This summer, I listened to an episode of Radio 4’s Soul Music1 programme, which explored the evocative and emotional effects of listening to Ravel’s Pavane for a dead princess. One of the interviewees was Annabel Abs, who wrote The Joyce Girl,2 a fictionalisation of the life of James Joyce’s daughter, Lucia. Annabel talked about how this gorgeous and talented young woman’s life moved from a promising career in expressive dancing to her incarceration in St Andrew’s psychiatric hospital in Northampton. One of her more memorable dances was to the Ravel piece, at a point in her life when she was at her happiest. It’s a story I know well and each time I hear it, it moves me deeply. Lucia’s is such a sad and tragic life and her treatment, not only in the sanitorium but also by her brother, Giorgio, was suppressive and harsh.
In the mid 1930s, when James Joyce became convinced that Lucia needed to be sectioned, the treatments for psychiatric conditions were cruel. Her experience of psychiatry included the common treatments of the day: being straight-jacketed, immersed in cold water, tied to chairs and confined to very small rooms.3 A little later, she may also have been threatened with the ultimate in permanent incarceration of the soul: lobotomy. The staff at the sanitorium would not have had any training in working with or understanding mental health issues, but were employed merely to keep inpatients out of sight and contact with the general public. The treatment of inpatients at the hands of these ‘guardians’ does not bear thinking about. Present-day psychiatric treatment has changed a great deal, though I often wonder if the profession has exchanged one type of incarceration for another.
An example I recall is that of a friend of mine, a young single mum. As we walk through the countryside with her son, mum and their Labrador, she tells of her diagnosis of borderline personality disorder, which may be changed to bipolar. I see her mind moving from the experience of her inner life to the list of symptoms prescribed to her through the diagnosis. I remember another young woman once strategically guiding me into the garden, where only the two of us were present. Within seconds of entering this sanctum, she threw up the words, and accompanying emotions, of the bipolar diagnosis she had been given weeks before. She too was preoccupied with the symptoms of the diagnosis, the prospect of which added to the struggles she already faced. In both cases, medication and behavioural therapy were part of the treatment programme. For both, the medication numbed their lived experience while the behavioural therapy set out to change the thinking and behaviour deemed so unacceptable in our society.
I watched the confusion and helplessness in these two young women’s eyes and heard a despair in their voices. It was reminiscent of the majority of clients I have seen in private practice whose lives are controlled by a mental health authority. Their energy reached out to me from the precipice that is a life of medicated numbness and behavioural manipulation. Both of them had faced challenges which few of us experience in a lifetime, yet these were not explored during the process of diagnosis, nor were their spiritualities respected. Their thoughts and emotions, behaviour and values were dissected and forced into predetermined patterns, while the stories that mattered to them were discarded as insignificant. Neither of them had been offered psychotherapy, only dialectical behavioural therapy (DBT) and a version of mindfulness that turned out to be relaxation exercises. Comprehensive and inclusive mindfulness therapy would have been a better option.
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Psychiatric understanding and treatment of mental health issues have no doubt moved on a great deal since Lucia’s experiences, though I still see the majority of treatment focusing on the omnipotence of the science of medicine and psychological models that neglect to notice the soul and the individual’s spirituality. Indeed, the presence of a psychiatrist’s spirituality is actively discouraged during training and in the course of their work,3 to the extent that conditioning to disregard their client’s spirituality is automatic and its connection to the possibility of their recovery, discounted.
Psychiatry no longer aims to physically restrict or incarcerate patients as a first option.4 However, a model of treatment that labels behaviour and manipulates our lived experiences without therapeutic curiosity into our inner world, works to shut away true meaning in our lives. Does this not amount to bolting the door on our emotions, keeping them from escaping and our soul from showing its presence; in essence, placating society? Forcing patients to conform to a norm that has yet to be defined in psychiatry, we are prescribed mind and emotion-altering medicines and given treatments meant to change our behaviour to fit in – with what, remains uncertain.
The possibility of a shift in thinking about spirituality within psychiatry is beginning to show itself in the form of the annual conference dedicated to spirituality and mental health5. This conference aims to bring together all professions working with mental issues, sharing research and expanding awareness and knowledge across disciplines. But I remain sceptical: while this conference talks about religion, will it tolerate a more nuanced view of a client’s spirituality when it is not grounded in a religion? I fear that unless the training of psychiatrists shifts from detachment to active inclusion of a psychiatrist’s personal spirituality, the neglect of their patient’s soul will remain.
There is no doubt that some of us need a little medical help in stabilising our lives, though psychiatric diagnosis and prescription seem to have become the norm rather than the exception. As more teenagers than ever before are handed the labels of a psychiatric diagnosis, we forget that being a teenager, for many, was never easy. At present, we stand the risk of medicalising a natural and significant transition and life stage. And it isn’t just young people who are readily medicated to fit in with the norm. Our daily struggles and anxieties are labelled and worn as badges of honour, and our lives medicalised, as the easy option to conform with the demands of life. This disconnects us from our souls and inner worlds rather than allowing us to learn to live in harmony with the full spectrum of our own emotional potential. While the common, freely available option remains the medical model, and while our internal confusion and emotional turmoil continue to be looked upon as inappropriate for our society, we will carry on expecting this medical incarceration of our soul.
