Thursday, 30 August 2018

The Dopamine Hypothesis of Schizophrenia

Readers of my blog will know I'm a genius, a "very stable genius" in the immortal words of my hero Donald Trump. Readers of my blog will also know that when I call Trump "my hero," I'm making a joke in poor taste. I attend a weekly pub trivia contest at which I join forces with the rest of my team to answer questions like "Who was the eighteenth president of the United States?" and "What is the most common protein in the human body?" – questions to which I usually don't know the answer. Sadly, I lack a head for random facts. But in terms of critical thinking I think I can at least rival most people, once I've had enough time to process an issue. I have, I humbly submit, a profound need to get to the Truth even if it takes me a long time.

In tonight's post, I want to talk about the Dopamine Hypothesis of Schizophrenia and demonstrate that it is totally bullshit.

The Dopamine Hypothesis of Schizophrenia has been around a while. I believe it was the most popular explanation for schizophrenia eleven years ago, when I myself first became 'unwell', but has lost popularity in the decade since. My psychiatrist at the first or second appointment, back in 2007, explained my illness to me by telling me that I had suffered "a dopamine explosion" and put me on 2.5mgs of Risperidone. I didn't know what dopamine was, then, but did a little research in those first couple of months, finding, for instance, that dopamine was a neuro-transmitter, a chemical synthesised in the brain, and that it was involved in learning new behaviours. In the first three years of my treatment I often worried, sometimes to the point of having panic attacks, about what the drug might be doing to me, to my brain, to my hormones, to everything. I worry less about that now, although I still think it possible antipsychotics may gradually cause brain damage over the long term and still desperately want to get off them. Of course, the reason my psychiatrist told me I had suffered "a dopamine explosion" is because the Dopamine Hypothesis was then and is still now the justification for putting people on antipsychotics, even as it is being gradually discredited. Basically, this theory proposes that the cause of schizophrenia is an excess of dopamine (in the same way that depression is the result of a deficit in serotonin); consequently schizophrenics should be treated by drugs that reduce the amount of this chemical in the brain or, to be more accurate about what the drugs actually do, block the neuronal receptors that dopamine molecules attach to. The evidence for the hypothesis is the apparent success in reducing visible symptoms of so-called antipsychotics, which operate on the dopamine system, and, conversely, the way in which drugs like cocaine and metamphetamines, which have the opposite effect on the dopamine system, increasing dopamine levels, can cause psychosis.

So what is dopamine's function? The Wikipedia article on dopamine is full of arcane language (chemicals, organs and organelles in the brain, different types of brain cell) but, although dopamine's role is complex, its most important function seems to be related to motivation. It is involved in both 'wanting something' and 'enjoying that something when it's got'. Humans, like all animals, are goal-seeking machines. When we were hunter-gatherers, we would need to find food and consume food on a regular basis; dopamine appears to be involved in both a person's desire to get something and his or her pleasure in attaining his or her objective. Today it is relatively easy to obtain nutrients (we don't need to hunt mastodons anymore) but our goal seeking behaviour remains unchanged, expressing itself through other activities, such as sports and the playing of computer games. Every time we successfully navigate past the man-eating Venus Fly Traps in Super Mario Brothers or defeat the end-of-level boss, we experience that little dopamine rush. Nicotine breaks down into dopamine in the brain –which explains why people smoke and why when I don't have cigarettes I go out hunting for a person who will give me one. Dopamine encourages us to do stuff and to enjoy doing it when we do it.

Once we recognise that dopamine's main function is related to motivation and pleasure, the problem with the Dopamine Hypothesis of Schizophrenia becomes immediately apparent. I enjoy cigarettes – but I hated psychosis. There appears to be a contradiction. If the neurological basis of psychosis is an overproduction of dopamine, why is madness so unpleasant? Why do schizophrenics kill themselves? I can attest to the fact that psychosis is terrible and, as readers of my blog will know, my worst experiences of psychosis occurred while I was taking antipsychotic medication. Psychosis often expresses itself through catatonia and anhedonia; logically, then it simply cannot be the result of an excess of dopamine – assuming that dopamine is indeed related to goal-seeking behaviour.

And now we hit the crux of the matter.

How can a psychiatrist tell who is well and who isn't, which patient is dangerously psychotic and which is manageable? On the one hand she is presented with a patient who is voluble, excitable, and perhaps belligerent; on the other she is presented with a patient who is subdued, pliable, dull, who doesn't go on about crazy notions, and perhaps simply sits staring at the floor. The second is the one who is 'responding to treatment'. One dirty secret of the psychiatric profession is that psychiatrists are not interested in treating or curing patients; rather they are simply seeking to protect the commuinity from potentially violent or even criminal elements by sedating them, a kind of social hygiene, even, I think sometimes, a kind of eugenics. The other dirty secret is that, as I know from experience and from my observations of others, so-called antipsychotics do nothing to alleviate psychosis; they are, rather, simply tranquillisers that suppress behaviour without reducing psychotic symptoms such as voice-hearing and delusions at all. The supposed success of antipsychotics is of course adduced from the observed behaviour and reports of patients, and quiet patients seem better than noisy ones. I can remember when I was first put on Risperidone – I felt like a barrier had come down between me and the rest of the world. I could barely talk. If you, dear reader, submitted to a regimen involving high doses of Respiridone or Olanzapine, all you'd feel like doing is sitting in one place staring at a wall as well, until your brain adjusted or you liver learnt to efficiently remove the poison from your bloodstream. This, by the way, is the argument put forward by British psychiatrist Joanna Moncrieff – that the term 'antipsychotic' is a misnomer and that such drugs should rather be called 'major tranquillisers' as they once were. (Moncrieff is misrepresented in the Wikipedia article about her incidentally.) 'Antipsychotics', to put it simply, do nothing to alleviate psychosis but they flatten out behaviour by reducing motivation, by reducing neuronal sensitivity to dopamine. Logically, the reason why schizophrenics display blunted affect and anhedonia, why they have difficulty finding work or forming relationships, is probably the drugs, not the condition.

The apparent success of antipsychotics is only that, apparent. The Dopamine Hypothesis was invented to account for the apparently improved behaviour of patients taking antipsychotics rather than any improvement in their actual condition. Psychiatrists do not have access to patients' minds or to their lives outside of the consultation room. The Dopamine Hypothesis, under scrutiny, falls apart, and the only possible conclusion is that psychiatrists prefer sick but sedated patients to ones who are well but who forcefully point out that the psychiatric profession is stupid and crooked.

I find myself differing with consensus wisdom on many issues. Thinking that the claim antipsychotics are effective is a lie told to patients, patients' families, and to the public is one example – although Moncrieff and others think so too. I want to mention another divergence. Several years ago I wrote a post "On Evolution" in which I put forward, tentatively, an objection to Darwinian accounts of evolution. I identified the problem but I couldn't think of a solution. The problem is this: Darwinian accounts of Evolution presume evolution occurs gradually in almost imperceptible increments. In fact, evolution must occur in discreet steps – for speciation to occur, an individual must be born with a significant mutation, this mutation must be beneficial rather than detrimental, and another individual must be born with the same significant, beneficial mutation at the same time in the same vicinity for the two to breed. Their children must then breed incestuously with each other. All of this is enormously improbable but is the only logical way to marry speciation with Darwinian evolution. At the beginning of this year a solution occurred to me – in fact, it came to me in the form of a voice. For speciation to occur, a large number of individuals in a population must all be born with the same mutation at the same time. This view, which is in a sense mystical, puts me directly at odds with evolutionary biologists like Richard Dawkins and his theory of "The Selfish Gene". It suggests evolution is guided by a higher intelligence or collective soul. I hope that mentioning this second divergence doesn't make me seem flakey.

I'll finish this post by making an observation. I sometimes think readers only stumble over my bad posts. Do people read my good posts as well? I would like people to read my stories: "69", "A Refusal to Mourn" and "The Great God Pan". I would also like them to read the two latter posts about Janet Frame, "On 'The Sellout' and 'An Angel at My Table'" and "Jon Stewart, Janet Frame, and Katy Perry." It may be hard to find the best posts but I worry that those in the great world outside my apartment only ever find the bad ones. I hope that you do read the good ones as well. And I hope that in this post I made the point I was trying to make.

