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

One year ago I decided to start a book group. Bang on trend for 2011 eh? However, this wasn’t any old book group, this one had decidedly high falutin’ aims. With psychiatric training focusing increasingly on competencies and MRCPsych requirements, there seems little time left for learning about concepts critical to the development and history of psychiatry and related fields e.g. psychoanalysis, psychology, philosophy, sociology, anthropology, neuroscience etc… Such disciplines can be hard to access for the uninitiated and a medical training doesn’t help much to furnish one with the necessary critical tools to appraise, say, a philosophy of mind book however relevant it might be to psychiatry. Thus Reading the Mind was born; unashamedly educational and aimed at psychiatric trainees wanting a little bit more.

Our first book was The Divided Self  by R D Laing (1960) a seminal work by a key figure in the anti-psychiatry movement critiquing the biological model of schizophrenia. Here Laing reworks psychosis as an understandable response to intolerable pressures placed on the patient by society and the family. This was followed by Notes Upon a Case of Obsessional Neurosis by Sigmund Freud (Rat Man) (1909), a great introductory text to Freud’s core concepts of psychopathology, particularly neurosis, and an exemplar case history on the descriptive phenomenology of OCD. Next, we discussed Consciousness Explained by Daniel Dennett (1994), an influential and contemporary philosophical critique of the paradigm we use to think about consciousness outlining the foundation for his own theory of consciousness. Opening Skinner’s Box by Lauren Slater (2004) provided the group with a run-through of the ten most important psychological experiments of the 20^th Century and in doing so provided a crash-course in the recent history of Psychology. We then read The Loss of Sadness by Allan Horowitz and Jerome Wakefield (2007) a devastating critique of the current concept of depression within psychiatric nosology; Illness as Metaphor by Susan Sontag (1978) a brilliant essay on the dangers of reducing illness to metaphor and the pervasive effect on doctor, patient and society; Winnicott by Adam Phillips (1998) a welcome introduction to his life, work and key concepts, and finally, The Mask of Sanity by Hervey Cleckley (1941,1982) a seminal study on the psychopath. Grounded in case studies, it profiles and refines the concept of the psychopath, and was used heavily by Robert Hare in developing his PCL checklist.

Our next meeting is on Tuesday 22^nd May and we’ll be discussing Anthony Clare’s Psychiatry in Dissent (1980).  Unfortunately, due to our funding, Reading the Mind is only open to Maudsley trainees.  However if you’re interested in starting a similar book group then please get in touch.

Dr Lisa Conlan, ST6 General Adult Psychiatry, SLAM.

There’s an interesting programme just broadcast on BBC Radio 4: Writing Madness

From the BBC website:

“Vivienne Parry takes her diagnoses of literary heroines into the 20th century and the age of Freud, the Great War and the explosion of the ‘sciences of the mind’ focusing on three great works of fiction, mixing contemporary psychiatric and literary insight.

How did modern literary and psychiatric ideas meet and how did each shape the other? Do these heroines show literature of the period to be a critical – and even emancipating – force…or is fiction really medicine’s stooge? Novels on the couch include Scott Fitzgerald’s Tender is the Night and Virginia Woolf’s Mrs Dalloway….interestingly with both novels there’s a tendency to base the heroines on real people – Nicole Diver is based on the case history of Fitzgerald’s own wife Zelda, whereas Woolf’s Mrs.Dalloway comes very close in literary terms to what Freud calls ‘self-analysis’ – one difference is that Woolf sometimes believed ‘madness’ was necessary to be creative, while Scott Fitzgerald depicted it as disastrous drain on creativity (ie. his). And both novels have the dynamic and lucrative new industry of psychotherapy in their sights. Vivienne compares fiction in the age of Freud to literary ideas of mental health in the Victorian age and in Dickens specifically, using Great Expectations’ Miss Havisham as a case study.

Contributors include psychotherapist and essayist Adam Philips, leading psychiatrist Simon Wessely, cultural historian Lisa Appignanesi and Chris Thompson, psychiatrist and medical director of The Priory”

The programme is broadcast again on March 31 at 2330 and is also currently available on iPlayer.

Picture via Wikipedia

SELPH: innovative community photo group for people with experience of illness opens first exhibition in Peckham, 29 March.

