context.

Can you explain what you mean by ‘medicine could be seen as a branch of psychiatry’

When I was a House Physician, I remember there were all these patients who came in on take with chest pain.  Of course we did ECGs and cardiac enzymes – but no luck.  Sometimes we sent off all manner of rarified tests.  All negative.  I remember working for the Professor of Medicine: the tests we were supposed to send for extended all down one page of A4 and half way down the next.  But no-one thought of – possibly, it occurs to me now, no-one even knew how to – sit down with them and ask about their lives: their families, their wives or husbands, their children, their jobs.  And when I was the House Surgeon it was the same, except the problem now was abdominal pain, rather than chest pain.  But the same picture – loads of tests, drips and invasive procedures: zero insight into the most common cause of abdominal pain.  The psyche.

It still seems to me a scandal, in view of the fact that over 60% of GP consultations are ultimately psychiatric in nature, that you can’t become a GP unless you have done attachments in obs & gynae, and paediatrics, but you don’t have to know the first thing about psychiatry.

That is in a way trivial answer, but I hope a vivid one.

A more serious one is that we need to see every complaint, physical or mental, in the context of the whole person.  Typically physical medicine looks only at this ‘machine’, the body.   I want us to look at the person as whole, by far the most important and complex part of which is the psyche.   Every physical illness affects the mind; every mental illness affects the mind.  Every symptom reported comes via the patient’s mind.  That is why medicine is a branch of psychiatry.  It is just the report of the person of physical as well as mental symptoms.  To understand mental symptoms you need to understand psychiatry.  To understand physical symptoms you need to understand – psychiatry.

Also it’s not clear to me why you write that physicists are less mechanical in their thought than biological scientists.  Surely if mechanistic thought has a place it is within the realm of physics?

You may not have kept up with contemporary physics!  If you look at Bohr, Bohm, Dirac, Planck, Heisenberg, Davies, Polkinghorne,  you will see that all the mechanistic assumptions of Newtonian physics have had to be abandoned, in the face of evidence that reality is not determinate, precise, atomistic, explicit, but indeterminate, probabilistic, interconnected and implicit. A vast topic, and one that has been very widely explored, but one that is of ultimate philosophical importance, and sets the ‘hard’ sciences against the current intellectually lazy mindset of biology.

Having started off working for the NHS you now work exclusively in private practice. What motivated your switch?

I never foresaw that I would end up working privately – I was completely committed to the ideal of the NHS; and to this day I do not have health insurance myself.  But I could not ignore what was happening.  I felt I was deskilled working as a psychiatrist in the NHS.  A largely politically motivated, and in my view deeply mistaken, drive to marginalise the role of the psychiatrist, and with it the skills of diagnosis and appropriate treatment, has been disastrous.  And the range of conditions with which, in practice, one gets to deal in the NHS is too limited, the therapeutic resources at one’s disposal are too meagre, and too much time is taken up with paperwork, ticking boxes, and keeping various bureaucrats happy – far too little in patient contact.

On top of that, I wanted freedom to be in control of my time and the way in which I worked.  I knew I wanted to write the book that became The Master and his Emissary, and I knew that there was no way I could do that unless I could choose to work as I do now, fitting a normal week’s work into three very long days (during which, incidentally, I get as much clinical contact as I would have done in weeks in the NHS). This gives me a fighting chance of spending the intercalated days in the library and on research.  I also felt, rightly or wrongly, that the sausage machine that academic psychiatry has become was no place for someone like myself, who wanted to do something unconventional – despite the fact that many people probably see me as a natural academic.  The constant pressure to publish papers would not have given me time to develop a long piece of work, and would have prematurely foreclosed the direction of my thinking.  And you can no longer get funding unless the work you do is fairly similar to what other people have already demonstrated to be ‘fruitful’, produces ‘positive’ findings in a limited period, and brings in money and prestige for the research group to which you belong. I fear that this is likely to have a stifling effect on originality, and can only encourage us to go ever more down the path we are already treading.

What are the main differences between NHS and private psychiatry?

