Occasionally the experts can be wrong. In this blog, I have returned to two subjects repeatedly, schizophrenia and homosexuality; in tonight's post I wish to talk about them again. I intend to present a theory about the causes of mental illness that I believe makes more sense than established theories and make an observation about sexuality that I believe to be very important. Both the theory and the observation run counter to conventional wisdom on these topics, and this may cause the reader to wonder if I am one of those people who endorses conspiracy theories, who distrusts established science. Do I agree with Bret Weinstein that mRNA vaccines are a dangerous and untested experiment foisted on the global population by pharmaceutical companies in order to enrich themselves? Do I believe Ivermectin to be a superior form of treatment for Covid 19 that has been ignored because it is off patent? Do I think Bill Gates is using vaccines to implant microchips in people? Am I of the opinion that the US is training birds to fly biological weapons from Ukraine into Russia? The answer to all these question is 'no'. But just because I agree with some experts (as they communicate their opinions through the media outlets I trust) on some issues does not mean I believe expert opinion to be conclusive on all issues, particularly those I have a stake in. Experts can cling to obsolete theories, mistaken theories, because of obstinacy, conservatism, lack of critical thinking, because of wilful blindness to evidence and even a type of prejudice. I shall return to the issue of where and why experts can be wrong towards the end of this post. However for the moment I shall focus on the two subjects I mentioned at the beginning of this paragraph.
Another subject I have returned to repeatedly in this blog is my life. In this post I will be talking about my life again because I now have a clearer understanding of it and because it proves a point I wish to make. If I have readers who come back to this blog because they are interested in my life... well, read on.
In order to present my theory of mental illness, I need to discuss two ideas: psychosomatic illness and the placebo effect. If you look up the term "psychosomatic" on wikipedia, you will be directed to the page "somatic symptom disorder", an entry that is, in my view, quite unhelpful. A better way to start is with the dictionary definition: "(of a physical illness or other condition) caused or aggravated by a mental factor such as internal conflict or stress". In my view, a better definition would be "a condition that seems to be somatic but has psychological causes". It is worth noting, first, that both the dictionary definition and my own definition assume Cartesian dualism, the idea that the mind and the body are two quite different things. If we presume instead that the mind and the body are identical, the term "psychosomatic" becomes immensely problematic – an illness caused by 'mental factors" must nevertheless also be an illness of the body. Secondly, it is worth noting that the term "psychosomatic" seems to have a peculiar relationship to the term "mental illness". A psychosomatic illness is an illness that presents as an illness of the body but is caused by "mental factors"; mental illness is (according to the psychiatrists) an illness of the mind that is caused by physical factors, such as excess dopamine production or insufficient serotonin production. This peculiarity is something I shall return to later when I discuss expertise.
Rather than rely on Wikipedia, the example I shall use when discussing psychosomatic illness is the condition chronic fatigue syndrome. I have known two men, David and Maudie, who respectively have it and had it. Chronic fatigue syndrome is a condition that causes the sufferer to become extremely tired after any physical or mental exertion; often sufferers spend much of their time in bed. It can be very debilitating. It can last months, years, or even a person's whole life. Importantly for my discussion, no one knows the cause of chronic fatigue syndrome and doctors in the past have often labelled it a psychosomatic illness; sufferers are accused of 'malingering'. pooh-poohed and told to snap out of it. Current opinion has changed however. Chronic fatigue syndrome is now recognised as a somatic disease – despite the fact that there is still no explanation for its cause (although candidate hypotheses include the proposal that it is caused by a virus). Although anecdotal evidence is often considered inadmissible in developing psychological theories, I shall describe David and Maudie briefly and then draw conclusions about chronic fatigue syndrome from their life stories afterwards.
David is the older brother of my older brother's best friend. At school he was driven and excelled – in his seventh form year, I believe in the mid-eighties, he topped the country in the Bursary exams. He went on to study law and then, I believe a year or two later, developed chronic fatigue syndrome. And never recovered. He has been on the sickness benefit his whole life, although he has had stints working part-time for law firms and has written humorous essays for magazines. Since developing the condition, he has been bashing his head against medical viewpoints much like those I described above, opinions that he is malingering, that his condition (sometimes known in New Zealand as Tapanui Flu) isn't real. He has flown to conferences overseas and consulted foreign specialists with the aim of proving that his condition is a real thing, a real physical disease. Of course, as I said, times have changed and presumably his view is now the majority opinion. This thumbnail sketch of David is I think accurate, close enough to the truth to carry weight. Very occasionally over the years I have bumped into David while he is out jogging – my sense of him is that he is a perfectionist but that he is also extremely negative, pessimistic about the world.
