Tom Stafford
If someone tells you something that isn’t true, they may not be lying. At least not in the conventional sense. Confabulation, a rare disorder resulting from severe brain damage, causes its sufferers to relentlessly invent and believe fictions—both mundane and fantastical—about their lives. If asked where she has just been, a patient might say that she was in the laundry room (when she wasn’t) or that she’s been visiting Scotland with her sister (who’s been dead for 20 years), or even that she isn’t in the room where you’re talking to her, but in one exactly like it, further down the corridor. And could you fetch her hand cream please? These stories aren’t maintained for long periods, but are sincerely believed.
While it only affects a tiny minority of those with brain damage, confabulation tells us something important: that spontaneous, fluid, even riotous creativity is a natural part of the design of the mind. The damage associated with confabulation—usually to the frontal lobes—adds nothing to the brain’s makeup. Instead it releases a capacity for fiction that lies dormant inside all of us. Anyone who has seen children at play knows that the desire to make up stories is deeply embedded in human nature. And it can be cultivated too, most clearly by anarchic improvisers like Paul Merton.
Chris Harvey John taught me “improv” at London’s Spontaneity Shop. He can step on stage in front of 200 people to perform a totally unscripted hour-long show. There’ll be no rehearsal, no discussion of characters or plot. Instead, he and the other actors invent a play from scratch, based entirely on their unplanned reactions to each other. This seemingly effortless, throwaway attitude is the opposite of what we normally assume about the creative process: that it is hard work. Artists are often talked about in reverent, mystical tones. Art does connect with deep and mysterious human forces, but that doesn’t mean it is only available to a select few who, through luck or special training, are allowed to invent things.
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Paul Broks
Sunday lunch. it’s a family reunion. Across the table, Ebby shoots me a smile and jams a finger into her right nostril. Would I like to see her bogeys? No thanks, I say, but too late. The finger reappears capped in a glob of snot. Such a charmer, my wife says on the drive home. Charming? Nose-picking at the dinner table? Disgusting, surely. Picture Ebby as a dribbling great aunt and there’s no question. But she’s a pretty two year old, and purity trumps repugnance.
Two year olds are full of emotions like joy, fear and surprise, but have no sense of disgust, which usually emerges around age four or five. Disgust is a late developer in evolutionary terms, too, and may be uniquely human. Infants and animals reject bad tastes, but taste aversion and disgust are not the same. Disgust has more to do with offensiveness. Chocolate tastes good, but shape and texture it like dogshit and most adults are put off. Not so two year olds. That was an experiment devised by pioneer disgust researcher, Paul Rozin. He and a young philosopher called Jonathan Haidt went on to explore disgust and morality. In his 2006 book The Happiness Hypothesis, Haidt describes the evolutionary gear shift from “core disgust,” which is triggered by the physically repugnant, to “elaborated disgust,” which is provoked by the morally outrageous.
Consider the following scenario: bloke goes to the supermarket and buys an oven-ready chicken. He gets it home, slips on a condom, and has sex with it. Then he cooks it thoroughly and serves it to his friends for dinner. What’s wrong with that? No one is any the wiser. The meat is uncontaminated and well cooked. Scenario two: one day (after a nice chicken dinner) our friend and his sister decide they would like to have sex together, just the once. So they do, enjoyably, using contraception, and agreeing to keep it a secret. The one-off experience enhances their relationship. Is that wrong? No one got hurt. Well, we can all agree such behaviour is distasteful and degrading, but can we give convincing reasons why we feel this way? Most people can’t. They flounder in a state of moral dumbfounding—knowing intuitively that something is wrong but being stuck for a rational justification. According to Haidt, this is because the brain has two separate moral evaluation systems, one driven by primitive, automatic reactions, the other by conscious reasoning. The ancient, intuitive system takes the lead. We think we use reason to make moral judgements, but in fact the conclusions we reach are already preset at gut level.
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Alexander Linklater
Trauma
by Patrick McGrath (Bloomsbury, £14.99)
“Dread,” says Dr Charlie Weir, the psychiatrist-narrator of Trauma, “signals not the imminence of a catastrophic event, but… the memory of a catastrophic event, one that has already happened.”
By raising this observation towards the end of his new novel, Patrick McGrath is not only steadying the reader for a denouement, he is describing his own narrative method. Charlie is a New York City psychiatrist helping his patients to deal with traumatic events in their past while trying to sort out his own life, unaware that he too is being manipulated by a hidden event. In little more than 200 spare pages, McGrath digs back through the chronology of Charlie’s life to expose his psychological origins. The brilliance of the storytelling lies in the way it gives this retrospective process the illusion of forward momentum: we march onward towards an undisclosed past.
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Alexander Linklater
To the annals of human depravity we have now added Josef Fritzl: the man who gave concrete shape to the incestuous unconscious. He fathered seven children in his own image through the quasi-mythical act of raping his daughter. One died in infancy; three joined the upper world of bourgeois Amstetten; the other three were consigned to the cellar below. For 24 years in this self-created underworld, Fritzl enjoyed the power of Hades. “The cellar of my house belonged to me alone,” he told his lawyer. “It was my kingdom, to which only I had access.”
