When the rather compelling Hollywood film “A Beautiful Mind” hit cinemas, millions upon millions of people were treated to a convienient mistruth. John Nash the Nobel Prize Winner on whose life the film is based, is shown coming off anti-psychotic medication (a treatment he is given for a condition known as paranoid schizophrenia) then returning to medication once he becomes aware that it is the only way he can live a normal life without the intrusion of his illness. The reality is that John Nash stopped taking anti-psychotic medication and never returned principally because the medication dulled his intellect. Rather than his life collapsing around him, he and his wife, the physicist Alicia Nash, enjoyed a commited and mutually supportive relationship up until their tragic death together in a traffic accident, and Nash continued to write and teach after abandoning the anti-psychotic treatment (something he felt he couldn’t do on the medication). The mistruth (much to the chagrin of Nash himself) was introduced by the director, on the advice of her psychologist mother, to avoid encouraging those taking anti-psychotics to abandon their medicine.
We can understand that decision entirely though we don’t agree with it. We at Marxist TEFL would not recommend anyone refuses or abandons treatment with anti-psychotics unless with the advice and support of a close network of people and a trusted medical practitioner. We must remember that John and Alicia’s son, who also has a diagnosis of paranoid schizophrenia, has not managed the condition as well as his father. Sensitivity to this issue is to be applauded even if the final decision of how to handle it was in our view erroneous and disrespectful to the actual experiences of John Nash.
Yet the unfair portrayal of John Nash’s struggle with his mental health does not end there and there are are those, none more spectacularly than Adam Curtis in his seminal documentary, “The Power of Nightmares”, who reduce Nash’s work to his mental health condition. Now we have no problems in drawing the parallels between paranoia and Nash’s game theory as Curtis does. Game Theory treats us as isolated with everybody else trying to maximise their interests at the expense of our own, co-operation being an unintended consequence of selfish convenience. However, such theories have a longer historical heritage within classical liberalism and Kant’s moral imperative that people should be treated as an end in themselves rather than a means to an end was quickly abandoned by nearly all moral philosophers who saw such an idea as putting unecessary fetters to the expansion of capitalist production (otherwise known as individual choice). Nash was merely transcribing this view, that we are all a means to someone else’s ends, and vice versa, into brilliant mathematical proofs. Indeed, there is a school of Marxism, Analytical Marxism (or “No Bullshit Marxism”) that uses Nash’s work to argue for the logical necessity of happy cooperation and socialism . To reduce Game Theory to paranoid schizophrenia then is neither accurate nor productive but rather a device to silence someone on the basis of their mental health diagnosis “Keep on taking the meds” is such a popular and disgusting refrain.
The responsibility of progressive forces wthin TEFL
There is some truly appalling treatment of the issues of mental health in TEFL literature and practice. However, we don’t want to begin there (as we doubt the worst offenders amongst material writers and teachers are visiting these pages) but rather amongst the more progessive elements of the community. Indeed, amongst the marxist left generally the treatment of mental health issues is shockingly bad (although much better amongst the anarchist movement with their anti-psychiatry focus) so we wouldn’t want to excuse ourselves from this polemic and we know we have much work to do to put our own house in order. In fact, we would draw parallels with the left’s slow and painful journey to incorporate Gay Rights into its focus and political organisation (now we just asume Gay Rights is an automatic part of Left politics but this was not always the case). For an excellent account of this see Lucy Robinson’s marvellous “Gay Men and the left in post-war Britain”.
We also see mental health as part of one of the most important struggles facing us today as we seek to redefine and reimagine a world not dictated by blind accumulation of capital, environmental destruction and the creation of useless jobs rather than increased leisure time. We refer readers to an earlier piece on “Capitalist realism” where we raised these issues. Ironically, in the field of mental health there has been much focus on the importance of meaningful social acitivies as both an expression of recovery from mental health issues and a means of recovery from those same issues. Moreover, researchers have developed a measurement, EMAS (Engagement in Meaningul Activity Scale), to identify the opportunities of marginalised groups (like the elderly or people with a mental health diagnosis) to participate in meaningful activities. This scale is then used to suggests certain positive correlations with general health and life expectancy levels. We would argue that capitalism is indeed largely meaningless and becoming more meaningless by the day, as it robs us of the possibility of creating meaningful collaborative lives outside the sphere of commodity production. Indeed, capitalism’s answer to the emptiness and chaos it has created in our social and psychic fabric is to guarantee large profits to the pharmaceutical industry selling us tranquilizers which it markets as anti-depressives, mood-stabilizers or anti-psychotics.
