Archive for the ‘The Art of Psychiatry’ Category

Interview with writer Will self part 1

Thursday, January 12th, 2012

The writer Will Self came to talk at a conference I organised in November 2010.  Here is a transcript of a conversation we had.  I started off by asking him about the Quantity Theory of Insanity, which was one of his first published works. 

 

SG: What was the inspiration for your short story the Quantity Theory of Insanity?

WS: Well, it’s a long time ago…

SG: Eighteen years ago?

WS: The story was written in 1990, more like twenty years ago.  All sorts of things came together in that story, but the most significant things were an exposure to the psychiatric ward at the Royal Free hospital in the 1980s.  At that time one of the consultants there was the father of somebody I’d been to school with. When I was growing up there was a psychiatrist who lived in the house behind ours and her son had a flamboyant psychotic breakdown when I was in my teens.  And I grew up around – this was the Hampstead Garden Surburb – the fringes of mental health professionals of various sorts and kinds and so had an awareness of the wider culture surrounding that. 

It struck me as an interesting conceit, that a lot of – but I‘m thinking more of another story in the collection called Ward 9 in which a ward in the hospital – it’s called ‘Health hospital’ in the books, but it’s based on the Royal Free hospital – in which a psychiatric ward in the hospital is full of the children of mental health professionals.  That relates to the Quantity of Insanity which in a way is an aggressive synthesis of RD Laing and Milton Freedman. 

There’s a classic study of suicide in Sweden, that some people have said seemed to conform to some of the outlines of the Quantity theory of insanity although I hadn’t read it and I didn’t know about it when I wrote the story.  The Quantity theory of insanity states that there’s only a given quantity of mental ill health to go around or a given quantity of sanity in any given society or societal group at any given time.  So if you palliate one group of mentally ill people inevitably a different mental illness will crop or up or maybe the same one in a different cohort of the population. 

My inspiration for that was more Milton Friedman’s work on the classical quantity theory of money, which was something that was very much in the air at that time because monetarism was one of the keystones of the second Thatcher government.  So it was a kind of unholy miscegenation between economics and some of the more radical theories about mental health propagated by some of the 1960s anti-psychiatrists.  So that was the intellectual and personal background to the story. 

SG: I got the feeling reading the story that you’d actually done quite a lot of reading on how psychiatric research is conducted.  Is that something you picked up by osmosis? 

WS: Yes I picked it up by osmosis.  I certainly knew how a scientific trial is conducted and my closest friend at school went on to become a psychiatrist and is now a consultant.  He’s helped me with my stuff over the years.  And I’m reasonably well read on some of the literature but not exhaustively, because one doesn’t as a layperson. 

SG: The interested difference between our viewpoints is that we’re very directed in terms of what we read about psychiatry and we’re moulded by our profession, whereas you as an outsider looking in, but nevertheless an interested one, would have a different viewpoint and be freer to come to your own conclusions

WS: A bit is not the right qualifier there! It’s not only the psychiatric profession that is guilty of a degree of professional closure, not only in terms of what it’s allowed to treat but also in the sense of mental closure.  All other professions are engaged in the kind of canalization and a certain blinkered view of what it is they do. 

The advantage of being a novelist is that we’re interested in everything, so by definition we shouldn’t be blinkered in that way.  And I think that psychiatry is increasingly interesting because of various things that have happened in our society over the twentieth century, the way in which we have come to regard mental ill health and the increasing specialization and pathologization of certain kinds of conduct and that’s what got me interested in it from the get-go. 

I studied philosophy in university and I come to psychiatry from Nietzsche rather than from medicine.

SG: It’s interested you should say that because generally speaking a psychiatrist doesn’t read much philosophy.  It’s often a very medical role of identifying symptoms, putting them into symptom clusters and then moving onto treatments.  Your view of psychiatry is quite different in that it’s very much from first principles.

WS: Yes, I was reading an account written by two doctors about a mental hospital in north London.  They make the observation – this is a book written in the 70’s – that in that era a psychiatrist wouldn’t physically examine a patient.  My impression is this still often happens.  The psychiatrist, although qualified as a medical doctor, has moved into psychiatry to stop laying on hands. 

