David Austin: Writing with Considered Intent

A Beneficial 'Prescription' For Improving Emotional Well-Being

2012-03-02T10:47:00.002Z

Mattheiu Ricard's book The Art Of Happiness (published by Atlantic) is a volume I would recommend very highly. It needs a bit of self-discipline to work through it — it isn’t a casual read — but it is well worth making the effort.

The author is a Buddhist monk with an academic background in genetics. More recently, he has conducted research into the neurological effects of meditation. Meditation is, indeed, very much commended in this book, and the author draws on both the natural sciences and Buddhist tradition to present an approach for increasing your 'happiness skills'. It’s probably worth mentioning that the British quality press has described Mattheiw Ricard as 'the happiest man in the world' (a claim prompted by results of an MRI scan of his left pre-frontal cortex).

Some readers of a resolutely secular persuasion may find the idea of some Buddhist content off-putting, as may those of other religious traditions. In fact, the Buddhist content, though definitely present (and, in my view, of interest in itself), isn’t overly emphasised. The author does not attempt to indoctrinate the reader; essentially, he is offering a methodology — and a frequently effective one at that.

This book is not a miracle cure for unhappiness, but it is a beneficial “prescription” for improving emotional well-being.
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The Art Of Happiness: A Guide To Developing Life's Most Important Skill by Matthieu Ricard is published by Atlantic (Paperback)
ISBN 978-1-59285-099-0

Delivered Unto Lions by David Austin is published by CheckPoint Press (Paperback and eBook)
ISBN 978-0-85789-273-7
For more information visit www.davidaustin.eu

Psychological Disturbance - Part of Our Shared Human Condition

2011-10-12T12:31:00.003+01:00

Broadcast journalist and weather presenter Reham Khan (well-known to BBC viewers and listeners in the south of England) occasionally likes to present her friends, acquaintances and aficionados with interesting intellectual challenges. She recently posed the question, ‘Using drugs for entertainment or relaxation is a sign of a psychologically disturbed individual. Do you agree?’ She did, of course, receive a number of responses of various flavours. Though I am not professionally or personally qualified to answer her question, I made an attempt anyway!

What interests me, though, is that Reham’s question taps into a whole range of assumptions. Her question has certainly made me aware of some of mine. Without thinking about it, I interpreted the term ‘psychologically disturbed’ in a negative light. I saw it as pejorative. To me, then, the question appeared to be asking whether recreational drug use was equated with some sort of personal moral shortcoming. Needless to say, Reham was not suggesting any such thing.

It was only after I pondered the question again later that I realised my mistake. I had interpreted the expression ‘psychologically disturbed’ in a judgemental way. In my defence, however, I would like to say that I don’t think I’m alone in making this error. There is a very long social history of seeing psychological disturbance (however it is defined) in negative terms. Sufferers of its more problematic manifestations have often been placed in institutions as ‘punishment’ for their conditions, or they have received other forms of apparently punitive attention.

What is especially disturbing today (psychologically or otherwise) is the quality of public discourse on the subject of these conditions. This has been prompted by current economic considerations. In the UK, where governmental agencies are seeking ways to reduce the cost of welfare, people with psychological disorders (and physical disorders) are finding that their claims for financial support are now being rejected. Where medical professionals used to assess the validity (or otherwise) of such claims, lower-paid administrative staff are now making the required judgements. If a claimant doesn’t use the exact words or phrases on the administrator’s check-list, his or her claim is rejected.

Rejection is a consequence of judgement. For some people who have to live with very challenging conditions, the rejection of a claim for benefits can read like moral disapproval. In such cases, not only is psychological disturbance equated with failure, it isn’t even seen as a worthy failure. And this feeds into the perception given by the popular press, and adopted by some members of the public, that the psychologically disturbed are shirkers who want to get something for nothing (even where they happen to be economically active, but need their incomes supplemented due to special needs).

I am not suggesting that this is actually happening, but given the current public discourse surrounding psychological and mental health problems, it wouldn’t be at all surprising if some people did indeed turn to recreational drugs for entertainment or relaxation – after all, it’s not as though they would be judged any more harshly.

Words are weapons, and I would suggest we need to change the words we use and the way we use them. The bigger challenge, though, is to change our attitudes. Psychological disturbance is not immoral, but it is very common. Let’s start treating it as part of our shared human condition, rather than as something to be condemned.

* * *

On another note, it is now one year since my book Delivered Unto Lions was published in paperback. In celebration of this one-year anniversary, a new eBook edition is about to be published. More details on that to come. In the meantime, if you are a new visitor to my blog, Delivered Unto Lions can be summarised as a factually-based novel inspired by my own experience as a child psychiatric in-patient in the 1970s. It is not just (a version of) my story, however, as it represents the terrible traumatic experiences of many children and teenagers caught up in the mental healthcare system as it was at that time.

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Delivered Unto Lions by David Austin is published in paperback by CheckPoint Press

ISBN 978-1-906628-21-5

eBook edition coming soon

For more information visit www.davidaustin.eu

Book Review - Get Me Out Of Here

2011-06-07T12:57:00.001+01:00

It has taken me an incredibly long time to get round to reviewing this particular book. Rachel Reiland’s Get Me Out Of Here (published by Hazelden) is a very challenging read. And, at 447 pages, it is a lengthy challenge. Rachel seemingly leads us through every minute and nuanced detail of her arduous recovery from (what is still commonly referred to as) borderline personality disorder (BPD). It appears that she spares the reader very little, hence a page-count which invites especially committed participation in a very unsettling story.

By way of a brief introduction I will attempt to sketch out the basics of borderline personality disorder. Among the many symptoms associated with BDP are: fear of being abandoned, unstable and intense personal relationships, impulsive and sometimes reckless behaviour, suicidal behaviour, kneejerk changes in mood, and problems in controlling anger.

There has been a definite stigma associated with BDP within health care services (with sufferers seen as ‘difficult’ or ‘attention seeking’, etc., due to their ‘faulty’ personalities). This is one of the reasons why there are currently moves to rename the condition; suggested alternative descriptions include ‘emotional dysregulation disorder’ and ‘post traumatic personality disorganisation’ (derived from the assumption that past trauma, especially in childhood, has caused the condition). Reiland’s book, however, does not deal with the controversies associated with the BDP diagnosis.

A particular aspect of this book that does not sit comfortably with me is the way Rachel Reiland (not actually her real name) is so gushing in her praise of the health care services which assist in her recovery. She particularly singles out her therapist, Dr Padgett (presumably not his real name either), for almost unconditional acclaim. It would certainly appear that the services and practitioners are indeed deserving of credit – they have, after all, helped Rachel to overcome a seriously limiting condition and enabled her to live a much fuller life (in terms of both family and professional career). But it also seems to me that there are ways in which the care provided is less than helpful.

Rachel’s periods as an in-patient in a psychiatric unit are especially unsettling. It is, in fact, a relatively common-place situation that leads to her initial admission: she succumbs to the stress of keeping house and caring for her demanding young children – essentially, she ‘loses it’. But the unit is hardly an understanding and compassionate environment. At one point, to relieve the boredom, Rachel ‘power walks’ around the unit while listening to her Walkman. A charge nurse, however, puts a stop to this, confiscating the Walkman and telling Rachel that she obviously can’t control herself. A second ‘power walking’ incident leads to Rachel being held in isolation in the ‘lockup’.

The bulk of the book, however, focuses on the out-patient therapeutic relationship between Rachel and Dr Padgett. Padgett (the Medical Director of Psychiatry at the unit) offers Rachel very frequent psychoanalytic therapy sessions over a considerable period. Rachel exhibits alternating attitudes to Padgett; one minute she idolises him, and the next she loathes him (this is portrayed as classic BDP behaviour). But from the very start she appears to be unhealthily dependent on him, and he almost seems to encourage this dependence – not that she ever criticises him for that.

As a reader involved in the unfolding story, I found myself increasingly ambivalent about Padgett. On the one hand, he is the key figure in Rachel’s recovery, the one who makes it all possible. But on the other, he comes over as the one calling the shots in an extremely unequal relationship. And, as this is in the context of American private health care, Rachel is paying to be the lesser participant in this situation. It seems to me that Padgett enables Rachel’s recovery, not by working in partnership with her, but by demanding that she yield to his will and superior status. On the occasions when Rachel becomes angry and unco-operative with Padgett, she appears to be quite right to react this way (though the scale of her reaction is usually excessive).

Get Me Out Of Here is, of course, a positive book. The fact is, Rachel recovers, and in doing so she offers hope to other sufferers of the same condition. I can’t help wondering, however, if she would have recovered just as well – if not better – if she’d had a therapist using a different and more collaborative approach. Rachel, however, is perfectly satisfied with the approach taken by Dr Padgett, and she, after all, is the one best placed to judge.

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Get Me Out Of Here: My Recovery From Borderline Personality Disorder by Rachel Reiland is published by Hazelden

ISBN 978-1-59285-099-0

Delivered Unto Lions by David Austin is published by CheckPoint Press

ISBN 978-1-906628-21-5

For more information visit www.davidaustin.eu

Do Actions Speak Louder?

2011-04-26T11:58:00.001+01:00

Actions speak louder than words, or so the saying goes. As someone who often spends far too much time thinking about such things, I sometimes find myself wondering if actions and words are really very different. Both are forms of communication which actually do things in the real world. If I pick up a hammer and drop it on your toe, that does something. If I then turn to you and say that you are a waste of space, and it’s your own fault that the hammer landed on your toe (because you were in the way), then that also does something.

We have intentions when we say things. We expect our words to achieve something. Indeed, there are many philosophers, sociolinguists, and other academics, who have put a good deal of effort into determining what words do, and how they do it. John L Austin, for example, is a name especially associated with speech-act theory. This theory emphasises various aspects of speech, and one of them is the actual effect that words have, whether it is the effect of persuading, inspiring, frightening, or making something else happen.

These observations are particularly relevant to me as the author of a book related to mental health care. In my writing (rather than speaking, in this case), there are (at least) three things that were going on. Firstly, there was the actual act of sitting down and writing, i.e. turning my memories and reflections into a novel. Secondly, there was the issue of what I intended my words to do, i.e. my aim of drawing attention (in an entertaining way, hopefully) to past institutional practices that I understood as unjust. And thirdly, there was the actual effect that my words had on the people who read them.

But what is probably far more interesting than any of that, is the use of words in mental health care itself. If we say that actions speak louder than words, we are in danger of ignoring just how powerful words are. One of the things I included in my book, Delivered Unto Lions, is a form of words I remember very well from my time as a teenage mental patient in the ’70s. That form of words went something like this: ‘You are not being punished; this is just a consequence of your actions.’

Naming a disciplinary act as a ‘consequence’ rather than a ‘punishment’ was, no doubt, intended to do something. My guess is that it was an attempted form of behaviouralist conditioning – i.e. you already know the consequence of putting your hand in the fire is a painful burn, so therefore you don’t do it because of the inevitable result; in the same way, the consequence of (for instance) running away is confinement with all your clothing removed, so therefore you learn not to defy institutional authority, because that too has an inevitable result (or so you are conditioned to believe). Consequences, after all, are things that happen naturally, whereas punishments are deliberately imposed.

It is also very interesting how people with mental health conditions get labelled, because, of course, labels are also words which do things. I’m currently reading a book which tells the story of someone’s experience of borderline personality disorder (which I will review here in due course). But the expression ‘borderline personality disorder’ itself represents a form of words with an effect. Some people see these words as having a judgemental effect, as they paint a picture of someone who’s very self (personality) is faulty, existing on a ‘borderline’ between ‘normal’ and ‘psychotic’ functioning. For this reason (among others), there are alternative words that have been suggested to describe this condition, such as ‘emotional instability disorder’ or ‘post traumatic personality disorganization’. As such, these alternative names do alternative things, whether good or bad.

Stigma continues to be a major issue for current and recovered sufferers of mental health problems. The words we use can speak just as loudly as any actions. By their strength, words can feed the power of stigma, reinforce prejudice, and prolong suffering; or by their strength, words can reduce the power of stigma, challenge prejudice, and help alleviate suffering. Words, as well as actions, do things in the real world. Perhaps we should be more careful in the words we use so that we make sure they do the right things.

