TW: Mentions hallucinations, self harm and anorexia. DO NOT read if in an unsafe place emotionally.
At the start of the second episode of Don’t Call Me Crazy we meet 14-year-old Crystal who has hallucinations and staff are determined to get to the bottom of why. These characters have been with her for a long time. The two most prominent ones are named 7 and 75.7 is a 14-year-old girl, 75 is a dog and there is another character Autumn, a rat who she describes as having really long teeth.
The key thing is that some of these characters are friends to Crystal whilst others are not. 7 is friendly whilst the rat Autumn is not and the reason why she was admitted is because the bad were making her feel suicidal.
The medical team begins to assess rightly by excluding physiological and biological explanations for these hallucinations. Such things, according to the McGuinness Unit’s psychiatrist Dr Ihenacho include deficiencies in liver, kidney and thyroid function.
I must emphasise here that people like Crystal are struggling, not crazy. For her the characters are 100% real, as real as you or I. When blood tests come back clear we know that the cause of Crystal’s hallucinations is psychological.
Art therapy is a tool which seems to help Crystal greatly. Through visualising painful memories it helps to unlock Crystal’s pain. She draws what art therapist Charlotte calls “the good guys” and then the bad guys.
One of them is simply called The Man and has no eyes, purely empty eye sockets denoted by extremely dark shading on the drawing. One way to rationalise people who have caused immense pain in our lives is to dehumanise them, and this seems to work for Crystal. One thing I love about this programme is that it does not seek to pathologise a patient’s symptoms but rather walk alongside them in a journey allowing someone not to feel isolated and alone.
Crystal observes to Charlotte that 7 does not look like 7 as she’s too old. Crystal has drawn her to look more like an adolescent and is not happy with this representation. Chronologically,7 is only four.
This is the age when Crystal was adopted. In the team meeting the tragic circumstances leading up to this adoption were revealed. They involved physical abuse and neglect. Crystal’s was a traumatic upbringing to say the least. We respond to trauma in different ways. Crystal also feels punished by the rats when she eats and so cuts afterwards, although she suggests to camera the rats have done it. Also discussed in the team meeting are the negative characters being a response to angry or jealous feelings.
On a home visit her parents are alarmed by these characters, and her mother confiscates a hair clip which has had the plastic pulled off thus having the desired effect of making it sharper and blunter to enable Crystal to use it to practice self-injurious behaviour.
In the grip of these hallucinations it is not only herself Crystal wants to harm. Also she reports that she has wanted to harm her stepfather Bill.
To me this is an impulse governed by fear. Fear that something good could be taken away and replaced with bad, which is after all a mirror image of her life up to this point.
When staff take Crystal out for a walk they persuade her that the best solution is one that will keep her Dad safe also.
The fears of families are another thing central to this episode. The biggest fear of Crystal’s parents is that her hallucinations are rooted in schizophrenia or psychosis.
Luckily for them, they were not but merely a coping mechanism to help her process the trauma of a difficult childhood. This is not uncommon. It is far easier to externalise traumas which have happened to you than to own them inside yourself. Indeed as Dr Ihenacho explains, children often indulge in fantasy between the ages of three and four. For me Crystal clearly had a vivid creative streak and was able to bring these traumas to life through art and fiction. Dr Ihenacho seemed confident that as Crystal created these characters she herself would be able to destroy them and was discharged from the unit.
This week was also a life changing episode for Gill. We saw her last week spending a lot of time under 24-hour supervision in the McGuinness Unit’s acute corridor under and unable to mix freely with other patients.
This time, we see her trying to build relationships up with her family. Familial relationships are very important and if these are damaged for whatever reason it can cause damage to an adolescent also. Gill disclosed this week that when she was growing up at a very young age she spent a lot of time caring for younger siblings whilst her mum had cancer. I suspect that she struggled to have a childhood of her own, plus that she probably imploded taking on adult responsibilities at such a young age.
All humans are built differently and we all respond to stress differently too. I think out of all the psychological qualities we need to cope with life, resilience is the hardest one to build up as there are so many things in the world that can knock it down again.
But Gill’s family came to visit this week and brought her an ice lolly. Simple things mean a lot to people with problems and those living away from home in restricted spaces. For it is more difficult to access the outside world and buy your own ice lolly. Her smile was priceless.
Little things mean so much. I think One Direction would agree with me. We then see Gill going into the hospital grounds for walks with her mother which are gradually increased in increments of five minutes, building up to a full 20 by the end of the episode. She is under supervision and with staff as well as her mother. It feels like some sort of rapport is being established and I feel an increasing sense of hope for Gill as the episode progresses.
