I’m listening to Radiohead in the car on the way to Liverpool…has the light gone out for you/ because the light’s gone out for me…I think of people I knew when I was ill and shaking and broken. I think they wouldn’t recognise me. I think of things I said or did five, ten, fifteen years ago and I cringe. I think of the work that I’m doing and how, if I edited it properly I would be left with 10 per cent of mediocre mumblings. I think of how often I have thought this. I think of how I wasn’t so anxious off anti-psychotics. I think of telling my husband who will tell me, again, that this started when our son was born, not because of pills and injections. I think of how he might be wrong. I think of how our son looked like he was turning blue even though he was really fine and just fast asleep. I think of all the women who made me feel inadequate because I couldn’t breastfeed anymore because they put me on the pills. I think of how my breasts are much smaller now, how they are redundant. I think of all the really real sad dreams I have about my brother-in-law and how even though I know he is very happy they trouble me all morning. I wonder who these dreams are really about. I think of my facebook friends and how I’d like to meet some of them in real life and how awkward it would be, for them. I think of how I’m too shy to post much on facebook because I have a neurotic fear of being exposed. I think this couldn’t be any more of a contradiction. I think of Shane because Radiohead is playing and the synchronicity of each of their album releases was insane. I think of the spectrum of emotions and experiences I had as a twenty-something and how different things feel now, how I’m insular and steeped in conscious and unconscious foreboding. I think of how I get on with people less and less, and how I smile more. I think about Carol at the clinic and how she saved my life and how I didn’t want her to, and how I’m grateful now. I think of songs I most associate with suicide. I think of Fresh Tendrils in my head and how that is my favourite song. I think of how Hell for me would be a closed room full to capacity of patterns and textures. I think of how this fear makes me visualize decay. I think of how the house might burn down because I’m not there to witness it. I think of things I’ll never be able to talk about. I think of how my husband knows these things exist. I think of our lad going around the house this morning with a pair of tweezers and a magnifying glass looking for stray bugs. I think of how Elizabeth worries I will get ill and have to go away again. I think of how I couldn’t promise her that will never happen. I think of how I know some truly beautiful people and how I am in awe of them. I think of how I never say the things I most want to in person. I think of the man who collapsed in Asda while I was singing The Perfect Needle to myself, how his teeth were all rotten and how we’re all going to die. I think of all the ways I might die. I think of executions. I wonder how my brain got so fucked. I think of Anne who is dying and the closest thing to a grandmother I have ever had and how I haven’t seen her in years for reasons that don’t really matter or make sense. I think of how she is sick and how I’ve missed her, and how I’m sorry. I think of how the dreams I have about my brother-in-law are really about me. I think of how this is the happiest and most stable I’ve ever been in my life. I think of how I’m glad the agitation is reasonable this morning. I think of how I’m nervous about the way I look today. I think of how I feel hideous most days and how this is pathetic in a world where disfigured people walk around regardless and get on with their lives. I think of how I feel disfigured inside, somehow. I think of how I don’t want to come across as self-indulgent. I think of how venomous a thought that is inside others. I think about how strange it is to go to Malaysia, blindfolded, and visually experience none of it, take lots of pictures and come home to see what you’ve missed, like the artist Pak Sheung Chuen did in 2008. I think of how a friend told me they’d rather lose an eye or a limb than have a mental illness. I think of how I’m sat in a French cafe with my husband. I think of how feelings of inadequacy permeate my day. I think of my too-small filter coffee and how good it tastes and how I’m drowsy and still wearing my coat and scarf. I think of Simryn Gill’s photographs of interiors and how I looked and looked for traces of anything warm or human, an empty cot for instance held my interest but how I as a viewer, felt abandoned, and how they seemed like a completely fathomless and cold apocalypse. I think of how I’ve lost the ability to play full albums in my head like I did on long journeys when I was fifteen. I think of how I’m sure all the pills have contributed to this decline in mental capability. I think of how ashamed I’ll feel if any of the parents from school read this, how there’s no reason I should, how I feel like a victim of societal repression, stigma, and my own self-consciousness. I think of how alienated I feel. I think of plunging my naked body into the sea, of freezing alive. I think of how remembering my dreams feels like clutching at vapour. I think of how unreal and unrealistic it is to accept advances in technology other people have created with themselves in mind, with money in mind, without knowing how they work or where their components came from. I think of all the people who don’t miss me. I think of all the people who are more valid than me. I think of all the people who are not more valid than me. I think about how my concept of validation is only reasonable in my head for a few minutes at a time and involves the occasional looks of people who don’t love me. I think of how my husband never wants to listen to what I want to listen to in the car. I think of the song Heaven by The Walkmen and how it makes him think of me, and how that makes me smile. I think about the plagiarist, Christian Ward and how I’d like to sit in a cold room with him for an hour and I don’t know why. I think of how I don’t feel sorry for him but how his audacity fascinates me. I think of how I’m amazed I’m thinking about it because I don’t really care. I think about my husband falling through the clouds. I think about him with perfectly formed, white wings. I think of myself as a harpy in the forests of the outskirts of my hometown. I think of how codeine helps. I think of how my brain feels like melting ice that freezes over without warning. I think of how that’s not very original. I think of how there’s not more to life than poems. I think of what a cold-hearted bitch I must be not to have cried for three years. I think about men on Death Row in Texas getting a glimpse of the sky on their way the their execution. I think of how maybe it is a primer for the afterlife, of Heaven and Redemption. I think of how insane this is. I think of how my husband and my daughter are committed in their atheism and how our six year old son believes in Heaven and how I don’t want him to be afraid. I think of how I used to dance in clubs and how I have a whole other body