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Delivered Unto Lions by David Austin is published by CheckPoint Press

ISBN 978-1-906628-21-5

For more information visit www.davidaustin.eu

Book Review - Winnicott

2011-03-21T10:25:00.004Z

D W Winnicott (1896-1971) was a pioneering paediatrician and psychoanalyst who dedicated his life to the field of child development. Adam Phillips’ book, Winnicott (published by Penguin), provides a thorough overview of the man’s life and achievements.

I must admit that, until I picked up this book, I knew next to nothing about D W Winnicott. But Adam Phillips (himself a child psychotherapist) corrects that gap in my knowledge with this affectionate – though not uncritical – exploration of a very significant figure in the history of child psychiatry and psychology.

Phillips covers Winnicott’s early life, starting with his birth and upbringing in Devon, where he was raised in the non-conformist Wesleyan tradition. Phillips identifies this as noteworthy because Winnicott borrowed from the tradition’s eighteenth century founder, John Wesley, the desire to make his work accessible by using plain language – he did not believe that presenting his message in a popular way weakened it. But unlike Wesley, Winnicott rejected the aim of converting his audience, because he came to see it as a sign of madness to make such big demands on other people’s trust.

Given that Winnicott had a preference for plain language, it is regrettable that Phillips’ preface and fairly lengthy introduction are rather dry in style, which may put off more casual readers. Fortunately, his writing style is more easily manageable in the main body of the book (though in quoting the work of other thinkers, he isn’t afraid to repeat what some readers might see as ‘psychobabble’).

As Winnicott’s focus was always on child developmental issues, it is more than appropriate that Phillips considers not only the facts of Winnicott’s upbringing, but also Winnicott’s own view of it (as expressed in published comments). For instance, Phillips makes a point of comparing apparent characteristics of Winnocott’s father (e.g. as a potentially humiliating presence) with his son’s positive and justifying view of him. But while Winnicott’s comments on his father gained wide circulation, he published very little about his mother until he was in his late sixties, when he reflected on her suffering of depression. Phillips does not let the reader miss the possible correlation of such remembered experiences with the emphasis on the mother-and-child relationship in Winnicott’s professional work.

Phillips places Winnicott’s activity within the context of psychoanalysis in general, as bequeathed to world by Sigmund Freud, and as subsequently applied in connection with children by the likes of Anna Freud and Melanie Klein in the late 1920s. Winnicott, while learning much from these practitioners of the late ’20s, also deviates from them, not least in the way he resists their rigid adherence to their (often opposing) dogmas.

One particular chapter especially grabbed my attention. This is the one which looks at Winnicott’s observations about children evacuated from their homes during World War II. In this chapter, Phillips examines how these unfortunate (and damaging) circumstances gave Winnicott the opportunity to learn a great deal about children’s behaviour. It would not have been possible to make the same discoveries in peacetime, as it would obviously have been unethical to remove children from their homes and place them in hostels simply for the sake of research. What fascinates me personally is the parallel between these wartime experiences (and discoveries) and my own interest in the situation of children removed from their homes and placed in psychiatric units (in the post-war years up until the mid-1990s).

Also of special interest for me, given how little I knew of Winnicott previously, is how familiar many of his ideas appear. For instance, he sees common childhood symptoms, not as evidence of disorders, but as part of a child’s expression of identity. Such symptoms, however, come to indicate disorders when they continue to be used despite being useless as forms of communication.

Phillips particularly refers to Winnicott’s example of bed-wetting. This may represent a child’s protest against overbearing control, in which case it cannot be considered a disorder. But if the bed-wetting fails to communicate that protest effectively, but carries on anyway, then it should indeed be regarded as disordered. So, it is the context of a symptom that determines whether or not there is a problem. Many parents will be familiar with (and sometimes sceptical of) ideas of this kind from child rearing self-help books and parenting ‘experts’ (health visitors, TV child care ‘gurus’, etc.).

For me, this book is a useful introduction to D W Winnicott and his work. The author has succeeded in bringing his subject to life on the page, revealing a good deal about Winnicott’s possible motivations, hopes and aims. Given how empathetic and caring a figure Winnicott appears to have been, it is perhaps disappointing that these aspects of his approach were less influential in children’s post-war mental health care than were his theoretical contributions.

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Winnicott by Adam Phillips is published by Penguin

ISBN 978-0-141-03150-7

Delivered Unto Lions by David Austin is published by CheckPoint Press

ISBN 978-1-906628-21-5

For more information visit www.davidaustin.eu

Thoughts and Concerns

2011-03-14T11:16:00.002Z

Over the past few months I have written a good deal on subjects that, either directly or indirectly, relate to some form of human suffering in connection with mental health. My main concern has been with the past suffering of children and adolescents – most of whom have hopefully survived into adulthood – who spent some (or all) of their formative years in residential psychiatric care.

From the age of twelve to seventeen, I myself spend some considerable time in a children’s psychiatric unit (it wasn’t a single continuous stay, but it certainly dominated that part of my life). It was a very unpleasant experience, but I freely acknowledge that I was very fortunate compared to some of the other young people I knew during that time. Back then (from early 1976 to late 1980) I witnessed a good deal of mental distress in others that put my own difficulties into perspective.

Needless to say, in that situation, much of the suffering in question was directly caused by the very reason for admission to a psychiatric unit in the first place. Those young mental patients suffered with a variety of problems, from depression to eating disorders, from neuroses to psychoses. But there was additional suffering for some of those kids. This was the result of separation from, or rejection by, their families, plus occasionally punitive and unjust treatment at the unit.

But there is another kind of suffering on my mind as I write this. The people of Japan are very much in my thoughts at the moment, as that country was hit by a devastating earthquake on Friday, 11 March 2011. Today, the following Monday, the scale of human suffering in the wake of that event is becoming more and more difficult to take in.

How are we to deal with the issue of human suffering? How are we to compare suffering on a relatively small scale, such as that experienced in a 1970s children’s unit, with that on a much larger scale?

This question reminded me of something I read in an introductory theology text a number of years ago. I had a rummage on my book shelves to see if I still had it, and if I could find the passage I remembered (and if I had remembered it correctly). As it happened, I was able to find it quite quickly, and so I will quote what I found:

Some [people] are appalled by the total, vast extent of evil and suffering. It is true, of course, that no one person can experience it all. If twenty thousand people suffer and die from cancer of the lung there is no one person who can suffer more than his own individual share of pain. No one can die twenty thousand deaths.

(John Stacey, 1977/1984, Groundwork of Theology, p. 98)

The reason I bring this up is because it deals with perspective, and also because I believe all suffering matters. It may be one person’s suffering, or it may be thousands of people’s suffering. Recovery may take place in just a few days, or it may take years (or, very sadly, recovery may be impossible). The point is that suffering is still a tragedy, no matter what the scale. This is not a competition. If you’ve been hurt or damaged, then that still matters, and working towards a better future for yourself and those close to you is important. There may be others who are suffering more, and you can empathise with them and help them if you can; but that does not devalue your experience.

My thoughts are very much with the people of Japan, but they also continue to be with those young people I once knew all those years ago. If the thought can translate into practical attention (however small), and if concern can translate into hope (however small), then I'm sure those thoughts and concerns are worth having.

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Delivered Unto Lions by David Austin is published by CheckPoint Press

ISBN 978-1-906628-21-5

For more information visit www.davidaustin.eu

Book Review - Me, Myself, and Them

2011-03-07T09:47:00.000Z

Having read one perspective on schizophrenia, in Henry’s Demons by Patrick and Henry Cockburn, I decided to investigate another point-of-view, and one that particularly made reference to childhood and adolescence (though onset of schizophrenia in childhood or early adolescence is comparatively rare). And so I found myself reading Me, Myself, and Them by Kurt Snyder (published by Oxford University Press).

Me, Myself, and Them is Kurt Snyder’s own account of living with schizophrenia, an experience that began for him at the age of 18. But his account is supplemented by observations from an academic in the field of psychiatry, neurology and radiology (Raquel E Gur) and a journalist specialising in mental health issues (Linda Wasmer Andrews).

Kurt looks back to his childhood, and although he identifies two unfortunate incidents which overly preoccupied him for some considerable time, it seems he was a relatively happy, if reserved, child. It was at the age of 18, shortly after having begun an engineering degree course, that symptoms of schizophrenia emerged.

He started to believe he was a genius on the verge of a major breakthrough in mathematics, but the breakthrough eluded him, and so he began to feel he simply wasn’t thinking hard enough. But he also became forgetful, disorganised, and very paranoid. Not surprisingly, his college work suffered.

Kurt’s symptoms intensified after dropping out of college and pursing work in general maintenance. As he tells his story, the reader is allowed into his world of fear, where hostility appears to lurk behind every corner, and where he believes his every movement is being watched. And these symptoms are contextualised in a useful overview of the different varieties and manifestations of schizophrenia.

It is hard to find anything much to criticise in this book. If I have one very minor criticism, it is that more hasn’t been done to address the issues of stigma and stereotyping in connection with schizophrenia. These issues are not ignored, but they are dealt with rather fleetingly towards the end of the book. My own feeling is that these are very important matters that should have been raised earlier, and dealt with more thoroughly.

There are two major benefits to this book, as I see it. First, it mixes personal experience with explanatory detail in a very readable way. Some of the background observations tend towards the technical, but they are offered in a straightforward and readily understandable way. The book also offers some guidance on legal and financial matters (for sufferers in the United States), thus adding another dimension to its more practical aspects. This book strikes the perfect balance between specialised medical description, advice for sufferers, ordinary everyday narrative, and emotional involvement.

Second, and perhaps more important, is the fact that this is a very positive, optimistic book. It clearly gives the message that schizophrenia is treatable. While it cannot actually be cured, substantial recovery is achievable. With treatment matched appropriately to the individual, a sufferer can go on to lead a very full and rewarding life, with the condition downgraded to little more than an occasional inconvenience – I certainly wasn’t previously aware that such a positive outcome was possible.

All these features make this book highly suitable for a variety of readers, including individuals or families affected by schizophrenia (or other mental health conditions). I would also suggest Me, Myself, and Them as a useful resource for teachers, tutors and lecturers, whose classes may include students with the kind of problems described. This book may also be useful for other community workers (youth leaders, clergy, etc.) who may, from time to time, encounter sufferers of this condition. And, of course, this book would be invaluable for anyone who wants to get away from popular misconceptions and gain a better-informed understanding of what schizophrenia is.

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Me, Myself, and Them: A Firsthand Account of One Young Person’s Experience with Schizophrenia by Kurt Snyder, with Raquel E Gur and Linda Wasmer Andrews, is published by Oxford University Press.

ISBN 978-0-19-531122-8

Delivered Unto Lions by David Austin is published by CheckPoint Press

ISBN 978-1-906628-21-5

For more information visit www.davidaustin.eu

To Care, or Not to Care .... in the Community

2011-02-28T10:40:00.003Z

‘Care in the Community’ is the expression used in Britain for the policy whereby residential psychiatric institutions are either reduced or eliminated, with sufferers of mental health disorders being cared for in their homes with the support of community mental health services. Similar policies known by various names – e.g. ‘Deinstitutionalization’, ‘Community Release’, etc. – have been followed in many other countries, including the United States.

In various comments I have made, I’ve tended to speak in favour of the policy – while also acknowledging that it is not without its problems. Given my particular interest in children’s psychiatric services, I have argued that it is far better for a child suffering with depression (for example) to be cared for in as normal and homely an environment as possible, rather than being ‘locked away’ in an institution as though he or she were a young offender.

In my blog of 21 February 2011, I reviewed Patrick and Henry’s Cockburn’s book, Henry’s Demons (published by Simon & Schuster). Patrick Cockburn is particularly vocal in his criticism of ‘Care in the Community’. He describes the expression as ‘one of the most deceptive and hypocritical phrases ever devised by a government’. As the old psychiatric institutions were closed down in the 1980s and ’90s, Cockburn argues that those patients who had known some level of protection in these places were suddenly flung out onto the streets to become ‘sidewalk psychotics’.

I have some sympathy for Patrick Cockburn’s position. After all, he has faced the difficulty of trying to secure the safety and effective treatment of his son Henry, a sufferer of schizophrenia, in a world of what he calls ‘couldn’t care less in the community’. Indeed, Cockburn presents a persuasive argument, seeing the closure of many psychiatric hospitals as nothing more than a money-saving measure leading to ‘cruelty and unnecessary misery’.

