Voice, sound – it’s such a curious thing, so tenuous, yet strong. Music is something physical, but purely mental too. In a recent BBC radio series, ‘Why Music?’, a panel of neurologists and musicians discussed singing. One said: ‘The voice is inside you. It is you and you are it. And it is hidden. The sound you’re imagining in your head you have to make come out of your mouth.’ This is a simple statement that encapsulates so much of the paradox and perplexity of expression in the human mind, and the challenge of expressing yourself through mental illness. How words can fail to grip the thoughts they were meant to contain. And there they go into the mind of someone else, uncomprehended.
The Herald recently reported the issue of extreme social isolation in Scotland, as cases were being presented to the Scottish Parliament in an urge to consider isolation as a public health issue ‘on par with poverty and poor housing’. It is a problem among elderly people in particular; as their partners and friends die, and due to ill-health, they are unable to find new people to socialise with, which can lead to further ill-health or dementia.
But it is also a problem that people face in all areas and ages, compounded or even caused by poverty. When the ‘sound you are imagining in your head’ feels desperate to you, and seems unwelcome to others, how do you make it come out of your mouth in a way that will be acceptable to the people around you? Those with mental health issues are particularly vulnerable to experiencing isolation and an inability to express their thoughts. But social isolation does also cause or trigger mental health issues. The two feed each other, tying the closed circuit tighter.
The Headspace Festival Day at Platform in Glasgow was a selection of performances and creative work designed to express experiences with mental ill-health from those who experience it first-hand. It featured the Easterhouse Conversations, Platform to Health and Creative Collective programs, where musicians working with people with mental health issues collaborated to write and perform songs; Ida’s Diary, a beautiful documentary film made out of the personal video diary of a woman dealing with borderline personality disorder and self-harm issues; the Aspire exhibition of paintings from Project Ability that empowers people with disabilities to become painters; and the spoken word collection ‘Mark of the Beast’ by poet Martin O’Conner about drinking and Glasgow, who will be working with people in recovery cafes over the next year to develop the work.
As each of the Creative Collective performers introduced their songs, they briefly described their pasts and the experiences that inspired them. The effects of creative practice, such as music, on mental health remarkably improves self-image. In turn, this helps bridge connections to a larger community, which positively impacts society’s relationship to those experiencing mental ill-health, and helps to heal the stigma. How do you find a way to describe those struggles to people around you every day, so that they might know you? It can be too much, too hard, to express in the everyday. But in moments like this, as they sang, you could see how good it felt to be honest. You can sing. You can paint. You can film.
The Turntable installation was also a part of the day’s events, where a selection of records was left out for people to choose and bring up to the record player where it would be played and you’d have a chance to talk to a volunteer about the song. But for me, it felt weird and flat to be talking about my memory of the song. I’d be more interested in the stories other people shared. When I was talking about my memory as we played my song, the person across from me was interested and related to me, but how can you make someone feel the associations that connect you to a specific bit of music? How can you communicate what you imagine in your head to a separate person?
This installation made me realise the way we are confounded in communication. It made me recognise the power of music to go beyond language. It’s the reason enacting in the body through music can feel more direct than talking about it. But how is music, something invisible, such a physical thing? Sound is nonlinear, unlike language. It connects unconnected things in a way that language can’t. It starts with a finite idea, but with each new person’s interaction, there are infinitely multiplying perspectives bouncing off it. That’s the way we tell stories about ourselves without saying a word. How we create art to communicate. But to talk to each other to try and express that selfsame thing – it can fail so many times. Music isn’t a tangible object but drifts into us, it encompasses us, it’s the atmosphere. It contains our bodies and pours into our minds. It’s better just to listen.
There was something very physical weaving together all the performances that day that affected the atmosphere. It felt genuinely like a community. The sounds of old records wafting through the lobby and the café, the way the film we saw about Ida had her scarred body fill up your eyes, as well as her joys and friendships, or the immensely expressive and colourful paintings by Project Ability, and the spoken word performance that resonated in everyone’s laughter.
Loneliness and isolation aren’t solved in one stroke, and that’s the challenge. These songs, films, paintings, poems had most impact in the humour, joy and passion between people. After you express the indecipherable feelings, there are smaller everyday moments that still need understanding and hope. To this end, Platform runs a year-round program of group activities called Platform to Health, including crafts, art, performance and music, to address social isolation and mental ill-health in east Glasgow.
