Our next meeting will be quite soon:  Tuesday December 11th when we return to the theme of psychiatry and its current discontents.

We will be discussing:  Richard Bentall's Doctoring the Mind: Why psychiatric treatments fail (Penguin 2010) We are reliably informed this is a more readable account of his approach from psychology than his  more lengthy Madness  Explained (2004), but just as lively and challenging.

Buy it here: http://amzn.to/ZbR9tz

http://www.guardian.co.uk/stage/2012/nov/14/the-effect-lucy-prebble-review

Tuesday 6th November 2012 at 6pm at the Institute of Psychiatry (seminar room 6).   

“How To Read Wittgenstein” by Ray Monk

Please buy via this link

Tuesday 6th November 2012 at 6pm at the Institute of Psychiatry (seminar room 6).   

“How To Read Wittgenstein” by Ray Monk

Date for next book club is Tuesday September 11th 2012 at 6pm, IoP, room to be confirmed.

Here are Amazon links – please use to support the book club

http://amzn.to/OIXWTL

http://amzn.to/NIBTSa

Institute of Psychoanalysis. 19 May 2012
Beate Schumacher, Vivian Green, chaired by Jenny stoker

The Institute of Psychoanalysis is currently hosting a dynamic series of lectures, film screenings and workshops under the name ‘Beyond the Couch’. These aim to engage the public and the wider psychotherapeutic community in a dialogue on the  contemporary aspects of psychoanalysis in modern life.

A recent Saturday morning lecture entitled ‘Oedipus Through the Life Cycle: Childhood’ used two case presentations to examine the clinical and therapeutic importance of the oedipal developmental stage (and its successful navigation) within psychoanalysis. Freud took his inspiration from Sophocles’ Greek tragedy, Oedipus Rex, in which Oedipus is doomed to kill his father, Laertes, and marry his mother, Jocasta. When they discover what they have done, guilt, shame and suicide follow. It is a tale of love and desire on both sides. It was posited by Freud (and later developed by Melanie Klein) as a fundamental stage in emotional development, consisting mainly of unconscious feelings of wanting to possess the parent of the opposite sex.

The first case was presented by Beate Schumacher, ‘How Can You Remember the Name of the Father? On the oedipal development of a single mother’s daughter.’ This addressed how the oedipus complex can develop and resolve appropriately when the parent of the opposite sex is absent. The case followed 6 year-old Stephanie who was likeable, curious but behaviourally troubled. She was brought into analysis by her mother concerned about her behaviour at home and with her peers. Schumacher looked at the case as one of disturbed oedipal development; how can one navigate this stage without a father? But there is always a third, put by Britton as ‘the crucial importance of the three points of the psychic triangle’ and Schumacher used Lacan’s concept of ‘the name of the father’ to conceptualise Stephanie’s difficulties and our understanding of this stage.

Viviane Green presented the second case of a man in his late thirties addicted to internet pornography. She took us through the case from a developmental perspective, looking at the symptoms as taken from the unresolved oedipal stage into adulthood. Pornography is seen here as a form of omnipotent seduction, with no need to account for the other. This has obvious parallels in that relinquishing omnipotence within (sexual) relationships is part of Oedipal development. Heather Woods is a psychoanalyst with an interest in this area and has suggested that pornography ‘colludes with a person’s wishes but conceals from them their origin and meaning’  and this, according to Viviane Green, is this way addiction to pornography acts like a classic psychoanalytic symptom (and relates to Oedipal development).

There was a good deal of time given for discussion and questions which allowed for points to be clarified and difficult concepts elaborated on. All in all, a very interesting and enriching experience that I would recommend to anyone with an interest in psychoanalytic work.

Dr Lisa Conlan
ST6 General Adult Psychiatry

Influential when it was published during the 1970s, how relevant is Anthony Clare’s Psychiatry in Dissent today?  We discussed this book last night at the Maudsley book group, and were joined by Prof Robin Murray, and friend and colleague of Clare.

Clare, a clever and urbane Irishman, was one of the first to take on the arguments of ‘anti-psychiatrists’ such as Thomas Szasz and R. D. Laing.  Although Clare was still in psychiatric training when Dissent was published he found himself propelled into the limelight as a spokesman for the profession.  This was something that Prof Murray said caused some resentment at the time, not least because Dissent is, in places, quite critical of contemporary senior psychiatrists.

