By Sam Smith
‘Insanity - a perfectly rational adjustment to an insane world.’
This book is written from the wealth of its author’s own experience as a worker in the UK’s mental health care system, although in the end we’re left wondering if ‘care’ is the right word. There is a polemical underpinning to the work, which is expressed forcefully in an Afterword to the narrative, in which the shortcomings and anomalies of the mental health care system are laid bare and a plea made for urgent reform.
The narrative takes the form of a transcription of tape recordings made by Robert, aged around 50 when he begins them. What the tapes contain is, of course, always and entirely his narrative, his thoughts, his perspective. The reader is drawn so tightly into Robert’s thoughtscape that at times one could almost feel worn down by it, and yearn for relief from its sheer intensity.
Since being diagnosed, at nineteen, as a paranoid schizophrenic, Robert has been through all the labyrinthine highways and byways of ‘The System’, including at times being Sectioned as being a danger to himself and others, at others being given limited freedom under so-called ‘supervision.’ He has experienced every known treatment and therapy, from drugs to electrotherapy. He is, indeed, a walking encyclopaedia on everything ‘The System’ has to offer those diagnosed mentally ill.
When the narrative begins, Robert is living in a care facility where he is permitted a degree of freedom. As the recorded tapes show, he observes and understands everything around him, especially his fellow inmates and the ‘carers’ who are employed to supervise them. It becomes painfully clear that ‘caring’, in any meaningful sense of that word, is not mostly what happens; the inadequacies of an extensive cast of ‘carers ‘ is detailed, from the down-right callous to the well-meaning, but ineffectual, social worker.
From the beginning, Robert is telling himself that something is wrong but is unable to quite put his finger on what that is. In making his tape recordings, he is determinendly, and ultimately successfully, thinking his way back to some form of normality. What we gradually learn is that what is wrong is the whole system to which he has been subjected and within which he has been ensnared. The regime of drugs and other therapies, far from ‘curing’ him, have served only to confirm the first diagnosis of the professionals: that he is mentally ill, suffering from paranoid schizophrenia. As the narrative proceeds we are invited to question and meditate on our own perceptions of ‘insanity’ and ‘normality.’
Through the transcription of the tapes we begin to get a picture of Robert’s early life and the reasons for his being diagnosed as mentally ill. We discover that he was the only child of his parents: father a sensible, responsible man who, as Robert eventually realizes, loved his son very much, albeit in an undemonstrative way. His mother, on the other hand, is revealed as over-doting, indulging him to the extent of tolerating, indeed encouraging, him in uninhibited horse-play. It becomes clear that she is, in part at least, the reason for Robert’s later behaviour and his failure to recognize limits. (The fact that she later hangs herself, unable to face up to Robert’s offence and its consequences, indicates that she was always unstable.) So when, at nineteen, he is involved in a fight outside a pub with another lad, he doesn’t know when to stop. As he puts it: how do you know when the other one isn’t going to get up and hit you again? As a result his opponent is badly injured, to the extent that he will spend the rest of his life in a wheelchair. Retribution is inevitable, but Robert has a history of other incidents of abnormal behaviour – the most serious being the occasion when he tied his mother up to a chair and sat by her until his father came home to release her. As a result, instead of being sent to prison for inflicting grievous bodily harm (in which case, he bitterly reflects, he would by the time he is recording these tapes have served his sentence and been a free man) he is diagnosed as paranoid schizophrenic and sent to a secure unit. As the tapes proceed, we gain the impression that he really is manic in his obsessive attention to detail, and he also refers to episodes of past manic behaviour. The question, always, is to what extent the treatment he has been receiving is the cause of his behaviour rather than the other way round.
In his observations of his life and times Robert comes across as eminently sane; he observes and comments on many features of contemporary life which, looked at objectively, are pretty strange: the ways people dress, the ways they behave. As well as the mental health system, property developers, lawyers, the state of our towns and homelessness are all critically examine – and mostly found wanting. I particularly enjoyed his critique of The Saturday Guardian, which he describes as ‘heavy’, with all its supplements and sections, but in which: ‘Every week the same. Like an empty bowl that has to be filled, week after week, but with words. Like a nervous chatterbox filling time with nonsense talk. No, not nonsense; but chirping away about things of little importance. Saying for the sake of saying.’ Amen to that!
So, how does Robert’s story end? It is not an easy resolution. He finally understands that the only way to escape the clutches of the system is to become entirely invisible; to disappear; to live outside any possibility of discovery. Since his whole journey through the mental health care system has been a series of encounters with the mentally ill, the addicted, the rejected, through them he has learnt the lessons which enable him to slip out of sight and to live outside any conceivable system. In other words, he learns how to efface himself completely.
Anyone who lived, and read, through the 1960s will remember people like R.D. Laing and Thomas Szasz, both of whom became gurus of alternative thinking about what was termed ‘mental illness.’ Laing stressed the role of society, and particularly the family, in the development of "madness" - his term. His rejection of the medicalisation of mental illness almost certainly went too far in denying the influence of biological or chemical causes of what was termed ‘madness’; in any case, Laing was largely discredited in his life-time, both for his ideas and because of his alcoholism and his drug-taking. Never the less, his ideas do still have resonance and there are those who adhere to them. In 2004 The International R.D. Laing Institute was established in Switzerland as ‘a meeting place for all those interested in the psychotherapeutic approach of and its theoretical reflections by R.D.Laing.’ Laing defined insanity as ‘a perfectly rational adjustment to an insane world.’ Robert could be seen as a case in point, with his confusing childhood experiences, followed by a regime of treatment which not only didn’t ‘cure’ him, but arguably made him worse. Laing also claimed that ‘There is no such condition as “schizophrenia,” but the label is a social fact and the social fact a political event.’
When Thomas Szasz wrote: "If you talk to God, you are praying; If God talks to you, you have schizophrenia. If the dead talk to you, you are a spiritualist; If you talk to the dead, you are a schizophrenic" he summed up what he saw as society’s ambivalent and illogical attitude to mental illness. Although he strongly opposed Laing’s ‘counter-cultural’ stand and the whole anti-psychiatry movement, he also rejected the ‘medicalisation’ of mental illness. No doubt many, if not most, contemporary mental health practitioners would take issue with the notion that mental illness is entirely a response to one’s environment, which seems too simplistic; more recent research indicates that chemical and hormonal influences on the brain may have greater influence than people like Laing or Szasz would ever have considered.
Nonetheless, the question remains: was Robert mad or was he driven mad?
Sam Smith's books here: http://samsmithbooks.weebly.com/
Sam Smith's books here: http://samsmithbooks.weebly.com/