Thursday, 26 April 2018

Concerning Jess

In this blog, I have often mentioned a girl I knew once, a girl I have been referring to as Jess because I deemed it inappropriate to use her real name. Inquisitive readers will probably be able to discover the lass's real name from the clues I've dropped. In 2012, I went so far as to write a screenplay about her although I don't think I did her justice in it. In tonight's post I want to try to say something about the real girl.

I first met Jess I think in November 2009. I had been hearing voices since January and the fuckwits treating me had decided that it would be helpful if I went to a Hearing Voices group, a chance for voice hearers to get together and share their experiences of voice hearing with others who have acquaintance with the same 'symptom'. This Voice Hearing Group, which I attended in November and early December and then in February of the next year, was perhaps the most helpful treatment I ever received from the Mental Health System (medication of course being absolutely useless). Some research has suggested, by the way, that Voice Hearers tend on average to be more intelligent than 'normal' people – a finding that, if it was more widely known, might help reduce the stigma associated with mental 'illness'. Before the first session, I was sitting in the waiting room of the Taylor Centre with my mother and Key Worker, and noticed a young unusual looking girl also waiting for the first get-together, wearing a hat and a single glove, fidgeting restlessly with excitement – presumably, I think now, because this group was a novel opportunity to feed her curiosity about other people.

Sometimes you can tell that someone is extremely clever at a glance. The girl was fairly short, with an aquiline nose and, as I'd find out, the most extraordinarily penetrating pale blue eyes I've ever encountered. When subject to her gaze, as I was sometimes that year and in 2011, I found it both attractive and intensely discomforting. At the Hearing Voices Group, Jess, a few other psychotics, and I sat in a circle in one of the meeting rooms and shared our experiences. Jess said that she had an imaginary friend she called her 'comrade' who, when she was in shops, would point out where the surveillance cameras were. For my part, I told the group that sometimes I would hear voices so loud that I thought my head was going to split open – when I said this, she flinched. Years later, she would tell me that I was the first person she'd met through the Mental Health Service who didn't seem to be faking it. After the first session had finished, I approached her and complimented her on her shoes. She said, "They're just Doc Martins!" I said, "I like the colour."

I had fallen for her straight away of course. I was thirty and she was twenty-four or twenty-five – not an insurmountable age gap. We went out for coffee at one of the cafes near the Taylor centre. I asked her, "Why do you wear one glove? Do you think you're Michael Jackson?" I found out she was an avid reader of poetry – she quoted the first lines of Eliot's Prufrolk, "Let us go then, you and I, where the dawn meets the sky, like a patient etherised on a table." I didn't then and don't have now Jess's deep and comprehensive knowledge of poetry, but I do have Prufrolk more or less memorised and was able to quote another couple of lines: "I should have been a pair of claws, scuttling across floors of silent seas." My feelings towards her were from the beginning a strange mixture of desire and hostility, perhaps because she exhibited the same ambivalence towards me. We exchanged phone numbers and I spoke with her on the phone soon after. She asked me, "Do you like the Veils?" I told her that I was getting bad vibes down the phone and hung up on her. This is the one of the many small cruelties I perpetuated against her that have caused me sleepless nights since.

At the last session in November, she shared some issues with her family with the group and even got a little teary. She quoted the first stanza of Philip Larkin's "This be the Verse" and, by chance again, this happened to be a poem I knew, and I quoted the last stanza. She hated this. After this last session, she was whisked off to a respite facility (called Mind Matters) and on the way out told me sarcastically, "Good memory!" In December and January, I had the intense episode that I have described in other posts in which from the moment I woke until the moment I slept I spoke with Jon and Jess in my head.  After New Years I spoke to others, including, from around January 10, Barack Obama. I won't share the things I 'learnt' about her during this period, because much of it was wrong, but perhaps a story will give some idea. One night, in bed, I asked her (telepathically of course), "Why don't you like me? Give me ten good reasons why you don't like me." She quoted, from memory, the speech at the end of Ten Things I Hate About You. In February of 2010, I again attended the Hearing Voices group but, by then, the voices had almost ceased – I was only present in the off chance the real girl would come back but she didn't, and after a couple of weeks I 'graduated' from the group.

At the Independent Review I had most recently, my psychiatrist said that when I was put on Olanzapine I was first put on 12.5mgs, but that I couldn't tolerate the dosage, had 'side effects' and that the dosage was reduced to 10mgs in early 2010. Once again this is untrue – I don't know why the psychiatrist decided to put it it the official report she submitted to the Tribunal. I asked her at an appointment just before the review what 'side effects' I supposedly experienced but she wouldn't tell me. The truth, of course, is that the highest dosage I was ever on was 10mgs. Because this period, the end of 2009 and beginning of 2010, is important I will try to provide some dates. I believe the last Hearing Voices session probably finished if not in November than in early December. Shortly before Christmas, my mother and I travelled to Taupo bay to spend the festive season at a bach belonging to a family member of my sister-in-law. We came back to Auckland New Years Day because the day I had to be at work (I was then working at the TAB taking phone bets). Around perhaps January 5, my mother and I travelled to Dunedin by plane so she could attend a wedding. We then drove across Southland in a rented car to visit Fjordland. It was at a hostel in Milford Sound that it seemed to me that Obama started talking directly, if telepathically, with me. My best guess is that this happened around January 10. I returned from the South Island to go to The Big Day Out, then New Zealand's largest music festival, which was held January 15th. By February, as I said, the voices had largely faded away. I had an appointment with Fernando that month – no side effects were mentioned. What I remember is telling him that I had fallen in love. He said, "A boy or a girl?". I said, "A girl." Of course, there was never any chance of me falling in love with a boy. But at the time I just thought, "Hopefully this will go on my record as proof that I'm straight." It was the only time he directly enquired into my sexuality.

I suspect now that Fernando either didn't specify the gender in his notes or possibly wrote down "A boy". This seems unbelievable but the terrible truth is that the psychiatric community lies constantly.

My relationship with Jess could have ended there but it didn't. During the period when I was hearing voices over the summer of 2009 and 2010, I had asked them once, "When will I get to speak to the real girl?" They said that I had to wait a year. I said, "A year? That's too long!" During 2010 I recovered and I even participated in some personal growth groups sessions and training at Youthline in the second half of the year. In early 2011 I texted Jess, a year after the voices had told me to wait that long. We met at the Library Bar. Over the year I hung out with perhaps six to a dozen times, less than I wanted but enough to acquire some idea of who she was. She seemed reluctant to see me more than that. Although I didn't see her often I felt I gained quite a good understanding of her. In the film I wrote about her in 2012, I mixed up her life story with mine – for instance, I gave her an interest in quantum physics although in fact I knew a lot more about quantum physics than she did and I also suggested that the root cause of her illness was her parents' divorce but I believe this etiology applied more to me than to her. But I still think I captured quite accurately the way the real girl spoke.

From an outsider's perspective, Jess probably didn't seem particularly alluring. She lived in a little flat she called her 'hutch' with only an elderly cat called Tigger for company, just down the road from her mother's. I think she spent a lot of time at her mother's place and sometimes slept there. She was unemployed. Although I am sure many people liked her, she considered herself friendless. Despite all this, I thought she was incredibly cool. She had fantastic taste in clothes and music – she introduced me to Frank Zappa. She kept an enormous poster of Syd Barrett on her living room wall. Whereas my hobby outside writing is music (I play the guitar and the piano), her hobby outside writing was art. She would drawn pictures of semi-naked men with KFC buckets over their heads – she wasn't very good at depicting faces. At parties, her party trick was to recite Pi to a thousand places. The first evening I spent at her hutch, she showed me her poetry. I might have been one of the first people in the world to realise that she was that rare thing, a true poet, although the wider world knows this now.

We had some things in common, of course. Early in 2011, I told her that I had diagnosed myself with Avoidant Personality Disorder. She said, "I have that too!" Both of us had experienced delusions of being the Antichrist briefly. I was then taking 10mgs Olanzapine and she was taking Aripreprizole. She'd been on about half a dozen different types of antipsychotic at different times. I was well but she wasn't. On one occasion, I met her at a bookshop (Borders) and she told me, bleary eyed, "I heard you on the radio last night!" She thought she'd heard me on National Radio talking about etymology. She'd even woken up her mother to say, "Andrew's on the radio!"