After the passage of years the book is notable for both what it does and doesn’t include.  The first two chapters of the book are perhaps the strongest.  They explain the concept of psychiatric illness and the process of diagnosis, both of which have undergone little change.  Also still relevant is Clare’s critique of the Rosenhan experiment .  This is an interesting, but methodologically flawed, study.  Controversy was raging about it in the mid-70s and its results are still cited uncritically today.

There’s no mention of ADHD, PTSD or bipolar spectrum – these didn’t ‘exist’ then.   A similar book written today would need to address controversy of the efficacy of SSRI antidepressants.  There is a chapter on psychosurgery, something of a non-topic now, and already on its way out during the 1970s.  The 40s, 50s and 60s had seen lobotomy used for a wide range of presentations from schizophrenia to migraine.

The final chapter “Contemporary psychiatry” is notable in that in many respects it echoes many of the problems of psychiatry today, as if nothing has changed: poor recruitment to the specialty and under provision of services.

Towards the end of his life Clare talked about updating Dissent, but a heart attack intervened.  It would be nice to have a contemporary critique of psychiatric practice aimed at the layman – a modern Psychiatry in Dissent is sorely required today.

At a recent meeting we held a screening of the film Shock Head Soul which is about the experiences of Paul Schreber who, at the turn of the 20th century published a famous account of his experiences of (what others saw as) mental disorder.  Afterwards Helen Taylor-Robinson (psychoanalyst and fellow of the Institute of Psychoanalysis London) and Clive Robinson (psychiatrist) talked about their work on the film, with which they were both involved.

They’ve kindly answered some questions for this website which give a flavour of the film’s subject matter and themes.

FP: Can you tell us about the film and how it tells Schreber’s story?

HTR & CR: The film is an imaginative drama documentary based on the German judge Daniel Paul Schreber’s Memoirs of my Nervous Illness (1903). The film is in narrative form, set in the period of the late nineteenth, early twentieth century. It depicts the key episodes of Schreber’s illness, his admission into care and treatment, and his subsequent release by the courts, after his plea on his own behalf (through the Memoirs) to be allowed his freedom, even though he continues to be unwell.

Alongside the narrative, and woven into it, are sections of commentary brought to bear on important questions regarding Schreber and his condition, which several experts from the fields of present day psychiatry, neuro psychiatry, psychoanalysis, the arts and film history contribute to the debate about mental illness and its treatment and care. These experts are dressed in 19^th century costume as if they were part of Schreber’s time, though they comment with the expertise of today. This blurring of time past with time present was a deliberate choice in making the film, in order to provide consistency with the way in which the various forms used in the film (documentary, animation, drama) are allowed to ‘bleed’ one into the other. This echoes an aspect of DP Schreber’s experience, where ‘reality’, ‘imagination’, and ‘delusion’ blend, interweave and collide and he struggles to make sense of it all. It also felt important to position the ‘expert’ commentators of today as somewhat in the same position as the experts of the late nineteenth/early twentieth century. That is, they are attempting to provide explanations, and suggest treatments based on the level of knowledge and understanding available. Our twenty first century knowledge may be more advanced in some respects, but it does not give us a definitive understanding, or a solution to many of the problems faced by Schreber, his family or the psychiatrists involved in his care. What we knew in the past about mental illness, its effects, and the most appropriate way of behaving towards someone like DP Schreber, may today appear to be better informed, may overlap with or may differ from then, but it continues to pose open and problematic questions.

Sections of the film also use animation to depict some aspects of Schreber’s delusional systems. Again the aim is to represent some aspects of the alternative reality experienced by someone in his situation and the suffering of those immersed in powerful internal processes. The viewer is subject to these ‘creations’ to some extent, as is Schreber. These animations form the basis of a separate art installation that has been staged alongside special screenings of SHS. The literal reality of these works of the imagination, conceived from the Memoirs by Simon Pummell the director, serves again to give weight and credence to the experience Schreber underwent.

Thus, the whole film is a complex interweaving of all these modes of communication with the viewer to try and engage affectively with Schreber’s circumstances—his detailed highly articulated personal autobiographical account of his visions/delusions and what he took them to represent. As a multi media work, Shock Head Soul, is a visual testament to the man and his belief system, a strange tableau of madness, and our responses to it, re-imagined.