Maudie is a lot younger than David; I know him a little because his foster-mother is a good friend of my own mother. Maudie is one of four children born to surrogates and fathered by a chap called Chuck, a very rich but I believe increasingly insane man who very probably has a syndrome called transgenerational trauma because his parents were Holocaust survivors; in addition, he has a schizophrenic brother. Most of the children, the youngest now nineteen, have acted out in various ways and they have all rejected their dad. My mother and I had coffee with the youngest recently, a lovely smart girl who has been hospitalised repeatedly for anorexia and has arms covered in scars from where she has cut herself. Maudie's 'madness' was chronic fatigue syndrome which I believe he developed in either year 12 or year 13. Maudie did well at school as well but, unlike David who was self-driven, Maudie was driven by his father. I remember one story (among many) that Chuck had taken one of the children to McDonalds and told him that if he didn't do well at school he would end up working there. After Maudie developed chronic fatigue syndrome, Maudie's foster mother, Jackie, took him to a specialist in South Auckland who had a good reputation. This woman took Maudie seriously, told him he had a real condition, and advised him to drop out of school, to go to bed when he felt like it, and to avoid strenuous activity. There may have been more to her therapy than this (I wouldn't be surprised if it involved Cognitive Behavioural Therapy) but this is all I know about it. To state the obvious, the specialist didn't prescribe medication because there is no known medication for chronic fatigue syndrome. Whatever form the therapy took, it worked, and Maudie recovered and went on to work for the Israeli Intelligence Service.
What conclusion can we draw from these two stories? Although a sample size of two is quite small, there seems enough evidence to me for me to propose that chronic fatigue syndrome is indeed a psychosomatic illness. This may seem cruel but only if we suppose that psychosomatic illnesses are somehow less real than 'genuine' organic illnesses. If a person suffers depression as the result of a bereavement, is her sadness somehow less real? If a combat veteran suffers recurrent nightmares, is her PTSD somehow less real? Both David and Maudie were under a lot of stress, David's self-imposed and Maudie's imposed by his father, when they developed chronic fatigue syndrome; anxiety, pessimism, and perfectionism probably played a role in their developing chronic fatigue syndrome and David's never recovering. The difference between the two is that no one took David seriously while the specialist who saw Maudie did.
I turn now to the placebo effect. The placebo effect is simply the observed faculty of supposedly ineffective forms of treatment to have positive outcomes with respect to physical diseases – if the patient believes the treatment to be effective. My mother, who was the lay person on the Medical Council for many years, has told me that a doctor on the council, presumably a highly distinguished and respected man, told her a long time ago that he believed 65% of all cures were psychosomatic or the result of the placebo effect. This points to the idea that the beliefs people hold can have a direct effect on their physical health. If you look up the placebo effect on Wikipedia, you'll find the tide has turned against this opinion however. It is now supposed that the placebo effect has an effect on pain, nausea, depression (controversially), and other symptoms that are mediated by the brain or mind, but has no curative effect on 'actual' diseases such as the growth of a cancerous tumour. The focus of the present essay is on 'mental illness' where the 'symptoms' are all undeniably mediated by the brain or mind – so, even if we accept that placebos have no effect on 'real' diseases, there is no reason to suppose that placebos might not have a significant effect on the the manifestations of 'mental illness' such as depression, anxiety, magical thinking, and so on, perhaps even voice-hearing. A related point, which I shall come back to when I discuss my own life, is that if a patient believes a form of treatment to be harmful it can become a self-fulfilling prophecy, something known as the 'nocebo effect'. Despite the apparent irrationality behind the idea of the placebo effect, its equally apparent effectiveness is evinced by the success of alternative medicine such as homeopathy and acupuncture.
If we combine the ideas I have presented when discussing psychosomatic illness and the placebo effect, it leads us to two bold claims. The first is that mental illness is caused by the beliefs of the sufferer and those around him or her, and that it can be cured by changing the beliefs of the sufferer and those around him or her. (Cognitive Behaviour Therapy makes approximately the same claim I gather.) The second even bolder claim runs as follows: psychiatric medication only works if the sufferer and those treating him or her believe that psychiatric medication works. This seems like an extraordinary claim to make but I can back it up with evidence from my own life.
Before I discuss my own life, I would like to clarify something that may seem strange. It seems reasonable to suppose that the beliefs a person holds can create and contribute to mental illness – but why do I say that the beliefs of those around the sufferer also have an effect on the person's mental health? What would be the mechanism for this? There are two explanations, the first flaky, paranormal, the second more 'rational' – I shall discuss the flaky explanation first. I am a big fan of the biologist and paranormal researcher Rupert Sheldrake. Sheldrake argues, in effect, that humans (and animals) are all telepathic, that consciousness is in some sense collective. I recommend the reader watch the Youtube clip "Directional Scopaesthesia" in which Sheldrake discusses his research into the common but seemingly inexplicable phenomenon of people knowing when others are looking at them from behind. To digress for a moment, I would like to tell an interesting story that is relevant to "'the sense of being stared at". In 2009, I believed that I was telepathic, that people could communicate with each other psychically. On one occasion in 2009, I was on a ferry travelling from Auckland to Waiheke. I was staring at the back of a woman sitting several rows ahead of me when I heard her voice in my head saying, "Eyes in the back of my head". A moment later, she turned around and looked at me. What is so interesting about this story is that not only did the woman sense I was staring at her, I sensed that she sensed I was staring at her. I have considered writing to Sheldrake to tell him this story. What is relevant to the present discussion however is that a person can know what others believe about him or her even if he or she is never told explicitly. The flaky explanation may seem to lead us to think that our beliefs and others' always cohere – but my beliefs and yours might clash. And this seems like reasonable grounds for the emergence of mental illness.
