Meaning Madness and Recovery
Originally published in Clinical Psychology Forum 103, May 1997 and based on a seminar presentation to the Meaning and Madness Conference, University of West of England 1995.
At first sight madness is when people have strange thoughts and feelings that render them unable to cope with the practicalities of life and relationships -or render other people unable to cope with them.
Odd thoughts, feelings (madness)... lead to disrupted relationships and non coping behaviours.
I want to argue that this way of seeing the direction of causation is a convention that may suit the interests of those involved, either personally or as mental health workers, with the mad individual, but that this way of thinking obscures our understanding of madness. If we want to understand the meaning of the madness -and part of the problem of interpretation is that a lot of people have an interest in not understanding that meaning - we will be a lot better off if we also consider the direction of causation working the other way round.
Ergo, disrupted relationships and chaos in life's practicalities - lead to thoughts and feelings which seem odd to mental health workers and other involved people.
When people's relationships are disrupted, those with whom they are at odds will mostly not want to see their part in creating mental health problems. Indeed, if a person starts to develop psychiatric problems other people are likely to see these "symptoms" as further evidence discrediting the person concerned. Thus, just before a person breaks down again, for example, under the pressure of hostile, over involved and over critical relatives who, in the jargon, are in a high "Expressed Emotion Relationship", the person subject to criticism may start to become what in German is called fisselig, and what in psychiatrese is called "relapsing".
fisselig. An untranslatable colloquial adjective meaning either a permanent state of inexactitude and sloppiness or a temporary one of nervousness and absence of composure brought about by another person's nagging. 'Jittery", "flustered" give some idea of its meaning (Cassells Colloquial German, 1992).
Voices, hallucinations and isolation
People with mental health problems are often very lonely, isolated and commonly at odds with those around them. In the ordinary way of seeing madness this is seen as the result of their strange thoughts and feelings. However, if we really want to find meaning in madness it frequently makes more sense to see things the other way round.
For example, when we read the collection of accounts edited by Romme and Escher (1993), we find that many times "voices" are a comfort or a companion. One way of seeing this is quite simply that the person needs a comforter and companion. But what about hostile voices? If loneliness arises in the context of disrupted reationships it will be likely to be associated with bitterness - for example at not getting the attention of others, feelings of being neglected and left on one's own. If a person thinks that they "ought not to feel" angry or bitter, if they feel that they are a nice person (which makes their loneliness even more galling) then they may expel the anger and frustration part of the personality from the inner stream of consciousness that is defined as "me". They therefore not only hear voices as companions and friends but voices which express hostile ideas and messages. If you, and only you, are hearing voices then, you may reason, who else could they be talking to but yourself?
In this interpretation voices might sometimes function as representatives of emotions that were not acknowledged as arising in the self (because of an upbringing that has caused the person to censor or invalidate those feelings). But there are other interpretations, as I pointed out in a seminar on "Hearing Voices" (1994a). At this seminar, hearing both users and professionals talk, it seemed to me that there was a very strong divergence between users insisting voices were not part of themselves and staff trying to promote strategies to get people to acknowledge that they were.
At the seminar Bentall and Haddock (1994) talked about their approach, a cognitive behavioural strategy, "based on the hypothesis that hallucinations result from the failure to attribute self generated internal events, particularly, inner speech, to the self, and that this failure reflects both core source monitoring deficits and patients' beliefs about themselves and the world."
But maybe it is wrong to try to get patients to acknowledge voices as arising inside the self. I gave a hypothetical example of someone who, as a child, when they had started to get angry, always heard a parent threaten them with words like "Just you watch out". I suggested that in later life, in circumstances which might ordinarily generate anger, they might hear a voice that said "Just you watch out" -instead of feeling anger -the voice cutting them off to access to that feeling. In this kind of hypothetical situation it would not be helpful to try to get users to acknowledge this voice as part of themselves. On the contrary, this voice would represent an earlier violation of themselves. It would represent, so to speak, an amputation of their access to the energy of anger - necessary to defend themselves or be assertive in particular conditions.
When people hear persecutory voices it is perhaps because in their mood of tension and isolation their past experience has accustomed them to anticipate hostility and the voices that are heard reflect this.
In my article (Davey, 1994b), I suggest that when a person is isolated and not constantly engaged in the world their internal mental contents are likely to be that much stronger. I suggest a parallel between sensory deprivation and an "experience starved existence, without comforts, interests and the warmth of emotional involvement" in which the "emotional and mental contents themselves will be thrown into clearer relief, have greater prominence in that person's mental life than would be the case if they were actively involved in a variety of activities and relationships".