FP: How did you come to be involved?

HTR: As a psychoanalyst (HTR) I had worked with Simon Pummel the film’s director some time ago when a film animation symposium was organized at the National Film Theatre where I commented with others (including Professor Ian Christie who also appears as an expert in SHS) on Simon’s work and that of another film animator Ruth Lingford. I have had an interest in the relationship of psychoanalysis to the arts over many years, and in particular to film, since the inception, in 2001, of The European Psychoanalysis and Film Festival (EPFF) that is held biennially at BAFTA by the British Psychoanalytic Society and to which I, and fellow psychoanalysts, film makers, performers and academics and have regularly contributed.

Simon got in touch about this project of his, something he has wanted to do for many years and together we worked, initially, the two of us, on the idea of the film, the background research for it, the seeking of funding and the working on several screenplays to completion, and I brought in my colleagues, including my husband, Clive Robinson, a Consultant in general psychiatry, and I prepared the questions with Simon for them to answer on screen. I am described as developing the concept of the film with Simon its director. We really enjoyed filming the interviews on screen with Simon and his crew—and then Simon shot the narrative with his actors, developed the animation and the art installation and the film went to the Venice Film Festival and the London Film Festival (2011) and the Rotterdam Film Festival (2012) and it continues its festival tour to the Czech Republic and Australia and then the UK this autumn.

I, and my husband and our colleagues have really enjoyed working in quite a different way on this film project, learning slowly what was wanted, and I have felt privileged to be asked to be involved. Psychoanalysts, despite Freud’s (among others) case study of Schreber which is part of our training and development, do not usually work with the floridly mentally ill, and they certainly do not (usually) become part of the creation of a film process—certainly not one as complex and, in my view, as original as this one!

FP: How is the Schreber case relevant today?

HTR & CR: Probably very few young trainee psychiatrists will read a first hand account of being as unwell mentally as DP Schreber is. Many psychoanalysts will only have read Freud’s commentary on Schreber, not his own memoirs, which this film is about. Sociologists, philosophers, professors of cultural studies, and others with political motives have focused on Schreber’s document, to make the case for a given aspect of interest to them, which Schreber’s story allows for—lends itself to one could say. Artists and writers, also, and those studying the religious aspects of Schreber’s delusional system, have something to say about this multi faceted document of madness—because there is so much first hand graphic detailed writing about an incomprehensibly mad experience that has very little apparent connection to our so called reality. To be with Schreber and try to follow him in his labyrinthine world is to submit to a very disturbing process. Yet Schreber makes his highly controlled vision available, powerful and immediate, even if, largely, ‘deadly’ to be in.

For most psychiatrists, and others in mental health services who spend time with seriously unwell people in their clinics or on the wards, many aspects of DP Schreber’s experience and behaviour will seem familiar. However, this kind of protracted and persistent monologue of madness is much less likely to occur nowadays, and his ability to represent his world in such an organized albeit complex fashion is far more unusual. In the twenty first century it would be extremely rare for someone to have Schreber’s type of experience without receiving very active interventions and treatment; at the very least the reasoning world would be much more likely to interrupt the experience continually and therefore dilute and diminish its power. Schreber’s story—in his memoirs—is unadulterated and horrifying, yet he is able to present it, and explain it, and account for it, on his own unquestioned terms. It allows all of us to try to imagine what it is like to be continually in the grip of something we usually have no access to whatever. This in itself is educative. But it also highlights the richness of our own less mad world and the riches of a different kind–that of Schreber’s. Should we not try to see such a different ‘other’ reality and discuss and debate and try to understand what we can from it?

In a sense independent of the actual content of his experience, once Schreber becomes unwell, the impact of the change in his behaviour on those around him, his changed position in the wider society, the question as to whether society has any right to interfere, where to treat him, whether to force treatment upon him, and when to allow him his liberty are as pertinent now as at the end of the nineteenth century.

FP: Which is most important, Schreber’s memoirs or Freud’s interpretation?

