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Mental health, mental illness, science fiction and horror

March 13, 2014 Leave a comment

I haven’t posted stuff for a couple of months because I’ve been writing a course on nutrition, which proved interesting at a number of levels. You may have seen some of the recent media coverage of the processed food industry and the way we’re encouraged to buy fat, sugar, salt and donkey meat – but I’ll leave all that for another blog post.

Then I started the latest project, which revisits an area I’ve worked on periodically since the 1980s – mental illness. This is an introductory course for non-medical people like care workers and hostel staff, so it covers a broad spectrum of conditions.

I got to the bit about schizophrenia, and since I also have an interest in writing various genres of fiction there was a sudden cross-pollination of ideas. I’m sure I’m far from the only person to make this link, but I thought it was worth a ‘note to self’ if nothing else.

There’s a summary of the symptoms of schizophrenia that appears on a general introductory information resource on the web, at www.helpguide.org if you’re interested. Schipohrenia has both positive and negative symptoms. A ‘positive’ symptom is where there is an abnormal mental function; a negative symptom is the lack of a mental function you’d normally expect. The positive symptoms are hallucinations and delusions. The hallucinations are often auditory (hearing voices – there’s a simulation of this on Youtube it you’re interested). The delusions, sets of beliefs about the self, others and the word,  take a wid range of forms but commonly fall into one of four patterns:

  • Delusions of persecution – Belief that others, often with vague identities are out to get the person. These persecutory delusions often involve bizarre ideas and plots (e.g. ‘The CIA is trying to poison me with toxins impregnated into my clothes’).
  • Delusions of reference – Something the person sees in their environment is believed to have a special and personal meaning. For example, a person with schizophrenia might believe a piece of street graffiti or workmen’s marks made by a utility company is sending a message meant specifically for them.
  • Delusions of grandeur – Belief that one is a famous or important figure, such as Jesus Christ or Napoleon. Alternately, delusions of grandeur may involve the belief that one has unusual powers that no one else has (e.g. the ability to fly).
  • Delusions of control – Belief that one’s thoughts or actions are being controlled by others. Common delusions of control include thought broadcasting (‘My private thoughts are being bugged or monitored’), thought insertion (‘Someone is putting thoughts in my head’), and thought withdrawal (‘Aliens are robbing me of my thoughts and preventing me remembering things’).

Just in case you’re wondering, the idea of impregnating clothes with toxins isn’t fictional – it was developed in South Africa in the 1970s as a means of killing opponents of apartheid, and the daughter of one activist, Donald Woods, was injured by an acid-laced T-shirt. Nor is the idea of graffiti or other signs of the street being used to communicate with individuals unusual. Intelligence services used such techniques from at least World War II onwards while traveller folklore records gypsies, American hobos and others developing discreet graffiti to provide information on places and people that ‘outsiders’ wouldn’t understand. As to unusual powers and thought-manipulation – there’s always the American MK Ultra intelligence programme, which did some pretty strange things and is often used to lend credence to almost any weirdness you can imagine.

At this point some mental cogwheels began to move, because my sense of a lot of SF, fantasy and horror stories is that they too revolve around one of these four ideas.

As it happens I’m also reading The Air Loom Gang at the moment, which deals with James Tilley Matthews. He was a ‘lunatic’ held in the Bethlem Hospital in London in the late 1700s and ealy 1800s, though by today’s standards he would probably be diagnosed as paranoid schizophrenic.

His highly elaborate delusions concerned the clandestine siting of Air Looms around London – devices that could control people by directing currents of gases at them that could change their thought patterns and influence their health. Matthews thought they were controlled by criminal gangs in the employ of French revolutionaries and, as is often the case in such delusions, there were small elements of truth embedded in the delusion. For one thing he had spent time in France acting in an unofficial capacity (or perhaps we should say seeking to act as an unofficial negotiator) in talks to make peace between England and revolutionary France; he had been imprisoned by the revolutionaries as a potential spy while in France; and his experiences took place at the time mesmerism, pneumatic chemistry, and experiments on the effects electricity were all in vogue.

