Memoirs of Madness: Five of the Best

The memoir of madness has been with us far longer than Sylvia Plath’s Bell Jar or William Styron’s Darkness Visible. Firsthand accounts of life beyond the limits of sanity have been around from at least the early nineteenth century, as this alluring bibliography attests. 

Below I’ve picked five of my favourites, all dealing with illness that includes elements of psychosis. I’ve chosen these memoirs because they are all vividly written and because they provide vital insights into the treatment and lifestyle needs of people with mental illness. Each and every one of these memoirs makes the loud and clear declaration that it is never more important to view the mentally ill person as a complete human being with human needs and emotions than when they are most acutely ill.

Madness: A Bipolar Life by Marya Hornbacher

Already a classic in the field, Hornbacher’s riveting immediacy, hold-onto-your-hat style and liquid prose make this memoir un-put-down-able, even as the reader squirms. She ignores her bipolar diagnosis, ditches her medication and descends into alcoholism, destructive relationships and psychosis before colliding with the consequences of her illness and making a slow journey back to sanity. Meeting her husband Jeff, finding meaningful work and suffering extended stays in a psychiatric ward are all part of the fabric of this painful and visceral but ultimately uplifting memoir.

Madness: A Memoir by Kate Richards

This memoir is written in the tradition of Hornbacher’s but Richards has a talent and voice that are hers alone. Richards’s seductive prose demonstrates that great pain and suffering can actually amplify the sensory perceptions that make life rich and meaningful. At the start of the memoir the narrator’s psychotic depression has left her an emotional adolescent, addicted to sleeping pills, dependent on alcohol and lacking in life skills. But sustained by music, literature, philosophy and the outdoors, meaningful work as a medical researcher, strong friendships and the support of a wise psychologist, Kate and the reader emerge into the daylight – with all the down sides as well as the joys and possibilities that stem from coming to terms with life and chronic illness.

One of the key strengths of this memoir is the passages written while the narrator is in psychosis, seemingly drawn from Richards’s diaries. They explore the limits of meaning, collapsing the difference between subject and object and demonstrating the dangers and lure of madness. At the same time the memoir encompasses vivid accounts of episodes in psychiatric hospitals and a grounded critique of Australia’s mental health system.

Flying with Paper Wings: Reflections on Living with Madness by Sandy Jeffs

Sandy Jeffs is a popular Melbourne poet and an acclaimed community educator on mental illness (in her own words ‘professional lunatic’). In this honest and moving memoir she reflects on a life lived with the chronic illness of schizophrenia following a semi-rural childhood riven by constant battles between her alcoholic mother and violent, controlling father.

Jeffs’s experiences in Melbourne mental hospitals from the 70s onwards, mostly harrowing but occasionally affirming, the stubborn viciousness of her inner voices, the sustaining support of her alternative family, and the world of literature and philosophy that feed her intellect and spirit all enrich this narrative. Entirely lacking in self-pity, this is a document imbued with the wisdom and clarity of a well-lived and nurturing life despite mental health that is at times precarious, with plenty of useful lessons for carers, professionals, policy makers and the general reader.

Hurry Down Sunshine: A Father’s Story of Love and Madness by Michael Greenberg

Photograph: Marion Ettlinger

This is a poignant and beautifully written memoir about bipolar disorder from the perspective of fatherhood. Greenberg narrates the horror of watching his beloved daughter Sally switch suddenly into bipolar psychosis at the age of 15 and eke out a slow, shaky recovery in a no-frills Manhattan psychiatric hospital during a sweltering summer. It is meticulously and delicately written in a realist style that conveys the heaviness and various losses that result from watching a loved child disintegrate, as well as the financial stresses of living in New York, and of dealing with an inflexible, privatised health care system.

Greenberg describes madness as something that takes his daughter far away from him, and vividly conveys his fears that she will never return. The awkward encounters between his current and his ex-wife, the eccentricities of the other patients, as well as the burden he already bears of supporting a mentally ill brother, ground this memoir in a complex and challenging context.

The Center Cannot Hold: My Journey through Madness by Elyn Saks

Elyn Saks is a tenured professor of law and psychiatry at the University of Southern California with degrees from Oxford, Yale and Vanderbilt, and an expert in mental health law. She has also had the experience of being forcibly restrained for hours on end in psychiatric wards and forcefed medication while suffering acute psychosis. This memoir describes Saks’s struggle to accept and manage a diagnosis of schizophrenia, while forging a stellar academic career.

Saks first experienced full-blown psychosis as a young postgraduate on a philosophy scholarship at Oxford. In The Center Cannot Hold she documents her torturous journey towards accepting the severity of her illness and the need to take medication. During this period she was able to avail herself of skilled psychoanalysts who understood the emotional content of her delusions and enabled her to maintain some degree of equilibrium.