If you say then “I’m interested in first principles”, I’m not just interested in looking at sets of symptoms and getting them to conform or not conform to pathologies. I’m interested in what psychiatry is in the wider sense.  What it is that psychiatrists are doing and how they relate to the other healing professions and how they relate to society’s expectation of itself.  Society’s own self regard.

SG: In your book Junk Mail you met Thomas Szasz, I’d love to meet him.  Although with his age it’s becoming increasingly unlikely. 

WS: He’s still very active.

SG: How was your meeting with him?

WS: it was a long time ago, seventeen years ago.  I wrote to him.  He had a book out called Our right to drugs and I went and interviewed him for the Times in Syracuse where he was attached to the medical centre there.  I’d read the Myth of mental illness before that and others of his books and was interested in him as a sort of Hungarian/Viennese/ American version of Ronnie Laing.  With the Myth of Mental illness perhaps standing in some relation to The Divided Self.

I wrote in my latest book (Walking to Hollywood) about meeting Szasz.  If you’re interested in my thinking about psychiatry over the years a lot that it is worked into this book.  It’s a fictionalized memoir so some of it’s fictionalized and some of it is not.  The meeting with Szasz is a mixture of fiction and fact.

SG: Does he appear in that book as a character?

WS: He does.  I’ve always had a character Zac Busner.  He appeared initially in the Quantity Theory and he’s in a lot of my books.  He’s a psychiatrist and he is the most consistent fictional character in my work overall.  He’s like a sort of practical philosopher he has a shape shifting quality, I suppose to express my view of the psychiatric profession as being our equivalent in secular society of a priesthood.  He has a shape shifting and hieratic character to stand for these different things.  Sometimes he seems more based on the neurologist Oliver Sacks and sometimes he appears more like Ronnie Laing.

SG: Why do you equate Psychiatrists with priests?  A lot of people equate GPs with vicars, why do you see psychiatrists as more in this vein?

WS: I think because in a sense Freudianism has been so successful in the West.  It really has, what’s interesting is that even psychiatrists who feel themselves to come from a hard scientific background, and feel themselves to have no truck with the ‘talking cures’, nonetheless are unable to evade Freudianism in all sorts of ways and are unable to evade the presumption that there is a sliding scale between relatively minor neurotic symptoms and major psychoses. And that means that psychiatrists stand – whether they acknowledge it themselves and whether people collectively acknowledge it- at the threshold between happiness and sadness and between sanity and madness, between the particular and quotidian and the transcendent.  This is a priestly role.  You might say that a GP occupies a ‘vicar function’ and but I’m thinking more of the old religion, in terms of priests who manage the transition from the phenomenal to the numinal.

SG: Almost as if we stand at the gateway, saying “you’re normal, but you’re supernatural”.   And we hold the key to that.

WS: Yes, whilst neurosis is in some ways rejected and stigmatized, in many other ways it’s embraced.  We have a culture of ‘compliant neurosis’.  These two readings which are sometimes directly contrary to one another are quite present in our culture.  In some ways psychosis is revered.  It’s our version of ecstasy.  There are all forms of experience that either are genuinely psychotic or verge on the psychosis.  They are revealing.

SG: One last question, if you had one piece of advice to psychiatrists what would this be?

WS: I’m very concerned about the prescription of SSRIs to everyone in our society.  It’s just the latest, pill fad.  They occupy the same role as baribituates did in the 1950s or benzodiazepines did in the 1960’s and 1970’s or tricyclics did in the 1980s and into the 1990s.  But I see so many people who are suffering from long-term SSRI use for all sorts of reasons.  Because of the very fact that they work on what used to be considered ‘exogenous depression’ – in other words they work to alleviate the subjective experience of unhappiness which should be felt – that they represent a very dangerous evolution in neuro-pharmacology. 

