Not mad, not bad – just traumatised. Excellent article by Carolyn Spring about demedicalising distress and trauma.
Not mad, not bad – just traumatised
By Carolyn Spring
I spend a lot of time thinking that I’m ‘mad’. And so do a lot of people I know. The funny thing, of course, is that for the most part none of us have adequately defined what exactly this ‘madness’ thing is supposed to be. It’s a concept that has leaked down into grubby little recesses of our cultural psyche from disparate sources: headlines in the Daily Mail (“Blair: I kept quiet about God so I wouldn’t be seen as a nutter”), comic books with their sociopathic comedy villains (The Joker, Lex Luthor), literary fantasy (The Mad Hatter) and an unsavoury social history of the ‘lunatic asylum’ and ‘mental wards’.
It’s just so normal to talk about insanity and madness. Look at the language of everyday life:
- “I’m going to New York on holiday. How mad is that?!”
- “He’s crazy about you.”
- “This total lunatic got on the bus without a ticket and refused to pay.”
- “My boss is a psycho.”
- “The English language is insane.”
- “I’m as mad as a hatter.”
- “If you keep acting like that, the men in white coats will come and take you away!”
- “She’s a total fruitcake.”
- “I’m a bit OCD about housework.”
- “He was driving like a maniac.”
- “You want to work overtime?! What are you, demented?!”
- “That teacher is off her rocker.”
- “Are you out of your mind?!”
- “The kids were driving me mad.”
This kind of language is so common that the concepts it evokes slip under the radar of rational consideration and just hang blithely in our cultural mindspace. Of course there is such a thing as madness, lunacy, insanity! And it’s something apparently so abnormal that we can joke about being ‘a bit mad’ knowing full well that no-one will think that we’re being serious. Truly ‘mad’ people are all locked up in mental hospitals, aren’t they?
The thing is, I do have what some people call a ‘serious psychiatric diagnosis’ (and the whys and wherefores of diagnosis I will dissect in another article) but I’m not mad. My husband regularly says that I am one of the most sane people he has ever met. My behaviours, my feelings, my thoughts, even my beliefs might not conform to those of the majority of people in the UK but they are all entirely and utterly logical. (By the way, if 10% of the population admits to hearing voices, then is even that most quintessential of symptoms of ‘madness’ quite so abnormal really?) I behave, feel, think and believe the way I do for the most part because of the experiences I have had in life to date. And that’s just the same for everyone else: psychiatric inpatients, therapists, teachers, politicians, cleaners and probably even mass murderers. We all respond to the world and build our interpretative mental maps of it based on our experience of it and the people in it. It’s called – scientific term alert – ‘learning’.
The only thing insane about my life is the experiences I’ve had. As Jacqui Dillon from the Hearing Voices Network says, “Bad things happen to us and they can drive us crazy.” (And in an act of blatant revolutionism, Jacqui didn’t even have to get a PhD to write that sentence. What seems so obvious to supposedly ‘insane’ people like me (people with psychiatric labels) is apparently almost unfathomable and maybe even a little psychotic to many people with letters after their name. I mean, if you’re going to call “feeling upset” something technical like “dysphoria”, you’re probably going to have to study for a great many years in academic institutions which create and then speak that language.
I had experiences throughout childhood of disorganised attachment and extreme trauma including child sexual abuse and torture. And all within a “standard middle-class upbringing” where what happened on a night wasn’t alluded to during the day, where denial was my staple diet and where I was presented with ‘black’ and told that it was ‘white’.
Despite all of that, my mind insisted on trying to reconcile these contradictions and never gave up the attempt to figure out what was really ‘true’. If my mind had just accepted that “this is the way it is”, that I really do deserve all this inhumane cruelty, that people who can be kind to you during the day can rape you at night, then I would be either dead by now or truly ‘mad’.
But my mind has for nearly forty years insisted on navigating a healing path through this mishmash of paradox. In doing so, it’s had to exclude the ‘black’ so that it can focus just on the ‘white’ and survive a little longer. It’s had to exclude the cruelty so that it can focus on the kindness. It’s had to keep out of sight and out of mind many of the irreconcilable contradictions that daily life unfolded upon me. And that’s a large part of what dissociation is – keeping the ‘white’ separate from the ‘black’, the ‘good mummy’ separate from the ‘bad mummy’. It’s the definitive sign, I think, of sanity in an insane world.
