Know Thyself How I have done better without the mental health system
In the late 1970s and early 1980s, in the years after I had left university I was regularly having psychotic breakdowns, periods of deep depression, and psychiatric hospital admissions. My first admission was in 1978. Thereafter I was having an admission every 20 months - up until 1983, and slightly more infrequently after that, in the late 1980s. My diagnosis started off as manic depression and was then changed to schizo-affective disorder. In 1992 I had my last psychiatric hospital admission. I did have a brief breakdown in 1998 and I spent one night, though not on a psychiatric ward, as I would stop breathing when I fell asleep. I recovered without medication and went back to work - and soon afterwards managed to get my employment transferred toa new employer. Since then I've been off for 3 months, again in a work crisis, with stress, two years ago. I did not, however, have a breakdown and went back to work. So, in the last ten years I've had one brief breakdown - but before that I was having lots.
What's the difference between the 70s and the 80s and the last ten years?
Well, one difference is that, in the early 1990s I stopped going to see my consultant psychiatrist and refused to take any more so called anti-psychotic medicine. But let me retrace my steps.
Developing my own framework of understanding
In 1986 I became involved in the psychiatric services user movement. Shortly afterwards I landed a job as mental health development worker in Nottingham MIND. From the mid 1980s, therefore, I became professionally interested in mental health issues. I could devote myself to trying to understand my own psychiatric problems, as part of my job. A process started in which I determined to take my own destiny into my own hands. Throughout the rest of the 1980s I developed my own model of mental health problems. To be sure I continued to have breakdowns but, as the time went on, I was becoming more and more self observant during, and after, these breakdowns. I was also giving much thought to the situation in my life immediately preceding the breakdowns.
As I worked out my own theory of breakdowns of what breakdowns were I became able to exercise more self control - while at the same time becoming more attentive to what things in my life I had to avoid in order not to have them..
As time went by my writings on these matters, circulated at first as photocopied essays, samizdat style, came to circulate widely. Then some were published and I did some lectures - for example, at the World Congress of Social Psychiatry in Hamburg in 1994. I also published in academic journals like Changes, in Clinical Psychology Forum, and in book collections of essays. I want to turn now to what ideas I developed and the successive stages in my thinking.
Stages in the development of self awareness
The first stage to recovery, in the mid 1980s, was the realisation that my psychological dificulties were arising out of the conditions of my life. They were not arising spontaneously in my head. In the late 70s and early 80s I was having breakdowns every 20 months, as if to a timetable. But in 1983 I lost my job, not because of my mental health problems, but because the money ran out for the project I was involved with. Simultaneously I had a disastrous break up of a brief relationship about which I felt very passionately. As a matter of fact the women concerned had previously been a psychiatric nurse! So in 1983 I then went through the most serious crisis of all - and this was followed by almost a year and a half's depression. The 20 month cycle was broken - not in my favour, but at least I recognised that my problems were somehow related to what has happening in my life.
In 1985 I got a job creation programme post at the University Careers service helping disabled graduates find work. I specialised in supporting graduates who, like myself, had had a psychiatric disability. For the first time I began to think about my problems consciously. I noticed how my depression lifted when I went back to work. For the first time noticed patterns in the odd thoughts and feelings of madness. I began to make sense of them. I became tremendously excited by this. I was going to be famous for my discoveries, I thought....and I had another manic breakdown. Nevertheless I had started analysing the content of my madnesses.
Watching one's own mind.
As the philosopher Socrates put it. "Know thyself". The long journey to knowing myself had begun. I remembered a quote from a Tibetan Buddhist saint, Milarepa, about "watching one's mind without distraction". I began to watch my mind as went crazy and wrote down what I noticed.
At this time the user movement was being born. I had come into contact via my careers job and stayed involved. In a few months I had landed a job as mental health development worker at Nottingham MIND. This was in 1986. My thinking about madness developed further as I read books on the psychotherapy of psychosis. The conventional wisdom around the psychiatric services was that you could not make sense of madness at all. Also that there was no talking treatment for psychosis. I now knew this not to be true and saw that a lot of consultant psychiatrists were talking rubbish. I found books that showed that not to be at all true. I was very influenced by a book by Karen and Vandenbos, the Psychotherapy of Schzophrenia. I also read, and began to understand, books by Dorothy Rowe, by Alice Miller and others. As I have said, I began to write and circulate my own ideas. A number of psychologists and critical psychiatrists were very supportive - particularly Dorothy Rowe and Professor Alec Jenner, at that time nearing retirement as professor of Psychiatry at Sheffield University.
