THE PRISON STAFF COULDN’T UNDERSTAND WHY Mick slept under his bed, on the concrete floor. There was an excellent reason, but he wasn’t telling them. He had been transferred to the prison hospital, from the Special Unit, so I’d lost touch with him to a degree. I didn’t have nearly as much control over the comings and goings of prisoners to and from that Special Unit – had it been more like a hospital ward, which it should have been, then the consultant in charge, me, would have had the final word. As it was, being a maximum security prison wing, I was decidedly second fiddle. Indeed barely mentioned on any of its ins and outs. However, I was still able to maintain contact, so I that’s why I had travelled over from C-Wing, the Special Unit, to the Hospital Wing, and was visiting Mick when he hit me. The only time I was ever hit – and it was entirely my very own fault.
By that time, I had built up a good working relationship with Mick. We had started unpacking his childhood terrors, slowly, and with blockages along the way. It was one of these that must have precipitated his transfer from the Special Unit to the Hospital Wing. Obviously, in hindsight, I’d been going too far too fast. Which was what I was just about to do all over again.
I sat on his bed, as I usually did when I couldn’t see people in my prison-cell office in the ordinary way. And he was telling me about his psychotic symptoms. I took these in my stride. They didn’t faze me. They were just part of the picture of a mind that was not fully in control of its own mental furniture. My objective, which I shared with them, was that by increasing their self-esteem, their self-confidence, they could corral the nasties, and promote the nicer. I knew this worked. Indeed, even with Mick, there was an almost fairy-tale ending to the story, which confirmed beyond any possible doubt how successful this intervention had been, though all that was much later. What I overlooked on this occasion was that the corralling had to come from within. However empowered I was, unless I could somehow transfer this to where it mattered, the overall gain would be zero.
In retrospect, it was probably the fact we were sited out of the normal setting that increased the likelihood of a confrontation. Whereas I normally saw clients in my designated office – just another of the cells in C-Wing – on this occasion, both the timing and the context of the interaction were up to me – unwise, as it turned out. The point all turns on the issue of consent. As Percy had demonstrated (#7), if things were not to your liking, you could up sticks and vacate the premises at will. Here, Mick was fixed, and I was the variable.
Mick wanted to withdraw his consent to the way the conversation was going. He was fully entitled to. Indeed in my way of working, it was quite essential that he had full control. Unless he was empowered in this, there was little chance of his being empowered anywhere else. I had lots of qualifications, and a good deal of experience by this time – what I couldn’t possess, by the very nature of things, was his permission. By definition, that had to come from within him, and from him alone.
So there we sat. Renewing acquaintances, and beginning to talk about his medical condition, which is why I was there. He confided in me that the reason he slept under his bed was because a huge image of his father’s face kept coming out of the cell wall, at him. Technically, this was a hallucination – a perception that’s not real. That, however, was not how Mick saw it. Here was an enormous presence of his terrifying father, 3 or 4 times its normal size, scowling at him through the bricks in the opposite wall. What would you have done?
Given this circumstance, hiding under his bed would have been eminently sensible. What moved the whole into the realm of psychotic symptoms was, of course, the real fact that his father was nowhere to be seen. This was a maximum security prison, difficult to get either in or out – there was simply no way Mick’s dad could have come anywhere near – I had difficulty doing just that myself, from time to time.
So here we hit a central philosophical problem – what’s real? What is reality? How do you define it? Can you ever define it? I was convinced, naturally enough, that his father’s presence was unreal. But how do I convey this conviction to Mick, or at least do so in a way which reduced his terror? Not easy at the best of times. However, there is a way, and this is where I was heading.
I was confident that my view of reality was more accurate than his – it was a no-brainer – I knew, insofar as I knew anything, that his real father was not appearing through the prison wall like some evil monster. This was where I started. But it was not where Mick was. My task was to link the two.
