I appeared at an event last weekend, in a local bookshop, to mark the publication of the paperback edition of The Locked Ward. Since hardback publication a year ago, I have done a fair number of these, up and down the length of the UK. The format is unvarying. A chairperson introduces me and the book, then asks me how I came to write it. Next, I read a section, or sections, from the text. The chair then asks more detailed questions before throwing the discussion open to the audience.
And the questions I am asked vary in seriousness and insight. Not everyone – in fact, not many – know how an Intensive Psychiatric Care Unit works. And they are intrigued by it. Indeed, many are intrigued by the whole issue of mental illness and how it is treated. Hence the interest in the book. Some are of the frankly prurient type. “What is the worst situation you had to deal with on the ward?” “Who was the most frightening patient?” I do not resent this kind of question. It shows that issues surrounding the care of the mentally ill are of interest to many. Or that they are intimidated by the more florid cases of psychiatric illness.
Others are more concerned about how and why I went into psychiatric care – what was my motivation? I am able to assure them that it was not saintliness, merely a desire to be of some service to my fellow human beings, especially to the most vulnerable and most misunderstood among us.
Some, perhaps more knowledgeable, perhaps even involved in the service themselves, are more interested in the specific environment and practices of that particular ward. They ask about staff/patient ratios and the ethos that arises from them; various therapies that might or might not be in evidence on the ward; or the medication policies in operation.
Yet others are interested in the literary aspect of the project. Because I have disguised the identities of the patients I cared for, do they now seem to me to be fictional figures? Was the process more like writing a novel as a result? The answer to both queries is no, but it was flattering to have my work complimented as being of literary value.
And then there are the questions that stump me. They usually come from people who have some direct knowledge of mental illness and the processes involved in treatment. One questioner, at the Edinburgh Book Festival, asked if I thought that there was a danger that trained psychiatric staff might see patients not as individuals, but as types – as representative examples of, say, schizophrenia, or bipolar illness. Of course, I could not, with any confidence or authority, speak of how the consultant on the ward or any of the trained staff, thought of patients. I could only speak as I saw: that they were, without exception, concerned and caring for every single man or woman admitted to our care. Their every action suggested that they saw patients as people. As different people, to be treated individually.
At Oxford, one lady who said she had been an inpatient in a ward very much like mine asked me how I thought the provision of care in Scotland compared to that of the UK generally, or that in the United States, or Russia. I had to admit that I was neither informed enough nor clever enough to be able to draw any comparisons. There are times when it’s best just to admit that you don’t know the answer!
But what my experience at these events has taught me is that there is still a great deal of ignorance of psychiatric illness, as well as a great deal of interest in it. And that it is imperative that we talk openly about it, bring the whole subject out of the shadows and into the light of day. Thereby we will show, eventually, that it is not a taboo subject, that sufferers are not to be feared or vilified, and that these are conditions that are astonishingly common.
I have said before that it is important to show that mental illness is not a witch’s curse, nor the influence of the bogeyman. It is an illness and, like a physical illness, it may be mild or severe, a singular episode or chronic. And, like physical illness, it can be treated, short term or long, and even cured.
I hope the book can contribute, however slightly, to that process.