Huge amounts of my madnesses now seemed comprehensible in terms of my previous life and as a reliving of childhood mind states. This is what was meant by 'regression'. Other obscure psychotherapy jargon words started to make some sense. I was able to see the childhood roots of much of my mad behaviour and thoughts. I became quite good at observing my own mental states - and that included when I was in them. I still had madnesses - but even as I was psychotic, there was a part of me was observing the other part of me that was out of control. There was a part of me that was thinking about my crazy emotions and thoughts and trying to make sense of them, trying to create a description of myself that I could put on paper. In my job as mental health development worker I earned a living, partly by developing an explanatory framework for my own madness.
It should be said that I did have conventional therapy, though from the Nottingham Counselling Service in the early 90s, not from the minstream mental health services. It was useful but I had already got a lot of the clarification about these issues by reading and reflection. What I found frustrating about therapy was that it always harked onto childhood relationships and sexual relationships - my therapist seemed unable to appreciate the stresses of my work as issues in their own right - a point on which I am looking into, in more depth, now.
Getting in touch with feelings and body
In my job I became much more aware of my own feelings. Therapists continually talk about getting in touch with one's feelings. I remembering realising, for example, in one my madnesses, that what I was feeling was rage. I remember sitting in a pub and thinking. "I am fuming. I am in a total rage. And I realised too that these were sensations that arose in my body. There was this tremendously powerful arousal state, a state of breathing, a state of muscular tension. Fuming and being in a rage is not only an angry accusatory word stream, a rant in the stream of consciousness, though it is these, as well. I noticed the connection between the feeling in my body and the word stream.
I also noticed that the emotion-driven word stream in my mind, or on my lips, was highly metaphorical. Often these metaphors came from my childhood play. In that sense they made sense and were interpretable. They were rather like the emotional allusions in advertising.
I also became more aware of my body. I began to think about my feelings as my awareness of my body. This was quite new for me. I had always thought of myself as a thinker, a head mounted on a body and legs. Now I became interested in my body.
Thinking, feeling and action
I became able to make the distinction between what I thought, and what I felt, and what I did. Understanding thinking, feeling and acting as different seems obvious to me now but at this stage it was an important insight. So too were the insights that I did not necessarily have to act on my feelings - and also that my thoughts and feelings did not always match up. I discovered that I did lots of things because I thought I ought to - although I really didn't feel like doing them at all. This was a good recipe for setting myself up for a breakdown.
Rather later I discovered too, how to think and stop myself before impulsively following my feelings. Of this more below........
During this time, in the late 1980s, my sexual life, after the terrible mess that I got in, in the 1970s and early 1980s, got started proper. I had a relationship which lasted several years, with a woman who is still my friend.
I also began to notice what was happening before I broke down. I was falling out with everyone. Now, in the usual view, falling out with everyone is seen as a result of the mental health problem. But I could not shake the conviction that there were real reasons as to why I had fallen out with people.
Confrontational Isolation
The next step in my thinking was to turn upside down the ordinary way of thinking about madness. In the ordinary way of understanding madness, the strange thoughts and feelings lead to isolation and to the mad person falling out with other people. It made more sense to me to reverse that idea. The madness arose because I had fallen out with people, not the other way round. The powerful emotions then unleashed in and by these conflicts, blew along my thought processes.
The way I figured it is like this - if you fall out with people you are in a state which I term, 'confrontational isolation'. If you think about the state of confrontational isolation, then a large number of psychiatric symptons follow almost automatically out of it.
For example, if you are isolated, and at odds, with your whole social and work network, then what else could you be but 'out of touch with reality'? What else could you be other than living in a fantasy world? It's inevitable. With no one to share your thoughts with, you cannot reality check, because reality checking is the day to day normal social intercourse with other people, in which you plan and execute normal and new routines. But if you are at odds with people you have no idea where they are coming from. You can only guess what they are up to, what they want, and what they think about you. And these guesses are filled with your hopes and fears. So living in a fantasy world is living in this world of emotion driven guesses. For me it was an unavoidable consequence of my lonely wars with everyone else.
It seemed to me too, that looked from the other side, lots of other "symptons" were equally easily explainable. For example, 'attentional deficit' - this means that you can't concentrate on what a doctor or nurse are saying - because you're very worked up and, therefore, your mind is on other things.