This implies a need for creative activity in social contexts for mental health. Some psychiatrists acknowledge that unemployment may account for the "flatness of affect", "poverty of speech" and "social withdrawal" phase of schizophrenia. But it provides part of the context of psychosis too - when one is overwhelmed by a life of unrelieved deprivation, with nothing to actually talk about and no one to talk to (hence: flatness of affect, poverty of speech and social withdrawal).
What about fantasies? When a person has withdrawn or rebelled against their world of relationships and activities which does not, or cannot be made to, meet their emotional needs, then they cannot "reality-check" since they challenge, or lose interest in the interpersonal and social reality of the others in their life. The same will be true if a person has been expelled from a social network -perhaps cold-shouldered because they have taken a different point of view from a group shibboleth. In conditions of a sort of confrontational withdrawal nothing else than fantasy is possible as, in a state of non dialogue, there will be no feedback from others to whatever hostile or hurt communications they are still trying to make. To substitute for feedback the person is reduced to highly emotionally charged fantasies filled with their hopes, fears and frustrations.
Projection, regression and play behaviour
In contexts like this one resorts to those psychological mechanisms that occur when one reads the tea leaves or takes an ink blot test. One resorts to metaphors. One reads sometimes reassuring and sometimes frightening messages from the world around. Everything one sees in the outer world triggers awareness of the hopes and fears in one's inner world. This goes beyond a discrete decision to read the tea leaves and becomes a reading of everything- street signs, advertising hoardings, the patterns of clouds, the background noises of everyday life - things that one would normally filter out of consciousness except where they have a socially common meaning. So traffic lights on red are not so much a way of holding back a driver at cross-roads but a personal warning of danger. The sight of an advertising hoarding with an arrow in a bull's eye is not so much a builder's advert but a confirmation that one is "on target" in the personal crusade that may have led to one's isolation. The psychological mechanisms are not different from those used by children in play. Objects come to stand in for and symbolize other things. Start thinking like this and one starts thinking like a playing child. One regresses to those childhood forms of play where one fantasises what it would be like to grow up and be at war with the world.
Inhabited by the mind of a child one mixes emotionally associated fantasy with reality in a manner that is not different from the psychology of play. Thus I used to go on "raids" to deliver "letter bombs" to people or "concept bombs". The raid and the concept bomb was a play metaphor. Part of the psychological roots of this metaphor lay in the fact that as a child I read huge numbers of war comics (absorbing the role model for adult life). It is relevant to note that this form of madness occured during the Libyan crisis, the Falklands and the Gulf crisis. The final root of this metaphorical thinking lay in the fact that I had on my bookshelf a book by Hans Magnus Enzenburgers called Raids and Reconstructions. Enzenburgers' raids are essays, critiques of society. Everytime I looked up from my bed a way of expressing my frustration suggested itself. My raids were also essays, mixed with critiques of people and situations that were frustrating me at that time, written up, and dropped through letter boxes or sent off to world leaders and power centres expressing my views of the wars that were happeningat the times when I was psychotic. Then I would retire to have my fantasies of how the recipients were going to react to what I had written. (Of course, my "concept bombs" never went off because, for example, the people who had ostracised me didn't read them. I did get a few replies from MPs, though, and one from the then Home Secretary, Michael Howard.)
In summary, ostracisation and isolation lead to madness and explain rather well its strange behaviours and thought patterns.
To interpret mad thinking -think like an advertiser
I have said that objects come to function as symbols with personal meanings. But how can one decide these meanings? The interpretation is often not really that difficult. The highly personal reading of the everyday world mostly uses associations that would not surprise advertisers. Adverts deliberately use emotionally associative ways of thinking. I would always smoke when mad because madness had associations of being grown up. But not only that - if I was in a new setting I would smoke Embassy. If I felt the need to feel powerful I would smoke Superkings or Samson, if I wanted to detach myself from the spider webs of commitment and obligation that other people seemed to be trying to put on me, I would smoke Silk Cut to magically cut the spider's web. Of course you were invincible if you smoked an Invincible cigar.