The Southeast London Photography Group opens its first ever public exhibition at 6pm Thursday 29th March, at New Gallery, 92 Peckham Road.

The group offers people with recent experience of illness the unique opportunity to take photographs and use them to express and reflect on their experiences. It celebrates how modern media makes it easier than ever before to make and share images, and shows how this process of creativity and sharing can be good for personal and community wellbeing. 

None of the members are from a professional photography background, and all the pictures were taken with the same ‘one-design’ compact camera. Yet the images are inspiring, fresh and each photographer brings a unique perspective on Southeast London.

The group runs as a voluntary collaboration between members, a photographer, social researcher and psychiatrist, and is supported by the Maudsley Charity. The exhibiton runs from 29 March to 5 April. All are welcome! For more information see twitter @SelphGroup.

Medfest is a medical film festival coming up soon.  They say:

In May 2011, the UKs first national medical film festival, “Medfest”, was established. Organised by a group of psychiatrists, its purpose was primarily to encourage medical students to choose a career in psychiatry, but ultimately the 9 events held around the UK drew an audience of students, health professionals, actors, filmmakers, scriptwriters, the public….. and indeed patients. It was a huge success, and was enthusiastically reviewed in “The Lancet”

MedFest is running again and in 2012 will be extending to events across 16 universities (with an anticipated audience of over 1,000) and is broadening its scope to all medical specialities. The theme this year is: HealthScreen: Understanding Illness through Film

We aim to provoke debate of the social, political and ethical implications of depictions of health and illness on our screens, not only in the form of Hollywood film, but also public health campaigns and advertisements. Such depictions are hugely powerful: When inaccurate, they can create myths and incite stigma; but when correctly presented, they have the potential to empower patient groups and dispel prejudice. We will be watching short films from The Wellcome Trust archive collection, charitably funded campaigns such as Animated Minds, and some silver screen successes and nightmares! Topics such as childhood obesity, autism, HIV and OCD will have prominent coverage.

Our diverse panellists include doctors, filmmakers, medical ethicists, social scientists and media celebrities with an interest in medicine. We look forward to welcoming the Prodcuer and Director of BBC2’s “Great Ormond Street”  Simon Gilchrist, author Max Pemberton, BBC’s ‘Radio Doctor’ and GP Stuart Flanagan, film director Mat Whitecross and  stand-up comedian Paul Sinha, amongst many others.  All events are FREE and will take place in February and March 2012. For further details on dates, venues and much much more, please visit www.medfest.co.uk

Richard Dadd (1 August 1817 – 7 January 1886) was an English painter of the Victorian era.  Following a long tour of the Middle East in the early 1840s he succumbed to a schizophrenia-type illness, following which he murdered his father and fled to France where he attacked another traveller.  After his return to England he spent over forty years in the Bethlem and Broadmoor, during which period most of the works for which he is best known were created.

Dadd’s painting The Fairy Feller’s Master Stroke is featured on the cover of a recent British Journal of Psychiatry.  Nicholas Tromans, a Senior Lecturer at London’s Kingston University, is widely published on the subject of 19th century art and is author of Richard Dadd: the Artist and the Asylum.  He came to talk to us about Dadd’s life and mental illness:

AoP: As a young man, how did Dadd go about establishing himself as a painter in London?

NT:  It seems that Richard owed a great deal to his father, who had been a high-street chemist in Kent but who, when Richard was a teenager, took over a gilding business in central London which must have had many professional artists among its clients. Dadd’s own beginnings as a professional artist were really entirely conventional. He became a student at the Royal Academy (virtually next door to his father’s shop) and made studies after the sculptures at the British Museum. He appears to have been extraordinarily self-confident, and was soon sending his pictures to exhibitions in London and in places like Birmingham and Manchester. He managed to attract the patronage of both London aristocrats and the self-made men of the industrial cities – as well as the support of some influential critics. By the time he left for his tour of the East in 1842 he was one of the risng stars of the London art scene.

AoP: What do we know about how and why he killed his father?