First of all, I think the difference between private medicine in general and private psychiatry is enormous.  In private medicine (or surgery) all you get by going privately is a chance to jump the queue and, when you get into hospital, to have a glass of wine in your hand.  The range of conditions covered, and the standard of treatments, is largely the same.  But private psychiatry is different.  There are whole swathes of suffering humanity who get little or no help under the NHS.  Unless you are psychotic, and about to kill yourself or someone else, you don’t stand much of a chance.  However there are enormous numbers of people, who, to my eternal shame, when I was in the NHS I learnt to think of as ‘the worried well’, who suffer at least as much as the psychotic, and in some cases more, from a range of anxiety and depressive disorders, often quite subtly interlaced with personality factors, and sometimes addictive behaviours, that are simply given short shrift in the NHS – because they are too complex and time-consuming to treat – but are treated, along with the psychotic, by private psychiatrists almost alone.   I am glad to say that I see many psychotic patients, in whose treatment medication plays a central part, but I am also able to help people who need much more than a drug can give.  And having control of one’s time is not only personally liberating, but makes it easier to be kind to people and to listen to them carefully.

Moving onto your book: the relationship between the right and left sides of the brain is not something that concerns most psychiatrists.  How did you come to be interested in it?

I think it again relates to my philosophical background.  That the two hemispheres interpret and create the world differently, with different modes of attention, different priorities and different values, emerged from Bogen and Sperry’s work in the 1960s and ’70s.  That should have been of the highest interest, since the world we inhabit is brought into being for us by our brains.  And at the time it did give rise to a lot of speculation.  But we were looking for different ‘functions’ for the two halves of the brain to do, as if it were a machine with a lot of little specialised modules –language here, maths there, or reason here, emotion there – again in a ridiculously naïve way.  Over time, we discovered that each so-called ‘function’ was carried out in both hemispheres, not one, and people gave up looking for a real difference.  This is despite the fact that there are obvious, undisputed objective differences in the shape, size, neuronal architecture, neurochemistry and neuropsychology of the two hemispheres.  It seems obvious to ask: what does all that signify?  What I began to see – and it was John Cutting’s work on the right hemisphere that set me thinking – was that the difference lay not in what they do, but how they do it.  In particular, the right hemisphere was capable of appreciating ambiguity, the implicit and the metaphorical, where the left hemisphere tended to require certainty, the explicit and the literal; the right hemisphere saw the broad context and the world as a seamless whole, interconnected within itself, where the left hemisphere focussed on detail and produced a lot of separate fragments; the right hemisphere was far more capable of understanding new information, while the left hemisphere dealt with the already known; the right hemisphere saw individuals where the left hemisphere saw categories; the right hemisphere realised the importance of what is intuitive and embodied, where the left hemisphere prioritised abstraction and rationality (here I distinguish mere ‘rationality’ from the all-important, and far more complex, ‘reason’, to which both hemispheres need to contribute).  This illuminated problems in the nature of human thought and experience that I had struggled with all my life, and which had been brought into focus by my study of literature.

Can you briefly tell us about the thesis of The Master and his Emissary?

Well, some of it I have already referred to.  I posit that evolution has kept two types of attention apart, because they tend to interfere with one another; it has separated them by the hemispheric divide.  There is now an enormous and expanding body of literature that suggests that in birds and animals the left hemisphere provides focussed attention on something that we have already decided is of significance, while the right hemisphere keeps an open attention for whatever may be, without preconception.  This enables them to feed (focussed grasp of what needs to be manipulated) while staying alive (the broadest possible open attention for conspecifics or predators).  For example, chicks use their left hemisphere (right eye) to pick out the seed from the gravel on which it lies, while their right hemisphere (left eye) remains vigilant for predators.  Equally mates and kin are best identified with the right hemisphere (left eye) in most species.

Humans have large frontal lobes, which enable them to stand back from experience: this puts the hemisphere division to new use.  For purposes of manipulation, the brain needs a relatively simple map of the world which enables it to be efficient in getting hold of things: denotative language and the ability to grasp with the hand are its tools in this representation and manipulation of the world, and they are controlled, as one might expect, from the left hemisphere.  All the rest, the ability to pick up the complexity of experience and take the broadest view, goes on in the right – which also means that it sees us, not as atomistic, distinct entities in competition with one another, as the left hemisphere must, but as interconnected, interdependent entities. Empathy, social understanding, humour, metaphor, more subtle emotional understanding, the appreciation of individuals, the reading of faces, and much else goes on in the right hemisphere.  Fascinatingly there is clear evidence that the left hemisphere alone codes for machines and tools – even in left-handers, who would be using their right hemisphere to use tools and build machines in daily life.