It’s worth pausing, and looking at this. I didn’t believe his father was there. Mick behaved as if he was. A discordant view of the same reality. How could it be reconciled? Well, in the ordinary way, you have to trust a person’s view – or rely on another’s. Could I build up enough trust, that magic five-letter word, in time to ease Mick’s mental pain? He would have to consent to trust me – not an easy commodity to come by, either in a maximum security prison, or anywhere else, for that matter. But either way, trust obviously plays a vital part in determining what’s real, and what is not. We none of us have eyes in the back of our heads, so unless we acquire this invaluable facility, trust, we’re always going to have unreality mocking us from time to time – and unreality can be deadly.
Which brings us to the second point about Mick’s dad. ‘Deadly’ is how Mick saw him. Suppose, for the sake of argument, that his dad loved him, and he him, then a bright, clear picture of his smiling visage would have brought nothing but good (to both parties, as it happens). But this was not happening. Indeed the opposite was going on every night. His father had left a decidedly toxic memory in Mick’s mind. This was so strong, it overcame all the normal checks and balances Mick employed, as we all do, to validate reality. His father was stronger than reality. This is the key, the heart of all psychotic symptoms. It is also the key to their cure. [Please note, I say “father”, because that was the parent involved with Mick – but I must stress that the infant is gender neutral – if you say it’s always “mum”, or invariably “dad” – you’ll miss out on the reality, which varies from person to person, like we all do.]
I saw two ways to tackle Mick’s problem. Either convince him that he was misperceiving reality, i.e. get him to accept my validation of it, rather than his. This would have been perfectly fine, so long as he trusted me. Indeed he would have to trust my version of reality more than his father’s – quite a big ask, as it turned out, but entirely appropriate in logic. Or, the alternative was to adjust his view of his dad, from terror to irrelevance. In this way, however many times his father did appear, none of them would upset him. And in both of these, of course, I played my master card – Mick was no longer a toddler. When he was, his life and very existence, to say nothing of his “reality”, was exclusively in his father’s hands, as they are for every toddler that ever lived. In contrast, nowadays, being an adult, both existence and “reality” were up to him. Sounds an elementary transition – toddler emotions to adult emotions – certainly a rational, logical and highly desirable one – but it can be curiously difficult to achieve – as happened next.
Now there’s only one way to readjust Mick’s view of his father, and thereby increase his personal confidence in telling him to get lost – we had to talk about him. Which is what I proceeded to do. But, and again I claim that the unusual setting contributed, I did not approach this fearsome topic carefully enough. “So”, I said, “how do you feel about your father? Tell me what your feelings are.”
Well, Mick didn’t consent. He could have said “I don’t want to talk about him at the moment”. He could have asked to have the conversation move onto less toxic topics. And, I’m sure, that today he would do so. Or he could have upped and offed, like Percy had done so dramatically, earlier.
But that highlights one of Mick’s central problems. He couldn’t think, nor talk coherently about his father, nor about his feelings in that regard. He too had a blackhole – as did every other person I worked with. And this blackhole blocked conversation.
So, to cut to the chase, he punched me in the mouth. Not hard. Not to cause serious injury to lip or tooth, nor indeed to inflict serious pain – but hard enough to say, non-verbally – “stop talking to me about that”.
Nevertheless a punch in the mouth hurts. I reeled back, and staggered out through the cell door. The prison staff were immediately there. They were solid and sympathetic. They seriously wanted to know, if I was going to press charges against Mick, have him brought up to a tribunal, to be suitably reprimanded, even punished, either by a spell in solitary confinement, or otherwise.
Though I was certainly taken aback, I had not seen this coming – I well knew that it was something that I should have foreseen. I promptly squelched all talk of retribution. I rubbed my lip, which wasn’t broken, and withdrew to the safety of my office.
And so the matter was closed, from my point of view. I knew where the blow had come from. I knew even clearer, that had I been more skilful, it would never have come. I bore no ill-will, the last thing I considered was retribution or revenge – that would have added injury to humiliation.