I don’t actually think that psychiatrists are usually responsible for writing too many prescriptions for SSRIs, I think that GPs are more to blame.  If I were a member of the psychiatric profession I would make it an imperative to open a conversation in society about the use of these drugs. 

Photo credit

Comic books and psychiatry

Tuesday, October 25th, 2011

I wrote this for the student BMJ (Sorry about the dreadful photo above)

Identifying mental illness in historical figures is a favourite hobby of psychiatric sleuths. Particular scrutiny has been paid to the lives of painter Vincent van Gogh and composer Robert Schumann. Both spent time in asylums, but their correct diagnoses remain in dispute. Similarly, descriptions of symptoms of mental disorder have been identified in creative works dating as far back as Shakespeare in the 16th and 17th centuries and the playwright Sophocles in ancient Greece.

Until recently depiction of mental disorders in comics (also known as graphic novels) has attracted less interest. This may be because of their historic association with younger readers, but comics are now read by people of all ages and are gaining more attention, particularly in healthcare. Long running series such as Batman have multiple characters who display symptoms of mental disorder, and works such as Couch Fiction and Psychiatric Tales have storylines specifically about mental health issues.

Looking at the psychopathology of comic book characters is an interesting diagnostic challenge and also a newly used approach to medical education. A comic book convention earlier this year was held to educate the public about psychiatric conditions. Various comics were studied, with Batman being heavily scrutinised.

Batman

Mental illness is ubiquitous in Batman’s Gotham city. “Over the years, the stories of the Batman comics have been intensely psychological,” says psychologist, writer, and visiting senior research fellow at the Institute of Psychiatry, Vaughan Bell.

The longevity and popularity of Batman comics and films make it one of the best known representations of mental illness. Arkham Asylum, Gotham’s sanatorium for the “criminally insane,” towers both literally and metaphorically over the city. Many of Batman’s adversaries have either escaped from there, or are destined to return there.

In Batman, “the fictional explanations of what causes madness tend to be particularly detailed,” says Dr Bell. The disorders often bear little relation to those seen in clinical practice, however. In Batman comics “two main themes are used to explain the development of madness,” says Dr Bell. “The influence of trauma and the pursuit of forbidden knowledge.”

The personas of Batman and his arch enemy the Joker are both trauma-induced. Batman’s crusade against crime begins with witnessing the death of his parents. The Joker becomes a villain when, as told in The Killing Joke, he falls into a toxic river shortly after the death of his wife.

Batman’s response to his traumatic experience is to become a masked vigilante. Objectively this is unusual behaviour, but not in Gotham city, where spandex-clad criminals are the norm. In contrast, the Joker is unable to show such a “mature” response and turns to crime. Both can be considered madness owing to trauma.

On the other hand, it is those who seek to know who also suffer. For example, being a psychiatrist in Gotham city’s Arkham Asylum is a particular “risk factor” for mental ill health. “A remarkable number of Arkham inmates are former psychiatrists who have been driven to madness as a result of their work as investigators of the human mind,” says Dr Bell. “Rarely are psychiatrists, psychologists, or neuroscientists portrayed as anything except figures of fear.”

Harley Quinn is an example of a disturbed psychiatrist, although her presentation has little resemblance to an established psychiatric disorder.

Quinn, originally Dr Harleen Quinzel, is an Arkham psychiatric intern who becomes fascinated with the Joker and offers to psychoanalyse him. During treatment, the Joker’s influence causes her to abandon her previous life and personality. She falls in love with him and helps him escape on several occasions.

Accuracy

The portrayals of mental disorder in the Batman characters such as the Joker and Harley Quinn are often highly inaccurate. This has been of interest to American psychiatrists Eric Bender, Praveen Kambam, and Vasilis Pozios.

“In the real world we don’t necessarily see someone either becoming a hero or a villain following a single traumatic event,” says Dr Bender, questioning the verisimilitude of the back stories of Batman and the Joker.

Dr Bender also says that the term “criminally insane,” although liberally used in the Batman stories, is not a term that is used either legally or in psychiatry.

Batman storylines often combine syndromes, and sometimes the use of terminology is just plain incorrect.

