Do Actions Speak Louder?

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

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

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

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