The more rational explanation is founded on the fact that human beings are social animals. We form conclusions about what others think about us often from very subtle cues, from body language, from the way others react, from what we can infer about decisions and processes going on when we are absent, behind the scenes. Our social environment is information rich. For someone diagnosed with a mental illness, an additional source of information is available – textbooks and the internet. The mentally ill learn about their supposed conditions from what is supposedly common knowledge. For instance, in 2007 it was supposed that schizophrenics very often lack verbal fluency. As someone who has had a lot of contact with others diagnosed schizophrenic since 2007, I can state categorically that this supposed diagnostic criterion is quite false. But nevertheless I still worry when I see my psychiatrist that I am not expressing myself clearly and am thus unwittingly confirming his diagnosis. In the post "Concerning The Sellout and An Angel at my Table" I discussed the way Janet Frame, when she was young and silly, deliberately conformed in her self-reports to the picture of schizophrenia she had found in textbooks, a decision that eventually nearly led to her having a lobotomy.
I would now like to back up the argument I have made by adducing my own life as evidence. I have discussed my first psychotic episode (which occurred in 2007 at the age of 27) a number of times in this blog, in the posts "My First Psychotic Episode", "My First Psychotic Episode and bFM", "Theory of Mind and The Big House", "Schizophrenia and Rationality", "Anatomy of a Delusion" and in the previous post "Bits and Pieces". I experienced psychosis again in 2009 and starting in 2013 and have also talked about these episodes in this blog. I fear that I may have sometimes expressed myself badly. What I would like to do now is to briefly discuss these episodes in relation to medication.
I first became a patient of the Taylor Centre, and was placed under the care of the psychiatrist Antony Fernando, around April or May of 2007 I believe. I am unsure of the precise date, which bothers me. I was prescribed 2.75 mgs of the antipsychotic Rispiridone at first, a dosage that was reduced to 2.5mgs very soon after because I complained of akathisia. (I can't be absolutely sure that this was the dosage I was put on although I am absolutely confident about the various dosages of Olanzapine I took subsequently.) I can remember at one of my first appointments with Tony I asked him how long I needed to take medication for and was told, "Two years." I replied in dismay, "Two years?" It seemed like a life sentence. What Fernando should have said was, "We'll see how you go."He pulled that figure, "two years", out of his arse, on the spot. Fernando had no idea of the onset or nature of the psychotic episode I was experiencing. Right at the beginning, when talking to Taylor Centre workers, I was very voluble although I never discussed what had happened at bFM or at the Big House with anyone. After a short period, the Rispiridone took effect – I felt like walls had come down between me and the rest of the world and became far less communicative. When I say that it "took effect", I do not mean that the psychosis abated. I remained psychotic until December 2007. I was worried from the beginning that the drug might somehow do me harm, that it might have undesirable side effects, and, although my mother, whose house I had moved back into, ensured I took a pill every night, on occasion I would spit it out. I can remember on one occasion, in 2007, Fernando told me (helpfully) that schizophrenia causes people's brains to shrink and that antipsychotics are "fertiliser for the brain". I know now that recent research has shown that it is the antipsychotics rather than the 'condition' that causes brains shrinkage but I was not aware of this in 2007 – I don't think the research had been carried out back then. Although I often worried that the drug might have deleterious effects, sometimes I would wonder if perhaps the Rispiridone might somehow actually make me smarter.
It is important to say that, right from the beginning, I believed that Fernando had diagnosed me as a latent or closet homosexual based on his body language and on the fact that at the very first appointment he told me to "stop avoiding". I have gone into other reasons for this conclusion in the previous post. This belief made my psychosis worse. I have described the two core delusions I entertained in 2007 in the post "Anatomy of a Delusion", the belief that the world was ruled by a conspiracy of closet homosexuals, that there were more homosexuals in the world than heterosexuals, and the belief that there was a microphone in my glasses. In my interactions with Fernando, I alternated between thinking he thought I was a latent or closet homosexual and thinking that he shared my delusional worldview. I thought that perhaps treatment with Rispiridone was the standard way of dealing with people who had cracked the secret of the homosexual conspiracy. (It is also important to say that I never discussed either delusion with anyone, although my mother knew that I had a delusion that there was a microphone in my glasses. Nor did I ever say either the word "gay" or "straight" at the time.)
As I said, my first psychotic episode faded away completely by December 2007 or perhaps January 2008. One might wonder, if antipsychotics are at all effective, why it took over six months for them to work. I don't believe that the reason that this episode abated was because of the medication but was rather the result of time and my long stint as a day patient at the respite facility Mind Matters, a period in my life during which I gained a better understanding of my position as a patient of the Mental Health System and of my fellow patients. I was free of psychotic symptoms for all of 2008. In this post, I am arguing that antipsychotics only work if the person believes that they do, that they are a kind of placebo, but this does not mean that they are harmless sugar pills – although I was free of psychosis, I believe that the drug caused a kind of cognitive fuzziness, an intellectual blunting, that I disliked. In fact, my delusions hadn't entirely gone away. Sometimes I thought people might still be monitoring me, but I thought that if I said nothing controversial, no one would be listening. Sometime in the second half of the year I broke up conclusively with my sort-of girlfriend Maya. Shortly after, an old acquaintance, the ex-husband of a friend of mine who had recently returned from the Czech Republic, called me up out of the blue and asked if he could stay. (My mother was at this time away visiting family in the UK.) He stayed for several weeks and then got himself his own place out at Piha. I would sometimes drive out there to visit him. John Gillanders was the only friend I had at this time and I told the people treating me at the Taylor Centre about him.