Matthews’ delusions of the Air Loom are consistent with what we have come to describe as ‘influencing machines’ – devices that the delusional person believes has an effect on their own mind and possibly on others, such as the hospital staff. But in his discussion of Matthews’ delusions, the author (Mike Jay) comments that the delusions may have some broader social underpinning:

‘Delusional subjects often unsettle those who encounter them not just by the form of their condition but its content: they can reflect back a disturbing, often nightmarish certainty about free-floating anxieties in the broader culture’ (p181)

Which is what much science fiction, fantasy and horror is also intended to do. The genres often explore elaborate nightmare situations that could come about from seeds in current society.

So next time you read a story in which: (a) someone is being persecuted or chased by unknown, shadowy figures who are trying to capture or kill them (b) someone has a sudden revelation by means of seeing something that’s in a public place or being broadcast, but is meant for them alone (c) an ‘ordinary’ person suddenly discovers they have a much grander and more important role in the world (or the universe) or (d) someone discovers they’re missing parts of their memory, have false memories implanted, or are being remotely controlled – remember that you’re reading something that draws on our understandings of mental illness and probably also draws on wider cultural anxieties, principally about the way power and authority are exercised.

At the same time, remember that despite the off-the-wall accounts you can find in some conspiracy theories, technologies have been developed often by intelligence services for use against ‘enemies of the state’, in the knowledge that anyone who says they’ve experienced them is likely to be discounted as mad. That’s not to say any given individual with delusions will have been targeted, of course. Just that the nature of the ‘influencing machines’ and covert weapons that are out there have probably outstripped even the imaginations of many SF and horror writers – and indeed many people with mental illness. Though if you do happen to think you’re Jesus or Napoleon, please seek help…

We need more Elmores!

July 3, 2010 Leave a comment

In the last week I’ve found out a great deal more about homelessness that I was hoping ever to have to know. This came about because the son of a friend of mine has just become homeless, having lost his private rented flat.

There’s a complex history to this, as you might expect. It revolves around this guy being ADHD, short attention span, bored, lonely, needing social interaction and not having much day-to-day support. In a nutshell he was ‘spotted’ by a bunch of drifters who realised he had something they could make use of – his flat. He was gullible enough to invite them home, they were manipulative enough to use it as a drinking den and then ran riot. When he ran into trouble with the landlord and tried to get them out, the vindictiveness started – burglary, smashed windows, people breaking in and refusing to leave, etc.

The landlord hasn’t been much help either. It’s not a ‘social landlord’ so they don’t have obligations to support tenants, and as best I can tell there’s been a certain amount of chicanery in terms of trying to get him to move out without actually issuing an eviction notice.

The result has been meetings with the local authority housing people, welfare rights, etc. etc. trying to negotiate a housing maze that revolves around whether he is ‘voluntarily’ homeless (I’d say the police incident numbers prove not) or otherwise. If he is, he can’t access locally authority controlled housing or hostels. Not that there are many places available anyway, and a long queue for them (and some of the people who caused the trouble in them…). However ‘supported’ accommodation is outwith the control of the local authority waiting lists so he’s potentially eligible – but even finding the trusts that run such places, checking their eligibility criteria, and sorting out applications is a huge job.

He has complex needs, which essentially amount to day-to-day support and patient, wise people who know how to get him motivated and arrange access to the services that can address at least some of his problems.

And this is where the Elmore thing comes in. In 1988-9, I was asked to be an in-house researcher to evaluate a then-new voluntary sector project in Oxford. Named for a local notable who had the original inspiration, the idea was for a small team of people who would deal with those who fell through the ‘cracks’ between agencies.

For example, it would arrange shared-care between two hostels, when people were challenging and regularly blew out their accommodation. If you could find two hostels and two people who were problematic, you could get an agreement to give each one a couple of weeks in one hostel and swap them over before they blew it. The new situation would help them remain stable and certainly give the staff in both places a respite.

When homeless mentally-disordered people were arrested and charged, the team would try to find temporary accommodation for them so they could be bailed, some attempt made to deal with their needs, and if necessary a worker dispatched to bring them to court so they didn’t forget the court date and wouldn’t then have an arrest warrant issued for non-appearance.

They were able to connect people to an outreach health team (which at that time ran out of a Portakabin on a night shelter car park, if I remember rightly) that dealt with underlying health issues – many of the homeless had, probably still have, conditions ranging from shingles to scabies to TB that often impaired their ability to even think straight – and also had a community psychiatric nurse who was experienced in locating homeless mentally ill people and getting them to take their medication so they wouldn’t end up doing stupid things that got them into court.

