Tag Archives: mental_illness

Who Needs to be Protected from Whom?

Here’s something interesting from the Royal College.

People with severe mental illness are at greater risk of being victims of crime.

“People with severe mental illness were five times more likely to be victims of assault, and three times more likely to be victims of household crime and criminal damage than the control group – even after taking into account differences in their demographics and social circumstances.”

Women were found to be particularly at risk of community and domestic violence.

It’s worth reading the whole article since there are so many misconceptions about mental illness.

 

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In Lieu of an original post…

I’m kind of busy, but here’s some linky goodness from The Rumpus.

 

Rumpus Interview with Paul Gilmartin

 

“Gilmartin is not a psychotherapist, he is not a psychoanalyst, he is not a psychiatrist; he is not even in the mental health field. He describes himself as a jackass who tells dick jokes. I disagree. He may tell dick jokes, but Paul Gilmartin is definitely not a jackass. He is a compassionate, funny human being who suffers from depression and childhood trauma and is on a mission to de-stigmatize mental illness one interview at a time.”

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BBC Radio 4 drama: ‘The Man Who Turned Into a Sofa’

You might want to take a look at this while it’s still available:

http://www.bbc.co.uk/programmes/b04gvw1t

Interesting account of depression from the points of view of sufferer, family and…er…sofa.

It’s a good window into what happens.

 

 

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Mental Illness Primer for Speculative Fiction Creators: Contents page

I wrote the primer from slides that I prepared for a talk. I know this is doing it backwards but someone requested a Table of Contents so:

Part 1: Why Should I Care?

Part 2: What is Mental Illness

Part 3: How to Assess Mental Illness

Part 4: Mini Case-Study: Buffy

Part 5: Electroconvulsive Therapy

Part 6: Suicide and the Sandman

Part 7: Hush and the Freakshow

 

 

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Mental Illness Primer for Speculative Fiction Writers 7: ‘Hush’ and the Freakshow

Key Learning Points So Far:

The portrayal of mental illness by writers/creators affects stigma. Stigma leads to negative treatment once individual is identified (‘marked’) as mentally unwell.

Mental illness is difficult to define but is socio-culturally determined. Cultural context is important when depicting a character as mentally ill. There should be no drug/alcohol intoxication or organic illness. Behaviour/experience also needs to be sustained in order to attribute it to mental illness.

The assessment of mental illness should draw information from as many sources as possible (self, others, mental health workers), and should consider a change from the baseline.

Examination of Buffy s6ep17 shows superficial attendance to reality of mental illness. 

Electro-convulsive Therapy (ECT) has a troubled history, but is both safe and effective.

Be sensitive. Suicide should not be a punchline or plot device. Remember that what you write affects real people with real lives. The suicide of Morpheus in Neil Gaiman’s Sandman was nuanced.

 Trigger Warning: Up to 1 in 4 people can be affected by mental illness so if any of the topics discussed here affect you contact your health professional (General Practitioner in the UK).

Scope: This is for creators of speculative fiction. The idea is to improve depiction of the mentally ill in narratives like film, books, music videos etc. It is just a primer, therefore it will not go into too much detail.

Spoiler Alert: Here there be spoilers. Deal with it. I will try not to reference anything currently showing in cinemas, but I make no promises.

 Part 7: ‘Hush’ and the Freakshow

 For the final part of this primer we’ll talk about Buffy again. ‘Hush’ is the episode 10 of season 4.

hush1

Before we get to this a few points about the freakshow tradition by way of Bedlam.

There was a guy called Tom Rakewell who ended up in the notorious Bethlem Hospital a.k.a Bedlam. Except that’s not true. Rakewell never existed, but he was a satirical invention of William Hogarth who painted a series of depictions titled ‘A Rake’s Progress’ in 1735. Plate number 8 is Tom Rakewell ends up in the Bethlehem Hospital Madhouse

rake

I’m not going to go into the details of very clear poor care. One particular touch is the inmate carving the name of Betty Careless, a famous sex worker, on a step, perhaps an allusion to neuro-syphillis (General Paralysis of the Insane).  What I would really like to draw your attention to is the two high class ladies incongruously placed. Note how the light falls on them in the painting. Hogarth wanted us to see them in particular. They were there to entertain themselves watching the suffering of the mentally ill. This was very common. The well-to-do would go to asylums and people with mental illness would be put on display.

The treatment of mental illness moved in seizures and spurts towards morality, but the use of psychiatric disorder as amusement continued and survives to this very day, though transmogrified into tropes such as the ‘psycho-killer’.  Historical freak shows such as those promoted by P.T Barnum in the 1800s used mostly physical deformity as a form of entertainment, but shows also included oddly-behaved people who may have been mentally ill. They key feature is the use of physical or mental abnormality as exhibition.

