Wednesday, 14 January 2015

Watching - Scene 5

Observations of a psychotic mind
- there and back again

Scene Five

Stage Directions: Spotlight USL.

Saul: Oh god! How am I ever going to face anyone? Why would anyone want to cope with me after this? The people I’ve shouted at and told to fuck off! The unpaid bills, I’m losing my house. Where are my spirits now when I need them to guide me? Please... please come. Help me!

Stage Directions: Crossfade to spot DSR.

Psychiatrist: (To audience) To continue our lecture... The first step toward recovering from a mental illness is self-awareness. Realising you are ill is the first step. Records show that among the mentally ill the suicide rate goes up at this stage. Or to put it another way, when a patient starts to recover by first understanding that they are ill, that’s when they are most at risk of taking their own life.

This is because at that point of realisation the social stigma affects the patient so profoundly they reject all possibility of recovery. Often they can remember thinking they were immune from mental illness and so they see themselves as having failed as a person for becoming ill. Guilt and shame for being ill along with this overwhelming feeling of failure can lead to suicide attempts. In the long run, it is actually the stigma that will be the harder battle to fight as never again will the patient feel completely at ease, complacent or blasé that they are immune.

The stats are that one in four people in England suffer from mental illness at some point in their lives. I suspect the figure is much higher as in England so much goes unreported. In fact I can testify to that as every day I can spot plenty of people who are not under mental health care but ought to be – I suspect you can name quite a few yourselves. People with ‘attitude problems’? Being outspoken and sharing what you are thinking and feeling can seem much more acceptable in other cultures. We’re not the best, nor the worst in that respect.

You’d think once a person sees that they’re ill and accepts it that it’s simple, but it isn’t. It takes time to unravel and discard the crazy habits and beliefs they’ve formed and all the while they acquire a new perspective.

Stage Directions: DSR area where the psychiatrist joins Saul.

 Psychiatrist: (To Saul) Do you hear voices or have visions?

Saul: No, I imagine voices like you do.

Psychiatrist: You ‘imagine’ voices. How do you mean?

Saul: I think them, as in I can imagine your voice when you’re not in the room but I don’t hear it. I can imagine what you might say or think. Are you telling me I’m the only person that does that?

Psychiatrist: No. But you must understand why I might need clarity in order to be able to help. Some people do hear voices, and if you did there are things I can do to help. Have you had any visions of people being there that you are aware of. Some people imagine imagine a very angry Brian Blessed shouting at them to throw themselves under a train and can see him too.

Saul: Bloody hell! How do people survive with that going on?

Psychiatrist: Amazingly they do so by taking their prescribed medication. It tends to get rid of such delusions. Difficult though it maybe to believe it. Have you had any such experiences that you know of?

Saul: No. (Pause while the psychiatrist studies Saul) Well I don’t and never have.

Psychiatrist: OK good. A word of advice – never assume anything and especially not what people think. We all do it, but it’s best to try not to. Now, I understand you were in the garden collecting pebbles yesterday. Can you tell me about that? Are you interested in geology?

Saul: (to himself) Shit, they ARE spying on me now! (To the psychiatrist) If you must know I was collecting them as Christmas presents for people. I don’t have any money and they struck me as quite pretty, there are forms of pink granite or something like it among the cobbles just as an example. I would like to know more about them so I might well take up geology. I personally can’t fathom why one rock that’s classified a gemstone is more valuable or considered more beautiful than any other, can you? But I can’t even afford a box to present them nicely, far less the varnish or polish.

Psychiatrist: (Smiling and making a note) Fair point.

Stage Directions: DSR dims. Lights up DSL area. We are in the garden of the hospital and a helicopter is flying over head and flies away. The appointment continues as a mime as lights now reveal other patients and Saul soon joins them.

Patient: So what’s the new guy like?

Patient: Which one? You mean the smelly one that’s hidden under a blanket or the one just out of Intensive Obs?

Patient: The one, I saw you talking to in the garden.

Patient: Delusional. Thinks it’s all a government plot, that half of us patients are really government agents and the helicopters are spying on him and him alone. All one big old experiment.

Patient: Oh, a bit like woman last month then?

Patient: Yeah, still it makes a change from aliens. You’re family visiting this week?

Patient: Nah, which is cool 'cos they only fuss. Yours?

Patient: Yeah, complete with bags of goodies. It makes them feel they’re doing something helpful. You want anything, I could ask them for some extras if there’s anything you fancy?

Patient: I could murder some chocolate if that’s OK?

Patient: Pst... he’s coming over. I wonder which suicide method he tried.

Patient: Dunno but I expect he’ll tell us in the end.

Patient: Been to see the shrink?

Saul: Yes.

Patient: Any use?

Patient: Oh don’t start, he’s new.

Patient: How do you know?  He might be an old hand like me. I didn’t quite make it you as you can see... I tried ending it all by throwing myself off a multi-storey car park and ended up in this ancient excuse of a wheelchair instead. So chucking yourself off a roof is not something I’d recommend trying. Still there are other options...

