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What to do if a friend goes mad

This article originally (to my regret) lent credibility to an extremely dodgy �anarchist� magazine called Attack in 1985, and was then published in the mental health magazine Asylum, which I was then involved in. I�ve substantially re-written it. Hope it�s still useful.

This is an attempt to give some practical advice on a problem most people don�t have much experience of but is becoming increasingly common among those on the margins of society. Most people realise that carting someone off to the thought police in the loony bin is, if anything, worse than handing them over to the real police - but it�s very difficult to think of an alternative when faced with an extremely exhausting and terrifying situation.

What is madness? Well, we�re all, and that certainly includes me, pretty fucked up, and we live in a society which is pretty oppressive, and based on violence. That violence is usually implicit in the case of the way the police and army back up inequality and power that people wouldn�t stand for if they weren�t around, and more explicit in the way that the West exploits the Third World, supporting military dictatorships and subversion and assassinations against popular movements and people it doesn�t like. We often have to conform to what those at the top of the hierarchy think we should do, whether at work or in other social relationships. Marx (I�m a very anti-communist reader of Marx - don�t put me down for one of them �marxists�!) described working in such a situation, where you have lost control of your life process - the work you are doing - as �alienation�. However people aren�t really free to talk about their feelings about work and elsewhere - imagine trying to discuss openly about who should have the right to make decisions at work - you would be got rid of, fast. Two marxist theoreticians of language, Baktin and Voloshinov, who were murdered by Stalin, described a continual conflict between a private, internal language where we tell ourselves what is going on, and what is permitted to be expressed publically.

A lot of people�s thoughts and feelings are kept suppressed, but something can happen which makes the pressure cooker explode - an event, taking a hallucinogenic drug, or just starting to question things and being rejected by other people who find that kind of thinking scary. If you find yourself isolated and rejected because you have started to question things, it�s very easy to become paranoid, although never forget the old saying �just because you�re paranoid doesn�t mean they�re not out to get you.� Another thing is that we live in a society where people lie to each other all the time - on a personal level, at work, or through the mass media - I don�t mean just straight lies - I mean a false and distorted picture of the world. It�s very hard for anyone to work out what is true and what is false and if you�re isolated and a bit freaked out and anyway, it�s very easy to make mistakes. I always think of the guy who climbed into the lion�s cage at London zoo a few years ago and got mauled by the lions - a very courageous thing to do. He thought he was in tune with the spirit of the lions, like a Christian mystic or Taoist sage, but he was mistaken. Making mistakes is part of living - we�re always testing the world to see if our reasoning works in reality. When people start to become rejected and isolated they can react against this social invalidation by challenging others in an extreme (and quite justifiable) way, but which only causes more rejection and isolation, paranoia etc until they completely freak out - that�s what madness is. Or maybe it�s just one form - it�s the one I know about - I�ve been there, and brought friends back from there with a bit of conversation and tender loving care.

The madman or madwoman - sounds better than �mad person� - often, despite their mistakes, do have deep and very rational insights into the world, a global awareness that can be something spiritual. But people can get so freaked out by trying to combine this awareness with dealing with people around them who are shitting on them and that they are afraid of, that their whole command of language and ability to form coherent sentences or string sentences together, breaks down completely which is terrifying for them.

If people are living with them their lives are increasingly disrupted, and fear multiplies as people get less sleep, and it is at this stage that people, despite their moral scruples, feel they can�t cope and hand the person over to the authorities. So what can be done about this situation? I don�t think there are any hard and fast rules - they tend to go out the window in this situation, but in general, nothing should be done without consulting the person, who should have total authority in every decision. That doesn�t prevent you from pointing out the situation and making suggestions to which they can say no. This can be frustrating, but it is very important to them in restoring the power of their personal autonomy, which has probably been threatened or invalidated in some way, making them go mad in the first place.