For me in my early thirties, I was trying to figure out who I was and what I wanted in life. I was trying to learn how to parent and build a career, trying to negotiate and construct an adult-to-adult relationship with my parents, trying to find somewhere to belong in this grown-up world that doesn’t give you after-school clubs and sports teams and the daily opportunity to make and break friends in an endless supply of peers.
Adult life doesn’t so easily spell out to you the rules for what you need to do and when to do it by, and dictate your dress code, and organise your timetable and give you merit cards and detentions. You have to start figuring all that out for yourself. And with all the inherent, unknown contradictions in my mind of the mental maps that I had laid down up to that point in life, none of it made sense. It was at that point that the ‘logic’ of the world that I had lived in once and for all exploded and shattered around me and I ‘went mad’.
But this ‘going mad’ wasn’t any form of insanity at all, no matter what diagnostic manuals may tell me. This ‘going mad’ was my mind beginning to make its own sense of the world for the first time, for itself, and lay out all the contradictions of the insanity of my childhood for me to unpick and comprehend. I could only do that by allowing myself, for the first time, to think and to remember. It was like a process of bringing out all the complicated bits of the jigsaw that just didn’t seem to fit into the picture at all and that I’d kept hidden away in the box because I couldn’t face the overwhelming sense of confusion that they evoked.
But, problematically, that act of allowing out the memories, the dissociative parts of the self that I had kept firmly in the box, brought with it a collapse of my previous coping strategies and my previous ‘logic’ for life. Things don’t work the way they used to. Life previously functioned a certain way, and then overnight, everything changes, and nothing is the same. As an analogy, a woman in her fifties goes to work in the morning and comes home in the evening and finds her husband dead in the lounge. Her life has unexpectedly been turned upside down. Suddenly, she can’t do what she was going to do that evening. She can’t make dinner and talk about her day and ask him to take the bin out and feed the cat. She can’t just get up the next morning and go to work and pop to Tesco’s on the way home and send a birthday card to her cousin. Suddenly everything is different. It’s a new situation. She’s got a funeral to organise, and she’s never done it before, and it’s overwhelming. She’s used to talking about her day with her husband and he’s not there. When she’s upset, she’s used to going to him for comfort and support, but at the point at which she most needs comfort and support, he’s not there. She’s not a married woman anymore; she’s a widow: it’s a change of identity. Her finances are different. She has to learn about the servicing schedule for the car and get someone to help her hump the Christmas tree down from the loft. Life is suddenly very, very different.
And when she goes a bit ‘crazy’, when she starts crying and can’t stop, when she sits and stares into space for an hour because she can’t figure out what to do next or how to do it, when she doesn’t want to go for a drink after work with her colleagues and can’t bear their jollity, when she can’t concentrate at work or remember what it was that she was doing, when she lies awake at night worrying about how to pay the mortgage … when all these things happen, no-one actually says that she’s gone mad. Everyone understands that she’s in grief and that it will take time, perhaps a long time if the death was sudden and unexpected, for her to rearrange her life again so that the new normal becomes automatic and comfortable and comprehensible. And even then, for decades afterwards she may contend with the why? questions of sudden tragedy and life not being as sugar-sweet as the John Lewis adverts suggest.
But when we have a ‘breakdown’, when our dissociative coping strategy that has kept our trauma or abuse at bay for years or years suddenly collapses in the lounge and dies on the floor, and we find when we come home from work that it’s not there anymore, people don’t see our resultant behaviour as normal. Even we ourselves think we have just ‘gone mad’. We don’t have a paradigm for it. And because there’s no corpse in the lounge, no funeral cortège, no life insurance pay-out and a bank statement in a single name, because it’s all intrapsychic and hidden in the undergrowth of our mind, then our outward behaviours do seem ‘crazy’. When we can’t go to work the next day, and we can’t concentrate, and we keep bursting into tears, and we can’t bear to socialise, and we lie awake at night, and everything seems too much, then we don’t think, “This is normal”. We think, “I’m insane.”