Arts programs like these deal with the isolation and mental illness by embodying expression in a physical way. It’s about making a place safe to communicate through your own body. Music and other creative pursuits make demands of your body and your mind, but rather than becoming forceful in response to pressure, it requires openness and fluidity. Music is unique in the way that it is able to encapsulate how the inner mind feels in an external way, without having to work with the failure of words. Playing music, and even just listening to it, physically expresses the inner world. It involves your body almost magically through intangible and omnipresent sound, bringing the freedom to express the inner worlds of multiple people at once without a single explanation.
Written by Heather Lune
Join host Nicole Bell in conversation with film journalist, Eliza Jorn, for the final episode in the Expressions series of podcasts.
This episode examines film as a platform for the representation of mental health, with discussion on a selection of three films, Mental, Rocks in My Pockets and I am Tom Moody, which were screened in this year's Scottish Mental Health Arts and Film Festival.
You can listen to this podcast and others in the series on Soundcloud:
You can also listen through Nicole's Youtube channel:
Mental and Rocks in My Pockets are available to purchase online. The animated short I am Tom Moody can be accessed on the director's Vimeo channel and screened as part of Heard It. Seen It. Done It at SMHAFF 2015.
Eliza Jorn is a film critic at The Culture Trip.
Winner of the Jury Prize at last night's International Film Awards ceremony, Dead When I Got Here is an unflinching account of life inside a mental asylum run by its own patients, situated in the barren, windswept desert surrounding Ciudad Juárez, then the murder capital of the world. But despite being filmed in this harsh environment, Mark Aitken’s remarkable documentary is far from being without hope. From within the asylum’s crumbing walls, he draws out a tale of compassion, empathy and redemption, emphasising the dignity and humanity of the people who live there, even when society has given them up for dead.
Speaking ahead of the film's European premiere at Flourish House earlier this month, Aitken admits that is was at first ‘a challenge’ to focus on the positive aspects of life in the asylum. ‘When I went there, one of my first responses was fear…I had been told that there were a lot of murderers in this place, a lot of people who had blown out their minds through drug abuse and a lot of people in different states of trauma. So I felt quite vulnerable.’ However, committed to living and filming there for an initial two weeks, he quickly needed to overcome that trepidation, and found the strength to do so in the way that the people were ‘helping each other’ survive and striving to make the best of their ‘chaotic situation’.
The conditions they live in are often troubling – patients are confined to cages, provisions are limited, petty violence is common and there is little in the way of professional medical treatment – but it is clear from the outset that the asylum does serve as a kind of sanctuary. The support it offers is crude and instinctive, but at the same time vital and humanitarian. ‘There was originally a subtitle for the film,’ says Aitken, ‘Asylum from the Madness’, which he now uses as the title for a book he has written about his experiences there. ‘The real madness is outside, in the city, which is an extremely violent place.
Located near the border between Mexico and Texas, Ciudad Juárez is a city of barely 1.5 million people. Yet, in 2010, there were over 3,000 murders, on average more than 8 each day. Since then, those figures have fallen rapidly and life has begun to return to relative normality, but the murder rate remains extremely high. Today there are roughly as many violent deaths in Juárez as there are in the UK as a whole. ‘Nearly everybody, including children,’ explains Aitken, ‘has seen somebody murdered in front of them or has seen a body on the street. There’s an element of psychological trauma that’s shared by everybody.’ Or, as Josué, the film’s enigmatic protagonist puts it: ‘Madness is the production of the city.’
The contrast between the madness of the outside world and the relative sanity of the asylum is one of the most intriguing aspects of Aitken’s film. It is shown most starkly when the camera follows Josué on a rare venture into the city, capturing vast neighbourhoods of derelict abandoned houses, now used as shelters and hiding places for drug addicts and people on the run from gangs or the police. Those who enter the asylum invariably come from these lawless streets, where they have experienced rape, extreme violence, addiction and ‘quite unimaginable trauma’.
Josué is familiar with these houses because he used to slum there as an addict himself. ‘This is the exact spot where I slept,’ he explains, almost nostalgically, standing on a pile of rubble between four collapsing walls. It was only after gangrene started consuming his hand and he lost all ability to function that he was able to break free from this world, taken first to the desert and left to die, then found and brought to the asylum.
‘I was just like a piece of wood,’ he says, referring to the days following his arrival. At that time, he had to wear diapers and used to lie in the same spot day in day out, unable to move. He attributes his rebirth to the compassion and care shown to him by the other patients. Throughout the film, we see him as one of a core group of ex-patients who run the asylum, treating people with the same care and kindness that they gave him, while Aitken reveals in the interview that Josué is now ‘in training to get official accreditation as a mental health nurse’.The film reveals few specific details about his past, making it impossible to tell the extent to which he can truly be redeemed, but it is clear that he is now a new man.
