A Window on Madness (part three)
By leo vine-knight
- 1154 reads
The Unit
2005
Another day, another dime.
Thinking nostalgically of the black dog (it had followed me again this morning), I drew up a chair, ensured there was no trace of human excrement on it, and prepared myself for the report, or as it was usually called in this part of the world 'hand over’. The first wails, shouts and coughs of the shift drifted down the staircase, and on this orchestral background we began.
“You look rather fetching in that Womble outfit, if I may say so.”
“Yes, I’m going straight from here to the charity walk”.
“That necklace of real bananas is a masterstroke.”
“Thank you.”
“It should be tremendous fun for all of you.”
“Ha ha ha ha ha “ we all reflexively chortled.
“But don’t forget to collect the sponsorship money this year will you?”
“Er….no…..of course not.”
“It was a quiet night then?”
“Yes, it was basically a quiet night” she said “David didn’t sleep much again. He was wet three times, and had a big bowel movement about an hour ago.”
“Yes, I smelt it as I walked in” I replied helpfully. “How big a bowel movement?”
“About sixteen inches long and five inches across.”
“Fairly average for him then” I observed without a trace of exaggeration.
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David
1946
‘The White Cliffs of Dover’ played on a distant radio while David sat listlessly in the little office attached to warehouse 3, and watched the belching trucks drive out of compound C. He pulled down the short sleeves of his khaki tunic, reached again for the dog-eared letter in his pocket, and drifted off into fruitless thought. The war was over, he had avoided contact with the enemy by being inconspicuously diligent in Supplies, and now all he had to do was wait for his discharge. But the end of the war meant the end of many things in David’s life, and now all he had left was a hollow feeling that wouldn’t go away, the hot tacky sheets of restless sleep, and a nagging anxiety. His parents had been killed in the blitz, his best friend from school had stepped onto a land mine, and the school itself had disappeared into a crater, having taken a direct V1 hit in the last months of 1944. These were the images of his days and his nights - as love, conscience and memory collided in growing darkness.
He had hated discipline ever since school, but he couldn’t act without it, and the prospect of civilian life, job hunting and independence mortified him. He wanted to get married so that a nice girl would look after him, but he could never aspire to the sort of passionate courtship he’d seen on ‘Brief Encounter’, and he carried his virginity around like a second head. He was tall, stooped, balding and ineffectual, dithering and stuttering his way through the world in a daze of puzzlement and worry. His unattractiveness was slowly turning into misogyny and decay.
There had been one special lady in his life during the war, and they had sometimes gone to the pictures or a dance when their leaves coincided, but his romantic overtures had never extended beyond a private erection in the cheap seats, and now
she had gone. Years of Errol Flynn, cocky yanks and celibacy had taken their toll, and she had written:
Dear Davy,
I’m afraid I have got some good news.
I’ve met a wonderful man called Frank who wants to marry me. He loves to tickle me with his thin black moustache, and has a case full of nylons and chocolate which he found near the docks. He is so good that he gave me a ring off the third finger of his left hand as an engagement gift, and I am besotted.
I am also pregnant.
If only you had kissed me once in the four years we had together, it could have been so different, but yearly handshakes at Christmas were never going to be enough for somebody hot-blooded like me (particularly when you kept your gloves on).
Goodbye.
Yours truly,
Daisy
David folded the letter carefully away for the twenty-fifth time, thought about his friend from school, and prayed for divine intervention. It came the following day in the form of a letter from his sister, who invited him to stay ‘for a few weeks’ until he got himself sorted out with a job and lodgings.
Two years later, she kicked him out onto the street, and told him that he was obviously incapable of keeping a job, and that she didn’t like the ‘unhealthy’ way he looked at her husband. David spent ten minutes looking at the closed door and his heavy bags, and finally decided to take a grip of the situation; appearing thirty minutes later on his brother’s doorstep instead. As the years passed by, David’s siblings all took it in turns to parent him, but as the options ran out he became increasingly desperate to prolong his stays, developing a puppy-like charm when anybody was kind to him, evading challenges with vague quizzical looks and half-deafness; often feigning illnesses.
Eventually, the family G.P. brought David to the attention of a consultant psychiatrist, and he recommended that David be admitted to the regional mental hospital for a short period of assessment. David was initially petrified, but he agreed, and then quite enjoyed the extra attention, free meals and regularity of the ward, taking great interest in the behaviours of long-stay patients, and the role of the nurses. His condition deteriorated shortly afterwards, and as frequent temporary stays merged into contiguous long stays, David willingly exchanged the army for the asylum, and felt safe again.
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Psychiatric nursing had a complete fixation with bowels, as mental health trained nurses strained to prove their general nursing credentials by making constant references to the frequency, amount, consistency, smell and colour of their patients’ stools. Bowel charts, stool samples, per rectum and abdominal examinations all excited the greatest interest and concern, while the administration of enemas and suppositories was a highlight of the week, invariably performed with near religious zeal and reverence.
Huge stool sizes were not in fact that abnormal in psychiatry, because patients often had constipation and sluggish bowels due to drug side-effects and sedentary life styles, leading to infrequent but massive ‘clear outs’. Sometimes the toilet would be totally blocked, necessitating a call out for the hospital engineers, and on one occasion the toilet bowl was filled to a level three inches above the seat, needing a shovel to remove the pile. Patients sometimes fainted when delivering these ‘babies’ because of fluctuations in blood pressure, and one patient was so used to these occasions that he obligingly rolled up his sleeves and cleared toilet obstructions himself, notwithstanding staff advice to the contrary. It was often joked that modern ‘holistic’ care approaches really revolved around one particular hole, and that this was in fact the ‘holy grail’ of psychiatric nursing activity. Disappointingly, one of the more sickening web sites had already disabused staff of any claim to record breaking fame, because stools up to six feet long had been recorded in the United States some years earlier.