Which brings us back to ‘Hush’.

The monsters of the week are the Gentlemen.

The rhyme about them goes Can’t even shout, can’t even cry, The Gentlemen are coming by. They arrive in a town, steal all the voices, then come at night to carve out hearts from seven people.

The horror of this episode is about failed anaesthesia. If you consider the semiotics, the Gentlemen are doctors (they wear suits, they use scalpels, they have doctors bags, they keep their extracted hearts in specimen jars, they congratulate themselves after successful heart extraction, and come across as genteel). The victims are unable to cry out, which would be the normal way to express pain or to indicate to the doctor or dentist that your flesh is not numb. It’s a great episode and one of my personal favourites. So what’s the problem?

These guys:

guys1 guys2

The assistants, familiars, servants, minions or whatever. They aren’t even named in the nursery rhyme or the episode. They do not matter. They are unnamed, and hence unimportant. While the Gentlemen are doctors the symbolism of these minions screams psycho-killer or mental patient.

They wear strait jackets, their faces are bandaged from psychosurgery, they act brainless, their crouched, almost simian movements and the weird jerky hand movements evokes the extreme side-effects of antipsychotics or some of the problems of Huntington’s Chorea. Interesting side note: the shirts used by the Gentlemen are not contemporary. They would have been used when asylums were around. These minions are made to seem more pathetic by the comparison with the Gentlemen who have graceful movements and who glide about a foot above the ground.

This is the essence of freak show: they are there to entertain by virtue of being mentally ill. The message to your subconscious is the mentally ill do not matter.

Conclusion

What I hope to do (or to have done) is inject some curiosity about the facts of mental illness. Most media representations are largely inaccurate. As writers, artists, film makers or creators of any kind do not shy away from the uncomfortable truth, but find it. You may discover that real mental illness is not sensational, but you must make an effort because with time what you write has the potential to change the experience of real people.

At least, that’s my hope.

(P.S. I know I’m going to regret this, but if you’re creating something and you need an opinion on the way you have portrayed mental illness feel free to contact me. I don’t charge a fee and it all leads to a reduction in stigma.)

 

 

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Mental Illness Primer for Speculative Fiction Writers 6: Suicide and the Sandman

Key Learning Points So Far:

The portrayal of mental illness by writers/creators affects stigma. Stigma leads to negative treatment once individual is identified (‘marked’) as mentally unwell.

Mental illness is difficult to define but is socio-culturally determined. Cultural context is important when depicting a character as mentally ill. There should be no drug/alcohol intoxication or organic illness. Behaviour/experience also needs to be sustained in order to attribute it to mental illness.

The assessment of mental illness should draw information from as many sources as possible (self, others, mental health workers), and should consider a change from the baseline.

Examination of Buffy s6ep17 shows superficial attendance to reality of mental illness. 

Electro-convulsive Therapy (ECT) has a troubled history, but is both safe and effective.

Trigger Warning: Up to 1 in 4 people can be affected by mental illness so if any of the topics discussed here affect you contact your health professional (General Practitioner in the UK).

Scope: This is for creators of speculative fiction. The idea is to improve depiction of the mentally ill in narratives like film, books, music videos etc. It is just a primer, therefore it will not go into too much detail.

Spoiler Alert: Here there be spoilers. Deal with it. I will try not to reference anything currently showing in cinemas, but I make no promises.

Part 6: Suicide and the Sandman

sandman 1

Neil Gaiman and an army of artists wrote ‘Sandman’ for 75 issues between 1989 and 1996. It is one of the high points of the sequential arts medium and has won a string of awards. If you have not read it stop now, because I will talk about the end. Seriously, do not proceed beyond this point.

The series ends in what is essentially the suicide of the eponymous Sandman (aka Morpheus aka Dream, of the Endless). There are many wonderful things about the series but the suicide of Morpheus was elegantly nuanced.

Family History

sandman2

 

Morpheus is one of the endless (pictured above): Dream, Destruction, Desire, Delirium (formerly Delight), Despair, Death and Destiny. They are godlike beings who represent some fundamental aspect of sentient life as their names suggest. We are never told who their parents are, but there is a birth order.

If you remember the previous parts we mentioned that in assessment of mental illness one has to check the family history. Is there evidence of mental illness in the Endless? Well, yes. We’ll leave out the absent parents (which we know can screw up any child) and go straight to the siblings.

  1. Destruction walked away from both his duties and the family.
  2. Despair constantly self-harms by cutting herself.
  3. Delirium is psychotic, and her change from Delight shows a definite onset of psychosis.
  4. Desire is not necessarily mentally ill, but S/he is homicidal and vindictive. The vindictiveness is a trait shared by Morpheus.

This shows a definite problem in the family.

