I didn't set out to do this, but I have inadvertently created a forum that allowed the psychologically afflicted, medicated or self-medicated, the walking wounded, to voice their truths. Those who are ignored and stepped around on the streets, the homeless who cycle in and out of wards and through rooming houses, are hardly seen as human, and are left to wander in a ghost garden – an interior haven where emotional pain can be suppressed.
In 2009, after author Susan Doherty spent months researching the history of mental illness treatment in the archives of Montreal's Douglas Institute, she decided to give back to the facility by volunteering her time. Doherty assumed she would be given some clerical duties and was surprised when she was asked to simply spend time with one of the residents, a woman with schizophrenia whom Doherty calls “Camilla” (all of the patients and their families in The Ghost Garden have had their names changed for privacy). Doherty writes that she and Camilla became friends that day, and in the ten years since, the author has become friends with many other of the Douglas Institute's severely mentally ill patients; taking their calls at all hours of the day and night; keeping in touch with those who return to the community; giving physical human contact to the feared and marginalised – many of whom with no one else who will take those calls or hold their hands. Meanwhile, a woman that the author grew up with contacted Doherty and, after explaining that her own sister has struggled with schizophrenia for over thirty years, offered the author access to “Caroline's” medical files, interviews with the family, and time with Caroline herself in order to trace one person's entire history of the disease's onset, efforts at management, its effects on social and domestic relationships, etc. The book that resulted is mainly Caroline's story – and it is thorough and honest and affecting – interspersed with what Doherty calls eighteen “vignettes”: brief sketches of some of the other troubled friends she has made in the past decade of her volunteer work. This book is kind of amazing – forcing us to look closely at the kind of people that we usually avert our eyes from; forcing us to recognise the people behind the illness. There's nothing prettified in this narrative – there are body fluids and violence and families pushed to the brink – but it's also not a gratuitous freak show: schizophrenia is an aspect of the human story and Doherty is simply asking us to recognise that fact. Amazing. (Note: I read an ARC and passages quoted may not be in their final forms.)
Psychosis does not discriminate. The worldwide prevalence of schizophrenia is one percent, across all nationalities, professions, income brackets. Schizophrenia is not the domain of the needy, neglected poor, the marginalized lower classes, but its sufferers can quickly descend to rungs reserved for the downgraded.I don't want to go over all of Caroline's story, but I will note that she was from a well off family in Montreal's Westmount neighbourhood, one of ten siblings born to a respected doctor and his homemaking wife. When she began to exhibit signs of mental illness, Caroline's parents reacted with shame and denial (her father's sister had been institutionalised, but neither that fact nor his medical expertise garnered Caroline any understanding from him), and ultimately, Caroline became so abusive and embarrassing that she drove away all of her family except for a couple of sisters. Throughout all of Caroline's story (and the vignettes) Doherty is never judgmental about how families deal with a mentally ill member; always stressing that schizophrenia is a series of never-ending and all-consuming tidal waves that some people, understandably, eventually need to shield themselves from. There are stories of parents who cut off contact with their schizophrenic children, parents desperately searching for the schizophrenic children who cut them off, and stories of those who have been left with no one. Caroline herself has a huge heart and a desire to care for everyone around her, but when she's suffering a psychotic episode, she hurls accusations of neglect and imagined sexual abuse at family members – which has left her isolated from everyone she wants to pour her love into. The book's title comes from one of Doherty's friends, Aleks, who is essentially alone in the world but who often reports that he has spent the night with his girlfriend, Jennifer Love Hewitt. When Doherty teasingly asked Aleks where the two of them meet, he replied, “Susie, I met her in the Ghost Garden. It's where I meet all the souls of people I love.”
I had to marvel. Aleks had just given me another gift: access to the hidden realms of mental illness. With that gentle correction, he'd shown me that a place of comfort exists for many who suffer from schizophrenia, an alternate world as real as Dorothy's Oz. So often we see the severely mentally ill as less than fully formed human beings, as ghosts of their “normal” selves. As ghosts, they can appear to be inanimate, unreachable, and frightening, but they, like all of us, tend an interior garden that is lushly alive.With the knowledge that Doherty has gleaned from her encounters with Caroline and others who are afflicted with schizophrenia, she has come to some (perhaps) controversial opinions about overmedicating the disorder. Caroline has never found a perfect pharmaceutical cocktail – and the brain-numbing side-effects of what she has been prescribed prompted every one of her relapses when she has decided to stop her meds – and as Doherty sees it, the main goal of an institution at the moment of admitting someone who is displaying a violent psychotic break is to immediately subdue and sedate to prevent harm to the self and others. Although Caroline has admittedly had many caring and hands-on teams working with her in institutions over the years, Doherty notes the ineffectiveness of the drugs to keep her safe and stable after her eventual release into the community. Doherty takes a couple of swipes at “Big Pharma” (specifically calling out one company that markets both an antipsychotic and a drug to manage the diabetes that that antipsychotic causes), and quotes one of Caroline's sons when he recalls his disbelief that Caroline, in a diminished mental state, was ever able to consent to shock therapy, and ultimately, Doherty concludes that even today, not enough is known about schizophrenia or how to control it (and in the case of creative geniuses, questions the necessity of suppressing it).
A crisis reveals the mind's need to fix something that has been damaged. Psychosis is a sign of that need for repair, just as a fractured bone can be a signal of insufficient calcium. Without a psychotic break, there is no indication of the problem, and so no opportunity to address the issue. But when the breakdown is treated only with medication, the person suffering has no chance to dig into what's going wrong.(Despite calling for alternatives, Doherty does ultimately conclude, “Clearly there are times when the drugs are beneficial.”) At the margins of every one of these stories is Doherty herself: someone who was initially scared to death to be asked to visit a ward for the severely mentally ill; someone who eventually befriended, emotionally supported, and held the hands of suffering humans who had no one else. I find that to be an impressive and inspirational transformation, and the book she made out of this experience has educated and changed me. Kind of amazing. I'll end on a favourite quote (attributed to the therapist of a schizophrenic's parents) that I couldn't fit in anywhere:
Living with a child with schizophrenia who isn't capable of accepting treatment is like eating a hippopotamus. The solution lies in the number of people at the table willing to take one bite at a time.
