A few weeks ago I reviewed Rachel Joyce’s second novel ‘Perfect’ for For Books’ Sake, but didn’t have the space to talk much about the central mental health theme, so I’m going to do that here instead.
One of Joyce’s main characters is a middle-aged man called Jim, who is introduced with the sentence: ‘Jim lives in a campervan, on the edge of the new housing estate.’ Later in that same chapter we learn that Jim, in his late teens, was found up on the moor near his current home in only his shoes and underwear, because he ‘had given his clothes to the trees…had been sleeping wild.’ Sectioned, Jim has electroconvulsive therapy that leaves a tingle he can feel even in middle age.
I was unable to find out how Joyce researched the mental health aspects of ‘Perfect’, but Jim is beautifully realised, as are his experiences. There was no legal framework for ECT usage on non-consenting patients (as Jim is) until the Mental Health Act 1983, which followed years of investigation and guidelines published by the Royal College of Psychiatrists that said ECT was useful in treating depression but under-investigated in terms of its effects on memory. Jim experiences memory loss, which is a common complaint among ECT patients, though a 2012 first-person newspaper article gives it a different spin.
As his story unfolds we learn that Jim has severe OCD, enjoys gardening, which was suggested to him as a hobby during one of his many periods of institutionalisation, and works in a supermarket cafe, where he has difficulties engaging with customers and colleagues. His story gets increasingly heartbreaking as we dip in and out of his life in psychiatric hospital Besley Hill, where the patients wore each others’ pyjamas because the nurses didn’t see the point in individual possessions, and where Jim was ridiculed by local school children who brought him a tin of pineapple chunks as a Christmas present.
All of this is, sadly, accurate; though there are thousands of people who have benefited hugely from stays in psychiatric hospitals/units, there are plenty of anecdotes about it not working, or horrible stories of ill-treatment and neglect. A good example comes from Professor Barbara Taylor, a London academic who has written a book about the history of psychoanalysis alongside her own experiences of mental health hospitals. While she found hospital life-saving, and formed fast friendships there, she admits it could be ‘very frightening’ and has been accused by fellow patients of romanticising her experiences.
In ‘Perfect’ we also see the stigma Jim faces every time he is released (‘A little while later his landlady got wind of his spells at Besley Hill and the room was no longer available’), and how his struggles to cope in the community oblige him to re-commit himself, for safety and security. Again, none of this is unrealistic.
Jim is and out of Besley Hill, for reasons that become clear as the novel nears its
conclusion, until it closes as part of national deinstitutionalisation. Deinstitutionalisation was a gradual process that began in the UK in earnest in the 1970s – partly on the basis that it would be cheaper, and people would be better able to cope in the community because of new drug treatments. Where there is support, this is often the case, though the media is brilliant at focusing on the tiny number of people with mental illnesses who commit heinous crimes, and a 2011 Centre for Social Justice report concluded that:
‘[m]any patients are being neglected and denied access to treatment because the closure of the old asylums was not accompanied by a parallel expansion of primary mental health services provided by GPs, psychiatrists and nurses.’
In the final group session at Besley Hill, Jim is told that the hospital’s closure is a beginning, rather than an end. He is given the supermarket job on trial, and continues to face stigma and ridicule, struggling to cope on his own until, in a warm, redemptive conclusion, he finds love with an ex-colleague called Eileen (who actually knocked Jim down in her car earlier in the book, but that’s by the by). This is fiction, and for the most part beautifully-written fiction at that, so this is the ending we want. It’s worth remembering though that for many people like Jim, that’s not the realistic ending.