Saul: Yes. Thanks for the advice.

Patient: You see, he’s not a newbie at all! I’m Greg, pleased to meet you old chap.

Saul: Saul, but I am a newbie so how do you get out of here?

Patient: Well... that rather depends.

Saul: On what?

Patient: On what you want to do when you get out, of course.

Stage Directions: Crossfade up on psychiatrist and Saul and down on DSL.

Psychiatrist: So how are you this week? You seem to be settling in.

Saul: Well that’s just it, I don’t want to settle here. I don’t belong here. There are inmates who are victims of child abuse. One guy was raped by his father who then passed him round a paedophile ring, did you know that?

Psychiatrist: Yes we know who you’re talking about.

Saul: Why isn’t he the one defecating in the corridor, nor the one screaming, or the one in the corner sitting silently? He’s not even the one weeping and wailing. It doesn’t make sense. In fact it was because he did none of these things and seemed really together that I asked him why he was here and that’s how we got talking. He said he self-harmed because (in his own words) it was quicker and less obtrusive than crying – his arms when he showed me are crinkled up like old tin foil with year upon year of scarring. But I expect you know all about that too.

Psychiatrist: Yes we do. But Saul that’s him, not you. We have these reviews each week to see how each of you are doing. I know it’s hard because you’re a caring person and want to help others, but you’re job is to concentrate on getting yourself better. If you’re worried about anyone else tell the staff and let them deal with it. We’re trained, you’re not. You’re main focus and only focus in here should be YOUR health.

Saul: Will he ever get better?

Psychiatrist: I can’t discuss that, but he is making progress. So... how are you? I hear you were found curled up under the shrubs in the garden earlier this week. Can you tell me about that?

Saul: (Embarrassed) I... just wanted the earth to swallow me up. I don’t like being here. Compared to others here I should feel pretty lucky I suppose but it was before I got talking to them and well... I just want to go home now. (Long pause) The other inmates I find rather disturbing if the truth be told.

Psychiatrist: That’s a pretty healthy sign to feel that way Saul. It isn’t anything to feel ashamed of.

Saul: But it should be, shouldn’t it?

Stage Directions: DSR dims. Lights up DSL area. The appointment continues as a mime as lights now reveal other patients and Saul soon joins them.

Patient: She didn’t!

Patient: Yep, in her nightie down the High Street in broad daylight. She’s in the Intensive Obs Unit now.

Patient: Hi Saul.

Patient: How’d it go? Going home yet?

Saul: Same as last week. Another week, but I might get into town on a Section 17 accompanied with a nurse. In any case I’ve said I want to go to church on Sunday so that will at least get me as far as the chapel as a change of scene.

Patient: Well you’re making progress to get that far that quick.

Patient: No he’s not, they can’t refuse church.

Patient: Yeah but he’s already on a ‘might for a 17’.

Patient: Well I’m next so wish me luck. Wish they’d hurry up, I mean it’s not as if they need to say much about boring old Saul here.

Saul: Oh they won’t be, they’ll be wading through the volumes of your notes by now.

Patient: I suppose I asked for that!

Patient: And you did say you thought Sonia was probably an alien in front of Bernie on Monday so I don’t reckon to your chances.

Patient: Oh shut up you lot. He knew I was joking. What do they expect when they muck you about so much? Us to worship the ground they walk on?

Saul: You have to be so accurate here; you have to be so precise in order to communicate. I told one of them that I wanted to move to Alpha Centuri and they thought I was serious! Two days later I told them I no longer wanted to move there and waited for the expression of relief to show on their face and then added that I’d decided on Andromeda instead. They didn’t see the joke at all and asked why there? I tried following it up with saying I was joking and telling them I wanted to move to London so now they know I’m crazy. And still they didn’t get that I was joking.

Stage Directions: Fade up on psychiatrist and down on DSL. Ambiguous machine noises before the psychiatrist resumes his lecture.

Psychiatrist: (To audience at the lectern) Listening attentively, carefully, in detail to patients provides the biggest insight. You have to set them at their ease no matter what they come up with to enable them to relax enough to share what’s going on in their heads. Key words like ‘I want to move’ are a giveaway for trouble at home, which could be neighbours, partners, family, landlords, all sorts. So we start to explore all that. One patient of mine was open about the death of his father, but he’d shut himself away for so long that he had added problems with finances and was about to lose his flat simply because he hadn’t any support from the community, not even via his chums at work or socially. In many ways, isolation in a community can be thought of as one of the major contributors to mental illness. And often it’s the simpliest of things that can make a difference, such as a chat about a program on telly, or someone making sure you can get a a cup of tea. Without those everyday practicalities we can all be reduced to throwing tantrums, but when it’s the very last shred of comfort left, going without a tea bag or breaking a finger nail can be the very last straw of all before a suicide attempt. When it comes to psychosis though, often it’s deadlines that figure large. If xyz does not happen by such and such a time then that becomes the appointed time to begin to plan and, (pardon the pun), execute one’s own suicide.