HTR & CR: As the film, SHS, points out all of us engaging with this subject of Schreber, are engaging with a text, not with a person and his experiences in situ, and we have no access to the actual events Schreber writes of—we have only his account. And Freud when he came to study the published Memoirs of Schreber, was doing so under the influence of Jung who was exploring the psychoses, and with a remit to further develop psychoanalytic ideas in relation to the psychoses, and to continue to refine his theories of psychic structures, to go on building his metapsychology. For Freud, without Schreber in the room to discuss all this with, in the give and take of an analytic process, as he states, his study is a severely limited kind of exploration—a nonclinical one—a theoretical one at a particular point in his own, that is, Freud’s, growth.

As to whose document, Schreber’s or Freud’s is most important, one can only answer from the perspective of the model of mind one is currently using to look at either. For psychoanalysts, like myself (HTR), we are reading and learning about a stage in psychoanalytic development—learning about the workings of paranoia, of grandiosity, of narcissism, of projection and repression, and Freud is an eloquent teacher, even if these ideas do not fit Schreber perhaps so well today, when we psychoanalysts have taken our discipline further. But the Schreber case by Freud is a piece of the history of psychoanalytic development, and, as such, is important reading for us. Inflected by reading Schreber’s memoirs themselves I would say—as John Steiner in his paper on Schreber does—(he uses Schreber’s writings AND Freud’s to go forward with his ideas drawn from psychoanalytic thinking of today)– the student psychoanalyst of the present, or indeed any other serious student of the mind, may judge and evaluate Freud’s work and that of Schreber’s together.

For those interested in other models of the mind, in literary, philosophical, political, social or indeed psychiatric frames of reference, Schreber’s memoirs are primary, Freud’s secondary. Overall Schreber’s testament as a statement about what it is to be human and suffer in this way is highly and disturbingly original—in that sense it has import beyond Freud’s case study. For psychiatrists the text of DP Schreber provides the working document of someone struggling with all his intellectual powers, with all the structure provided by his legal training and with his very considerable personal strength, to make sense of his experience and the meaning of his life.

FP: How was the film’s title decided on?

HTR: One of the features of this film was the interest in Schreber’s father, Moritz Schreber who was an educationalist who developed ideas and practical equipment for the controlling and rearing of children in Germany—he was held in very high esteem and his methods and equipment were tried out on his son and were very popular indeed throughout the land. They may appear barbaric in conception and application to our eyes—and yet at the time were acceptable ways of trying to manage the impulses and primitive behaviours of young children. As well as attempts to control the body, the control of conduct and morality was disseminated by such very popular children’s illustrative books like Strewwelpeter,(by Dr Heinrich Hoffmann) which means ‘shock headed peter’ in which a boy is denigrated for leaving his hair and his nails to grow long and dirty—these are cautionary tales with vivid words and pictures– to frighten or shame a child into obedience, cleanliness, tidiness, and more.

Although one of the views of Schreber is that a lot of the content of his delusions may owe something to his father’s physical treatment of him, for his own good as it were, the question of its arising directly from this environmental impingement is another matter. Did Schreber senior bring about Schreber junior’s psychotic breakdown? This is speculation as we now know more of the likely organic sources of the psychoses rather than as a result of external forces. But ofcourse those external forces come into play in the psyche’s use of them as the illness develops.

So it was thought that the popular children’s book (quoted directly in SHS where a child’s thumbs are cut off for thumbsucking—and this rhyme Schreber repeats to himself in his padded cell –with a reference to his castration there in isolation and further withdrawal from others) could have its title adapted and that Schreber could be seen as the outcast or naughty boy, Strewwelpeter, with not just his body or his conduct treated with unenlightened methods, but also his soul itself—subjected to physical and intellectual methods of care within German psychiatry and its institutions. The use of this widely known text, Strewwelpeter, thus adapted, is an intended symbol—one of many compressed poetic references the film uses to tell its’ tale. In addition,, the term ‘soul murder’ is coined by Schreber (Chap 2 of the Memoirs) to refer at length to the means by which, in Schreber’s view, his soul, and that of others, at different times and for different purposes, was procured and possessed by ‘another’ in order, among other things, to prolong life for that soul at the expense of the ‘stolen’ one—to which terrible things were also required to be done.

FP: What has been the reaction to your film?