Interpreting pre-verbal material
The interpretation gets more difficult when the regressive dements of madness take us back to very early infantile memories and material before we had the ability to speak with words. These are the more frightening memories and experiences because at this stage in our lives we were very vulnerable if things were not as we needed with those giant entities that managed our worlds. When those giants around us, on whom were dependent, acted in ways that were abusive or neglecting it was horrifying and terrifying. The worst feelings at the heart of madness I term "slave feelings" because they are the feelings of a tiny child when it finds that it fears it will always be there for the convenience of others, when it finds that it is there for others' use, its own feelings do not count, its own sense of agency and what it wants to do is to be blocked. I find it interesting that Melanie Klein suggests that all children go through a period akin to psychosis. I would suggest that this is because they come to a stage when they realise that they are to be made to feel small because they are small, that in their dealings with parents "might is right", and that "being good" essentially means being obedient and not questioning. At the heart of madness is a feeling of being alone, vulnerable and terrifyingly powerless to the whim of others. The fragility of one's existence - a sense that one could die and it would be as if one had never existed - is immobilizing. The anxiety we feel during periods of isolation, withdrawal and disempowerment in adult life, touches the oldest wounds and deepest fears. During a short period in my infancy a number of things happened in quite quick succession. My mother's mother had a stroke which transformed my mother's mood and
therefore the quality of my world radically -she was very upset and it was something to do with a mystery named "death". My father, a meat inspector, was looking after me one day and took me to a slaughterhouse. It became clear what meat was and death too. Also I realised that the chickens in the backyard, my friends, were what we were eating. It was freaky to learn too what had happened to the kittens that the cat had had. And my sister, five years older, persecuted me and probably played on my fears. When parents would say things like: "If you don't stop whining I'll wring your bloody neck" this did not help. Years later, in a period of great fear and vulnerability, I could not stop having strange horror thoughts about pigs. Hollowed out trunks, logs of wood, reminded me of their decapitated and gutted carcasses.
The creation of crises
But why does one get into these sorts of crisis in the first place? The content of a breakdown, with all its material from earlier in one's life, can be distinguished from its immediate causative context. It seems almost too trite to be worthy of note but life usually consists of involvement in, and exposure to, repeated patterns of events and experiences. These are things like rising and washing, the preparation of meals, cleaning and other domestic work, the journey to school or work, the activities of our school of paid work, or signing on as unemployed, repeated recreational and leisure activities. Many of these things are relatively unchanging. They represent a limited realm of experience that corresponds to our age, skills, abilities, relationships, income and habitats. They tend to be context specific to the community, society, class, income, gender, and age groups that we live in. We do these things with a relatively small and relatively unchanging group of people -our immediate personal relationships and our wider school, work and social networks. Madness is doing, thinking and feeling what is regarded in the social environment of the mad person as inappropriate to the contexts.
Madness occurs when the pattern becomes unsustainable in some way. It occurs when a change is forced upon us that is too big for our coping mechanisms or when we try to change it ourselves in a direction that is unsustainable or unviable. This is why it typically first occurs at times when a person is supposed to make the biggest life changes under their own agency -namely in early adult life when they are supposed to leave home and set up their own relationships.
Sometimes madness is precipitated because the agendas we set for ourselves are rejected by and upset other people. This is often the case when to change our individual world we try to change the world of everyone else. The true meaning of mania is often that the person is elated and spurred on to more and more grandiose plans by the idea that they are on the road to personal glory in which everyone else will recognize them as moral and intellectual superstars. Their practical agenda is often unattainable for two reasons. Firstly because one must also eat, sleep and do one's washing within a 24-hour day, i.e. one must work within limits and there is nothing more unconvincing than a prophet who does not wash or clean their teeth. The second reason is that everyone else in the person's world finds the manic person more and more arrogant, abrasive and difficult to get on with. At first people go along with the person for a quiet life, or because, given their energy they are really doing interesting and important things. Later, however, they make themselves unavailable on the phone, hang up or rows break out. In mania a person who only gained recognition as a child for performance may, without being self aware about it, be seeking relationships through trying to gain the admiration of others, working hard for fame and glory. They do not grasp that relationships based on admiration, in which one looks up to another person, are not the same as affectionate relationships in which one can show vulnerability, change one's mind, make mistakes, in which reciprocity is possible. Indeed the manic person gets irritated and impatient with others when these others do not recognize how wonderful they are. Their anger and impatience feeds back into the manic cycle giving it yet more energy. They declare war on their world of relationships and thus lose touch with reality.
This is not to deny that manic people are also often scapegoats and victims. A person that sets themselves up to know better than everyone else is highly likely to be scapegoated. As and when they get ostracised the bad feelings channelled against them are often not fully earned. This happens, for example, when a person's life is given pattern and meaning by participation in a religious or political sect. These are full of people convinced that they are the moral and intellectual superiors of others. However, when the sect is clearly going nowhere and clearly does not meet the emotional needs of its members, problems may emerge. At the least sign of criticism of orthodoxy the heretics are jumped on. The loyal members channel their frustrated feelings at the critics whose disloyalty is identified as "the problem", the reason they are not getting anywhere.
