Book Review
Cockburn, Patrick, and Cockburn, Henry: Henry's Demons: Living with Schizophrenia: a Father and Son's Story, Scribner, 2011, ISBN 978-1-4391-5470-0, 238 pages.
(Swans - August 1, 2011) Three weeks after Jared Loughner shot six people to death in Tucson, Arizona, and wounded another 14 including US Representative Gabrielle Giffords, Henry's Demons hit the bookstores. So dismayed was I at the time by the level of ignorance on the left about mental illness, including, I am afraid, an article by Sam Smith that appeared on Patrick's brother Alexander's CounterPunch, I only wished that every single subscriber to the "Tea-Party-made-him-do-it" theory could read Henry's Demon. (Smith opined that Loughner drew "bizarre conclusions" from the books he read, a function of not developing "critical thinking" in school or college. This completely ignores the question of brain chemistry, as if sending Loughner to Philips Exeter and Yale would have made any difference.)
As someone who has studied this issue in some depth because of both a close friend's and a relative's struggle with schizophrenia, I can say that Henry's Demons is a book that will go a long way in illuminating one of society's most intractable public health problems. By making the personal political, Patrick Cockburn has made an enormous contribution to our knowledge about a disease that is subject to the most ignorant prejudices, unfortunately even from our most educated classes.
In Kabul on February 8, 2002, Patrick Cockburn received a phone call from his wife Jan informing him that a fisherman had pulled his twenty-one-year-old son Henry fully clothed from a freezing cold river in Brighton. Suffering from hypothermia and just one step ahead of death, the youth was taken to a local hospital and then shortly transferred to a mental hospital. This was the beginning of an ordeal that lasted for the better part of a decade. It is almost impossible to imagine how Cockburn continued to function as one of the world's top foreign correspondents while coping with his son's never-ending dalliance with death. Although many people associate psychosis with violence against others, the greatest risk for the mentally ill is that they will do harm to themselves.
Henry himself wrote chapter three of Henry's Demons, as well as a number of other chapters. Cockburn believes that this co-authorship helped in his son's partial recovery (all recoveries from schizophrenia are only partial, unfortunately) as well as giving the general public an idea of how someone like Henry perceives the world.
When I was in Newhaven, I hid under a heap of ladders. I felt that people were following me. I went to the estuary and hid by a low wall. I didn't want to go into the water at first, but finally, I did get in and heard somebody shout: "You stupid bastard!" I thought I was going to die. I saw brambles everywhere. It was about twenty yards across, and after I got out on the other side, it was freezing. I was underneath a jetty, and there were steel girders. It was so cold that I went back in the water, and I was there when a fisherman held out his hand. The next thing I remember, I was in an ambulance with no windows, being taken to the hospital in Brighton.
What gives Henry's Demons its power is Patrick Cockburn's superb ability to describe in telling detail his own coming to terms with the reality of mental illness, coming from a place not much different from where most leftists were at right after the Tucson tragedy. Needless to say, when your own son is in the grips of such an illness, it tends to focus one's attention.
Cockburn began by reading scientific papers from the National Institute of Mental Health in the U.S. He was dismayed to learn that a physician described schizophrenia as being to mental illness as cancer was to physical ailments. Since it is estimated that there are 51 million people suffering from schizophrenia worldwide, it is obviously a major health problem and one that is exacerbated by cuts in spending. Cockburn writes:
As asylums closed en masse in the 1980s, those who once found a measure of protection in them had nowhere to go and were sometimes thrown onto the streets, becoming "sidewalk psychotics"; were sent to prison; or, more usually, were looked after by their overburdened families. Between the 1950s and today, the number of beds available to psychiatric patients in Britain fell from 150,000 to 30,000. In the U.S. a similar shutdown of mental asylums was presented as "deinstitutionalisation," a word which has a fine libertarian ring to it until one realises that many people with mental problems have a desperate need for an institution to protect and look after them. In the U.S. the number of beds available for psychiatric patients in public hospitals fell 90 percent, from 558,000 in 1955 to 53,000 in 2005. Many patients became homeless and were dealt with by the police rather than by health workers. An expert report on the shortage of hospital beds for the mentally ill notes sardonically that the three largest de facto psychiatric institutions in the U.S. today are the Los Angeles County jail, Chicago's Cook County jail, and New York's Rikers Island. The worst of the old asylums may have been hellholes, but the response should have been their improvement, not their abolition.
