Being Insane: A Voice Listener’S Story

By Eddie Blacklock

This narrative documents the life of a young man (Samuel Coates) as he is diagnosed with paranoid schizophrenia and admitted involuntarily under the Mental Health Act into a fictitious public hospital in Brisbane, Queensland, Australia. While on the mental health unit, the naive young Samuel befriends Theo Walker, a street-savvy young man with a diagnosis of antisocial personality disorder. Theo takes Samuel under his wing and tries to teach him how to manipulate the system to his advantage. Because of his schizophrenia diagnosis, Samuel often misinterprets the world around him, and he falls under the charismatic charm of Theo and later one of his young female associates, which has dramatic consequences for Samuel. Trying to control these developments are the nurses and doctors on the mental health unit and the real-life dilemmas that mental health professionals have to manage on a daily basis. The narrative is used as a backdrop to raise awareness of the plight of people diagnosed with schizophrenia and the limited resources that contemporary mental health services have to manage them effectively.

• Language: English
• Publisher: Xlibris AU
• Release date: Mar 24, 2015
• ISBN: 9781503503946

Eddie Blacklock

I worked as a mental health nurse in a large public institution in England for five years. In Australia, I worked in both public mental health facilities (Tasmania and Alice Springs, Northern Territory) and in Brisbane, Queensland, in a private mental health facility. My last thirteen years as a clinician, I managed an acute admission unit for thirteen years. When I left that role, I started lecturing at Griffith University in Brisbane where I currently teach mental health in an undergraduate nursing program. Since 2000, I have run a private counseling service where I see people either in their homes or workplace with a range of mental health, relationship crisis, and posttraumatic stress issues. I also provide clinical supervision to a wide range of mental health professional disciplines in both public and private hospitals here in Brisbane.

Book preview

Copyright © 2015 by Eddie Blacklock.

Library of Congress Control Number:   2015904066

ISBN:      Hardcover      978-1-5035-0392-2

                Softcover        978-1-5035-0393-9

                eBook            978-1-5035-0394-6

All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording, or by any information storage and retrieval system, without permission in writing from the copyright owner.

This is a work of fiction. Names, characters, places and incidents either are the product of the author’s imagination or are used fictitiously, and any resemblance to any actual persons, living or dead, events, or locales is entirely coincidental.

Any people depicted in stock imagery provided by Thinkstock are models, and such images are being used for illustrative purposes only.

Certain stock imagery © Thinkstock.

Rev. date: 03/23/2015

Xlibris

1-800-455-039

www.Xlibris.com.au

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CONTENTS

Acknowledgements

Disclaimer

Chapter 1

Was It A Dream, A Nightmare, Or Reality?

Chapter 2

Be Mindful Who Listens When You Are Talking

Chapter 3

Definition Of Friend: Someone You Get Attracted To By Associating Them With Feelings Of Affection And Trustworthiness

Chapter 4

21St Century Psychiatry

And A Person Of Influence

Chapter 5

The Unit: A Microcosm Of Humanity

Chapter 6

Enter Stage Left, Unforgettable Eyes

Chapter 7

A Visitor And Opposing Perceptions

Of What It Is That Constitutes A Friend

Chapter 8

A Clinical Meeting With Important Management Guidelines

Chapter 9

A Friendship Deepens With An Option To Tongue?

Chapter 10

A Meeting Of Persuasive Proportions

Chapter 11

Again, Be Mindful Who Listens When You Talk!

Chapter 12

An Absconding Incident

Chapter 13

Personalities Clash And Testicles Are Squeezed

Chapter 14

The Anatomy Of An Absconding Incident

Chapter 15

An Asylum In Morningside: A Place Of Safety?