It is, of course, perfectly true that community-based psychiatric services are often poor to non-existent (depending on region), and that many troubled people are left neglected. But just take a look at The Light in My Mind by Joyce Passmore (published by Speak Up Somerset), or my own book, Delivered Unto Lions (published by CheckPoint Press), to see the other side of the coin. These are reminders of the horrors of institutional ‘care’ in the recent past. Surely, whatever the failures of ‘Care in the Community’ might be, we cannot wish to return troubled people (young or old) to these repugnant places of incarceration.

It is also the case that we have been seriously misled if we are to believe that residential psychiatric care no longer exists. It is true that the larger Victorian-style asylums have gone, as have many of their associated children’s units, but that is not to say that in-patient mental institutions have completely disappeared. I was very surprised to discover that there are roughly seventy-five children’s and adolescents’ residential mental units – run by the NHS (National Health Service) – in the UK today (plus several more privately run units).

My hope is, of course, that these units of today are more caring and empathetic places than the ones that existed in the past. But given that their existence is hardly common knowledge, what happens inside them – good or bad – is hidden from our view.

And this, I think, brings us to what might be the central issue. These places are hidden, and maybe this is what we as a society prefer; we don’t want the mentally and emotionally disturbed living among us. Perhaps this is why many of us don’t like ‘Care in the Community’. Maybe we would prefer damaged and troubled individuals – adults and children – to be shut away where we can’t see them. It isn't nice to think about these things, so perhaps we prefer the easy option of not having to – that is, until we or our families are affected personally.

In this time of austerity, when already hard-pressed services are likely to face further cuts, I would dare to suggest that ‘Care in the Community’ can still work, and work well, but only if we as a community actually start to care. After all, even in hard times, we are perfectly prepared to do our best in supporting the people we care about.

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Delivered Unto Lions by David Austin is published by CheckPoint Press

ISBN 978-1-906628-21-5

For more information visit www.davidaustin.eu

Book Review - Henry's Demons

2011-02-21T13:48:00.002Z

Henry’s Demons by Patrick and Henry Cockburn (published by Simon & Schuster) tells the story of a family’s testing experience of schizophrenia.

Henry (one of the co-authors) is diagnosed with this condition in 2002 at the age of 20. While an art student in Brighton, Henry’s behaviour rapidly becomes more eccentric and hazardous, until he ventures, fully clothed, into the sea at Newhaven. This leads to his admission, as a mental patient, to the Priory Hospital in Hove.

Parts of the story are narrated by Patrick Cockburn (Henry’s father) in a considered documentary style. He interweaves explanatory details with narrative account, but what is immediately striking is how little any of the background information on schizophrenia contributes to his (or the reader’s) understanding – the reason for Henry’s development of the condition largely remains a mystery (though cannabis use is heavily implicated as a possible cause). And so the reader is drawn into the anxiety and bewilderment associated with the situation.

Other parts are narrated by Henry himself, in an almost hurried, but extremely arresting, style. He talks of experiencing the onset of his condition as a spiritual awakening, with his perspective on the world becoming significantly altered. As some of the events described take place in Brighton – somewhere I’m reasonably familiar with – I personally find it fascinating to see particular experiences unfolding against recognisable backdrops. For instance, there’s a vision of the Buddha on Brighton beach and the planting of a banana tree outside the Concorde 2 music venue. This locatedness – whether in Brighton, Canterbury, Youghal (in Ireland), or elsewhere – gives an additional tangibility to these occurrences.

As the story unfolds, via one or other of the narrators, a growing sense of the enormity of Henry’s condition becomes apparent. There is no quick fix for what had happened; in fact, there is no fix at all. What is more, Henry himself is not always convinced that he has a problem, and so his willingness to take his medication (olanzapine, clozapine, etc.) is intermittent. When he takes it, his delusions and erratic actions are somewhat controlled (though not reliably so); when he doesn’t, he seems to positively revel in extreme and disturbing behaviour (climbing to great heights, walking close to railways lines, running naked through snow, and so on). What Henry doesn’t necessarily realise, but what becomes clear to his family (and to the reader), is that this is a life sentence.

One particularly valuable service this book does is to underline the injustices associated with mental health problems, especially schizophrenia. Various truths are highlighted, including the fact that the media often demonise sufferers as violent (statistically, very few are), that society in general often treats them with (at best) disregard, and that sufferers are far more likely to be dismissed from their jobs than if they had a physical condition. It is also pointed out that, on occasions, sufferers placed in hospital wards can be allowed less fresh air and exercise than would a convicted offender.

Given the downbeat quality of the story and many of the associated observations, it is tempting to wonder if there’s any chance of the book ending on a positive, uplifting note. I won’t give anything away, but it I will say that the reader does not finish the final chapter with a sense of desolation. Instead (for me, anyway) there is a sense of worthwhile insight bordering on enlightenment.

____________

Henry’s Demons: Living with Schizophrenia, a Father and Son's Story by Patrick and Henry Cockburn is published by Simon & Schuster

ISBN 978-1-84737-703-6

Delivered Unto Lions by David Austin is published by CheckPoint Press

ISBN 978-1-906628-21-5

For more information visit www.davidaustin.eu

What Then and Where Now?

2011-02-15T11:00:00.005Z

Sometimes as I prepare to write my blog I start to wonder if there’s anything left to say. But then some little thing will happen that makes me realise that there is nearly always something to say.

This week, two questions have come to mind: (1) ‘What then?’ and (2) ‘Where now?’ I’ll deal with the ‘What then?’ first.

Thanks to the wonders of social networking, I received a message this week from one of my old school classmates from the mid-1970s. This was someone I knew immediately before I experienced the events that ‘inspired’ my novel Delivered Unto Lions. She told me that, as far as she knew, I had just ‘disappeared’ from school with no explanation. Having become aware of my book, she now realised what had happened – that I’d been taken away from school (and home) and placed in a psychiatric unit because I was depressed.

This made me think of three other children who went to that same school who were also (at different times) ‘spirited away’ to the very same psychiatric institution. I didn’t know any of them while I was at that school, but I got to know them at the institution. This makes me wonder whether their sudden absences went unexplained in the same way that mine did. After all, I certainly hadn’t been aware of anyone ‘disappearing’ like that, but at least one of those ‘disappearances’ had happened before mine.

It is a horrible thought that, on certain (comparatively rare) occasions, children could simply be plucked out of their schools almost unnoticed. Their friends would wonder what had happened to them, of course, and no doubt some vague words of non-explanation would have been offered. But unless a child eventually returned to his or her school (some children did, some didn’t), life for everyone else would just go on, and that child would be gone and (in the end) virtually forgotten.

And that brings me to the ‘Where now?’

I have been greatly encouraged by the shift towards Care in the Community which began in the late 1980s, and which by the mid-’90s had seen many of these old children’s units closed. Care in the Community has its critics, of course – and often for good reason – but I tend to focus on the idea that a child with depression, anxiety, or some other similar condition, is far better off in as normal environment as possible, rather than being ‘incarcerated’ in a clinical and often hostile mental unit.

The hope is that things are far better these days, and that far fewer troubled children get institutionalised. But how can we be sure of this? The fact is that, prior to the rise of Care in the Community, very few people were aware that it happened anyway. So, if it was still happening today, would we notice?

This may sound like I’m being a little alarmist. Perhaps I am. But what prompts this is what I've found (which isn't much) from my attempts to discover exactly what does happen today. Unless you are a mental health professional, your are unlikely ever to have come across the Royal College of Psychiatrists' directory of children's units. This, however, lists all the child and adolescent mental health in-patient units in Britain and Ireland – and there are actually quite a lot of them!

I'm not going to start flinging wild accusations about. My hope (and my belief) is that these present-day units are far more compassionate and empathetic places than the ones that used to exist. But they are still well-hidden. Unless you go looking for these places, you'll never know anything about them.

My book is about exposing a hidden world from the recent past (and Wikipedia helps too!). But there remains a hidden world in the present. What I would like to see is more transparency, so that society as a whole – as well as healthcare providers – can scrutinise current practice and ensure that it is just and caring.

____________

Delivered Unto Lions by David Austin is published by CheckPoint Press

ISBN 978-1-906628-21-5

For more information visit www.davidaustin.eu

Book Review - Welcome to My Country

2011-02-09T15:49:00.003Z

Lauren Slater is a psychologist who obviously enjoys a colourful turn of phrase. In Welcome to My Country (published by Penguin), Slater recounts her experiences of working at a clinic in Boston alongside the schizophrenic, the chronically depressed, the sociopathic, and the otherwise troubled. She positively revels in vivid description, describing one patient as having ‘skin the color of deep coal’, another as having a spine ‘standing out like a string of pearls’, and yet another as having a ‘voice as bleak as a British moor’ (though, given the context of this last phrase, I can’t help wondering how many British moors the author has actually seen!). This very much underlines the fact that this is not a textbook containing dispassionate case histories, but an experiential account of engaging with mentally and emotionally disturbed individuals.

Slater’s academic grounding at Harvard and Boston Universities has not fully prepared her for suddenly entering a foreign land populated by people who seem to experience reality very differently. This is a world where women can also be paintbrushes, where spaceships can rest on people’s stomachs, and where intimate relationships can be maintained with albino girls in the sky. It is among disparate individuals with disparate delusions that Slater – uneasy and occasionally offended – has to conduct group and individual therapy, encouraging patients out of their bizarre individual world experiences into a more common shared world experience.

As Slater’s story unfolds it becomes apparent that she often succeeds in entering into the worlds of her patients – even when those worlds remain stubbornly unintelligible. She comes to empathise with her patients, even when initially revolted by some of their characteristics. This is a very striking aspect of the story, especially given her admission of how little confidence she often has in formally understanding her patients’ needs.

Despite Slater’s robust theoretical knowledge, much of what she seems to do in therapy – in terms of procedure – is little more than trial and error. Slater’s strength (and her vulnerability) seems to lie in her ability to empathise. Indeed, aspects of her patients’ stories stir up personal memories and emotions for her, leaving her pondering on the content of therapy sessions long after she has finished work for the day, and forcing her to confront certain aspects of herself. Slater even expresses the general observation that the mentally disturbed sometimes ‘force you into things you’d rather not see, not say.’ And she expands on this by confessing that, in knowing certain patients, she finds herself returning to a state of shame followed by emptiness.

What is so disarming about this book – and what only gradually becomes apparent – is that Slater is personally familiar with psychological torment. It is this which finally gives contextual meaning to the entire book in an exquisitely moving final chapter.

Welcome to My Country is a beautifully written memoir, expressing well-informed insight through a fusion of imagination, poetic language and technical knowledge. An extraordinary book.

____________

Welcome to My Country: A Therapist’s Memoir of Madness by Lauren Slater is published by Penguin Books

ISBN 978-0-14-025465-5

Delivered Unto Lions by David Austin is published by CheckPoint Press

ISBN 978-1-906628-21-5

For more information visit www.davidaustin.eu

Accepting Difference

2011-02-07T10:35:00.001Z

The speech on multiculturalism, delivered in Munich by British Prime Minister David Cameron on 5 February 2011, has been generating a good deal of discussion in the press. Comments like ‘We need a lot less of the passive tolerance of recent years’ have gathered a good deal of support from some papers (e.g. The Times) while being greeted with suspicion by others (e.g. The Guardian). Cameron was, of course, primarily criticising alleged tolerance of one very particular and small subculture, i.e. ‘extremists’ of the Islamic faith persuasion. But multiculturalism (depending on how you define it) encapsulates far more than this one single issue.

So what does multiculturalism have to do with the usual topic for discussion on this blog, i.e. matters related to mental health? The answer to that lies in the issue of ‘difference’. Difference of the cultural variety may not seem obviously related to mental health. When presented with the word ‘culture’, I suspect many of us will think either of ‘high culture’ (e.g. opera) or something vaguely connected with ‘national culture’. But many groups have their own cultures, such as families or members of a particular profession. And other groups are often seen as though they were a culture, such as the so-called ‘disabled community’.

Society, very broadly speaking, can sometimes appear to regard people with mental health problems – or past sufferers of mental health problems – as if they were an identifiable cultural group. In this way, a whole swathe of people with little or no connection to one another get marked out as ‘different’.

David Cameron has said, '[W]e have encouraged different cultures to live separate lives, apart from each other and the mainstream.'