What about Morpheus himself?

sandman3

The Sandman is rigid and inflexible. He is narcissistic and vindictive, prone to excessive vengeance.

He is prone to depression as is demonstrated many times throughout the series. He bears the guilt of killing his own son (long story) and imprisoning a woman who spurned him for over a thousand years in Hell.

Morpheus dies in the end. In my opinion he committed suicide.

“The only reason you’ve got yourself into this mess is because this is where you wanted to be”

-Death

The circumstances that lead to Sandman’s death were engineered in part by Desire, but we are clearly informed that Morpheus could have avoided it, but chose not to.

In my opinion his suicide was made realistic by the absent parents, the family history and his personal experience of depression combined with an inflexible personality.

Some points about suicide

Suicide is extremely tragic and has been depicted in dramatic form and fiction since man could form sentences. It appears to have been with us throughout recorded history. I’ve heard it said that one suicide can affect up to sixty people.

Because suicide is rather dramatic and eye-catching we often lose sight of one thing: it is uncommon. In most countries it is in the order of 11-16 per 100,000 per year. It is never casually done.

There are three components to suicide: 1. The person is dead. 2. The person died by their own hand. 3. They intended to die by their own hand.

These three components (but 3 in particular) make suicide difficult to prove, and for historical reasons it is defined differently in different countries (For example, England and Wales have a different way of determining suicide when compared with Scotland). This makes research difficult and comparison of statistics tricky.

Most but not all victims suffer from a mental illness at the time of suicide. Mood disorders increase risk. 60-70% have depression, people with schizophrenia are at risk, especially around the time of diagnosis and during recovery; substance abuse is a risk factor; anxiety and panic disorders can be risk factors. Note that people who have experienced non-lethal self-harm or suicide attempts are at increased risk of completed suicide (and can we just put that whole ‘cry for help’ malarkey to rest please?).  Even though two thirds of those who kill themselves have never tried to harm themselves about one tenth of those who harm themselves may go on to kill themselves. A chronic medical condition can be a risk factor, especially if associated with chronic pain.

Twin studies demonstrate that there is a genetic component to suicide, but it isn’t Mendelian.  The captain of the HMS Beagle (yes, the one with Darwin) was a man called Robert FitzRoy. He was noted to be odd and almost certainly suffered from Bipolar disorder. FitzRoy killed himself by slitting his own throat in 1865. FitzRoy’s uncle had killed himself by similar means about a decade earlier. According to Bryson, 2003, “FitzRoy came from a family well known for a depressive instinct.”

To Nuance Suicide in Fiction Consider:

  • Past history of suicide attempts
  • A history of impulsive behaviour
  • A family history of depression or suicide attempts
  • Living alone
  • Being widowed/divorced
  • Sometimes seen in white elderly males more commonly
  • There should be access to the means
  • There may be a childhood adverse experience
  • There may be previous suicidal ideation
  • There may have been planning
  • Substance misuse is very common
  • Recent loss is common
  • A personal history of depression/panic disorder

Remember: Be sensitive. Suicide should not be a punchline or plot device. Remember that what you write affects real people with real lives.

Next: Mini Case Study: ‘Hush’

 

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Mental Illness Primer for Speculative Fiction Writers 5: Electro-convulsive Therapy

Key Learning Points So Far:

The portrayal of mental illness by writers/creators affects stigma. Stigma leads to negative treatment once individual is identified (‘marked’) as mentally unwell.

Mental illness is difficult to define but is socio-culturally determined. Cultural context is important when depicting a character as mentally ill. There should be no drug/alcohol intoxication or organic illness. Behaviour/experience also needs to be sustained in order to attribute it to mental illness.

The assessment of mental illness should draw information from as many sources as possible (self, others, mental health workers), and should consider a change from the baseline.

Examination of Buffy s6ep17 shows superficial attendance to reality of mental illness. 

Trigger Warning: Up to 1 in 4 people can be affected by mental illness so if any of the topics discussed here affect you contact your health professional (General Practitioner in the UK).

Scope: This is for creators of speculative fiction. The idea is to improve depiction of the mentally ill in narratives like film, books, music videos etc. It is just a primer, therefore it will not go into too much detail.

Spoiler Alert: Here there be spoilers. Deal with it. I will try not to reference anything currently showing in cinemas, but I make no promises.

Part 4: Electro-convulsive Therapy

One Flew Over the Cuckoo's Nest

One Flew Over the Cuckoo’s Nest

I’m going to go ahead and say this from the start: Electro-convulsive Therapy (ECT) is both safe and effective. ECT is a controversial topic, but not a controversial treatment. The problems with public acceptance of modern ECT are understandable, but historical and subjective. As a writer/filmmaker, you need to know how ECT was performed in the historical era you are writing in.