and sense of rhythm now. I think of how diazepam helps. I think of how I barely talk to anyone so it doesn’t matter what I think or what I need to say. I think of how The Pixies song I Bleed used to make me want to cut myself. I think of how before I took lithium lots of things made me think of self-mutilation. I think of how lithium dulls everything, reinforces apathy and inertia, dampens all the feelings that make you you. I think of how I wouldn’t dare not take it again. I think of how being overweight and having bad skin and no emotions is better than being dead or permanently in the agony of despair. I think of how many people have told me they don’t take medication because of the side effects, and I think of what it’s like to have a choice. I think about when I took that photograph that lit up the room and nobody wanted me to take it and I felt like an insult thrown back. I think about the swimming pool and the very hairy man who is always striding up and down and occasionally diving in and showing off all his hairy male-ness and how he must be giving someone a rash. I think about my boy tumbling in that time. I think about falling in sideways, a hundred times, hitting and hitting the pale blue surface of the water fully clothed, my mouth open. I hear the other mothers applauding. I think about how I’m empty inside and so nothing that anyone says to me can penetrate and I slump down in the deck chair and I feel my heart slow down. I feel my heart slow, slow. I think of how anyone reading this far must want more than I’ve got to give and will possibly see me in a worse light than ever. I think of how my father and I used to dream we were painting all the town’s houses primary colours in the night, how we both had the same dreams. I think of how my husband sometimes kisses me, like someone he hasn’t seen for a long while. I think of how he won’t understand why I’m writing this. I think I’m not sure either. I think of the girl stabbed and set alight in Blackpool. I think of all the screaming ones. I think of all the sad ones. I think of myself in wide, midnight dreams of nothing.
I’d just like to share a few thoughts about this letter from Dr Skogstad, who is the consultant psychiatrist at the Cassel Hospital. (NB. He wasn’t the man in charge when I was there all those years ago; I have never met Dr Skogstad.)
One of my feelings when I read and then re-read this letter was: this isn’t really a proper response to what I have written. Another feeling was: the tone is ostensibly polite but actually rather patronizing.
The most troubling aspect of it is: there is no acknowledgement that what I experienced at home was abuse. This is where I get the impression that the Cassel (and by extension, a lot of psychoanalytical psychotherapy) is actually lagging behind societal attitudes. I haven’t shown this letter to anyone except Melissa and the readers of this blog but my hunch would be, most people nowadays would recognize what I describe as abusive.
Linked up with this is the doctor’s failure to recognize that health professionals themselves can contribute to someone’s difficulties. By labelling very distressed teenagers in his care as having “personality disorder” while not giving that description to the parents who have abused them, he is basically saying that responses to abuse such as depression, anxiety, low self-esteem are pathological (i.e. abnormal) but that abuse itself is not pathological or abnormal. He is still operating a hospital where parents of teenagers are given a forum, as they were in my day, a forum that the more disturbed parents used in order to justify themselves and to manipulate the hospital staff. In short, the focus is still on Keeping the Family Together. (A family where the teenagers are this distressed, have attempted suicide often more than once, etc. is a family that has already fallen apart. If it was ever, in any real sense, “together”.)
His suggestion that the term “personality disorder” is not denigratory or pejorative in any way also marks this man and his hospital as out of touch. He should speak to a few more GPs if he thinks it’s seen as just another diagnostic term, and while he’s at it he should check what social workers, probation officers, the police think when they hear the term. The way the term is generally used it is taken to mean “untreatable” and, in many cases, “not to be trusted” and also “violent.” I don’t care for the insinuation in this part of the letter that I have somehow got this wrong: I have known plenty of people who are burdened with this often very unhelpful label. (And why is it unhelpful? Crucially, because it locates someone’s difficulties within them, as if that person is somehow fatally flawed; it pays no heed to the external factors involved. And abuse is a very important external factor.)
Freud famously decided that all the accounts of abuse he was hearing couldn’t possibly be true, that they were fantasies. It seems that some of his heirs are still swayed by him.
I have decided not to respond to the doctor’s letter personally.
23rd January 2013
Dear Ms Hamilton,
Thank you for your letter to my secretary and my sincere apologies again for responding only so late and only after your prompting. It seems that the Cassel has made a lasting impression on you, as you are thinking about it and making contact with us after such a long time. I hope that your time here helped you and gave you capacities and strengths that you could use in your life since. I also hope the reason you are thinking so much of the Cassel again now is a good one rather than another particularly difficult period in your life.
Since the early 1980s, when you were here, there have been numerous changes to the Cassel to respond to our research and to adapt to changes in the NHS and its increasingly harsher financial realities. However, the hospital is still there to help people with severe emotional difficulties and has retained many of its old principles. We are now much smaller than when you were here, but we do still treat adolescents, as long as they are over 16, together with (mostly young) adults. Structures have also changed and so we don’t have the particular meeting anymore that you describe, but we do regular family work with adolescents or young adults as part of their treatment and sometimes offer forums for parents or carers.
Like you describe about yourself, all our patients had a troubled and often very traumatic upbringing, which has formed them and has often made it difficult for them to get on with themselves and their own lives. When we call what our patients suffer from “personality disorder”, we are not using this in any denigrating way, as it is sometimes perceived and you seem to hear it. For me and my colleagues, it is a way of describing as a short hand deep rooted emotional difficulties that need understanding and appropriate treatment, usually through psychotherapy and other support. In fact, the term has in recent years also helped to instigate developments in different parts of the country to establish services for such people.
Thank you for your good wishes to the Cassel.
With best wishes,
Dr. W. Skogstad