ON BEING MAD

HUMPHRY OSMOND

Perhaps you are shocked at this unhygienic title and feel that some comfortable synonym should have been substituted for that harsh three-letter word; but surely there are occasions when a spade should be called a spade and semantic nice-ties left to those who don't have to dig for a living. During the past fifty years we have had a welter of theories explain-ing the great insanities, and each fresh batch spawns a new terminology, usually in bastard Greek, which cuts less sharply than the edged words of the plain tongue. We cushion our-selves, with catatonia and complexes, with schizophrenia and the Oedipus story, with the id and the sphaira, from the hard facts that we don't know what is wrong with our pa-tients and we don't care to guess what they are enduring.

These new formidable words, schizophrenia, dementia prae-cox, and Paranoia, are weightier but less penetrating than the old short ones, daft, crazy, and mad, and by their very size they fend us from our patients and stop them from coming too close to us. They insulate "us" from "them." Schizophrenia, the greatest and most incomprehensible of our adversaries, is schizophrenia, and that handy label allows us to pigeon-hole the patient and think no more about him. The thinking has already been done for us by the masters of our mystery, who have each, according to his lights, described the illness, outlined its course, laid down methods of treatment, and usually indicated how it is caused. It sometimes looks as if there is nothing more to be said.

And yet, one can read whole books of psychiatry and never know what it feels like to be mad, which is a pity, because our ignorance makes it harder to help patients; and we be-come more inclined to rely on stale authority rather than on fresh observation and experiment. A useful but neglected source of information might be patients who have recovered, but, for various reasons, they are commonly reticent about their experiences. A hospital patient who frequently discusses his delusions and hallucinations with doctors and nurses does not enchance the likelihood of discharge; indeed, patients must often feel that the less they talk about such matters the more chance they have of leaving. Afterward, the pa-tient may not wish to recall visions of an anarchic world in which primitive instinctual drives manifest themselves, un-trammeled by the usual internal prohibitions. In addition, doctors, nurses, and friends often combine to make the pa-tient so ashamed of his illness that he dare not talk of it. We do not understand and we cannot forgive the madman's defiance of our well-ordered, safe, but precarious little world.

Nevertheless, heroic souls have given us some remarkable accounts of their illnesses. One of the most vivid that I know is The Witnesses (1938), by Thomas Hennell. He wrote, about a prolonged schizophrenic illness, with the penetrating eye of a skilled artist. Unfortunately, his book is hard to get. Another famous book was by Clifford Beers, A Mind That Found Itself (1998). Beers referred to his illness as being a manic-depressive one, but this may have been a piece of nec-essary self-deception, brought about by the extremely gloomy prognosis that it was customary to give to dementia praecox in those days. J. H. Ogdon's Kingdom of the Lost (1946), published in 1947, is a good book marred by too much polemic and too little description. Wisdom, Madness and Folly (1952), by John Custance, is a fine piece of work deal-ing courageously with very severe episodes of mania and de-pression. It is interesting to compare this with some of the more frankly schizophrenic illnesses. These four books, and there are doubtless many others, will help the alert and sym-pathetic reader to picture that other world which our patients inhabit, and from which we must try to rescue them.

However, even the best-written book must fail to transmit an experience that many claim is incommunicable, and the doctor often wishes that he could enter the illness and see with a madman's eyes, hear with his ears, and feel with his skin. This might seem an unlikely privilege, but it is avail-able to anyone who is prepared to take a small quantity of the alkaloid mescaline or a minute amount of the ergotlike substance lysergic acid diethylamide, which transmits the taker into another world for a few hours. In a recently pub-lished paper, the similarity between the mescaline and schiz-ophrenic experiences was noted, and it was observed that mescaline reproduced every single major symptom of acute schizophrenia, though not always to the same degree, and a detailed table showed that the two states have much in common.