Cameron was not, of course, talking about mental health. But he may as well have been. Because many people with present or past mental health difficulties are marked out as different by society (as are many people of certain national, ethnic or faith backgrounds) they are not really welcomed into the mainstream. As such it is only natural that some should choose to live separately from those around them. And by segregating themselves, they become even less welcomed by the mainstream, and so they segregate themselves further.

What has prompted me to post these observations is hearing the story of a physically disabled woman (whom I will not identify) who is so fed up with the verbal abuse she receives when venturing out into public areas that she often avoids it, feeling very uninclined to ‘integrate’ with the mainstream. This is, no doubt, an experience she has in common with people with many conditions – mental and neurological, as well as physical.

Cameron says, ‘We need a lot less of the passive tolerance of recent years.’ Given that so many people, through no fault of their own, are not tolerated by much of society – passively or otherwise – leads me to conclude that this was a very unfortunate statement. Clearly I am interpreting it in a way that was not intended, but surely politicians should be aware that the ‘enemies’ they target are not always the ones who take the hit. I am sure this is not what Cameron wants, but many people will get (and, apparently, have got) the message that it’s good and proper to be intolerant of difference.

So when it comes to people with mental, neurological or physical difficulties (along with many other people), I say that what we need instead of ‘passive tolerance’ is ‘active acceptance’.

____________

Delivered Unto Lions by David Austin is published by CheckPoint Press

ISBN 978-1-906628-21-5

For more information visit www.davidaustin.eu

Where is the Case for the Defence?

2011-01-31T12:56:00.002Z

In some recent radio interviews (and a YouTube video) in which I have discussed my book, Delivered Unto Lions, I have made a number of general allegations in connection with the experiences and issues that ‘inspired’ it. I have talked about the former Merrifield Children’s Unit at Tone Vale Psychiatric Hospital in Somerset (the basis for the fictional Oakdale Unit of my book), and I have suggested that some of what I experienced and witnessed there in the 1970s was abusive.

My allegations have, admittedly, been non-specific. I haven’t named names, but focussed instead on the system that allowed certain things to happen. I have criticised the institution’s reliance on drugs to treat and control its patients, along with my opinion that it was inappropriate to subject developing brains to these potent substances, and in such doses. I have also referred to excessively aggressive forms of restraint, and the isolation of children in a small room with their clothes taken away from them (and I haven’t always remembered to point out that these things were occasional rather than regular events).

I could have said more, of course, but daytime radio may not be the best forum for a discussion on the horrendous response to incidents of sexual abuse (but such things are covered in my book).

What amazes me is that no one (as far as I am aware) has yet come forward to defend Merrifield Unit, or children’s psychiatric units more generally. And no one (again, as far as I am aware) has yet emerged to condemn my book as sensationalist fabrication (though, if anything, I consider it understated in places).

It is true, of course, that my book is only a modest seller and that my radio interviews have only been broadcast on local stations, and have not therefore enjoyed an especially high profile. But I have certainly heard from people who confirm the picture I have painted, so there is clear evidence that what I have said has reached at least some of those interested in the topic.

What I have said in my interviews is, of course, the truth. And the content of Delivered Unto Lions is a representation of that same truth. But I recognise that there are at least two sides to every story. So, where is the case for the defence? Why hasn’t anyone challenged me?

It would be nice to think that those concerned (where they are aware of what I have said) have recognised the validity of my arguments and accepted that I am in the right (in which case an apology directed at former child patients would be an appropriate response). But it would be both naive and conceited to believe that that is the case. So, what is the reason for the silence? Maybe those who disagree with me simply think the issue isn’t important.

In some ways it is rather foolish of me to invite a challenge – I don’t actually want to be challenged. But the issues that lie behind my book are important ones, and that makes the silence from certain quarters ‘deafening’. Everything I have written and said on the subject is concerned with exposing the ‘hidden world’ of children’s mental health care in the recent past, but it seems that the former ‘rulers’ of this ‘hidden world’ are doing all they can to stay hidden – which is hardly encouraging if the same diffidence applies with regard to the current state of child psychiatric care.

I am aware that I am being unusually provocative here, and I continue in that vein by ending on a similarly provocative note. I have asked, ‘Where is the case for the defence?’ Could it be that there is no possible defence?

____________

Delivered Unto Lions by David Austin is published by CheckPoint Press

ISBN 978-1-906628-21-5

For more information visit www.davidaustin.eu

Book Review - The Lives They Left Behind

2011-01-24T10:42:00.004Z

I wasn’t quite sure what to expect of The Lives They Left Behind by Darby Penny and Peter Stastny (published by Bellevue Literary Press). In a way, the subheading gave it away: Suitcases From a State Hospital Attic. But what could possibly be so interesting about suitcases? Could anything of any significance really have been left inside them? Well, the answer is a very definite yes.

The hospital in question is the Willard State Hospital in New York – originally called the Willard Asylum for the Insane – which opened in 1869 and finally closed in 1995. Soon after its closure, a very large number of patients’ suitcases were discovered in the attic of the Sheltered Workshop Building by the curator of the New York State Museum. He had been exploring the site in search of artefacts worthy of preservation.

The various crates, trunks, and suitcases that were found there were not empty. They contained all the remaining possessions of the patients they had belonged to: clothing, photographs, books, papers, mementos, and much more besides. The luggage was saved, and a group of archivists and curators began a ten-year plan to sift through the materials.

What The Lives They Left Behind does is reconstruct – as far as is possible – the biographies of a few selected patients (mainly from the earlier part of the twentieth century), drawing on the content of their suitcases supplemented by any medical records or other documents that may have survived. What emerges makes grim reading, as these few unfortunate incarcerated patients of Willard are (at last) acknowledged as real people with real histories.

It is notable that almost all of the patients portrayed in this book are immigrants to the United States. Whether these few patients are truly representative of Willard patients in general is unclear, but if they are, there is a definite suggestion that factors such as nationality, social class and ethnicity played a role in deciding who was to be admitted to the institution. A little more clarity about this would have been helpful.

It is certainly apparent that the psychiatrists who diagnosed these patients did so according to their own social and cultural assumptions. Where there was evidence of psychotic delusion, the doctors made no effort to appreciate elements in the patient’s background – such as unfamiliar religious practices – that may have given rise to the delusions. Symptoms were observed and described, but no effort was made to understand them.

But, as the book makes clear, until the 1960s, there was never any real thought given to ‘curing’ or rehabilitating patients; they were simply kept out of the way at Willard – often for many decades – and frequently put to work to maintain the hospital’s partially self-sustaining economy. It is especially telling that following the death of a patient whose job was to tend the hospital’s cemetery, that that particular patient was given an anonymous grave and the cemetery he had cared for so meticulously was left to become overgrown.

Although the lives represented in this book are well reconstructed, I get the impression that the priority given to documentary facts and their interpretation sometimes gets in the way of letting these lost voices really speak. But, on the whole, the authors achieve a good deal in bringing these hidden lives to public attention, and also drawing lessons from past psychiatric practices in a critique of the present state of mental health services.

The Lives They Left Behind has a lot to recommend it, though it may be a little ‘dry’ for some readers. However, it resists the temptation to be overly academic, and therefore paints a picture of Willard State Hospital that will be readily accessible to most people.

____________

The Lives They Left Behind: Suitcases From a State Hospital Attic (2009) by Darby Penney and Peter Stastny, with Photographs by Lisa Rinzler, is published by Bellevue Literary Press

ISBN 978-1-934137-14-7

Delivered Unto Lions by David Austin is published by CheckPoint Press

ISBN 978-1-906628-21-5

For more information visit www.davidaustin.eu

Interview for BBC Somerset, 13 January 2011

2011-01-17T11:27:00.002Z

On Thursday, 13 January 2011, I was interviewed live (over the ’phone) by Emma Britton of BBC Somerset. The interview went out shortly after 11 am, and it concerned my book, Delivered Unto Lions, and the experiences that inspired it: those of having been a child psychiatric patient in the former Merrifield Children’s Unit at Tone Vale Hospital, near Taunton, in the 1970s. For copyright reasons, I cannot offer a full transcript of the interview, but I reproduce here a transcript of my own words as broadcast.

Emma Britton began by asking me how I became a patient at Merrifield.

‘I was 12 years old and I was suffering with depression. It was causing problems at school, and things like that. I went through the old Child Guidance system, as it was in those days, and it was suggested that I be admitted for a short time to Merrifield. But a ‘short time’ stretched out into a much longer time, and I was there, on and off, for just over four years.’

Emma then asked what I had thought at the time about being admitted to the unit.

‘I think, prior to it actually happening, I felt quite positive about it. I thought that it would be a good thing, that it would sort out the problems I had. And a rather rosy picture of the unit had been painted for me by the psychiatrist. So I was actually quite positive – until I actually arrived there.’

I was then asked to describe what it was like.

‘It was all very traumatic. I suddenly found myself in this place surrounded by other kids with all sorts of other problems. There were kids, similar to myself, with depression, but there were also kids with anorexia. I’d never come across anything like that before, so that was quite a shock. And there were also kids who had been in trouble with the police, and perhaps had some violent tendencies. I was quite frightened of those, er, older kids, particularly. We were really such a mixed bunch of people. And although a lot of the staff were very good, very caring, a few of them weren’t really very sympathetic at all. It very much felt like a punitive environment, as though I was being punished for being unwell.’

Then Emma asked why a child of 12 would have been suffering with depression in the first place.

‘Well, I guess we’d had a few problems in the family. My father had been quite unwell, we’d also moved house quite recently, and I had a new baby sister. Things were very much changing at home, and I’d only been in my new school for about a year or so, and I hadn’t really adjusted too well to our new circumstances – and I think that’s what really led to my depression.’

Emma enquired about my medical treatment.

‘It was mostly drugs – antidepressants, initially. But then there were drugs like benzodiazepines, and even antipsychotics at one point. Quite a lot of drugs. And the prescription would be changed without any prior warning, so I never knew what was happening. Although my memory of the whole period is pretty good, there’s a whole section in the middle that I really don’t remember at all, and I put that down to the effect of drugs.’

The depiction of mental hospitals in films like One Flew Over the Cuckoo’s Nest was raised, and I was asked if Merrifield was anything like that.

‘Cosmetically, it was different. The actual building itself and the furnishings were a lot more pleasant than what you see portrayed in films like that, and, indeed, what you see in documentaries on the old asylums. So, as I say, cosmetically it was rather better. But I think in practice there was still a lot of the same sort of attitudes: the same sort of institutional culture prevailed.’

Emma then asked why I wanted to revisit my experiences in writing Delivered Unto Lions. Was it difficult? she asked.

‘Yes, it was. It was extremely difficult, actually. I’d had it vaguely in mind for a number of years that I might try and do something positive with my experience. But then, a few years ago, I came across this ‘urban exploration’ website. Now, I don’t really know too much about ‘urban exploration’ myself, but they had a feature on the old Tone Vale Hospital, and there was a sort of forum there, and a number of former Merrifield patients had posted things on there. I suddenly realised this was a very important cause, it wasn’t just about me, it was about my generation, and also about people who preceded me and followed me at Merrifield. I very much felt we all had a story to get out, that this was very much a hidden world. People in the Taunton area and West Somerset will have all heard of Tone Vale, but very few people will have heard of Merrifield – they won’t have known that children were treated in this sort of way. So I wanted to get the story out.’

The question then came up of my book being described as a novel.

‘It falls between two stalls really, because it’s not, strictly speaking, biography – although there’s a lot of biography in it – and it’s not, strictly speaking, fiction. What I’ve done, to protect the identities of other people, is to change names and alter some of the situations a bit, and relocate the whole thing to another location, in Sussex. So, I’ve done that, so in that sense it’s like a work of fiction, but it very closely follows my own experiences and also the things I witnessed. So a lot of it can be taken quite literally, but there is some sort of artistic invention in there as well, particularly to cover gaps in my memory.’

Emma then asked if I was pleased to hear that Merrifield and Tone Vale had been closed and a new village built in their place. She also asked how I felt about the shift in the approach towards people with mental health problems.