NT: Towards the end of his tour of the Mediterranean, in the Spring of 1843, Richard began to suffer from delusions – that there were people trying to harm him, perhaps that he could see the devil in human forms. Many of those who had known him were worried by his unusual behaviour after his return to London, and his father consulted a psychiatrist at St Luke’s – Alexander Sutherland – who recommended hospitalisation. Possibly in response to this suggestion, Richard carefully planned a knife attack on his father, which succeeded in killing him. Richard was soon afterwards arrested and eventually sent to Bethlem Hospital in Lambeth. Later Dadd explained that the killing had been required of him by the Ancient Egyptian god of the dead, Osiris, and that although Richard approved of the destruction of the imposter who claimed to be his father, he was in effect only an instrument in the hands of the deity. It was a fantastic delusion, but one in keeping with Richard’s larger set of beliefs about the continuing truth and relevance of the philosophies of ancient cultures.

AoP: What do we know about how he was as a patient?

With regard to his time at Bethlem (1844-64) – not a lot. There are really only two entries in his casenotes, and the first of these dates from as late as 1854. This entry describes how violent Dadd was considered when first admitted, and how he would suddenly strike another patient without provocation (and then immediately apologise). The formal designation of ‘dangerous’ was applied to Dadd even during the last years of his time at Bethlem. I infer from the lack of detail in the notes, however, that he was by and large not an especially troublesome patient – not one who required strategies to manage. That he painted ambitious pictures for the two senior managers of Bethlem – paintings which he worked on for years – suggests some kind of relationship between patient and staff, although certainly not an uncomplicatedly collaborative one.

AoP: Why was he transferred to Broadmoor?

Dadd was admitted to Bethlem as a Criminal Lunatic – someone too unwell to be punished for a crime, or (from the 1840s) one too unwell to stand trial at all. This meant being placed in a special wing of the hospital in very cramped, minimally furnished, high-security conditions. It was obvious to the authorities that something needed to be done with this novel legal category of prisoner/patient, and a dedicated new hospital was made possible by an Act of Parliament in the early 1860s. This was to be Broadmoor near Reading, to which Dadd was transferred along with his fellow male Criminal Lunatics, in 1864, and where he died and is buried. There were those – among them the Superintendent of Bethlem – who feared that gathering together these cases out in the countryside would produce “a bastile of lunacy”, feared and resented by the public. These critics were to be proved at least partly right, but for Dadd the change brought improvements. By any common-sense criteria of well-being, his life got better: he was able to see more, to move about more; he took an interest in cricket and chess; and the range of media in which he himself worked expanded.

AoP: How has Dadd’s legacy been regarded after his death?

Dadd’s meticulous watercolours never entirely went off the radar of the art market. Collectors were able to buy them as they left Bethlem and Broadmoor by one route or another. The V&A and the British Museum both acquired watercolours by Dadd while he was still living at Broadmoor. But after his death there were really only a series of false starts when it came to retrieving his biography and reconstructing his oeuvre. Various people had a go, but there was just too little to go on. Things changed only in the 1960s when the Fairy Feller arrived at the Tate and when Bethlem acquired a dynamic and imaginative archivist who was in a position to become Dadd’s first proper biographer. This all coincided of course with the passionate debates generated by the so-called anti-psychiatry movement, and Dadd – in the guise of heroic ‘survivor’ of the Victorian asylum – seemed suddenly of acute cultural significance. Interest in him has calmed down since. As I say in the preface to my own book on Dadd, I have not tried to resurrect him as a hero of any kind: I have tried to understand him as a wonderful artist – one of the most exciting of the Victorian age in my opinion – who happened to spend his career in unusual circumstances.

AoP: Despite his situation, Dadd’s pictures seem untouched by the content of his delusion and he never addressed asylum life in paint.  Can you reflect on this?”

Well, “sane” Victorian artists rarely painted the streets on which they lived, or pictures which sought to sum up their philosophies of history. They were typically more interested in the same kinds of things on which Dadd remained fixed, that is, the topography of exotic places filtered through the memory, portraits, and illustrations to literature. Dadd had never been a Realist — on the contrary he was from the start of his career a painter of poetic imagination. And in any case, one reason for spending so much time thinking back, visually, over his time abroad in the early 1840s must surely have been a need to escape from the very limited environment in which he had to live.

AoP: And where can interested people see Dadd’s stuff?  

NT: Not a lot of oil paintings in public collections (the watercolours can only be shown periodically of course because of their vulnerability to light).

