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...That was when my soul dropped out.

By Clark Nida

I have been a lot of different things in my time, including a mental health nurse. It was my job to man the “Three Day Order”: the observation unit to which people with florid mental symptoms were admitted in emergency, awaiting diagnosis by a doctor within the statutory period of 72 hours under Section 29 of the Mental Health Act, 1959 (hence “Three Day Order”).

A consequence of this highly-charged experience so early in my adult life has been to give me a lifelong interest in schizophrenia, its causes and social consequences.

Many of the sad people I sat up with all night (a dangerous task, if I may say) went on to be diagnosed with schizophrenia, which in those days was tantamount to a life sentence. It is, as qualified people have assured me, a “difficult diagnosis to make”. To me, with my limited medical training, that means a difficult label to apply correctly. But that’s not how doctors put it. In my youth and inexperience I was inclined to dismiss it as a fancy word for barking mad.

But things have moved on and I’m assured the situation isn’t as bad as it then appeared. For one thing, there is now a greater range of drugs and treatments available, enabling many sufferers to enjoy an independent life in the community who formerly would have been institutionalised. Such treatments are effective in stabilising mood and providing relief from desperate obsessions: about which more later.

Recently the Newcastle Philosophical Society organised a series of talks entitled 100 Years of Schizophrenia. Last Monday I attended the second talk in the series, given by Tony Wright, a counsellor working with the Medical Foundation for the Care of Victims of Torture – or Freedom From Torture as it now wishes to be known.

The speaker alerted me to a fact I’d not hitherto appreciated: his clients – torture survivors – express symptoms scarcely distinguishable from schizophrenia. A doctor not knowing the patient had been tortured might have little hesitation in making such a diagnosis. Wouldn’t the patient tell the doctor? Not necessarily: indeed the patient may have a host of reservations about doing so. A woman, say, might not like to confide such intimate things to a man. Men from Arab countries do not like confiding such things to anyone. Even such a little thing as the speaker’s spectacles upset his client: they made the former look so much like his torturer.

In hindsight it stands to reason: the word schizophrenia doesn’t mean “split mind”, as it’s often rendered, so much as “shattered mind”. But the symptoms can’t be expected to depend on how the shattering has arisen. Torturers, people who deliberately shatter other people’s minds in order to interrogate or silence them, know exactly what they are doing. Many of them are expert in their trade, with a wealth of experience. As with medical treatment, there is a range of well-attested techniques they can employ, and (Hippocratic Oath notwithstanding) they have access to excellent medical advice.

The speaker was at pains not to inflict appalling detail on his lay audience. Moreover one of the effects of getting old is that I’m becoming ever harder to shock. It is less, I fear, about acquiring wisdom and maturity than a sign of nervous degeneration. Nevertheless the speaker managed to find one raw nerve in me to touch. A poignant moment was when he quoted one of his clients (who had suffered an aggravated form of strappado) as saying “...that was when my soul dropped out”.

This of course had to be translated from the client’s own language, and the counsellor (who had a medical form to complete for the client’s appeal process) was at pains to discover exactly what was meant. It appears the sufferer was not being fanciful but describing literally how he felt.

Now I can’t imagine what it’s like to walk around with the feeling you’ve got no soul. Nor, incidentally, could the speaker, although he’d know the medical term depersonalisation disorder.

He went on to say – and here’s where at last he succeeded in shocking me – that asylum seekers are now being denied treatment under the NHS for their mood disorders if their symptoms are judged to have arisen from being tortured rather than what’s normally considered mental illness. This is like saying: “We will mend your broken leg if it has arisen by accident, but not if someone has deliberately broken it for you.”

It so happens that this client has tried to end his life on at least eight occasions, for which he has been offered no palliative treatment and continues to have to spend long periods of time on his own. His counsellor is in receipt of an official letter explaining why, under the policy alluded to.

Is it then official policy to tell this unfortunate man that he would be doing everyone a big favour if he were indeed to end his life, saving his host-nation the cost of having to offer him relief for his mood disorder, on top of its generosity in letting him into the country in the first place? Leaving aside the little matter of our treaty obligations, it could be argued that if you’ve got no soul, you’re not eligible for human rights. You are lebensunwertes Leben as the SS used to say: a life-form not fit to be alive.

Possession of a soul is an enormous gift, and it seems not everyone enjoys it. Having a soul (or being “endowed with reason” if you like) obliges us to “act towards one another in a spirit of brotherhood” (Article 1 of the UN Universal Declaration of Human Rights, 1948). Absence of soul goes hand-in-hand with feelings of isolation and worthlessness. Alone in a strange land, sufferers are prey to despair. We should be seeking to alleviate such distress, not aggravate it.