The Portrait of the Poetaster as a Man - Book XII - Psychiatric diagnosis

Although the label's changed with changing years
It's now schizoaffective disorder :
This half new term should mean something to shrinks,
By God, it does to most the rest of you!
This diagnosis is debatable:
It represents a mixture of disease
From different camps - and that which doesn't fit
Is reassessed and joined by but a name.
To classify as either 'thought' or 'mood'
Is superseded using this new term,
Before the cause was one or other (choice),
Now nothing's said by simply choosing both.
And too, I may not meet conditions set
By diagnosis that's debatable -
I question twice - and though not claiming health,
I'd guess a calmer diagnosis fits.
So you can tell I've been in hospital,
And thus you know for sure that I've been ill,
Which means that I possess experience
That you will never have (you thank your Lord).
Subjectively I've passed the bounds of sense
And thought outside the box - said otherwise,
At times like these I've known insanity,
And mark the thing as feared known quantity.
And should I try to share subjective thoughts
Associated with insanity?
Not only do I want to speak of health
But view the thoughts beyond my power to share.
My current state could be my best attempt
At even maintenance of mental health,
God praised, for once it may be true to say,
I do not drink and know sobriety.
And in this state it seems wise to describe
My mental map of what it means to live
A person tainted by psychiatry:
Rough guide to diagnosis (ups and downs).
My fundamentals for smooth mental health
Are facts, hard come by facts which bolster self,
Which can maintain my sense of buoyancy,
And court and call remission's sober train.
These are the type of thinking thoughts which help,
Not those fast rules, the likes of "Do not drink",
But those which go towards an overview,
Which makes the whole as comprehensible.
A stricken mind needs facts to tie it down,
This, how I've lived now year on year, it's clear
Madness remains sterile: my verse, my wealth,
I'll tell ten facts which prop my mental health.

Fact one - ill health will lead to happiness:
Of all the bastard traps of fate and truth
(And having known a few in weal and strife)
This is the one that tricks me every time.
The problem is that much is chemical
Whoever knows an elevated mood
(Not least if it's produced by some disease)
Will know well-being, and a happiness.
And those who've known the highs and lows of love
Can tell you best how happiness deceives
And such would understand me when I speak
Of how a joy can be chimerical.
Ignoring this detached philosophy
When ill, I am content to be content,
And think that life has finally born fruit
In that I seem to know my share of joy.
The happiness that's ignorant with bliss
I treasure, feel and know; not shared by those
Who have to deal with me and new found 'joy'
(Such as the bar staff, family and friends).
Although I'm happy, it is true I show
The pent belligerence of teenage child,
And with the passion for opposing all
A brusque simplicity will correspond.
I blindly cause offence and think I'm smart
(Let's say, more often than I tend to do)
And also think myself superior
(And not to most, to almost, if not all).
To top these attitudes I think I'm right
(And dealing with subjects unknown to me)
My arguments are pitched against the wind
And claim such things as of I'm ignorant.
It's with this petulance I choose to drink
And snatch disaster from fair ruin's jaws:
Belligerence and drink will form a pair
Which each half aggravating other one.
My feelings (from disease) of 'happiness'
Are better termed an elevated mood,
And this is what I'm known to suffer from,
Known otherwise as mania, a high.
However named, the thoughts as these undo
And turn me to abysmal company:
And certainly, I will commit offence
The scale of which sometimes defies excuse.
When manic I ignore important facts,
I'll not consider whereabouts to sleep:
Like this I'll oversimplify my needs,
And tangle up myself in reeds nay weeds.

