By J R Mansberger
Key Themes: case study, mental health care, psychiatry, mythology
This book is a verbatim account which lays bare for inspection the Kafkaesque reality of a young American’s experience inside the modern British mental health care system. Combining the pathos and tragedy of Greek myth and the analytic dryness of textbook case study, it may be seen as a chronicle of a young man’s heroic battle against arrest, incarceration, detention, enforced medication, and the infliction of extreme mental suffering within a medico-legal system devoid of fewer human rights than those accorded to anyone arrested under the Terrorism Act.
Incorporating only original medical records and documents and reading like a fly-on-the-wall docudrama, it pushes the boundaries of “confidentiality” and discards the mantle of secrecy which has always clothed the profession of psychiatry, forcing us to re-examine our concept of “mental illness” and its “treatment.” In the annals of psychiatry or modern literature, a detailed objective account of this kind, revealing what really happens to someone caught in the web of the mental health care system has heretofore neither been written nor published for general readership.
This book should be of interest not only to students of psychiatry, psychiatrists, mental health professionals, mental health service users and all people who are affected by or question the practice of modern psychiatry and mental health care, but also to a wider general public.
About the Author
Joe Mansberger was born in 1953 and lives in Oxford.
“In the serene world of mental illness, modern man no longer communicates with the madman:
on one hand, the man of reason delegates the physician to madness, thereby authorising a relation only through the abstract universality of disease; on the other, the man of madness
communicates with society only by the intermediary of an equally abstract reason which is order, physical and moral constraint, the anonymous pressure of the group, the requirements of conformity. As for a common language, there is no such thing; or rather, there is no such thing any longer; the constitution of madness as a mental illness, at the end of the eighteenth century, affords the evidence of a broken dialogue, posits the separation as already effected, and thrusts into oblivion all those stammered, imperfect words without fixed syntax in which the exchange between madness and reason was made. The language of psychiatry, which is a monologue of reason about madness, has been established on the basis of such a silence.” [Foucault 1967]
In his great seminal work, Histoire de la Folie, Foucault sought to give voice to the “silence” of the mad by constructing an “archaeology of that silence.” Employing an historical approach, he essentially aimed to provide an account of the forces which produced the condition of madness through an examination of its historico-political context [Foucault 2006]. Similarly, Elie Wiesel , who was awarded the Nobel Prize for Peace in 1986, believed that by working within “its own parameters and its own context,” an “archaeology of silence” could itself “become a way of communication” or a “testimony” of silence.
Personal testimonies or factual, first-hand, written accounts of the experience of “madness” and the resulting medical treatment of “mental illness” in modern institutions are very rare or almost non-existent in modern literature, owing mainly, perhaps, to the extreme mental trauma endured by individuals in such circumstances. Consequently, and tragically, in order to understand what really happens to someone caught inside the mental health care system, we have had to rely on either (1) second-hand, semi-fictional, anecdotal, popular accounts or (2) brief psychiatric case studies published in obscure scientific journals. In the absence of broadly published, detailed, personal accounts, our understanding must necessarily continue to derive from a construction of an “archaeology of silence.”
Any attempt to understand “mental illness” and its “treatment” should include recognition of the philosophical basis of the discipline of psychiatry. We must remember that the meaning of psychiatry, as originally conceived, was based on the anti-rational, romantic, transcendental and philosophical
insights of Johan Christian Reil, who coined the term “psychiatry” in the early 19th Century. His choice of the term “psyche” introduced the origins of mythological thought into the discipline. Later developments in the early treatment of “mental illness” continued to draw upon ancient mythology, with references, for example, to “psyches” who were “figures of dreams” dwelling in a “faraway place” or near the “village of dreams.” By the end of the 20th Century, the use of the term “psyche” had evolved to be “not a faculty or agency of the self so much as a continuation of the whole person,” and also carrying the “connotation of the double,” as in the reflection of Narcissus [Walmsley 1984].
The mythological underpinnings of psychiatry can be further elucidated by an examination of the myth of Psyche herself, whose relevance to our present account will become apparent to the Reader. According to the myth, the innocent Psyche is punished by the gods because of her earthly and transcendental beauty. She is in turn abducted, deceived, violated and banished to the Underworld where she is tortured and hypnotised. She eventually survives her ordeal to become the personification of the soul. One analysis of the myth, as recreated by Keats in his Ode to Psyche, posits that it essentially symbolises “a struggle [with] the acceptance of imaginative experience that exists only in a small part of the mind” (Perkins 1959).