So the first part of the book looks at the evidence in considerable detail, and then explores the significance of this for the nature of the world which each hemisphere ‘sees’ – the take, if  you like, that it has on the world.  Overall it seems that the right hemisphere sees and knows far more than the left hemisphere, but does not have the left hemisphere’s  tools for asserting its point of view: denotative language and serial analysis.  Applying them achieves something very important, certainly, but it is also incompatible with seeing the whole.  Hence the need for separation of the two realms of thought and experience (the principle function of the corpus callosum is to inhibit).  But the relationship between them is asymmetrical, as is the brain itself.   The first appreciation of anything comes to us via the right hemisphere, and the ultimate understanding of it in context does so also. Some very subtle research by David McNeill, amongst others, confirms that thought originates in the right hemisphere, is processed for expression in speech by the left hemisphere, and the meaning integrated again by the right (which alone understands the overall meaning of a complex utterance, taking everything into account).  More generally I would see the left hemisphere as having an intermediate role: it ‘unpacks’ what the right hemisphere knows, but then must hand it back to the right hemisphere for integration into the body of our knowledge and experience.

The trouble is that the left hemisphere’s far simpler world is self-consistent, because all the complexity has been sheared off – and this makes the left hemisphere prone to believe it knows everything, when it absolutely does not: it remains ignorant of all that is most important.  The second part of the book explores the history of the Western World, looking at our changing way of thinking about ourselves in terms of what we know about hemisphere differences.  My overall conclusion is that what starts off well balanced in Ancient Greece, and again at the Renaissance, with both hemispheres working in tandem – the optimal, indeed necessary, state of affairs –  turns into unstable swings of the pendulum, with a relentless movement ever further into the world of the left hemisphere alone.

In your book you take us through, in light of your thesis, the movements which have shaped Western Civilization over the past 2,500 years.  However anthropologists hold that behavioural modernity emerged 50,000 years ago, so presumably the conflict of which you write started long before then.  Can you reflect on this? 

Yes, it’s an interesting question.  I do deal with that in Chapter 3 of the book, where I ask what kind of a thing language is, and why we have it.  The answers are, I believe, not at all what we might think.

In any case, the Middle/Upper Palaeolithic transition 50,000 years ago which you refer to, also known as the Upper Palaeolithic revolution, reveals a massive and sudden expansion in artefacts, symbolic tokens and images which is thought to indicate the origins of language.  However language only became written much later, about 3,300 BC in Sumer.  In brief, the evolution of writing resulted in a complex tool which enables us to deal with what is no longer in front of us, to stand back from things in time and space and consider them at leisure and in detail.  Whether it was something to do with this or not, there was certainly what looks like an expansion in frontal lobe function evident in Greek civilisation: an ability to stand back from the world and from one another.  This enables us to be better at manipulating one another, to be sure, as we tirelessly hear, but also – and this seems to have been completely overlooked – to empathise more with one another, seeing others as individuals just like ourselves for the first time.  Hence Greek civilisation is marked by a need for an expansion in both what the right hemisphere does, and what the left hemisphere does.  One of these, the right, led to pre-Socratic philosophy, the sense of individual justice, of moral virtue, mythology, mathematics, empirical science, the evolution of drama, music, and poetry rich in narrative, metaphor and humour; the other to the development of Plato’s analytical philosophy, the codification of laws, military efficiency, the expansion of commerce, science in which theory came to predominate over empirical exploration, and in general the systematisation of knowledge.  There is an accentuation at this time in what each hemisphere can achieve – each becomes more individuated, in a way ‘more itself’, more distinguished from its counterpart.  Which means that they become more separate.  This is where the trouble starts.  At first they hold together like a pair of horses pulling a chariot at speed –later they pull apart and the wheels come off the chariot.  This may sound rather fanciful, since I haven’t got the space here to elaborate a very complex argument and to adduce the necessary evidence.  But I would just say to readers – please take a look for yourselves at what I have to say.