Although in some ways we could understand each other better than others did, in other ways we were very different. A big difference between us, I think now, was our understandings of sexuality. I was always a bit homophobic in my music taste. I didn't like Queen or Elton John; I had liked George Michael when I was a child but went off him when I became a teenager. I didn't even like bands who gave off a gay vibe, like the Smashing Pumpkins and REM. I liked the Beatles; I had no time for David Bowie. I liked the Smiths but only because I had decided Morrissey was straight. I didn't like Nick Cave because I picked up the mistaken idea once that he wasn't. Jess, by contrast, I think now, liked androgynous men. To get some idea of what she looked liked the summer I first met her, google "Experience of Mental Illness as a Teenager" and "The New Zealand Herald" and a picture should pop up. Note that she's wearing a Ziggy Stardust t-shirt.

I am unsure how to end this post, or how much more to say. I very much wanted to see her more than I did. I gave her a ticket to Modest Mouse once (I had been unable to go because of another commitment) and hoped to see her afterwards, but she decided against it. In 2011 she apparently asked a psychologist if it was possible for schizophrenic girls to have boyfriends. In 2013 I saw her twice and again she seemed to entertain the possibility of taking me up as a boyfriend but, for some reason I've never understood, the relationship never eventuated. Of course, if we had settled into a relationship in either 2011 or 2013, I would never have written this blog. And it is possible that her success as a poet was somehow contingent on her remaining single.

Like I said, I am unsure what more to say about Jess. I think this is the last post in which I shall discuss or even mention her. Jess is significant because she is the proof that I'm straight. Of course, I had girlfriends before I became 'unwell' in 2007 but she was proof that I had remained straight through the terrible psychotic episodes I suffered in 2007 and 2009, periods in which I had believed for extended periods that there was a microphone in my glasses and that everything I said was being transmitted to third parties of some sort. The film I wrote about Jess in 2012 is also, in its way, proof. I had written love poems to both my previous girlfriends and the film was, in its way, a kind of long love poem. I made mistakes with respect to Jess but I still feel that, like King Lear, I am a man "more sinned against than sinning."



Wednesday, 28 March 2018

A Pigeon, a Motorcade, and a Sure Suspicion

About a month or so ago I was walking along K Road when I encountered, coming along in the other direction, a somewhat disreputable looking middle-aged gent with a pigeon perched on his right shoulder. The pigeon was neither dead, nor attached – in fact, it kept fluttering its wings to keep its balance. I said, as you do, "Is that your pet pigeon?" The gent said that he had found it injured and had nursed back to health at his home. "Then I accidentally gave it some crack and now it won't go away!"

I try to look at the world from other people's perspectives and so I have tried to imagine what it was like to be that pigeon. While in the company of this human, it had enjoyed some kind of euphoria. Presumably it could only attribute its extraordinary feelings of happiness to the human who was around when they happened. Perhaps it was sticking with him in the hopes that he would once again provide similar such feelings of ecstatic joy. Or perhaps it was sticking with him out of gratitude. Either hypothesis is conceivable. When you think about it, the idea of a crack-addicted pigeon is less odd than the idea that someone could "accidentally" give a pigeon crack cocaine.

Recently I have started to feel that there is little point keeping this blog. I have been distracted over the last couple of months by a long essay I needed to write to finish my degree, and it may well be that I will wind this blog up sometime soon. However I am still committed to trying to tell the truth and so, in this post, I will slightly amend something I have said in another post and will reiterate a strong suspicion that I have voiced before. In the post "Comedy and Political Correctness" I said that I heard Jess perform the senryu which I quoted in that post in 2014. I'm pretty sure I actually heard her perform it in 2015. For years I have been a little bit of an online stalker when it comes to the girl I call Jess. Reasonably regularly she publishes poetry under her real name on the internet, but I have only seen her a handful of times since 2013. I did see her perform in 2014. I knew she was due to give a performance and trailed up to the venue. Before the poetry readings had begun, I had a couple of moments conversation with her. She didn't seem altogether well. She shared with me, with the utter honesty she has, "I have a girlfriend." I asked her the obvious question. "Have you come out?" She said, "Sort of. I think I go both ways." The girlfriend she mentioned was in fact only eighteen at the time. The girlfriend appeared on the scene and they kissed – I had to go out back of the pub and throw up. That night I met for the first time a man a little younger than me – a heterosexual Borderline who had escaped the Mental Health System through the simple expedient of no longer showing up to appointments. My interest in Jess made him unsure of my sexuality and so he asked me, "Do you have a girlfriend?", an effective, indirect way of determining whether a man is gay or not. I said, understanding the intent behind his question, and with a certain self-hatred, "No, but I want one." He had found out at the same time as I did about Jess's girlfriend and said to me something like, "Why are you chasing that girl? She's a Lesbian!" I was already upset and this made it worse. A little later in the evening, unable to help myself, I asked him, "Would you give a man a blowjob?" This is of course an alternative but equally effective way of determining a male's sexuality. He found the question hard to bear of course, but he had brought it on himself.

The evening was profoundly distressing because I couldn't tell this chap, or the friend I was with, that Jess hadn't been a lesbian when I was hanging out with her in 2011, that her treatment by the Mental Health System had made deranged her, had driven to sexual confusion, in the period since 2011. As I have said before, the girl had spent eight whole months in hospital in 2012.

Readers of my blog may remember that when I was hearing voices over the New Zealand summer of 2009 and 2010, for a period in early 2010 I would talk, in my head, with Barack Obama. The real Obama was in Auckland last week. I was walking down Khyber Pass to visit my mother when a police motorcyclist pulled into at the intersection and bade the oncoming traffic hold still. A police car followed, then a motorcade, then another police car. Now, New Zealand politicians don't get motorcades or police escorts, so I feel fairly confident that behind one of those tinted windows was Obama himself, travelling to Government House near Mt Eden to meet with Jacinda Ardern. I had been within a dozen feet of the former President, someone I had imagined I was communicating with telepathically eight years previously.

This post is a little all over the place but I want finally to bring up something I have alluded to in earlier posts. Simply for the sake of completeness. In early 2014, just after being put under the Mental Heath Act, I wrote a long essay, around twenty-five pages long, describing my entire life, one copy of which I gave to my lawyer and another which I brought into the Taylor Centre, asking for it to be given to my psychiatrist Jen Murphy. I just assumed they would read it but I can remember alluding to it later in the year when talking with my Key Worker Josh Brazil and him having no idea what I was talking about. The reason my sessions with the retarded psychologist Simon Judkins in 2014 failed so spectacularly was perhaps that he, too, hadn't read this particular essay. I think now that the psychiatrist Tony Fernando, the arsehole who had 'treated' me from 2007 until the beginning of 2012, had removed this essay from Murphy's cubbyhole before it had reached her, that it never found its way to either Jen Murphy or Simon Judkins. I remember one time later that year or the next bringing in a blog post to be given to her– Fernando emerged from his office briefly, without looking at me or talking to me, evidently simply to make sure it was me in the reception, and then returned immediately, head-down, to his office. I believe, incredible as it is to say, that he was intercepting my communications with Jen Murphy. I have said before that Fernando is a sociopath but, even if he isn't a total sociopath, the man is undoubtedly a quack and a fraud, a man who shouldn't be practicing medicine let alone psychiatry. The world would be a better place if he slit his wrists. You might wonder why it has taken me four years to voice this suspicion, that Fernando had been intercepting my communications – but it has been hard for me to accept that the Mental Health System could be so corrupt, so mendacious, so morally bankrupt. It beggars belief. I simply couldn't believe it. But I now know it to be true.

Like I say, I don't know if I will continue to write future posts. My writing skills seem to have deteriorated. However, even if this post is badly written, it still contains things that needed to be said.