Saks gives important insights into her state of mind during her most acute episodes and how traumatised she was by the dehumanising treatment she experienced after suffering a breakdown at Yale. Key here are the human aspects of the illness – the way it is affected by stress, Saks’s struggles to maintain her academic career, and the shocking attitudes of psychiatric staff who valued compliance over healing. ‘While medication had kept me alive, it had been psychoanalysis that had helped me find a life worth living’, Saks asserts. The support and intellectual engagement that her career and her academic colleagues provide, her ultimate acceptance of the need for ongoing medication and her fulfilling marriage in her mid-forties together enable a life that is ‘rich and satisfying’.

Narratives of madness

These memoirs are riveting yet educational reads for the general public, as well as important guideposts for sufferers. But they are also vital documents for mental health practitioners, akin to qualitative research about the experiences of users of mental health services.

Three of them, Madness: A Bipolar Life, Madness: A Memoir and The Center Cannot Hold, contain a similar trajectory – after experiencing the extremes of the illness, sometimes worsened by addiction, the sufferer eventually comes to accept the need to take medication and to manage addictions and stresses, and learns how to maintain a balanced, fulfilling life. 

This trajectory suggests that if the right level of support and skill were offered early enough, sufferers might be able achieve recovery without the self-destruction and descent into addiction that are so commonly represented as necessary stages on the journey.

All five of them reflect on the human elements that make the long-term management of illness – and just as important a fulfilling life – possible.

In The Center Cannot Hold and Madness: A Memoir, what makes this journey possible is the loving, sustained attention of therapists who provide a safe psychic space in which the patient can explore emotional defences and gradually embrace maturity.

In Hornbacher’s case it is her ever-patient psychiatrist, the hospital she lives in for months on end, where staff are unendingly accepting and supportive, and the unconditional love and fortitude of her husband that together create a safety net in which she is harboured until the illness is tamed.

In Flying with Paper Wings, it is Jeffs’s ‘two Demeters’ – the female friends with whom she has lived in a peaceful setting on the rural fringes of Melbourne for 30 years.

In Hurry Down Sunshine, it is the sustained love and attention of Sally’s family, including the father–narrator, that eases Sally's transition to precarious sanity.

Creativity, purposeful work and strong friendships also play vital roles. Secure housing is vital and the fact that most of the stories feature middle class sufferers is no accident. Kate Richards expresses how lucky she is to be able to afford to choose her own therapist, and to buy a home that offers not just long-term security but a haven.

One of the reasons for the importance of these memoirs is their various critiques of the psychiatric profession and the mental health sector.

The memoir of Richards, a medical researcher, has not one decent psychiatrist throughout its 200-plus pages. Not one. They are helpful in dispensing medication, but the healing she receives comes from a psychologist. The implication is that the problem is systemic, due to faulty training – Richards is ‘sacked’ by one psychiatrist, while others demonstrate various levels of boredom and disengagement.

Sandy Jeffs also questions psychiatry, having left her long-term therapist, Dr Y, after 27 years. She is critical of what she calls ‘Fastpsychiatry’ and ponders the dangers and possibilities of investigating the psychic content of her delusions with a new therapist, Dr K, who is willing to explore with her the darkest underpinnings of her hostile voices: ‘If I could heal that little girl, would the persecutory content of my delusions and voices diminish, and allow me to embrace her?’

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Fame Junkies: Dr Drew and Celebrity Rehab

Okay, I admit it. I’ve recently been tuning into Celebrity Rehab with Dr. Drew, on the not-so-venerable ABC2. It’s emotional car-crash television and I feel guilty watching it.

This low-rent reality TV program follows a group of the kind of people who qualify as celebrities these days – actors, porn stars, models, reality TV stars, rock stars, sports stars, and the parents of stars – as they attempt to recover from addictions to alcohol, drugs and prescription pills in a luxury treatment centre in Pasadena, California. Swollen lips, flouncy hair, floods of tears, tantrums and attitude problems abound. Perhaps the most poignant participant was Leif Garrett, a 1970s teen idol addicted to heroin and cocaine.

The group leader and treating doctor is celebrity medico Drew Pinsky, who was also executive producer on the first five seasons of the show. True to the fact that the budget of ABC2 matches its trashy values, the fourth season, which first aired in the US in late 2010, is currently screening in Melbourne.

When I started researching the show I discovered I was hopelessly out of date; Pinsky finally ended the series this year after six seasons. He'd grown tired of the storm of criticism he received from doctors, psychologists and addiction experts every time a former participant died. Those critics were quick to point the finger when Mindy McCready, a country singer who had appeared on the show’s third season in early 2010, shot herself in February 2013, just a month after her boyfriend’s suicide; she was the fifth former participant of the show to die. 