Schizophrenia is not a split personality
One of the irritating and unfortunate practices many people have, and this is growing, is to use psychiatric labels to describe a behaviour which is so far down the range of behaviours to be insulting to the people who do actually exhibit behaviours which are deeply painful and upsetting both to them and the people around them also affected. We are thinking here about Bi-Polar Disorder. Obsessive Compulsive Disorder and Disogenes Syndrome. Something similar is in operation around the neural degenerative condition alzhiemers, where people are quick to use the label to describe the most mundane aspects of memory failure. We very much doubt someone would openly declare they had bowel cancer because they had somachache or Multiple Sclerosis because something slipped from their grip, so why use serious pyschiatric or neurodegenerative terms to describe other mundane happenings.
In the case of schizophrenia this is doubly unsettling because the common non-medical use couldn’t be further from the experience of those diagnised with schizophrenia. Put simply, schizophrenia has nothing to do with a split personality.
We should therefore be careful when citing Peter Medgyes classic 1983 paper on the experience of NNESTs (Non-Native Speaking English Teachers) where he implies that such teachers experience “schizophrenia” because they are both teachers and learners (aren’t we all??) and struggle to reconcile the two roles. Now not only is Medgyes an early pioneer for NNEST recognition he can be forgiven for his political incorrectness when we consider he was writing in another centrury. What is more difficult to accept, however, is when ELT practioners today quote his work using such a label as both accurate and acceptable. For example, on one blog we can read:
The first thing that caught my attention in this article was the author’s choice of title: The Schizophrenic Teacher. According to Webster’s New World College Dictionary, a schizophrenic is “someone suffering from a major mental disorder of unknown cause typically characterized by a separation between the thought processes and the emotions, a distortion of reality accompanied by delusions and hallucinations”. And in the same dictionary, a teacher is defined as “a person whose job is to teach students about certain subjects”. How come did these two words come together and what was the author trying to communicate? These were the two questions that intrigued my mind while reading the article.
In the article, the author shares some of his own experiences as a Non-native speaking English teacher (NNSET) and states that most NNSETs feel unsafe about using the language they have to teach and therefore they might tend to have either a deeply pessimistic or an aggressive attitude to ELT. The author states that by being both teacher and learner simultaneously, NNSETs are driven into “schizophrenia”. He also points out that sooner or later NNSETs might tend to regret having chosen this career because there are not many options apart from having a nervous breakdown. One of the options is total resignation, and another is restricting the language to those rules which he or she has learned or mislearned. He argues that NNSETs should admit that they are students of English too. This would be the best way to take a more confident stance in the classroom.
Really, would the author of the article look up the meaning of cystitis or hemorrhoids in Webster’s New World College Dictionary?
The whole piece lacks any critical reflection on the use or accuracy of this psychiatric label.
On Paul Walsh’s blog Decentralised Learning, however, we do get a more serious engagement with the actual diagnosis of schizophrenia, as we would expect from such a serious thinker. Unfortunately, on this occassion, it is simply not deep or critical enough and we say this as huge admirers of the author and particularly his campaign for recognising teachers as workers inside the IATEFL structure of working groups. To be fair to the author he does immediately print a disclaimer:
Disclaimer: Schizophrenia is used here in this blog post as a trope, a metaphor; in no way do I wish to demean the experience of mental illness.
N.B. If anyone wants to argue against the points raised here–you’re more than welcome–but to save me time and hassle please:
1) Respond to the arguments put forward
2) Don’t sidetrack the discussion by nitpicking or getting bogged down in tiny points or details
3) Refrain from personal attacks
However, we would ask why such a metaphor is at all necesary. Why not just ask whether we are delusional in seeing ourselves as a profession or exhibiting low self-esteem when not seeing ourselves as such. The title could be “Delusional or having low self-esteem – the two horns of of an ELT dilema”. Put simply, and we mean this in the most fraternal way, schizophrenia is no more an apt metaphor for talking about such issues than breast cancer is.