‘On the whole, I’m quite pleased about that. I know there’s been a lot of criticism of Care in the Community, and there’s been a number of high-profile cases where it hasn’t worked, with tragic results. But on the whole, I think it’s been a very positive move, especially for children. And, of course, I was very pleased to hear that the hospital and the children’s unit had been closed down. But I do have some reservations as well, because now, at Cotford St Luke [the new village built on the site], there’s no real sign that Merrifield Unit existed at all – you wouldn’t know it had ever been there. Although that’s good in one sense – that something new and positive has been built on the site – on the other hand, it’s a bit like having your memories buried. I very much think we should learn from history to make sure these things don’t happen again, so it’s almost as if the evidence has been removed. But, generally, I think it’s a very positive thing. In a way, that piece of land, as it were, has been kind of 'redeemed' or 'saved' by having housing built on it. That’s great, really.

The issue of catharsis was then broached: had writing the book laid any demons to rest?

‘To a certain extent, but rather than the actual act of writing the book – which, as I said, was extremely difficult – what I have found very helpful for me is some of the reaction I’ve had to it. I’ve heard from some other former patients of Merrifield, and other people who are interested, and just hearing that reaction, hearing that perhaps in a small way I may have helped one or two people, that has really helped me. That’s made quite a big difference to me, and it’s put the whole experience into a new perspective.

Finally, Emma asked about my current state of health.

‘Well, I have my ups and downs. I’m pretty good, on the whole. Not perfect, but not bad.’

____________

Delivered Unto Lions by David Austin is published by CheckPoint Press

ISBN 978-1-906628-21-5

For more information visit www.davidaustin.eu

Demolishing the Asylum

2011-01-13T10:40:00.001Z

With the rise of Care in the Community in the 1980s and ’90s, the old Victorian asylums were finally closed. What is less well known is that this period also saw the closure of children’s psychiatric units – places like Merrifield in Somerset and Gwynfa in North Wales (both were closed in the mid-’90s).

The reason why the closure of these units is less well known than that of the adult mental hospitals is that very few people were aware these places existed in the first place. Before Care in the Community reached its height, most people in any given area would know the name of their region’s ‘madhouse’, but hardly anyone would be aware of the equivalent provision for children.

Although my book, Delivered Unto Lions, is set in a fictional children’s unit in Mid Sussex, I make no secret of the fact that it is inspired by the Merrifield Children’s Unit which used to stand in the grounds of the former Tone Vale Hospital in Somerset. Merrifield is gone now, completely demolished, as is most of the Tone Vale complex – only a few (Grade II Listed) buildings remain.

Tone Vale is not unique in this respect. This is what has happened to many of the old asylums in Britain – parts have been demolished (or allowed to fall down) while features considered to be of architectural merit have been preserved.

In some cases, new housing has been built on the sites of old mental hospitals, and some former hospital buildings have been converted into flats. This is what has been happening with High Royds Asylum in West Yorkshire and the Cumberland and Westmorland Counties Asylum near Carlisle, to name just two.

This is also what has happened with Tone Vale. A whole new village – called Cotford St Luke – has been built on the site. But while the few remaining parts of the old hospital have been incorporated into the village, there is nothing left of the children’s unit whatsoever – you would never know it had been there.

On the whole, I think this is very positive. To my mind it is quite right that a place where children were subjected to unpleasant institutional ‘care’ should have been ‘rescued’ from its dark history and put to new and better use. There is a sense in which Merrifield has been ‘redeemed’.

Merrifield was an institution where children with a wide variety of mental health disorders (and sometimes with no real disorders at all!), were placed in isolation from normal society. It was common practice to drug these children excessively, and often inappropriately, with no thought to what these substances might do to the developing brain. Some children were also occasionally subjected to abuse, and many were treated in a generally punitive way, as though being depressed or anorexic, for instance, was some sort of moral offence. But the site where these things happened is now a housing estate, providing homes for individuals and families. It has been saved from its past.

Of course, not all of Merrifield’s former patients can say that they too have been saved from their past. While some have made substantial recoveries from their original conditions and also overcome the trauma of their time in residential psychiatric care, others have had their lives permanently blighted by the way they were once treated – even if that treatment was well-intentioned. As a former Merrifield patient myself, I can say that I am very lucky, having been able to live a relatively full and satisfying life since leaving that place – though I am still very much haunted by my memories.

This introduces another aspect to the demolition of Merrifield – and places like Merrifield. While it is good that the unit is gone, having been replaced by something of greater community benefit, I have one particular concern connected with its destruction. There is now no concrete reminder at that place of what once happened there. While there are many adults still troubled by their experiences at Merrifield, there is a sense in which the evidence for these past traumas has been swept under the carpet. While few people would have known of Merrifield’s existence when it was open, now there is no sign that the place ever existed at all.

And so I conclude with a challenging paradox. It is good to build over a place of past distress with something new and positive. But it is also bad to bury the past as though it never happened. In rescuing places and people from troubled histories, we should still remember those histories and learn from them. How else can we make sure that history is not repeated?

____________

Delivered Unto Lions by David Austin is published by CheckPoint Press

ISBN 978-1-906628-21-5

For more information visit www.davidaustin.eu

Book Review - The Curious Incident of the Dog in the Night-Time

2011-01-10T12:28:00.004Z

For my second attempt at a book review I have decided to take a look at The Curious Incident of the Dog in the Night-Time by Mark Haddon (published by Vintage). Curious Incident is a work of fiction written in the first-person from the perspective of a 15-year old boy with Asperger’s Syndrome (an Autism Spectrum Disorder).

The book is, supposedly, a murder mystery in which teenager Christopher Boone sets about investigating the death of a neighbour’s dog. But the ‘murder mystery’ isn’t really the subject of the book, but rather a means for getting into the real story. This is the story of a boy who, due to his condition, has difficulty relating to the ‘normal’ social world. Much of the plot centres on the way he naively attempts to satisfy his enquiring mind while steering his way through family tensions and the well-meant advice of staff at his special school.

The novel has been generally well-received – indeed, it is an international bestseller – but some commentators with first-hand experience of Asperger’s Syndrome have questioned its accuracy in portraying the condition. For readers who would prefer a more authentic account of AS, I would suggest they read Freaks, Geeks and Asperger Syndrome by Luke Jackson.

Nonetheless, the confidence of Mark Haddon’s writing means that the central character of Christopher comes over as convincing (allowing for the absence of a more nuanced view of AS) and the story is plotted in a very engaging way.

The major strength of Curious Incident, in my view, lies not in the accuracy (or inaccuracy) of its portrayal of Asperger’s, but in its observation of the ‘normal’ social world of human relationships and interactions. In this sense it stands alongside modern fable, such as Richard Adams’ Watership Down, and some of the more literary examples of science fiction, in placing the reader at a distance from the ‘real’ subject matter. From this distance, the reader is able to see essential themes from a new angle while also being entertained.

Another strength rests in what the book says about the responses of ‘normal’ people to someone with a mental health or neurological condition. These responses range from the impatient refusal to answer questions and well-intentioned deception, all the way through to blatant mockery and hostility.

I must, however, raise another word of caution. Curious Incident is written in a style somewhat reminiscent of Jacqueline Wilson’s Tracy Beaker books. Wilson’s books are, of course, aimed at children, but while Curious Incident is indeed available in a children’s edition (with a different cover design; the text remains unchanged), it is not suitable for pre-teens due to some of its content (including a very high number of expletives).

Allowing for the two qualifications I have mentioned (its inexact portrayal of Asperger’s and its unsuitability for children), I have no hesitation in recommending this book.

____________

The Curious Incident of the Dog in the Night-Time by Mark Haddon is published by Vintage

ISBN 0-099-45025-9

Delivered Unto Lions by David Austin is published by CheckPoint Press

ISBN 978-1-906628-21-5

For more information visit www.davidaustin.eu

The Privilege of Being Heard

2011-01-06T11:27:00.001Z

As I began to think about what I was going to write for my first blog of 2011, I started reflecting upon the privilege of being a published author. By having a book in print, you have the possibility of having your message heard by a potentially wide audience – most of us only have very limited opportunities for getting our thoughts across to many people.

But with more than 130,000 books being published each year in Britain alone (according to the Writers’ & Artists’ Yearbook) there are many titles out there vying for attention. They cannot all be bestsellers. But once a book is out there it can – with the help of appropriate publicity – find an audience. That audience may not be a huge one, but it will probably be larger than the one that might give you a hearing in your local pub!

The fact is that if your book is any good, or tackles a subject people are interested in, the word-of-mouth generated by satisfied readers will bring it to the attention of others and perhaps even make it a bestseller. On the other hand, if your book is relatively poor, word-of-mouth will probably kill it.

A mass market novel that sells 15,000 copies is a bestseller. A title that only sells a dozen copies (and such books do exist) is a flop. Looking at it that way, my book, Delivered Unto Lions, is closer to being a flop than a bestseller. But in actual fact it is neither. While it is hardly a mass market title (local bookshops won’t stock it without guaranteed customer orders), in the two short months it has been out it has succeeded in finding an audience and selling enough copies to remain on my publisher’s catalogue for some time to come.

The point I am making is that I am very fortunate to have been able to get my story out there. I make no secret of the fact that I have an axe to grind. I am railing at the way children were once treated by institutions supposedly offering psychiatric ‘care’. I am raging at the systemic injustices and abuses that were relatively commonplace – right up until the emergence of ‘Care in the Community’ in the 1990s. I am protesting at the institutional forces that have conspired to keep this hidden world a secret for so long. And I am challenging the powers-that-be to confirm that no such hidden world exists today...

This may all sound rather self-aggrandising, as if to suggest that my views and perspectives are so important that voicing them could possibly make a difference. No doubt there are people out there who will not appreciate what I have had to say – and sooner or later I expect to get a negative review. But I want to underline the good fortune I have had in being able to get my message out. That is a privilege. Until recently I couldn’t really make my views known or have them taken seriously. That has now changed – and I do not take it for granted.

Words are precious. For those of us who have the freedom to get our words heard by others, let us not waste those words. Let us do whatever we can to make our words count. If you are fortunate enough to have this freedom – and not everyone does – please use it. If there are words inside you that matter, give them voice. If you can write a book and get it published ... do it. If you can write a blog ... do it. If you can contribute to forums (whether on the Internet or in the real world) ... do it. Words are a gift, and you can make your words a gift for other people.

____________

Delivered Unto Lions by David Austin is published by CheckPoint Press

ISBN 978-1-906628-21-5

For more information visit www.davidaustin.eu

Book Review - The Light in My Mind

2010-12-23T10:50:00.000Z

I hadn’t expected to be blogging again before the new year, but having just read The Light in My Mind by Joyce Passmore (published by Speak Up Somerset) I just had to share my review of this very significant book.

The Light in My Mind tells Joyce Passmore’s personal story of having been a patient in a psychiatric hospital from 1957 to 1972 and her subsequent recovery from this horrific and unjust experience.

At the age of 13, Joyce was admitted to the Merrifield Children’s Unit (the very same institution, albeit in an earlier guise, which inspired my own book). Merrifield was, essentially, the children’s wing of Tone Vale Hospital – an old Victorian asylum – in Somerset. Joyce did not, however, have a mental health problem; she suffered with epilepsy, and she was told she would only be in the unit for three weeks while they attempted to stabilise her condition with medication. She writes of the austere atmosphere of the unit, and the quiescent oblivion of the children who surrounded her – all numbed by tranquilising drugs. Joyce, too, came to suffer the effects of excessive and inappropriate medication. Joyce relates all of this using very direct and minimalist language, painting a remarkably unadorned picture of her situation.

Joyce goes on to describe how she was given a more thorough diagnosis of her condition by a neurologist at Guy’s Hospital, London, together with the recommendation that she be discharged from the unit in Somerset. But Merrifield ignored the findings of this authority and continued to keep her incarcerated and subject to unsuitable drug therapies.

If Joyce’s experience thus far is shocking, it is nothing compared to the horrors she encountered when transferred to the adult hospital, Tone Vale, at the age of 16. Joyce’s use of language continues to be plain and unadorned as she moves into this phase of her experience. She doesn’t wallow in her misfortune, but simply portrays it in a matter-of-fact way, punctuated with the occasional insight enabled by more recently gathered information.

In reading her account of this period (which continued for well over a decade) the various elements – including electroconvulsive therapy, violent attacks on her by other patients, and unconscionably abusive and dishonest staff – all merge to form a seamless nightmare. But while we have the ability to put her book to one side for a moment if we wish, for Joyce this nightmare would have seemed never-ending.