Chapter 16

A Trip

Chapter 17

Return Of The Prodigal Patient

Chapter 18

Some Stories Are Simply Too Disturbing To Be True

Chapter 19

All Is Well, The Story Was False

Chapter 20

Discharge Planning And A Surprise Option

Chapter 21

Accommodation At Carina Heights

Chapter 22

Notwithstanding Drowsiness From Medication, Three New Faces Difficult To Forget

Chapter 23

Discharge Of Unforgettable Eyes

Chapter 24

Friend And Foe Visit Carina Heights

Chapter 25

A Meeting Of Bodies

Chapter 26

Post-Traumatic Stress Or Something Else Perhaps?

Chapter 27

A Visit, A Party In West End, And Oblivion

Chapter 28

Readmission, Some Reflections, And Modern Psychiatry Goes To Sleep

Chapter 29

West End Again, A Difference Of Opinion Expressed And Some Irritating Dust

In Dedication

This narrative is dedicated to all those people who have been diagnosed with the range of symptoms that are internationally recognised as the schizophrenias. This is a condition that affects many of its sufferers in different ways; some people become only mildly affected, while others live in a world of terror. To you all, whoever and wherever you are, I wish that you are actively listened to by people who are authentic about how you think and feel, that you are treated with courtesy and respect, and that you find at least one person in your often troubled lives you can trust enough to call a friend.

Eddie Blacklock

2014

ACKNOWLEDGEMENTS

Kind appreciation is extended to the following people.

To all those people diagnosed with schizophrenia who I was fortunate to have trust me; thank you for sharing your stories. To Lee Earle, Griffith University’s Great Sage; sincere apologies for traumatizing you with that first crude draft, and thank you for your support and constant belief in the project. To my darling wife and clinician Charlie, thank you for your patience in wading through those early clumsily written chapters. To clinicians Rosie and Geoff Fosbrooke, thank you both for your dear friendship over many years and your critique of that first draft. To consultant editor Joe Marrable, thank you for your support on those first two chapters, and in guiding me in letting go of my academic hat and embracing creative writing. To academic, teacher and friend Mary-elena Macnamara, thank you for your early structural report which brought more cohesion and direction to what I needed to say. To clinician and dear friend Marie Simpson, thank you for all those crucial comments you made about patients’ rights and confidentiality. To my darling daughter Becky Wyatt, thank you for sharpening up the first two paragraphs in Chapter 1. To clinician, friend and personality disorder guru, Kim Dahl, thank you for some very pertinent comments which helped me re-shape characters. To my brother-in-law and dear friend Gerard Pereira, thank you for your generosity in allowing me the solitude of your beautiful home in Malaysia where so much of this manuscript was sculptured. To all the team at Xlibris Publishing House, thank you for your support and direction.

Last but not least to my beautiful wife Charlie and children Daniel, Sarah, Becky and Naomi, thank you all for your love and support.

Eddie Blacklock 2015

DISCLAIMER

This story is set in Brisbane, Queensland, Australia in a fictitious mental health unit. The clinical processes and procedures described are not fictitious and not peculiar to Brisbane. They would occur in relatively similar manner in mental health facilities throughout the world. All the characters in the story are based on real people, but their names have been changed to protect the identity of those living and dead.

CHAPTER 1

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Was it a dream, a nightmare, or reality?

He fought hard against the embrace of sleep, compelling his mind to wake from its nightmarish reality. Again he felt himself being dragged under dark foreboding waves. He thrashed his arms around wildly, gasping life-saving air into his bursting lungs. But the thin, sinewy hands of his doctor remained firmly clasped around his neck, pulling him down into the liquid darkness. He and his aggressor were naked, and though elderly, the doctor was relentless in his effort to drown him. Grasping desperately in the wet darkness that surrounded him, his hands searched for anything to cling to that would keep his head above the enveloping waves. He awoke sweating, his heart pounding so hard against his chest he thought it would burst out. He was overcome by a sudden rush of relief to find himself grasping at damp bed sheets. There was no water he was drowning in. It was only a dream, and he was safe in bed. Someone was standing close to him, saying something repetitively. He squinted towards what sounded like a male voice that kept repeating over and over again, ‘Come on, Samuel. Wake up, wake up, your doctor wants to see you.’