This rings a bell for anybody who lives in New York, or even one making a brief visit. One cannot help but observe that many of the men and women pushing a grocery cart overflowing with their life's belongings are conducting a conversation with themselves, a primary symptom of schizophrenia. For those suffering from the illness, the voices in one's head are as real as those of real people. When a voice accused Henry of being a "stupid bastard," the natural tendency was self-punishment. Despite all the terrible side effects of antipsychotic medicines, they do tend to turn down the volume of those voices dramatically, from a roar to a whisper.
This is not to say that someone taking medication can lead a "normal" life. Schizophrenia is not just a disease that generates hallucinations (mostly auditory at that); it also results in diminished affect and inappropriate responses to stimuli. A joke, in other words, produces tears and a sad story might produce uncontrollable laughter. This means that someone suffering from schizophrenia, even under the best of conditions, might never be able to hold down a typical office job that involves constant interaction with other workers or with customers.
Despite all the obstacles presented by the disease, there are success stories -- most notably that of Nobel Prize winner John Nash, whose struggles were dramatized in the film A Beautiful Mind. Since Nash's success is explained to some extent by his own native intelligence and the loving support of his friends and relatives, then we can at least say that there is hope for Henry Cockburn as well.
The earlier comparison between schizophrenia and cancer can be expanded by seeing such illnesses as operating in a kind of black box that science has not yet penetrated, and according to some experts never will. Cancer is an illness that in many ways is the evil twin of the life process itself. When a cancer cell "goes rogue," it is only following the same pattern as normal growth itself but in an unregulated manner. Understanding how this process unfolds requires a much better understanding of microbiology than medical science possesses at this point.
Schizophrenia is an even more daunting illness to unravel. Since the human brain is the ultimate black box, its secrets are a challenge to medical science far more than cancer. All that can be said for sure is that schizophrenia is a disease that becomes fully manifest in the late teens or early twenties and that responds to psychotropic medication.
But the history of its treatment is an indictment of civilization, as Michel Foucault's Madness and Civilization: A History of Insanity in the Age of Reason documents. When Europe was progressing through the Age of Reason, the psychotic was deemed a threat to its values and confined to institutions alongside prostitutes, vagrants, and the like.
When the insane were not being confined in such a manner, they were being "treated" in ways that had little to do with medical science, including freezing-cold waters not much different than those into which Henry Cockburn dove. Treatment also includes electroshock and, most barbarically, prefrontal lobotomy.
While psychotherapy can be a real benefit, especially when medication has reduced the most extreme symptoms, the uses of Freudian-type psychoanalysis have been illusory at best. Freud himself was capable of the most ignorant theorizing about schizophrenia, stating at one point that it was caused by repressed homosexuality.
One Freudian psychiatrist named John Rosen developed a theory called "direct analysis" that involved browbeating schizophrenics into reality. When one patient "whined endlessly that he was going to be cut up into little pieces and fed to the tigers," Rosen walked into his room with a big knife and announced that he would cut him up himself (an incident described in Edward Dolnick's extremely useful Madness on the Couch).
Although not a strict Freudian, R.D. Laing stood out in a crowded field for taking medical science in the wrong direction during a controversial career that rested on the proposition that insanity was a kind of healthy reaction to a sick world. In a way it is, but Laing clearly did not understand that the mentally ill needed help in overcoming hallucinations in order to function properly. In his warped view of the disease, the hallucination was some kind of inner wisdom akin to a Shaman's vision.
The worst part of Laing's bogus science was the notion that parents were to blame for their children's insanity, a view that clearly is derived from Freud. This puts the mother and father in the untenable position of blaming themselves, thus leading to a paralyzing feeling of guilt that can block effective support. Fortunately Patrick and Jan Cockburn never allowed themselves to feel this way.
The proof of course is in the pudding. The final chapter of Henry's Demons concludes with these words from Henry, a sure sign that he is making progress through a combination of support from his parents and judicious aid from doctors, including medication:
I was born in London, and maybe that is why I feel so much at home there. I see the psychiatrist every Monday. I am still on section, which means that everything I do is at the doctor's discretion. The psychiatrist seems nice and listens to what I have to say, but he has his own agenda. He does not remove my sectioning, telling me that it is necessary to keep tabs on my progress in the hospital. I get the impression that if Socrates himself wrote my appeal against being sectioned, it would still be turned down by the doctor. During my years in mental hospitals, I have met a lot of psychiatrists, and none of them wants to take risks. Maybe they feel their jobs are on the line and are scared that I will run under a bus if I am free.
It has been a very long road for me, but I think I'm entering the final straight. There is a tree I sit under in the garden in Lewisham which speaks to me and gives me hope.
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