Who is mad? Who is sane? Who decides? Welcome to the Dorothy Fish, a hospital in North London. N has been a patient for thirteen years. Day after day she sits smoking in the common room and swapping medication. Like the other patients, N’s ambition is never to be discharged. Then in walks Poppy Shakespeare in a short skirt and snakeskin heels. Poppy is certain she isn’t mentally ill and desperate to return to her life outside and, though baffled, N agrees to help her. But in a world where everything’s upside down, are they crazy enough to upset the system?
I recently re-read this to refresh my memory of it, after having read initially it when it first came out. Between reads I saw the Channel 4 adaptation, which I thought worked pretty well, especially considering how badly adapted some books are!
Anyway, I shall focus on the book…
I loved the main narrator N, who has spent her entire life submersed in mental health problems (in other family members and the community in which she lives). N is a day patient at Dorothy Fish, the local psych unit, and is convinced she will never be discharged. It becomes clear there was very little question as to whether N would be a patient in Dorothy Fish, simply because of the family and situation she heralded from. I would like to think that this is partly due to the story being told from N’s perspective, rather than the way in which local authorities truly operate. For me, this throws up a problem with fiction such as this: how much does the author know about the mental health system? (or rather, have they experienced it themselves either directly or indirectly through family/friends, and if so, how much are they putting into this novel?). I would like to think local authorities don’t ear-mark children from families with history of mental health issues to follow in the footsteps of their parent(s) into institutions, and instead they are more sensitive (I know in serious circumstances social services would be involved anyway, to help both parent and child).
The reader needs to bear in mind that the story is from N’s point of view. She feels the authorities have assumed, as she is from a long line of ‘dribblers’ (the Dorothy Fish slang for those with learning difficulties/mental health issues who use the day service), that she will go straight into the unit. We don’t know what support & assessments she has had. This is N’s version of the truth, and I’m sure if the narrator was an employee at Dorothy Fish the version of the truth would be different. I love it when a book makes you question what the true reality is. Is there one solid version of events (regardless of whether someone has mental health issues or not, everyone surely has different bias/agendas/roles to play).
This comes into play even more when we meet Poppy. Poppy is determined she is not mad (a term bandied around by the patients freely), and has been ordered to attend the Dorothy Fish. As you can imagine, all Poppy wants to do is prove she not mad and get out of there and back home to her daughter. The author Clare Allan gets this absolutely spot-on. Unfortunately, as Poppy discovers, the more you protest you are not mad upon being labelled as having mental health problems, the less likely people are to believe you, and indeed such protests are put down to being so ill you are unaware of your own wellness. Indeed, it works both ways – it is very rare that someone who asks to be sectioned is.
At this point, I can’t help thinking back to an episode of Don’t Call Me Crazy (a series following teenagers in a psych ward currently on the BBC) I saw recently where an outwardly smiling, energetic girl is admitted for depression and an eating disorder. During her treatment she starts to worsen and has numerous meetings to try new things to improve her situation, warning her she on the path to being sectioned. She is adamant it’s just empty threats and tells everyone she is fine and shouldn’t need to be there at all. The next meeting they have they decide they need to section her for her own safety.
Overall I feel the book portrays a quite real and accurate experience of a long-term day-patient. Not necessarily the way the system works (although in any unit like this there will be cynicism, speculation and rumours as to how the system works – in the case of Dorothy Fish the Ministry of Madness, and MAD money to name but a few), but the way the group works together, and the relationships between patients, definitely so. Everyone is so wrapped up in their own ‘stuff’ that although they have little cliques, ultimately they are out for themselves – their own targets (whether that be to get out of there, to stay as long as possible etc etc).
I found I recognised the assumed knowledge there was within the group, which came to the fore as Poppy was introduced to each of them by N. A little back-story would be given, but N assumes Poppy will know the intricacies of each disorder & character. In a similar vein, Dorothy Fish dribblers have similar rules to (in my experience) families; they can call each other nicknames, and they can call each other things like ‘mad’. If someone from outside of the support network/family/group of dribblers called them something similar they’d all be up in arms against the outsider. This shows, the dribblers do have a supportive network between themselves, indeed, they do worry for one another when someone is discharged, or when someone is sectioned.
Ultimately, I love this book. It smacks of a time when mental health care wasn’t top of the agenda, and as the government works to amend this, the Dorothy Fish centre changes to adopt the ‘care in the community’ stance to which I was subject to (in 2006, the year of publication). Clare Allan has worked hard to show the reforms needed in mental health care, both inpatients and out-patients. She has created this world, in a run-down area of London where there is a struggle to see who is mad and who isn’t. Where there is a struggle to see who needs help and who doesn’t. Where there is a struggle to see who is in-charge and able to care for those who need it and who isn’t.
At a time when the NHS is currently under-threat from those who think it should be run as a business, and who are more bothered about figures than the people this book comes into its own yet again.