Fact two - is when I'm ill, I think I'm not:
Is this a myth that's simply shown a lie?
Perhaps for those observing from the line
But not for those caught in the heat of things.
When I've opposed the world with lack of sense
(Insisting all was wrong and I was right)
It would seem obvious that fervour was
The throes of lunatic and self-forged bands?
The painful truth is not to be ignored,
Though mad will claim its false repeatedly:
It's seen a sign towards recovery
When lunatics admit they have been mad.
The term for this ability: insight ;
Though I've not sought this balm in manic times
It's almost needed more than lacking sense,
This aptitude, a missing source of light.
It tends to be as I become unwell
That I'm convinced that all is sound and good,
So much the case that I've been known to stop
The medication that I am prescribed.
I feel so fine that some may think me sane
(And that includes some psychiatric staff)
The rot is hidden by the surface layers
And hidden such that some won't think me mad.
But circumstance may cause the rot to show
(Particularly when alcohol's concerned):
I hope that people mark (I know some don't)
The differences between madness and me.
Confused and overlapping with insight
(Or, what I mean, the frequent lack of it)
Is wish to stay away (at every cost)
From psychiatric hospitals and wards.
And this desire dovetails with thoughts of health
(The thoughts of health of those who lack insight)
Although revulsion for the dreaded wards
A reasoned 'nay' in any circumstance.
This strong desire to spurn the hospitals
Is justified by knowing what they mean,
More will be said about these places soon,
And why they're not all that they're meant to be.
At times not only do I lack insight,
But every fibre of my being stands
Against the hospital: together these
Bode ill for voluntary, good treatment plans.
When ill, if I but knew that I was ill,
Perhaps this asks for more than God would grant,
Not only would my past be free of much
But future would not threaten so and such.

I've cursed a thousand oaths against fact three
(And wasted breath on what is set in stone):
Despite experience some still won't see
That I'm a mix of illness and of health.
You'd think most realise the gulf between
One diagnosed who's in remission now
And state of illness, say, or (long gone) health?
You'd think but be surprised by each extreme.
The first ones seem as though they won't forgive
What has been caused when ravaged by disease
And also seem to see the suffering mind
A threat (and see attack the best defence).
This attitude would seem a moral stance
Belonging to an individualist
I'd guess that such a view goes hand in hand
With opposition to the welfare state.
With each example one who's needing help
Would be considered author of their ills:
The unemployed should work or else they'll starve
The mentally ill can just retire and die.
And everyone's entitled to their views
Which state: if God disfavoured my disease
I might discover my morality
Should be aligned with individualists.
And I am still entitled to my views
Which state: if God had felt for my disease
Some might discover their morality
No longer was aligned with seraphim.
And then there's those that think me right as rain
Regard remission as a state of health
Equated to that shown by everyone
Who is and never was one touched by this.
In truth I'm in between - the half see ill -
The other half see health - and neither's right:
Perhaps the blame is undeserved by me,
And some cause stress as they expect the moon.
And each extreme remains a stress and strain
So half the time insults will patronise
The other half with standards reaching stars:
One shoe too big, the other one too small.
So some remain just cautious of offence
And other ones pretend that nothing's wrong,
Where does a person who's impaired in thought
Begin to put themselves to navigate.
And to one side - an enemy of sorts:
And to the other - expectation claws:
To ostracise and thus avoid the stress?
There's those so close, I have to second guess.

Fact four - disease is harsh and yet remits:
Though there are those who having seen ill health
Believe that only this repeats itself:
Perhaps disease remits, but not for them.
My metaphor - not fixed firm I can change
I'm not a million different people, no,
But in my mode I'm good as I can be:
Remission asks, almost earns, forgiveness.
So after being ill I have been known
To gain full-time employment, earn a wage,
To go to work and toil each working day,
And live and pay my rent and bills and tax.
Thus could remission show more willingness,
Or more desire to mix and take a part?
I've worked as software factory's employee,
Remunerated at the going rate.
Although I've seized the chance (and after woe)
And studied at good universities,
Vocational, so academic course,
Although I've tried I've never qualified.
Both post- and undergraduate degrees
(And one was taught in foreign language too);
Ambitious even with remission's grace:
I'd be surprised if current one bears fruit.
To make attempt is good enough for me,
In fourth decade it's hard to socialise,
To learn with those a generation less:
And better to have tried to learn and failed ...
And after being ill I have been known
To live (in most ways) independently,
So now I've found a flat and clothe myself
And eat and drink (avoiding alcohol).
And independent living's novel still,
And I have learnt new skills and with the help
Of this remission, seeming to expand
More broadly than preceding illness plunged.
Remission is a joy and wonderful,
And it surprises that the human mind
Can mend at all when having known descent
Into the depths of chaos that's disease.
Remission seems to be the gift of God;
At times it makes the one who knows it think
That pleasures (void of stimulants) exist
And life's been granted them in part for joy.
So some refuse acknowledgement for this:
Let them concern themselves with what has passed,
But grant me sympathy, although little;
I may have shards, but still more than tittle.