With the above-mentioned in mind, I have attempted to construct a modern account, an “archaeology of silence,” of “mental illness” and its “treatment” as medically defined at the beginning of the 21st Century, based on the particular experience of my son, Kai. To my knowledge, an account of this kind has heretofore neither been written nor published for general readership.
This present verbatim account, incorporating only original documents and medical records (e.g. admission assessments, mental health examinations, consultations, ward reviews, nursing reports, psychiatric reports, mental health tribunal decisions, discharge summaries, letters, etc.) lays bare for inspection the reality of my son’s experience inside the mental health care system. It is not a work of fiction: the people, organisations and events are real, not imagined. In actuality, it may be seen as a chronicle of a young man’s heroic battle against arrest, incarceration, detention, enforced medication, mental torture and the infliction of extreme mental suffering within a medico-legal system devoid of fewer human rights than those accorded to anyone arrested under the Terrorism Act.
In order to facilitate an understanding of the underlying medical issues in this account, the Reader is
strongly encouraged to refer to the List of Abbreviations and the Appendices. The List of Abbreviations contains those abbreviations commonly used in medical shorthand. Appendix I provides descriptions of all the psychiatric drugs (and their side effects) that were administered to Kai in the course of his “treatment.” Appendix II provides short definitions of psychiatric terminology directly or indirectly related to the main text. Throughout the body of the text itself, daily Drug Prescription and Administration Charts [which give information about exactly which drugs, and how much, when, how and why they were administered to Kai] provide a running tally of his chemical “treatment.” The Reader may also wish to consult the References and Further References for information containing the medical and other literature used in constructing this account.
Although this present “archaeology of silence” is based on the observations of others, the discerning Reader will see that a personal narrative emerges within the main text of medical documentation. Even if the Reader is unfamiliar with the works of Kierkegaard, Camus or Kafka, the gradual unfolding of an element of existential absurdity and irrationality is detectable as our subject appeals to reason and struggles to find an explanation for his situation and the world around him.
To add further poignancy to the existential nature of this personal narrative, several short works of prose and poetry, written by Kai himself, are included between the sections of medical text. These personal creative accounts afford us only a very small glimpse of the intelligent mind of someone who is suffering from “mental illness,” who is also a gifted musician, mathematician, computer programmer, linguist, champion athlete, and student of philosophy and writer, whose magnum opus (unpublished) is a film script entitled The Philosophy of Tenderness.
As the Nearest Relative of someone languishing inside a mental hospital, for reasons of “patient confidentiality,” I was consistently denied access to any medical records or drug administration charts relating to my son’s ongoing treatment. Now, long after the irreparable damage has been done, I have come to know about the true extent of the horror of that treatment. I now also realise that, in addition to the severe side effects of his medication, he must have endured an unimaginably deep sense of powerlessness, psychological pain and inner despair as a consequence of a course of “treatment” without recourse to humane intervention or justice.
With the introduction of new antidepressant and antipsychotic drugs in the modern era, “mental illness” has increased at an alarming rate in the worldwide population, virtually doubling and tripling in Australia, North America and Europe in the last 25 years. Recent court disclosures of clinical drug trial information previously hidden from the public by drug manufacturers, and reports of the overcrowding of mental hospitals and community care programmes by millions of the newly mentally disabled, lend fuel to the fire that perhaps modern psychiatry (operating outside the normal legal machinery and possessing powers of judgement, control, treatment and punishment), has got something wrong. These issues are presented in the Epilogue.
After murder, rape and torture (mental and physical) are the two most heinous crimes committed against a human being. Like murder, rape or torture is the manifestation of one person’s power over another, resulting in physical, emotional and mental harm or injury. Harming is an act of intentional destructiveness against the defenceless, yet rape and torture in the 21st Century often escape punishment and the full force or scrutiny of the law. However, because of the existence of medical records and documents and the Freedom of Information Act, the victim of institutionalised rape or torture can still be heard after the event, his/her cries of agony and pain cannot be silenced.
In researching, compiling and presenting this account I have refrained from adding any personal commentary [note: all italicisation, bold print and underlining is mine]. My principle aim is to give voice to “mental illness” in a way that may be understandable, accessible and “appropriate” within the bounds of a sympathetic and enlightened modern society. In so doing, I hope to help restore a dialogue and redress the balance between reason and unreason, between sanity and insanity.
This product was added to our catalog on Tuesday 08 March, 2011.