In January 2009 I became psychotic again. Just to be clear, I was still taking 2.5mgs of Rispiridone. I suspect now that the people treating me thought my relationship with John was a homosexual relationship – although I didn't make this connection explicitly at the time, I suddenly became intensely paranoid that he might be secretly homosexual and severed my ties with him. Bizarrely this occurred immediately after he had got himself a girlfriend. I formed the belief that I had been outed as gay in my patient notes even though I had never used the word 'gay' or 'straight' with anyone in the Mental Health Service except for right at the beginning. An additional negative influence was that I had been on Rispiridone for, it seemed to me, close to two years and the people treating me seemed to have no intention of ever letting me discontinue it. For the first time, I began hearing voices – I decided that I could communicate telepathically with people. Almost the first person I spoke with in my head was George W. Bush.
The episode that began in January 2009 lasted eight months. A number of years ago, I met a trainee doctor at the Taylor Centre and told him that my most unpleasant psychotic episode occurred while I was taking the drug Rispiridone. He was astonished, saying, "You were psychotic while you were taking antipsychotics?" This is where the nocebo effect comes in. I had decided that the drug I was taking was intended for latent or closet homosexuals, perhaps to help them come out. In around July I began hearing voices in my head saying, "I'm gay! I'm gay!" I thought that it was everyone in the world who was on Rispiridone coming out as gay. I became afraid I might say this out loud. Around this time, I also heard a voice in my head that said, "The only difference between you and them is testosterone." I thought that the Rispiridone might somehow turn me gay by affecting my hormone levels. Immediately after my mother's birthday in August, I contemplated suicide – when Fernando found out about this, he panicked and allowed me to discontinue the drug. I was allowed to go off it 0.5mgs a week over about five weeks and was prescribed the sleeping pill Zopiclone. I had shared my fears about my testosterone levels with those treating me and was referred to an endocrinologist who I refused to let examine me because, at this time, I believed the medical fraternity was full of closet homosexuals.
Being allowed to discontinue the Rispiridone cured my psychosis. A month or two later, my mother and I attended a wedding in Sydney, a trip I remember very fondly for all the hot young women I saw there, one of whom I hit on at the wedding reception held on a boat. A couple of weeks after I returned, some two months after I had been allowed to discontinue the Rispiridone, I had a sudden relapse. In this blog, I have said that the trigger for this relapse was seeing Iggy Pop on TV. However, although this was the trigger, the truth is that the relapse was caused by two factors, the stress I had been under for many years, and my sudden realisation that, even though I was no longer taking Rispiridone, I was still stuck with the same diagnosis as either a latent or closet homosexual. The 'voices' came back with a vengeance. I ended up back in Antony Fernando's office and was put on 10mgs of Olanzapine.
For the purposes of this essay, which concerns medication and the placebo effect, it is very important for me to describe the consultation with Tony in which I was first prescribed Olanzapine. One important difference between this consultation and the first few in 2007 was that, in October or November 2009, I knew that I was 'ill'. I was hearing voices in my head all the time. Furthermore, Fernando's body language and demeanour were different, more genuine. There was a tray of Olanzapine tablets on the table; I remember looking at them and thinking they were communion wafers. I had experienced some religiosity in late 2007 and in 2009 and so was disposed to thinking that, unlike the Rispiridone, Olanzapine might be harmless, even therapeutic. I decided that Olanzapine was the right drug for me.
The Olanzapine did not 'work' immediately. I remained psychotic for the next three or four months, although this psychosis was much less unpleasant than the psychosis I experienced when taking Rispiridone. My most intense period of 'voice-hearing' occurred in December 2009 and January 2010; from the time I woke until the time I went to sleep, I used to have long conversations in my head with Jon Stewart, with a girl I had met in November at a Hearing Voices group, a girl I have called Jess in this blog, and, later, with Barack Obama, among others. In many ways it was an enjoyable experience; Jon and Jess used to tell me jokes all the time. The psychosis faded away in February or March 2010 and I remained totally symptom free and was often quite happy for the next three years. Readers may think that this proves Olanzapine does indeed work but the truth is more complicated. In around October of 2009, I had walked up Mt Hobson and asked the voices how I could escape the hell I was in. The voices replied, "Accept consensus reality". I said, "Okay". On the way back down the hill, I saw a vagrant and heard a voice that said, "The saved" and another that said, "The damned". I didn't know which of us was which. A second causative factor is a delusional experience I had in January 2010 which I have never been able to describe in this blog. Third, in early 2010, I believed that I had succeeded in doing what I had tried to do way back when I first made contact with the Taylor Centre, that I had finally "come out as straight" even though I still had never used either the words 'gay' or 'straight'.