As media commentators have sought to explain the ghoul of Amstetten, they have split between three types of analysis: the psychiatric, the theological and the cultural. The man is insane; or he is evil; or he is an incarnation of the pathology that begot Hitler and the idea of consigning a race of people to cellars. Though contradictory, these three tropes have a common objective: to keep Josef Fritzl at a safe distance from humanity.
Yet the anxiety of this case lies in its sinister ability to draw us in empathically. There are those pictures of the narrow entrance beckoning down to the cellar, the neat toilet facilities, the children’s poignant drawings. There are haunting details: the airlessness of the space, Elisabeth teaching her pale offspring to speak, the underground family dinners, the patriarch in the bed. All of us can imagine family life and, in the creepiest possible sense, Fritzl was a family man.
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Annie Maccoby Berglof
Discuss this article on First Drafts, Prospect’s blog
The recent Hull University report, which suggested that antidepressant drugs were no more effective than placebos for mild depression, was greeted as a welcome antidote to the age of pills. Yet missing from the media debate was an awareness of a new and fundamental shift in our understanding of mood disorders. Many of those who wrote articles lamenting their experiences on Prozac and Seroxat are, in fact, still taking psychiatric pills—but mood stabilisers rather than antidepressants. They have simply traded in one diagnosis for another. Formerly depressed, they are now officially bipolar.
If trends in the original Prozac nation, the US, are anything to go by, bipolar disorder will be the next big mood disorder to hit Britain. All across the US, the chronically gloomy have been re-diagnosed as moody. If Woody Allen was neurotic in the 1970s, he would have been declared depressed in the 1980s and bipolar today (maybe he is). Even depression guru Andrew Solomon, who dissected gloom in his bestselling The Noonday Demon: An Atlas of Depression, revealed not long ago that he is bipolar.
First used in the 1960s and 1970s as a new name for classic manic depression, bipolar disorder has subsequently been broadened as a category to include a number of softer symptoms. The Diagnostic and Statistical Manual of Mental Disorders (DSM), the American “bible” of mood disorders, officially lists four kinds of bipolar disorder. Manic depression has been recast as bipolar I, for extreme swings between “episodes” of depression and exuberance that can careen into mania. The second kind listed in the DSM, bipolar II, is a harder-to-spot version in which patients seesaw between depression and milder ups or “hypomania,” meaning, literally, “beneath” mania. The third type of bipolar disorder, which is characterised by milder but equally disruptive ups and downs, is called “cyclothymia.” A fourth type, NOS (or “not otherwise specified”), covers conditions that don’t conform to any of these labels.
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Adam Phillips
There is a famous sentence in Thomas Jefferson’s declaration of independence that formulates something essential about what most modern liberals believe about both government and education: “We hold these truths to be self-evident, that all men are created equal, that they are endowed by their Creator with certain unalienable Rights, that among these are Life, Liberty and the pursuit of happiness.” Some of us might not believe in the creator part, and all of us would assume now that by men Jefferson means men and women, but probably none of us would quibble with the idea that people are born, if not created, equal, and that they have a right to life and liberty. But what does it mean to have an unalienable right to the pursuit of happiness? At first sight, it seems to be a pretty good idea; no one, presumably, wants to promote the pursuit of unhappiness. If we are convinced of anything now, it is that we are pleasure-seeking creatures who want to minimise the pain and frustration of our lives. We are creatures who, perhaps unlike any other animal, pursue happiness.
But fortunately, and unfortunately, the other thing we know is that pleasure, like happiness, is not as simple as we would like it to be; that people can be frightened of pleasure, or can hide their real pleasures from themselves; that they can use pleasure as a way of avoiding necessary pain (drinking alcohol or taking drugs, for example, to avoid intimacy or the useful and necessary awkwardness of social life); that they can get pleasure from their own pain and that of others; and that they can have competing pleasures (a child’s pleasure in pleasing parents and teachers can outstrip the desire to avoid schoolwork, so he sacrifices his genuine—if short-term—interests for the love and approval of the grown-ups).
“A people who conceive life to be the pursuit of happiness must be chronically unhappy,” the anthropologist Marshall Sahlins wrote in Utilitarianism. Whether or not this is true—and I think in many ways it is—it raises the question of why happiness should matter to us at all. It has certainly become the focus of much debate. Anthony Seldon has introduced “wellbeing lessons” to the curriculum of Wellington College, where he is headmaster, and some would like to see the innovation rolled out across the country. Discussions of what makes a good life, and whether virtue can be taught, are as old as literate human enquiry. But happiness is now the thing, and so we need to have some idea of what the pursuit of happiness is the pursuit of; whether education can make people anything (that is, how open to influence children are, and in what ways); and what the much-cherished phrase “making someone happy” might mean.
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William Skidelsky
I have never thought of myself as a violent or aggressive person. So it was a shock to discover, several years ago, that I am capable of behaving like a yob. The occasion of this discovery was a night out in London with university friends, which ended with some of us going back to my parents’ (unoccupied) house with a bottle of vodka. Several hours later I suggested, with the ebullience of severe drunkenness, that a girl I quite liked step out with me for an early morning stroll.