Tuesday, 13 March 2018

Screenplays and Their Reception

I wonder if anyone regularly reads my blog? Some time ago I published a badly written post about a screenplay I wrote in 2012. Tonight I want to talk a little more about some of the film scripts I've written, none made and in fact none ever quite finished. Of course, in doing so, I'm also talking about my life, some aspects of which are slightly unusual. In the post "Bruce Sells Out" I discussed the first feature length screenplay I ever wrote, back in 2001 ("Bruce Sells Out" being its title), how it was optioned by a New Zealand production company but never made, and how I thought the writers of "Bruce Almighty" had somehow stolen my idea. I don't intend to talk about that film again, tonight, but, as I said, rather about some other screenplays I've written. Bear with me (I always say that). This post will get more interesting as it goes along.

After 2001, for a long time I wasn't creative at all. I started but didn't complete two short stories in around 2005, stories I didn't come back to and finish until 2013. At some point during those years I also tried writing pilot episodes for a sci-fi TV series. In 2007, of course, I became 'unwell', something I've talked about so often I shouldn't need to rehash it again. In 2009 I was again 'unwell' but, during that year, decided to write another film. It would have been a horror, if I'd ever finished it. It concerned a character like a young Kurt Cobain, pursued by demons, who falls in with a whole bunch of drug addicted swingers who get killed off one by one by the monsters. I didn't get very far with this film and, as the concept suggests, it emerged from a state of existence dominated by thoughts of vampires, ghouls, zombies, and brain damage. Towards the end of the year, after I was off the Rispiridone, still unwell but in a better emotional frame of mind, I had another idea. I had a vision of two fourteen year old boys driving around through lonely, deserted, suburban streets at night, a picture of a teenage wasteland, a film I envisaged combining the social commentary of a Ken Loach movie with the feel of T.S. Eliot's famous poem. Towards the end of the year, while thinking about this film, I heard a voice. It was Jon. He said, "A film about two fourteen year olds who steal a car." I had my idea. Two fourteen year old kids, poor, friends only with each other, who steal a car, go for a joy-ride, are enlisted by an older brother to deliver drugs, and spend the night encountering various representatives of Auckland's motley demi-monde, a roundtrip through the dark secret underbelly of the city that would end with them returning the car, now with its windscreen staved in, to its original parking spot, where it would be found the next morning by its bewildered owner.

I started the script in December 2009. During this period, I was talking with Jon and Jess continuously in my head, a period that I have described in other posts such as "Me and Jon Stewart Part 2" and "Bruce Sells Out". December is summer in New Zealand. I remember staying at a bach ('bach' is a Kiwi word for a holiday home) up at Taupo Bay. From the moment I woke until the moment I went to sleep I was continually talking with my two imaginary friends, joking with them and laughing at their jokes. It was, bizarrely, a happy time. I started writing the film there at the bach by the beach. It was only when I was writing that the voices would quieten down, offering only words of encouragement and not intruding. At one point up there I wrote a scene, a scene that occurs early in the film, in which one of the two boys, Mark, says to the other boy, Daniel, that their English teacher is a faggot. At the time I wrote this, neither of my two imaginary friends objected but, later that day, when I was at the table with family, Jon jumped back into my head. He said something like, "You can't use that word!"  He was involved in the creative process, had thought about my employment of this slur, and, knowing how offensive people found the term, had decided to warn me against it, knowing that if I did use it, it would get me into trouble.

I continued writing the film into 2010 but had given up by the middle of the year. I couldn't get it quite right. By that time I had recovered from the psychosis I had experienced all of 2009 and no longer heard either Jon or Jess. In 2011, I hung out a few times with the real Jess and wrote a blog for a while that no longer exists called 'Persiflage'. Then in early 2012 I resolved to finish the film about the boys and decided that the best way to actually muster up the impetus to complete it would be to undertake a creative writing degree, and so enrolled at AUT. I had almost completed a draft of the screenplay after a couple of months study. The film I wrote had many fantastic moments I think. Daniel and Mark meet a bunch of rich spoiled twenty-year olds, drinking and drugging and loafing around the pool of their Parnell mansion while the parents are away, one of whom says, "You know the real reason the planet's heating up? It's because the Earth's orbit is decaying and we're all plunging into the sun." But I couldn't quite get the third act to work. The last part of the film involved the boys at a party in a hippie commune and twenty-five minutes of a ridiculously eclectic cast of characters never met before standing around just talking to each other. The problem was that, by 2012, my idea for the film was completely different to the idea I'd had in 2009.

This is not to say that the story was without merit. My godmother, a well known author here in New Zealand, often says to me, "I'd wish you'd finish the story about the two boys!"

I could tell that my supervisor, a novelist with no understanding of film scripts, and perhaps not that serious about helping his students, was completely uninterested in my film. Feeling discouraged, and sensing that the film I'd developed didn't quite work, I decided, on an impulse, to write something else, something different. I wrote a scene depicting Jess in the consultation room with her psychiatrist. It had occurred to me, you see, that the general public knew next to nothing about schizophrenia, that I'd had experiences (in 2007 and 2009) that gave me unique insight into this 'condition' and that I could, maybe, change the world by telling people what it is actually like to be a patient of the Mental Health System. I didn't tell Jess that I was writing a film about her and she didn't find out until the next year, after I'd more or less finished it.

When I started writing this film, I thought it would be a comedy. A couple of weeks into the process, I was driving when a scene occurred to me. I imagined Jess dreaming – in her dream she is standing on a hilltop in a barren ochre landscape while a crowd of people mill below. She says, in voiceover, "The other night I had a dream. I dreamt I was on a plain, looking down on hundreds of people. And a terrible wind was blowing. And I was screaming. I was screaming, 'I'm here! Can't you hear me? Can't you see me?'" When this scene occurred to me, it struck me as so powerful that I had to pull over and vomit. I had my Plot Point 2. I knew then what the film would be – it would start a comedy about a likeable, eccentric, funny young woman, and then descend into something much darker. Although the rest of the plot would only come to me gradually, I had the idea.

The film (with the rotten title "The Hounds of Heaven" and atrocious spelling throughout) is on the  internet so I won't provide a plot summary. I will describe two moments in it however. Jess, at the nadir of the psychotic episode that occurs between the mid-point of the film and Plot Point 2, is watching The Daily Show, in February 2011, and hears Jon telling her that she is responsible for the Christchurch earthquake that has just taken place. This scene probably seems extraordinarily insensitive. However, first, it is very close to being a true story. I was with the real Jess when the earthquake happened; she received a call from her mother saying it had happened; having just been with me, she went to WINZ and while there thought she overheard someone saying she had caused the quake. It upset her terribly I think for a long time. Second, the whole last act is set in Christchurch. My intention was to present a true depiction of the city in the months after the quake, to show Jess (both the character and the real girl) that she wasn't actually responsible for it. During the writing, I spent a week in Christchurch with family friends to research what it was like in the immediate aftermath. I wasn't intending to be insensitive. I was truly trying to represent two different tragedies.

I wish to describe and explain another moment, for reasons that will become apparent later. There is a whole long sequence in the film in which Jess is in the company of a bunch of stoners who are discussing conspiracy theories. One of the stoners suggests that Neanderthals and humans had coexisted "for, like, millions of years" and so probably interbred. Another stoner says, "Wouldn't that mean there are Neanderthals walking around the streets?" The first stoner says, "All I'm saying is, imagine you're a Neanderthal and you come out of your cave with your club and you see, you know, a pretty girl, are you going to let it stop you just because she's, you know, a different species?" (To which the other stoner replies, "True. Good point.") This was a joke. I learnt at school that different species don't interbreed, that this is in fact the way one distinguishes one species from another, so the idea of Neanderthals and humans interbreeding seemed funny, seemed absurd; moreover, the idea that men and women are of different species also seemed inherently funny. Years later, however, I read in the newspaper that recent research suggested that humans and Neanderthals did interbreed – and that people with significant amounts of Neanderthal DNA are more likely to suffer depression. When I read this, I wondered if the world had gone mad instead of me.

