Hazel McHaffie

delusion

From the Edge of the Couch

When I was a student I made a conscious decision not to do a stint in psychiatry. Why? I was acutely conscious of the fine dividing line between what’s ‘normal’ and what’s ‘abnormal’, and had a sneaking suspicion I was too close to the edge for comfort myself at times. Decades on, I’m more sanguine about my own mental resilience, and more sympathetic to others’ strengths and weaknesses, and I guess, more curious about how the mind works.

Why am I re-living this decision now? Let me explain.

I was at a bit of a loss as to what book to take for eight hours sitting on a train with weighty matters on my mind. I needed something that I could dip in and out of, but something sufficiently absorbing to hold my interest. Ahah! Time maybe to tackle From the Edge of the Couch: Bizarre psychiatric cases and what they teach us about ourselves. The author: Dr Raj Persaud, a consultant psychiatrist, writer and TV personality.

It’s disturbing (as expected) and raises all sorts of questions about the way the mind functions, the variety of delusions and distorted beliefs that can lurk in its hinterland, and the cracks and flaws that can derail the psyche. More than that, it shows how delusions are far more common than we might imagine, and probing them can reveal much more understanding of how the ‘normal’ mind works.

From werewolves and vampires, to phantom lovers and stalkers, to Munchausens and gender issues, to various distorted perceptions relating to parts of the body, Dr Persaud unravels the problems, the possible causes, and the treatments, through the lives of real people amassed from reported cases over many countries, many years, and from many clinicians. It’s detailed, it’s research based, and it corroborates my remembered feeling that the line between the healthy and the disordered can indeed be thin.

Which of us doesn’t feel unworthy at times?
But most of us don’t resort to eating animal faeces as penitence, or slicing off a hand with a chain saw.

Which of us has not at times disliked a part of our appearance, or experienced anxiety about something untoward happening to cause us acute embarrassment or public humiliation?
But most of us don’t shut ourselves away from society altogether, or deliberately inflict injuries to ourselves and then infect them in order to get a limb amputated.

Which of us has not at some stage tried to alter their body image by something like dieting or exercise?
But most of us don’t eat industrial quantities of toilet paper or our own hair.

Which of us does not have some an experience in our childhood that was fairly traumatic?
But most of us don’t deliberately mutilate our face, amputate limbs, castrate ourselves or enucleate our eyes.

Which of us has not worried about body odour of some kind?
But most of us don’t opt our of work/school to obsessively wash our clothes, and avoid all social and domestic excursions out of the house.

Which of us has not known someone who had a stroke?
But most of us don’t react by becoming pathologically obsessed with eating fine haute cuisine food ourselves.

The list goes on and on. Puts our normal little anxieties into perspective, doesn’t it?

Dr Persaud takes delusions very seriously – sometimes indeed more seriously that the disturbed patient! Furthermore, for him, anything we can learn from them is valuable, as he points out in the postscript:
… dialogue with the delusional has much to offer us. It will not only assist in the specialized scientific enterprise of understanding the brain and mind, but such people’s experience should inform our personal understanding of what it is to be human … If we can grope towards some understanding of the most bizarre and incomprehensible ideas of all, then surely there is more hope for us to understand what each other thinks.
Many have said the most complex entity in the known universe is the human brain, but in fact there is something much more intricate and elaborate: human society – or groups of brains interacting. What is produced when minds try to understand and manipulate each other is where the real mystery and excitement of the human sciences lie.

From the Edge of the Couch is a lengthy tome, and holds a wealth of information – 59 pages of footnotes alone! All made viable by the bringing together of cases from so many sources, enabling deductions to be generated which would not be possible from the occasional single example that comes the way of any specific clinician. It’s perhaps small comfort that, as Dr Persaud admits, psychiatry is far from being an exact science, and relies heavily on objective interpretation of symptoms. That’s part of my worry!