“The Joker is the character who is most commonly referred to as ‘psychotic’,” says Dr Kambam, “but in over 70 years of stories you’d be hard pressed to find evidence of actual psychosis depicted.” Classically, the definition of psychosis is a mental state seen in serious mental disorders such as schizophrenia, when a patient has disorganised behaviour and thinking.

“What the Joker actually displays more of is psychopathic traits,” says Dr Kambam. Psychopathic traits include manipulativeness and a lack of empathy.

Reaching out

Drs Bender, Kambam and Pozios are using the depictions of mental states in Batman as a way to talk to the general public about psychiatric disorders. The histories of comic book characters are well known and, unlike other public figures, can be discussed without fear of impropriety.

Pioneering this form of medical education, they held a seminar at Comic Con, a large comic convention held in San Diego in July 2011.

“We looked at whether the character of Bruce Wayne [Batman] displays any symptoms of post-traumatic stress disorder (PTSD) in the film Batman Begins,” says Dr Pozios. During the seminar they explored the nature of PTSD and the challenges in making a diagnosis. They felt that Batman had symptoms of PTSD but does not meet the full diagnostic criteria.

Audience questions also provided an opportunity to correct misperceptions. One audience question was, “If Batman doesn’t have PTSD then is it better to say that he has schizophrenia?” This refers to the common misunderstanding that schizophrenia means split personality.

“That’s not correct,” says Dr Bender, “schizophrenia is a psychotic illness.” PTSD is an anxiety disorder.

Beyond the bat cave

Many other comic book characters are amenable to psychiatric scrutiny. Could we diagnose the Hulk with an impulse control disorder? And how has Superman been affected by being the last survivor of his planet?

Mental disorder is also depicted in characters who are not superheroes. “The examination of mental illness in comic form goes well beyond that seen in genre comics,” says Ian Williams, a general practitioner and comics artist. “Batman comics primarily aim to entertain, and their interest in mental disorder is second to this. Other more thoughtful works address the subtleties of mental disorder directly, and aim for a more realistic depiction,” says Dr Williams. “Comics are able to convey an immediate visceral understanding in a way that conventional texts cannot.”

“The handling of mental disorder is particularly effective in The Long Road Home by G B Trudeau,” says Dr Williams.

G B Trudeau draws the well known newspaper comic strip Doonesbury. In The Long Road Home he examines the life of a Doonesbury character following active duty in Iraq.

“The comic documents how the character’s life changes after he loses a limb traumatically,” says Dr Williams. “The author spent time in rehabilitation centres in order to make the approach more realistic.” The character develops PTSD, becomes withdrawn, and has constant flashbacks.

Another comic, Depresso, by Brick, examines depression. “The visual metaphors in Depresso are very powerful,” says Dr Williams. “Especially when he likens depression to being entombed in wet shrinking concrete.”

Brick’s approach to doctors is interesting. “Brick takes a deliberately provocative point of view to his medical care,” says Dr Williams. “He is by nature suspicious, and this influences his view of the psychiatrists who treat him.”

Dr Williams also recommends Psychiatric Tales. This is a collection of 11 strips about psychiatric illness, which was published to acclaim in 2010. Its author, Darryl Cunningham, worked as a healthcare assistant on psychiatric wards and also had his own problems with mental illness.

“Psychiatric Tales is patient centred and humane as Cunningham has experienced mental illness from both sides,” says Dr Williams. “Despite the seriousness of the subject he has a light touch and the book is funny and informative.”

Rich medium

Comics are very accessible as they are quick and easy to read. Their ability to juxtapose image and text means that they are a rich medium for both storytelling and documenting.

Established comics such as Batman have featured mental disorder for many years. Although the characters’ disorders in Batman often display a high degree of artistic licence, they can still be used as a teaching aid and may engage an audience who would otherwise lack interest.

Non-fiction comics such as Psychiatric Tales are often more realistic and can provide us with valuable insights into the lives of psychiatric patients.