The voice he didn’t recognise. It was distinctly deep and gentle in its tone.

‘Come on, wake up, Samuel. Wake up, your doctor is waiting to see you.’

Feeling a hand lightly squeezing his shoulder, he brought his attention to where the voice was coming from and screwed his eyes into focus, trying to recollect where he was. He didn’t recognise the bed or the crisp, coarse white sheet that he still clutched in his damp hands. He knew instinctively this wasn’t his home. This was definitely not the same place he had fallen asleep in the night before.

The soft, pleasant male voice continued, ‘Come on now, Samuel, please get up.’

Bright sunshine was streaming into the room. A window was open nearby, and he watched a net curtain float lazily from the wall. He smelt the light perfume of jasmine flowers. The vague aromas of brewed coffee and fried bacon further confirmed that he was not anywhere familiar. Through blurred vision, he saw a male close to the bed. He had dark curly hair, some of which hung onto his forehead. He had wide-set brown eyes with high cheekbones and the dark shadow of an emerging beard. He was standing beside the bed, waiting patiently for a response. An ID with a photograph was pinned to the collar of his shirt. Levering himself up on one elbow, Samuel struggled to sit. Squinting through unfocussed eyes at the ID, he hoped it would reveal something about where he was. The small rectangle came slowly into focus and he read ‘Dan’ followed by ‘Clinical Nurse’. The accompanying photograph depicted a stern, yet professional countenance, quite unlike the pleasant, smiling expression that currently confronted him but it was the same face nonetheless. Before his brain could interpret this new information, Dan, Clinical Nurse, continued to plead gently with him, ‘Will you please get out of your bed, Samuel. There are other patients that I have to see.’

Giving himself a final push to prop himself up on both elbows, Samuel slowly scanned the room for anything he could recognise, but all of it looked unfamiliar. He was in a large, unremarkable room. The walls were a pale, pastel green. Nondescript prints hung on the walls. Opposite was another bed, unmade. On the table beside it was a tray with an unfinished meal. He recognised a piece of bacon on the plate and felt hungry. He tried to mouth some words to ask where he was and what was happening to him. His mind was starting to wake up, but much to his consternation, he found his tongue appeared unable to move. He’d never experienced anything like this before. Instead of feeling panic at this strange development, paradoxically he felt remarkably relaxed. Dan continued in his pleasingly persuasive tone, and offered an explanation of who he was, ‘My name is Dan, Samuel, and I’m your nurse for the day. Your doctor is waiting to see you with the team and he also has other patients to see today. Come on now; let me give you a hand to sit up.’

This statement made no sense whatsoever. Leaning back on his elbows, Samuel heard and understood all the words spoken, but none of them made it any clearer to him where he was, or why he was here. He tried to speak but his tongue was too heavy to move. Speaking in a lower, more pleading tone, Dan said, ‘Please, Samuel, I need you to get up so I can take you to your doctor. Come on, let me help you up and I’ll take you to where he’s waiting.’

Samuel felt the stiffly starched sleeve of Dan’s tunic under his armpit, gently pulling him from the bed. He did not resist. He was too busy trying to comprehend why would he have a nurse for the day? Whatever would he need a nurse for? These thoughts were quickly dismissed as he found himself being expertly pulled out from under the bedclothes and slid from the bed into an unsteady standing position, supported by Dan, his apparent nurse for the day. He noticed he stood a head taller than this person called Dan. Looking down, he saw he was wearing a strange, ill-fitting, faded blue-and-white striped pyjama jacket. He felt his feet touch a cold-tiled floor.

Dan was speaking again. ‘Oh dear, these hospital-issue pyjamas aren’t the best look for the clinical meeting, but they’ll have to do for now. We’ll have to pull them up.’ Feeling a cool change in temperature around his genitals, Samuel looked down and realised that his trousers had fallen around his ankles. Embarrassed, he bent down quickly to pull them up but became light-headed and reached to the bedrail for support. He heard Dan give out a long sigh and shout out loudly, ‘Aaron, will you get over here and help me. You know they’re waiting for us in the team meeting!’

