Making Sense of Madness

Contesting the Meaning of Schizophrenia

Jim Geekie, John Read

• Publisher: Routledge
• Year: 2009
• ISBN:
  9781134043361
• Edition: 1
• Topic: Psychology
• Subtopic: Abnormal Psychology
• Index: Psychology

The experience of madness – which might also be referred to more formally as 'schizophrenia' or 'psychosis' – consists of a complex, confusing and often distressing collection of experiences, such as hearing voices or developing unusual, seemingly unfounded beliefs. Madness, in its various forms and guises, seems to be a ubiquitous feature of being human, yet our ability to make sense of madness, and our knowledge of how to help those who are so troubled, is limited.

Making Sense of Madness explores the subjective experiences of madness. Using clients' stories and verbatim descriptions, it argues that the experience of 'madness' is an integral part of what it is to be human, and that greater focus on subjective experiences can contribute to professional understandings and ways of helping those who might be troubledby these experiences.

Areas of discussion include:

• how people who experience psychosis make sense of it themselves
• scientific/professional understandings of 'madness'
• what the public thinks about 'schizophrenia'

Making Sense of Madness will be essential reading for all mental health professionals as well as being of great interest to people who experience psychosis and their families and friends.

Chapter 1
Introduction

As this is, in many ways, a book about stories, we have decided that we should begin this book with a story. A true story.

A young mother sits at home every night thinking about her predicament. Her two boys, aged 2 and 5, are asleep, and her husband is out working night shift in a coal mine. He won’t be back until early the next morning. She’s preoccupied with how her life has been going recently, and finds she thinks about nothing else once the kids are in bed. Night after night after night, she returns to the same old issues, the same old questions, and finds she reaches the same old dead-ends in looking for answers.

As the weeks pass, the content of her thoughts remains much the same, but the way in which she thinks about her situation starts to change. It moves from being an internal monologue to being an external dialogue. She finds that instead of having her thoughts running around in endless circles in her mind, she is now having a discussion with her own head, which has somehow, miraculously she thinks, started to appear in the top corner of the bedroom, looking down on her, talking to her and contributing ideas and suggestions about ways of dealing with her current circumstances. Her head appears pretty much every night, and she finds that the discussions she has with her head are more fruitful than just having the thoughts running around in her mind.

After some months of these nocturnal discussions, the young mother and her disembodied head together find a solution. It’s simple: she just has to kill herself. That now seems fairly straightforward to her. However, this in itself creates another problem: what to do with the children? It would be cruel to leave them behind. Indeed, she would find it impossible to do so given the circumstances. The solution to this dilemma also develops out of the dialogue the young woman has with her head. Again, it’s a simple and obvious solution. She will kill her two children first, then she’ll kill herself, thus ensuring that they all escape and that the kids are not left behind to face the situation on their own.

It seems so clear and simple, yet something about it does not sit easily with the young woman. Somehow it just doesn’t feel right. She decides to go to see her family doctor, hoping there’s something he might be able to do that will prevent her ending her own and her children’s lives. She decides not to start off by telling him about the discussions she’s been having with her head. Instead, she begins by talking about another problem she’s been having. She believes she’s been walking in a strange way, with her body leaning over to one side. She told her family, but they dismissed her concerns, saying she walks just fine. She believes they are lying, for some reason deliberately hiding something from her. She tells the doctor about her walk and he responds, not surprisingly, by asking her to walk around the surgery. The doctor sees nothing remarkable about her way of walking and tells her so. She believes the doctor is in cahoots with her family. The doctor senses the young woman is troubled, and, this being the early 1960s, he gives her a prescription of phenobarbitone, which she never actually uses. She’s seeking help, but she’s been distrustful of medicine ever since she was offered, and refused, thalidomide while pregnant with her second child. The doctor, clearly of the opinion that the young woman is mentally unwell, then tells her that if she doesn’t stop thinking this way, he’ll have to send her off to the mental hospital to see a psychiatrist. The woman experiences this as a veiled threat, becomes more frightened, and decides – wisely, we might think – to say no more about her difficulties. The doctor hears nothing about her conversations with her head.

The young woman doesn’t kill herself, nor does she kill her children. Instead, she decides to leave her husband, a task which proves far from easy as she has few other supports. After leaving her husband, she finds that, in time, the discussions with her head cease, and she no longer feels that she’s leaning over to one side when walking.

The above story is one which confronts us with a number of important questions and many of the issues which we hope to explore in this book. What are we to make of this woman’s experience? Is she mad? Does she have a mental illness? Does she need help? What kind of help? We might also ask about her children. Are they safe? Is she safe? We might also wonder what she herself makes of her difficulties seeing as she is clearly troubled by them. Some of these questions are rather academic at this point in time, given that the events took place in the 1960s, and the woman and her now grown-up children are safe and well. She no longer has experiences of such intensity, which would cause us to have concerns about her, or anybody else’s safety. She has never received any input from mental health services. However, although these events happened quite some time in the past, we can still fruitfully consider the question of what we are to make of this woman’s story. While her story is, of course, unique in its details, it also has elements which it shares with other people’s experiences and, as such, the question of what we make of these stories has ongoing relevance.