HTR& CR: I think we have been pleased that the unusual subject matter and its complex treatment has won attention, raised questions, moved and saddened audiences and overall held and engaged them. At the Venice Film Festival the question was put as to whether we feared this film would actively make people feel mad. It seems to me a question to ask—but it has not been the usual response. We hope it reflects on madness rather than engendering it—but of course it depends on the viewers and film is a very powerful medium—it is a powerful introject, to use a technical term, and it needs working on and shaping after the experience, but it is also a powerful provoker of projections—and things are attributed to it that come from the viewers rather than the film itself necessarily.

Usually people have said, in question and answer sessions after the screenings, how serious and dignified a picture it is of mental illness, those with a serious mental illness have said it felt like the most authentic account of what it is like to be ill in this way, others have been perplexed and have felt the film gives no clear or straightforward answers, and yet as those behind its creation would argue, this is a good not a bad thing—the film certainly bears viewing several times. It may be that paradoxes rather than simple yes or no answers are there to be found in the film if it can be digested slowly. And people have also said how surprising it is that such an amalgam of forms and structures and methods of film making have come together successfully into one.

We do hope that with screenings and discussions and dissemination of the ideas around Schreber, —whose work is such a complex one in its own right–that Shock Head Soul a kind of testament to the art (skill) of the insane will take off for the viewers, get challenged, debated, questioned and hopefully enjoyed also, and come to have a life of its own and a proper place in the genre of truly experimental film.

Drawn from Distress to Recovery

A Call for ‘Graphic Memoirs’.
Editors: John Stuart Clark & Theodore Stickley

An undervalued feature of the recovery movement is the powerful narratives of those who have survived mental health problems and the psychiatric system.

Increasingly people in distress or recovery have turned to the graphic medium of comics to tell their sensitive stories, sometimes collaborating with friends or therapists, more commonly working alone to produce a personal diary or recollection. While a few have emerged as published ‘graphic memoirs’, most never see the light of day, or at best, are only accessible as web-comics.

Going some way to correct this, we invite submissions for a compendium book of graphic short stories of personal journeys (or part of) to be published early next year. The invitation goes out to everybody, past or present ‘sufferer’, regardless of artistic or literary expertise.

The editors appreciate that the form and dimensions of any proposed book are critical to those who create comics, so before committing, we ask for expressions of interest.

This should be no more than a title and paragraph outlining your proposed story, plus a sample page of artwork submitted as a jpeg no bigger than 2MB. As a rough guide, imagine the finished book is A4 format and in black & white. Your finished story or episode should be no more than ten pages long, but can be as short as a single page.

Provided it is indicative of your style or that of the person you will collaborate with, the sample artwork can be of anything and any dimension. It is not necessary to work up a sample of your proposed story. Postal submissions will be accepted, but your outline must be typed, the artwork must be a photocopy, and a stamped self-addressed envelope must be included. Foreign language contributors will need to provide their own translations into English, and the page must read left to right.

The editors will respect full confidentiality should you wish your work to be included anonymously, but we need full contact details, even if you prefer to use a pseudonym. The editors cannot team up writers with artists, or visa versa.

COPYRIGHT: Standard copyright practice is adhered to.

DATA PROTECTION: The editors will retain entrants’ personal data for use solely in conjunction with work on this project and will not make this available to other organisations.

Digital submissions: Theo.Stickley@nottingham.ac.uk see also www.brickbats.co.uk

Postal submissions: Theo Stickley, Faculty of Medicine, Institute of Mental Health Building, University of Nottingham, Jubilee Campus, Wollaton Road, Nottingham NG8 1BB, U.K.

The deadline for expressions is July 31^st 2012.

Meeting tonight – Wednesday 2nd May 2012

Screening of Shock Head Soul

Small Lecture Theatre Institute of Psychiatry 6.00pm

Followed by discussion with Helen Taylor-Robinson (screenwriter and psychoanalyst) and Clive Robinson (psychiatrist) who appears in the film.

Born in 1842 Daniel Paul Schreber was a successful German judge.  In this middle age he developed delusions of control, suffering the belief that he was shifting gender and that his body was subjected to cruel ‘miracles’. He was diagnosed as having dementia praecox and spent time in an asylum.

In an effort to be judged sane enough to return to living with his wife and daughter, Schreber described his illness in his book Memoirs of My Nervous Illness.  This became influential in the history of psychiatry and psychoanalysis due to its interpretation by Sigmund Freud.

