Growing up in Cumbria in the 1980s, we all knew the name of the nearest psychiatric hospital: Garlands. It was a name to provoke both ridicule and fear, not least because it sounded so obscenely jaunty, conjuring up images of gaudy paintwork and nineteenth-century lunatics’ balls. Garlands was where the mad people – the really, really mad ones – ended up, trussed up in strait jackets, bouncing off the walls of padded cells. It was oddly exciting, like having a Victorian workhouse plonked in the midst of perfectly ordinary schools, houses and shops. In the playground we’d say that certain kids “should be in Garlands” or spread rumours about one of their family members actually having been inside (this only happened to the poor children, mind, what with poverty and mental infirmity being firmly aligned in the minds of spiteful kids and Conservative politicians alike).
Later on, in the sixth form, two members of staff from Garlands came to talk to our year group about mental health stigma. We were older, not wiser. They asked what we thought of when we heard the name “Garlands” so we called out the name of a teacher who’d ended up there, because obviously this was funny. And so the staff earnestly wrote the name on a flipchart while asking us “and how does the name Mr … make you feel?” Of course, most people sniggered. I didn’t tell them that by that point I’d had a relative in Garlands. I didn’t want to see my name up there on the board, too.
At the risk of sounding a million years old, I’m not sure children today would understand this. Fear of the institution has gone; the “infamous” Bedlam is now a museum. Much of Garlands has been demolished (mid-Nineties whistle-blowing suggesting it may even have come close to our horror-strewn childhood imaginings). Psychiatric hospitals still exist but children can take a much more direct route towards stigmatising adults suffering from mental illness. Nowadays they walk among us, being fellow humans, reminding us that states of mind are fragile and that somehow we all must care.
We are past the two-faced hysteria over Care in the Community – several years during which the right-wing press produced article after article fretting over patients dealing with the trauma of deinstitutionalisation while simultaneously suggesting that said patients would kill us all – but prejudice still thrives. At best, we oscillate between two extremes: either the mentally ill are “just like you and me” (and hence not permitted to exhibit any symptoms of illness whatsoever) or they’re machete-wielding murderers. It’s an artificial boundary replacing the brick walls that once separated us from them. Most families no longer have “difficult” members who “conveniently” disappear, at least not physically, but finding a way to talk about what this means – honestly, with kindness and without fear – can still feel beyond our reach. Our children do not have an innate fear of schizophrenia but it is easy for them to learn it from us.
I have, repeatedly, made a complete mess of talking about mental illness with my children, not least because I am unsure how to explain something I don’t really understand myself. They know that someone close to them is a sufferer but most of the things they perceive as symptoms are really the side-effects of anti-psychotic drugs. That, to them, is “the illness”. I am fearful of revealing to them (too soon?) that your mind is not always your friend. I want to keep them innocent. I’ll answer questions about sex, but mental illness? Where to even start?
This is a question Alice Hoyle has sought to answer in Pretend Friends: A story about schizophrenia and other illnesses that can cause hallucinations, written with the support of Rethink Mental Illness. A picture book aimed at children under ten, it uses the idea of childhood pretend friends – the ones who come and go whenever you want them to – to introduce the idea that some people hear voices that don’t say what they want them to and don’t go away when asked. Over the course of the story, Little Bea gets to know the difference between her pretend friends and those of an older relative, Big Jay, who suffers from schizophrenia. It’s a very simple conceit and one which cannot sum up the breadth and diversity of how people experience psychosis – but then, what could? The message is not that one can “know” another’s illness, but that it is possible to engage with someone who is suffering, not to save them, but to be a “real friend”.
Children can be often the cruellest people but they can also be the most receptive to breaking down barriers. If a person has not had decades in which to absorb our rigid cultural messages about what a schizophrenia patient is, then the fact that it is someone who feels and experiences things that may not be real in the way most people would understand it – and who can often feel desperately sad or angry or alone as a result – is not so remarkable. It’s just another way in which people differ from one another. It’s not a difference one might wish to celebrate – even if suffering is part of life’s rich tapestry, I think it’s always fair to wish it wasn’t – but it is not something that has to be feared. As Little Bea learns, “it can be hard sometimes when we see that Big Jay is sad, upset or angry because of his pretend friends, but it is very important that we love him exactly how he is.” Which might sound incredibly twee, but this is a book that acknowledges loving is hard, without any promised rewards. Bea’s learns that her role as “real friend” cannot be “to try to make Big Jay’s pretend friends go away and make him better”. It is, quite simply, to be there.
Most of us don’t want to be there. I know I don’t. The vague, embarrassed way in which I respond to straightforward questions from colleagues and my never-giving-too-much-away vocabulary – unemployed, not well, disabled, has problems – make that obvious enough. I don’t want to be associated with a “Garlands” type and yet, for all our sakes, I don’t want that stigma to be there at all. There is no them and us. Deep down we know this but we let it fuel our fear rather than speak to our humanity. We need to talk about why this is and how we can be better. It’s a conversation we need to be having with our children, but also with ourselves.
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