Of course I hadn't come out as straight at all. I wish to digress, to describe a young friend of mine, to make an interesting point about sexuality. I have known this young woman, the daughter of a good friend, a long time and tutored her in mathematics in 2011 when she was still at high school. She often comes to the Pub Quiz I have attended since 2010. One day about two years ago, she started coming with a female friend and it became apparent that they were in a relationship. My friend has never come out explicitly as gay (or bisexual) and I have never really discussed sexuality with her at all. I like her and treat her like an ordinary human being and a friend. This leads to the following observation: in the contemporary world, where most people are progressive and non-homophobic, it is possible for a person to be thought gay and for that person to never realise. What relevance does this have to my own story? I believe that my Key Worker, Kate Whelan, thought I was gay and simply never brought it up directly in any way in all the time I knew her. In early 2010, Kate set up a weekly coffee group for patients of the Taylor Centre and, if I remember this correctly, initially wanted me to help run it. In 2011, when I was pursuing the girl I call Jess, I made no secret about this when talking with other patients; I believe Kate thought I was spinning a story because I didn't want to come out publicly and tactfully kept silent. I sensed this sometimes, that Kate thought I was gay, but it didn't cause me distress at the time. It only became truly apparent and distressing that she thought this in 2013 when Kate seemed to become impatient about the fact that I still hadn't come out as gay. For instance, I recall seeing her in early 2013, when I was becoming psychotic again and (exhibiting some pressure of speech) talked about the women I had loved in my life, including Jess. Kate said to me, "Don't you want to be part of a community?"
In January 2012, having been well for close to two years, I asked Fernando if I could reduce my dosage from 10mgs to 7.5 and be discharged from the service into my GP's care. Fernando said, "No...delusions?" I decided to assume that he was talking about the delusion I'd harboured about my father and said, "No". I felt so well that I reduced my dosage myself to 5mgs. In 2012, I started and completed a Masters in Creative Writing, penning a film script about schizophrenia based on Jess. I was totally well all of 2012 and only on 5mgs of Olanzapine. This shows that the idea that reductions in antipsychotic medication necessarily lead to relapses is obviously wrong.
In late January 2013, still feeling totally well, I approached my GP and asked her if I could reduce my dosage from 5mgs to 2.5mgs. She suggested I alternate between the two dosages. I have talked about the episode I suffered that year before in this blog, in the post "What Happened in 2013", but I wish to rehash this a little now, although not in the same detail. The trigger for the psychotic episode, occurring I think in February, was a letter I wrote to the Herald about an historical connection between lead exposure and crime, a letter the Herald published. Shortly after, I formed the belief, possibly false but possibly true, that people in the public arena, and I mean specifically the media, were still unsure about my sexuality, remembering me as that madman who had worked at bFM. I formed the belief that the cause of homosexuality might be having others around the person think one is gay. The delusion that I had entertained in 2007, that my father was gay, came back. I decided to reengage with the Taylor Centre – for a couple of reasons. I wanted what I believed then to be the true cause of my illness to be known in order to debunk rumours or impressions that I might be gay; I wanted it on the public record that I am heterosexual and always have been. I also thought that if I got it on the record that I am heterosexual, it would somehow help Jess who I had recently learned had spent eight months in a psychiatric ward in 2012. Having asked to see any psychiatrist other than Antony Fernando, I was put with a locum called Dharma, having my first appointment with him immediately before Easter. I told him that my father was gay and that he had divorced my mother when I was seven because he thought I was gay as well. My new Key Worker, Josh Brasil, asked me how I identified, the first and only time I have ever been asked this question by anyone in the Mental Health Service. I said, "Straight". He asked me, perhaps flippantly, "When did you know you were straight?" I replied, "Since puberty". I told them that when I first became sick, I had decided that everyone in the world was gay except me. Dharma was astonished. He said, "You thought everyone in the world was gay except you?" I listed the three women I'd loved in my life, Danielle, Sara, and Jess, and quoted something Kurt Cobain had apparently said, "I wish I could be gay just to piss off homophobes". Dharma said to me, "Would you choose to be gay?" I said, "I'd rather die first."
I had perhaps two more appointments with Dharma and then, not at my request, one with Tony. He advised me to increase my dosage back to 10mgs but I didn't want to do this for reasons I will come back to later. Shortly after, I started seeing a new psychiatrist, Jennifer Murphy. Immediately before my first appointment with her, I heard a little voice in my head that said, "Don't talk about love, talk about sex" and so, at my first appointment with her, I told her, truthfully, that the first time I'd had sex was New Years Eve 1997 and the last time I'd had sex was a one night stand in Wellington two years previously. This didn't seem to be enough and so, just before an appointment perhaps a month later, I gave her a short essay describing the closest I've ever come to a homosexual experience, a true story I have told in the post "Concerning Some Experiences". I may have expressed myself badly. In that essay, I said that I no longer believed that my father was gay – the delusion that my father was gay had lasted some four months and has never come back since. I believe now that this delusion about my father was, at the time, simply a mechanism, a means to help me get it on the record that I have always been heterosexual. The floodgates had now opened and I was now talking about homosexuality quite freely; I also felt during the middle part of the year that I had succeeded, that I had finally "come out as straight." Although I had considered the idea that the cause of homosexuality might be having others think one gay, I also believed it possible that the cause of homosexuality might be a single homosexual experience, an act of molestation or rape, a hypothesis (which I no longer believe) that I presented a long time ago in this blog in the posts "Concerning Recruitment" and "An Unpalatable Suggestion"; I talked about this with her as well.