Ultimately, however, The Light in My Mind is a story of hope and recovery. One thing that supported Joyce through this nightmare was the Christian faith she had inherited from her early upbringing. She writes of this hopeful thread running through her life with a tangible sense of gratitude – it is the only thing that offers her relief, and without expressing it explicitly, it is clear from her turn of phrase that she doesn’t take it for granted.

The background to this faith is located in the time before Joyce’s nightmare began. Having been sent to a church Sunday School by her parents, she had absorbed teaching centred on the figure of Jesus, and so she clung on desperately to this figure, her only source of hope in the darkness. In the present-day climate, where there are so many voices objecting to the exposure of children to religious teaching, it is interested to see that it was this kind of teaching that equipped Joyce for survival in the ‘hell’ she had to endure.

A good proportion of the book is devoted to the support Joyce received from Christian organisations and individuals following her final discharge from Tone Vale – most notably in Tunbridge Wells, well away from the geographical site of her torment. After such a long period of institutional captivity, it is no surprise to learn that Joyce emerged ill-fitted for life in the outside world. But it was people of faith who enabled Joyce to make the long and difficult transition. It is also worth noting that, during this period, she found a real sense of satisfaction in her singing ability, using a talent affirmed by the validation of others – outside her immediate faith community as well as inside it. If the earlier description of her troubles was matter-of-fact, her description of the pleasure she found in singing overflows with real delight.

Those who are sceptical, or perhaps hostile, to the whole issue of religious belief should pause for a moment to note what faith has actually done in Joyce’s case. It is true that many injustices and wrongs can be attributed to religion, but here we see a life genuinely saved by faith (to use a very loaded expression).

I can make no negative criticisms of this book, though I do have one fear. My fear is that Joyce’s emphasis on her faith – which is inevitable, given how instrumental it has been in her recovery – will mean that some people may avoid reading this book (and, just to be upfront, I note this as a person of faith myself). But this book is essential reading beyond those who share Joyce’s faith. If you have an interest in mental health issues, in social justice, and in the mechanisms by which people can be rescued from victimhood, then this book is hugely significant.

____________

The Light in My Mind by Joyce Passmore is published by Speak Up Somerset

ISBN 978-0-9549772-5-2

Delivered Unto Lions by David Austin is published by CheckPoint Press

ISBN 978-1-906628-21-5

For more information visit www.davidaustin.eu

Children’s Welfare and Entitlements, Needs and ‘Givens’

2010-12-20T10:50:00.001Z

I woke up this morning, as I generally do, to the Today programme on BBC Radio 4. I continued listening for a little longer than I often do and happened to catch ‘Thought for the Day’ just before eight o’clock. Today’s ‘thought’ was offered by John Bell of the Iona Community, who had chosen speak on the ‘culture of entitlement’. I won’t repeat his observations and conclusions here, but I will follow his lead by offering a few observations of my own (while, hopefully, also following John Bell’s example of not being too preachy).

‘Culture of entitlement’ refers to the supposed expectation on the part of individuals and society that we all have a right to certain things, such as employment, food and shelter, health care, etc. But the ‘culture of entitlement’ notion can be extended to the (suggested) belief of children that they have a right to the latest games console or designer trainers. At Christmas, and given the current economic climate, this can be a real problem for struggling parents faced with their children’s demands.

But what should children be entitled to? What should any of us be entitled to? Although this isn’t really the same thing as entitlement, we do all have needs. In the 1940s, the psychologist Abraham Maslow proposed a ‘hierarchy of needs’, i.e. a list of things we each need in order to function properly. Our most basic needs (such as the requirement for survival) form the foundation of the hierarchy, with other needs (such as the requirements for security, health, intimacy, etc.) built on top.

A similar idea to this hierarchy can be found the current Human Givens approach to psychotherapy developed by Joe Griffin and Ivan Tyrrell. This approach assumes that there are particular ‘givens’ (resources) we need in order to live successful and fulfilled lives. There are several of these ‘givens’, and they include the obvious things like food, water and shelter, but they also include:

having some control over our lives
having emotional connection to others
having a sense of competence/achievement
having a sense of meaning/purpose

Many of us, at some time or another, are denied certain of these ‘givens’. Many of my posts have referred to the situation of a child caught up in residential psychiatric care. In such circumstances a child will be (at least partly) denied many of the needs suggested by these ‘givens’. While it may be perfectly justifiable – indeed, quite proper – to say that a child is not entitled to the latest games console, can we really say the same about the ‘givens’ of human existence?

There will, inevitably, be children who are at this moment facing the prospect of spending Christmas in institutional care. Far fewer of them will be psychiatric patients than was once the case, but some will be. And there will be others who are detained for other reasons, whether as a result of their own fault or that of others.

And so I would like to suggest we consider carefully what our entitlements are (as compared to our wishes or desires) while also remembering the entitlements of others, especially troubled children. Whether you are about to celebrate Christmas (25 December or 6 January) or Winter Solstice (21 December), or whether you have just celebrated Hanukkah (2-9 December, this year) – or if you have some other December/January festival that is special to you – please also celebrate young life, all life, and respect (in your own way) the ‘givens’ of that life.

May I wish you all the best for this season and for the coming year.

____________

Delivered Unto Lions by David Austin is published by CheckPoint Press.

For more information visit www.davidaustin.eu

Child Pscyhiatric Services and Unjust Institutional Trends

2010-12-16T11:41:00.001Z

As an author I regularly visit Amazon.co.uk to see how Delivered Unto Lions – my only published book (so far) – currently ranks in the Amazon bestsellers. As write this, I see that it is placed at No. 70,247! This Amazon chart is updated hourly, so my book – like most books – will drop down the chart as more and more other titles outsell it, but occasionally someone will buy a copy and send it leaping up to a much higher position.

While checking on how my book is doing, relative to the competition, I will also look to see if a new customer review has been added. Earlier this week I found that there was indeed a new review, and reading it left me quite stunned. The review was by someone calling him or herself ‘Tworth’, and it said the following:

A ‘must’ read if nothing other than to make sure that this type of cruelty is non-existent in the future. Having been a student nurse at the actual real childrens unit that this is based in (names have been changed) I can remember with horror specific aspects of this sad but very well written book. [...] I sincerely hope some of the ex-staff are able to read this and feel remorse, horror and sadness for the effect their actions have had on the reader throughout his adult life, not to mention the poor children who were not so lucky. [...]

To be honest, I had half-expected some former member of staff (from the children’s unit where I was once a patient) to surface and contradict or discredit my book (and, of course, it could still happen). But here we have an ex-student nurse coming out and endorsing what I have written. Tworth’s comments reveal another aspect to the story that is only partly explored in my book: namely the impact that working in such an institution can have on a member of its staff.

I certainly hope that my book does not cast all the worker’s in the institution it portrays as villains! One or two of them – obviously – are shown in that light, but on the whole, Delivered Unto Lions reserves its fire for the institution and its culture. What we have here is an institution, a particular setting with its own rules and conventions, which allows – almost encourages – inappropriate, unpleasant, and sometimes abusive actions on the part of its staff. Certain staff members get away with things because the system lets them, while others find themselves either unable to challenge what is going on or drawn in (possibly) to acting in ways which conflict with their consciences.

Tworth expresses the hope that ‘some of the ex-staff [of the real unit which inspired my novel] are able to read this and feel remorse, horror and sadness’. I am aware that some of these individuals are no longer living, so it’s too late to hope for remorse from them. But of those who may still be around, I certainly hope that they can acknowledge where they went wrong, and if any of them are still involved in children’s psychiatric services, I hope they will have learnt from their past ‘mistakes’.

There is, however, something more that I hope for. I hope there can now be a greater awareness of the impact that institutional cultures can have on the individuals working within them. Just as we have seen institutional racism brought out into the light and challenged, I want to see any tendency towards unjust institutional trends in psychiatric services – especially those aimed at children – openly acknowledged and guarded against. Continued vigilance is needed if we are to avoid a return to how things used to be.

____________

Delivered Unto Lions by David Austin is published by CheckPoint Press.

For more information visit www.davidaustin.eu

Children’s Mental Health and the Inequality of Knowledge

2010-12-13T10:40:00.001Z

In my last post (9 December 2010) I commented on two particular challenges among those identified by the Children and Young People’s Mental Health Coalition. These challenges relate – obviously – to children’s mental health, and centre on (1) the ongoing problem of stigma surrounding mental health issues, and (2) the matter of the unheard voices of children from particular backgrounds. In both cases I referred to how these things can delay people (i.e. children and their families) from accessing help.

The assumption is that if you access help for a mental health condition early on, then there is less opportunity for that condition to worsen and require a more drastic intervention. I am very aware, however, that my novel, Delivered Unto Lions, is all about a drastic intervention (residential psychiatric care) directed at a child who happens to be suffering from depression. Are we to suppose that this child and his family did not seek help early enough, hence the severity of the intervention?

This question is not answered (or even raised) in my book. But given that this novel is based substantially on my own childhood experience in the 1970s, I am able to say, with reasonable confidence, that the timing of the intervention is not the issue. What matters here is the nature and the appropriateness of the intervention.

In a media release that was issued at the time of my book’s publication, I am quoted as expressing the hope that Delivered Unto Lions might not only increase awareness of how children’s mental health problems were once treated, but also encourage parents and professionals to consider the possible unintended consequences of treatments used today.

The main character in my novel, Daniel, became a residential psychiatric patient because his parents accepted the advice of the professionals (as did my own parents). This does not imply a criticism of the parents (in either case), but hints at some essential differences between (most) parents and (most) psychiatric professionals.

Parents (in common with all of us) may have their own areas of experience and skill, but this won’t usually be in psychiatry or psychology. This inequality of knowledge places parents, and their children, in a disadvantaged role in relation to the psychiatrist (or other mental health professional). While child psychiatrists may have the best of intentions (and we all hope they do!), they are in a position of power because, as the saying goes, ‘knowledge is power’. It doesn’t necessarily matter whether that knowledge is being used appropriately or not, it is a source of power either way. Faced with this, parents have a choice: they can submit to this power and agree to everything the professional suggests (as many have done), or they can resist (as many others have done) and accept the incredible responsibility that goes with defying the ‘expert’.

But there’s another significant difference between parent and professional. The professional is not involved in the child’s life in the same way that the parent is. Good parents care deeply for their child’s wellbeing; professionals – while they may well be caring people – do not care in the same way, and so they have less at stake.

Obviously, if a professional makes an obvious blunder it may well harm his or her career, but the ‘best guess’ which later turn out to have been a mistake is not likely to have the same effect. Professionals (mostly) do not have to live with the consequences, but children and their parents do.

What I am suggesting (not that I expect many people to hear me) is that parents and child mental health professionals both need to think about what could go wrong with the treatments being considered for a particular child, and weigh-up these possibilities against the hoped-for benefits.

I would also urge parents – and children, where they are able – to ask plenty of questions of the professionals, and not blindly accept everything suggested. The professional is, after all, the expert, so get him or her to share some of his expertise – but not in a ‘this is how it is’ sort of way, but in an open and scrutinised way. Clearly, the more assertive and better educated the parents, the easier this will be, but hopefully all parents will be able to wrest some power from the expert. And hopefully the expert will be pleased at the opportunity of working with more actively involved parents and children.

And what qualification do I have for making these bold (and possibly arrogant) pronouncements? Well, I make no claim to being an expert or professional, but I do claim the knowledge of what can happen when a child is ‘delivered unto lions’, subjected to unchecked professional and institutional power, though no fault of his own or his misinformed parents.

____________

Delivered Unto Lions by David Austin is published by CheckPoint Press.
For more information visit www.davidaustin.eu

Today’s Challenges for Children’s Mental Health

2010-12-09T11:35:00.002Z

My book, Delivered Unto Lions, is centred on an unpleasant aspect of children’s mental health care in 1970s Britian. We have come a long way since the ’70s, and hopefully today’s services for young people are more compassionate and understanding. But there remain, even now, a number of challenges that need to be overcome if we are to treat our troubled children and teenagers with proper care and dignity.

The Children and Young People’s Mental Health Coalition has identified a number of particular challenges, including:

promoting good mental health in the early years
tackling the ongoing problem of stigma
encouraging emotional resilience
filling the gap in mental health care provision between adolescence and adulthood
listening to the unheard voices of some children

And there are more. But I am just going to focus on the issues of stigma and unheard voices.