Many people in an emerging ‘Critical Psychiatric Network’ of professionals are arguing for the ‘demedicalisation of misery’ and it’s the most sane thing I’ve heard people say in a long time. When bad stuff happens to us, it’s distressing. When lots of bad stuff happens to us, in ways that we simply can’t cope with because it’s too awful and we’re too young and we don’t have the support, it’s distressing beyond belief. The result of that distress is what have been termed ‘symptoms’ of ‘mental illness’. But that’s suggesting that something has gone wrong in the brain. Is the widow – crying over her dead husband’s belongings as she packs them away – is she insane? Has something gone wrong in her brain? Or is she just naturally expressing the grief and the upset and the distress that losing someone you’ve loved for over 30 years will naturally bring? Does she have a mental disorder?
No. And neither, I would argue, do we as trauma survivors. Should the widow be put on medication to numb down her feelings of grief and loss or should she be allowed to cry? Should friends and family gather around her and support her and be with her, help her with those boxes from the loft, take her car to the garage until she knows what a cambelt is, be with her on long, lonely evenings, send her flowers, phone her up? Or should they just tell her to go to the GP and get some ‘anti-depressants’ for her ‘mental health problem’?
It’s funny how, as a society, we feel that certain types of distress are normal and on the whole we can cope with them and tolerate them – although some people would still rather cross the road than have to talk to the recently bereaved. But when it comes to extreme trauma, when it comes to decades of abuse, criminal acts perpetrated on defenceless children which have never been prosecuted or even voiced, then we are expected to either take tablets, live in a hospital, or just get over it. The unhealed suffering, in all its technicoloured distress, is bad enough, but then to add to it, society as a whole dumps on us the stigma and rejection of a label of being ‘mad’. It suggests that there’s no reason for our grief and our distress, and that we have a ‘disorder’.
Certainly, a lot of the so-called ‘symptoms’ of mental distress don’t appear logical. When in my early thirties I would crawl under a table, shaking and crying and trembling, and wail, “I don’t want the nasty men to come” in a child-like voice, it didn’t seem ‘normal’, or ‘sane’, or ‘understandable’ to my husband. My mind evidently couldn’t cope with that contradiction either – the professional, competent me and this quivering, terrorised child-me – and so my ‘adult’ brain wouldn’t remember that this was what I had just done. So then my husband is faced with two apparent forms of insanity: me under the table as a child-part-of-me, then me denying that that’s what I’d just done. I can and do understand why he thought I’d gone mad. It’s logical only when you know the history. And you only know the history if it’s allowed to be told.
For me the stigma of ‘madness’ caused a swell of suffering on top of my already stressed-out and distressed-out state of mind. People don’t like ‘mad’ people. People think that ‘mad’ people are dangerous. If you’re mad, they take your children away. If you’re mad, you get locked up in a mental ward and drugged. If you’re mad, no one takes you seriously or listens to what you want any more. If you’re mad, no one believes what you say, because whatever you say is a sign of your madness.
It’s ironic that the label of ‘madness’ itself causes the same kind of powerlessness, the same abusive wrenching-away of choice and freedom and autonomy, the same kind of shame and humiliation, that the original trauma did. As a child, no one took me seriously or believed me, listened to what I wanted, respected my body, treated me as if what I felt mattered. Being a ‘psychiatric patient’ is rarely any different.
But what is more than ironic – what in reality is a tragic human rights atrocity – is that the system of care of psychiatry in this country and much of the Western world is based upon ‘treatment’ for severe trauma which replicates the dynamics of that original abuse. Do we really, as a nation, think that in order to ‘get better’, in order to recover from the distress of decades of abuse, we have to be treated as if we have no rights – the right to be believed and listened to, the right to be in control of our life and our body? Should we be treated as if we have no value or worth? Why is it that to treat the effects of powerlessness, which is the core of so much trauma and abuse, psychiatry thinks that we should be powerless?