The essential feature of ECT is the induction of seizures by way of electric current.   Electricity gets a bad rap in psychiatry, yet it is used all the time in medical treatment e.g. Defibrillators, TENS (Transcutaneous Electrical Nerve Stimulation) machines, diathermy in surgery to name a few. Nobody gets upset about all this, so it is not electricity that is the problem.

History 

Convulsive treatment started in the late 1930s out of an erroneous belief that people with epilepsy did not suffer from schizophrenia. The scientists of the day decided that induced seizures might cure schizophrenia. They used electricity, but also chemicals like cardiazol. With time electricity became the only method of inducing seizures.

We do, however, need to place the use of ECT in historical context. There have been, unfortunately, many abuses of psychiatry. Some of these have been nefarious, others well-meaning though paternalistic, but all led to some degree of suffering. This is not a talk on history, but a few key points should be noted. Psychiatrists in Nazi Germany subscribed to Lebensunwertes leben (‘lives unworthy of life’) and allowed or encouraged thousands of patients to be killed in ‘Action T4’ which is  believed to have been a dress-rehearsal for the extermination of Jews and Roma. The Soviets also gave us something called ‘Sluggish Schizophrenia’ which was a euphemism for dissident behaviour and the use of psychiatry for social control.

Asylums were seen by some as places to keep the mentally ill apart and (with hints of eugenics) to stop them from breeding. Interesting side note: being gay was considered a mental illness at this time.  The plight of patients on the Greek Island of Leros discovered in 1989 should remind us that such abuses are still possible in modern times. All kinds of purported ‘treatments’ emerged including insulin coma therapy, water dousing, centrifuging, mechanical restraints, psychosurgery, shock treatment, etc. By the end of WWII only ECT, psycho-surgery and Insulin Coma therapy survived as effective physical treatments for serious mental illness.

In the 1950s psychotropic drugs were discovered (by mistake while we were trying to make antihistamines). The simultaneous massive social change at the time along with the work of Goffman, Laing and Foucault as well as a financial incentive for governments led to the progressive closure of asylums. I am aware that I have simplified and collapsed a number of events and interpretations, but you can look these up. They are a matter of public record.

What’s important with respect to ECT is that it still drags around the historical and socio-cultural baggage of the asylums, inhuman treatment, coercion, paternalism, experimentation, eugenics and the immense human suffering that preceded modern mental health treatment.

When is ECT given today?

 ·        Severe depression ·        Catatonia·        Prolonged or severe mania·        Especially if there is refusal of food or drink 

What Does Modern ECT Involve?

In simple terms the psychiatrist explains the procedure and reasons for choosing that treatment option. They should seek consent in writing. The individual should undergo a physical assessment to ensure that there are no physical ailments that might make ECT risky. There should be a baseline memory test. Ideally, there should be a chat with an anaesthetist. After double-checking the consent, anaesthesia and muscle relaxation is induced. The pulse of electricity is applied with electrodes and seizure activity is monitored. The patient then goes on to recovery.

So, in summary:   Consent, anaesthesia, muscle relaxation, seizure, recovery.

It is usually about as dangerous as a dental procedure. You can read more about it from the Royal College of Psychiatry page

The events in the Jack Nicholson film may have happened once, but not any longer. ‘One Flew Over the Cuckoo’s Nest’ was already dated at the time of its release in 1975. It was based on a book published in 1962 (during the wave of asylum closures mentioned above).

Smallville s3e9 ‘Asylum’: Lex Luthor gets ECT

Lex Luthor gets science fictional ECT

Lex Luthor gets science fictional ECT

 ECT is a plot device in this TV programme about the early years of Superman. Short term memory loss is a side-effect of ECT. Lex Luthor’s father wishes for his son to forget something so he engineers a dose of ECT to perform a memory wipe. It would have been more useful to get Clark Kent to kiss Luthor. This episode is an incredibly negative portrayal of the mentally ill and displays ignorance of how ECT works. It describes ECT as “draconian” and risking irreparable brain damage and successful in 50%. ECT cannot be used to wipe memories. The patient will not remember the treatment or scream. ECT in the episode is done without anaesthesia.

Similarly in Batman # 471 where Killer Croc is given ECT, there are visible sparks, there is no anaesthesia, and the doctors wear surgical masks.

This is the second time Killer Croc appears in this talk. Co-incidence?

This is the second time Killer Croc appears in this talk. Co-incidence?

Some criticism has been levelled at ‘Homeland’ Season one’s portrayal of ECT because the recipient winces when the treatment is applied. I’ve seen what looks like a wince in some patients, although it could be seizure-related.

Please read this 2012 Guardian article from someone who has experienced ECT.

Summary: ECT is both effective and safe. Try to avoid mass media as source material.

Next: Suicide and the Sandman 

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