Another example of a pattern leading to a breakdown is that where a person who has actually held a group together comes under increasing strain as a group comes under strain and is trapped - the breakdown is really an expression of a deeper crisis in a group. Wedded to the performance principle they are often over-conscientious and sometimes everyone is very happy for them to work harder and harder. The conscientious person takes the organizational strain, they work in their own hours so that everyone else can go home on time and keep their jobs. Or so they see it. But, if their work world falls apart then all their world falls apart as they only have a work world.
Madness and chaos in life's practicalities
Madness is not only a period of bewildering mental contents. It is commonly associated with chaos in the practical arrangements of life. It tends to be assumed that the chaos in practical arrangements of everyday things is the result of the bewildering mental contents, but I want to argue that it is often more plausible to see the direction of causation as being the other way round.
A friend of mine lost everything when his business life and marriage crashed and started to have mental health problems which were expressed in a particular way. He would go to the supermarket and find himself at the checkout with a trolley overloaded with masses of goods. He could not stop himself doing this. The denial of his loss of business, wife, family and life style took the form of reasserting his role as family provisioner. He repeated in an exaggerated way a practical aspect of his previous life that was now inappropriate.
In rehabilitation psychiatry much time is spent trying to get people to learn to look after them selves in the practicalities of life like cooking, washing and so on. This is after people have been institutionalised and lost the routine and confidence to do those things for themselves. Often, however, people may leave home without those skills. They may find a partner to do those things for them, or a college hall of residence. But if things go wrong they may get, quite literally, in a terrible mess.
I know people who live in a perpetual state of chaos, whose houses and rooms look as if they were hit with bombshells. They are trying to do so many things at once and have many commitments, few resources and little time to tidy up. Because this is normal for them no one thinks them out of their mind. However, when a normally tidy person descends into this chaos this is seen as evidence of their insanity by those around them - they have "let themselves go". But sometimes in reality, as in Fawlty Towers, problems can come on top of each other leaving one reeling to keep one's balance in life's practicalities. Chaos theory steps out of the books and into the normally ordered routines of life. The common routine is thrown awry and it takes time to find a new balance as one reels from one improvisation to another.
For want of a nail...
When one is working at the limits of one's abilities, time and resources if even a small thing goes wrong the consequences can just keep on rolling and getting worse and worse. One can miss a tram or a plane by just a few seconds and one has missed it... the .next one may be too late (or too expensive) and there may not be money left for staying where one is... Even when things are going fine one may be in a state of anxiety because one is aware one is living too close to this edge, beyond which is chaos. This state of anxiety may, indeed, lead to that very lapse that tips one over...in one's nervous state one can lose one's composure at the slightest thing. Sometimes I feel people's breakdowns are a mystery only because therapists and psychiatrists have no conception of the kind of life their patients might be leading and the kind or stresses they may be under. No school of therapy has any discussion of the stresses of my job as a development worker -which have nothing to do with my ego or my id. I find it difficult to control my work load from one month to the next because I cannot control the outcome of so many variables that I am working with. When one is moving into new work territory one cannot necessarily know what is involved in all that one is doing and one can, even with care, become frightfully stressed.
Sometimes people experience a breakdown in the more ordinary routines of life. Perhaps the most frightening of all is when one has reason to fear whether one will have enough to eat. In this case the chaos in one's own life may be started elsewhere, for example, in the welfare bureaucracy:
"Clinical experience shows us that economic uncertainty is a serious stress for many patients. As social security regulations were tightened during me Reagan administration, for example, many stable psychotics whose disability payments were abruptly terminated suffered relapses of their illnesses. The mental condition of many psychotics similarly becomes worse when their most basic needs are not provided for. In me United States homeless, male schizophrenics are admitted to hospital hungry, dirty, sleepless and floridly psychotic. When after some meals and a good night's sleep, their mental condition improves dramatically, hospital staff claim that the patient "manipulated" his way into free board and accommodation. More benign observers argue that the patients' improvement is evidence of the efficacy of the dose of anti-psychotic medication he received on admission. In fact, such patients often improve as readily without medication. The florid features of their psychosis are an acute response to the stress of abject poverty and deprivation". (Warner, 1985: p.132).