Gill also goes out to a local shopping centre and is really excited. She said “it’s just nice to go out with normal people.”
Now I often wonder to myself what normal means but I understand Gill’s point in this context. It is nice to be a label free person; to have nobody know you are from a psychiatric unit.
Although she had one slip up during the episode, this is the only time we only saw her in the acute corridor. This is a massive improvement on numerous times. The episode ended with the happy news she was being taken off her section after taking it to panel. The death of a friend kick started better motivation in Gill. Sometimes we all need that. Events that encourage us to simply take stock and reflect.
We also revisit Beth this week. At times in this episode she appears to be complying with the Rainbow Programme more and at other times she appears to regress. But that is the harsh truth of anorexia. There are many ups and downs, with the two extremes often interchangeable.
A lighter moment for Beth happens this week when she composes a poem with other patients, with jokes about being mental and living in a mental home. Now in as much as the programme is trying to break down stigma by reducing insensitive jokes around mental health and misuse of words like crazy and mental, I think that those who have mental health problems are entitled to use them. It is simply a way of coping with society’s lack of understanding of them. The poem was quite cool too.
Dr Ihenacho and the team also have to deal with a very sad development for Beth this week. It is a letter she writes to staff, explaining that she wants to die, but that she is not sure how to do it or get away with it in the McGuinness Unit.
Now of course this is very sad, and gauging faces of the staff when they view it they too are saddened. For the staff to are not detached automatons but people who have feelings also and want to help. It is never nice to see anyone struggle.
People don’t realise just how desperate the mindset of anorexia can become. It takes over literally everything, indeed Beth admits that her eating disorder was a method of controlling her life and that staff were now trying to take back control away from her.
Now, the narration states clearly that Beth wrote that letter to staff. Often suicidal ideations are just that -thoughts but left bottled up and unexpressed they can become dangerous for people who experience them. The letter was sad, and Beth may have ups and downs but I am glad she felt safe enough to write down reflections on paper to enable them to be discussed, and to ensure staff were able to help and support when she was struggling.
We see her beginning to eat more this week, but poignantly we also see that this new found eating comes at a price.
She feels she needs to punish herself for eating and so cuts herself afterwards. This is another feature of anorexia. It is devious. It can fool you into thinking that even the most natural of everyday behaviours are somehow wrong.
We return to the themes of judgement and support in a psychiatric setting. Beth says on the topic of self harm;
“In here everyone’s done it. Nobody judges you in a psychiatric unit. When I do it it’s nice to see the pain coming out in the blood.”
That is what people with mental health problems need in a sense. A judgement free space without worldly condemnation. The problem is even though mental health problems are not widely understood, it does not prevent people from expressing opinions which well, to be diplomatic lack nuance. Such opinions can be damaging and not conducive to well being.
Regarding pain and blood let me explain a little further. We can see physical pain. If we fall over and injure ourselves, we may see a bruise or cut. However it is harder to see the pain that lurks within our souls. So self harm then is a way of seeing your emotional pain manifest itself physically and this is what Beth is talking about. We all deal with pain differently. Beth says on the outside people judge you on the way you look, and that she would find it difficult to go out with her scars – these are the result of her self-injurious behaviour.
Indeed, some have queried whether there is a need for such graphic footage of self harm in the programme. To those against it I say two things. First of all this programme is designed to raise awareness. It cannot do that fully without confronting the most difficult and perhaps visually disturbing aspects of mental health.
Secondly I have my own views about scars. There are also for me signs of battles won as well as battles lost. Soldiers have scars after fighting in war zones sometimes. Are they ashamed? Sometimes learning to live with scars is part of recovery. That includes the internal scars as well as the external ones which are so often a feature of mental health problems.
Finally we see by the end of the programme that Beth is no longer classified in the anorexia nervosa band but in the underweight one. This is a huge accomplishment. We saw her at Christmas unable to go home and having to have Christmas away from her family. Beth’s friend remarks upon how well she’s doing and how much she wants her to get better.
At the end of the episode though we saw Beth denied an appeal to come off her section.
What I learnt most from this episode was again about stigma and the importance of thinking free of value judgements in relation to mental health. Also how important our family and friends are when it comes to maintaining or indeed not be able to maintain our mental health unit a young age. Many factors can precipitate a mental health breakdown and it is nothing whatsoever to be ashamed of.
Crystal’s characters it seemed to me were manifestations of the good and bad people in her childhood
I look forward to the final episode next week.