Review of ‘High Society’ at the Wellcome Collection – guest post

Thursday, March 17th, 2011

Unfortunately this exhibition has now closed, but this review by Dr Lisa Conlan is still well worth reading.  It was originally featured in the London Division March 2011 newsletter.  Photo credit: Wellcome Collection

‘Every society is a high society’ is the tagline of this topical and playful exhibition. ‘High Society’ challenges the status quo that we live in an era of unprecedented levels of drug addiction, that it is a very modern disease. With billions spent yearly on the ‘war against drugs’ and UN estimates putting the yearly turnover of the illicit drugs trade at $320 billion (£200bn), it’s easy to see where this idea comes from. In fact, as this exhibition sets out to demonstrate, addiction is nothing new and psychoactive experimentation, rather than a minority activity, is something of a universal experience. Using historical relics, paintings and commissioned installations, ‘High Society’ charts humanity’s long and intimate relationship with mind-altering substances, licit and illicit, be it caffeine, alcohol, kava root, opium, cocaine eye drops. You name it, this exhibition has got it.

The first part takes a brief but broadly historical look at drug use and trade through the ages, focusing on the important role opium trade played in the 19th century in the development of the British Empire. As tea increased in price and the British ran out of silver to exchange for it, the East India Trading Company sanctioned the mass manufacture of opium in India to trade for it; actively establishing, promoting and fostering opium addiction in China. 

A good part of the exhibition is given to an anthropological overview of drugs, from ritual kava ceremonies in Polynesia to Native American peyote. Colourful US Prohibition-era posters hint at the current debate on legalisation but sadly, this theme is explored no further. There are featured original manuscripts including Samuel Taylor Coleridge’s Kubla Khan and Thomas de Quincey’s Confessions of an English Opium-Eater. Paintings and photographs are used to good effect, in particular, Keith Coventry’s haunting photographs of gaunt crack addicts. Fun installation pieces recreated the dizzying experience of being high, my favourite being Rodney Graham’s comical acid-fuelled bicycle ride to a Pink Floyd soundtrack. Some interesting film and video excerpts were featured, including Jonathan Miller’s wonderful and enchanting BBC version of Alice in Wonderland, 1966, shot as if in the haze of a drug-fuelled dream (or perhaps a nightmare).

My main criticism of the exhibition was the lack of decent explanatory material. For example, there was brilliant video footage of the landmark late 1970s experiment by Bruce Alexander, known as ‘Rat Park’, but little, in fact, almost no notes to aid the viewer to make sense of it. This is a shame because it was a landmark addiction experiment, which challenged the orthodox theory of addiction, still very current in addiction research and treatment today, that dependency is a property of the drug itself. Alexander, who worked with addicts for years as a clinician, thought dependency was more about social and environmental factors than the intrinsic power of the drug itself.

Briefly, for anyone who’s interested, the experiment consisted of caged rats versus rats in a park called ‘Rat Park’. Rat Park was a large plywood construction designed so rats could roam free with ample space for social interaction and play, food, and nests for raising young. Both sets had the choice between morphine-laced water or tap water. Despite many attempts and variations on the experiment, Alexander could not make addicts of the rat park rats. The caged rats preferentially took the morphine solution and became dependent, while the rats in Rat Park overwhelmingly preferred water. In one variation, Alexander exploited the fact that rats are very partial to sweet things by adding sugar to the morphine solution (morphine has a bitter taste). As before, the caged rats preferentially drank morphine but, in general, the rat park rats snubbed it for water. It was only when naloxone was added to the water that the rat park residents started drinking the sweet morphine water. In another striking variation, Alexander transferred addicted caged rats into the Rat Park to see what would happen. The transferred rats mostly took up tap water instead of morphine, suffering mild withdrawals only. Alexander concluded that in optimal social conditions, the rats did not want anything that would interfere with their normal social interaction and attachment. Alexander’s theory was that it was not an inherent property of the drug that led to dependency but social and environmental deprivation and distress. Alexander could not get his work published in Nature or Science and it was later published in the minor journal, Pharmacology, Biochemistry and Behavior, and failed to have any impact. It’s interesting to note that this experiment was replicated on a human scale (this wasn’t in the exhibition by the way) when the Vietnam veterans returned to the USA. Thousands had severe heroin dependency but back in their home environments most just stopped using when they returned home, also suffering only mild withdrawals.