Mania and glory seeking
Mania - it's just a word that means that you are permanently excited. It was the same state I was in as a child, on the evening and night before my birthday, at the anticipation of presents and attention. But why should I be permanently excited? Well, if I observed myself, then it was always the idea that my tremendous new thinking on madness was going to earn me fame and glory. I realised that I was hooked on the idea of fame and that I was for ever having fantasies of being covered in glory for my intellectual creations. This was something that went back to my school days. I failed my 11+ examination (exam to determine which grade of school one went to in Britain in the 1960s). This was a very traumatic failure. The school I went to because of this failure was very brutal and I worked very hard and came top of the class there. I did this repeatedly. My parents struggled to get me to grammar school at the age 13 and at grammar school I continued working very hard - and started coming top of the class there too. It was a habit I was hooked into. I wanted to be 'top dog' intellectually in anything, and everything, I did. I even thought that that was what would get me the girls. After I got my degree I remember thinking - gosh, now the girls will really want me, as I have a first in economics. And this was what made me so furious with the psychiatrists. I wanted them to acknowledge my better grasp of things. I was excited and worked incredibly hard when I thought fame and glory was near.
I realised that my mental health problems were rooted in this. So I had to stop. When I found myself becoming manic again I realised I could not simply switch off this response and thought pattern of a lifetime, even though intellectually I could see how futile it was.
Mania Busting
So one morning, rather than get up even earlier to dash into work, I realised I was entering another mania and determined to do something about it. I lay on my bed, observed my body getting wound up, ready to spring up, and go off to do an ever bigger pile of work.
And I thought, I have to start turning this around. So I gave myself the mental task of inventing lots of reasons as to why I should not go into work that day, why I should make a bombfire of my commitments. When I actually started to think, as opposed to impulsively following my feelings, I could actually find lots of reasons not to do any more work. For example, the most telling argument of all was that if I went manic again, then I would discredit myself again - and where would that get me? So I was involved in something quite futile.
This insight did not, however, turn off the aroused bodily state I was in. I concentrated on tis aroused body state, characteristic of excitement. How could I describe it? I noticed where the excitement as a body sensation was located and determined that it was a tension in my shoulders in particular. I was tense like a runner on the starter block, poised ready to spring into action. When I noticed which aroused muscles were tensed poised for action I was able to release them. I began to relax and to calm down. I lay on my bed, after having phoned myself off work, and came down from a mania. I had learned an important lesson in self control.
I noticed in all this that I was trapped in a paradox. Hoorah, I thought, I am now going to be famous because I have found a self management approach to mania. I must get up immediately and tell everyone about it. I immediately felt excited again. Of course, I recognised that that would put me right back where I started. So I decided that I would tell no one about my self management technique, for mania, at least for the time being. And indeed I did not, until about 3 years later, at a MIND national conference, when I went to a workshop organised by the Manic Depression Fellowship, on self management of manic depression. I explained my technique - refusing to leave my bed while I gave myself reasons not to work more and more, and focusing on my aroused body state until I calmed down. There was immediate interest.
I subsequently published a technique in the MD Fellowship newsletter and spoke at a conference they organised on self management. By the time of the conference other people had tried the technique. One person told me he had also successfully stopped an incipient manias from developing any further.
The mental health service user indentity
Several years on I've not stayed involved in that debate. I don't know if they promote the technique or not. Without being too rude I didn't want to stay involved in the Manic Depression Fellowship..
The reason is that is that members of the MD Fellowship, like many other mental health voluntary organisations, actually have an interest in staying as they are. I saw this early in the user movement. Disturbed, depressed and lonely people found each other through the user movement - they find people like themselves who they can talk to about experiences that they share. This is tremendously important, but it has a catch. Relationships in the group are founded in discussions about the last mania, about how awful everyone is to people with mental health problems, about experiences with medication, about why psychiatrists are such terrible people, why users never get listened to, about how impossible it is, about how it is such a terrible world.
In a word it can too easily become a ghetto. If you stay in this ghetto you never will "get well", you will only ever have a partial life, because your identity and life is bound up with being a mental health service user. I determined I would no longer be a mental health service user. I had a life to live and it was time I got on with it. However I was tied into the mental health services in two ways - I was still taking the medication and seeing the consultant. Also, I was still working as a mental health development worker, trying to change this system.