A male voice remarked from somewhere in the room, ‘He’s got no shoes.’

‘I think they’re under the bed, please get them while I sit him back down.’

He was sat back on the bed and watched while another male with a shaved head guided his feet impatiently into a pair of casual shoes. He recognised them as his own, which brought a small level of comfort in a place that was totally alien. Dan spoke again to Aaron. ‘Samuel is a tall lad, so be careful he doesn’t stumble when he stands. I think he is still groggy from earlier medication. Take his other arm while I take this one. Come on, Samuel, off we go.’

The man with the shaved head took his other arm and, using considerably more pressure than Dan, guided him out of the bedroom. As groggy as Samuel was feeling, he was able to distinguish a significant difference between these two strangers and how they manoeuvred him through strange-smelling hallways. Dan was soft in voice and gentle in touch, while Aaron’s voice was deep and gruff and his handling of him was rough. There was something else about Aaron. Some undefined hostility? He felt himself being hurriedly led by these two strangers, along draughty corridors, passing vague shapes of people, trying to make sense of where he was and where were they taking him. Was this another dream or was it reality? If this was reality, he felt totally out of its control. He looked down at his feet and again felt small comfort, recognising the familiarity of his two shoes as his legs were made to walk quickly along tiled floors. The harsh sound of an alarm inexplicably invaded his ears, followed by a strident female voice over an intercom, explaining a fire alarm testing procedure. Confused and frightened, he was forced to a halt in front of a door with a sign that read ‘Consulting Room’. Dan knocked and, without waiting for an answer, opened it, and he was led into a large room. Guided to a chair by his escorts, he sat down and watched as they sat somewhere else in the periphery of the room.

Slowly looking around, he squinted his eyes to focus. Much to his discomfort, he saw the chair he had been seated was in the centre of the room. Shapes were now starting to become clearer and more defined. Feeling the different texture of a carpet beneath his shoes, he looked down and saw what he imagined to be a big Persian rug, worn and faded. Bright light made him look up. The sun was streaming through wide windows, reflecting off more of the cheap framed nondescript prints of abstract shapes and designs he’d seen hanging on the walls of the room he’d been woken in. Bringing his confused attention back to the semicircle of strangers sitting in front of him, he noticed their attentive expressions. Some of them had clipboards, others had writing pads. All were fully dressed, making him very self-conscious about his pair of ill-fitting pyjamas. Toying with the waist cord of the trousers, he tried to equalise its exposed lengths by running it through the pleated hem because he found the uneven lengths vaguely annoying.

‘Good morning, Samuel. Have you had a good rest?’

These people seemed to know him here. This was the second time someone had addressed him by his name, which put him at a distinct disadvantage, as he knew no one. He didn’t even know where he was or why he was here. Turning and looking in the direction of the voice, he saw a mature-aged man smiling benignly at him. The man was dressed immaculately in a dark suit, white shirt, and red tie. He was leaning back comfortably in a large padded leather desk chair. His black hair was brushed back from his high forehead, his piercing blue eyes steadily holding Samuel’s gaze. Looking quickly away, he again tried to gather his thoughts and make some cognitive sense of these last few minutes of conscious awareness. He tried to speak but his heavy tongue seemed to tangle itself in his mouth and before any intelligible words could come out, the suit’s voice continued, ‘You look puzzled, Samuel, as I’m sure you must be. Hopefully, I can make everything clear to you and why you’ve been brought here. Let me first introduce myself. My name is Dr Orelowitz. I’m a consultant psychiatrist here at the Queen Anne’s mental health unit here in Brisbane and this is the team I lead. We’ll be looking after you while you’re here in our mental health unit. Let me start by introducing to you other people in the room. On my right is Mary Maynard, our social worker. Next to her is Theresa Willis, our community nurse. And next to her are Dan and Aaron, whom you know are both nurses on the unit. Last, but not least, is my registrar, Dr Marion Shelnk.’