Not long after I began seeing Jennifer Murphy, when I still believed my father was gay, I asked her my diagnosis. She told me, "Schizophrenia." This was upsetting because, up until then, I had believed that my diagnosis was 'psychosis not otherwise specified', the label entered into all my official documentation such as that for my benefit. I asked her if people could recover from schizophrenia and she replied, "Of course people can recover from schizophrenia!" I knew even then that she was lying because, starting in 2010, I had undertaken some independent research into schizophrenia, research that had informed the film I wrote in 2012; I knew that schizophrenia was considered both congenital and incurable. In around October or November I was bullied into increasing my dosage from 5mgs to 12.5mgs, the highest dosage I had ever been on, under the threat of being put under the Mental Health Act; my mother ensured I took it every night but I began vomiting it up. At the next appointment with Jen Murphy, with my near-suicidal honesty, I told her this. Her body language changed immediately. My mother said that she couldn't be a mother and a nursemaid at the same time and I was allowed to go off antipsychotics completely. I was close to well for a couple of months and then became 'ill' again starting January 18 2014. The reason I became ill is that I sensed I was going to be put under the Act regardless of anything I said or did. I can't remember what immediate preceded this event but a week or two later I was brought into the Taylor Centre and bullied by about half a dozen people into signing some form that I didn't even read. I was sent to a truly horrible respite facility in Point Chevalier and put under observation. I have described this time a little in the posts "Concerning Religion", "The Double-Bind Theory of Schizophrenia", and "Mind Matters". Shortly after this I had a perfunctory judicial hearing and was placed under a Compulsory Treatment Order, an Order I am still under today. This involves me being legally compelled to come into the Taylor Centre and receive a long-lasting injection of 300mgs of Olanzapine once a month. (From 2018 until quite recently it was once a fortnight.)
I imagine I have readers who are more amenable to the idea that antipsychotics work than I am. Such readers may suppose it is a good thing that I am being compelled to take medication, that my psychosis and other psychological distress must have abated as a result. The truth is that for much of the last eight years I have been profoundly unhappy and, until a couple of years ago, I still experienced some psychotic symptoms. (Two partial reasons for the abatement in symptoms is this blog and the fact that I now see a different psychiatrist than Jen Murphy.) In 2016, for instance, there were brief periods when, at night in bed, I would pretend to have telepathic conversations with people like John Oliver and Stephen Colbert. I would also, sometimes when I was walking, hear a little voice telling me about some of the people who have treated me, saying things like "Today Jennifer Murphy died" or "Today Simon Judkin's life winked out." (To be clear, these are not auditory hallucinations but rather intrusive thoughts.) I haven't been delusional as far as I know but I used to experience psychotic symptoms that don't fit neatly into the DSM. For instance, from January 18 2014 until the beginning of 2016 I would wake up every morning with distressing, almost unbearable thoughts of homosexuality in my head. We now turn to the fundamental question. I took Olanzapine from late 2009 until 2013 quite willingly and was happy and well. Why did I resist increasing my dosage back to 10mgs in 2013 and why have I continued to suffer mental anguish in the years since? Why did the Olanzpine work for me at one stage of my life and no longer does? One obvious answer is that I took Olanzapine voluntarily in 2010 and 2011 whereas these days I am legally compelled to take it. Secondly, when Tony Fernando advised me to increase my dosage back to 10mgs in 2013, I believed that I had a psychological issue rather than a neurological disease and so thought medication was the wrong answer – I wanted psychological therapy, counselling, talk therapy, not drugs. I thought getting it on the record that I am straight would cure me. Thirdly, although I had decided to "accept consensus reality" in late 2009, a decision that meant in effect that I had decided to accept the label "schizophrenic", by 2013 I had realised that there was a great deal of stigma attached to the label, something I hadn't considered in 2010. (A similar change in outlook can be found in the life story of Janet Frame and the woman I talked about in the post "An Interpretation of The Hounds of Heaven, Patte Randal.). Fundamentally, however, the reason I no longer believe Olanzapine works is that I have a clear sense, a sense that I developed in late 2013, that the cause of my illness was people thinking I'm gay when I'm not, that I was diagnosed schizophrenic by Jen Murphy for saying that I'm straight (presumably because of whatever Tony Fernando had written about me in my notes), and that the cure for my illness is proving to the world that I am not lying, that I am indeed straight and thus not schizophrenic. (I should note that only some people in my life have thought I was gay. For instance, I had a Key Worker, Terri, who at one of the Independent Reviews I had requested said, "He hates people thinking he's gay because he's not", a fair summation of my illness. Unfortunately for me she retired years ago.) Something else that enters into this is that I no longer trusted the medication, thought it might be addictive and brain damaging – I can't fully explain this change in my view of Olanzapine except to say that it had something to do with how it was administered. I have wondered sometimes over the years if my Olanzapine had been switched to Rispiridone without anyone telling me.