So, despite the general lack of explanatory text, High Society was a stimulating, fun and thought-provoking exhibition.

High Society website

High society: Mind altering drugs in history and culture by Mike Jay

Dr Lisa Conlan, General Adult psychiatrist, currently in an Addiction Post

Art of Psychiatry Society

Thursday, March 17th, 2011

I’m sorry that I’ve not posted much recently busy, busy.  I have been tweeting quite a lot though: www.twitter.com/psychiatrist which is less time intensive and sort of fun.

I’ve just set up a new blog and a society: The Art of Psychiatry Society, which I hope will be of interest.  The blog will feature the treatment of psychiatry and mental illness in the arts: books, films, television, theatre; it’s planned that the society will hold monthly meetings on similar topics.  Please check out the new blog, and let me know if there’s anything arty going on I should know about. 

Conference – Comics & Medicine: The Sequential Art of Illness

Saturday, January 15th, 2011

This conference may interest some readers of this blog.  

Even if you don’t have the inclination to go to Illinois, the graphic medicine website is worth a visit.

Comics & Medicine: The Sequential Art of Illness
9-11 June 2011
Northwestern University Feinberg School of Medicine
Chicago, Illinois

This second international interdisciplinary conference* aims to explore the past, present, and possible future of comics in the context of the healthcare experience. Programs in medical humanities have long touted the benefits of reading literature and  studying visual art in the medical  setting, but the use of comics in healthcare practice and education is relatively new. The melding of text and image has much to offer all members of the healthcare team, including patients and families. As such, a subgenre of graphic narrative known as graphic medicine is emerging as a field of interest to both scholars and creators of comics.

We invite proposals for scholarly papers (15 minutes), poster presentations, and panel discussions (60 minutes), focused on medicine and comics in any form (e.g., graphic novels, comic strips, graphic pathographies, manga, and/or web comics) on the following—and related—topics:

  • graphic pathographies of illness and disability
  • the use of comics in medical education
  • the use of comics in patient care
  • the interface of graphic medicine and other visual arts in popular culture
  • ethical implications for using comics to educate the public
  • ethical implications of patient representation in comics by healthcare providers
  • trends in international use of comics in healthcare settings
  • the role of comics in provider/patient communication
  • comics as a virtual support group for patients and caregivers
  • the use of comics in bioethics discussions and education

We also welcome workshops (120 minutes) by creators of comics on the process, rationale, methods, and general theories behind the use of comics to explore medical themes. These are intended to be “hands-on” interactive workshops for participants who wish to obtain particular skills with regard to the creation or teaching about comics in the medical context.

We envision this gathering as a collaboration among humanities scholars, comics scholars, comics creators, healthcare professionals, and comics enthusiasts. Confirmed keynote speakers thus far include David Small, author of “Stitches” and Phoebe Gloeckner, author of “A Childs Life” and “Diary of a Teenage Girl.”

300 word proposals should be submitted by Friday, 28 February 2011 to submissions@graphicmedicine.org. Proposals may be in Word, WordPerfect, or RTF formats with the following information and in this order:

  • author(s)
  • affiliation
  • email address
  • title of abstract
  • body of abstract

Please identify your presentation preference:

  • oral presentation
  • poster presentation
  • panel discussion
  • workshop

While we cannot guarantee that presenters will receive their first choice, we will attempt to honor people’s preferences, and we will acknowledge the receipt of all proposals submitted. Abstracts will be peer-reviewed by an interdisciplinary selection committee. Notification of acceptance or rejection will be completed by 14 March 2011. This event is co-sponsored by the Medical Humanities and Bioethics Program at Northwestern University Feinberg School of Medicine, the Department of Humanities at Penn State College of Medicine, and the Science, Technology and Society Program of Penn State University, and is supported by a grant from the Charles Schulz Foundation.