Saying goodbye to psychiatrists and their medicine
I therefore stopped seeing my psychiatrist, stopped taking medication and stopped trying to change the mental health services - I interpreted my job in a new way, developing an environmental project for people who had had mental health problems to get involved with, alongside others who were interested in the environmental focus.
Of course, as time went on, I had become more and more aware what a complete waste of time mainstream psychiatric treatment was for me - indeed the key turning point was the realisation that trying to change the psychiatric services was actually winding me up and contributing to my problems. I therefore determined to walk away from the services. I figured the biggest critique I could make of the service would be if I got better without them. This would take time to prove, but that was OK. One does not always have to lead with the chin - if I was going to make my most devastating critique of psychiatry then nothing would be more effective than doing without them. Ten years later that is what I think I have proved my case.
In this respect a critical Dutch academic psychatrist called Marius Romme was most helpful to me. As I became more critical of psychiatry I would get tremendously angry and wound up, criticising the mental health system. My criticisms got a sympathetic hearing in many quarters, including by Romme, who was interested in people's own explanatory frameworks for their problems. But in the mental health services locally my criticisms, though listened to politely, did not make a substantial difference. Marius Romme asked me why I addressed my criticisms to people who would not listen to me, rather than building up alliances and a movement with those who would.
Doing this is very common. I suppose if you are a Freudian you would describe it as a sort of father fixation. You attack the authority figures in your world with where they are going wrong. What you hope for is that they will respect you and roll over on their backs and say "Yes, of course, you are right. We have been wrong all our professional lives. We will set to work and re-organise the whole mental health system, the drug industry and mental health law, on your advice." Now, of course, that is a fantasy, a real fantasy. And, as I now understood, if you pursue futile fantasies you wind yourself up, you fall out with people, you isolate yourself and, in a state of confrontational isolation, you cease to be able to cope........and you have another breakdown.
'Bridges' out of the mental health system - getting a life
Part of getting better was recognising that there had to be other ways than pursuing futile paths like this. So I changed direction. Whereas before I had been directing my work to trying to change the mental health system, I set to work to try to develop a project on the edge, or outside of that system. In my thinking of the early 1990s people had breakdowns and could not recover because, for a variety of reasons, they were isolated, poor and had no non futile directions in life. I was lucky because I had a job and an income. Others were not and their poverty, and lack of involvement in positive activities, with other people, meant that they were adrift, in an extended experience akin to sensory deprivation. I knew 'where they were at' because, for periods, I had been there myself.
At your lowest ebb your greatest fear is that you will die soon - and you fear death, because you fear that your life will be over, before you have properly existed. To improve, you have to 'get a life' and, to get a life, you needed to work co-operatively and positively with other people. In the early 1990s I started a relationship with a woman who had come to Nottingham, from East Berlin, after the fall of the Berlin wall. Luckily for me she started as a volunteer at the NAG, which was my new employer. I started visiting Berlin and Germany and visited a project in Berlin called Atlantis. Atlantis provided the inspiration for the sort of project I felt I should set up in Nottingham in my role as mental health development worker. Atlantis worked as training organisation for people who had had breakdowns, drug problems or scrapes with the law, in the fields of wind energy, solar energy, the greening of neighbourhoods. It combined a response to the ecological crisis, with locality regeneration, with giving people employment prospects.
Back in Nottingham I discovered a group of people who wanted to form a Nottingham Alternative Technology Association and we joined forces. We set up Ecoworks. For the next few years I was immersed in environmental gardening, ecological design, locality redevelopment, and continuing my links with Germany. All this brought me into contact with a large group of non mental health people doing non mental health things, while providing me with the ability to provide new activities for people who did have mental health problems. I escaped the ghetto. I was getting a life.
My life in Germany - and the crisis of going backwards
That included in Germany. In 1995 I was invited to work for 3 months at the Bauhaus Dessau Foundation in the former East Germany and, in fact, worked there for 6 months from New Year 1996 to June 1996. My job was to show how to do community development work in a small village, called Volkerode, and a town called Wolfen. This had nothing to do with mental health, as such, and brought me into contact with an international network of academics and activists around Europe and Eastern Europe. I no longer felt of myself as a user, or even, really, an ex user.
But I had to come back. Back from being a reasonable size fish in a German pond, to being a small fish in the Nottingham pond. Back from meetings and seminars in which I was regarded as a somebody, sitting alongside the environment minister in a German provincial government, in international seminars organised in Brussels, to being a mental health development worker in Nottingham. I came back to my employer the Nottingham Advocacy Group (NAG).