The director focuses on Josué’s story partly for practical reasons – ‘he spoke better English than I did Spanish’ – but he also needed to find a way to tie his footage together in a way that would resonate with audiences. ‘I was very concerned about issues of exploitation and voyeurism, offering up these people as specimens to be examined. And then I met Josué and he was so articulate and so reflective. He is a poet – in another life, he would be a poet – and an actor…I realised I needed a guide for the place and he was going to be it.’
Late in the film, Josué’s story takes an unexpected twist, as he is reunited with his estranged daughter with a little help from the filmmakers and the internet. ‘His past life story was catapulted into the present,’ says Aitken, giving him an obvious narrative structure around which he could base his film. Even so, it has been a difficult journey from completing the film until now, with distribution proving ‘much, much harder’ than he imagined.
‘I wrongly assumed that people would be as fascinated with this place…and as humbled by these people as I was,’ he says. ‘And I’ve been wrong. I think the indifference has a lot to do with the encroaching market forces that seem to dominate everything. It it’s not a tried and tested formula, they shy away from it. Here, we have a film about destitute people who are sorting out their own lives without any help from outside. And it’s humbling to experience it and very uplifting.
Winning the top prize at the Scottish Mental Health Arts and Film Festival therefore means a lot to him. ‘It’s great for the film’s sake because it gives it recognition. It enables people here to see it and hopefully more people to see it in the future.’ When asked what audiences can take from the film, Aitken is clear to emphasise what everybody can learn from the patients in the asylum about ‘empathy and compassion’. ‘If the audience comes away appreciating what a powerful tool empathy can be, then I think the film has achieved something…If you are more empathetic to people in your life in general, then it’s going to make you a better person. The world will be a better place.’
Written by Rob Dickie
Question: How many mental health carers are there in the UK? Do you know? Or would you have to guess?
Answer: 1.5 million people in the UK are currently caring for someone with a mental health problem. On average, a carer’s role involves 60 hours of unpaid work a week.
In the context of under pressure services and funding cuts across the board – such as the £800,000 taken from the annual budget of the Glasgow Association of Mental Health (GAMH) earlier this year – the role of carers has recently shot up the political agenda. With the Scottish Government’s mental health strategy up for revision in January 2016, this is a crucial time to pay heed to this unseen and unheard workforce, and to give them the visibility and voice they deserve.
Enter Headtorch – an innovative group founded by Amy McDonald (who has already addressed the issue of mental health at work with The Cynthia Show). Now, in collaboration with GAMH and funded by Greater Glasgow and Clyde NHS and Care Information Scotland, they have devised a new project, The Guessing Game, that focuses attention on the role of carers in mental health.
What emerges, then, is a timely call for action. Based on research by GAMH and carers’ first-hand accounts and participation in a Headtorch drama group, this is an interactive drama that puts into performance a much-needed shift in approach. Rather than following a traditional linear model – where carers and professionals stand either side of the service user and never get to meet – the drama introduces us to the holistic ‘Triangle of Care’ (see this PDF for more information), a ‘therapeutic alliance’ in which all three come together to address acute mental health care as a team.
This collaborative approach towards mental health treatment is mirrored by the collaborative approach to the The Guessing Game itself. After all, as the character of Derek says in his opening speech to the audience: ‘This could be anyone’s story, this could be your story’. We’re all already involved and implicated, right from the start. Engagement takes centre stage so that, rather than passively watching, those who witness also get to co-produce. The play is therefore interrupted, altered, edited, rewound and rerun by suggestions shouted out by audience members, a back and forth that disrupts the usual theatrical experience and draws everyone in.
The three Headtorch actors, Amy, Steve and Kate, play the roles of Jane, a woman whose mental health issues gradually worsen throughout the performance; Derek, her husband and carer; and Sophie, Jane’s sister; as well as a series of professional figures: boss, GP, Community Psychiatric Nurse and Registered Mental Health Nurse. Scenes from Jane’s life are interspersed with song excerpts with lyrics that play on the actors’ lines, piecing together a story of how a woman’s mental decline affects her husband and children and how their encounters with service providers risks aggravating the crisis rather than resolving it.
However, while ‘narrative disruption’ is often seen as a negative consequence of mental health and disability issues, in which the flow of ‘normal life’ is radically thrown off course, in the context of The Guessing Game, it is disruption which provides a positive space and opportunity for change and intervention to take place.
Intermittently, McDonald ‘presses pause’ on the performance, steps out of character, turns to the audience and invites them to engage. An unsuccessful early encounter between Jane and a harassed and dismissive GP is opened up for analysis, with audience members talking directly to the characters involved, asking the GP about her avoidance of eye contact and distractedness, while the GP in turn has the chance to say how much pressure she is under and how unable she feels to cope.