The experts who slammed Pinsky accused him of having an inherent conflict of interest: his need for the show to be entertaining versus his interest in his patients’ recovery. They claimed that his methods were dangerous and outdated, and went against treatment guidelines from the National Institute on Drug Abuse. Detoxing at the clinic was done quickly and painfully, a practice that was potentially deadly but conveniently dramatic; and contrary to Pinsky’s belief, 12-step programs and complete abstinence were not the only means of recovery, and not right for everyone.

They also criticised the fact that participants were paid to appear in the show – five hundred thousand dollars in some cases – because it amounted to luring addicts with the promise of money they could then splash on their addiction. This also goes against the whole concept of addiction recovery – the addict has to want to recover, and shouldn’t need a financial incentive to do so.

I’m in no position to make judgements about the causes of the deaths. The people concerned weren’t in Pinsky’s care at the time and in some cases it was years since he’d treated them, and addiction is a notoriously stubborn condition. But that’s not my main point here. My point is that the whole concept of filming a celebrity being treated for addiction is toxic.

Pinsky, by the way, is no Dr Phil - he is Assistant Clinical Professor of Psychiatry at Keck School of Medicine at the University of California.

Abusive therapy?

My issue with the show centres around narcissism. It’s the curse of our age, and the term narcissist is used as a term of derision, but narcissism is actually a crippling disorder. Many narcissists harbour deep childhood wounds from years of abuse. Pinsky himself has researched narcissism and fame, co-authoring a 2006 study that demonstrated that celebrities were significantly more narcissistic than the general population (which makes him doubly culpable for playing on his patients' incessant need for attention).

To be a celebrity these days almost automatically demands narcissism to begin with. To film these celebrity addicts is, I believe, a kind of abuse, because the presence of the camera actually encourages their narcissistic tendencies without dealing with those tendencies as part of the therapy.

A case in point is Janice Dickinson, who styles herself as the world’s first supermodel and these days makes her living as a talent agent, photographer and writer. With her face so plastered with filler she can barely move it, and beestung lips so thick she can hardly talk, this woman displays levels of anger and exhibitionism that suggest serious emotional damage. Dickinson has spoken out about the physical and emotional abuse she suffered at the hands of her father, and her decades-long drug habit. Given that she filed for bankruptcy earlier this year, it’s also likely she has a spending problem. 

In one scene she complains to Dr Pinsky that another patient has been playing up to the camera. She then stages a walk-out, declaring that she’s leaving the treatment centre. The camera keeps filming her and the question of whether she is acting or not suddenly becomes incredibly complicated. While she rants and packs, she accuses the camera of being intrusive. No doubt she too is playing up to it, and probably thinking about her own career, yet she also seems aware that the camera is actually part of the problem.

It strikes me that the last thing these people need is to have a camera pointed at them. The lure and promises of the camera – an increase in fame, recognition, attention, love – would be a barrier against effective recovery. And surely the first thing a good doctor would do, for a celeb or would-be celeb deep in addiction, would be to turn the camera off; to hide her away from the world so that she has the chance to heal. These are people at rock bottom, at their most vulnerable. Privacy is the very least they deserve. Giving Dickinson a camera to parade in front of may have simply played on her vulnerabilities, and actually worsened them. Just because you exploit yourself doesn’t mean you’re not also being exploited by others.

But the show itself is the thin end of the wedge; the use of Dickinson to promote the show is far worse. In this video, probably promoting the show’s fifth season, Dr Pinsky and two others, who appear to be producers, start a line of questioning about the penis size of the many famous men Dickinson has bedded, and then prompt her to list these men (don’t watch it if you’re easily offended). She’s slurring just a tiny bit, which suggests that she may be on some kind of tranquilliser or antidepressant. This promo goes so far against the ethics of the patient–doctor relationship that it’s breathtaking. It also demonstrates that for Pinsky at least, the line between entertainment and therapy, between staged drama and reality, has not simply blurred but completely disappeared.

Dickinson has written about a hellish childhood in which she was beaten repeatedly by her father, a paedophile, for refusing sex with him. If we assume that her addiction is linked to that childhood abuse, it’s beyond the pale that a woman who has never been fathered is being encouraged by her male therapist to boast about her sexual conquests with men in graphic terms. It is likely that she would seek the love and approval from her therapist that she never got from her father, and would use her sexuality to try to obtain that love. If so, this would amount to a toxic relationship that involved simply re-enacting her incessant need for attention rather than actually examining it.