The night nurse went on to recount that the fire alarm had gone off overnight due to a fault in the circuit and that, as usual, it had proved virtually impossible to persuade most of the patients to leave their beds while the situation was investigated.
“Yes.” I remarked, “Once, when we had a fire procedure test, the Fire Officer set off a smoke machine in the kitchen, and just like clockwork most of the patients saw the smoke and ran upstairs.”
“I’m only surprised the staff didn’t follow them” said the auxiliary night nurse.
“Well in fact they did go upstairs to plead with the patients. If I remember correctly, the Fire Officer and the unit manager were the only ones stood outside when the Brigade came”.
“Of course. Wasn’t that the day the Fire Officer told staff he couldn’t train them to use the fire extinguishers because the Health and Safety Officer had declared it too risky?”
“That’s right.” I said “They were afraid somebody might get burnt.”
And so it went on. The handover was the institution within the institution, serving many purposes beyond the simple communication of relevant information, and usually diversifying well beyond the matters in hand. Because the unit had been totally bed-blocked with intractable patients for many years, the report was robbed of genuinely interesting facts such as clinical progress, transfers and admissions, so it had largely degenerated into minutely detailed accounts of patients’ regular day to day behaviour. It was almost as though we were reviewing an episode of ‘Big Brother’ or some other fly on the wall pseudo documentary, as we tirelessly regurgitated needless observations on the patients’ personal routines, repetitious statements, and dietary habits. It was a rut we had fallen into and the report usually contained very little information that the receiving nurses didn’t already have before they arrived, leading some to refer to it as ‘Groundhog Day’. Tragically, even the patients’ most bizarre behaviours, such as screaming abuse across the fence at members of the public, presenting fixed delusions to staff, or attention-seeking incontinence, were all part of a well known pattern which no longer gave the slightest surprise to permanent staff, and was indeed expected at regular intervals. As one person put it, the bizarre had become boring, but this predictability did not mean the report was necessarily a short affair.
A few years ago, the report was regularly timed at one and a half hours, requiring tea, coffee, soft drinks, biscuits, platters of cakes and sandwiches to sustain the noble throng in their professional deliberations. The patients were usually totally abandoned during these gatherings, until the most aggressive individuals would try to kick down the locked door to request some input from the “busy” people inside. Notoriously, it was next to impossible to contact the unit by phone during these periods, because staff took the precaution of having their meetings down the corridor out of telephone range, and on a number of occasions visitors to the unit came and went without being able to locate a single staff member. In one famous case, staff spent well over an hour nobly debating welfare issues, only to discover afterwards that one patient had fallen downstairs and broken a leg while they were all pontificating. It was only when the growing tumult of (im)patient outrage beyond the door reached fever pitch that staff would reluctantly tear themselves away from the narcotic repartee, age-old complaints and circular analyses to re-enter the fray. Escape from real work and real patients was no doubt an important part of this tradition, but it remained unspoken, like all the unconscious collusions in this weird, dysfunctional place.
Eventually the situation became more than ridiculous, and I remember the day well when one charge nurse becoming terminally frustrated with the excesses of the system. Resorting to a theatrical solution, he simply picked up the care plan folders, read out the names and placed them back on the desk. This, he maintained, covered all the information we needed to run the next shift, and he proved the point by challenging his colleagues to come up with anything new that the afternoon shift wouldn’t already be aware of from either their own experience, or the desk diary. There was a resounding silence, and we moved on.
“Here’re your keys” said the night nurse, as she passed across a colour-coded mass of brass and steel. “Hope you have a quiet shift”.
Feeling my hand move downwards a full inch because of the weight, I bid him, the diminutive Zebulon and their auxiliary nurse goodbye. I then sighed resignedly as I watched their smoking estate cars carefully traverse the frozen car park, and turn through the main gates. Some of the other night nurses were also clearly destined for the charity walk, as they left their wards variously dressed as Barney the Dinosaur, Gandalf, Harry Potter and a Cyberman.
“Ha ha. Tee hee” they chortled.
“Don’t forget to collect the sponsorship money again” I called across.
Well, at least they would have lots and lots of fun. That’s the main thing.
Isn’t it?
Looking down at the keys, I disentangled a ‘handy’ bunch of twenty for my nursing assistant and considered, not for the first time, why we had so many keys for a relatively small unit. Altogether, there were two hundred and fifty-five keys on the premises, sub-divided into three staff bunches and a special collection which lived in a ‘handy’ cupboard down the corridor (and through two locked doors).
Technically, the simple act of giving a patient one of his own cigarettes involved the use of four keys, as the staff nurse bunch was used to unlock the door to the room which contained the key cupboard, and then the key cupboard was opened to recover a further key which opened a cash tin back in the office where the valuable cigarettes were kept. This tin was of course carefully secured in a locked filing cabinet where a particular dainty skeleton type key (and safe cracker sensitivity) was used to wheedle the lock into life and finally reveal the prized fag packet – usually empty.
Needless to say, most of the nurses kept the residents’ cigarettes on the desktop, hidden behind the computer.
Grimacing, I put the large bunch of keys in my pocket and felt them descend rapidly down my trouser leg and pin my foot to the rancid carpet. They had, I realised, already worn out these trouser pockets, so I picked the keys up and proceeded to carry them about like a Dartmoor jailer. The unit was really an open prison though, because not one of the two hundred and fifty-five keys would lock or unlock the main doors from the outside. It was a standing joke that V.I.P. visitors had frequently been left soaking in the rain because a witty patient had switched the bell off and then bolted the doors on the inside, while deluded patients could freely wander off into the local suburbs to deposit bricks through peoples’ windows or urinate in their gardens. This occurred because we weren’t physically able (or legally entitled) to lock them in and we didn’t have enough staff to observe every patient continually.
“Buzzzzz.” Went the doorbell.
