Lost in the Forest

It’s obvious that someone lying on the ground with a broken leg can’t walk, so no one expects them to get up and pop into A&E to get it set, and then get on with their business, but it seems it is much harder for many to believe in the physical anguish, debilitations and incapacitations of mental illness, and see the need to offer relief.

There are many consoling clichés abroad about breakdown: one is that it is ‘like breaking your leg’. Another is that it can make you a better person. Neither of these statements is true. Anyone who tries to tell me them again will end up severely mutilated.

My problems began in 1984 when I wrote letters to Francis Pym and Sarah Kennedy about the Falklands War and Sir Robin Day’s part in it. Sarah was presenting a radio programme and I thought she was talking about me when she spoke of a young man who had just lost his mother. Francis Pym said, ‘Guns fire from Number 10’ on the Sarah Kennedy show. I took this to mean the PM had given the order to sink the Belgrano. But Mr Pym was speaking in a different context. Paul Daniels, who was also a guest, said: ‘Something strange is going to happen.’

For researchers interested in schizophrenia, the Galvins seemed like a bonanza: figure out why six of the twelve children got sick, but not the other six, and maybe you could get somewhere. A pharmaceutical company took an interest in them, as did the University of Colorado Health Sciences Centre and the National Institute of Mental Health. Blood was drawn; brainwaves were studied.

Mental illnesses often involve some degree of copycatting: homicidal mania inspires homicidal mania, and recovered memories of satanic abuse come not singly but in epidemics. But hysteria became known as the illness that, more than any other, mimics illness, mimics even itself, and so entirely that to many observers it looks like nothing more than malingering.

Trying to get the DSM right, in revision after revision, perpetuates the long-standing idea that, in our present state of knowledge, the recognised varieties of mental illness should neatly sort themselves into tidy blocks, in the way that plants and animals do.

Growing up in Glasgow, I knew that bad people went to Barlinnie Prison and mad ones to Gartnavel Hospital. I used to pass Gartnavel whenever I went into the city centre. It’s a grey, bleak but not unattractive building. There was a wall round it, but it wasn’t very high, certainly nothing like the wall that surrounded Barlinnie. From the train you could see people coming and going through a gate at the corner where the wall dipped into a valley.

I am agoraphobic – though when I hear case-histories of some of my fellow agoraphobics, who have to slay mental dragons and scale psychological Matterhorns before they can even begin to think about going out of the house, I feel pretty lucky. There are people who haven’t been outdoors for twenty or thirty years. In my own case, I have extended periods of complete equilibrium before what behaviourists would call a ‘bad learning experience’ intervenes, and seems somehow to teach me about the possibility of the phobia all over again.

Colonial psychiatry wasn’t merely a racist instrument of confinement. These were sophisticated scientists at the top of their profession, and some of them cared about their patients. But the combination of utopianism, technical innovation, scientific sophistication and racism is not so surprising in the history of 20th-century science.

Franco Basaglia regarded the asylum itself as the problem. As a logical extension of the authoritarian society that had built it, it was irredeemable, and even an improved version – a ‘golden cage’ – was a trap.