Firstly, the situation needs to be faced as a problem that needs organised action. The more people involved, the better. A small number of people is much more likely to suffer from fear and exhaustion; a large number of people, acting supportively as a community, has the resources to cope. If the person�s (I don�t know if I like this �person� entity - I think I�ll start calling him/her Janet/Douglas) � if Janet�s madness has come about through the relationships with the people she is living with, she may feel safer if she goes to stay in a safe house. Madness often comes about through a lack of safe space.

In the past I have organised a rota (hey Microsoft�s dictionary doesn�t have rota in it - these Americans, I ask you) of people to be with Douglas at all times, but it occurs to me that I never asked him if he wanted to see these people or be alone. That�s a difficult one actually - he really (the person I�m thinking of is actually a she, but still) did need people around them and was only really brought through by that personal contact. See what I mean about rules - I�m just going to leave that one open, as an example of the moral dilemmas that are thrown up in this situation. If someone is really out of it, it can be virtually impossible to have that sort of conversation with them, so you end up taking decisions for them, which is bad but somehow unavoidable. (This is not intended to provide a door for untold psychiatric bullshit) Oh, and by the way, none of the people on this rota had what is euphemistically known as �training� - they weren�t the usual socially approved and vetted professionals earning vast sums to provide �therapy� - they were just real people - a bunch of squatters in fact, with no previous experience except life and their own personal integrity. It is important that those people, who are going to be under a lot of stress, are also cared about - in fact if possible there should be people making sure that other things in people�s lives are sorted out and that there is food which gets eaten. (In case anyone who was around then reads this I can say that food is (often) obtained in shops with stuff called money, although in the case of Safeways special offer it doesn�t need much of the stuff)

It is important to reassure Janet that she is safe and that we�re not going to let the bad guys get her. As I�ve tried to make clear earlier, madness is basically about fear and invalidation, and when people realise that they�re safe and cared about, they will quite quickly calm down again - but it can take a month or so until they�re sort of OK. Never use violence against someone who is obviously lashing out because they�re terrified - you can restrain someone by holding them until they calm down - although I guess it depends on what size they are.

It�s very important to be honest with someone who is mad about what you think and feel, especially if you feel scared or threatened by them. Probably a lot of the reason they went mad was because people were emotionally dishonest to them. People have the right to have whatever identity they choose respected, even if it�s Jesus, or a tree, or whatever. It�s true that they might have arrived at that identity by mistaken reasoning, but that�s for them to work out, not for you, although you may have to negotiate how this tree that was Douglas is now going to interact with the world, and you have the right to say that he doesn�t seem much like your idea of a tree. But nevertheless, that identity won�t be based on anything stupid, and you should respect it, which doesn�t mean you can�t discuss it in a respectful way, if it puzzles you - Douglas may value that.

OK The above could be an example of what psychiatrists call a delusion or hallucination. I want to say something about �hallucinations�. The way we perceive what we call external reality depends on the particular biochemical or physiological state of our brains at a particular time - we have a social consensus about what is called reality, which conditions what we perceive. Our brains work through a process of what�s called �active perception� - that is, they select and abstract only a tiny amount of the information available - the information that fits into the socially determined structures of perception. If the biochemical and physiological state of our brain changes, we may have a complete different perception of reality. One example of that is sleep - a little known fact is that all psychiatrists suffer from delusions and hallucinations every night when they go to sleep - but who is to say that what we see in dreams is less �real� than when we are awake - Hindus use the word Maya to describe this world, which they see as a delusion. We conventionally use the word �reality� to correspond to perceptions which we think are valid, but this is purely a social convention and other perceptions are equally valid. Incidentally, I recently discovered that aborigines dream while awake, not at night, and they think that part of the reason why most of the world is �Koyaanisqatsi� (Hopi for a life out of balance that calls for another way of living) is that we have dissociated our waking life from dreamtime. For the last couple of years I have been exploring the world of shamanism, and shamans go into an altered state of consciousness using visualisation techniques with the aid of repetitive drumming where they ask for support and assistance from talking animals and other beings - are they then suffering from delusions? Perhaps, prior to the rise of science and organised religion, our perceptions used to include fairies and demons - in one way, the triumph of Western colonialism in places like Africa was the triumph of one sort of perception over another, although the shaman from Burkino Faso, Malidoma, makes clear that shamans (for a reason I can�t remember) by and large stood back during the colonial conquest. But the most apt quote I can remember regarding psychotic hallucinations comes from the radical psychiatrist Ronald Laing: �Mystics and madmen are floating in the same ocean, but the mystics are swimming, and the madmen are drowning.�

Ultimately, if people are given enough love and care and someone to talk to, however frightening it all is, it will eventually come right. It is also a good idea to go off to the country as it�s much more peaceful and everybody can let go without fear of the police. I got a lift from a van driver once, who told me that he and a group of his friends once kidnapped (with her permission) a friend from the loony bin and took her off to Wales, where she came back to earth and has been OK ever since.

Ultimately, if you can�t cope or communicate with the person, you can at least take care of them physically, by feeding them for a couple of weeks, and put them in a fairly bare, soft, room. Try smiling at them. It works wonders. So, when appropriate, does giving someone a cuddle. Even if you don�t understand at all where a person is at, if you just patiently sit with them over a period of time and listen, you will eventually piece together some kind of meaning. But it takes patience and experience to know how to cope with these ideas and talk someone through. But you only learn by trying - it�s just life experience - there�s no special theory to learn.

You have to go mad with someone for a bit to help them make sense of their lives and come back down to earth. It will be a very different earth though for both of you.

In connection with this, I have always been fascinated by the account of madness given by Dorris Lessing in her novel �The Four Gated City�, the most powerful book I have ever read - a story which is a kind of personal history of London in the 50s and 60s. This is the last book in her �Children of Violence� series, but very different from the first four books, which are set in Southern Africa. Much of the writing in these books is autobiographical, and at the end of the second volume of her autobiography she refers, frustratingly for me, to the period she spent living in a house where some people were in distressed mental states, but says that she thinks it better not to go into detail. I know that she was a friend of the radical South African psychiatrist David Cooper, who founded the anti-psychiatry movement, at that time. So I�ve always wondered how much of the account in her book is fact and which fiction. It is too detailed to be completely fiction. In the book, the main character, Martha, becomes involved with a lady called Lynda who is �mentally ill� and spends time �being� with her. Eventually her brain tunes in to Lynda�s reality, and she describes a process of going through a wall of sound and into a state where her perception becomes as watching a film script where she has an unusual perception of people and events and can see into the future. (I need to re-read this book - I�m not sure how true my description is) She has also written about madness in �The Golden Notebook� and �Briefing for a descent into hell�. I have never experienced anything like this nor know anyone who has, but it did sound too detailed for pure fiction.

If someone has been carted off to the loony bin, the more people who go to visit them the better, especially because the authorities are much more prepared to let someone go if they know there are people who will take care of the person and who will cause them trouble if they don�t let them go. Don�t take any bullshit from psychiatrists or nurses although play them along if you think they might let the person go. Get the person to sign a declaration that they don�t want Electro Convulsive Therapy (ECT) or to be drugged against their will and make sure that the psychiatrists have copies and are aware that there will be substantial trouble for them if they try it on.

Most of the strange ways that patients behave in psychiatric hospitals have got little to do with madness - it�s the effects of having their brains fried and being drugged into a zombie like state. Psychiatrists, as brutal enforcers of capitalist normality - although they usually get their minions to carry out the violence, so that they maintain a state of grace - respond to people�s extreme distress with the biochemically inappropriate and destructive use of mains electricity, neuroleptic and anti-depressant drugs, instead of with the biochemically appropriate use of sensitive human communication and tender loving care.