In a couple of years I had fallen out with them. I saw new people going to NAG, with new ideas, with different approaches, as I saw it, strangled by an 'old guard'. There were also many things that I felt I had to blow a whistle about. There was a conflict that was very deep and very bitter. For a time I got isolated again. I became paranoid. I fled down to stay with my mother in Kent. Out of the conflict zone in Nottingham, with my mother in New Romney, I recovered within a few days. I spent one night in a normal hospital but was imediately discharged. I again refused to take psychiatric medication. I did not go into psychiatric hospital but I did take a few more weeks off work and recovered, though was in a state of aggravation and rage. My trade union official was tremendously helpful. He was tuned into the emotional side of my situation - he described what I was feeling better than any psychiatrist had ever done before, as well as giving me practical employment support and advice. When I got back to NAG it was not very nice, but I got support from my official. I started to organise a transfer of my employment to Ecoworks.
In Ecoworks too, after a couple of years, I have had stressed times. However, when that happened I simply took time off work. I did not break down. 3 months later I returned to work again.
So, over ten years I have had one short breakdown. I have not taken medication and I am well.
In retrospect - my psychological problems of the 70s and 80s..
Looking back now it seems to me obvious why I should have been in psychological and emotional turmoil in the 1970s and 1980s. I arrived at University without the life skills or background to cope with what happened to me. I became a campus rebel, a left wing student demagogue who enjoyed the notoriety of being a student revolutionary and agitator. However I was not at all self aware. I was not self confident in my sexual self. My strategy for finding love was to try to shine intellectually and be a politically clever rebel - as if the girls would love me for getting a good degree and being an agitator. After university I was not clear what I was to do - my left wing beliefs got in the way of an academic career. I "fell between two stools". I no longer had the opportunities for demagogy and I was unrealistic about looking for work. After I got involved in community activity, and the voluntary sector, I found my occupational niche, but was at first out of my depth in my new work.
As I can see now, being out of your depth in the voluntary, not for profit sector, is not uncommon, in some of the smaller organisations. In the last few months I have been researching occupational stress in voluntary sector where many workers are chucked in at the deep end, with not a lot of support, to work largely on their own initiative. I see many many people who are highly stressed and I now see that my anxieties and worries, in the late 1970s and 80s, were largely real emotional reactions to my work situation at that time. These worries and anxieties did not help my sexual life - as I did not feel good enough about myself to enter into a real 'give and take' sexual relationship. So I worked very hard when I thought that my work opened up real opportunities for me - in which my reputation and self esteem would be resurrected, hoping thereby to get the necessary reputation and respect to be taken on by one of the sisters in the feminist movement. Meanwhile the feminist movement was turning to lesbianism. Nothing wrong with that, of course, but I was looking in the wrong social networks for my love life. Later I discovered, to my great pleasure, heterosexual women who enjoyed heterosexual sex. At that time however my job was insecure and finally came to an end when the money ran out in 1983 chucking me into the deepest ever psychological crisis.
There is nothing much in my misery and emotional turmoil that is not explicable in the circumstances of my life, my lack of self awareness, and my futile and self defeating strategies for finding love and security.
'Medication' - the uselessness of psychiatry
Yet during none of this time did the mental health services help me find that self awareness, the techniques of self control and the new directions I needed. My psychiatrists ruminated on whether I was schizo-affective or manic depressive. They tinkered with my medication. They put me on lithium and then took me off it. They put me on 'heroic dosages' of the so called anti-psychotics - neuroeleptic drugs that gave me ferocious akathesias and dyskinesias. While psychotic under Haloperidol I fantasised I was a tortured tree, screwing myself into agonised knots of cramped muscle - only much later did I realise that this was the medication tensing up an alread partly twisted muscular and skeletal system. For a long time I thought this was simply another aspect of the bizarre experience I was having. It certainly did not helped me keep a grip on reality - and none of the doctors or nurses recognised my agony. The Largactil pushed my mind into a glue like state in which I could barely stay awake. Perhaps I was being punished for my arrogance - for my assumption that knew it all, or for showing off at the peak of mania.
At any event. Other than taking me off the streets, where I made a complete fool and nuisance of myself, providing me with a place of safety, psychiatry largely did not help me. For several years psychiatry and psychiatrists kept me in an illusion that my mind and life was only something that they could treat and heal. When I cured myself of that fantasy I eventually walked away from their system.
I got well myself.
Brian Davey
May - July 2002
© BRIAN DAVEY