Fact five - is seen a truth by everyone,
(And only slightly irks on stepping back):
This fact that those who lose their liberty,
When sectioned, are, because of way they think.
It can't be said that my psychiatrists
Have maintained privacy of views on this:
They have professed with utmost clarity
'Your mood is interfering with your thought'.
Majority regard the fact as fine
That if you're thinking wrong, that you should be
Away from things a while, or put in prose,
Be locked in hospital awaiting health.
And those who say this seem to be a type
Who think if everyone should think like them
The problems of the world would start to fade:
The prototype of social engineer.
And such as these (most) think it's fine to tell
Someone who's suicidal how to think,
And if they don't agree, to lock them up:
'For their own good' - of course that is the line.
But what if these, the social engineers,
Themselves were told just what to think and do
There would be cries of foul from left and right
Talk of eroded civil liberties.
We (those who lack a fully functioning mind)
Are not at liberty to think, not free,
This is fact five, which all would think as right,
But analysed should raise some questions, too.
If what is said should mean locked ward for months
Who should decide that I'm not thinking right?
And damned by them am I entitled to
A second, free opinion, one which counts?
And should there be bureaucracy in place
With patients kept in hospital despite
The fact they've not been shown as thinking wrong?
And under lock and key why 'voluntary'?
Expecting seven years less life when ill
(With some disease), is not a part of this
The medication we are forced to take?
That, with some cognitive impairment, too?
Fact five would state that if I'm thinking wrong
(Ignoring what I think to be the case)
A ward that's locked is where I will be sent:
That's nothing less than loss of liberty.
For thinking wrong! what's meeted out seems harsh
But no one ever said the world was fair:
But were a London psychiatric ward
A nicer place, the narrow path were broad.

I spoke of few accepting me (fact three),
Although I would include the everyday
In things which should accept me more, and so,
Fact six - I struggle with what's thought mundane.
And by 'mundane' I mean the same as you,
Our definition's match for 'everyday':
So we agree on meanings for these words,
It's just for me these meanings mean distress.
So these realities of everyday,
Those things that grate and grind at best of times,
The kind of things you don't accept with joy,
These things cause stress and angst, and challenge me.
I think my inability to deal
With normal quantities of stress and angst
Remains associated with the fact
I've been one diagnosed for fifteen years.
Although it's clearly not the label damns,
But underlying state of health which fails:
Attempting leaving pathos be, I say,
Compared to most there's something wrong with me.
I'd guess where I have written of myself
The reader might not think - 'Get over it!' -
But might be brought through verse to understand:
This, my portrait, attempts a truth to life.
I emphasise my problem (as above)
And state the case as plain as plain can be -
A major psychiatric disorder,
Not an existential ennui, oh no!
And so I claim the everyday (mundane)
Affects me in a way that's negative
A way to which the most are not exposed,
And that because the most are well, not ill.
For me this means a mild paranoia;
The passing thought that strangers know your face:
That private thoughts are public in domain:
Those reasons for peculiarities.
Each day in London paranoia wells:
The sane resist its swell as easily
As oil and water separate to layers:
The diagnosed react and take the bait.
And so in smile or nod or look or glance
I see a meaning you will nip in bud,
A meaning given me by my disease,
A meaning making everyday to angst.
And this you say remains figment of mind
(Those diagnosed well know the power this holds)
If this figment of mind is cause of stress,
I feel the strain of thought as real, no less.