The Scottish National Portrait Gallery have Dadd’s wonderful portrait of Dr. Alexander Morison:

Tate Britain Dadd collection

And just last year, the Harris Museum and Art Gallery in Preston acquired the early fairy subject Puck which had been in a Preston collection in the nineteenth century

The best place to head is however Bethlem Hospital itself where a substantial number of Dadd’s works can be seen in a context which helps make sense of them.

A small collection of Richard Dadd’s paintings is being exhibited Feb – April 2012 in the Bethlem Hospital museum – details.

Links:

Richard Dadd: The artist and the asylum on Amazon.co.uk

This clip of a Richard Dadd painting being discovered on Antiques Roadshow is worth a watch (starts at 4:24)

Tate channel: Richard Dadd the artist and the asylum

Wikipedia

Richard Dadd: Masterpieces of the asylum Independent 2011

Richard Dadd: Madness and Beauty Telegraph 2008

Review of Artist and the asylum:
Guardian A S Byatt September 2011
Telegraph Nicholas Shakespeare July 2011

The Tragedy of Suicide – a perspective from Shakespeare.

by Katrina Davis

I recently saw the Royal Shakespeare Company perform “Cardenio”, which they claim is a ‘lost play’ by Shakespeare. I was struck that there were many threats of suicide, especially by the poorly treated Lucinda, who, thankfully, flees to a nunnery instead. Thus she is around for a happy ending.

Psychiatrists contend that the vast majority of attempted and completed suicides are due, in part at least, to mental illness robbing people of their happy ending. Yet in many plays, suicide seems to be a great romantic or noble gesture. I wondered if it was possible to demonstrate modern methods of thinking in mental health and crisis intervention to the problems thrown up in the tragedy plays of Shakespeare.

Romeo and Juliet

This story is not one of Shakespeare’s devising, as there were many versions of the basic story. The Chorus warns us “…Never was a story of more woe Than this of Juliet and her Romeo”. But could modern day mental health have prevented the eventual outcome of two young people ending their lives? Firstly, I would hope that herbalism of the type practised by Friar Laurence would be more strictly legislated. A potion that would bring someone so close to a death-like state, must surely be quite a dangerous one; as Juliet herself perceives, wandering if the Friar really wanted her dead. The use of such a potion would be a very dangerous cry for help, and would probably be banned or restricted, as has happened to paracetamol, where the public health approach of limiting pack size and availability is thought to have saved many lives.

Poor Juliet is let down by both her religious by the friar and personal counsel from her nurse. She is forced into a marriage for political reasons. Forced marriage is illegal in the UK, and defined as where “…one or both spouses do not (or, in the case of some vulnerable adults, cannot) consent to the marriage and duress is involved. Duress can include physical, psychological, financial, sexual and emotional pressure.” Juliet would also be subject to legal protection due to her young age as “[t]he government regards forced marriage as an abuse of human rights and a form of domestic abuse and, where it affects children and young people, child abuse.” Therefore, I would hope that Juliet could have turned to the police and that they would have passed her case to the Forced Marriage Unit at the Foreign and Commonwealth Office (which helps those in the UK and abroad).

If Juliet had continued down the path of taking a dodgy sleeping potion, is there any way that Romeo could have been prevented to react the way he had to the awful sight of it? Well of course electronic communication should have meant he got the message that it was all a ruse, but if it hadn’t, I hope that he would have been supported having just been convicted by the justice system. I would hope that the probation service would have been keeping an eye on him, and would have enrolled him into a suitable Offender Behaviour Programmes. For example, their most commonly delivered programme is “Enhanced Thinking Skills”, which includes impulse control, flexible thinking, social perspective taking, values and inter-personal problem solving. For this impetuous, hot headed youth, these would all be very useful things to learn, and may have helped him take a step back from the situation in hand. However, I suspect hundreds of years on, there is still some way to go in the rehabilitation of offenders for the benefit of themselves and society.

