Square world…

I went for a meeting today in a posh new hospital. Everything squeaked as if in disapproval of my polluting presence.

I was there to chair a meeting about one of the patients, who had been transferred there recently to receive more specialist care. She had previously spent most of the last 40 years of her life as a resident of the local psychiatric hospital. Things went wrong after the death of her husband, and she somehow lost herself in the grief of it all. The whole range of psychiatric science was rolled out for her benefit – drugs that greyed her vision, Electric Shock Therapy that blew holes in her memory then finally psycho surgery in an attempt to cut grief out of her brain with a scalpel.

And here she remains – toothless, but given to scratching. Occasionally abusive but still with sense of humour intact.

She used to be a worker, a wife, a mother. She used to go on picnics and loved to dance. She enjoyed holidays and gossiped with her friends about the comings and goings of the village.

But that was 40 years ago.

Today we met to discuss her future care – a likely move to a specialist nursing home, and the legal issues around that given her lack of capacity to understand or to give consent.

But in the middle of this, she looked at the ceiling and said;

I hate those squares. Everything is square in here. Put me outside next to the beech hedge. Just put me outside.

And I looked out at the brown beech hedge, with dry leaves still rattling on the close cropped branches.

Through the square window.

And I wanted to wheel her out there, and sit her under the winter sky, wind waving her long grey hair in a curve of protest against all those bloody awful squares.

Recovery stories, and how we understand mental ill health…

I have been reading a few of the personal stories on the SRN website, and it set me thinking again about this thing called mental illness.

For those who are unaware of the powerful and life giving concept of ‘recovery’- in this use, is applies to a way of understanding mental illness that is radical and yet very simple. For too long, the dominant way of understanding mental illness has been through a medical paradigm-


But for years, there have been voices saying that this way of seeing mental illness just does not work on any level.


What is ‘dysfunction’ when we apply it to mental health? We all have problems. We all have fluctuating mental health. One in four of us seek medical help because of this at some point of our lives. For the most part- we just get on with it, life goes on.

It is such a subjective experience. What you experience and cope with, I might experience and not cope with.

It might relate to a dreadful life event, like bereavement, or it might be because of vulnerabilities that we have carried since childhood. It also might have a biological/genetic element- although no-one has ever been able to agree how much of our vulnerability is nature, and how much is nurture. Because of this, the same ‘dysfunction’ may in fact relate to very different issues.

But there is no doubt that many of us do hit the rocks emotionally, psychologically and spiritually. Some of us will need help, so we go to the experts.


Then we come to all the labels that psychiatry has come up with in an attempt to categorise dysfunction. Each one with its own set of sub categories- some examples below:

Schizophrenia (simple, paranoid, hebefrenic, etc)

Depression (reactive, chronic, manic, agitated etc)

Anxiety disorder (panic disorder, phobia, obsessive compulsive disorder etc)

Now all of these categories have a set of symptoms that we look for, and even (in today’s parlance) a ‘care pathway’ that people will then be expected to follow- with recognised assessment processes and evidence based interventions lined up and ready.

But make no mistake- researchers have looked in vain for a virus, or a brain-wiring fault, or any kind of identifiable physical, testable, observable location for these disorders. They are not like a broken leg, or a cancer, or other kinds of medical issue that are diagnosed according to observable scientific observation. Rather they are always nuanced, individualistic, mixed in with all sorts of personality/life experience/drug use stuff, and all that messy, unquantifiable humanity.

So what we have is a changing picture (we currently use international standard diagnostic classification version 10) of fairly loose observationally based, subjective categories, albeit applied as consistently as possible by highly trained and experienced doctors. The edges of the diagnostic categories are blurred, and their usefulness still much disputed.

Check out this decent summary of labelling theory.


When we have our diagnosis, then we have associated treatments- usually drug based, intially from our GP. Sure there are lots of other ways of getting help- often called rather condescendingly ‘talking treatments’- counselling, psychological therapy etc, but these are not universally available, and the middle classes get far more than their fair share. Also because of the dominance of the medical model (which assumes some kind of biological basis for serious mental illnesses like schizophrenia) then most of this talking stuff is aimed at people who are regarded as ‘neurotic‘- as if these people are some how totally different in their needs to be listened to, understood and helped towards a greater self knowledge and self worth.

Most of the drug treatments are very ‘dirty’- in the sense that they are loaded with extremely debilitating side effects. The activity of the drug companies, and the power and position the system allows them to take within hospitals has to be seen to be believed. There is always a new wonder drug just round the corner- a new ‘lilly the pink’.

And yet, research would suggest that ‘getting better’ is not the goal of all this treatment for many of us. Rather it is aimed at alleviating some of our symptoms, and ‘maintaining’ us in some kind of stasis.

For some, this is OK- they are grateful and satisfied. For many more, the effect of the psycho-medical machine is to give a half life, or even a no-life. People lose just about everything- job, relationships, income, role, self worth, self determination, hope. Is there any wonder then that suicide rates are so high?

At the same time as experiencing all these losses people gain a few other things- a label, a new ‘sick’ role, benefits that have diminished in value in real terms. It is a poor exchange. Because in gaining this kind of identity- or rather being expected to live within the boundaries of this kind of identity- we are condemned to a dependent life. And transcending this can be extremely difficult.

Perhaps it might be far more difficult than the mental distress that started us down this road in the first place…

So, returning to the recovery stories.

These are records of people who have decided that it is possible to experience good mental wellbeing despite the presence (or the absence) of mental ill health.

They describe the landmarks on the journey towards a different kind of recovery- one that is less concerned with diagnosis or treatment, and much more motivated towards real life issues like


Self worth.

Real choice.


Meaningful activities.


Please read some of them- because I suspect that there is more of the Kingdom of God in one of these stories than in a thousand sermons.