Stage Directions: Saul returns to psychiatrist for another weekly assessment meeting

Saul: Crazy people are not so crazy as I thought. You get the odd one that swears and kicks off, the odd one that sits in silence and doesn’t move, the odd one that is forever weeping but most you can hold a normal conversation with, chat about music, the latest mobile phone, have political debates with them, discuss the weather, hobbies, interests anything really or almost.

Psychiatrist: It’s a funny thing but while people with mental illness can spot illness in others, they seldom see all the symptoms they themselves display. So how did your weekend at home go?

Saul: Alright. Quiet. Nice to get out of here, could have done without the chaperone and checks but I expect you’ll say it was for my safety. (pause) I didn’t really want Ronnie to even visit, but I was so desperate to get out of here and as he offered. Never rated him as a friend at all as we have so little in common, but you take what you can get. I felt like some freakshow for the handful that bothered to pop by, and with Ronnie too. But, it was good. I...(Long pause)  I came across some of my writings, notes and stuff. I remember that the letter E equalled everything but I couldn’t follow any of the rest. Total gibberish. I can’t believe I could think like that. It’s like the connections I made make no sense at all. Like I forgot how to count or something. Two apples and three oranges somehow equalled five pears in the way I was thinking.

Psychiatrist: Instead of five pieces of fruit you mean?

Saul: Yes. Yes exactly. At least there was a semblance of accuracy eh? I mean I got the number five right and the fact it was all fruit of some kind.

Psychiatrist: Did you feel you were being watched or followed still?

Saul: No. No one watching me. No one cares a bit about what I’m up to. They’re just ordinary folk about their ordinary lives again. No cameras, no microphones anymore which is a relief in a way but still depressing. Except of course there are cameras all the time these days with CCTV, but I remembered what you said and not exactly ignored them, more fuck ‘em. Not as if the government gives a shit anyway, or does anything useful anyway. There’s probably loads of pics of me by down doing an up yours sign at them, but not from this weekend. 

I can’t believe what a state the house is in. I feel really shaky and cringe at the thought of how I’ve been and how I was living, what I was doing and thinking. How could that have been me?

Psychiatrist: You were ill. Everyone’s behaviour changes when they’re ill even when it’s a simple cold or stomach bug. If we all protest and get grumpy over those things, is it surprising we get into a state over more serious things?

Saul: I suppose.

Psychiatrist: This type of illness happens to people more than you think. There’s nothing to be ashamed of here. Like any other type of illness, you didn’t ask for it; didn’t wake up one morning and decide “Hmmm today I think I’m going to have a breakdown.”  Did you?

Saul: No. I suppose if you put it like that...

Psychiatrist: I think we can start looking at sending you home now, don’t you? Would you like that?

Saul: Given how I’ve been I think it’s a miracle you got me back. Thank you. As to liking the thought of going home though, it’s kind of not as appealing as I thought it was. It’s never going to be the same as it was before, I mean when I was well... I mean before I lost my Dad and there’s all that to wade through yet too.

Psychiatrist: One step at a time. All major events change our way of looking at the world Saul, but you are a survivor, just like your Dad said you were. Try and give me a little credit for knowing the difference with all my years of experience. You are not a recurring... to use your words, inmate of a mental health hospital. Stop trying to cross bridges before you get to them especially when you might not even need to cross them. That would not be the behaviour of the Saul I’ve come to know now would it?

Saul: Shall I tell you something funny?

Psychiatrist: Go on.

Saul: Now I wish our conversations had been recorded so I could keep playing them back whenever I need to.

Psychiatrist: You don’t need recordings for that... you have the capacity to remember. Don’t you?

Saul: Yeah. Damn you’re good. I hope I find a career that I can be good at.

Psychiatrist: I have no doubt you will, so long as you take your time and enjoy exploring to get there.

Saul: Hmmm, maybe I’ll be a shrink one day too.

Psychiatrist: If it feels right, why not. You’ll find your way Saul. Of that I have no doubt, so long as you cling onto rocks and not flimsy heather, right?

PLEASE NOTE: Currently in the UK no mental health professional ever wears white coats and seldom wear uniforms of any kind unless they are nursing staff. CPN is the abbreviation for Community Psychiatric Nurse and they do not wear uniforms. Sectioning in other countries is the term that used to known as committed i.e. placed in hospital by decree from a medical team. 

In the UK it takes a committee of medical staff trained in mental health to agree that you are too ill to be left to cope on your own and it is very common for a member of public not related to you to ensure that medical staff are not in breach of the law. 

All people in the UK can appeal against being placed in hospital under the Mental Health Act.

By kind permission of Mel Dixon, the Mindwalking team is proud to publish a joint venture in the form of a play. Copyright and performance rights remains with Mel Dixon who we would like to thank for writing this piece with us and for all of us. 

We hope this will enable every to understand what both isolation and loss can lead to if people are left unsupported. No one should suffer alone, but sadly all too many still do.

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