“I’ve just come to check your unit for asbestos” said a blue-coloured man, flourishing his 6”x6” identity card vaguely in my direction and disappearing down the corridor like an express train.
“Okay” I said to silence.
Although the patients’ shouts, wails and coughs seemed to be coming ever closer, I had one quick look at the paperwork to see what lay ahead of me. As most psychiatric nurses knew, the ‘main’ work was done in the office where endless reassessments, four-inch thick care plans, and wheel barrows full of Trust guidelines and protocols, all helped the practitioner stay away from his or her embarrassingly unchangeable patients. The office was effectively the unit ‘computer’ where virtual reality took over from the real world, and great strides forward were made in the abstract. Here, the staff could demonstrate immaculate records, action plans and lots of locked cupboards to the numerous auditors and inspectors of one form or another who constantly packed the place like robots at a cybernetics convention.
Curiously, very few methods of measuring patient progress had been developed by the Trust since the Community Care Act (1990), and those that had belatedly appeared were generally lost in the snowstorm of paperwork that covered our desks, leading to a dubious collation of results. People couldn’t even agree on how to define community care success, never mind how to prove or disprove its achievement, so nurses continued to pursue the policy like blind-folded men looking for the way home. We all knew, of course, that clinical effectiveness was a poor relation to cost effectiveness, and that it was only if the government eventually perceived community care as too expensive, that it would then change.
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The Politics of Madness
When community mental health care was first ‘sold’ to the public, it was packaged as a democratic, liberal, modern idea, which naturally suited a civilised, progressive society like our own. Dissenting voices at the time warned that governments usually favoured policies which supported their own interests, rather than anything else, and that ’community’ mental health care policy would prove to be no exception. They also anticipated a backlash.
And they were right.
Discharging people into the community was in theory a lot cheaper than maintaining the old Victorian hospitals which, by the 1980’s, often needed major renovation works. Under the Community Care Act (1990) government agencies were intended to have a much lower (and cheaper) profile, leaving families, charities, neighbours and friends to play a more prominent part in helping the unwell person ‘recover’ in familiar, homely surroundings. In reality, community mental health services have expanded into legions, and their harassed members are still running around like plate balancers at a circus, striving to keep the myth of social integration even half-alive.
It was expected that ‘self-reliant’ service users would help to support themselves practically and financially, even to the extent of contributing to the inland revenue and providing a little bit of extra demand in the market place. They were pictured as happy, successful capitalist citizens, leaving behind the backward communal worlds they had previously inhabited, and the unwanted socialist ideas on which they were based. In reality, the financial burden has simply passed straight across to Local Authorities and state welfare agencies, who distribute millions in aid to masses of largely dependent service users, living on open-ended benefits, demonstrating socialism at its worst.
It was assumed that individualized care would prove to be the most effective therapeutic approach, because it emphasised the idea of self-improvement and dovetailed nicely with the individualism of modern society. This would stop policy-makers and clinicians wasting time on the fictitious social and cultural causes of mental disorder, such as inadequate socialization, gender/class/culture conflicts, secularity, materialism, alienation and community disintegration. Instead, there would be cohorts of beautifully rebuilt ex-patients coming off therapists’ couches, achieving their challenging personal ambitions in a perfectly conducive social world. In reality, the social fabric has rotted away to threads, many ex-patients can’t cope with their individual isolation, there is more recorded mental disorder than ever before, and now even the policy-makers can sense it.
There was certainly method in the government’s madness.
But madness in the method.
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I picked up an assortment of expensively headed Trust memoranda from my pigeonhole and read part of the first one:
“Improve Communications by not using Jargon”
Putting this rare gem of wisdom to one side for later scrutiny, I then moved on to the next memo:
“…A process pathway details the steps involved in the management of care. It should include those steps which add value to the patient’s journey…..A clinical pathway enjoins all the anticipated elements of care and treatment of all members of the multi-disciplinary and inter-agency teams. These are specific to a patient or client or person of a particular case type or grouping (see needs pathway) within an agreed timeframe, for the attainment of agreed outcomes. Any variation from the plan is documented as a variance, the analysis of which provides data for the evaluation of current practice….”
Stunned for a few moments by the fact that both these items originated from the same organisation, I then tore them both democratically in half, and deposited them neatly in the overflowing wastepaper basket, positioned conveniently close to the desk. Nearly all of my memo’s, bulletins, updates and circulars ended up that way, apart from a few which were used for shopping lists at home. The Trust was devilishly clever, though, and made sure the paper was too thick for toilet use, otherwise I would have gladly recycled it. Some staff allowed their documents to accumulate in their pigeonholes for years, working on the principle that this would eventually prevent any further sedimentation occurring because the holes would be impregnably full.
Management countered this by providing the recalcitrant staff with an extra pigeonhole each.
One of the patient’s shouts finally appeared on the threshold, and I looked up to see Hettie hovering in the doorway with both her hands writhing about in her underclothes, and yesterday’s tea accurately recorded on the front of her blouse. Flinching, because I knew what the response would be, I asked her if she wouldn’t mind tidying herself up before she came down for breakfast.
“I don’t want to!” she bellowed. “I want breakfast now!”
Using the ‘cracked record’ approach of repeating myself amiably but assertively, and pointing out the virtues of compromise and composure, I finally prevailed on her to return to her room for a wash and change of clothes. This allowed me to move through to the kitchen and make an initial inspection (i.e. make a cup of coffee).
“I’m going to discharge myself!” Hettie hurled over her shoulder.
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Hettie
1974
Hettie smiled as she heard the splashing in the bath, and turned back towards her other ‘babies’. There were 23 cats and 4 dogs in her tiny terraced chalkstone cottage, as well as an assortment of gerbils and rabbits in cages along the walls, and two noisy parrots flying about at will. The carpets had long since rotted away under the constant flow of uric acid, and they had now been replaced with shovel loads of sawdust, brought weekly from the local carpenter’s workshop. She raked up the caked mass of urine, dung and vomit once a week, and bribed the dustbin men to take it away (against their better judgement) each Monday.
