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What I've learnt about 'madness'

I can’t remember when I first started worrying about the idea of ‘going mad’, but by my late teens it had become such a deep-rooted fear that it helped to fuel a spiral of obsessive thoughts, anxiety and depression that I took years to recover fro

m. However, although at times I thought I’d created a self-fulfilling prophecy, the reality was that I never actually endured the sort of experiences I associated with ‘madness’.

I’m caveating ‘going mad’ and ‘madness’ with inverted commas because these are vague, nebulous terms that gesture towards a set of ideas and images rather than offering any tangible definition. If I was asked at the time what these concepts meant to m

e, I would have probably resorted to other imprecise phrases such as ‘losing my mind’, or else invoked stereotypes of a caricatured ‘crazy’ person running amok.

This illustrates the other reason I’m wary of employing these expressions — in popular usage they often carry such negative and stigmatising connotations. Some people with experience of mental health problems are reclaiming the word ‘mad’ as a subversive act of self-empowerment. But in wider society, such labels are often still used casually with the effect, intended or not, of reducing complex human experiences to a two-dimensional ‘otherness’. My own personal and professional journey has taken me from a similarly simplistic understanding, to a place of respect, curiosity and compassion.

Looking back now, I think what I feared in my youth was some amalgamation of symptoms of severe mental health problems (voices, hallucinations, delusions) and the implications of danger and chaos these are imbued with by media and cultural representations. But in many ways, it was the ambiguity of the fear that gave it such power — the underlying sense of threat and dread that couldn’t be rationalised away. In fact, the very act of trying to control my anxiety through obsessive thoughts contributed to me becoming unwell.

It might seem odd that, as someone so unsettled by these ideas, I’ve gone on to spend my career working on mental health in different capacities — mostly in social policy but more recently in frontline NHS services as a Social Worker. The truth is though that many people who have experienced mental health problems find themselves attracted by the idea of trying to help others who are struggling.

For me, if I’m honest, there is also an allure to being close to the thing that I fear. Although my primary focus is always on trying to help the people I encounter as a mental health professional, I have also found it hugely enriching to learn and understand more about the reality of symptoms that previously provoked such unease in me. It has been a privilege to have people open up to me about what they are going through — it has allowed me to become more comfortable with the experiences being described, which in turn has made me better able to respond with effective support.

None of this is to say that I was undaunted by my transition into frontline work. For all the training and shadowing I undertook before being able to see people alone, I was full of trepidation as I made the way up the steps of a huge council block to make my first solo home visit. This was mainly due to self-doubt about what I really had to offer the person, and how I would respond if I simply felt out of my depth. But there was undoubtedly also an element of fear — as much as I’d like to disown them, I know that tropes about severe mental health problems and dangerousness linger in my subconscious.

My initial appointments were indeed challenging. I found some of the things people said and some of the ways they behaved unnerving, even disturbing at times, and I often felt unsure about how to respond. But what was most striking to me was how people’s underlying personality and humanity remained apparent, and how there would always be moments of connection, even when we were perceiving and experiencing the world in very different ways. In my simplistic and naïve conception of ‘madness’, I’d worried I might cross a line at some point and ‘lose myself’, but it was clear that what constitutes our ‘self’ is much more adaptable and resilient than this, and can manifest both through and around even the most severe mental health problems.

In my mind, ‘madness’ had also been tied up with ideas of chaos and ‘losing control’. At first glance, the lives of some of the people I’ve been supporting may have seemed to conform to this preconception. But the better I have got to know people, the more I have understood the order and logic in how they respond to the world as they experience it. People try to find ways to cope with the circumstances they find themselves in. These strategies may not always seem positive and constructive to an outside observer, but an outside observer doesn’t have to live within the same circumstances.

Similarly, people’s brains seem to try to find ways to cope with the stresses and strains they are put under. Experiences like hearing voices and developing unusual beliefs may be the brain’s ‘coping mechanism’ for extreme circumstances. Recurring themes within what different people hear, see and think in these situations certainly suggest these are not simply the random concoctions of malfunctioning minds. Getting past the initial strangeness of these phenomena also allowed me to see how they might connect to people’s pasts.

It is often traumatic events in people’s lives that both precipitate and shape experiences such as voices or hallucinations. People will often hear the voice of someone significant from their past, or see things that relate to a formative event. Stories of abuse, discrimination and immense hardship are common among the people I have supported, often with poverty and isolation as the backdrop that enables and compounds such experiences.

Through working in NHS mental health services, I feel I have developed a much more nuanced relationship with the idea of ‘madness’. I recognise and appreciate how far away I am, or have ever been, from the difficulties others face, but can also see more clearly how people end up in such a place. I see potential explanations where once I just saw disorder, but I also have a better sense of the depths of anguish that severe mental health problems, and the circumstances that contribute to them, can inflict.

However, for all the knowledge and understanding I feel I have gained over the last few years, I am also aware of the dangers of making assumptions and generalisations about what are deeply personal and subjective experiences. I have shared here my observations and reflections on the situations I have encountered, but I recognise that these are shaped significantly by my perspective and I do not mean to claim that they are universally applicable or that I can truly understand what others have experienced.

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