Hamlet

From the first in Hamlet, all the other characters regard Hamlet as being mad or at the least “distracted”. But it is not a doctor that they trust can help him, but his sweetheart, Ophelia. In Act 3 Scene 1, the new King arranges a meeting between Hamlet and Ophelia as if by accident, and the queen tells Ophelia “I hope your virtues Will bring him to his wonted way again”. But when Hamlet appears and gives his speech, it is clear his is not in a mood to be comforted. He denies he has ever loved her, talks in riddles, and tells her “To a nunnery, go, and quickly too.” She is most alarmed, comparing his reasoning to “sweet bells jangled, out of tune and harsh”, and she feels “deject and wretched”.

If Ophelia had the opportunity to discuss this with a modern doctor and refer Hamlet for some help, he may well have been seen by an Early Intervention project. These are teams specialising in assessment and management of young people experiencing psychosis for the first time. They usually consist of psychiatrists, psychotherapists, community psychiatric nurses, social workers and occupational / vocational therapists. They are geared towards helping people developing schizophrenia, but will often take on people with psychotic depression or even complicated grief reactions such as Hamlet is likely to have been experiencing. Among the useful things they would have done would be to: support the carers, especially Ophelia; do a risk assessment that would have thrown up the easy access to daggers and swords; and put in place a structure to help Hamlet get back to University as soon as he was able – since idling around in such a morbid castle could not have been doing Hamlet much good.

While in turmoil, paranoid and disillusioned, Hamlet kills a figure he believes to be his father’s killer, but is in fact Ophelia’s father. Ophelia then becomes deranged in her grief, feigning indifference and singing bawdy songs. It is in these circumstances she drowns in a muddy brook, despite the new King having recognised the danger and asked of Horatio “Follow her close; give her good watch, I pray you.” I would hope that today, someone might have taken Ophelia to the local A&E department or walk-in clinic where she could be assessed by a psychiatric liaison nurse, perhaps referred for a short hospital admission or given support at home by the crisis team and some Valium, or perhaps just be given the opportunity to talk. In the next few days, she may also seek help from Victim Support if the murder of her father is officially reported. They allocate a caseworker to each family bereaved through homicide and tailor support to people’s differing needs, and this can extend over several years if needed. There are specific services for children, and the crime doesn’t need to be reported for children to call the supportline and speak to someone in confidence about the aftermath of a crime.

Macbeth

The attitudes of Macbeth and Lady Macbeth to begin with over the killing of Duncan seem to clearly different, with his mental torment contrasting with her savage imagery. He feels his hand will never be clean; she that a little water will clear them of the deed. She sees “The sleeping and the dead Are but as pictures”, where he sees only unnaturalness in killing. He fears the unknown, while she does not question their future success. But then the nightmares start. They are both afflicted after a curse Macbeth received from the dark after killing Duncan in Act 2 Scene 2: “Glamis hath murder’d sleep, and therefore Cawdor Shall sleep no more; Macbeth shall sleep no more.”

While sleep deprivation appears to put Lady Macbeth on edge, it seems to numb Macbeth, who becomes inoculated against terror so much he declares “I am in blood Stepped so far that, should I wade no more, Returning were as tedious as go o’er.” Lady Macbeth continues her disintegration with sleepwalking and muttering of unnatural events and apparitions. She ends her life shortly after. Her husband is so numb as to make when of the bleakest statements in Shakespeare in Act 5 Scene 5: “She should have died hereafter; There would have been a time for such a word”. It is a sentiment that seems all too true when thinking about someone’s suicide – they died too early.

One organisation set up to prevent the loss of life, and also indirectly the grief of others, from suicide is the Samaritans. The Samaritans is a charity based in the United Kingdom that was started from a single phone in 1953 and in 2009 made over 5 million contacts with people by telephone, email, SMS, minicom, Typetalk, letter or face to face. The phone lines are open seven days a week, 24 hours a day, as they know that people can find night can a very unsettling time, as did Lady Macbeth. According to 2009 figures, most people are distressed when they called the Samaritans, 19% of people were suicidal, and 0.6% had already endangered their life when they called. The Samaritans strategy is to take a lead reducing suicide by engaging individuals and groups at risk of suicide, offering effective and acceptable responses which reduce their level of risk. One of these groups is offenders such as Lady Macbeth, as suicide is seven times more common among the prison population. They train prisoners to be ‘listeners’: a confidential, non-judgemental presence that can support those experiencing distress and despair.

King Lear

This play, set in Ancient Britain, owes much to the tradition of Greek drama. It is both a domestic drama on the nature of the relationship between fathers and children, and a public drama, dealing as it does with a King and the succession.