On Tuesday, she went shopping for ‘lights’ and other waste material from the butcher, continuously boiling this offal in a vast cauldron on her 1950’s Belling cooker. The combined smell of stewed lungs and stinking floorboards was overpowering to everyone but Hettie, and in a moderate breeze the reek could be detected 200 yards away. The fumes were now entering the next-door neighbours’ attics and condensing as a horrible sticky scum, so the Environmental Health Department and the Parish Council were attempting to take her to court. She ignored each summons when it arrived, putting it alongside the other unopened buff envelopes behind the broken carriage clock, on the white splattered mantelpiece.
“Idiots!” she said.
But later that week a loud, persistent knock was heard on the front door, and when Hettie at last opened it, she saw a man from the Council and two police officers standing on the doorstep. She quickly slammed the door and addressed them through the letterbox, but when it became clear that they were going to force an entry if necessary, she wearily capitulated and let them in. They stood askance at the scene before them, and instinctively clutched their noses as the odour covered them like a mouldy blanket, and the cats circled their legs. Over the years, all Hettie’s furniture had been burnt on the open fire, and now only a brass bedstead occupied the room, covered in grey sheets and sacking. In the back yard they found the skeleton of a donkey, and upstairs they discovered a half grown alligator in the bath.
Hettie refused to co-operate with anybody and instead took refuge in a series of bizarre delusions about the ‘communist’ authorities and her own ‘royal’ status, so she was taken into psychiatric care under the Mental Health Act. It later transpired that she had been jilted at the altar in 1959 by a philandering cobbler, and this had unhinged her rather delicate psyche in the direction of loyal animals, social insularity, and general misanthropy. Because she was intelligent, and living in a rural backwater, she had managed to avoid or ignore public opinion for many years, and would probably have continued to do so, if her old friends had not been replaced with commuting yuppies.
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“Do you want decaffinated?” I asked my nursing assistant.
“No, full strength please.” he replied, adding after a pause “That’ll be my turd.”
“Pardon?”
“That’ll be my third cup this morning” he corrected.
I said nothing, remembering the curious range of Freudian slips Sidney often produced during the working day. He was a real veteran of psychiatric nursing, with a career stretching back almost 40 years, and while most of his contemporaries had moved into different fields, escaped through promotion or retired early, he had somehow survived the worst experiences the asylum could offer, hanging on for full pension like an old bloodied bull dog on the burglar’s arm. But his resilience had come at a price, and now the four decades of filth, horror and stress which packed his unconscious mind were slowly seeping out; tripping and stalling his intended speech with tragic-comic mischief. A bit like a half mad beast reaching through the bars of a cage to scratch its own keeper.
He looked a bit like Ziggy Stardust through a fisheye security peep-hole, stuck unapologetically in the 1970’s, but with a cracking, dusty husk, somewhat reminiscent of the girl who aged horribly when she unwisely left the magical confines of Shangri-La.
“There you are” I said, handing him the hot cup.
“Wanks a lot” he replied cheerfully.
“Don’t mention it?” I said.
The kitchen itself brought back many happy memories, and for a short while I revisited the time when the unit had been a therapeutic community, with patients expected to make their own meals, clean the unit, challenge each others’ excesses, and generally take collective responsibility for their own lives. In those days, ‘patient rights’ were even more important than bureaucratic controls, and the kitchen was always unlocked to allow patients free movement. But the principle had its drawbacks as demonstrated by one patient who would often refuse to leave the kitchen having once entered it, and another who would examine the contents of boiling pans with her bare hands. One man had a habit of evacuating small pieces of faeces with his fingers, and then entering the kitchen to stir the gravy without the aid of a spoon, while another was famous for urinating in the fish tank, and sometimes feeding the fish with sandwiches, tea bags, chips or (on his birthday) lager.
The kitchen in those days was overworked, grubby, and rather old-fashioned, so following a couple of unflattering inspections from the local council our senior managers authorised a lavish programme of improvements. The place was entirely gutted and rebuilt, with stainless steel work surfaces, state of the art cookers, and a fantastic extractor system which looked like the conning tower of a submarine bolted onto the ceiling above the ovens. It was so powerful that the ceiling tiles visibly shook when it was turned on, and people under sixty kilograms in weight were banned from standing near it in case they were sucked into oblivion. Needless to say, the same managers who had agreed the expenditure then agreed that most of the patients were incapable of making meals, so that cooked food should be henceforth brought in from the main hospital kitchens. Now the place looked like a disused rocket range in Arizona, and when the stock items arrived (e.g. tea, coffee, sugar) they occupied about one tenth of the space available, disappearing into distant corners alongside the odd vintage tin of baked beans, and other isolated collectibles.
Sidney joined me in the kitchen and said:
“Have you heard of the six second rule yet?”
Suspecting more insane bureaucracy, I naively replied:
“No”
“Well, according to a bloke on telly last night, some cafés have a six second rule. If the waitresses drop food on the floor and it’s down there for more than six seconds, they play safe and don’t serve it.”
“Under six seconds on the floor and it’s okay then?” I enquired.
“That’s it.”
“If only we were that careful here” I said.
The kitchen radio then announced:
“Apparently, tents are to be erected in hospital car parks for patients waiting to be treated. In the latest symptom of the N.H.S. budgeting problems, patients will be housed in special inflatable shelters until space is found in Accident and Emergency.”