Dickinson, it must be said, credits the show with getting her sober. Good luck to her; perhaps in between all the exploitation by self and others, she somehow got what she needed. But to take the risk that a minority of patients, even a tiny minority, could be damaged or even killed by such a flawed treatment method seems negligent in the extreme. And it’s sad and disheartening to see these vulnerable people, sometimes with faces ravaged by abuse, parading in front of the camera.

Ethical TV therapy
The idea of filming people in therapy is not necessarily bad. I thought Pamela Stephenson’s ShrinkRap one of the best things on television, suggesting its potential as a medium for genuine inquiry and discovery. Sitting opposite each other in comfy chairs in a dimly lit room, Stephenson confronted a tortured celebrity or artist, and asked them therapeutic questions about their childhoods and the way their pasts affected their careers and personal lives. The show featured megastars like Robin Williams, Salman Rushdie and Joan Rivers (ironically, Stephenson like a few of her own guests, sports ironed hair and face).

There is a sense of dignity and choice. Stephenson manages to cover tabloid topics in a way that probes for the reasons behind public scandals and private torment. Questions mimick those of a therapy session but are cleverly geared to television, and the whole thing takes about fifty minutes, the time of an average therapy session. Stephenson's demeanour is respectful yet fairly detached, her approach finding a balance between letting her guest go off in their own direction, and bringing them back to difficult topics. Imagining yourself in that particular therapy chair is neither difficult nor unpleasant.

If you enjoyed this blog entry, you might also like The mysterious life of the psyche: on watching United States of Tara and A tale of two talk show hosts.

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The Dilemmas of Therapy

I’ve been seeing a psychologist for the last few months. This is a kind of miracle – I stopped seeing my last therapist in 2003 – but it’s more low-key than it sounds. Anyway, something that happened last week made me think of the differences between different kinds of mental health professionals, and the way these differences have played out in terms of my own experiences and the various life stages at which I’ve seen therapists.

My therapist is a registered, or counselling, psychologist. This means she’s a full member of the Australian Psychological Society and is entitled to practise as a psychologist, but she doesn’t have a Masters degree in psychology or, I assume, the extent of supervised clinical experience with the mentally ill that a Masters would entail. This is the first time I’ve seen any kind of psychologist for any length of time. Previously, in my early to late thirties, I saw two psychiatrists consecutively over a period of about nine years.

She’s good at what she does, and has a talent for ‘reading’ people, which I think makes up for her presumed relative lack of clinical experience. But I sometimes feel as if I know the ‘rules’ of therapy better than she does; and the arrangement as a whole, with her modus operandi as part of it, is very different from the therapeutic relationships I’ve had in the past.

For example, my psychologist is never on time, and she never apologises for being late. Sometimes the lateness is a piddling few minutes but it’s usually more. Once she was almost fifteen minutes late and appeared at the door of the dollhouse-sized waiting room with nary a ‘sorry’.

As someone chronically deprived of my mother’s attention, this presses all my buttons. What’s most fascinating about it is not that as a patient my reactions to such a situation might be overblown – that would be expected. It’s that these reactions aren’t – can’t be – a key part of the therapeutic relationship. They can’t be examined and their underlying dynamics unearthed.

Such a situation simply wouldn’t have occurred with my previous therapists – for one, if a rare example of extreme lateness had occurred they would have apologised; for another, they would probably have raised for discussion in the consulting room the feelings that such an episode would have aroused in me.

Inevitably the therapeutic relationship, as it applies to my psychologist and me, does have some degree of the type of parent–child dynamic that occurred with the two psychiatrists – I feel needy before I see her, relieved when I can sit opposite in the tiny, untidy room and pour out my fears and triumphs. But this dynamic is underlying rather than dominant, and it’s not being used as part of the therapeutic process.

This is not just because of her perceived lack of qualifications, of course. It’s also partly due to the fact that I don’t, consciously at least, want to put her in that position – how many parent figures can you have throughout your life (an infinite number, it seems, as I still treat people in authority as parent figures); partly that my therapist is either about my age or slightly younger (it’s hard to tell – she’s very good looking, and probably botoxes); partly due to my lowered expectations as a result of my excessive aloneness in the last few years; and partly because of the way the Medicare (national insurance scheme) operates – the rebate is limited for psychological help compared with psychiatry, a maximum of 12 visits a year or 18 if the GP approves, so the sessions are widely spaced (once every two or three weeks) and they’re very practically oriented.

My psychologist and I mainly talk about strategies, tactics and techniques in relation to examples I bring up of problematic episodes that have already occurred or potential scenarios I’d like to venture into. We’ve looked at the past, but mainly in terms of how it affects my perceptions of others and of relationships today.