My life story proves, I believe, that psychiatric medication only works if the person taking it believes that it does. I wish to conclude this section with another story that illustrates how illness can be psychosomatic, the result of "mental factors". 2015 was perhaps the worst year of my life – I had a truly terrible job carrying out market research over the phone and was dealing with a great deal of emotional distress. That year I often experienced a very unpleasant sensation, an intrusive awareness of my penis. Sometimes it became so bad, I would have to leave work early. I knew that it was psychosomatic and considered it possible that the reason I was experiencing this 'psychotic symptom' was people in the world thinking I get erections around men rather than women. I approached my GP, told her about this discomfort, and said that I thought it was probably psychosomatic; I told her that I hoped that by talking about it with her, it would go away. She offered to give me a physical examination but I declined. The discomfort didn't ease and a while later I visited her again. I told her that I had changed my mind, that I now thought it must be a real thing and was perhaps a side effect of the Olanzapine. She gave me an examination and referred me to an oncology lab where I received an ultrasound to determine if I had testicular cancer. I didn't. But after the ultrasound the intrusive awareness went away and never came back. It seems that I needed temporarily to believe I had a real health problem, even though in reality it was psychosomatic, in order to recover from it. This has relevance to the stories I told above about David and Maudie.
I hope that this brief life story might persuade you that mental illness is the result of beliefs, the beliefs of both the sufferer and those around him or her.
In the introduction to this post, I said that I also intended to make an observation about sexuality – I hope to do so briefly now. The first thing to note is that it is a bit of a crude observation but I believe that my readers have the intestinal fortitude to cope with it. As I shall explain later, it is an observation that is inappropriate to share with twelve year old boys and girls. However, it is referenced obliquely in films like Little Miss Sunshine and The Power of the Dog – all I am doing is making the implicit explicit. In fact, it is so important to an understanding of sexuality that I shall call it the Cardinal Principle. The Cardinal Principle runs as follows: "Heterosexual men fantasise about women when they masturbate. Heterosexual women fantasise about men when they masturbate. Homosexual men fantasise about men when they masturbate. Homosexual women fantasise about women when they masturbate. Bisexuals fantasise about both." Some of my readers may want to say, "Well, duh, that's obvious". (Others may be shocked.) Now, in phrasing the Cardinal Principle this way I am assuming symmetry between the sexes, but men and women may fantasise in different ways – although I have had relationships with women in the past, I have never asked a woman what she thinks about when she is using a vibrator. Straight men often enjoy lesbian porn but I suspect few women enjoy gay male porn. I once came across a blog by a woman in which she said that, although she identifies as straight, she enjoyed lesbian porn – it is hard to imagine a man who identifies as straight enjoying gay male porn. This suggests that there may not be total symmetry between the sexes, although it is moot whether this symmetry breaking is the result of nature or nurture. However, the Cardinal Principle is robust enough, I think, for us to accept it moving forward.
The reason I have brought up the Cardinal Principle is because, although issues to do with sexuality are often discussed in contemporary society, very many people do not know it. I myself did not know it for most of my life. True, I knew that I was straight and knew that I only fantasised about women but I didn't realise for most of my life that straight women fantasise about men. I had read the novel Jig by Campbell Armstrong when I was a teenager, a novel that includes a scene in which a woman masturbates and fantasises about a man, but the implications obviously didn't sink in. I assumed that when a woman masturbated, she thought about herself. Nor did I truly realise that gay men fantasise about men – even though I was preoccupied by thoughts related to homosexuality in 2007 and 2009, and perhaps was aware of the Cardinal Principle subconsciously, I had never really registered this fact. Earlier in this post, I described how in July 2009, I became worried that the Rispiridone might somehow turn me gay. I never considered fantasising about a man – rather, I became afraid that the drug might somehow make me impotent. In reality, there was nothing wrong with my sexual functioning. I didn't realise that gay men fantasise about men until Easter 2013, when I was thirty-three. The night after my first appointment with Dharma, the appointment at which he had asked me if I would choose to be gay, I had terrible nightmares involving zombies and featuring Edward Norton. When I woke, in the middle of the night, I considered fantasising about Norton. To fantasise about a man was something I had never considered doing before ever. I didn't, and never have subsequently, although for a lengthy period I became afraid that I might accidentally think about a man when I was jerking off. Thankfully, this worry went away a long time ago. I realised that night that it was indeed possible for a person to choose to be gay. I felt like I had been admitted into the Illuminati because this was a revelation that I thought I couldn't share with anyone, that irreparable consequences might follow if I did, a terrible source of stress. If you want to know how I felt, check out the music video to the Radiohead song Just.