Yep, I’ve no regrets at bypassing psychiatry! But after finishing this book, I’ve got the gratitude-for-what-life-has-dealt-me T-shirt and the mug.

 

 

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Look Behind You

Treading too close to delusion and insanity is bad for my health! I knew that when I was in my early twenties: I steered well away from psychiatry during my training, all too aware of the fine dividing line between normal and abnormal. I’m conscious of that same sense of unease when I read excellent novels about psychological and emotional fragility or abuse.

But having had a healthy break from psychological thrillers recently, I decided it was time to get back into them. So I chose Look Behind You by Sibel Hodge from my bookshelves, and was instantly sucked into that tense feeling when someone is playing with your mind, and you really don’t know what’s real and what’s imagined and what’s dangerous.

From the outset we’re dragged into a terrifying world, where the borderline between reality and fantasy is frighteningly blurred. 27-year-old English teacher, Chloe Benson, emerges from unconsciousness unsure where she is … is she coming to during an operation? after an accident? a bomb blast? in prison? after a terrorist attack? Her bewilderment and growing terror are palpable. Whatever the precursors, her senses tell her that her wrists and ankles are bound with rope, her head is splitting, she’s in some kind of underground tomb, surrounded by the smell of earthy mouldiness, dankness and decay. But why is she restrained? Who has abducted and imprisoned her? And what has happened to reduce her to this state of amnesia?

When she eventually escapes, more torment awaits her. No one seems to believe her story – not the doctors, not the police, and certainly not her husband, Liam. What’s more there’s ample evidence that she has a history of depression and hallucinations, paranoia and delusion. She’s even been sectioned under the Mental Health Act and detained in a psychiatric hospital. Papers and Liam attest to that, and the fact that her mother committed suicide.

Could she have imagined it all?

What is an indisputable fact, however, is that somehow she has lost seven weeks of memories. The doctors say she’s had an adverse reaction to medication – records show it’s happened before after a miscarriage. Is this simply another psychotic episode? By the time she’s sent home from hospital she has no idea what the truth is.

‘…the only one who really believes me is me, and until I know the truth, my life is in danger.’

Painfully, little by little, she pieces together the last seven weeks. Doubts and fears mount. And her conviction that someone is determined to harm her grows daily. Where can she go? Who can she trust? Not her husband certainly; she has endured two years of psychological abuse from him; she’s quite sure of that. Her best friend has gone into a retreat abroad, and is somehow unreachable. Her boss has as good as fired her, and one of her staunch allies among the students is under investigation by the police. There are no independent witnesses to verify Chloe’s version of events; the police repeatedly draw blanks, so they’re forced to the conclusion that it seems highly unlikely that any crime has been committed.

We, on the other hand, know something bad has happened. We’re on tenterhooks as Chloe relaxes her guard … will whoever harmed her strike again?

‘The constant fear is a burning hole in my chest as I blindly wait for something dreadful and painful to happen. I’m driving myself mad with it. I want it to be over.’

A large part of her doesn’t want to know the answer. The human brain is capable of blocking traumatic memories with amnesia, and some things are too awful to remember; could this be one of them? If she gets to know what really happened, she’ll be forced to re-live the horror of the underground tomb, feel again the terror … When she starts scrutinising the people around her, looking for clues, looking for suspects, everyone seems sinister or weird. But she can’t spend the rest of her life looking over her shoulder.

When the appalling truth finally reveals itself, Chloe feels something akin to a sense of resigned calm. Sometimes it’s easier to just give up and give in to the fate destined for you. The waiting is finally over. She doesn’t have the strength to resist any longer. And it’s then that the police finally accept her story.

Phew. It was a relief to get to the end of this one. It reminded me of SJ Watson’s Before I Go to Sleep: you’re suspicious of everyone and everything. An uncomfortable place to be. I felt decidedly edgy all day until I knew the truth. Good thing I didn’t specialise in psychiatry, huh?!

 

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