Your conclusions refer to Western Civilization.  Why do you not think that left/right conflict is more universal?

I suppose that I would have to say that I do not know enough about other civilisations to talk about them with any authority.  It may be that something similar can be found elsewhere.  But at the end of the book I do adduce evidence that has been gradually amassing over the last decade or two that Far Eastern peoples, the Chinese, Japanese and Koreans, use strategies of either hemisphere equally, in a very balanced way, in approaching the world and solving problems, whereas Westerners are very heavily skewed towards using only the strategies of the left hemisphere.  The Scientific Revolution which has, as Stephen Gaukroger, the great historian of science, puts it, led in the West to the ‘gradual assimilation of all cognitive values to scientific ones’, is ‘exceptional and anomalous’: in oriental cultures, where there were very sophisticated advances in empirical science long before we began to make them, science is seen as ‘just one of a number of activities in the culture, and attention devoted to it changes in the same way attention devoted to the other features may change, with the result that there is competition for intellectual resources within an overall balance of interests in the culture.’

My reading of your writings is that pervasive societal norms form a feedback loop with the relevant part of the brain reinforcing particular characteristics and it is this that has led to what you postulate as the current dominance of the left brain.  Do you think that that brain has evolved in the past 2,000 or so years?

Well, I believe that the world of experience obviously modifies the brain, and the brain in turn, modifies our experience.  There is a reciprocal influence.  What we experience, how we think, and what we do with our brains modifies the brain, by affecting synaptic growth and threshold, amongst other things: that modifies the likelihood of our brains responding to what they experience in a certain way.  Equally we tend to mould our environment according to how we think of the world: the cities and the great projects that we conceive and build express our values and our beliefs.  That means that we are constantly exposed to numerous positive feedback loops.  First, the more we think x now, the more we are likely to think x in the future.  Second, the more we think x, the more we will build a world that expresses x, and the more we will experience x, and so the more we will think x, etc.

That looks like an argument for change being impossible.  But we know that it is not.  That is largely because we have in the past been open to new ideas, without preconception, in a flexible way, thanks to our right hemispheres, which are better adapted than the left to see, understand and take up new ‘information’, new habits of mind, and have a far greater repertoire of ways of thinking than the left hemisphere.  But the left hemisphere displays an unreasonable certainty that its own mechanistic construction of the world is the only one that has any validity.  The more entrenched its way of thinking becomes, the more it undermines the basis on which we might have been able to transcend its narrow way of thinking.  Remember that it deals with what it already (thinks it) knows.  Thus it ‘deconstructs’ everything that doesn’t fit its model – the power of nature, the importance of the implicit, of inherited cultural wisdom, of the meaning and value of religion and the arts – all of which the right hemisphere alone can really hope to understand.  So now we have a further positive feedback loop – the one that stops us evading the first two.

Amongst your conclusions is that Western society has become more decontextualised with prominent loneliness and materialism as a result of left brain dominance.  Are there not other ways of explaining this same outcome without invoking brain structure?  Increasingly complex societies with market triumphalism at their core for instance?

Of course you are right.  There are a very large number of levels at which one can account for any human phenomenon.  If I ask you why you robbed an old lady, you could give a number of different answers: economic – ‘I needed the cash’; psychosocial – ‘I was under irresistible peer pressure’; culturohistorical – ‘in Mrs Thatcher’s Britain it was considered normal to rob old ladies’; neurochemical – ‘I was on speed’; genetic – ‘my father was a psychopath’, etc.  Which is the right answer?  My book is about how the brain constrains the possible views of the world we can take.  As I have said above, I do not say that the brain is not in dialogue with its world.  But to speak of market triumphalism, or societal complexity, is to beg the question why we have market triumphalism and a society that is in this sense ‘complex’, or as I would say more bluntly, deracinated and fragmented.  I would say that these are direct consequences of capitalism, and the mechanistic way of thinking that characterises the Enlightenment, out of which it arose: a new way of thinking about ourselves and our relationship – or rather lack of it –  with the world.  This way of thinking happens to reflect remarkably closely the sort of world that the left hemisphere creates.  The point of my book was to draw attention to that fact, amongst others.  But I agree one could prioritise economic history, as Marx does, and try to account for everything in terms of that.  I’m just not convinced that that gets to the bottom of it at all, and I think it often leads to worse misconceptions.