First, let’s consider the woman’s relationship with her family doctor. She feared that if she had told him her whole story, he would have viewed her as insane, and treated her accordingly, most likely by sending her off to the ‘mental hospital’. In this respect, she is almost certainly correct. Her story can be construed from a clinical perspective, where we find a vast literature aimed at investigating, making sense of, and ‘treating’ experiences of this nature. From this position, which, for our purposes, we are assuming her doctor would have upheld, her experiences are indeed seen as indicative of a mental illness. Using medical terminology, we would say she was experiencing psychosis: hallucinations of a visual and auditory nature along with delusional ideas about her way of walking and her family conspiring to hide things from her. Both at that time in the 1960s and in the present day, she would, in all likelihood, receive a diagnosis of schizophrenia were she to share her experiences with her doctor. Given the apparent risk issues, where her own and her children’s safety seemed of concern, she would, as she feared, have been hospitalized and, both then and now, medication would have been the mainstay of the treatment she received.

However, the clinical perspective, as would have been embodied and enforced by her doctor, is not the only perspective that could have been brought to bear on this woman’s experience. She could also have solicited the opinions of family and friends. She did speak to them about her concerns about walking to the side, but, as with her doctor, she kept from them the parts of her experience that she considered most likely to cause them alarm. She felt ‘shunned’ by her family when she mentioned any of her troubles, and she suspected that if they knew more of the story they too would have seen her experiences as indicating that she had something seriously wrong with her mind. She believed they would have seen her as mad, and most probably would have wanted her to be hospitalized and treated with medication. She assumed they would have felt that her experiences lay outside their realm of expertise and they would have seen medical professionals as the most appropriate people to address these experiences.

Because of her fears about the ways in which the medical profession and her family and friends would have construed and responded to the most unusual aspects of her experiences, the young woman chose to keep these experiences to herself. In some ways this compounded her distress, making her feel all the more alone with what was going on and uncertain about what to make of it. Of course, we might add that by not sharing her story with these significant others, the woman thereby excluded herself from any assistance that she might have been offered by her family or by the medical profession. We should also recognize that the woman did not, in fact, solicit opinions from her family about her talking to her head, but rather she surmised what they were likely to think, based on her knowledge of them and on how they had responded to her other difficulties. It is possible that she may have been mistaken in this regard. However, whether or not she was correct in her assumptions about what others would have thought (and we suspect she was not mistaken), her story nonetheless illustrates that different perspectives can be brought to bear on such experiences.

In asking the question of what we are to make of this woman’s story, the professional, clinical opinion of her doctor and the lay perspectives of family and friends are, of course, both important. They tell us a lot about how such experiences are construed from these perspectives and provide us with some ideas about how we might respond to the person who is having these experiences. It so happened in this situation that there was considerable overlap between the medical and family perspectives, something which, as we shall see later in this book (Chapter 4), is not always the case. Further, it is important to recognize that the perspectives expressed in this story are specific instances of both clinical and lay understandings of such experiences. Each of these broad frameworks – the professional and the lay – encompasses a wide range of ways of making sense of the kind of madness experienced by this young woman. Later in this book we will explore in more depth the range and variety of ways of understanding madness that we find in both the professional literature (Chapter 5) and in research that investigates family members’ and other lay understandings of psychosis (Chapter 4).

Illuminating though the professional and the lay perspectives are, they are clearly not exhaustive in terms of the positions from which such experiences can be understood. Another important perspective, often overlooked in research into schizophrenia and psychosis, is that of the very person who has the experiences, in this case the young woman. Might it be that she herself could shed some light on these unusual and distressing experiences? Perhaps we should consider the advice of the great American psychologist, George Kelly (1955:322) who suggested, somewhat ironically, ‘If you don’t know what’s wrong with a person, ask him: he may tell you’. Kelly is here pointing out the folly of assuming that only the ‘experts’ can make insightful observations about clients’ subjective experiences; a folly sadly found still in much of today’s research literature on mental health difficulties and clinical approaches to offering help to those who have such experiences.