Yet, psychiatric diagnosis can also come as a relief. To some of us, a diagnosis is a recognition and acceptance that there is something wrong, igniting hope that an inherent solution will follow. Our diagnosis will provide us, and our family, with a medical understanding of what is happening to us – though also with the perfect excuse for refusing to engage with the truth of who we are. As we reach for the pills, emotions that just wanted to be witnessed are forced out of reach, trapping our ability to fully engage with our world, both inside and out. As we medicate one set of extreme emotions, we are likely to inadvertently numb their counter opposite. Is this the medical equivalent to the lobotomy? One of its many side effects was reduced capacity to feel our emotions and experience the deeper meaning of life.6
Perhaps a psychiatric diagnosis will provide an anchor point for a while, an explanation for emotional fluctuations. But I wonder if these treatment programmes help to embrace the truth of who we are and if the diagnosis itself solves issues the way we hope it will. And when it doesn’t, will we be too numb to realise we have a choice?
My friend tells me as we walk, how she is manipulating the drugs she is taking, that when she has to get up in the mornings, she doesn’t take her dose the evening before because, as she puts it, it leaves her ‘like a zombie’ the following day. Her 11-year-old son calls from the hedgerow and she hurries to see what he wants, leaving me with her mum who, up until now, has remained in the background, nodding in support of her daughter.
She looks at me with desperation lurking behind a composed exterior and tells me how the behavioural treatment her daughter has received hasn’t worked, that she hasn’t applied the suggestions as regularly as she was advised to. Mum talks about how she, her daughter and the rest of the family use the prescribed symptoms of the disorder to explain the continued unhealthy behaviours: an excuse to collude, so their lives can remain the same. She then tells me that her daughter will not let go of a situation that happened many years ago, that she doesn’t understand why her daughter keeps on clinging to this devastating memory. This to me is good news: for this young woman, there is still hope. If she is experiencing the past as if it is emotionally still happening, her soul will still be strong enough to work therapeutically towards embracing everything that is her. Inside, I sigh with relief on her behalf, a relief I hope she too will feel one day. I talk with them both about the possibility of psychotherapy, a concept they have little understanding of, but are willing to explore.
The next time I see them, I hear that my friend has begun therapy. I keep my fingers crossed that this will be the beginning of her journey of reparation.
Lucia was not so lucky, despite having achieved more than most women of that era. She attended a dance school in Paris, danced with various groups on and off stage, lived a bohemian life in France, and fell in love with the playwright Samuel Beckett. Hers was a full and spirited life. The consistent support of her father, James Joyce, I suspect will have caused some sibling rivalry with her brother. When Samuel Beckett informed Lucia that he was only interested in his relationship with her father, Lucia’s heart was broken, and she struggled to cope. Who wouldn’t have?
She tried to engage in simpler activities, suggested by her family, but these did not suit her spirit, nor her character. The series of short-term relationships that followed was perhaps an effort to mend the pain she felt inside. This was not a joyful time for Lucia.
Coming from a strict Catholic background, her mother could not have approved of what she no doubt saw as her daughter flaunting her half-naked body on stage in erratic, perhaps even erotic, dance. With two such contradictory characters, I can only imagine the conversation that took place on the fated day when Lucia threw a chair at her mother. This was the incident that resulted in Giorgio taking Lucia to a sanatorium, and the beginning of her descent into a spiritless life.
Lucia was incarcerated in St Andrew’s Asylum and drugged because of her vivacious character, her talent in expressive dance, her broken heart and the differences in values with her mother. If Lucia had lived today, her talent would have been celebrated. Would she still have been diagnosed with schizophrenia? Possibly not. Perhaps her circumstances would not have triggered this in her. During her 30 years at St Andrew’s, she no doubt remembered dancing to Ravel’s Pavane For A Dead Princess. Perhaps her creative expression lived on: no longer on the physical plane, but in a place far away, only available to Lucia.
1 Soul music. What makes Ravel’s Pavane For A Dead Princess so evocative and emotional? Maggie Ayre (producer). BBC Radio 4, 2020; 22 July. https://www.bbc.co.uk/sounds/play/m000l0j1 (accessed 18 August).
2 Abbs A. The Joyce girl. New York: Harper Collins; 2016
3 Lawrence RM, Duggal A. Spirituality in psychiatric education and training. Journal of the Royal Society of Medicine 2001; 94.
4 NHS. Restraining adult patients in hospitals. [Online.] https://www. uhs.nhs.uk/HealthProfessionals/Clinical-law-updates/ Restrainingadultpatientsinhospital.aspx (accessed 18 August).
5 Winkler A. A dispatch from WPA’s 4th global meeting in spirituality and mental health. The American Journal of Psychiatry Residents’ Journal 2020; 15(4). https://doi.org/10.1176/appi.ajp-rj.2020.150404 (accessed 18 August).
6 Shutts D. Lobotomy: resort to the knife. US: Van Nostrand Reinhold; 1982.