Dawn was breaking, and the streets were miraculously empty. We wandered around for a while, and soon came to a restaurant where, the summer before starting university, I’d worked as a waiter. This combination of circumstances—the bright early morning sunshine, the deserted streets, the presence of a woman to show off to—must have triggered something within me, for I decided that a spot of vandalism was in order. “I hated this place. They were bastards to work for,” I declared. “I’m going to smash it up.”
When my companion showed no sign of objecting, I set about laying into the restaurant’s pair of glass-fronted menu display cases. These were located a few metres in front of its entrance, on a sort of raised patio, and were mounted on gleaming metallic stands. (It was quite a smart restaurant.) Demolishing them was no easy task; several running kicks were required. Nonetheless, within a few minutes, the metallic stands had been uprooted, and the display cases lay on the ground, their glass smashed. My companion celebrated with a high-spirited giggle. Our morning’s work completed, we made our way back home.
What do I make of this episode now, roughly a decade later? As vandalism goes, it was fairly petty stuff: at most I caused a few hundred pounds’ worth of damage. But what I did was criminal and, if not totally mindless (I had a motive of sorts), then certainly stupid. If I had been caught, I might well have been prosecuted. My parents and tutors would not have been impressed. In my defence, all I can point to is the fact that I was, at the time, on anti-depressants. These made me feel happy, but also unleashed something manic inside me. When combined with alcohol, the effect was especially pronounced. My assault on the restaurant was only the worst of a string of regrettable incidents during this period. I was getting into a lot arguments, behaving irresponsibly, and generally was not quite in control of myself.
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Robert Drummond
The young psychiatrist shifted uncomfortably on the bench outside the court, a file of notes gripped in his sweaty right hand. The newspaper article clipped to the outside of it was entitled “Teenage suicide,” and was half hidden, like a guilty secret, under the arm of his suit.
He had only met William Holden once, six months before, on the first day of a new job. He had been meeting his predecessor’s patients, all of them for the first time, and it was proving complicated as he attempted to disentangle psychiatric phenomena from their understandable reactions to meeting a new doctor. William, however, appeared relatively straightforward. His appointment lasted 20 minutes, and provided welcome relief between one angry patient with a history of assault and another whose paperwork had been mislaid.
Fortunately, William’s notes were in order and documented how he had come to the clinic. The sparsely written professional letters suggested a difficult childhood. He was an only child whose parents had split when he was seven. His father moved away and he lived with his mother. Physically he was a slow developer. He was bullied at school. It sounded relentless. But compared to many patients the teenager had proved resilient, at least superficially. He had finished school, passed A-levels and started a foundation course in art. He may have smoked a bit too much dope, yet to the casual observer he had survived adolescence. He now had a dog and the beginnings of an adult identity.
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Michael Blastland
Discuss this article at First Drafts, Prospect’s blog
Neil Vickers: It’s a striking fact that before the late 1950s there were very few “illness narratives,” and those that did come to public notice were produced almost entirely in the US. Until the mid-1970s, illness narrative was really just a first cousin of the self-help book; about the nuts and bolts of being ill, not about the effects on your life. What I think began to transform the genre was that by the late 1980s there were a number of celebrity illness narratives that changed the rules significantly—like William Styron’s Darkness Visible—and then there were lots from the early 1990s. It’s around that period, early to mid-1990s, that you start to get the first volumes of criticism about the form, and this criticism is very much about “how do you avoid selling out?” when you’re writing as a patient, especially if you have an illness that’s scaring the hell out of you. One influential critic is John Wiltshire, who is now working on a history of medicine solely from the patient’s point of view.
Michael Blastland: When you say “selling out,” do you mean that the concern is that people may be exploiting something deep and personal in a slightly sordid way?
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CAR Hills
Last year was the worst year of my life. On Christmas Eve 2005, I unexpectedly, at the age of 50, went into my first episode of psychosis. This lasted until March and, because my delusions had been giving me hope, was followed by deep depression.
The worsening of my mental health was connected with the deaths, in 2002 and 2004, of my parents. I had had a poor relationship with my father, and did not see him for the last 20 years of his life. In contrast, I had been deeply attached to my mother, but this relationship also ended badly, with my mother willing her house, her only substantial asset, to a much younger lover. I became taken up with (entirely futile) plans to murder him, which were diagnosed as obsessive-compulsive disorder. Later, a visit to the place where my mother had lived, and where her lover occupied her house, intensified my sorrow and my mind gave way.
I suffered from delusions which seemed very exciting and significant at the time, but which I have since learnt are the commonplaces of psychosis. I believed that I was at the centre of world politics, that I was three quarters Jewish and also the grandson of Dr Goebbels, that some of my friends were secret agents and trying to murder me, that my parents had been international criminals and had hidden a fortune away for me in a Swiss bank, and that my mother’s lover was also her son and therefore my half-brother. None of this, as far as I know now, was true. I was eventually admitted to hospital in a frenzied state and screamed the place down in the intervals of being put on to Risperidone.
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