Looking at each other without comment, we finished our coffee and made our way upstairs to ‘assist patients with their hygiene needs’; a delightful euphemism for activities such as bum wiping, bed-changing, shaving, bathing, dressing, laundering and sweating a lot. Although technically a community ‘rehabilitation’ establishment, the unit was in fact a continuing care ward mainly populated by people who had been in-patients for an average of around twenty years. The rehabilitation tag was really a product of wishful community care packaging, which had occurred when most of the patients were transferred from the closing regional asylum, and it was based on the ‘principle’ that patients could be de-institutionalised at the rate of two years rehabilitation for every year of previous institutional living. Given that the average age of patients was about 50, and they had been institutionalised for 20 years, this meant that they were expected to be fully functioning members of society by the age of 90. It was not an auspicious start to our project, and the reality was one of continuing supportive care for people who either couldn’t or wouldn’t change their way of life. Consequently, many of the patients were still incapable of meeting their hygiene needs independently, and the nurses were still very much in a job.
To imagine the refreshing, systematic washing routines that most people follow in the morning, or even to picture the chaotic but enjoyable bath time exploits of children, is to seriously underestimate the personal hygiene problems of these long stay psychiatric patients. Many of them were extremely resistant to bathing and getting changed because they were confused, suspicious, lethargic, or otherwise irrational about the process, and this meant that days or even weeks could pass before the patient could be coaxed or cajoled into accepting the nurses’ help. Given also that many of them were frequently incontinent of faeces, urine or both, and that some were unpredictably violent, the delivery of hygiene cares could be much nearer hell on earth, than singing in the bath at home. We were frequently castigated for allowing the residents to become dishevelled and (at the same time) frequently warned about exerting pressure on them to become less dishevelled (as this breached patient rights).
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The Bathroom
The main bathroom at the unit was an aircraft hanger of a place made from a pair of large bedrooms knocked together. It was of Romanesque proportions, with the toilet, washbasin and specialist lifting equipment dotted around distant walls, and a huge bath occupying centre stage. ‘The hoist’ (as we called the lifting equipment) was occasionally wheeled out to swing the larger residents around the room like Peter Pan at the theatre, but this was generally for the benefit of staff members who wanted to demonstrate their skills to students, or for histrionic patients who had decided against walking.
The toilet was the purest form of grotesquery the unit had to offer. The bowl would often contain two different evacuations of faeces, together with a garish soup of fetid yellow urine and phlegm. Sometimes blood from piles and periods would be added to the melange and - if we were really lucky - there might be an entire toilet roll floating gaily on top. However, it was much more likely that the toilet paper wouldn’t be used at all, while the toilet handle probably remained the cleanest thing in the entire unit. It was rarely touched.
Interestingly, a combination of warm water and unusual exercise would frequently stimulate a sluggish bowel into belated action, so the bath itself would also double as a toilet. For that reason, a residual brown sludge traditionally occupied the bottom of the tub; mysteriously reforming after every rinsing attempt.
The contents of the U-bend were best left unimagined.
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On opening the fire door to the landing, we were immediately overpowered by the silage-like stench of fresh, loose faeces, so we donned our imaginary gas masks and began our search for the source. We soon noticed a trail of orange-brown smears on the lino leading to a bathroom, and in the bath we discovered a large amount of bedding, covered liberally in excrement, blocking the plughole. The taps had helpfully been turned on, the floor had an inch of water on it, and we were just in time to see a large turd coming over the side of the bath, heading in our direction. The room from which the bedding had been taken was of course heavily soiled, as was the laughing, naked lady responsible for the incident, but most memorable of all was the full set of brown handprints which she had carefully placed around the walls - like a nursery frieze.
“Would you mind cleaning the walls, Sid?” I said.
“Have a fart, boss” he replied
“Pardon?”
“Have a heart” he repeated.
“I do sympathise, old mate, believe me I do. But that’s the big problem with psychiatric nursing.”
“What?”
“It’s the ultimate bum deal.”
Apart from this, the morning shift was actually running quite smoothly, and on our return to the office I was able to reflect that dementia wards had it even harder. In my student days, seven consecutive night duties of eleven hours each were normal practice, and I can well remember the feeling I had at 6.00 a.m. (after nine and half hours duty) when I had to help get eighteen demented patients up and give them breakfast. Most of the dementia patients were elderly, doubly incontinent, confused, disorientated, restless and fearful, while some found it impossible to sleep and others were agitated and physically aggressive. I can recall the unworldly wailing, endless toileting, daily falls, tears and heart ache, dreadful smells as the urine rotted the floorboards under the fermenting lino, angry relatives, sutures and vomit, and of course the hopelessness of it all. It was an absolute nightmare, a living Hieronymous Bosch painting; the backside of life which everyone thinks will never happen to them.
But very well might.
The cessation of torture makes imprisonment temporarily very welcome, so I thanked my lucky stars I wasn’t on the dementia ward, and looked up at the reappearance of Hettie with an ecstatic grin on my face. She now had a different dirty dress on, and a face coated in thick orange makeup.
“You look a lot smarter, Hettie.”
“I need tea now!” she replied.
“Follow me then” I said.
“I’m going to discharge myself!”
Leading her through to the kitchen, I then watched her prepare a breakfast of tea, corn flakes and toast. She loved her food, and even though she added only a dash of water to three tea bags and dropped half the corn flakes on the floor as she left, I did not intercede because I knew from long experience that she did things that way out of agreeable habit, not error. Other patients were now appearing downstairs, and we gradually worked through the idiosyncratic diets, vast appetites, delicate moods, and frequent mishaps that this process invariably involved.
“My radio won’t work” moaned a middle-aged lady.
“Are you sure you’ve switched it on properly, Maddie?” I replied, also more out of agreeable habit, than hope.
“My radio won’t work “ she repeated.
“Okay, let’s go and have a look.”