The bottom line was that the team didn’t itself offer much in the way of services but did enable people with complex needs and difficult problems to connect with agencies – it put together, jigsaw fashion, care packages in which each of a number of agencies agreed to take on a defined role in relation to part of the problem, against the assurance that other agencies were addressing other parts of the whole situation. It was person-orientated rather than agency orientated, and that was its strength.

And it worked.

But it was in Oxford, and my friend’s son isn’t.

I did the evaluation in 1988-9, on a short term contract, and then moved on. But I’ve just caught up with the Elmore thing again. It’s grown into Elmore Community Services (yes, that’s a link) and has expanded to deal with a much wider range of problems than it could tackle when it first started, such as antisocial behaviour and parenthood problems.

The original report I wrote (I still have a copy somewhere) clearly hasn’t survived the transition from print to online publishing, but obviously is just a little outdated now anyway. However there are several worthwhile and recent publications available on the website.

This whole experience with my friend’s son, and my memory of the early Elmore work, leaves me with this thought. We proved the Elmore concept worked, twenty years ago. It’s still there and still working. It must save all the agencies involved significant amounts of money by ensuring that people with complex needs actually get them addressed, don’t fall through gaps in service provision, don’t end up receiving unco-ordinated and ineffective care that breaks down every two minutes, and don’t end up going through the revolving door syndrome of repeated short prison sentences for stupid things they do when care breaks down.

So if it’s good for the people with these needs and arguably cost effective in the long run for all the agencies involved, why on earth isn’t there an Elmore type service in every city?

Beauty and the beast?

March 15, 2010 Leave a comment

It’s been an interesting weekend. Not a lot of sleep, but interesting. In the early hours of Sunday morning someone I know was assaulted outside a nightclub and ended up as an emergency admission in hospital. Actually he’s ok and now discharged, and this post isn’t about him. I drove his mum, V, over to the hospital, and we found him in an assessment unit, under observation.
In the same ward was a woman waiting for psychiatric assessment. And we got to talking. Her story was essentially this. She’s a single mother, professional job, and she’s bought into the whole commercial/advertising beauty thing of how unless you’re perfect in every physical way, you’re worthless as a person. Bought into it really heavily, because once you start noticing it, it’s in every women’s mag and a huge proportion of TV adverts, along with every other advertising media you can think of.
Now at this point we’re into ‘as if’ speculations. Because I’m male, I have grey hair and my teeth will start falling out soon unless I can be bothered to fix the overdue dentist’s appointment. And basically I don’t really care. For 99% of the time, anyway, all anybody ever sees of me is the words I write.
But if I were female, late 30s/early 40s, and there’s that much media telling me how I need to be perfect physically, and I’m also trying to work and bring up a kid and feel insecure and don’t have a partner to support me, how would I react to that kind of pressure? Would I feel completely insecure if I had lifeless hair and a couple of crow’s feet beginning to show around the eyes?
OK, so I have no idea if there’s a longer back story to her illness. And there probably is. But it seemed at face value as if she’d touched on something important to her and possibly to many other women as well; the way advertising, and other media content, exploit women’s insecurities in search of a fast buck and the ‘collateral damage’ of this exploitation.
So the three of us – me, V and the woman – went and had a cigarette (another of my failings though socially useful in this case), for which we had to walk about a mile to some specially designated zone. And in the course of the smoke, both V and I told her that beauty isn’t about physical appearance, it’s about how you feel inside. Everyone has a kind of inner beauty that comes with confidence and feeling secure in yourself. If you can connect with that, you look beautiful to others irrespective of your physical looks and makeup. Equally, we all have dark periods when we lose the plot. That’s life. And we know that in those dark periods you think you’ll never come out the other side, but somehow we do. And if you can find a way to get just a little bit of confidence back, it can all come back really quickly.
So as a tribute to an unknown woman waiting for psychiatric admission, I’d say this is a story about beauty and the beast. Except in this version, she’s the beauty but she just doesn’t know it. The beast, unfortunately, can’t be slain. But it can be made irrelevant and powerless if she just realises she’s beautiful anyway.
And while I’m on a rant I’d just like to nod to Karen Ranney on writing romance, which is a powerful post and one that was waiting on my PC when we got back from the hospital. It was that post, really, that made me think I should write this one. OK, she writes romance and I write SF and horror, but there’s something fundamental about human experience that she touches on and it transcends our respective genres…

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