Information about the 2010 conference, “Comics and Medicine: Medical Narrative in Graphic Novels,” in London, England can be found at www.graphicmedicine.org.

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.

Portraits: Patients and Psychiatrists – Interview with Tim McInerny

Tuesday, November 23rd, 2010


The exhibition Portraits: Patients and Psychiatrists is currently being held at the Acme Project space in Bethnal Green London.  The exhibition represents a collaboration between artist Gemma Anderson with consultant psychiatrist Dr Tim McInerny.  Dr McInerny has kindly agreed to be interviewed by Frontier Psychiatrist

 

What should visitors to Portraits: Patients and Psychiatrists expect?

The exhibition is of etched portraits and recorded interviews with patients and psychiatrists at Bethlem Royal Hospital, London. All the etchings are drawn directly from life onto copperplate and also show objects and imagery which reflect the sitter.

Where is it being held and what dates?

The Acme Project Space is found at 44 Bonner Road, Bethnal Green E2 9JS and the exhibition runs until 6 December. Details

Acme Studios was established in 1972 and is a London based charity that provides affordable studio space, residencies and awards for artists

How did you meet Gemma Anderson and begin work on this project?

I met Gemma Anderson at the Royal College of Art Degree Show, and soon after we began to discuss the concept of a series of portraits of psychiatric patients and their doctors.  The project has taken three years and was originally part of an exhibition at the Jerwood Space in London in 2008.  Subsequent to this in 2009 we received funding from with the Wellcome Trust and there have been exhibitions of the work in non-gallery venues such as the Freud Museum and Globe Theatre in London.

What did you wish to achieve with the project?

Our approach was borne from a wish to move away from a written representation of mental illness and a view that the connection between a doctor and patient is through words.  Instead we wished to develop images that provoke the viewer into creating their own language to understand how a patient might be experiencing symptoms of mental illness and how the doctor listens, formulates and treats.

With the portraits we wished to create works that reflected relationships in psychiatric care towards recovery and a return to society.  In psychiatry the stories that patients carry with them are often distressing and sometimes violent.  In the exhibition the visitor is invited to consider how a psychiatrist hears these narratives and how they can process them into meaningful therapy. 

In the exhibition sitters are identified only by their first name – why is this?

Neither doctors nor patients are identified by their status when exhibited.  Patients and doctors are thus equals, and patients are not seen solely as visual objects or objects for the doctor to treat.

How did Gemma go about making the portraits? And what was the reaction of your colleagues and of patients?

Gemma Anderson was given the opportunity to attend psychiatric services to hear the stories of patients and their doctors, and to discover the therapeutic process of rehabilitation.

Both the doctor and the patient were drawn in the same process, following an interview with the artist, which explored favourite personal objects, preferred landscapes, and what doctor and patient shared.

There was strong support from the clinical teams involved and psychiatrists from different specialties, gender and ethnic groups became interested in the project.  The publication of one image on the cover of the British Journal of Psychiatry has indicated the support of a leading scientific journal in this field.

Patients who have visited an exhibition of their own and the other portraits described feeling empowered by the experience and the public exhibition of the portrait series has now furthered the dialogue which now includes artists, doctors, patients and the public.

On a more general note, I know that you have long been interested in using the creative arts to inform your practice.  Why do you think that the creative arts are important to psychiatry?

Psychiatry has always had an association with the arts. Its most important creative relationship has arguably been with visual art, which has served as a means of representing mental disorder, as a form of treatment and as a channel of expression for patients.

Over recent years I’ve been committed to bringing the creative arts into the secure settings where I work and I have collaborated with comedians, actors, musicians and artists to introduce contemporary theatre and the other arts to Broadmoor Hospital and psychiatric forensic units such as River House at the Bethlem Royal Hospital.

 

Links:

There are several posts on this exhibition on Gemma Anderson’s blog:

Patient S

Drawing patient A

Drawing Dr V

Drawing Dr F

Ward Round- Chaffinch Ward, River House, Bethlem Royal Hospital, 10/12/09