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Madeleine
1950
Maddie looked across the dinner table at her husband and focused her longstanding hatred into a laser beam (forgive anachronism) of pure loathing, aimed right between his staring eyes. He was an endless source of work and worry to her, and yet he could defeat her in argument with effortless ease, chilling sarcasm, and undeviating contempt. They were mismatched at the start, driven into a hasty marriage by animal lust and an unloved child, while Maddie soon found that her winsome ways had only limited appeal to a husband who was easily bored and intellectually demanding. Little issues became constant problems, and constant problems led to mutual disdain. Love would have been lost, if it had ever been found.
Then one day many years later her husband lost his eyesight in a chemical explosion at the laboratory where he worked, and Maddie found that she had to nurse a person she detested. Her life slowly trickled away down the sink of drudgery, as the frustrated man berated and reviled the woman who could never restore him. Their conflicts steadily intensified, and when one day he lashed out in anger, she instinctively slapped him in return. She was racked by guilt, but relieved by the act, and as the blood dripped from her swollen nose, a new idea began to form. She would fight back against this tyrant in her life. She would relegate the pointless misgivings, morals and civilities……….She would leave the way clear for revenge.
Her personality tilted, and over the next three years she consistently tortured the man who used to share her bed - adding shards of glass and a variety of foreign bodies to his food, leaving doors closed so that he would walk into them and placing red hot cups with the handles facing away. She put chairs in the middle of rooms, changed the furniture around constantly, disconnected the ‘phone, and opened his letters. She remained silent for weeks, or she made herself hoarse by shouting into his face.
Eventually the unloved son returned from abroad, discovered some of the tricks and abuses, informed the authorities who eventually intervened, and freed the prisoner. Maddie was admitted to a psychiatric ward, as her fragile mind defensively collapsed, and she was propelled into a melodrama of hysteria and self-neglect. She crawled along the corridors, lay on the floors for long periods, moaned and groaned, talked of suicide and wrote articulate malicious letters to her family. The marriage was dissolved, her son corresponded dutifully but occasionally, her ex-husband took up ballroom dancing, and she settled into an open-ended institutional life.
She looked a bit like the old lady in the Bates’ motel.
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Her cassette-radio-CD player was plugged into the mains correctly, but one of the switches had been moved to the ‘cassette’ position instead of ‘radio’. As there was no tape in the cassette player and the switch was on the wrong position for the radio, there was no music issuing from the speakers, and the machine was termed “broken”.
“Can I have a new radio please?” said Maddie.
“There’s nothing wrong with this one” I said. “It just needs adjusting.”
“I’d like a new radio please. A new one!”
Unfortunately, this was one of the many examples of modern culture completely undermining modern mental health policy. It was hard enough for the average person to keep up with the ever-changing catalogue of CD players, DVD’s, mini-disc players, and I-pods etc., but for many people with mental health problems, it was simply asking the impossible. They were invariably bamboozled by the instructions which accompanied these ‘must have’ gadgets, and in many cases could not master the basic controls even after scores of demonstrations and reminders. After a while, they would become understandably frustrated and appear in the office with fists full of cassette tape, jammed CD player drawers, crushed earphones and ferocious tempers, or they would give up the struggle entirely and use the staff as butlers every time they needed the machine turning on. Money, of course, was no object and it became an almost weekly occurrence for staff to replace terminally damaged equipment with the latest (and even more incomprehensible) hi-tech equivalents at high street shops.
It would have made more sense for us to simplify the situation as far as possible, rather than complicate it, so that residents had a realistic chance of retaining their skills. Instead, those residents who had spent years typing on mechanical typewriters were suddenly given portable word-processors, which quickly baffled them and spent their lives being thrown into distant corners during fits of pique. The sensible solution, according to one enlightened key worker, was to upgrade the portable word processors, to laptops. “The package would be much more consumer friendly” he informed us in a voice synthesizer monotone. Like hell it would.
“Buzzzz” went the doorbell.
“Right, your radio’s working now Maddie. I’ll have to answer the door”
(silence)
“I’ve just come to check for silver fish in the kitchen” said a red-coloured man pushing his identity card up my nose, before disappearing into a kitchen cupboard.
“Okay” I said to his retreating rump.
Another resident had to be prompted about his personal hygiene, leading to the loud protest that he’d already spent half an hour in the bathroom and he certainly wasn’t going again. We pointed out that he had been seen the previous morning sitting on a chair in the bathroom, splashing the water about loudly with his left hand, while his other hand attended to more libidinous needs.
It was a fair cop, and off he went.
Sacrilegious as it may sound, these patients were often incredibly skilled at dodging personal responsibility, even to the extent of putting more energy into the avoidance of the task, than its completion. Indeed, avoidance was really a longstanding attitude, rather than a skill, which had developed over many years of what the consultants called ‘inadequate personality’. Biographically, most of them were disinterested at school, withdrawn at home, intermittently employed at best, and over-reliant on parents, relatives or partners. They were generally self-centred, easily stressed, often melodramatic in relation to their needs, and characterised by a ’learned helplessness’ which ultimately led them into professional care situations. As one old timer put it, this was ‘his job’; a psychiatric career which had spiralled from vague anxieties and depressions about life’s challenges, to a full-on evasion of society through the psychiatric system. In many ways, it was the forerunner and quintessence of the modern ‘soft touch’ state, where benefit fraud and manipulation, lawsuits and compensation, voluntary unemployment, and spurious sickness and disablement have now become commonplace abuses. Certainly, the work ethic in our unit was completely non-existent, leaving ‘welfarism’ triumphant. The radio seemed to hear me, and announced:
“People are writing their own sick notes as overtaxed GPs struggle to deal with the number of workers taking time off. Doctors have taken to leaving piles of pre-signed notes in surgery receptions for people to pick up without a consultation…. They say the measures are needed to deal with an epidemic of ‘malingerers’ who are filling up surgeries with their requests for sick time. ….This is further evidence that the U.K. is becoming a haven for work-shy layabouts.”
“I need a cigarette now” said Hettie.
“Buzzzzz…….buzzzzzzz.”
“Just a minute Hettie.”