My therapist was chosen for me by my GP and I listened to my gut feeling in deciding to see her, and then to stick with her. I had to rely on my gut feeling because I was desperate to see someone at the time, and I knew that if I checked on her credentials before my first appointment and she wasn’t sufficiently qualified my head would say all sorts of judgmental things about her.

And my gut feeling was on the money. The fact that she wasn’t a clinical psychologist initially quietly horrified me (‘But I’m sick! I have about five different mental illnesses all blended together in an indivisible whole – how can she possibly help me?’). She does, however, have a human resources background, which was perfect for the issues I was grappling with at the time. She continues to be great at putting my many work issues into perspective.

So the current situation has both advantages and disadvantages. Because of her not being a clinical psychologist, as well as all the other reasons outlined above, I still feel as if I’m essentially on my own.

In some ways this is good for someone like me, who was never parented properly and has spent their lives searching for the perfect parent. In the past I relied on my psyches to be excessively parental, and while I was seeing them, I didn’t ever really take full responsibility for seeking sustainable adult relationships.

This had serious and long-term implications for my emotional development. Neither of my previous psyches fully realised the extent to which I needed to be ordered around when it came to relationships. There was one crucial point in my life when I needed to be told very firmly to have sex with the first realistic contender that came my way, to be set sexual ‘homework’ if you like. But the extent of that need simply wasn’t evident to my therapist at the time, and I didn’t have the maturity or self-awareness to articulate it.

Realising the limitations of my psychologist’s skills (and she is skilled in many ways) puts the responsibility onto me for my own recovery. And I’m hardly a rank beginner. I have a friend with OCD who has been practising exposure for so many years now he’s virtually an expert, and we have regular debriefings about it. I’ve also done plenty of my own reading as well as attended a social phobia group that included CBT and exposure.

Yes, my social phobia is complex and difficult, as it’s combined with a compulsion to display my symptoms to particular people and an underlying terror of making meaningful connections with others. My therapist works with me on exposure, but because of the nature of my problem, I have to tailor the program in conjunction with her. It would be wonderful if my therapist could tailor a program exactly to suit me. But exposure is exposure. I know enough now to tailor my own program with her help – she is my back-up.

And I have another weapon in my armory, a weapon that only I can wield – meditation. I finally have the self-love to use it regularly, and it’s beginning to show subtle but noticeable results.

Those are the advantages of not being able to completely turn my therapist into a parent figure. There is also a major disadvantage.

Because I can’t go through the ‘transference’ (when the patient falls in love with the therapist as an all-powerful parent figure) it means that I don’t feel emotionally ‘held’ during the session. And this means that the scary feelings that come up for me whenever I am in close contact with a person for any period of time can’t be taken out and looked at honestly.

Oh, I suppose they could if I insisted, but it would all be terribly awkward. I like my psyche and she says amazing things at just the right time, but she’s not really ‘mine’ – and to talk about some of the feelings that come up for me in relation to her (as opposed to the outside world – I can talk about that, no problem) would be more than my fragile self-image could cope with.

I think I’m a bit frightened that if I reveal those feelings, she won’t be on my side any more. And that inability feeds on itself – if I can’t articulate those feelings then I may start to display them through my panic symptoms in the consulting room, and that would be extremely embarassing. And my fear is that I’d then be on my own again, just as I was before I started seeing her. This is not a positive therapeutic situation!

My current way of dealing with this problem is to see the sessions themselves as part of my exposure therapy. It’s difficult for me to sit in the same room with just one other person for an hour. The session becomes part of my (self-administered) treatment, with the psychologist as unknowing resource.

Of course, this may not work indefinitely. My symptoms are already clamouring for attention in the consulting room and there may come a time when I can no longer manage them adequately without acknowledging them. I guess that will be a time of reckoning: the time either to seek another therapist or to attempt to turn the therapeutic relationship into something more challenging for both of us.

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Attention!

Attend!
Pay attention!
Are you paying attention?

It seems that attention is what's missing in this society. But how important is it?

Lately a few things I've been hearing and observing have made me think about this scarce commodity, so hard to come by in our rushed, atomised, money-obsessed world.

But what does it mean? And why have I suddenly become fixated on it?

In the last few years, a few books relating to this idea have been published in Australia. A young Australian philosopher, Damon Young, wrote Distraction: A Philosopher's Guide to Being Free, about the prevalence of distraction in the modern world, ruefully admitting his addiction to his Blackberry even while on holiday. And Hugh Mackay wrote Why Don't People Listen?, a well-received book in which he urged readers to start really listening to others.

Both of these books' topics are related to attention. Distraction is attention's obvious opposite. Listening is impossible to do properly if you're not attending to someone. But attention has wider scope than listening. It's a focus on someone or something, sometimes an intense focus. Why does it matter?