The Tragedy of King Lear actually has an averted suicide in Act 4 Scene 6. The Earl of Gloucester has been loyal to the King, but is horribly tortured for this. He is tied down, treated like a thief, yanked by his beard, and then his eyes are gouged out. When he is finally allowed to go to Dover, it is in order to go to the highest cliff and “repair the misery”. He shows hopelessness and helplessness, proclaiming “As flies to wanton boys are we to the gods; They kill us for their sport” (4.1.37–38). But his guide to Dover is his own son, disguised, and he tricks him into thinking he is at the top of a cliff when he is actually on the flat. Thus when he survives the leap, his son is able to tell him it was a miracle he was saved. He even goes so far as to say that he had seen the devil with Gloucester before he leapt. Here, he is externalising the suicidal urge and it works very well. Gloucester says he now will “bear Affliction” more patiently and speaks of the “fiend” that brought him to the cliff. Sometimes people more unfamiliar with mental health can feel it is futile to save someone when they have determined to kill themselves, but this is not the case, and follow-up studies of those who have attempted suicide and failed show that the vast majority do not try again in the following years (for example, Tidemalm et al. Risk of suicide after suicide attempt according to coexisting psychiatric disorder BMJ 2008). The most important thing to be done for these people is help for any major mental illness and support, be it psychotherapy or generic. In order to do this, it is essential to ask people who have “accidents” or harm themselves about depression and suicidal urges so that they can get the support they need.

The one person who actually does kill themselves in this play, the King’s daughter Goneril, is such a foul character that it is hard to have sympathy enough to wish to save her. But in fact, she is only ever exploiting the situation that comes around through her father’s “madness”, which is the real villain of the piece. Whether Lear is mad or vain, and if mad, whether it is dementia (“the infirmity of his age” as Regan would put it), I won’t try to determine: there has definitely been a change. Regan, Goneril and Kent all express surprise as his treatment of Cordelia as he cuts her off, and they all blame this on his current state of mind. Inheritance can be an issue for families today. Often, a member of the family will take over managing the affairs of one who is not capable of the judgement needed to do so themselves. But the instruction for this must be made when they were still capable of nominating such a person. What happens if, as in this case, it is not until the decisions are made (or fail to be made) that it is clear that someone’s judgement was clouded? And if even when told, they lacked the insight to know they were doing the wrong thing? We would class these people as “vulnerable adults” in that they need help and protection from the law and statutory authorities.

The Mental Capacity Act 2005 (MCA) clarified the law around people who lacked the capacity to make decisions. Someone is lacking in capacity if they cannot do any one of: understand the nature of the decision; retain the information for long enough to make a decision; weigh and balance the information to make a decision; or communicate the decision. The Earl of Kent shows himself to be Lear’s most loyal advisor. If he felt that the Lear lacked capacity, he could have referred his estate to the Court of Protection, which is a body set up by the MCA. The court can make decisions or appoint someone to make decisions in the categories of ‘property and affairs’ and ‘healthcare and personal welfare’. It can be a little complicated – there are up to ten long forms to fill out to make a referral. One way to get assistance with his is through a “memory clinic”. This is a community mental health team formed exclusively to assess, advise and manage people with suspected dementia. With Lear, I would hope the first thing to be done would be to rule out an acute medical illness causing a fluctuating confusion (i.e. delirium).

Conclusions

We have seen that there are a number of deaths in Shakespeare tragedies our society might view as preventable. Public health measures against suicide and poisoning may have helped Juliet, and her Romeo might have been helped by offender rehabilitation. Treatment for mental health or emotional problems might have helped Hamlet and Lady Macbeth. An integrated approach to assessing and managing cognitive decline may have helped King Lear and his family. Better support for victims of crime and carers of people with mental health problems may have helped Hamlet’s Ophelia, and many of the other characters in Shakespeare’s tragedies. These priorities, of reducing means of suicide and supporting those most at risk – those at the margins of society, with mental illnesses, offenders and victims of crime, the young and impulsive, the old and in pain – still ring true today. That is one of the attractions of Shakespeare plays. But we must beware of romanticising suicide as Shakespeare can do, and instead think of every one as an avoidable tragedy.