Mescaline, which is now usually produced synthetically, occurs naturally as the active principle of the peyotl, a cactus found in New Mexico and called, after Lewin, a great con-noisseur of strange drugs, anhalonium lewinii. It has been known for many years, and its chemical formula, which is quite simple, resembles that of adrenalin. This important fact has only recently been recorded. 'The mescal buttons have been used by Indian tribes in divinatory and religious ceremonies for many hundreds of years. It is of interest that the U. S. Narcotics Control Bureau has some evidence that mescal taking is slowly spreading northward among the In-dians in Saskatchewan. It would not surprise the writer if these unlucky people, whose culture has been overwhelmed by our own, should turn to experiences that even we, with our astonishing ingenuity, cannot match.

It is not, however, by tables or statements that we are made aware of the nature of unusual experiences, so the writer will take some rough notes, transcribed by a mescaline taker, as a basis for describing the effect of this drug, and then will discuss the application, of any information we may derive from observations of this sort, to people suffering from schizophrenia and other severe illnesses.

The subject was a psychiatrist, aged thirty-four, married, and in good health. The experiment took place in his col-league's (John) flat in London. Present in the flat during the e,xperiment was a friend (Edward) who had a tape recorder, and John's wife (Vanna). The flat was in a back street that leads to Wimpole Street, in the center of the fashionable doctors' area in London. The experiment began shortly after midday on an August aftemoon, when the subject took four hundred milligrams of mescal on an empty stomach. A con-densed version of the notes taken at the time, and his recol-lections, will be used in this account of his experience.

About half an hour after taking the mescaline, I noticed an uneasy sense of rising tension and a need to move around the room. Chanc-ing to look across the street at the window opposite, I saw that it was curiously sharp. It seemed to be made of old yellowing ivory which had, perhaps, been long buried and then cleaned. John was inclined to discount this observation, because he thought that it would be about an hour before I noticed anything, but I knew that there was something wrong with the window opposite. Shortly after this, a sense of special significance began to invest everything in the room; objects which I would normally accept as just being there began to assume some strange importance. A plain wooden chair was invested with a "chairliness" which no chair ever had for me before. In the many thousand stitches of a well-wom carpet, I saw the foot-prints of mankind plodding wearily down the ages. Barbed wire on a fence outside was sharp and bitter, a crown of thoms, man's eternal cruelty to man. It hurt me.

I noticed, about this time, that when I shut my eyes, I saw spar-kling lights flashing across the darkness. I was restless and walked into another room, where I was alone. I remember how brilliantly sharp the little objects on a dressing table were. I ran my fingers over my old corduroy slacks and, as I did so, the most vivid memories began to well up in my mind of dangerous times in the past when I had wom them. Memories of the London blitz, of seagoing during the war, these had a curious quality which is hard to put into words. I was at first aware that I was simply recalling something that had once happened to me, but gradually I began to feel that I was not merely recalling, but re-experiencing the past. The room had peeling white wallpaper, and behind this was a patch of green, a milky jade green. I was much interested in this patch of green until I realized that I was looking at the winter sea, and that if I stayed there any longer, I would see a ship sinking in a storm, and that once again our ship would plow through those unhappy survivors in pursuit of a submarine. I did not wish to see all that again. I retumed to the other room and asked John to come in and join me. To live com-fortably, the past should remain in its place.

By now, everything was brilliantly sharp and significant: if I fixed my attention on a flower, I felt that I could spend all day in con-templating it. A faded camation was worth a lifetime study. Although the world was sharper and brighter, it was also infinitely more fluid and changeable. A bird in the street, a sparrow small and far away, might suddenly become the focus of one's attention, the most im-portant thing one had ever seen, the most important thing in the world, the bird of the world, a key to the universe. Beauty, a terrible beauty, was being bom every moment. Phrases such as "I have seen with the eye of the world, the eye of the newborn and the new dead" sprang to my tongue apparently without construction.

Gradually, all sense perception became increasingly vivid—sight, sound, taste, touch, and smell all grew in intensity, and with this I noticed that things seemed distorted, especially if I became worried.