At other times, the audience are able to shout out the names of characters so that they can freeze-frame the action and gain privileged access to their inner monologues, a crucial insight into all that goes unsaid beneath the surface of everyday conversations and the miscommunication that so often results.
Later, we witness a fraught conversation between Derek and a Registered Mental Health Nurse on the psychiatric ward where his wife has been sectioned, with the consequences of bad practice vividly enacted before us. The scene is then replayed, but this time with the audience able to intervene, voicing advice and instructions about how to proceed. From a heated and dramatic confrontation, the scene is transformed into an empathetic encounter between two people dealing with a difficult situation the best they can. The critical insights and suggestions of audience members effectively rewrite the script, re-choreographing the on-stage dance so that the outcome is radically different.
The stop-start, jigsaw pieces of the play are united in part by Macdonald’s role as mediator, and in part by the thread of the ‘6 standards’ taken from the Triangle of Care model and identified on cards held up at key moments. The 6 principles are therefore woven into the action on stage, taking what might have felt like a dry list of criteria and bringing them to life before us:
Taken from the Royal College of Nursing website, the six key principles are:
- Carers and the essential role they play are identified at first contact or as soon as possible thereafter.
- Staff are carer aware and trained in carer engagement strategies.
- Policy and practice protocols re confidentiality and sharing information are in place.
- Defined post(s) responsible for carers are in place.
- A carer introduction to the service and staff is available, with a relevant range of information across the acute care pathway.
- A range of carer support services is available along with a self-assessment tool.
While respecting confidentiality and the rights of the service user, the Triangle of Care nevertheless brings the carers into the picture, recognising them as an important asset. At one crucial moment, there’s a long pause when the audience are invited to question Derek directly. Voices that had been forthright in their condemnation of poor medical practice are momentarily silent. There’s a discomfort, perhaps, at coming face-to-face with the struggles and realities of life as a carer, the stigma and isolation that can arise, the lack of respite from living with increased suicide risk and unpredictable behaviour, the toll this daily work takes on the carer’s own physical and mental health. But it is precisely this dialogue that needs to take place, and it does eventually unfold, as audience members dare to ask the questions that only a carer can truly answer.
While we start off by realising how little we know, entering into the ‘guessing game’ with our feelings of confusion mirrored by Derek – ‘It’s like being in a land of mystery’ – we gradually move towards a greater sense of understanding. Through new scenes that emerge from audience participation and dialogue, we begin an open conversation, adding fresh perspectives into the ongoing debate around mental health care.
Ultimately, then, this is a profoundly empowering experience for all involved - especially for the diverse audience made up of professionals, service users, members of the public and carers themselves. In drawing the focus back to the 6 standards, the play leaves us with a challenge to assume collective responsibility for how things develop from here. Julie Cameron, Programme Manager for the Mental Health Foundation, talked in the after-show panel about how the project is being used with Mental Health Nursing students at Glasgow Caledonian University, as well as with staff in psychiatric clinics, showing how transformative drama can be when incorporated into training.
As Rosemary Nicolson, GAMH Carers Development Worker, put it, this is very much a ‘work in progress’ in which we all have a part to play. Asked what she hoped would be the take-home message of the event, she called for greater awareness and acknowledgement of carers: ‘Please include family and carers. Don’t exclude them. Listen and respect them…. They just want to be heard and to know how to help. Instead of a burden, they should be seen as a precious resource and as trusted members of the team.’
Rather than treating the problem in isolation, the Triangle of Care and the creative outreach of projects such as The Guessing Game invite us to take a holistic and collaborative approach to what is a problem that affects us all, reminding us how we all stand to gain when guesswork makes way for debate.
Written by Clare Blackburne
The Guessing Game was performed at Gorbals Parish Church as part of the Scottish Mental Health Arts & Film Festival, featuring a post-show panel discussion with Amy Mcdonald (founder and CEO of Headtorch); Rosemary Nicolson (GAMH); Julie Cameron (The Mental Health Foundation); Derek Ferguson (Triangle of Care steering group); Steven (volunteer actor with Headtorch); and Shelley Paterson (GAMH).
In light of the Scottish Mental Health Arts and Film Festival’s screenings of Still Alice in two regions this year, host Nicole Bell speaks to Dr Maggie Ellis, a Fellow in Dementia Care at the University of St Andrew, for the second episode in her Expressions series of podcasts.
The episode examines how dementia is represented in the film and the role of film as a platform for the representation of dementia.
Listen to the podcast on Soundclound, and check out the first installment from the series on our channel:
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