An important aspect of my experience of the Creative Writing course that year was that, although I was writing a film about schizophrenia, none of the other students had the foggiest clue that I had ever suffered psychosis myself. When I told my supervisor that Jess decides that she is responsible for the February Christchurch earthquake, he said, "They do that, don't they?" He had worked in an asylum and told me once that, in his view, schizophrenia was caused by spinal injuries. One of the other students, incredibly, was actually a retired psychiatrist, and she also didn't seem to suspect in the slightest. When she read the scene in the film in which Jess starts telepathically overhearing the thoughts of those around her in a supermarket (I had shared this scene with the whole class), she questioned its plausibility, telling me that schizophrenics don't tend to hear voices in the way I'd described. I felt like saying, "I actually know more about this than you do." At this time though I was keeping the fact that I'd been 'ill' on a need-to-know basis, and saw no reason to admit her to the source of my insight. Despite the egregious spelling mistakes in the film, I was in fact totally well all of 2012 and had been well since early 2010. The reason I was able to describe madness so well was because, when I was actually very ill indeed, in 2007 and 2009, I used to tell myself, "Remember what this is like, you'll be able to use this in your writing later." And of course the film was also inspired by my observations of a real person. As readers of my blog will know, I have a good memory. If people think that I was mad because I chose to represent madness, that only shows how stupid people can be. Just because someone has been mad in the past doesn't mean that he'll be mad forever – and it is ridiculous to think that the sane who have been crazy cannot remember what their craziness was like.

At the end of the year I submitted the screenplay for assessment. In February of 2013, I became 'ill' again. And this is where it gets weird. The reason I became ill was because I decided that somehow people in the media had obtained or at least heard about my film script – there seemed to be veiled references to it in the newspaper and on the TV all the time throughout 2013. And the people who'd read it didn't like it. This feeling that my film had got out was distressing. For three reasons. First, I had no idea how journalists could have read the screenplay – it was supposedly under embargo. And it wasn't a finished draft. Second, I had no clear idea what these readers thought of it or of me. Third, because no one directly told me that they had read my screenplay, I couldn't be sure whether my feeling that people had read it was true or whether I was experiencing delusions of reference. Psychotics often imagine that they are famous, and it was possible that I was delusional. Some weeks after the episode started I received notes from the film director tasked with assessing it: he advised me "not to show it to anyone else in the film industry." I thought I had said something about schizophrenia so controversial it had to be hushed up. Perhaps the clearest clue I received that people had indeed read it occurred I think about halfway through the year. The columnist Paul Thomas wrote an article offering advice to young people in which he said something like, "Girls aren't a different species. Not even the pretty ones," and also said, without saying who he was addressing, "You're not half so objectionable as I thought."

In late February or early March, I re-entered the Mental Health Service proper, as I have described before in this blog. I felt driven to do so. The 'delusions of reference' together with a reappearance of voice-hearing impelled me. Although I had become a patient in early 2007, I had never told the people treating me why I had become ill in the first place– I felt I needed to set the record straight, finally explain why I had first fallen ill. I also felt that I had made a terrible mistake writing the film about Jess and that I needed to set her record straight as well. It didn't work for either of us. And of course ever since the beginning of 2014 I have been under the Mental Health Act. But I have talked about that enough in this blog. Although I will once again reiterate my bottomless contempt and hatred for the psychiatric profession.

It may be interesting to end this post by saying that I still experience 'delusions of reference'. I have no idea how many people read this blog but sometimes receive signs that others must have read it. One example of such a 'delusion of reference' which I want to mention concerns one of the short stories that I began in 2005 and finished in 2013, called "Live in the Present". It was about a young woman who lacks object permanence. I submitted it to The New Yorker that year. For a long time now, Stephen Colbert has been banging on about object permanence and recently so did John Oliver, a concept I don't think the ordinary public once knew about and certainly wasn't talked about in the popular media. I know it must be a coincidence but my life is so full of coincidences that eventually it makes one wonder where imagination ends and reality begins.

Friday, 2 February 2018

On Comedy and Political Correctness

Recently I have been watching "The History of Comedy" on TV1, and it has stirred me to write a little more about humour. Bear with me: I will find my theme as I go along.

I wrote a little about humour a year or two ago in the post "Concerning Jokes". In that post, I argued that a joke is a logical argument of the reductio ad absurdum variety. I can add to this today. When a stand-up comic makes a joke, he or she deliberately says something absurd; his or her audience laugh because they recognise, perhaps subconsciously, that the joke is something silly. This creates a bond between the comic and the comic's audience. Humour creates a sense of community; it also hopefully encourages tolerance. Moreover, jokes separate sensible ideas from ridiculous ones, the sensical from the absurd. To get a joke, one must recognise that it is absurd, that the comic himself (or herself) doesn't believe it. One needs some sense of 'reality'. The community the joke creates is one of 'right-thinking people'.

The problem with humour is that one cannot always know if the teller is making a joke deliberately or presenting something meant seriously. To know for sure, often one must know the perpetrator of the joke. An example. My friend Jess included in her book of poetry the following senryu:

left without a note
but on the lavatory soap
one last pubic hair.

I first read this poem on the Internet in early 2014 and it provoked mixed feelings – I wasn't sure how to take it. Later in 2014, I saw Jess perform at a poetry reading; she was cajoled into reciting this senryu and, after delivering it, burst into a peal of nervous laughter. The poem was intended as a joke – something I hadn't realised until then because my feelings had clouded my perception of her. She didn't mean it seriously.

In order to recognise the joke, one first needs to recognise the joker.

Another example can be given. In "The Night of Too Many Stars" comic relief gala event towards the end of last year, Sarah Silverman provided a "Stars That Care" clip (viewable on Youtube) which was 'evidently' originally a plea on behalf of the Puerto Rican victims of Hurricane Maria. Every mention of the hurricane's name had been deleted and replaced with the word "autism". The clip, to state perhaps the obvious, was meant as a satire on celebrities who phone in support for a cause, or jump on a bandwagon, but for a joke like this to work, the audience needs to feel reassured that the 'real' Sarah Silverman does genuinely understand what autism is and does genuinely care about the people who have this condition. The audience needs to recognise her satiric intent, that she is satirising herself. Unfortunately, though, I couldn't really enjoy this joke – I couldn't feel really confident that Sarah genuinely did understand and care.

A gap needs to exist between the joke and the joker.

Although this blog might not evince it, I did once have a sense of humour. I grew up reading Douglas Adams and Terry Pratchett. In 2001, my first year as an MA student, I had some small involvement with the Auckland University student magazine. I wrote an investigative piece exposing the operations of an evangelical on-campus Christian organisation called the Morningstar Church, and decided to begin the article with a joke. I said that I wasn't a Christian but had considered converting to Judaism because the book was half as long. The joke's absurdity, of course, is the idea that a person might pick his or her religion based on the length of the required reading. Later that year, I wrote a short article pointing out that despite continued medical breakthroughs, the overall mortality rate was still 100%. "Death is still the leading killer in the world today, striking with especial ferocity the elderly and infirm." Some years later The Onion published a piece based around the same joke, coincidentally, I'm sure. Obviously my sense of humour was reasonably sophisticated. I suspect that the reason I became 'ill' in 2007, as I discussed in the post "My First Psychotic Episode" was that I had told a joke, or series of jokes, while working at a radio station, which had been taken seriously by others. In 2012, when I wrote the screenplay "The Hounds of Heaven" I included a long scene in which a bunch of stoners promulgate conspiracy theories. The intent was partly to satirise these theories but also to present a world in which it was no longer possible to distinguish between the sensible and the absurd. My intention may have gone over the heads of the film's readers but I only had in mind an audience consisting of one person.

The previous post "Representations of Mental Illness in Shakespeare"was also a satire but in order to get the joke, one needs some passing knowledge of Shakespeare's plays and the criticism around them.

It seems that to get a joke, audiences need to know that the joker is joking. This vitally important fact can be imparted in two ways – through internal clues and through external clues, the situation in which the joke is told. If the joker says something patently false, this constitutes an internal clue that the discourse is comedic. In the previous post, for instance, I described Edgar an an "itinerate schizophrenic" when anyone who has read King Lear knows that Edgar is only pretending to be mad. If one watches a stand-up comedian in a club, one knows that he or she is going to deliver joke after joke because of the physical environment comic and audience find themselves in. We know that Stephen Colbert is going to make a series of witticisms at Donald Trump's expense during his opening monologue every night, because that is the point of his monologue. We know that Family Guy's caricature Mort is intended as a joke rather than an antisemitic slur because it is included in a silly cartoon (and because we feel confident that Seth MacFarlane and the other writers are not themselves antisemitic.) We need clues. I sometimes suspect audiences laugh because they are expected to, because they pick up on such clues,rather than because they get the point of a particular joke.