I discussed this quote with user colleagues in the Nottingham Advocacy Group and it struck a much bigger chord than I expected. It is not something one would expect professionals with secure jobs, on large incomes, eating in subsidized hospital cafeterias to be aware of, or understand. One colleague talked about the deep sense of panic at feeling one might not have enough money to buy things to eat. She mentioned her niece, a student, subject to cuts, who had run out of money and was having anxiety attacks over that question. At the brink of subsistence, with limited skills, chaos is much more likely in lots of circumstances -even if nothing has happened to directly disrupt one's income flow. For example, from the sort of things that have happened to me I can envisage how, as a relationship of someone on a low income breaks up, so might that person's access to their partner's washing machine and a routine way of eating or keeping clean and tidy. Their thinking becomes panicky and they might then feel like a child that needs its mother to clean it up - but that is the last thing they would want to happen. If, in the past, their mother bullied them over having a bath and keeping clean such a person might react very badly to the comments and rejection of former friends. In this manner I have known people in crisis get back into childhood forms of defiance and refuse to wash any more. Later they have a bath when admitted onto a psychiatric ward under a section.
We say that a person is having a mental breakdown but actually it would be more accurate to say that they are having a life management breakdown of which their mental breakdown is just one part. Going mad is a process in which a person's mind disintegrates as their world disintegrates -and in large part because their world is disintegrating.
What follows from this analysis? Conventional approaches to madness follow academic subject boundaries and reflect institutional divisions of labour. Doctors deal with the (probably fictitious) organic causes of madness, social workers help sort out income and benefit problems, nurses work with the problem of personal hygiene on the ward, occupational therapists work to keep the person active, psychologists work with their mental contents and relationships, rehabilitation workers try to teach cooking and cleaning skills. The mental health services work to a model where the whole is less than the sum of the parts because the services break up, and deal separately with issues for a person where the main problem for that person is their inability to integrate all these things. The mental health service cannot understand madness because it elaborates separate theories about the different elements of the person's crisis that have to be understood in their interrelationship (or lack of integrated relationship) to be understood at all.
The mental health services are only useful for providing a place to go when one's world falls to bits. Many people are thankful for being lifted out of their crises in this way -before they make too much of a fool of themselves in a world where there are plenty that will laugh at them and kick them when they are down. Their thankfulness is therefore understandable. However, we should not let this blind us to the fact that the mental health service works with an inadequate explanatory framework for madness and often makes things worse because it misleads people about their problems.
Sanity usually means managing
If we are able, as individuals to give structure, meaning and direction to the patterning of our lives, if we can manage it, we will be OK. Sanity is merely the mental framework that allows us the ability to manage in the context we find ourselves. For most people this translates to more or less adequately managing their relationships in their habitats within their income.
Our habits are very much formed in and by our habitats (i.e. Living environments). This starts in childhood. For example, there is much to suggest that if parents are too controlling of their children - the over involved, over critical and hostile High Expressed Emotion family - then children are damaged by this. Their sense of their agency is damaged. So to speak these children are institutionalised by their own family. They then find it difficult to make their own choices and perhaps they are not well prepared for life practicalities - as either mum has always done it for them or mum and dad together never let them try to do the things that they wanted to. But these kind of HEE relationships are often created or made worse by environmental or economic conditions. The evidence suggests that hard up families have great tensions between adults and children. Also if adults and children live in cramped surroundings then adults and children can never escape each other. Ideally families need space for the children to have their own realm, with separate spaces for the adults and children as well as shared spaces where adults and children can be together. Otherwise the whole living area takes on the chracteristics of a children's room. This creates for adults a pressure to deny the children any control over physical space - thereby allowing the children no psychological space. There is also disturbing evidence that heavy traffic in a district radically reduces the scope for parents to allow children to live "free range" and that this is a rapidly increasing problem. If a neighbourhood is one with high criminality and other social problems parents may also try to control the movements and contacts of their offspring (often counterproductively).
If life consists largely of our habits in our habitats then we can envisage different kinds of life crises and parallel psychological crises. There are those where an event undermines a routine lifestyle - the loss of loved ones, job loss, retirement of so on. There are those where, after a period of time an existing life style can no longer be endured - some apparently trivial event may trigger a deeper problem like an unsuitable relationship which then separates a person from their children and their home. There are those when people move into a new setting without adequate preparation and with an inadequate sense of the differences of that setting - where the learned response patterns do not prepare them adequately for the new relationships in the new settings. There are those where our habits and our habitats no longer suit our abilities and needs. Where the existing pond provides no variety, no room for growth, nothing that corresponds to our, usually age specific, need to move on (e.g. Leave the parental home and relationship network to form one of our own).