I regularly take my sister's little cocker spaniel, Jordan, to the park for a romp. When we get back to his place, I usually play Fetch with him for a little while. Occasionally we play Fetch at the park but he's usually too distracted by his all-consuming sense of smell to keep focused on the game. With such succulent, wafting scents everywhere, it's almost impossible to get him to follow the track of the ball (Fetch!) let alone bring it to me (Come!) and drop it at my feet (Give!)

What I have noticed, though, is that he performs much better when I focus on him. When I look at him and am very aware of what I intend him to do, what I want him to do, he seems to sense it. If I'm half-hearted and distracted, so is he.

Attention seems to be to be related to love and bonding. I have a strong bond with Jordan, and when I 'activate' it through my attention, this no doubt helps him to keep focused on me as we play this game.

Children, as we all know, absolutely crave their parents' attention, and will act out mercilessly if they don't get it.

I'm hopelessly intolerant of my friends having their mobile phones on and answering them when I'm socialising with them one-on-one, because for those minutes they're on the phone they've let go of that attentiveness that I'm hungry for.

Journalist Rupert Isaacson is the father of an autistic boy, Rowan. The child was incontinent, constantly having tantrums and unable to relate to others when Isaacson and his wife, psychology professor Kristin Neff, decided to take him on a trip to Mongolia to be healed by shamans (horses were already playing a large role in his progress, so the trip also involved horses).

After the shamanic healings took place, miraculous changes occurred. Rowan became toilet trained, his tantrums virtually ended and he made his first friend. Isaacson wrote a book about the experience, Horse Boy, and a documentary has been made about the journey.

Isaacson can only speculate on what actually caused the changes. But could part of the shamans' powers have come from the intense focus they had on Rowan, and the inner healing powers they were able to summon up, during the healings, partly through that focus?

And could some of the trip's success have come about because Rowan's parents were so intensely focused on him and what they wanted for him, not in a grasping way but in their willingness to drop everything for him? (This is not to suggest, of course, that attention will cure everything, or that parents with disabled children who can't be helped are not giving enough attention.)

Recently a UK journalist, Simon Singh, along with coauthor Edzard Ernst, wrote the book Trick or Treatment? Alternative Medicine on Trial (I think this is too complex an area to have only one opinion on; homeopathics are nothing but water, yet herbs are clearly medicines that we still need to know much more about.)

Naturally Singh was down on homeopathics, and I don't blame him. But when western scientists and science writers such as Singh have discovered that people benefit from homeopathics anyway, I think they too easily dismiss the reasons. There's the placebo effect of course; that's the mind healing itself, which is highly significant and extremely worth exploring.

But it's also acknowledged that sitting down with a naturopath who listens to your problems, asks you questions about all aspects of your life and gives you the time and attention that so many GPs are just too busy to give may also help the healing process.

But, you might well ask, what about animals and children? How could they possibly benefit from homeopathics and get better as some seem to? Of course, the usual maxim applies that many would have got better anyway regardless of treatment. But perhaps the actual dispensing of the homeopathics, with the ritual involved and the attentiveness necessary, has something to do with it?

Too bad that kind of thing can't be measured, and too bad it can't be bottled and marketed and made it into a brand (I guess capitalism tries to do that, but I'm talking about real attention …).

What if all medical students, in addition to having good marks, had to demonstrate qualities such as empathy and compassion? Perhaps this is an essential aspect of healing, not just an add-on?

Attention is perhaps a kind of love, or perhaps love is not the word I'm looking for. I don't mean individualistic love or romantic love but the life force that flows through us. Perhaps when we give something or someone our attention we allow our minds to provide the beginnings of healing. That's one reason why truth and justice commissions are so important after terrible massacres. Sufferers need to be heard by other humans.

And that's why in naturopathic, but also psychotherapeutic, consulting rooms all over the world, people seek out and are willing to pay large sums of money to those who will listen to their stories, mobile phones and pagers turned off and no computer blinking in the background. That's one aspect of therapy I really miss – the quietness of the consulting room, and the sense that someone was giving me their complete, undivided, fully focused attention, even if only for 45 minutes a week.

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Familial angst

Lately I have been wondering if my blog should be called very nutty rather than slightly nutty.

As usual at times like this my thoughts turn to my family but not in a good way. I’m full of blame, angst and bile.

The thing is I am caught between two competing positions. The first is that my parents are responsible for scrambling my brain and therefore should do everything within their power, alter their lives in significant ways if need be, to assist me (even though they’re now in their 70s – shouldn’t I be assisting them? – but this is no longer a new position for me).