So, let us return to our young woman’s story, to see if she, with her unique perspective based on lived experience, is able to help us make some sense of what might have been going on when she started speaking with her own head, and developing her plan to kill her children and herself. Looking back on this time, the woman, now in her sixties, comments:

My life was in very real danger. My husband was beating me severely more or less every day when he came home from work. The beatings were so bad that I believe that if I hadn’t got out of that situation, he really would have killed me. I felt ashamed about the beatings, as if they were my fault, and I had no-one I could turn to. Friends and family shunned me and either didn’t notice, or pretended not to notice my bruises from the beatings. I felt stuck in the situation, and could see no way out. Talking to my head at least provided me with an outlet for some of my distress, and let me consider my options from different points of view. Killing myself and my children was preferable to being killed by him. It took me a while to see that there were other options, and that even if it would be difficult, I could leave him, as I did, and continue living with my bairns. It was the 1960s, so there weren’t many supports for battered women at that time. As for why I thought I was walking to the side … Well, that’s a bit of a strange one, eh?

Here then, we see another way of making sense of the woman’s unusual experiences. We can see these experiences, or some of them at least, as being related in important ways to her lived experience. In particular, she suggests that her madness can be made sense of in the context of her life circumstances at the time. Though the comment above was given retrospectively, the woman was clear that even at the time of her psychotic episode, she saw these experiences as closely connected to the abusive nature of her marriage, and her limited options for escaping this. The fact that her experience of talking to her head as well as her thoughts about killing herself and her children stopped after she had left her husband, shows that her understanding of the situation was a useful one which led to a successful resolution of her difficulties. We might ponder what the outcome might have been if she had followed the path of telling her family doctor, and then being admitted to the mental hospital. One of the points we wish to make in reference to this story is the seemingly simple claim that the person who experiences such distressing and confusing experiences is, just as George Kelly suggested, able to make an important contribution to how it is that we might understand such experiences. Surely, not a contentious position to take, one might think, although in fact (as we shall see in Chapter 2) people who experience madness have, by and large, been excluded from discussions about how to understand the experience and how to help those troubled by such experiences.

Our story above illustrates many of the themes that we will be exploring in this book. First, the story serves to illustrate the kind of unusual, even bizarre, and often distressing experiences that this book focuses on. Having a discussion with one’s disembodied head about killing one’s own children is not, we assume, a commonplace experience. Similarly, believing that your family is conspiring against you to cover up your unconventional way of walking seems like an unusual belief to have, particularly in the absence of any convincing evidence to support it. In the psychiatric literature these experiences would be referred to as hallucinations and delusions and would most likely lead to the individual being given a diagnosis of schizophrenia.

Second, the story illustrates the variety of ways in which these experiences can be understood. The woman herself was troubled by her experience, and perplexed by aspects of it. However, and this is a crucial point, she did not see her experiences as lacking meaning. She identified a connection between what was going on in her life at that time and the seemingly bizarre experiences, thus rendering them less bizarre to her. There were aspects of her experience (such as the feeling of walking to the side), that did not make much sense to her, and we might hypothesize that were she able to discuss these experiences in some detail with someone else, this might have helped her develop an understanding of these experiences too. However, although she was aware that others would construe her experiences differently, she did not feel that she was able to do this with those around her. She believed that her doctor, as well as her family and friends, would pathologize her experience, consider her dangerous and so take what they consider to be appropriate steps to contain this danger. Of course, the fact that the young woman did not tell others about her story means we cannot be absolutely sure that those around her would have seen her experience in this way. Nonetheless, her assumption about how others would see her experience does illustrate a common way of making sense of her experience, namely, as signs of a mental illness, or in lay parlance a ‘mental breakdown’ or ‘madness’. The focus of this book will be on the various ways we can understand experiences like those in the woman’s story.

We believe that the experience of ‘madness’ is a quintessentially human experience, found in all human societies, and as far as we know, across all times. The propensity for the mind to deviate from what is considered ‘normal’ and acceptable in any given society, and for other members of this society to construe these deviations as signs of madness seem to us to be central aspects of what it is to be human. The kinds of deviations from ‘normality’ that we are talking about here are generally those where some of the fundamental assumptions about the world, or how we perceive the world, are called into question. This might include, for example, perceiving something that others cannot perceive (such as a voice), or developing a firmly held belief that is not shared by others, nor based on what might be considered sound reasoning (and so might be referred to as a delusion). Experiences such as these, which can be intense in nature, inevitably generate a range of questions: questions for the individual concerned, for others around him or her, and more generally, questions for all of us engaged in and concerned with the human enterprise. These questions might include, for example, how these experiences come about, how they can be responded to and how we might make sense of them. In this book we want to explore some of these questions, which emerge from a consideration o...

Table of contents

• The International Society for the Psychological Treatments of Schizophrenias and other Psychoses book series
• Contents
• Figures and tables
• Acknowledgements
• Abbreviations
• Chapter 1 Introduction
• Chapter 2 The subjective experience of madness
• Chapter 3 Making sense of madness I
• Chapter 4 Making sense of madness II
• Chapter 5 Making sense of madness III
• Chapter 6 Bringing it all together
• Chapter 7 Where to from here?
• References
• Index