I deem myself quite smart but even I didn't get and fully understand the Cardinal Principle until years after that night. Most people, including people who work in the Mental Health Service, don't appreciate the Cardinal Principle. A number of years ago I went into the Taylor Centre and had a brief conversation with the receptionist at the time. This woman, who knew nothing about my life or obsessions, had the night before seen the film Far From Heaven. She told me, apropos of nothing, obviously because it had disturbed her, "He went with a man!" I suspect that this woman knew gay men existed but didn't realise that gay men sleep with other men. Other people in the Mental Heath System know more than this receptionist, who probably wasn't that bright, but very few fully understand the Cardinal Principle. I suspect that my Key Worker Kate saw homosexuality primarily in terms of identity and community, rather than in terms of attractions. As I have suggested in my posts about him, I do not believe the clinical psychologist I saw in 2014 understood the Cardinal Principle. Even psychiatrists may not be aware of it. I recall at the end of the appointment I had with Dharma just before Easter 2013, he smiled and said, "I can tell that you're a thinker!" This comment caused me to realise two things. The first was that Dharma, even though he gave off a strong gay vibe, was straight. The second, something I only realised inchoately at the time, was that Dharma believed that gay men, or perhaps latently gay men, don't fantasise, an idea I held myself that year. (Incidentally, I strongly suspect that the doctors believed that I was going to come out as gay at that appointment and this was why I was referred to Dharma.)
People need to understand the Cardinal Principle. If I had understood the Cardinal Principle in 2007, I probably wouldn't have formed the delusion that my father was gay. A close reading of Janet Frame's autobiography An Angel at my Table reveals that a major factor in her mental illness was her ignorance of the Cardinal Principle. Issues to do with sexuality and the Cardinal Principle often feature in mental illness I believe, and so people who work in the Mental Health System should be cognisant of it. Important consequences follow if we acknowledge it. If the Cardinal Principle is true and if all adults masturbate at least a little, we must abandon the idea of the latent homosexual, the man or woman who is gay but doesn't know it. I believe people turn gay, a position I adopted a long time ago in the post "The Myth of the Repressed Homosexual", a post I stand by. However, although adults, particularly those who work with the mentally ill, should understand the Cardinal Principle, I do not believe twelve year old boys and girls should be told about it. That would be a recipe for manufacturing a generation of homosexuals and bisexuals.
As I said, this observation is crude but is nevertheless important, not only because it has general scope but because it relates to my own life and 'illness'.
Now I would like to turn to the question of apparent expertise. If schizophrenia, as I have argued, is a psychosomatic condition and its cure involves changing the beliefs of the sufferer and those around him (including rejecting the belief that if a person goes off medication, he or she will become psychotic again), why do doctors cling to the idea that it is a physical, neurological, congenital and incurable disease? One reason is that they are doctors. I have noticed that the psychiatrists I've seen are very quick to refer patients to other specialists if the patient complains of some physical ailment, such as in 2009 when I was referred to an endocrinologist and in early 2014, when having complained of myocarditis, probably stress related, I was sent to hospital for an electrocardiogram. The psychiatrists are doctors and want to be seen as doctors by the community and by their peers. So they are committed to the idea that mental illness is symptomatic of a physical illness – even though a better approach would be to address the underlying psychological and environmental causes of a psychotic episode, the type of therapy performed by people like Patte Randal before she retired. But this would involve abandoning a century of 'research'. A second problem with psychiatry is the assumption that this thing 'schizophrenia' exists. Supposedly, there are schizophrenics and non-schizophrenics and all schizophrenics are the same. They lack verbal fluency, exhibit thought disorder, have trouble looking after themselves, are promiscuous, have bad relationships with their mothers, and so on and so forth. For instance, it is often assumed that if a person hears voices, the voices must be abusive. I have never heard abusive voices and, in fact, have only twice in life had an auditory hallucination, both times very briefly. The psychiatrists, relying on the idea that this thing 'schizophrenia' exists, look for patterns in the data, in the noise, patterns that don't exist because, in fact, every person diagnosed schizophrenic is different from every other person diagnosed schizophrenic, every sufferer's illness has different causes, a different natural history, and a different cure. It is perhaps because psychiatry itself is so misfounded, so insane it its assumptions, that the psychiatrists are so corrupt, so dishonest, as I have talked about in this blog before.
I wish to finish this post by talking about my life circumstances. I have recently started studying a couple of postgraduate papers in philosophy, very good courses which I am enjoying. More relevant to this blog is the fact that my dosage has been reduced. I have gone from 300mgs of Olanzapine a fortnight to 300mgs of Olanzapine a month. In fact, because first my mother and then I caught Covid, I haven't had an injection in six weeks. I feel very well indeed, as well as I did in 2012. I am still under a Compulsory Treatment Order but I hope that this might change, that my psychiatrist will admit that errors were made and let me go. I probably shouldn't be optimistic.
One last thing... in this blog I used to talk about Jon Stewart sometimes. In 2009, the reader might remember, I adopted him as an imaginary friend. I would now like to put on my Rupert Sheldrake hat and make a conjecture for which I have little evidence. I suspect that the 'revelation' that occurred to me over Easter 2013, that it was possible for a person to choose to be gay, occurred to him as well. I would even guess that it occurred to him in January or February 2010. This might explain why, as I think is becoming gradually public, he experienced some mental illness a few years later. Of course, this is speculation but it is still interesting.
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