Like this, one could avoid the use of terms like “mild schizophrenia” (a contradiction in terms) and unwittingly introducing a highly controversial image which is like a red rag to a bull to those of us involved in mental health campaigns
We are presented indeed with two images which are generally purported to show the difference between a “normal healthy person’s” brain structure and that of somebody suffering from schizophrenia. Now such an image suggests that schizophrenia is something other than a diagnosis made by a psychiatrist on the basis of concordance between a patient’s symptoms and those listed in a diagnostic manual. We can assure people, however, that there is not one recorded case of a person undergoing a brain scan who has later been referred to a psychiatrist on the basis of the image produced.
Now crucially there have been important and rigorous studies which show that people with schizophrenia are often found to have smaller brains and larger brain ventricles than normal. However, we must be careful not to confuse cause and effect. Indeed, studies in social isolation have shown that social isolation causes changes to the hippocampus, it is smaller due to the life experiences suffered (just one example). Similarly, therefore, we may not be seeing schizophrenia as such but the effect of suffering from the symptoms of schizophrenia and the isolation which that usually involves. But more worryingly, and this is why we choose to be both hard and comradely, a significant number of studies show that it is the anti-psychotics themselves that are producing this damage and nothing to do with a physical illness. In short, the preferred method for dealing with schizophrenia, does not cure (it never claimed to) but it does cause long lasting damage to the patient’s cognitive capacity. A point that John Nash was more than aware of. “Keep on taking the meds” sounds even more sinister when we take this possibility into consideration.
Don’t tell tales about PTSD.
Again, our “target” here is someday we greatly admire, Frank Brennan. Brennan is the author of popular graded readers like “The Fruitcake Special and Other Stories”, “Joe Faust” and, pertinently here, “Windows of the Mind”. Now not only does Brennan have a way of creating engaging stories accessible to English learners but his stories are often packed with a respect for the underdog and a critique of people who abuse power. Indeed, the story we want to critique is in fact a searing attack on those who put corporate interest before a person’s welfare. What is there not to like?
Well, in this story, “Arlo’s War”, we are presented with a war veteran with an oversensitivity to loud noise and taking medication as result of traumatic war experiences. However, after a series of unfortunate events Arlo stops taking his medication and declares war on the sources of noise in the city, injuring innocent people when his radio controlled bombs strike their targets. Brennan doesn’t use the term PTSD (Post Traumatic Stress Disorder) but we can be sure what he is referring to in his description of sensitivity and war experience.
What we would like to say is that 1) the treatment of PTSD with medication has proved to be not very effective (especially in the long term) and certainly not as effective as non-pharmacological alternatives 2) while there have been studies linking PTSD to an increased risk of anger management problems and domestic violence (especially with the comorbid problem of alcohol abuse) there has been nothing to suggest increased risk of waging terrorist campaigns or any other planned violent acts. No, the most striking thing about PTSD (and other psychiatric disorders) is the increased risk of suicide. Indeed, certain so called anti-depressives and anti-psychotics list suicidal thoughts as possible side effects of taking the medicine.
We would like to repeat that we do not advise anyone to cease use of anti-depressives or anti-psychotics without seeking professional advice and support and that of close friends and family. We do not deny either that such medical treatment has helped many people cope with debilitating symptoms and live as close to a “normal life” as possible. However, such treatments are not cures but deal with symptoms, and such treatments have serious downsides.
Basically, people with mental health problems are not particularly well-served by current treatments. Worse still, many people misunderstand the nature of these problems and somehow feel that current medication is an acceptable solution. We would argue that it is not, people deserve safer more effective medicines and treatments where possible which cure rather than “dampen symptoms” (dampening so much else too).
As activists and progressives we need to improve our literacy on these issues and not spread ignorance. We need to work closely with people suffering from mental health problems and those who support them to develop whole new perspectives on how to promote mental health for all of us.
Happy World Mental Health Day – Let us try to take better care of each other.