Under the relentless shadow
Mental illness in modern society
ANDREW LODGE STAFF
Note: The individual’s name and certain details have been changed to protect his identity.
Bill sits awkwardly in a chair across from me. He glances nervously at the mirror-like window on the wall. Bill knows that this is a two-way mirror, with an adjoining room on the other side where “observers” can watch while Bill and I “discuss” Bill’s problem(s). I reassure Bill that, today at least, there is no one watching. It is just him and I. Bill looks at me distrustfully, but he is resigned. After all, he knows there is little choice in the matter.
Bill is a temporary and repeat resident at one of Manitoba’s psychiatric wards. This time around, he was brought in by the police and committed involuntarily after he became agitated with his landlord, whom he believed was helping others spy on him and who, according to Bill, was in cahoots with the spies. So Bill cannot leave. It is against the law, and if he does manage to escape, the police will find him and bring him back.
“Let’s begin,” I say in the most soothing voice I can muster. My training teaches me to make an effort to be gentle, to talk quietly, to sound kind. As a professional psych patient, Bill has heard the best and the worst imitations of a “soothing” voice. I wonder to myself how I rank. “How are you feeling today?” I continue after a pause.
Bill shrugs and looks back over at the mirror and then back at me. We make eye contact for a moment, before he looks away.
“Fine, I guess,” he shrugs again. The interview continues in this manner. I ask him about voices, hallucinations, thoughts of hurting himself or others, and so on. Bill knows the drill and he plays his role well on this day.
The confinement has a logic of its own. The walls of the ward have a way of closing in. To alleviate that, “patients” (also called “residents,” “clients,” and so on in psych-speak) go on “passes” of varying lengths, doled out according to their “ability to cope” and their flight risk. Bill has been here for four days now and today he will be granted his first 15-minute pass where he can go outside but may not leave the grounds. Much like a prison, cooperation and “good behaviour” are effective methods of securing passes. On the flip-side, refusal of permission of a pass can result in extreme frustration and can, not surprisingly, generate an outward reaction to this frustration. Such behaviour can put a pass out of reach for a greater length of time. And so it goes.
There is no area of human study that evokes as much reaction and controversy as the realm of mental health and illness. Since the earliest recorded history, there have been references to madness, and today the conundrum over how society should address issues involving the mind remains.
In the context of modern medicine, psychiatry has long sought to prove itself as a rightful member of the biomedicine club. That is to say, psychiatric research has placed wanton effort into showing conclusively that the etiology of mental disorder
finds its basis in biochemical pathology. This argument has been buttressed in part by extensive research into psychoactive substances that act on the neurotransmitter level in the brain. The most well-known examples of these are the famed selective serotonin reuptake inhibitors, or SSRIs, which have been marketed as Paxil and Prozac, among others. Skyrocketing depression rates in richer countries and the penchant for many physicians to prescribe SSRIs spawned the notion of the Prozac nation, a society where everyone has a reason to be a bit sad and therefore everyone needs a little help to take the edge off. The pharmaceutical companies have been laughing all the way to the bank.
There are others who dispute this, however. In his recently published book, Daggers of the Mind: Psychiatry and the Myth of Mental Disease, former University of Toronto professor Gordon Warme argues that the biological basis of mental disorder is far from clear-cut. “There is not a scrape of evidence that there are biological abnormalities in any of the so-called psychiatric diseases,” he writes.
Well before Warme, back in the ’60s, some researchers and theorists argued that a new perspective was needed. To that end, a group of rogue psychiatrists borrowed heavily from a school of thought emerging from the social sciences. They argued that the problems faced by an individual were not the result of pathology per se, but were instead the result of the stigmatization generated by the “societal reaction” to their unconventional behaviour. So, for instance, a person walking down the street carrying on a conversation with an apparently non-existent companion only encountered real difficulty when the rest of the world shunned him or her, refusing employment or companionship on the basis that he/she was “crazy.”
A leading psychiatrist at the time, Thomas Szasz, went on to argue in his controversial book The Myth of Mental Illness that problems faced by people he saw in his practice were the result not of pathology festering within their minds, but of the stresses and difficulties encountered on an everyday basis in contemporary society. He wrote that “The notion of mental illness thus serves mainly to obscure the
— Gordon Warme, in Daggers of the Mind
everyday fact that life for most people is a continuous struggle, not for biological survival, but for a ‘place in the sun,’ ‘peace of mind,’ or some other human value.” Szasz’s thesis seems almost prophetic now, as the incidence of diagnosed depression in industrialized societies, where safeguards to promote “biological survival” have been enacted as never before in history, has increased dramatically. More and more people find it increasingly difficult to cope in the struggle for human value.
Others took Szasz’s argument further, arguing that the medicalization of behaviour amounted to “moral entrepreneurship,” where institutions such as medicine and law determined what was acceptable and what was not. Borrowing heavily from the works of Michel Foucault, they argued that the realm of “normal” lay within a set of rigid parameters. Those falling outside the established (and heavily guarded) boundaries were either sick or criminals, or both.
Bill’s behaviour is decidedly not “normal.” He has ongoing conversations with himself, sometimes for hours on end. His outfits can be quite bizarre and he is often dishevelled by the norms or standards set out for appropriate dress. He is extremely paranoid and assumes from the outset that everyone he enters into contact with is out to get him.
As I sit across from him, I wonder about his paranoia. Bill is a “schizophrenic,” just as other people are waitresses or lawyers or carpenters. That is his label; schizophrenia defines him more than any other attribute or any other feature of his existence. Within the walls of the asylum he is summed up as such: “This is a 66-year-old man with a longstanding history of schizophrenia.”
Outside, while less clinical, there is the same synopsis: “Oh, that’s Bill. He’s schizophrenic, you know?”
As such, it’s easy to imagine how all his relationships are contoured by this simple but primordial “fact.” Any paranoia that was already fomenting in his mind can only be aggravated by such interaction.
For many years, Bill has, on and off, voluntarily and involuntarily, taken a class of medication called neuroleptics, intended to alleviate some of his symptoms. For most of his adult life he has been on the so-called “typical” neuroleptics, drugs like Haldol. For whatever their benefit, these drugs also have some severe side effects. They can cause noticeable alterations in speech, and some who are on them experience the jerky movements most easily recognizable in those with Parkinson’s disease. Bill has the misfortune of experiencing both. Slurred speech and uncontrollable motor function do nothing to prevent Bill from standing out in day-to-day interaction. Today he is on some newer drugs, termed “atypicals,” which have a more forgiving side-effect profile, but these acquired problems have not subsided. The dyskinesias caused by the drugs only serve to compound the wackiness that is perceived to be Bill.
The interview concludes. Bill waits for me to stand up and then does the same. I hold the door open and he shuffles out. For a moment, it feels like a game. Bill only wants to leave this place and he does everything in his limited power to realize this goal. There is no doubt that he suffers everyday, not just here, but everywhere he goes. He cannot escape his mind. But he has no illusions that things will improve. He has lived with his demons for too long to expect any sort of amelioration.
The funny thing is, everyone “treating” Bill agrees with him on this one point. No one expects anything positive from Bill. He is Bill. More pertinently, he is a schizophrenic.