This position sees my mental illness as no different from a physical one. What if I had been confined to a wheelchair? They couldn’t have ignored the problem even if they’d wanted to. Imagine the ignominy, the opprobrium of their many parish friends if they had done nothing to help me, say by placing me in a home. And of course they wouldn’t have done such a thing. But their lives would have been different – harder, with less time for socialising (they are deeply social people, and in my mother’s case more bonded with friends than immediate family).

My parents have always been extremely uncomfortable with my mental illness because acknowledging it fully would have opened up too many cans of worms. They have therefore never been able to intervene in any significant way to ‘save’ me (more of saving later). At a critical time in my life – the age of 15 – they stood by as I went into a shell I would never fully emerge from (like an obedient child my illness took a form that was never dramatic enough to warrant hospitalisation).

In theory they have always offered sanctuary (ie allowed me to move back home, but very much on their terms) and when I had a breakdown at 21 my mother gave me a fair bit of emotional support. But they’ve never actively assisted me, apart from giving me the kind of practical help they give their other daughters, for example, when moving house. And since I’ve been living close by, my father to his great credit comes around on call to mow my lawns and do any handyperson tasks that I can’t.

So, when I take this position, how would I like my parents to be? My fantasy parents would have long ago renounced their Catholicism, spurning it because its rigid doctrines and twisted representatives had helped to bring about my emotional demise. Instead they would be exploring non-denominational spirituality. Needless to say, they would have come to terms with the fact that their basic incompatibility was a huge cause of my problems and would have reached a level of emotional maturity unthinkable if I had not been ill.

And decades ago they would have urged me to see a psychologist or psychiatrist (instead of the GP and gestalt therapist I mainly saw for years) and to pay for any expenses or at least helped. They would have gently pointed out that I was going to need to pursue a career that could be managed within my anxieties and offered to help financially with any study expenses.

And when they decided to buy an investment property ten years ago they would have bought one with an eye to me moving in there somewhere further down the track (paying rent of course, but with some degree of security). And long ago they would have come to terms with the fact that I probably wouldn’t get married, and given me a nice little payout equivalent to the cost of their other daughters’ weddings.

It’s such a lovely fantasy. Who would want to abandon it? I can’t, not completely. But let’s face it, it’s based on the lives of secular, middle class baby boomers. My parents are religious and more than half a generation older than baby boomers, their lives relatively untouched by feminism and the other social movements. Inexplicably, my father still enthusiastically attends events run by the Catholic, socially right-wing political organisation he so adored when I was a kid.

It also ignores the obvious – that some mental illnesses, or at least the way they present themselves, are the result of family dynamics. In my case, I think I was trying to adapt to some impossible contradictions in the family. So how could my parents possibly be part of the solution? We had one session of family therapy when I was 21 but it threatened to uncover some uncomfortable truths, and my mother put a stop to it.

But there is also another position. This position is partly based on new age ideas about responsibility but it’s also more grounded in psychotherapy. It says that on one level I am responsible for everything that happens to me (I can’t buy that completely) but, on a more mundane level, that I’m an adult and have to take responsibility for myself.

In fact, the last psychiatrist I saw, around five years ago, said at one point something to the effect of ‘isn’t it about time you laid off your parents?’

And this is the nub of it, the sticking point.

Because despite the bad start they gave me, despite the part they played in ‘stuffing me up’, I’d reached a point about ten years ago where I had grown in many ways, and could have made a very fundamental change in my life.

This was at at time when I had finally accessed some psychiatric help (far from perfect, but good in some ways) as well as spiritual help through a 12-step program. I understood that it was possible to go out on a limb – I had seen people in the program grow in amazing ways and take on new challenges. I also had plenty of people who could have helped me make this leap (in fact one of them belatedly tried to help me for weeks).

This leap would have freed me from my emotional reliance on my family, at least temporarily. And I chose not to make it.

Yes, it would have been incredibly difficult – for about 5 minutes. But I decided to play it safe.

Of course there had been many times earlier than that when in theory I could have broken away. But it really wasn’t possible before then. This was a genuine choice.

So I’m stuck between the two positions. I guess in some ways I have no choice but to take up the latter position – that I’m responsible for myself and my life. But this is very difficult at the moment because I can’t work or socialise much. I still equate work with taking responsibility, so if I can’t look after myself financially where do I stand?

Do I need to let go of that connection and see myself as still dignified even if the state is being a parent of sorts and helping me out financially? Of course, but it’s hard. It’s also hard because I believe very deeply that I am never going to be able to work in a way that frees me from this dependence. (Possibly this is in itself deluded but that is the way it feels at the moment.) And that makes me want to turn back around to my parents and shake my fist at them: ‘You caused all this! What are you going to do about it?’