A psychiatrist is not actually interested in the content of what someone is saying; they are only interested in putting it into one of the myriad categories outlined in their bible - DSM4 (the fourth edition of the Diagnostic and Statistical Manual, published by the American Psychiatric Association) In the psychiatric survivor movement, it is a standing joke that any human behaviour can be fitted into one of these categories, and as Paula Caplan points out in her book, the whole thing is being driven by the profits of the drug industry, who make more and more money from the medicalisation of human distress and suffering, instead of addressing the real social causes. The figleaf for the profit of the pharmeceutical industry from social control is the pseudoscience of psychiatry, which has been heavily criticised by one of the most respected figures in neurobiology, Steven Rose, in a research paper jokingly called �Disordered Molecules and Diseased Minds�. Classifications like schizophrenia and manic-depressive psychosis are arbitary generalisations of people�s behaviour and are psychiatrist�s way of avoiding having to confront the content of human distress. (There are of course, extremely courageous exceptions to this, like the psychiatrists in the Critical Psychiatry Group) The fact that these classifications are basically nonsense has been exposed by psychologists like Mary Boyle (see below) and is shown by the fact that different shrinks give varying diagnoses. Psychiatrists have very little training and no more insight into the human condition than the rest of us; often they are quite rigid and aloof people obsessed with social status who have repressed their own human sensititivity because they feel threatened by other people�s problems. Clinical psychologists can sometimes be a bit better, and in recent years there has been increasing criticism of psychiatry by psychologists and a challenge to psychiatric power.

One product of the psychiatric survivor movement (also known as the user movement) that has sprung up in the last 20 years is advocacy - in many hospitals it is now possible to ask to see an advocate who knows the system and the law and who will stand up for your rights. These vary enormously, from those who toady to the system to valiant opposers of terror and corruption - because psychiatry, with its ties to the drug industry, is enormously corrupt. Advocates have an organisation: UKAN - the United Kingdom Advocacy Network, which can be contacted for advice.

Lastly, don�t forget the survivor movement and its allies, who can be enormously useful in terms of information and support. The survivor movement in recent years has become very involved with the mental health charity Mind, which is much more radical than groups like Sane, who support psychiatry. Mind groups vary tremendously, from user run and extremely radical, to reactionary and in bed with the system. But you�ll be able to find someone to help. Good luck!

Contacts (I haven�t given detailed contacts because I haven�t got them with me now, but they�re all available from the Mind national office information line in London.)

User Movement Mad Pride (www.ctono.freeserve.co.uk) ECT Anonymous, Hearing Voices Network

Allies Politics Psychology Resistance (radical psychologists group), Critical Psychiatry group

Books �Users and Abusers of Psychiatry� - Lucy Johnstone (psychologist) - this is the �it� book �Toxic Psychiatry� - Peter Breggin (American psychiatrist - www.breggin.com) - a close second �The Politics of Experience and the Bird of Paradise� and �Sanity, Madness and the Family� - R.D. Laing (famous 60s radical psychiatrist and rich alcoholic egomaniac) �The Loony Bin Trip� - Kate Millet - American feminist - an account of her own experience - I always thought the bit about her infatuation with a horse was over the top but it�s only four pages - the chapter about Ireland is a nightmare �Journey through madness� - Mary Barnes and Joe Berke (madwoman and her shrink) �They say you�re crazy� - Paula Caplan (American psychologist) - the book is about the moral corruption involved in producing DSM4, to which she was a consultant �I didn�t have to go mad here� - Joe Berke - �radical� American shrink living in London who founded the Arbours Crisis Centre, which you can escape to if you have enough money (lots) to maintain him in his lifestyle - he lives in Regents Park Terrace and now talks to his patients through a white sheet, but the book gives useful advice. �Accepting Voices� - Marius Romme and Sondra Escher - open minded book by Dutch shrinks about hearing voices, with accounts by British and Dutch users �Schizophrenia - a scientific delusion� - Mary Boyle (Professor of Clinical Psychology) �Against Therapy� - Jeffrey Masson - everything therapists don�t want you to know