One of my indelible experiences of the last few years is seeing the ‘backdraft’ of people withdrawing, unconsciously and imperceptibly perhaps at first, when I say that I have a ‘mental health condition’ or that I am a ‘survivor of abuse’. Many people treat me instinctively as if I am dangerous, as if I am about to act in a bizarre or illogical way: “No sudden movements – she startles easily!” More than anything, they don’t want to talk about the reality of what my life has been, or is. On the whole I am welcome for dinner or lunch or to social gatherings as long as I don’t say what I do, or how I am, or how I’ve been; as long as I don’t talk about trauma or abuse or mental health or any of those oh-so-uncomfortable topics. The result is a deep sense of stigma and rejection: I am only acceptable as long as I act ‘normal’ and dissociate my trauma. Both ‘madness’ and suffering are unwelcome realities in our society.
So for me, the path of recovery has involved having to think differently about myself and my ‘symptoms’. I’m not ‘mad’. Not when the piercing scream inside can only be quietened with self-harm. Not when I act and talk and think as if I am five years old and “the nasty men are coming.” Not when I don’t know where I’ve been for the last few hours and there is a cacophony in my head of squabbling voices. Not when I can’t sleep, night after night after panic-ridden night. Not even when I feel sensations in my body that have no obvious cause, such as the tightness of ropes around my wrists, or burning in my genitals – things that objectively aren’t there, but feel as if they are.
None of these experiences are ‘symptoms’ of mental disorder, of the brain gone wrong through some supposed ‘chemical imbalance’ or organic disease. They are just the traumas of my childhood, the jigsaw pieces which my mind didn’t have space or capacity to process at the time, coming out of the box and finding their way, bit by bit, into the picture that is my life. The process of ‘recovery’ has been delayed every time I have discarded one of those pieces as being just a bizarre, illogical sign of ‘madness’. It feels terribly shameful to accept that these experiences are actually logical, that I was actually abused, that these memories are mine, and so are these beliefs and thoughts and voices. But that is a shame that society has put on me for being apparently ‘mad’ and a survivor of sexual abuse; it is not a shame that belongs to me.
The process of recovery is an individual one. There are a lot of discarded jigsaw pieces that each one of us has to pick up, turn around, examine, fit in. But it is made all the harder by living in a society where we are stigmatised, rejected and shamed for being ‘nutters’ who ought to be locked away in psychiatric wards, away from public view. Certainly it would be easier on society that way – they wouldn’t have to face up to the prevalence of trauma and abuse in our oh-so-civilised country, or their complicity by operating on a “see no evil, hear no evil” basis as the Jimmy Savile case has so abundantly made clear.
But society needs to want to do more than ‘treat’ us by drugging us so that we can’t remember the trauma anymore, so that we can’t feel the distress anymore. Society needs to let us grieve and reorganise and reorder our lives and come to terms with what happened to us, and with what our families were or were not, and support us in the process.
That process, what I’m calling here ‘recovery’, might involve a lot of ‘crazy’ behaviour as we stare into space or cry uncontrollably or fail to turn up for work or do a thousand other things that make perfect sense when we understand the context. But we are not ‘crazy’: not us, as individuals. It is all of us together, corporately, as a society that are ‘crazy’: this society that churns out adults who abuse children with such impunity and lack of remorse; this society that builds ‘crazy’, dissociative structures in our healthcare system that denies us appropriate help and support as budget-anxiety shifts responsibility to another department. That, in fact, may be the greater, the more traumatic realisation – that we weren’t abused because we were bad, and toxic, and sick, but because society as a whole is. Perhaps we need to take the label off us as individuals as being ‘bad’ or ‘mad’ and start looking, every one of us, at what we each need to do – for we are all part of this ‘crazy’ society – to develop a more compassionate, caring, remorseful, empathic, non-violent way of living together.
Importantly, we won’t do that if we don’t remove our ‘mad/bad’ label, because we won’t have the courage to speak up, and we will allow our label to silence us. Who listens to a ‘mad’ person?! The first and the best thing we can do to contribute towards a saner society is to start to recover, and to demand by our very survival that we are treated with dignity and respect, not with stigmatising labels and sometimes-irrelevant diagnoses. Recovery will always be, in my mind, the best revenge for what happened to us.
So I’m not mad. I’m not bad. I’m just traumatised. And I’m recovering.
Read the full article here: http://www.pods-online.org.uk/notmadnotbad.html