Affording only a brief glance at each person as the suit’s voice introduced them, he caught half smiles from each of them. Were these introductions supposed to make everything clearer to him? None of these people were recognisable. Nothing was making any sense at all. Perhaps this was another weird dream? Recalling his recent nightmare where he was drowning, he tried to distinguish that experience from the predicament he currently found himself in. This room and its audience appeared to have a sharper reality to it, indicating he was not dreaming. Trying to consolidate being awake, he stared hard at the light switch on the wall near the door. What he imagined to be grubby food stains on the white plastic casing only reminded him how hungry he was. Through the windows he studied a large poinciana tree, and became mesmerised by its lower branches swaying gently in the breeze. The suit’s voice speaking again brought his attention back inside the room. ‘The police were called to your home approximately thirty-six hours ago. Your mother called them after a physical altercation between you and your general practitioner, who’d made a house call in the early hours of the morning. The doctor was responding to your mother’s distress over an emotional disturbance you were experiencing. The subsequent assault resulted in a serious head injury to that poor gentleman, and it’s entirely possible you could be formally charged. The police were subsequently called and they escorted you to this general hospital’s casualty department, where you were given some tranquillising medication to settle you. From there you were transferred here to our mental health unit. I suspect you may still be feeling drowsy after the injection. Are you, Samuel?’

After waiting moments for a response, the suit’s voice continued, ‘I understand you may not fully comprehend everything I’m saying to you right now, but nevertheless, I’ll try to make things as clear as possible. I’ve placed you under the Mental Health Act on an involuntary treatment order. That means there’ll be restrictions on your movements around this hospital, and legal expectations that you comply with your treatment program. The nurses will explain that to you in more detail later. Do you understand what I’ve said to you so far, Samuel?’

He understood the meaning of each and every word the voice spoke in its perfectly clipped English, albeit with just the trace of a foreign accent. Was it European or South African? No, it was from somewhere else, but he couldn’t think where. Taken collectively, however, the words meant nothing. They must have made a mistake. A terrible, catastrophic error. Physical assault? The police? Mental health unit? Mental Health Act? They must have mistaken him for somebody else with the same name, as none of this applied to him. Once again he tried to move his tongue to speak, but it only flopped heavily in his mouth. When he tried to move his jaw, someone in the group spoke.

‘I think he may be trying to say something, Dr Orelowitz.’

The suit’s voice spoke again. ‘Do you understand what I’m saying, Samuel? Raise your hand if you can hear me.’

Responding to the direction, he discovered he could move his right hand off his knee to communicate. But no one had asked if he understood what was being said. The suit’s voice continued, ‘It is possible you may still be feeling drowsy from the injection you were given earlier and cannot talk properly yet. That’s all right, as you’ll not need to say much for now—please just listen. I want to explain to you your diagnosis and the treatment plans. I’ve spoken at length to your mother and she’s told us a history that would indicate you’ve been suffering at home for quite some time, which, we can only imagine, must have been very frightening for you. The behaviour your mother described indicates a broad range of symptoms which are indicative, we suspect, of you experiencing an episode of acute schizophrenia. I understand from your mother your first year at university was problematic and you had to defer from your English literature studies earlier this year. I can understand how frustrating that must have been. However, all that’s behind you. We’re going to take good care of you and get you back on the road to recovery. Can you tell us about the voices you hear, Samuel?’

This time, the suit’s voice paused for longer with an expectation that he would speak, but he made no attempt this time. Even if he’d been able to, he would have been reluctant to talk about his problems at university or his ‘private conversations’ to this room full of strangers. Those private conversations were a very personal part of his life, and he’d learned a harsh lesson many years ago to keep them well hidden. He recalled the first time he’d been found publicly talking back to the voices that nobody else could hear. The incident had occurred in high school, when two students overheard him arguing with one of these voices. He’d thought he was alone in the classroom, and was telling it to stop pestering him. The students had confronted him and taunted him and afterwards told their friends, who had collectively set about to make his life as miserable as possible. The telling of their story around the playground only confirmed what a lot of other students already believed, that he was a psycho. The suit’s voice was continuing to talk. ‘Both your mother and family doctor have indicated that auditory hallucinations have become a significant part of your life for some years now, Samuel. Are you able to tell us anything about them?’