Over the last several decades, comedy has become riskier and more confrontational, more obscene, has proliferated through different channels, and has extended far beyond its traditional boundaries. John Stewart's The Daily Show, for instance, smudged the distinction between news and humour. This change in comedic activity occurred simultaneously with the rise of social media, and it has become increasingly difficult to know what is intended as a joke and what isn't. Ironically, or perhaps consequently, advocates of Political Correctness have become louder and more aggressive. I read in the newspaper this week that many Millennial commentators, having been exposed to the 'nineties sitcom Friends for the first time via Netflix, have denounced it as homophobic, transphobic, and racist. In the 'nineties, it seemed quite anodyne. Critics have castigated Friends also for depicting a romantic relationship between Monica and Tom Selleck's character, but these critics don't bother to explain why it is acceptable for two women to date but unacceptable for a youngish woman to date an older man. I am currently briefly a student again at Auckland University and see on campus signs all over the place saying, "This university does not tolerate homophobia, transphobia, sexism, or ageism." When I was first a student at Auckland University in 2000, these signs did not exist. They were unnecessary in any case because neither I nor any of my contemporaries were remotely prejudiced. These signs I see today in 2018 only have the effect of making me feel obscurely guilty, as though I am being accused of a crime I never committed. And why stop at the four items on the list? Why not also include 'racism' and 'religionism'?

I do not deny that these 'isms' exist. In 2008 I returned to university as a twenty-seven year old and took an undergraduate paper with a whole bunch of eighteen year olds. In this class I was the victim of 'ageism' – although this discrimination took the form more of attitude or body language among my classmates than overt words and actions. I suffered in silence because I knew that, if I was eighteen, I would have related in the same way to a mature student. I tolerated it. Why find cause to become upset at everything? To try to eradicate all prejudice entirely is a kind of barbarism or totalitarianism – it forces people to monitor and regulate not just what they say and do, but also what they think and feel, surely too heavy a burden to place on young people.

Political correctness conceals a great deal of hypocrisy. Sometimes the staunchest heterosexual supporters of gay rights are the most homophobic. (I could tell a story in support of this contention but it would be impolitic.) Political correctness often also hides a great deal of simple ignorance and fuzzy logic. I came of age in the 'eighties and 'nineties when the AIDS epidemic was at its height. Millennials today don't however seem to appreciate the obvious fact that gay men have sex with men. The posture is one of continued vociferous, sententious outrage on behalf of others; when Trump is not being attacked, the Left turns upon and cannibalises itself.

The culture is bifurcated. One the one hand, we have comedy shows that are increasingly dark, violent and obscene; on the other hand we have a culture, bred, as Bill Maher rightly points out, in the universities, of militant and hypocritical Political Correctness, in which any deviation from 'right-thinking' is pounced upon and denounced. Then we have shows like Last Week Tonight that attempts the near impossible task of appealing to right-thinking students schooled in this politically correct mindset, while still being funny. Comedy's task should be, as I said at the beginning of the post, to create tolerance and acceptance – but today it has been swept up in a culture in which the scope of 'the sensible' is very narrow indeed and 'the absurd' covers almost everything, in which everyone is potentially a villain and scapegoat. The absurdity in American culture reached its apotheosis, of course, in the election of Donald J. Trump. A guest I think on Stephen Colbert's show, I forget who, a little while ago said that Trump might be "the first president destroyed by parody" but I think Trump was created by parody. In a world in which everyone is joking all the time, how can we tell who's telling the truth?

It may be The History of Comedy is performing a public service by putting comedy neatly back into its traditional compartment, its box.

I'll finish this post by returning to my brief stint working at the Student Magazine Craccum in 2001, when I wasn't the dinosaur I am today, and describe another joke we told. 9/11 happened while I was helping out. I asked the editor how we could let such an world-changing historical event pass us by without comment, but he had already made up his mind that that week's issue should be a parody of Rolling Stone Magazine. So we compromised. We put Bruce Springsteen on the cover, holding his guitar, with the caption "BRUCE SPRINGSTEEN vows to take on Middle-East by himself". It was funnier then than now.

Wednesday, 10 January 2018

Representations of Mental Illness in Shakespeare

In tonight's post, I would like to say that I am faithfully reproducing the opinions of my learned psychiatrist friend Dr C.R. Etin – but I'm not. The following short treatise is a satire, a little like the essay A Modest Proposal, written by Jonathan Swift in 1729, in which Swift argued that the famine then gripping Ireland could be eased by the poor selling their children as food to the rich. The ideas and even the language of tonight's essay is exactly the same as those in the previous post "Representations of Madness in Shakespeare" but the tone and intention is different, a little more focussed I hope. Sometimes a kick in the head is the only way to wake a person up. I actually tried to get this published in my local newspaper but obviously it doesn't belong to the right genre.

I turn you over now to my learned friend Dr Etin.

***

Representations of Mental Illness in Shakespeare

Who can deny the incredible progress psychiatry has made since the nineteenth century in the identification, classification, description, and treatment of the mentally ill? Milestones include the discovery of dementia praecox by Pick and Kraepelin in the 1890s, the discovery of autism, in its modern sense, by Asperger in 1938, and the first publication of the Diagnostic and Statistical Manual of Mental Disorders in 1952. Today psychiatrists have at their disposal a comprehensive and sophisticated taxonomy of human kinds that greatly facilitates the diagnoses and care of those whose deviations from the norm cause themselves and others social distress. It is truly a wonderful time to practice psychiatry.

Of course, it would be absurd to suggest that mental illness was invented by the medical profession; although in previous eras, perceptive observers lacked the vocabulary educated professionals today possess, a vocabulary which enables us to describe and catalogue the various mental disorders found among patients today, these disorders must have been present even in the Elizabethan and Jacobean periods, the eras on which I shall focus. It is my contention that the playwright William Shakespeare, himself a perceptive observer, recognised these disorders among members of his own community and wrote about them in many of his plays. In this article I shall consider the ways Shakespeare represented mental illness in four of his major works: King Lear, Macbeth, Othello, and Hamlet.

I shall begin with King Lear. It is not the purpose of this article to provide a comprehensive synopsis of each of these plays but, when considering King Lear, it is necessary to provide some idea of the plot. At the beginning of the play, Lear, the rule of Britain, decides, somewhat capriciously, to divide his kingdom between his three daughters. Dissatisfied with his youngest daughter’s reply to the question, “Which of you shall say doth love us most,” he deprives her of her inheritance and apportions his realm between his two older daughters. Lear seems to believe that he can retain “the name and all th’ addition to a king” and delegate “the sway/ Revenue, execution of the rest” to his sons-in-law. He also seeks with “reservation of an hundred knights” to alternate his stay between the two daughters’ homes. After his daughters whittle away his retinue to nothing after a month and bicker about who will put him up, he cries “I shall go mad!” and charges into the heath accompanied only by his loyal friends, the Fool, Gloucester, and Kent.

In the next several acts, Shakespeare provides a virtuoso depiction of a psychotic episode. There can be no doubt that Lear displays an abnormal state of mind. He exhibits signs of both persecutory delusions and delusions of reference, seeming to believe the thunderstorm he encounters is allied with his daughters and telling the elements, “yet I call you servile ministers/ That will with two pernicious daughters join/ Your high-engendered battles ‘gainst a head/ So old and white as this” and telling an itinerant schizophrenic he encounters “Didst thou give all to thy daughters? And art thou come to this?” Later, Lear addresses people who are not physically present, suggesting either visual or auditory hallucinations. He also shows all the symptoms of pronounced thought disorder, at times making him difficult to understand.

This could lead us to the conclusion that in King Lear Shakespeare is presenting us with a depiction of schizophrenia. The problem with this interpretation is that schizophrenia typically manifests itself in late adolescence or early adulthood, and Lear is an old man. Could we suppose that Lear has suffered repeated psychotic episodes all his life and that Shakespeare is only dramatising the last? Such a reading is contraindicated by the fact that when Lear informs his court of his intention to divide his realm between his daughters, his friend Kent sees it as atypical, surprising behaviour, behaviour he has not exhibited previously. A more fitting diagnosis would be, in my opinion, dementia; Lear’s decision to divide his kingdom could be seen as an early warning sign. Shakespeare probably knew elderly people with this condition and, inspired by his concern for these poor individuals, wrote this play to raise awareness of it. At its heart, King Lear is a compassionate portrayal of an elderly dementia sufferer.

