The care of madness

In today’s age of science, mental illness is still often treated more like a crime than an affliction.
WHAT is it about madness that makes us recoil? In earlier times it was feared because people thought it was caused by evil, that its sufferers were marked by the devil’s touch.

The physicians of ancient Greece might have known that abnormalities of the mind arose from natural causes, like other diseases, but their theories did not survive the Middle Ages. Christianity’s darkest hour saw madness as a sign of possession by evil spirits, heresy, or other immorality; those who saw visions were witches.

Their treatment was incarceration, exorcism, torture or death _ not unlike what Brian Burdekin has said is meted out to many of the mentally ill today, in what we like to think of as an age of science.

Today few would see mental illness as evil, but it is still feared as dangerous and often treated more like a crime than an affliction. Get a compound fracture of the leg while in the bush, Mr Burdekin has said, and a medical team flies out, stabilises your condition and flies you back to appropriate hospital care. Have a psychotic episode, and police put you in the back of a paddywagon and drive you miles to the nearest hospital.

Ignorance is still widespread and profound, despite the fact that, with psychiatric illness touching one in five, most people will see a friend or relative succumb at some stage. Anyone who has done a first- aid course knows how to deal with an epileptic seizure; how many have been taught how to cope with a terror-struck schizophrenic in full flight from reality? The mentally ill are often uncomfortable to be around. Bizarre behavior is like psychic incontinence, a bubbling up of thoughts and feelings embarrassing to those of us schooled in restraint and containment as the proper way to deal with the outside world.

Most people would find it burdensome if commonplaces such as “How are you?” elicited a truthful, detailed response; it is even more confronting to have to deal with those who have been, even temporarily, subsumed by the chaos within. We circle them, warily, with an atavistic instinct to avoid the strange one, the loner, the one who does not hunt with the pack.

But in many ways we no longer have a pack. Needing help in an age of rugged individualism has somehow become shameful. Not managing has become a failure that must be hidden, whether you be a new mother drowning in your infant’s neediness or an agoraphobic so overcome with anxiety you cannot leave the house.

Mental illness, which often has no discernible cause and no permanent cure, is too often seen not as an illness but as a weakness, a character flaw, something that could be overcome if only one struggled enough: “Everyone else copes, why can’t you?” The devil’s touch has been replaced by the wimp’s touch.

This contempt for the “defective” is a cop-out. It is a shield against having to acknowledge that there, but for the grace of God, a good enough family, body chemicals that mix in harmony and a life free of overwhelming struggle, goes any one of us.

We have all felt fear, like the schizophrenic, and rage, like the paranoic, and the lassitude of despair, like the depressive; many of us will spend our final years demented. Contempt for the mentally ill is also a shield against having to acknowledge and tackle the ways our society makes people sick, the factors over which we as a community have some control: poverty, racism, gender inequality and poor support for families, to name a few.

There are cultures that have no taboo on mental illness, and they tend to be cultures with a holistic view of life, which do not delineate between things of the body, the mind and the spirit; a sick person has disturbances on all three levels.

These societies, which include traditional Aboriginal cultures, wisely see individual wellbeing as closely tied to collective wellbeing. Our obsession with the integrity of the individual higher consciousness, our assumption that losing your mind means losing your humanity, seems primitive by comparison.

It also undermines the right of the mentally ill to care and dignity.

Judging by the Burdekin report, Charlotte Bronte’s Rochester had more compassion for the mad wife in his attic, a fiend who tore flesh with her teeth, than some of today’s professional carers have for the fragile people entrusted to them.

Madness, like mysticism and genius, is about sliding from the everyday world into uncharted parts of the psyche. It causes much pain but is also part of the kaleidoscope of human differences and might sometimes produce some of its brighter colors; studies have suggested that creativity is closely linked with mania and depression.

But the more a society values conformity, the less able it will be to appreciate whatever the affected person still has to offer. One patient told the Burdekin inquiry that although the illness was episodic the label was continuous: “The minute your mental illness is perceived you vanish. All they see is that.” Said another: “No one perceives the value of differentness. If Van Gogh was in Australia he would be behavior-modified out of painting; if Virginia Woolf was writing she would be locked up.”
Perhaps everyday reality, once returned to, is transformed after psychotic episodes as pleasurable and visionary as these: “I have danced glowing around gum trees (and) played piano concertos with joy.

There have been lions and dragons and unicorns.

“I have walked with God through fields of color and light surrounded by jewelled butterflies, with birds free-wheeling above me and daisies at my feet.” It sounds a glorious place to visit, even if you wouldn’t want to live there.

First published in The Age.