“Buzzz…….buzzzzzz”
“A cigarette now. Now, now now!”
“Rehab!” I shouted into the telephone.
“Hi Steve, it’s Kate. Just to say we’re meeting at the ‘Rose and Clown’ on Saturday, if you can make it.”
“Oh, Kate….Yes, that’s fine. The ‘Rose and Clown’ is the one next to the Chinese takeaway isn’t it?”
“That’s the one.”
“Great.”
“Did you enjoy yourself last week.”
“Yes, I did. It was very…er….interesting.”
“You don’t sound very convinced.”
“Oh….it’s just my obscure and asocial nature – don’t worry about it. I had a great time, honest.”
“I don’t really know how to take you, Steve.”
“You’d better rephrase that Kate.”
“Devil!”
“Just joking….of course”
“You sounded a bit wound up, when you answered the ‘phone.”
“Yes…er….sorry about that. But you know what it’s like here.”
“I do. Tell me about it on Saturday.”
“I will indeed…. but I’d better get back to the treadmill. Thanks for the invitation.”
“’Bye, Steve.”
“’Bye.”
It was now uncannily quiet in the office, but of course that was because I’d ambidextrously handed Hettie her cigarette during the telephone conversation. I could see her clearly through the window, depositing lighted matches in the litterbin outside.
“I’m going to discharge myself!” she shouted to an unidentified resident asleep in the back of the unit vehicle.
Flinching at the recollection of my faux pas with Kate, but once again invigorated by the promise of Saturday, I moved through to the dining room with my anti-sceptic spray, dishcloth and fork to clear up the mess. The fork was a personal innovation, which I used to scrape off the thick residues of dried-out corn flakes which invariably glued themselves to the table edges. All in all, it had been a fairly relaxed breakfast of only two broken plates, one spillage, two lost tempers and one puddle of frothy urine, so I allowed myself the privilege of standing at the front door for a few minutes rejuvenation. The air was clear as crystal and I drew it into my lungs with an epicurean relish, while for a few moments my slightly sweating body stood wonderfully impervious to the frost and whirling sleet. I took in the rather gloomy panorama of quiet icy streets with distant Lowry figures, perpendicular church spires and ominous jet clouds, before reluctantly turning around; thus missing the two scruffy white vans which were just entering the main gates.
“I need a cigarette now” said a voice in my ear.
“Follow me then” I said.
But when I looked nobody was there.
Tick tock went the clock.
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Llewelyn
1976
Llewelyn spent the summer of 1976 working in a rock club as a cloakroom attendant, occasionally nipping out of his den to watch the ‘Sex Pistols’, the ‘Stranglers’, ‘Sham 69’, and other new wave iconoclasts. He drank six pints of snakebite each evening and watched a kaleidoscope of irreplaceable educational images float through his pickled brain. These included a happy-go-lucky Scotsman who tried to proposition a succession of “chicks” without realising he had a large pendulous bogie hanging out of his nose, and two androgynous women who fell over a first floor banister still fighting tooth and nail as they landed on the pay desk fifteen feet below. The club closed at 2.00 a.m. and then the staff really started to party, playing old ‘Jethro Tull’, ‘Wishbone Ash’ and ‘Boston’ records until daybreak, and still finding time for a joint on the way home.
It was sensible on one level though, because he needed the money to ‘bankroll’ himself through his local F.E. college where he was soon due to start an ‘A’ level. In the meantime, he sat around his favourite bar at lunchtime with a half of lager in one hand and ‘Making Philosophy Simple’ in the other, listening to Bob Dylan on the sympathetic jukebox and feeling like a Parisian art student at the turn of the century. Lwewelyn was idealising the future to an absurd extent, but he felt delightfully liberated that office drudgery was now behind him, and academic ‘enlightenment’ just in front.
He began college with a tiered hair cut, patchwork flares and white platform shoes, but this didn’t prevent him from enjoying life too much, and he soon found some other mature students (he was 23) who were willing to overlook his manifest imperfections. They drank in the Theatre Bar and saw ex-soap stars in rep, spent evenings in a Jazz club and discussed heavy subjects with superficial ease. By 1978, Llewelyn’s exams were going well and university life lay just around the corner.
As a gifted fashion victim, he thought he’d start his undergraduate career with a perm, and for about six months everybody thought the curls were admirably natural, but he was instinctively gravitating towards hippy culture and in 1979 his beard, John Lennon glasses and long black trench coat were soon joined by belt-mounted leather tobacco pouch and de rigueur shoulder-length mop. His musical tastes became ‘The Enid’ and ‘Renaissance’, plus good old heavy metal, and he really couldn’t have been much happier – or so he thought. He swapped the dissected pigeon brains and conditioned rats of psychology, for the philosophy and dissidence of sociology, and was immediately swept up into a vortex of big ideas, historical analysis and demystification. Mrs. Thatcher came to power in 1979, and Llewelyn moved swiftly in the opposite direction - on his brand new Marxist hobbyhorse.
“So you’re transferring to Sociology, Llewelyn?” said one of the psychology lecturers with a twinkle in his eye. “ And I thought you were an intelligent lad.”
“Ah, but you psychologists can’t agree on what intelligence actually is” Llewelyn said “so I’m not too worried.”
“Perhaps you should be” he replied.
He was right in a way, because scientists have subsequently demonstrated that intelligent life doesn’t exist anywhere in the solar system, and that’s a tough one to swallow.
Isn’t it?
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The Mad Scientists
Llewelyn found that he had a great affinity with existential and psychoanalytical work, allowing it to expand his hungry mind like spinach blowing up Popeye’s biceps. He read Jean-Paul Sartre, Ronald Laing, and Erich Fromm voraciously, applying old ideas in new contexts, finding ‘solutions’ to classical problems, and reinvigorating his own life with fresh revelatory principles. He discovered his forte, met like-minded people and anticipated a glittering academic career. He felt as though he was finally, truly, understanding the world around him.