I have already written about stigma in previous posts. This is a particular interest of mine as, I believe, it is the stigma of mental health problems that has kept many of the injustices of past psychiatric ‘care’ hidden – a topic that Delivered Unto Lions tries to open up.

The charity YoungMinds wants the UK Government to back a high-profile anti-stigma campaign to be fronted by young people. There is a fear, however, that in these financially difficult times, the current administration will not want to channel the country’s limited resources into such a campaign. But stigma and discrimination can have serious consequences for the economy. If people with problems are made to feel ashamed or guilty because of stigma, then they are less likely to ask for help at an early stage. And so they will enter the mental health care system much later on when their problems have become worse and more entrenched, needing far more expensive – and often less helpful – specialist treatments. They will also be likely to have become too unwell to work.

Society’s attitudes to mental health are absorbed by children, and so a lot of anti-stigma work needs to be done in the early years so that future generations are not burdened with the same discriminatory and damaging views of mental health that persist in the present generation.

The issue of ‘unheard voices’ is also of special interest to me. I am currently a postgraduate student on an archives administration course, and I am especially fascinated by the question of which voices get preserved in archives and which voices get ignored. Obviously, in centuries gone by, only the wealthy and privileged were literate, so only they were capable of making the records that can still be read today. The voices of ‘peasants’, however, were not recorded.

Some archives and museums (if they can afford it) are involved in ‘documentation strategies’. These are efforts to go out and actually record the thoughts and memories of people whose voices might not otherwise be represented in archives. These are the voices of ‘ordinary’ people and members of minority groups, etc. For example, as time moves on it is becoming especially important to preserve people’s memories of World War II before it is too late. We already have governmental and military records, of course, and the writings of important figures, but what was the war like for other people, the people who stayed at home or served the war effort in less obvious ways?

The issue of unheard voices is also very important when it comes to children and mental health services. My memories of the 1970s suggest that all of us who were child psychiatric patients had difficulty making our voices heard – the ‘powers-that-be’ did not listen to us. Today it is particular groups of children, rather than children in general, whose voices are not heard (though I imagine that most children have trouble making themselves heard in certain circumstances).

In adult psychiatric services, Black and African-Caribbean communities are overrepresented. In 2002, a study found that fear often delays people from an African-Caribbean background in seeking help for their problems. And so, when they finally do seek help, their problems are often more severe. The (perfectly understandable) fear of both children and parents means that voices don’t get heard by those who could help those who are suffering. It is only when the problems have become much more serious that those voices get noticed – and sometimes treated very harshly.

There are many more challenges that our society needs to face with regard to children’s mental health – I’ve just covered two of those issues very briefly. But if our society is to grow into one that is more healthy and happy, we really must face up to all of these challenges.

____________

Delivered Unto Lions by David Austin is published by CheckPoint Press.
For more information visit www.davidaustin.eu

Children's Mental Health Care and the Language of Judgement

2010-12-06T14:55:00.004Z

My book, Delivered Unto Lions, is set in a children’s psychiatric unit in the 1970s. The consultant psychiatrist Dora Black has written a ‘brief history’ of the mental health care model reflected in my book. She identifies a 1920s ‘child guidance clinic’ in Boston, Massachusetts, as the originator of the ‘scientific’ approach to ‘deviant’ children. It is, of course, very telling that children with mental health problems were described as ‘deviant’ (or even ‘delinquent’), and this may well account for the persistent impression held by child patients (right up until the 1970s and later) that they were being punished.

‘Child guidance’ came to the UK in 1927 with the founding of a clinic in the East End of London. The honorary director of this clinic was Emanuel Miller, who had trained in Boston, thus reinforcing in Britain the assumptions maintained in that first ever clinic in the US.

Soon there were other children’s psychiatric clinics established in the UK capital: The London Child Guidance Centre in 1928 and the Tavistock Clinic in 1933. By the late 1940s, there was child psychiatric service provision (of one kind or another) in most regions of Britain. Some of this provision was of the residential in-patient variety. A quick look at a British parliamentary Hansard transcript for 29 November 1961 reveals a handful of residential institutions for ‘psychotic or severely maladjusted’ children, including Gwynfa (Colwyn Bay), High Wick (North West London), West Stowell (Oxfordshire), and Merrifield (Somerset – the direct inspiration for Delivered Unto Lions).

It was by the end of the 1960s that the background scenario to Delivered Unto Lions was fully in place. Child psychiatrists were being employed in the UK by the National Health Service (NHS) and were based in child guidance clinics alongside social workers, educational psychologists and ‘remedial’ teachers. Many of these clinics represented joint provision by the NHS and the local education authority.

Dora Black describes how many of the children’s psychiatric services were based in isolated locations, thus separating child psychiatrists from most of their clinical and academic colleagues. Black sees this separation – along with heavy workload – as a block to progress and development; child psychiatrists were left unable to engage in very much research, and in any case, they were largely bereft of the necessary collegiality to support such research. This, therefore, left most children’s mental health disorders misunderstood and improperly treated.

One of the things I find particularly interesting is the use of language in reference to emotionally or mentally disturbed children. The early labels from the ‘child guidance’ movement included terms such as ‘deviant’ and ‘delinquent’. As time moved on the labels changed, but a notion of moral judgement remained; it was as though children were being punished for being unwell.

In my own experience as a child patient I saw some evidence of an attempt by authority figures to change the language of judgement. At the Merrifield Children’s Unit of the 1970s (and in the fictional unit of my novel), it was not uncommon for a child to be subjected to a ‘consequence of his (or her) actions’. Children were not ‘punished’, but they had to endure ‘consequences’. This language must surely have been intended to give the impression that unpleasant penalties (confinement, sedation, etc.) for distressed behaviour were ‘natural’, rather than the result of draconian decisions by institutional staff.

I would hope that since the 1990s, when residential children’s units began to give way to ‘care in the community’, that the closed environment of children’s mental health professionals was finally thrown open to admit some fresh air and new ideas. But the fear emerges that, where ‘care in the community’ is seen as inadequate, the new children’s residential units (such as Orchard Lodge, successor to Merrifield) will withdraw into that same invisible world, isolated from scrutiny and alternative sources of insight.

____________

Delivered Unto Lions by David Austin is published by CheckPoint Press.
For more information visit www.davidaustin.eu

Blowing Your Own Trumpet

2010-12-02T15:04:00.001Z

One of the challenges of being a newly-published author is the issue of publicity and marketing. No doubt those who have been fortunate enough to be signed up by the big publishing houses will have more support in this area than people like myself who have been signed to small independent publishers. But whatever the case, an author cannot simply sit back and relax once the book is out. Indeed, an author has to put a good deal of time and energy into pushing his or her published work, and that leaves very little left over for writing the next one!

I can’t speak for anyone else, of course, but I suspect that most authors would rather be writing than selling. I, for one, am not a salesman, and yet I’m having to behave like a salesman to help my book reach its audience. It wouldn’t be so bad, of course, if the only thing I was selling was my book, Delivered Unto Lions. But it isn’t. An author has to sell himself (or herself). This is especially the case when the book is so closely associated with the author’s own experience, as mine is. But even if that isn’t the case, the fact is that the editors of newspapers, websites, etc., want stories about people, not inanimate objects like books. So, you have to make yourself sound interesting, and you have to be prepared to ‘blow your own trumpet’ – and, to be perfectly honest, the trumpet lessons I had as a child did not produce very convincing results!

But at least there are some good sources of information out there to advise the reluctant author-come-publicist. For anyone else in a similar position – or anyone who is likely to be in the near future – I recommend three books which are packed full of good marketing ideas:

The Frugal Book Promoter by Carolyn Howard-Johnson (Star Publish, 2004)
Aiming at Amazon by Aaron Shepard (Shepard Publications, 2009)
Plug Your Book! by Steve Weber (Weber Books, 2007)

These books are addressed primarily to authors in the US, but a lot of the advice can be adapted for non-US authors – and in any case, even if the US is not your main market, it isn’t a market you would want to ignore.

Anyway, I need to get back to work now – no, not on my next book; there are media releases I’ve got to send out!

____________

Delivered Unto Lions by David Austin is published by CheckPoint Press.
For more information visit www.davidaustin.eu

Living Adventurously

2010-11-29T16:04:00.001Z

When I started submitting the manuscript for Delivered Unto Lions to various agents and publishers, I was offering it as a work of fiction. I stressed that it had a factual basis, but I didn’t really give much clue as to the details of that factual basis. In fact, the book is very closely based on my own experience as child mental patient in the 1970s, but being aware of the stigma associated with mental health problems, I wanted to put some personal distance between me and what I had written. In taking this approach, I was living very cautiously. And as it happens, none of the agents or publishers I approached showed any interest in my book – with the exception of one publisher who was willing to put it out for an ‘author contribution’ just short of £10,000!

Yesterday afternoon (Sunday, 28 November 2010), I attended a Memorial Meeting celebrating the life of Edward Stanley Nattrass (1920-2010), who died suddenly on 21 October. The meeting was held at the local Friends’ Meeting House according to the Quaker tradition to which Stan belonged. Many of the people who spoke at the meeting had known Stan for decades. Although I had only known him for about three and a half years, he had been a good friend to me.

When I was exploring the possibility of becoming a Quaker myself (which I did, in due course), Stan was one of the people who particularly befriended me. He patiently answered all my questions, and posed quite a few of his own. I particularly enjoyed hearing some of his anecdotes about the various things he had done in his very full life.

As well as being a Quaker, Stan was very involved in various spheres of community life. He was chairman of the Bognor Regis Housing Trust (an organisation supporting the homeless), and an active member of both the Littlehampton Town Twinning Association and the local History Society. He was also a Labour Party campaigner and activist. And he was always very courageous in standing up for what he believed.

In recounting some of his experiences to me, Stan spoke with amusement and humility, telling stories about his involvement in protests, some of which took place in other countries in the face of sometimes very intimidating police and security forces. He also referred to the rather mischievous attitude he adopted towards certain authority figures when he took on the role of ‘McKenzie Friend’ in the early ’90s, assisting in the defence of individuals who refused to pay the controversial Community Charge (‘Poll Tax’).

Needless to say, not everyone would agree with Stan’s passionately held religious and political views, but no one would deny his courage in holding fast to his values.

Since Stan’s death, two well-loved Quaker phrases have been used over and over again in the tributes that have been paid to him: ‘Let your life speak’ and ‘Live adventurously’. Stan’s life certainly did speak, and, of course, he lived adventurously.

By contrast, my attitude when trying to get Delivered Unto Lions published was very guarded. But I discovered the mistake I was making when I submitted my manuscript to CheckPoint Press, Ireland. The editor at CheckPoint got back to me with two alternative offers. I could pay CheckPoint a three-figure sum to have my novel published as a fictional work, or I could come clean about the factual background and have it published as biography under a traditional ‘no fees’ contract. I chose the latter – the ‘no fees’ option (and avoidance of the ‘vanity publishing’ tag) was very persuasive!

With Delivered Unto Lions, I did not set out to live adventurously; I wanted to be cautious. But in the end I made the right choice (even if not necessarily for the right reasons). I took ‘ownership’ of the experience which had prompted my book, and allowed the novel come out supported by a new openness about my past. In doing this I hope I have made it possible for other people with similar histories to take ‘ownership’ of their experiences too.

The lesson I take from Stan Nattrass is that I shouldn’t have had to think twice about living adventurously. At least I got there in the end – but I won’t try to kid anyone that I intended it this way.

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Delivered Unto Lions by David Austin is published by CheckPoint Press.
For more information visit www.davidaustin.eu

Does Society 'Choose' Who Must Suffer Mental Health Problems?

2010-11-27T12:21:00.000Z

Does society ‘choose’ who must suffer mental health problems? In the early 1990s, Stephen Pattison, an academic in the field of ethics and theology, set out to answer that question. His interest was, of course, religious, but his methods were taken from secular sociology. What he discovered is included in his book Pastoral Care and Liberation Theology (Cambridge University Press, 1994).

Pattison found that social status and background has a lot to do with who goes on to have contact with the mental health services. The lower down you are in society, the more likely you are to be diagnosed as mentally ill. Ethnic minorities, women, and people from ‘working class’ backgrounds are excessively represented among those supposedly suffering psychiatric disorders. Pattison argues that these are all people who can be counted as among the less privileged in Western society. And so he concludes that mental illness is a social/political issue, something that is often ‘given’ to some people by others because of the way our society is ordered.

