Category Archives: psychosis

The human rights of psychotic patients

Buddha-like calm: R.D. Laing

Dalrymple explains that as the law stands in Britain, prison doctors

are not permitted to give treatment against a patient’s will, except under the direst emergency, for fear that they might abuse such power and forcibly sedate whomever they choose contrary to the patient’s human rights.

Hence psychotic patients

are kept in prison hospitals for months without any treatment, taking part in an interesting if not altogether pleasing experiment in the natural history of psychosis.

Recently Dalrymple observed a psychotic patient for several weeks, who

  • addressed the world night and day through his prison window in words of muddled religious exaltation
  • refused all food on the grounds that it was poisoned, his flesh melting away before my eyes
  • attacked anyone who came within reach
  • painted religious slogans on the walls of his cell with his excrement, imparting a nauseating fæculent smell to the entire hospital

It might be alleged, says Dalrymple,

that he behaved in so disturbed a fashion because he was incarcerated, and that his conduct was (in the opinion of R.D. Laing) a meaningful and enlightened response to his terrible social situation, and that he, of all the 1,400 prisoners in the prison, was acting in the most appropriate way. But this would be not only to ignore his medical history but also the fact that he was incarcerated because he had viciously and without provocation attacked a 79-year-old woman in a church, injuring her badly while reciting verses from the Bible, which suggests that his disturbed mental state preceded his incarceration and was not a consequence of it.

Dalrymple checked the situation with lawyers.

Although he had a fully documented history of psychosis and an entirely favourable response to treatment, attested to by both doctors and relatives (who said that when treated he was a pleasant and intelligent man), I was not entitled, in the name of human rights, to treat him against his will. In the name of human rights, the prison officers and the other prisoners had to endure weeks of revolting air, as well as disturbed nights in which sleep was all but impossible.

The doctors to whom Dalrymple proposed to send the patient

accepted the conditions in which he lived with Buddha-like calm that would have been admirable had the suffering been theirs. Only the prison officers, among the most despised of all public servants, seemed to be moved by the scandal. The doctors were so inured to such situations that they accepted it as normal and nothing to get excited about. The shortage of beds and the administrative difficulties that this shortage caused had steadily eroded their common humanity.

It was only when Dalrymple threatened to expose the scandal publicly, and had taken photographs of the man’s cell and said he would send them to the government minister responsible for prisons (a proceeding against the rules, but supported by the prison warden, who did not want his prison turned into a surrogate lunatic asylum), that the man was finally found a place in a hospital, where he could be treated.

The age of emotional incontinence

Lear on the couch

Was the king demented? asks Dalrymple.

If so, was the dementia of the Alzheimer’s, Lewy body, or multi-infarct type? (His variable mental states suggests the second or third.) Or was he depressed, perhaps as the result of an unresolved grief reaction to the death of his wife, mother of his three daughters? This doesn’t seem likely, since he hardly mentions her, perhaps because she died so long before the action of the play starts. Brief psychotic episode, perhaps? Manic depressive psychosis (rapid cycling type)? Or even personality disorder?

They who emote the most are believed to feel the most

For Dalrymple’s money, the critical point is made by the Duke of Kent:

Thy youngest daughter does not love thee least,
Nor are those empty-hearted whose low sound
Reverb no hollowness.

If, says Dalrymple,

Lear had realised this, then none of the tragedy and suffering would have ensued. And here the play speaks to our age: for we live in an age of emotional incontinence, when they who emote the most are believed to feel the most.

Lear and Cordelia, Ford Madox Brown, 1849-54, Tate

Mental mastery

Drawing by Hyacinth Freiherr von Wieser at the Prinzhorn Collection, 'the first, largest, and best collection of art by psychotic patients'. Dalrymple goes on: 'To Dr Hans Prinzhorn [1886-1933] belongs the honour, to my mind a considerable one, of having recognized artistic merit in the productions of psychotic persons and not merely pathological manifestations of grossly disordered psyches. It bespeaks a laudable openness and largeness of spirit in him as well as an admirably independent aesthetic judgment.'

Drawing by Hyacinth Freiherr von Wieser. Held at the Prinzhorn Collection, ‘the first, largest, and best collection of art by psychotic patients’, says Dalrymple. ‘To Dr Hans Prinzhorn [1886-1933] belongs the honour, to my mind a considerable one, of having recognized artistic merit in the productions of psychotic persons and not merely pathological manifestations of grossly disordered psyches. It bespeaks a laudable openness and largeness of spirit in him as well as an admirably independent aesthetic judgment.’