In a sense madness can often be seen as a transition crisis from one life pattern to another, from one life style to another, from one habitat to another. Our previous lives may have prepared us well or badly for these transitions.
Strategies for changing what has to be coped with
Therapy and coping mechanisms are useful -but often only up to a point -for we must also address the magnitudes of what we have to cope with. Many people are not as lucky as I have been in keeping their jobs when they break down (I am even able to use reflections on my breakdowns in my work!). Their problems often arise in interlocking contexts of poverty and poor environments where, if they are to do anything, they have to work together with others to produce changes in their circumstanes, and not just find a way of coping better with those circumstances.
As George Orwell (1936) put it, "Lack of money means discomfort, means squalid worries, means shortage of tobacco, means ever present consciousness of failure -above all means loneliness". Yet often we are treated by mental health workers who seek to help us gain insight as to how our discomfort is self-inflicted, how our worries are biologically based, how our sense of failure lies in our childhood relationships and how our loneliness is because of poor interpersonal skills.
Statistical studies have shown that when people live in an area of heavy traffic they have far fewer friends and acquaintances. In the author's experience, most professionals seem to assume that a person is lonely because there is something wrong with their psychology. How often do they notice that a person might be depressed because they are living in a dark, damp, cold flat with a north facing window, with no money to live in warmth and sunlight? Yet environmental psychologists have shown how light effects mood and seasonal affective syndrome is about this. In my experience workers do not think about things like these.
When one raises things like this professionals will tend to say "Lots of people are poor, lots of people live in appalling environments and suffer abuse and oppression and this is regrettable -but only some break down. What matters most of all is the underlying vulnerability which we will treat with drugs, psychotherapy, counselling, relaxation techniques and the like."
In fact, I feel it will often be legirimate for users to turn the thinking of professionals upside down - we can say that lots of people are vulnerable and inadequate but only some are subjected at particular times of their lives to crushing life circumstances with which they cannot cope -for which they have insufficient power or leverage in their lives to cope. After the immediate crisis is stabilized what such people need is above all to be put in touch with people like themselves working in projects, in initiatives, in networks of mutual aid that are trying to resolve these difficult conditions.
The preceding analysis means that we need iniatives where people can begin to reintegrate their lives. The model that we are working towards through the Nottingham user movement is aimed to provide people an opportunity to rebuild their relationships with each other, improve the quality of their habitats and their standard of living. We do not need huge capital and location costs to do this. The locations of the mental health services .-the workshops of day centres, the gardens of residential projects and the fabric of the buildings we use and live in can be the starting point for the development of skills and projects. After madness many people become unemployed and have little prospect of getting paid work but users can nevertheless develop their own projects to supplement and improve their quality of lift through arrangements for food, shelter, affordable warmth and child care. This means mutual aid projects which are neighbourhood and home based. It means allotments projects and food projects using their organic produce, it means insulation and draught-proofing; it means, as we become more skilled, installing solar voltaic panels on roofs. It involves arrangements to look after our children as we do this. These things are not out of the reach of users as they recover - after all in the user movement there are plenty of business people, ex-bankers, accountants and the whole range of practical and trade skills. It is often easier to organize things as informal relationships between friends. The project I am involved with, Ecoworks, is currently pursuing an idea for a project where a small employed team of architects, energy workers, electricians, etc. would support and train people to do ecological DIY renovations of their own homes. That way people can considerably improve their quality of life -but without, at the beginning, going out to work to a distant workplace. With ideas like this we can connect community care to community regeneration and help people rebuild their confidence and their lives with a respected place in society.
This article was originally prepared by me for the Meaning and Madness Conference organized by the University of the West of England, June 1995. Special thanks to Lucy Johnstone for inviting me.
Bentall, R, and Haddock, G. (1994) Focusing, a technique that differentiates the experience (of hearing voices) and diminishes the frequency and anxiety. Paper to the World Congress of Social Psychiatry, Hamburg, June 1994
Davey, B. (1994a) Upbringing and psychosis. Paper to the World Congress of Social psychiatry, Hamburg,June 1994
Davey, B. (1994b) Madness and its causative contexts. Changes, 12, 2, 113-32 .
Orwel1, G. (1936) Keep the Aspidistra Flying. Har- mondsworth: Penguin
Warner, R. (1985) Recovery from Schizophrenia: Psychiatry and political economy. London: Routledge