Is your right/left brain conflict best viewed as a metaphor or something more ‘real’?

Well, first of all, I don’t think that metaphors are an alternative to reality: I believe they are intrinsic to all forms of understanding whatever, including scientific understanding.  They are just so deeply buried in scientific discourse that we hardly see them, and are not encouraged to question them.  But there is little doubt in my mind, having spent so long gathering evidence about the difference between the hemispheres, that they do yield different experiential worlds in the most literal sense available to us – ie, if you have damage to one or other hemisphere, predictable things happen to your world.  And the differences are not a rag bag of odd findings, either, but lead to two (in their own terms) completely coherent, but philosophically distinct, worlds.  The differences I record are all backed up by scientific evidence, whether from lesion studies, imaging or EEG studies, Wada tests, commissurotomy, ECT or TMS studies, or tachistoscope or dichotic-listening experiments, and in most cases I have drawn evidence from more than one source, and always from repeated findings.

However knowledge is never certain, always provisional. At the end of the book I say that it would surprise me if there turned out to be no correlation between the two ways, not just of thinking, but of ‘being in the world’ that I describe, and the two cerebral hemispheres, but I would not be unhappy.   I say that, not as one reviewer seemed to assume, because I don’t believe my own thesis, but because having drawn attention to these two coherent ‘takes’ on the world is itself an important step forward.  Many people will not care whether these ‘takes’ are actually to do with differences in their hemispheres or some other part of the brain or even the spinal cord – so for them it would still have meaning, I hope.  But while, like all models, it is provisional and just a basis for further thought by others, I would be amazed if it were ever shown to have no validity at all.  There is just far too much evidence.

In his review Grayling said that neuroscientific knowledge isn’t advanced enough to allow you to reach the conclusions you’ve drawn.  Would you care to comment on this?

Of course I disagree profoundly.  But he said a lot of very generous things, as well, so I don’t want to make too much of it.

If, as is clearly the case, an emphasis on right or left hemisphere function in an individual results in certain things happening to the way that individual conceives the world, it cannot help being the case that such an emphasis in a group of individuals who share values, concepts, habits of thought – in other words a culture – will result in the same sort of things happening to the way that culture conceives the world.

Grayling sees himself as ‘quite considerably a left-hemispheric creature’.  That may be part of the problem.  So are the majority of scientists these days – though not in the past, and with some very great exceptions among the most distinguished scientists of all.  For the left-hemisphere crowd, there will never be enough neuroscientific knowledge to relate the brain to culture.  For them not only is everything valid only within its own compartment of knowledge, but each little fragment of knowledge within that compartment, each little research paper, is just that – another tiny piece of information.  The bigger picture is lost, and even professionally frowned on.  At what point, according to Grayling, would one have enough information to be able to make sense of it at the phenomenological level – in the world where we live?  And one might ask gently, how would he know?  The information grows at an absolutely staggering rate every day.  Indeed my worry is that soon there will be so much of it that, unless someone like myself is foolish enough to try to make sense of it now, we will never be able to see what is going on at all.  More information does not necessarily lead to philosophical insight.  And it’s that, not information, that we lack.  And it’s that, not information (though there is a lot of it in my book), that I hope I have offered.

How would you like your book to influence the thinking of psychiatrists like me, and the way we conceptualize mental illness?

I would like it to humanise psychiatry, and help us to see that we need to relate what we know about the body and the brain to the history of humanity.

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There are reviews of Dr McGilchrist’s book available on the internet:

The Economist November 26 2009 – The human brain: right and left
Mary Midgley – The Guardian 2 January 2010 – The Master and His Emissary: The Divided Brain and the Making of the Western World by Iain McGilchrist
A C Grayling – Literary review – In two minds

And here an appearance of Dr McGilchrist on the Today Programme 14 November 2009

The Master and his Emissary Wikipedia page has some further links

Review of “Stiff” by Mary Roach

Sunday, December 20th, 2009

Stiff-cover

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…

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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.