The eponymous protagonist of Macbeth also quite evidently shows signs of an abnormal state of mind. Macbeth hallucinates twice, the first time when passing surreptitiously towards Duncan’s bedroom with the intention of killing him, the second time when he sees the ghost of Banquo during a formal dinner, an apparition none of the other guests can see. I’ll quote a little known passage that describes the first hallucination.

Is this a dagger which I see before me,
The handle towards my hand? Come, let me clutch thee:
I have thee not, and yet I see thee still.
Art thou not, fatal vision, sensible
To feeling as to sign? or art thou but
A dagger of the mind, a false creation,
Proceeding from the heat-oppressed brain?
I see thee yet, in form as palpable
As this which now I draw.
Thou marshall’st me the way that was going,
And such an instrument I was to use!
Mine eyes are made the fools o’th’other senses,
Or else worth all the rest: I see thee still;
And on thy blade and dudgeon gouts of blood,
Which was not so before. There’s no such thing:
It is the bloody business which informs
Thus to mine eyes…

If there was doubt about Lear’s diagnosis, there can be none about Macbeth’s. Visual hallucinations are a first-rank symptom of schizophrenia and the fact that Macbeth considers the possibility he is hallucinating here, that the dagger might be the product of “a heat-oppressed brain”, strongly suggests he has hallucinated before. Macbeth is, evidently, schizophrenic. We can feel reassured that this diagnosis is correct by considering the speech he delivers after being informed of Lady Macbeth’s suicide. We would expect Macbeth to exhibit signs of grief or guilt but in the “Tomorrow and tomorrow and tomorrow” soliloquy, he shows an inappropriate emotional response, indeed signs of ‘blunted affect’. This of course is one of the negative symptoms of schizophrenia. Just as Macbeth is a portrayal of a schizophrenic, Lady Macbeth, with her compulsive hand-washing, is obviously a depiction of someone suffering from OCD.

Through Othello, Shakespeare again dramatises a figure with an abnormal state of mind. After he is persuaded by Iago of Desdemona’s infidelity, he delivers a speech characterised by paraphrasia or ‘word-salad’ before falling on the floor in a fit. When approaching Desdemona’s bedroom with the intent of smothering her with a pillow, his “Put out the light” soliloquy displays strong evidence of depersonalisation. However, Othello does not display any other symptoms of psychosis and so a diagnosis other than schizophrenia is called for. In the later part of the play, he seems to think Iago all good and Desdemona all bad – this ‘splitting’ suggests Borderline Personality Disorder. If we consider the fact that he is taken in by Iago’s deception, although it should be obvious that Iago is duplicitous, we might alternatively consider Autistic Spectrum Disorder. Autists of course have impairments with respect to social interaction, with ‘theory of mind’, and Othello’s inability to ‘read’ Iago suggests precisely that condition.

Finally, we might consider the most famous ‘madman’ in Shakespeare’s corpus – Hamlet. After Hamlet converses with the ghost of his father, he tells his friend Horatio that he shall “think meet/ To put an antic disposition on”. He thereafter shows a conspicuous lack of self care, presenting himself to Ophelia “with his doublet all unbraced/ No hat upon his head, his stockings fouled./ Ungart’re and down-gyved to his ankle/ Pale as his shirt, his knees knocking each other, And with a look so piteous in purport/ As if he had been loosed out of hell/ To speak of horrors”. He presents with delusions, telling Polonius, the Secretary of State, “I know thee well – thou art a fishmonger.” We have circumstantial evidence that he experiences both suicidal ideation and aboulia. He describes man as a “quintessence of dust” to his friends and says “man delights not me, no, nor woman either”, strongly suggesting anhedonia. Moreover he shows only limited insight into his condition, appearing to believe his mental health is weather-dependent, at one point telling Rosencratz and Guildenstern “I am but mad north-north-west; when the wind is southerly, I know a hawk from a handsaw.”

If Hamlet, like Macbeth, is a depiction of schizophrenia, it is also a trenchant critique of attitudes towards the mentally ill in Shakespeare’s day. Polonius appears to believe that Hamlet’s illness results from his strong feelings towards Polonius’s daughter Ophelia; Shakespeare is obviously satirising the idea, widespread in his own time but today discredited, that mental illnesses have causes, that a person goes mad for a reason. Shakespeare is also dramatising the inhumane treatment of the mentally ill in Shakespeare’s time. After Hamlet kills Polonius, he is sent to England ostensibly for a rest but (unbeknownst to him) bearing instructions that he be executed. If Hamlet had become ill in the world we live in today, he would be treated much more compassionately of course. He would be committed to a secure ward at a mental hospital and treated with suitably high dosages of an appropriate anti-psychotic, such as Rispiridone and Clozapine, and, for the safety of the public, never released.


It may appear odd to seek to find the mental disorders Shakespeare represents in his work but the attempt is not so far removed from modern psychiatric practice. In 2007, the New Zealand Psychiatric Journal published an article posthumously diagnosing Janet Frame with Autistic Spectrum Disorder, presumably based on a deep and thorough reading of her many novels, short stories and poems as well as her autobiographies. Shakespeare must often have observed that those around him were mentally disordered; in fact the deep intention evidently underlying his whole oeuvre was surely to raise awareness among his contemporaries of the problem of mental illness in the society in which he lived. Shakespeare was truly a genius. We can have no doubt that, if he were alive today, Shakespeare, with his penetrating understanding of human nature, would have become a psychiatrist rather than a playwright!

Saturday, 30 December 2017

Representations of Madness in Shakespeare

I am no expert on Shakespeare but I have read a few of his plays and thought about them at least a little over the years. Madness was very much an interest of Shakespeare and, in today's post, I want to talk a little about representations of madness in his works. I am only going to cite well known plays, so this should be accessible to a reader of only limited knowledge, and intend to alternate between my own interpretations and the interpretations conceivably given by twenty-first century psychiatrists. I have a point for doing so, as you'll see at the end.

I'll start with King Lear, whose eponymous monarch famously goes mad during a storm on a hearth and then recovers his sanity towards the end of the play. The story begins with Lear deciding to abdicate his position as ruler of Britain and divide his kingdom between his three daughters. He demands his daughters declare their love for him and his two elder daughters fulsomely and insincerely extol their total devotion, while the youngest, Cordelia, the only good one, says "I love your Majesty/ According to my bond, no more, no less." Furious, Lear expels her and deprives her of her inheritance. He then lays out his plan concerning the future of his realm to his remaining two sons-in-law.

    I do invest you jointly with my power,
    Pre-eminence, and all the large effects
    That troop with majesty. Ourself, by monthly course,
    With reservation of an hundred knights
    By you to be sustained, shall our abode
    Make with you by due turn. Only we shall retain
    The name and all th' addition to a king: the sway
    Revenue, execution of the rest,
    Beloved sons, be yours: which to confirm,
    This coronet part between you.

Lear's fatal error is to think that he can retain the dignity or authority of his former office while relieving himself of its responsibility. It is the act of a foolish, capricious god, an act the success of which depends on his two elder daughters being honest in their claims of unconditional love. Of course, it all goes awry. Lear's retinue is soon whittled away by his ungrateful, and in fact evil, daughters to nothing and Lear, crying "I shall go mad!" storms away into the hearth, accompanied only by his few faithful friends, the Fool, Gloucester and Kent.

It is not the purpose of this essay to provide a rigorous interpretation of King Lear. I can simply say however that it concerns Lear's learning the lesson of humility. On the hearth he calls the elements he rails against "servile ministers/ That will with two pernicious daughters join/ Your high-engendered battles 'gainst a head/ So old and white as this". As himself the victim of injustice, called by Lear "filial ingratitude", Lear comes at last to recognise that many others in his realm are also the victims of injustice, if of a different sort, individuals he now realises he should have given more thought to when he had his former position. He, who has always had power, has found out what it is like to be powerless. He says, "As flies to wanton boys are we to th' gods,/ They kill us for their sport", the theme of the play summed up. In Lear's pagan kingdom, a kingdom before Christ or Providence, the gods are foolish and capricious, as he was, the poor and the mad suffer unnecessarily, and the good die for no reason at all, as Cordelia does at the end. The world is unfair, absurd, meaningless; yet the play is at its heart an argument for a liberal, left-leaning politics.