But that was a self-delusion. The world is never still enough to be known.
It was a few years later when he recognised the gulf between theoretical knowledge and practical experience, but even while he was still at college he began to realise the self-contradictory nature of academia itself. Every philosophy, theory, argument and empirical study had a complete opposite somewhere, if only the student committed sufficient effort to find it, or sufficient time to wait for it. It was only possible to keep the illusion of truth or progress alive on the basis of incomplete knowledge, because as soon as wider information became available it invariably neutralised or confused the earlier findings. In his own field, he had carefully read contemporary orthodox work, revisited older classical perspectives, identified the latest avant-garde papers, made cross-cultural comparisons, and reconsidered the subject through alternative disciplines. The views expressed and findings reported where so perfectly contradictory that, taken together, they effectively added up to one big fat zero.
It was just another form of madness. Everyone talked a lot, but ‘knew’ nothing.
Even so, the artificial segregation of university departments ensured that academics could spend their entire working lives protected from the contamination of alternative views and antagonistic disciplines elsewhere, but this was no comfort to Llewelyn. He eventually discovered that the endless replacement of one paradigm by another was the truth, and that slippery post-modernists could now join hands with the ancient mystics to celebrate the ungraspable mysteries of our human condition.
Great.
Of course, powerful groups could cherry-pick the most amenable academic theories and findings to serve their own political purposes; conveniently forgetting the rest. Social reality was no more than dominant values and interests, cleverly packaged as progress.
What really mattered was influence, not knowledge.
As the rest of his life was to confirm.
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So, Llewelyn gaily danced on quicksand, blissfully unaware that the only really enduring memories he would retain were those of the equally odd and self-deluded people around him. He would always remember the extremely vain chap who wouldn’t go out in the rain in case he got his hair wet (“I have a steel plate in my head you know”), and the female foreign language tutor who would often walk around in black tights and no skirt or dress (“a continental custom you know”). An Austrian friend once baffled Llewelyn by approaching a delectable young women, saying:
“You come fuck offy. Yes?”
He was successful, but Llewelyn later realised that his friend actually meant:
“You come for coffee. Yes?”
He was obviously a natural.
For a while Llewelyn had an excellent social life, drinking every lunchtime, partying every night, and still somehow managed to keep up with his work. His tutors were typical 1970’s sociologists - a wonderful lesbian pipe-smoking lady complete with dog, a previously persecuted Jewish émigré, an intense shaven-headed anarchist, and a larger than life celebrity professor who often appeared on T.V. shows and had once auditioned for the part of Dr. Who. The corridors also often bustled with well-known ex-criminals in muscle-filled string vests, who had completed their degrees and were now on lecture tours.
He spent some vacations alone on campus, while his college friends went back to their families, but this was generally a positive experience which allowed him to experiment with a second adolescence. He made vegetarian stews with marmite and soya beans (initially failing to soak them overnight and giving himself a mild stomach bleed) and he tried various forms of wacky meditation techniques which simply made him lethargic. He invited across rock club friends from his hometown, and graduated from wholesome joints and ‘scrumpy’ to the more esoteric delights of magic mushrooms and lysergic acid. These experiences provided a perfect complement to the abstract theories he was then dabbling with, and for a short time Llewelyn walked on air.
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The Mad Hatter’s Tea Party
When Llewelyn went upstairs they were already adding the morning harvest to a Waldorf salad. There were quite a few dubious specimens with blue tinges and strange shapes, but the majority had that familiar phallic profile, so he ate his and waited for take off.
After twenty minutes or so, the tingling started and everything seemed funny. His mates began to smell a lot and a twist of fear ran around the group, as they reassured themselves with grins and smans. Somebody began picking their nose and the disturbed nostril swelled like a crater, while others swung their cigarettes around to leave bright orange arcs hanging in the air. There was some broken wind from the salad, and it fell on them like giant fly spit.
They were painfully inarticulate, then silent, experiencing periodic waves of euphoria and nausea, as the outside world shrank to a vague penumbra, and the room drifted like a raft in the beyond. Pink Floyd played, and they rode the rhythms of breath and heartbeat, while the wallpaper illusions shimmered and changed. Distinctions between object and subject began to blur, and they felt the thrill of disembodiment, loosing the feeling in arms and legs, swimming in the air, entering the music, leaving egos behind. Fragmenting.
But all too soon their minds sprung back into place, alcohol and joints were passed around, conversation returned, and they stepped back from the edge; personalities restored to what they weren’t.
They looked through the window and saw the zebra crossing, rising to the centre of the road in a perfect half circle; like a hill.
---------------------------------------------------
The dangers of psychosis and ‘flashbacks’ didn’t perturb Llewelyn, and for two or three years he freewheeled between college and his hometown, occasionally hitch-hiking with friends to Stonehenge, Glastonbury and lesser known festivals. He loved the perceptual changes offered by psychedelic drugs, the enhanced consciousness, the stomach-splitting hilarity and even the paranoia of a ‘bad trip, but he was smoking and drinking heavily, minimising his studies, feeling infallible, and pushing his luck way too far. At this time, he met his wife-to-be, read about the Brixton Riots, stumbled across the line with a 2.1 degree, and started getting headaches, tremors and neuralgia.
All too soon, he was to discover that his formula for success was fatally flawed, his knowledge of the world was laughably inadequate, and his ambitious plans were destined for radical modification. Through his inebriate daze he played the Led Zepplin ‘runes’ album at 45 r.p.m instead of 33 r.p.m., and didn’t even notice the difference until the record finished. The pendulum was about to swing back again, and he was on it.
Travelling narrows the mind.
Tick tock.
To be continued
Full story on www.windowsofmadness.co.uk.
Paperback available at www.booklocker.com/books/4150.html
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This is superb - but it's
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