One of the things my book, Delivered Unto Lions, focuses on is the powerlessness of being a child caught up in the psychiatric services – and Pattison’s work particularly focuses on issues of power and powerlessness in connection with psychiatric health-care provision. Pattison looks to those elements in society that support the privileged against the less privileged. Being a religious studies academic, he especially looks at the role of the churches in this situation.

The chaplain is a particularly visible indication of church involvement in health-care. When I was a patient at Merrifield Children’s Unit in Somerset, I remember the unit often being visited by a Methodist chaplain. Chaplains are usually employed by the health-care provider, but even where churches provide the chaplain’s income, it is still the case that the person offering pastoral care is part of the dominant social structure. He or she (even if unintentionally) is acting on behalf of the powerful.

Pattison says that religion has a ‘conservative function’ in Western society; it isn’t usually politically radical and so, by default, it supports the powers-that-be. The chaplain may well offer kind words to the suffering patient, but these words do not challenge the powers and institutions that placed that person in that ‘care’ environment in the first place.

My own view is that all bodies – whether they be churches, political organisations, charities, voluntary groups, etc. – need to step back and look at what their actual function is in society (something like a Business Classification Scheme analysis might help with that). Once they know their actual function, they can then decide if it is the same as their intended function. For instance, if a church was to find that it did indeed function in support of the powerful against the weak, it could then decide whether it really wanted to be on the side of the powerful, or whether, perhaps, it wanted to take someone else’s side.

Those who are mentally ill – or who are viewed as mentally ill – need more than kind words. They need people on their side.

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Delivered Unto Lions by David Austin is published by CheckPoint Press.
For more information visit www.davidaustin.eu

Mental Health Professionals Cannot Read Minds

2010-11-25T14:25:00.000Z

I’m no expert on psychology, but over the years I have undertaken some courses of study which have touched upon various aspects of the subject. One area I have found particularly interesting is discursive psychology. This is something which focuses on what people do (through words and actions), rather than on what they think.

My novel, Delivered Unto Lions, is written in the first person, so the only thoughts that readers get to know are those of the character who narrates the story. When it comes to the other characters, readers can only ‘see’ what they do and ‘hear’ what they say. As my book is about children in a mental unit, that is the context in which the words and actions of the characters do things. We can see what they do, but we don’t know their thoughts and motivations. This is particularly significant in the case of the adult characters (nurses, psychiatrists, social workers, etc.), as we just do not know how they reached particular conclusions about the children in their care, or why they decided to treat them in the way that they did.

It is probably the case that we generally assume psychology to be about internal states or processes in the mind. But as the social psychologist Michael Billig has pointed out, what goes on in the privacy of people’s minds cannot be observed; we can only guess at what is going on in someone’s head from his or her outward behaviour. This would suggest that a lot of conventional psychology – and psychiatry, too – is guesswork. The therapies received by the children in Delivered Unto Lions (which is, of course, factually-grounded) are therefore based on inferring what might be going on in their heads. The behaviour of those children is observed and noted, of course, but it is assumed – without real evidence – to have particular meanings.

If I were to try and guess at what goes on in people’s minds, I would suspect that most of us feel (at sometime or other) that we are misunderstood. Someone might appear to assume he or she knows what I’m thinking, but I know that person has got it wrong. In the setting of the (real life) children’s psychiatric unit, where young people were subjected to all kinds of treatments by those who ‘knew best’, I wonder how many felt they were misunderstood? I wonder how many knew with absolute certainly that the experts had got it wrong?

Personally, I find the assumptions of discursive psychology very persuasive. Discursive psychology – while it may well offer interpretations – primarily concentrates on what you can see and hear with your own eyes and ears. It then analyses what it observes and tries to identify established patterns of speech and action and then discover what these ‘discourses’ actually achieve. What discursive psychology does not do is try to tell you what you’re thinking.

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Delivered Unto Lions by David Austin is published by CheckPoint Press.
For more information visit www.davidaustin.eu

Television and the Portrayal of Mental Health

2010-11-23T11:12:00.004Z

Yesterday, 22 November 2010, it was widely reported in the British press that a study had found that television drama often portrayed those with mental health problems as ‘dangerous’. The study was conducted by the Glasgow Media Group who produced the following findings:

45% of fictional characters with mental health difficulties were portrayed as a threat
63% of references to mental health problems by fictional characters were derogatory

So what, actually, is television drama doing? It is presenting a particular view of mental health entirely generated by the imagination of its writers? Or is it reflecting the misapprehensions and prejudices of society in general? I would suggest that it is indeed reflecting common prejudices, but it is also reinforcing them.

In a previous post in which I wrote about some of the intentions behind my book, Delivered Unto Lions, I said that mental health problems, even today, still carry a stigma. This stigma will not go away as long as society’s misapprehensions and prejudices go unchallenged. As I see it, TV drama should represent these prejudices (and this may involve characters using derogatory language), but it is lazy writing that depicts a false representation of the reality (i.e. that those with mental health disorders are dangerous).

Needless to say, a small number of widely reported incidents may persuade us that many people with mental health problems are a threat to us, but the facts say something different. Violence (for example) is proportionally less common in suffers of such problems than it is in the general population. Indeed, sufferers of mental health problems are far more likely to be victims of violence than they are perpetrators. According to Heather Stuart of Queen’s University in Kingston, Ontario, the mentally ill do not contribute significantly to the prevalence of violence in wider society. If all people with mental disorders were removed from society, violent crime would be reduced by less than 5%.

The writers of television drama are, of course, mainly operating in the sphere of fiction, but surely that fiction would serve viewers better if it displayed a better understanding of the reality.

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Delivered Unto Lions by David Austin is published by CheckPoint Press.
For more information visit www.davidaustin.eu

Harry Potter and the Psychiatric Unit of Cadaverous Misfortune

2010-11-22T10:19:00.000Z

People often ask me about the striking similarity between my book, Delivered Unto Lions, and J K Rowling’s Harry Potter series. Actually, that’s a lie. I don’t think anyone has ever asked me about this striking similarity, because it simply isn’t that striking.

What we have, however, are two narratives which follow the story of a boy who is something of a misfit. The boy ends up in a rather unusual school environment where he is subjected to various threatening experiences. However, the similarity ends there.

The celebrated fantasy writer Terry Pratchett has questioned certain aspects of the Harry Potter mythos. In particular, he is critical of the (perhaps) derogatory attitude portrayed in relation to ‘muggles’, i.e. ordinary people without magical powers. Ordinary people are looked down upon in the Harry Potter stories, and yet, Pratchett argues, ordinary people have skills and abilities of their own. An ordinary person can be a skilled fisherman, for example, while a particularly gifted wizard might not be able to tell one end of a fishing boat from the other.

I agree with Pratchett to a large extent. But I also suspect that he may be missing the point of the Harry Potter books. When we first come across the character of Harry, he is a child in very unhappy circumstances. He is living with an unsympathetic family who force him to deny the person he is. But he is special and they are ordinary. And his special nature is eventually recognised and rewarded by admittance to Hogwarts, a unique school where his talents can be fostered and where he can work towards reaching his potential.

This is all in stark contrast to the character of the 12-year old Daniel Kinsley in Delivered Unto Lions. He too – as a sufferer of depression – is living in very unhappy circumstances. But there’s no reason to think that his family aren’t sympathetic; indeed, they are loving and caring. But his depression – the thing that is ‘special’ about him – is ‘rewarded’ by admittance to Oakdale Children’s Unit, a residential psychiatric institution which, if anything, stunts his potential and makes his unfortunate condition worse.

For children whose lives are unhappy, dreams of being special in some way may be the only things that keep them going through the darkness. So, in a sense, the Harry Potter stories encourage hope in those children who may feel like misfits, hope that they can rise above the unhappiness and be something more. It may be just a dream, it may not have any basis in reality, but it is supportive. With the right support and encouragement even an ordinary (or problematic) child can flourish and grow up to live a worthwhile life.

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Delivered Unto Lions by David Austin is published by CheckPoint Press.
For more information visit www.davidaustin.eu

Should We Forget the Trauma of Past Mental Health 'Care'?

2010-11-20T10:09:00.000Z

I recently came across a very interesting comment from a former child psychiatric patient. This woman had been admitted to children’s mental unit back in the 1950s, and she was responding on an Internet forum to various posts from other former patients. Many of these other posts had referred to various horrific ordeals, including physical and psychological abuse, all of which had been experienced while in the ‘protection’ of a supposedly caring service. But this particular woman, now in her 70s, advised them to try and forget their experiences: ‘[Y]our only hope is to put [it] out of your mind and never let them win.’ By ‘them’, of course, she meant the perpetrators of the suffering these people had known.

Is this the best approach to the trauma of past mental health ‘care’? Is this something that those concerned should forget? Is forgetting the only way to ‘defeat’ the institutions and individuals responsible for such awful memories?

The answers to these questions will be different for different people. It is certainly the case that people need to move on in their lives and live in the present, not in the past. But does this mean they must forget the past?

My book, Delivered Unto Lions, tends to answer these questions with a definite no. I wrote it from the assumption that the past needs to be remembered, that lessons need to be learnt. Needless to say, for some people past memories will be so painful that it would not be a good idea to deliberately call them to mind. But for many of us, we can use our memories in a constructive way as we move forward and live our lives.

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Delivered Unto Lions by David Austin is published by CheckPoint Press.
For more information visit www.davidaustin.eu

Child Mental Health Care: Hidden Truth Revealed

2010-11-19T12:45:00.000Z

Conspiracy theories are all very well, but many of them lack credibility and can often be dismissed by looking sensibly at the evidence. Were the moon landings faked? Unlikely. Those who believe they were may well have considered the evidence, but their interpretation of it has been coloured by rumour and suspicion. Much the same can be said of those who believe the US Government staged the 9/11 attacks on the World Trade Center in New York.

Such conspiracy theories assume there is a concealed truth, that someone is deliberately hiding something from the public gaze. And there are, in fact, many things that are hidden from the public gaze. But occasionally fragments of fact that slip out.

This is certainly case when it comes to mental health care. In the past, people with mental health problems – and even people simply imagined to have mental health problems – were removed to isolated asylums. Once there, they were ‘out of sight, out of mind’. Most people, of course, would have known that these asylums existed, but they wouldn’t have known – or wanted to know – what happened at these places.

By the latter part of the 20th century, these asylums (now known as psychiatric hospitals) were more visible than they used to be – though what went on inside them was still largely hidden. But one type of mental institution that remained unknown to most people was the children’s psychiatric unit. This may not have been a deliberate conspiracy, but that hardly matters to the children who were admitted to such places.

My novel, Delivered Unto Lions, is about revealing the hidden existence of these institutions and what happened in them. Back in the 1970s, I was unfortunate enough to become a patient in a children’s unit of this kind in Somerset, England (due to depression). Before I ended up there, I had never heard of the place, and I was surprised to learn later that very few others had heard of it either.

When things are hidden away they take on a special kind of power. Because of the stigma that still persists in connection with mental health, few former child patients are willing to speak out about what happened to them, and few parents will want to be reminded that a child of theirs was taken away from them and placed in such an institution. And so the hidden past can continue to control the present.

Delivered Unto Lions seeks to uncover something of the past treatment of emotionally disturbed children. There was physical and psychological abuse, and powerful psychoactive drugs were often used in a punitive way. All this was hidden away, largely unknown to the families and friends of the children who suffered. That’s not to say that the people involved in caring for disturbed children – nurses, psychiatrists, therapists, etc. – were bad people. Apart from a few exceptions, most of them were caring and dedicated. But terrible things still happened.

In Delivered Unto Lions I adopt a ‘fictionalised’ narrative approach to the issue. This is to present an accessible, readable story; to protect identities; to fill the odd gap in my memory; and to enable particular themes to be drawn out – themes of hidden truth, of a child’s powerlessness, of institutional callousness, and of the impact of genuine kindness in an often thoughtless environment.

While my book cannot be described as literally true (though a lot of it is very close), I believe it is representative of the truth. And so I want my book to push at a door and open it just wide enough for the truth to come through. If that can happen, I hope that it will have a liberating effect – in whatever modest way – for children past and present.

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Delivered Unto Lions by David Austin is published by CheckPoint Press. It is available from Amazon and all good online booksellers, and can also be ordered from many local bookshops.
For more information visit www.davidaustin.eu