And it’s also hard because I know that at one point things could have been different. I can’t really blame my parents for that, much as I’d like to.

So perhaps there is a dual responsibility? That still doesn’t change my parents’ behaviour or attitude towards me.

When I was in my mid-20s I assumed a faux sense of independence from my parents, convinced it was better that I asked nothing of them. This hid many unconscious resentments, and I slowly came to realise that they did indeed bear some responsibility. I’ve since accused them of all sorts of shortcomings. But that time of acute grief and anger is past. Although I may not stop feeling angry, I need to let go of the belief that some time in the future, they will look after me. There really is no choice now but to do so. That’s what I have to work on.

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Celebrity meltdowns: Joaquin Phoenix on Letterman

Seeing Joaquin Phoenix's strange performance on David Letterman about a week ago set me thinking about the pathologies that fame can give rise to. Phoenix refused to answer most questions beyond 'yes' and 'no' and appeared bemused, befuddled and deeply uncomfortable (but not exactly disorientated, as has been reported). Letterman was fulsome in his praise for Phoenix's performance in the film Two Lovers but stands condemned for his brutal encouragement of the audience's sometimes contemptuous laughter.

Okay, so Phoenix may be on drugs, or having some kind of nervous collapse, or both. If so, like Britney before him, he is forced to undergo his trials in the public eye -- surely a magnification whose implications we can't begin to guess at? There were a couple of things that this strange interview -- one wonders why it wasn't pulled at the last minute -- made me think about.

Nowadays the famous are likely to be those who lack talent but seek fame, the drug we all scream for -- the tired example of Paris Hilton is perhaps the most obvious. It's easy to forget that many, though not all, actors and actresses are, or were before they got onto the Hollywood treadmill, artists first and stars second. Like successful authors who must relentlessly sit on an endless series of panels at writers festivals to spruik their wares, they may well be shy, retiring or simply highly strung.

The self-confessed depressive Guy Pierce and the short-tempered Russell Crowe spring to mind, while Judy Davis in her heyday was famously perfectionistic. The tragedy of Heath Ledger is still fresh in the public's mind, but even at his most stable he appeared uncomfortable, shy and self-deprecating in interviews. It's now a truism that the legendary Monroe dwelt in a bottomless pit of insecurity. Cate Blanchett is perhaps one of the few stars who is allowed to be an artist first and a celebrity second.

Clinical psychologist and television personality Pamela Connolly, who made the psychological effects of fame the subject of her PhD thesis, believes that the famous become traumatised by an idealised version of themselves, constructed by the media, that they cannot possibly live up to. If this is true, such an effect would surely stir up any pre-existing psychiatric condition or issues arising from a difficult or abusive childhood.

Phoenix's odd appearance on Letterman might seem to bear this out: he's an attractive man, but the shaggy dog look does nothing for him. Was he trying to distance himself from an image that had started to tyrannise him?

Perhaps Phoenix could benefit from a session or two with Connolly. She makes full use of her talents in the television series Shrinkwrap, which aired in Melbourne on the ABC during the summer non-ratings period. Each program featured Connolly carrying out a public version of a psychotherapeutic session on a celebrity or public figure, including Sarah Ferguson, Sharon Osbourne and the stubbornly cheerful Stephen Fry.

I adored this show, largely because it was everything Andrew Denton's now-defunct talk show, Enough Rope, was not. The success of Enough Rope relied on Denton's sharp wit and his willingness to exploit his interviewees to get confessions and cheap emotions out of them.

Connolly of course is no stranger to television, veteran as she is of the comedy shows Not the Nine O'Clock News and Saturday Night Live, but her questioning has different motivations. She is genuinely interested in how people tick and how they came to be how they are but she is also on the side of the frightened child within them, sometimes relentlessly but always patiently so. And she knows that this is good television because when you dig down most people's stories are inherently interesting and exciting of our empathy.

This is why everything about this show seems oddly old-fashioned: the low-key lighting, the lack of an audience or special effects. Sometimes while watching I felt I was in a parallel universe in which the capacities of television were used in the ways its makers might have hoped for (and that the ABC is still legally obliged to do): to inform and educate as well as entertain. I kept thinking about those moody BBC Shakespeare productions.

And what's interesting about this is that it takes a while for the subject to submit to Connolly's digging and for their personal story to take off: you need a modicum of patience to get the most out of it. It's both odd and pleasing that the show has been made possible by the evil twins of trash culture and reality television: the show relies and rides on the assumption that we all want to eat celebrities and would-be celebrities alive, but instead it allows us to see them as vulnerable and needy human beings, just like the rest of us. And it also invites those of us who are not psychoanalytically aware to look at our own 'inner child' with a tolerant and even loving eye.

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