Shock Head Soul interleaves documentary interviews, fictional re-construction and CGI animation to portray Schreber’s story. The film’s mix of forms creates both a love story and a cinematic essay that explores the borderline between religious vision and deluded fanaticism, and explores the intimate link between family secrets, psychiatric diagnosis, and the limits to our contemporary understanding of mental illness.

The film is directed by Simon Pummell and was shown at both the Venice and London film festivals.  More details of the film here

(Unfortunately this is not a public meeting and is for employees of the Institute of Psychiatry/South London and the Maudsley Trust and by invitation)

Michael Fassbender seems to have a thing about sex.  First he appears as Brandon in Shame, Steve McQueen’s unflinching examination of disturbed sexuality and damaged relationships, and then he plays a repressed, sado-masochistic Carl Jung spanking a gasping and grimacing Keira Knightley in David Cronenberg’s A Dangerous Method, which purports to explore the origins of psychoanalysis and the relationship between Jung and an omniscient, perpetually cigar-puffing, paternalistic Viggo Mortensen as Freud.

The former is by far the more successful film.  I went with some reluctance, having read reviews that it was about ‘sex addiction’.   In the event, it was a sensitive treatment of two broken individuals, a brother and sister (borderline personality disorder played to perfection by Carey Mulligan).  Brandon acts out his internal bleakness through compulsive sexual acts both with himself and others, ultimately resorting to homosexual and orgiastic sex in self-flagellating desperation.  The sex and nudity are unadorned and in the Greek sense of the word, pathetic.  Eros is conspicuously absent, and when Brandon is offered the opportunity of a consensual, adult sexual relationship, he backs out in confusion and, true to the film’s title, shame.

There are no easy solutions, and no comforting explanations as to why the brother and sister ended up this way, though there are hints of significant childhood traumas, and it is hard to escape the conclusion that Brandon and his sister were subject to extensive sexual and emotional abuse in childhood.  All in all, it was a moving and accurate portrayal of psychopathology which was all too familiar.

‘A Dangerous Method’, co-written by Christopher (‘Dangerous Liaisons’) Hampton and based on his stage play, was not so much dangerous as dull.  After a melodramatic start, in which Keira Knightley as Sabina Speilrein is forcefully carried, rigid and screaming, into a mental institution, where she is ‘cured’ by Herr Doctor’s Jung’s painstaking talking treatment, it rapidly dwindles into a cross between an inaccurate bio-pic and soft porn.

The film follows with breathless fascination, not necessarily shared by the viewer, the affair between Jung and his ex-patient, and the gentle but beautiful suffering of his gentle but beautiful wife.  For good measure there are technically laboured conversations between Jung and Freud about the importance of various precepts central to their new method of treatment, which Freud has decided to call psychoanalysis, which bear as much resemblance to real clinical discussions as Dumbo does to a real elephant.

It did, however, feature lots of big psychiatry names in bit parts such as Eugen Bleuler (‘do have a go with your new treatment, Dr Jung, because my methods have failed’ – I may have misquoted a tad) and Ernest Jones, whose appearances would have significance for almost nobody apart from psychiatrists of a certain vintage.  The lovely Vincent Cassel was a deliciously reprobate Otto Gross, and the cast list told us that we also caught a glimpse of the young Anna Freud, though I had no idea which one was her amongst the many Freudlets gathered round a dinner table.

To resume:  Shame – compulsory viewing for all practising clinicians; A Dangerous Method – I’d prefer to take the medication.

by Dr Abby Seltzer

Picture credit: Momentum films

We recently visited Yayoi Kusama retrospective at Tate Modern.

Kusama is perhaps Japan’s best-known living artist.  Now in her ninth decade her body or work stretches back to the 1940s and encompasses painting, sculpture, drawing and collage.  She is best known for immersive large-scale installations.

In the 1960’s and 1970’s she became a well-known figure in the New York avant-garde, returning to Japan in 1973.  Since 1977 she has lived voluntarily in a psychiatric institution and much of her work is marked by obsessiveness and a desire to escape psychological trauma.  Her installations are an attempt to share her experiences with endless dots and infinitely mirrored space.

Wikipedia entry

Yayoi Kusama autobiography

Tate Modern page

Artist official site

On the cover of the BJP

Observer review