The prison however, took its own course. At the administrative meeting the following morning, when all the heads of the departments met for a catch-up, this incident duly came up. One member of C-Wing staff had circulated the story – with additional embroidery, that they wouldn't be seeing me for three weeks. He based this fabrication on what had recently happened to another doctor in the Hospital Wing, who, when he had been recently hit, disappeared from view for that length of time.
I had not the least wish to disappear. I rebutted this rumour head on. I declared that if a psychiatrist didn’t know how to approach a person with psychotic symptoms, then who could? The meeting dissolved in laughter – especially as the individual originating the rumour, was himself absent on sick leave. The biter bit?
But Mick’s story highlights a central problem. It may sound a dry academic issue – what is reality? Is my reality “stronger” than his? Why not just tell him to pull himself together, and stop seeing things which weren’t there? What justification did I have to impose my view of things on his?
Well, the way I approached this significant issues was to start with the master emotion – fear. Pull that out, and all the others fall meekly into place. But, and here’s the catch, excess fear, better known as terror, creates what I keep calling a blackhole. That blackhole prevents you working out precisely where the fear itself comes from, and therefore blocks any attempts you might make to rid yourself of it. This is what happened to Mick. His father had terrified him. The evidence for this was that he still did. An amiable father’s face would have been mutually beneficial – a deadly one, stopped Mick even thinking about it. And when I started talking about it, he even closed my mouth, literally.
My task therefore was threefold. First, I needed to have no fear of his father, nor therefore fear of his father’s face, whether I could see that or not. Secondly, I needed to know that there was a healthy Mick underneath it all, who also wished to a take relaxed view of irate fathers.
Finally, I needed to be 100% secure in the knowledge that anything to do with his past, whether father, mother, or anyone else, was now 100% obsolete. Only the blackhole itself was maintaining it there. What had been planted decades before needed bring up to date. This required no high jinks, no magic, no laying on of hands – merely knowledge, insight – which I absolutely knew, and which I somehow also needed, to transfer.
And here’s the fairy tale ending – you couldn’t make it up. It would take an exceptional imagination to invent anything quite so out of the ordinary. Truth here, is even stranger than fiction. It happened like this. Years later, and miles away from Parkhurst Prison, Mick, while still in another UK prison, was with a group of prisoners who had been selected to meet a formal group of official prison visitors.
Wheeled carefully in, and lined up along one side of the room, seated opposite the row of visitors on the other, he erupted. To his delight, he had recognised a member of that group, and didn’t hesitate. He immediately rushed across the room, breaking with all prison visiting protocols, saying – “please, please, tell my psychiatrist, I didn’t mean to hit him”.
His fellow prisons were dumbfounded. What could he possibly mean “my psychiatrist”? How did he ever have a psychiatrist? When he told them he had been on C-wing Special Unit in Parkhurst, they recoiled in horror. That Unit has a dire reputation. It was the deepest dungeon for the most dangerous, depraved and deadly of all. Mick by this time, was anything but. He was well known as the direct opposite – friendly, responsible, caring, realistic. Not psychopathic, no psychotic symptoms – just a friendly normal human being, in exactly the way he had been born. Indeed as we have all been born, and sometimes struggle to return. The deeper philosophical truth is that we all share the same reality – we may only see parts of it, at any one time, but it’s the only one we have, and when we do manage to agree, then we all become that much more real. Quite an achievement –wouldn't you agree?
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MEDICAL NOTE – at one level this is just as simple as it sounds. At another, it involves life-or-death emotions – which is why it all gets so gummed up. So you need to be extra careful when discussing these points with people who might have similar, deeply buried problems. IF IN DOUBT, DON’T. Life-or-death could mean yours.
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MEDICAL NOTE – never stop psychiatric drugs abruptly – seek expert help – see next post when it comes. I’m happy to answer Qs & As (if slowly), but can no longer discuss individual cases, I closed my clinic when I retired.
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NOTE These posts are a new venture for me. I’ll aim for at least twice monthly. If you like what I write, please encourage me by responding, all but the latest will be free. You can always read the academic background to it all, free, by clicking The Simple Science of Sanity. Thanx.
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