Lear learns his lesson though madness. Now, suppose we look at Lear from the point of view of a twenty-first century psychiatrist. Lear clearly experiences, on the hearth, in the hovel, a severe psychotic episode, involving thought disorder, that passes when he is reunited with Cordelia. Obviously he must have some type of mental illness. We could say, "Lear is schizophrenic". The problem is that schizophrenia is supposed usually to manifest itself in late adolescence or early adulthood and Lear is an old man. Perhaps he has experienced psychosis before? On and off since he was perhaps seventeen or eighteen? And Shakespeare omitted to mention this? Unlikely. Surely, if Lear regularly went mad, Shakespeare would find a way to bring this fact into the story and this would influence other characters' attitudes towards Lear.

There is a way out for the twenty-first century psychiatrist. Lear has dementia. This would explain his stupid decision to give away his crown – it was an early warning sign. Shakespeare may have had experience of observing elderly people around him with this condition, and, evidently (the psychiatrist will say), Shakespeare was painting a picture of an elderly man with this tragic disease.

Lear announces that he is going to go mad but other characters in Shakespeare's plays don't seem to know that they are mad at all. One such is Macbeth. Macbeth hallucinates twice, the first time on the way to kill Duncan, the second time when he sees the ghost of Banquo at dinner – an apparition no-one else can see. I'll quote the famous soliloquy describing the first hallucination in full.

    Is this a dagger which I see before me,
    The handle toward my hand? Come, let me clutch thee;
    I have thee not, and yet I see thee still.
    Art thou not, fatal vision, sensible
    To feeling as to sight? or art thou but
    A dagger of the mind, a false creation,
    Proceeding from the heat-oppressed brain?
    I see thee yet, in form as palpable
    As this which now I draw.
    Thou marshall's me the way that I was going,
    And such an instrument I was to use!
    Mine eyes are made the fools o'h'other senses,
    Or else worth all the rest: I see thee still'
    And on thy blade and dudgeon gouts of blood,
    Which was not so before. There's no such thing:
    It is the bloody business which informs
    Thus to mine eyes... Now o'er the half-world
    Nature seems dead, and wicked dreams abuse
    The curtained sleep; Witchcraft celebrates
    Pale Hecate's offering; and withered Murder,
    Alarumed by his sentinel, the wolf,
    Whose howl's his watch, thus with his stealthy pace,
    With Tarquin's ravishing strides, towards his design
    Moves like a ghost. Thou sure and firm-set earth,
    Hear not my steps, which way they walk, for fear
    Thy very stones prate of my whereabout,
    And take the present horror from the time,
    Which now suits with it. Whiles I threat, he lives:
    Words to the heat of deeds too cold breath gives.
    I go and it is done, the bell invites me.
    Hear it not, Duncan, for it is a knell
    That summons thee to heaven, or to hell.

In Macbeth's world, what we could now 'insanity' is an expression of the supernatural. The dagger and the ghost could be hallucinations but we know the witches and their fatal prophecies to be real –because Banquo sees and hears them as well. In the soliloquy quoted above, Macbeth considers the idea that the dagger is a hallucination "Proceeding from the heat-oppressed brain" but ends up siding with the supernatural. He becomes the embodiment or personification of Murder in a world where "nature seems dead". Macbeth is founded on a dichotomy between the natural and the unnatural, between a real world and a supernatural world that is a battleground between Good and Evil, between heaven and hell. It is a world in which spiritual or religious judgements continually intrude. In the end it is the natural world which prevails, however, because God and nature are on the same side. I once worked out a more detailed interpretation of Macbeth which I have forgotten but it is sufficient here to say that Macbeth is perhaps mad and perhaps knows it.

What would a twenty-first century psychiatrist say about Macbeth? Hallucinations are a first-rank symptom of schizophrenia. Macbeth evidently has anosognosia or 'lack of insight'. Furthermore, when Macbeth hears about Lady Macbeth's suicide and delivers his signature "Tomorrow and tomorrow and tomorrow" speech, he evidently seems to be displaying 'blunted affect', a negative symptom of schizophrenia, another sign that this diagnosis must be correct. Shakespeare was evidently painting a picture of schizophrenia just as, with Lady Macbeth, with her compulsive hand-washing, he was evidently painting a picture of OCD.

Shakespeare often featured characters if not in the grips of madness, than in the grips of a passion resembling madness in its intensity or extremity. When Othello is finally persuaded by Iago that Desdemona has been unfaithful, he displays signs of thought disorder or even paraphasia before collapsing and having a fit. Then later, when advancing towards Desdemona's bedroom with the intention of smothering her with a pillow, he shows clear signs of depersonalisation. Evidently, the psychiatrist would say, even if Othello is not schizophrenic, he is suffering from some kind of mental illness or personality disorder.

I turn now to the most famous madman in Shakespeare's ouvre: Hamlet. After Hamlet junior converses with the ghost of Hamlet senior, the prince tells Horatio he "shall think meet/ To put an antic disposition on". Thereafter he demonstrates problems with self-care, appearing to Orphelia "with his doublet all unbraced/ No hat upon his head, his stockings fouled/ Ungart'red and down-gyved to his ankle, / Pale as his shirt, his knees knocking each other/ And with a look so piteous in purport/ As if he had been loosed out of hell/ To speak of horrors". His family and friends become concerned about him. He shows indications of being delusional, telling Polonius "I know you well – you are a fishmonger." He demonstrates difficulties  with abstract thinking and limited insight, appearing to believe his mental health is weather-dependent, telling Rosencrantz and Guildenstern, "I am but mad north-north-west: when the wind is southerly, I know a hawk from a handsaw."

The history of Hamlet criticism is bedevilled by two basic questions. First, why is Hamlet so indecisive? Why does he exhibit what the psychiatrists today call 'aboulia'? Second, is Hamlet genuinely mad or just pretending to be mad? I believe both questions have the same answer. Hamlet doesn't know himself if he's mad or not. Consider the situation from Hamlet's point of view. He is an educated rationalist who has conversed with a ghost; he is a Protestant who doesn't believe in Purgatory who has been informed by the spectre of his father that the father spends his days there. Hamlet can't commit himself to exacting bloody revenge on Claudius because of the very real possibility that the ghost wasn't real. This is why he organises the play within the play ("the play's the thing/ Wherein I'll catch the conscience of a king.") He engages in what psychiatrists today call "reality-testing". Only after he sees Claudius's reaction to the play does he know for sure that the ghost was real and telling the truth – whereafter he flips out completely, abusing his mother in her bedroom and killing Polonius in the mistaken belief that he is killing Claudius.

Claudius and Gertrude decide to send Hamlet to England for a rest; there, according to Claudius's secret instructions, Hamlet is to be killed. If Hamlet were set in the 1950s or 1960s, he would have been sent to a Mental Hospital with instructions that he be lobotomised.

In this post, readers may have noticed a certain inconsistency of tone. Sometimes I have provided sincerely meant interpretations, sometimes satirical ones. To spell out my hidden meaning: Shakespeare was a genius and the psychiatric profession today is full of cretins. To understand the mad people in Shakespeare, as in real life, we must look for causes as well as symptoms. King Lear goes mad because of his treatment by his daughters; Macbeth's madness is an expression of his guilty conscience or foreknowledge; Othello loses his grip on reality because of Iago's manipulation; Hamlet goes mad because his uncle has killed his father and married his mother. In writing this post, I have been influenced, I should say, by my reading of critical texts about Shakespeare, such as What Happens in Hamlet by J. Dover Wilson; the topic of madness in Shakespeare probably merits a full book rather than this hastily written post but this is a start. I will finish by making one more point to be read straight. It is often a mistake to look for autobiographical content in a writer's work, but Shakespeare's interest in madness might conceivably be because he experienced a little madness himself, what we would now call 'psychotic symptoms'. His characters never hear voices but madness was quite literally something different in the Elizabethan age than it is now. Perhaps, like Hamlet, Shakespeare was sometimes unsure if he was mad or not.