Again, silence was provided for him to speak before the psychiatrist continued talking in a gentler tone, ‘That’s all right, Samuel. We understand if you don’t want to discuss these things today. While you are here, we’ll be making routine formal mental health assessments of you and these will be tendered to the Mental Health Review Tribunal about the assault charge. This is so that your mental illness is seen as a mitigating factor, and you’ll not have to be formally charged.’

Speaking in what sounded a more authoritative tone, the suit’s voice said, ‘It’s important you understand, Samuel, that any kind of violence by you towards other patients, staff, or property here will not be tolerated on this unit. Do you understand me?’

The implication that he might be violent towards anyone made his sluggish brain start to reel in horror. Assault, the police, an injection, acute schizophrenia! The combination of his slow, fuzzy brain and his even slower tongue movement was transposing the dreamlike quality of this experience into a living nightmare. He started to feel anxiety building from somewhere deep within him. The growing sense of unease made him start to fiddle with the trouser cord again, and he thought he really ought to say something, anything to defend himself. But his tongue only allowed a slurred mumble to come out.

The suit’s voice reverted back to its gentler tone. ‘The police report indicated you were found naked with your arm around the doctor you assaulted. We’re not making any judgements about any sexual preferences you may have, Samuel, but I’m curious as to whether you are gay, or if the unusual presentation the police found you in may have been part of some delusional thought processes.’

He didn’t understand the rationale of the question, but following on from everything else he was being subjected to, it didn’t strike him as a strange question to ask. In the absence of any response, the suit’s voice pressed him for an answer. ‘Are you gay, Samuel?’

Again, he opened his mouth to speak, but still his tongue would only allow an unintelligible grunt to come out. The suit’s voice continued in the same gentle questioning tone, ‘Do you have a boyfriend, Samuel? Or, perhaps a girlfriend?’

A growing realisation dawned on him that he was a target for whatever anyone said in the room about him, even if he was able to talk. Being unable to speak only consolidated his vulnerability, which further drove him to close down and go inside himself. After years of being bullied and tormented, he had learnt whenever he found himself in a challenging situation, to always avoid looking into anyone’s eyes. This strategy had done more than help him to minimise both verbal and physical confrontations. In times like these of acute stress, he felt as fragile as a thin sheet of glass, and if anyone pressed him for eye contact, he believed he would shatter into a thousand splintered particles. So now, he simply stared at the worn carpeted floor. Grumbling from his stomach physically reminded him how hungry he was and he imagined eating bacon he’d smelt earlier. After a short silence, the suit’s voice continued, ‘We can always cover that another time, Samuel. We do insist though you keep your clothes on at all times, whatever time of the day or night it is.’ After a brief pause, he continued, ‘I’m going to withhold any formal diagnosis of you at this stage, but my preliminary assessment is one of schizophrenia. Essentially, Samuel, you have developed a chemical imbalance in your brain, which is causing you to feel and behave so differently to the rest of us. This imbalance manifests itself in a group of disorders known to health professionals as the schizophrenias. Given the suspicious nature of your auditory hallucinations, I suspect you are suffering from a subtype called paranoid schizophrenia. We’re going to start you right away on a regime of medications, which will include antipsychotics and antidepressants. I’ll also prescribe you some hypnotics to help you sleep, and some anti-anxiety medication to reduce any tension you may be feeling. That’s all for now. Thank you for coming in to see us. Dan and Aaron, will you please take Samuel back to the unit and administer the medications I’ve prescribed. Goodbye for now, Samuel. We’ll see you next week.’

CHAPTER 2

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Be mindful who listens when you are talking

In total silence, he found himself being guided by Dan and Aaron back to