Fact seven - sure the poison poisons me:
Much like my views on sectioning and thoughts
Although this might appear self evident
It's taken leaps and bounds to realise.
With psychiatric ills, the starting point
Is to consider self immune from harm:
It's only with progression that you see
How much the whole disease is part of you.
And when I say the poison poisons me
I mean I suffer, like (not with) the rest:
The rest are those, labelled with this label,
Who tend to isolate, and not commune.
The pain I know is of and in the mind
And thus might not be thought as genuine,
I hear critique and claim reality
Because the actions realised are real.
If one in three have tried to end their life
And one in three of those have known success
Approximating, one in ten has died,
And what is worse, has died at their own hands.
So tell me then just what is in the mind
When one in ten have found their life so bad
That ending it would seem the only choice
That's left in life, and they have chosen death.
These sable facts to illustrate my point:
I strain and suffer under my disease,
My angst remains an actuality,
And this is shown in shapes and shades of death.
Repeating from elsewhere: with most and me
There is no common frame of reference:
I have the feeling that the stress I bear
Is only known to me and my disease.
But then I may be wrong to draw boundaries:
Perhaps the most will suffer, just like me,
But deal with it in ways which normalise -
The playing field is level - I might state.
The stuff of dreams is this equality:
Although I wish I could stand proud and claim
Subjective evenness for most and me
I know that diagnosis drives a wedge.
So using verse and what I know of most
I try to cultivate a common ground
(The one I found and chose to plough and sow
Is both a thorny and a stony one).
I have my diagnosis and disease,
And though I shame admitting that it's true
I've suffered being one in three whose tried,
But writing this, not one of those who's died.

Fact eight - there's little solace to be found
In London's state run psychiatric wards:
They serve a function, they contain an ill
And force not foster sought recovery.
To take this fact and analyse a part;
Go ask one thousand folk what they would find
As fit to aid somebody convalesce:
What they'd suggest would not be found in there.
And who was it who said that madman should
Keep company with those deranged and mad:
For most mad company's a punishment
For us a feature of recovery.
Thus, lunacy will play a greater part
When health's rebuilt than when a person's ill,
When illness was diluted by the fact
That you're but one, and not surrounded by.
I've heard of shrinks, who dealing with the mad,
Have had to go to shrinks themselves to cope;
And what of we when locked up night and day:
This aggravating factor is ignored.
And so, the medication's there to take,
And ward is free (ha ha) of substances:
Where there's a will - and God there is a will
As strong as strong can be - there is a way.
There is a roof and walls and beds and food
And running water (hot and cold) and chairs
And then one door that locks and then the rest
The most of which don't lock and you are watched.
It's not the kind of place you'd send your mum
Were it the case her nerves were playing up:
It is the kind of place you would think twice
Of paying call, your mum in there or not.
And round about I'm trying to express
That London state run psychiatric wards
Are not ones suited to recovery
(Recovery in spite of, not because).
Last year a doctor examined the state
Of psychiatric wards: once seen he said
He would not let his relatives (if ill)
Use NHS's wards - he'd rather pay.
The place, not good enough for doctor's kin:
I'm not the only one to criticise,
And here I haven't even touched upon
'Practices' that have passed into practice.
No one in their right mind would choose this place
To convalesce, to rest, or wait awhile:
That any here regain their sanity
But shows the force that buoys recovery.

Fact nine - the fact that thoughts and feelings rule
Psychiatry - there's science and there's this:
And I'm amazed by those who see this 'art'
As branch of medicine with power to heal.
Their power to heal: a printed sign which read
'Keep taking the tablets' and was obeyed
Would better any live psychiatrist:
They know about locked wards, are blind to weal.
(And of the 'thoughts' of these psychiatrists
I mean judgement which varies, is at odds,
From one to other, or from one to one
At different times - opinion's variance.)
Psychiatry as ruled by facts or thoughts?
To find which better fits I think I will
Investigate some motivations, but,
Helped by hindsight and things that I have learned.
There's an international guideline which states
My diagnosis can't be handed out
If symptoms of withdrawal play a part,
And this would seem as sensible to most:
If someone shows delusions at the time
They are withdrawing from addiction's clasp
It seems as fair to blame the drug withdrawn
And not invent some new disease or ill.
In residential detox (alcohol)
It was thought fit to diagnose disease:
Against this guideline, I was labelled worse:
It stuck: not long ago I asked 'Why thus?'
It was explained that my clinician, then,
Had 'feelings' which outweighed, had greater worth,
Than what the international guideline states:
Put plain - 'Whatever he should think is true!'
Now I have read the guideline more than once
And nowhere does it mention 'feelings', no,
And were it to it wouldn't be a guide
But in effect state open season's here.
You cannot have a guideline which then says
'Ignore if you are feeling otherwise':
'Go vaccinate against the mumps, unless,
You feel different' - it doesn't work like that.
And so, I think you see, psychiatrists
May deal with 'thoughts' and feelings over facts,
Whatever other the objections raised:
The discipline is like no science known.
This is a form of strict authority,
And just whatever they will think or feel
Replaces judge and jury - true but sad -
This is psychiatry - it drives me mad.

