Out of mind

On a cold afternoon in south London, they gathered outside the crumbling façades of a Victorian terrace: two psychiatrists, a social worker and police in body armour. Then came the ambulance, followed by a locksmith. "Here we go," said the social worker with a sigh. The group converged on number 71.

A policewoman rang the bell for flat two. No answer. She rang again. With a squeal of cracked paint, the window above them opened. A middle-aged black man with a ragged beard stuck his head out of the window, a spliff in one hand and a can of beer in the other. "What you want?" he bellowed.

"Hello, Mr Lewis, it's Dr Adichie here," the older psychiatrist called up. "Can we come in for a chat?"



"My doctor is dead!" the man yelled, triumphantly waving his spliff and splattering the social worker with beer. "I am Haile Selassie. I am the son of Jesus Christ. You cannot come in!"

The locksmith hammered a screwdriver into the mortice. The wood splintered and two policemen crammed themselves up a narrow staircase. By the time the psychiatrists had followed them in, Victor Lewis was already handcuffed. The room was chaotic, but not from any struggle. Damp wallpaper hung loose from the ceiling, floorboards had been torn up, wires like multi-coloured spiders' legs sprouted from a hole where the entry phone used to be.

The psychiatrists' interview didn't take long. Dr Adichie had a calming effect on his patient. They got on well, despite Victor's occasional rants against Nigerian "coconuts." The pattern of his symptoms had been recurring from the time of his first admission in 1986. It all started with voices in the radio, telling of black men being persecuted by the police. There was a recording device twitching under the skin of his face, Victor claimed, which caught on his razor. Examining the blood between his fingers, the twitches became voices which coalesced into a single, overwhelming realisation: there were devilers under his skin and under the floorboards.

The paranoid symptoms of schizophrenia in its pure form can be almost abstract, and eerily devoid of emotion. But Victor's illness was also desperate, grandiose and raging: schizo-affective disorder, sometimes nicknamed the "Brixton psychosis," because the combination of schizophrenic delusions with mania appears more commonly among Afro-Caribbean patients. Research shows differing rates of mental illness among different ethnic and migrant groups, with the black population suffering less from anxiety disorders but significantly more from psychosis.

No one really understands why. Schizophrenic symptoms occur in all ethnic groups. The competing explanations, biological or social, of why some groups experience higher rates are fraught with tension. Perhaps the close family networks of south Asian immigrant groups act as stabilisers in an isolating city, while the more fragmentary family circumstances of Afro-Caribbeans have the reverse effect. Some argue that such findings reveal an inability among researchers to understand black culture; some that a prevalence of cannabis use plays a part in shaping Afro-Caribbean psychosis; others that racism either causes the disorder, or causes white psychiatrists to over-diagnose black patients.

For Victor, the basic problem was his reluctance to stick to his medication. Neighbours called the police because he'd been screaming and banging the walls. Section 3 of the Mental Health Act is perhaps the most authoritarian piece of legislation in the British statute book. It allows doctors to lock up a patient for compulsory treatment for far longer than anti-terror legislation can hold a prisoner without charge. But the pink sectioning papers require a complex array of signatures: hence, in Victor's case, two psychiatrists and a social worker. His remaining relatives had long since given up on him.

The young psychiatrist had familiarised himself with Victor's history. His parents had arrived from Jamaica in 1963, and he was born in 1965. Shortly afterwards, his father walked out. Victor's mother put the collapse of her marriage down to the stress her husband had been under trying to find work and watching his dreams evaporate.

As a child, Victor had been shy and introverted: a loner rather than a street kid. He left home at 16, got a job packing swivel chairs, and then, with no prior warning, aged 21, had his first psychotic episode. During the 1990s, attempts were made to treat him in the community, but Victor refused to accept that he was ill. His adult life had been a constant journey through a psychiatric revolving door. There was no long-term way of either keeping him in hospital or enforcing treatment at home. He would improve on medication, leave the ward, get back on cannabis, then back on to the ward. It was a hell of a fate, the young psychiatrist thought. But it would be another kind of madness to pretend that his condition wasn't real, that it was somehow invented or exaggerated by psychiatrists like him and Dr Adichie. He turned to Victor as he was led to the ambulance. "We'll try and sort out your flat while you're in hospital," he said gently.

Victor stopped and turned back. He sized up this young, white doctor with his neat suit and concerned expression. "What the fuck do you know about what it means to be a black man in London?" For a moment, Victor's voice sounded completely rational.