Fact ten - this tragedy - that's what it is -
This needn't be a dire catastrophe:
Thus I have thought - though it's a job to prove,
And demonstrate the grounds to persevere.
Fact ten not just reworking of fact four -
The emphasis does differentiate:
I guess this fact might seem embodiment
Of one to nine's essential distillates.
Fact ten then represents a stone inscribed
With that experience that heartens hearts,
A sign that guides the way to words of truth,
A simple mark that borders narrow path.
And so fact ten accepts the tragedy
As that - a reason for unhappiness:
It pains, to be institutionalised,
And most prescription drugs are kind but harsh.
The most unpleasant tragedy of all
Is people's minds, Coleridge's verse explains:
Let Eagles bid the Tortoise sunward soar -
As vainly Strength speaks to a broken mind.
There is a point of disconnection found
That means the disengaged of mind are mad,
And though a pity is invoked, they flail
And try to grasp a senseless object's sense.
But here I speak of others on the ward
And only reading some of Shakespeare's plays
Can I begin to know the tragedy
Which must be felt when loved ones see their mad.
(But then converse, I name hystericy,
Which is the way that many see the mad
Projecting drama onto what's real life:
The sane like Eumenides in pursuit.)
When ill, you have to hope that things improve,
And if they don't, you have to hope some more,
Blind optimism is the only cure,
And don't complain, you know it could be worse.
And even though disease is cyclical
I stand up proud and say this to myself:
"Perhaps you tilt today, are not perfect,
Just let another year improve and heal."
Fact ten will say that out of tragedy
(If managed with the mind and thought in check)
Will come remission, with a portion health,
More self-reliance, greater good all round.
A tragedy is reason for sorrow:
Catastrophe a reason for despair:
The mind can separate the two of these
And not despair when fate begins to tease.

I hope you see the truth (at least in part)
Of these ten facts (despite tendentiousness)
I treasure these and they have leant me strength:
It's now two years since I was sectioned last.
Before I talk of that which I may call
Prolonged remission (though I speak to soon
For any certainty) please let me first
Digress and speak on an unusual case.
I think I have inherited a gene
That runs in my maternal family
And could well be the cause of this disease:
Some family succumb but function well.
With this in mind I'm saying to myself
That alcohol is my Achilles' heel
And now I start to grasp the root of this
My chances multiply and but increase.
My mother: diagnosed when young, and now
Retired professor, having known through life
A permanent remission, furthermore,
Her medication, long ago, was stopped.
And if the cause is in this gene I have
(From her) I don't expect the usual course
For this disease (which can but give me hope)
My mother, I, avoid the alcohol.
This, not the way that my psychiatrist
Has time to know about and view my case:
These are but thoughts, and only abstinence
And weal can start to prove if they are true.
So now I aim and pray for what I call
Prolonged remission, that which I define
As state of health not needing hospital
And during which my team don't intervene.
Two weeks ago it was two years ago
That I was sectioned last - two years have passed -
I cycle on a two year interval
Could it be now I live on borrowed time?
Although, this part of cycle seems different
I'm off the drink and there's subjective weal ...
If not on borrowed time, this could well be
Prolonged remission, just two weeks of it.
Unlike the other times, I've worked for health,
And whether it's been gifted me or not
I'm proud to say that I've stood firm and tried
It's better to have striven for first place ...
I gamble for a prize (without a loss)
And do what's good for me (the good's all gain)
And if (as hoped) this brings health back to me
It pays out more than any lottery.