I can only give glimpses of the strange, often frightening, and some-times very beautiful world which began to replace the familiar one. For instance, John, sitting in his chair opposite, became the focus of my attention, and as I gazed at him he began to change. I might have been looking at an impressionist portrait of him and, as I thought of this, he leered at me in an unpleasant way. The lighting changed, the whole room was darker and more threatening and seemed to become larger, the perspectives changing. However, as soon as John spoke again, I realized that it was only my strange condition. Then I looked out of the window at the building opposite, which towered up like a cliff, immensely tall; yet, about an hour before, it had seemed quite ordinary.

Shortly after this, Edward came with the recording machine, and by the time they had set it up I was in the full flood of the psychosis. I hadn't met Edward before, and when he brought the machine to me, the unfamiliarity made me afraid. He urged me not to be afraid of it, but as he brought it closer it began to glow, a dull purple which turned to a deep cherry red, and the heat of it overwhelmed me as when a fumace door is opened in your face. I knew that it could not be; yet it was so. However, as I got accustomed to the microphone, it assumed a normal appearance and I was able to speak into it.

I also noticed that my hands tingled and had a curious dirty feel-ing which seemed to be inside the skin. I scrutinized one hand and it appeared shmnken and dawlike: I realized that beneath the dried leathery skin was bone and dust alone—no flesh. My hand had withered away, yet I could remind myself that this unusual happening had been induced simply by taking mescal.

John had no radio or phonograph, so that we could not discover how I responded to music. From time to time I would close my eyes and become absorbed in the brilliant visions which I then saw. 'These had become very complicated and of singular beauty; showers of jewels flashed across this inner vision, great landscapes of color spread out before me, and almost any thought would be accompanied by a vision which was often supernaturally beautiful. These are, I believe, indescribable, using the word in an exact sense. Language is a means of communicating experiences held in common and is, therefore, un-suitable for matters which are out of common. Glittering fountains of liquid jewels, pearly depths of the infinite, the apricot clouds of etemity's sunrise, seen through a shimmering filigree of the finest silver mesh, do not begin to describe these enchanting mindscapes.

From time to time I recorded snatches of sentences which gave some idea of what I saw, but to give true account of them would re-quire a tongue, a brush, a pen, an art which I do not possess, and a language which does not exist.

My companions roused me from my absorption with these things and suggested a walk. I would not have gone out alone, for I felt that this inner reality might break out, as it were, from its place, and invade the everyday world. Every so often the walls of the room would shiver, and I knew that behind those perilously unsolid walls something was waiting to burst throtigh. I believed that would be disastrous; these two worlds must remain discrete. Not all the visions were pleasant, but I found that as long as I remained calm and ob-served them as a series of never-to-be-forgotten experiences, all would be well. If I became frightened, their quality might change and they would become more and more threatening. It was essential to remain calm and to refuse to be overwhelmed. If it became unbearable, I dis-covered that I could reduce the tension by concentrating on pleasant, reassuring themes, such as my wife and little daughter, but of course my companions had to discourage this, since we were engaged in an experiment.

Before the walk, I asked for some water. I drank the glass which John brought, and found that it tasted strange. I wondered if there might be something wrong with it: poison crossed my mind and al-most at the same time the story of Socrates and the hemlock cup; and with that a calculation made by a physicist who claimed that every glass of water contains an atom of Socrates, due to diffusion in the twenty-five or so centuries since his death. I looked into the glass of water. In its swirling depths was a vortex which went down into the center of the world and the heart of time. My companions dragged me away from the water for a walk.

In the alleyway, just before we went out, a dog barked and its piercing reverberant howl might have been all the wolves in Tartary. Once on the street, the distortion of perspective became evident. The distances were immense, the colors vivid; the August sun burned on a purple patch of willow herbs on a bomb site with such intensity that I had to shade my eyes. Everything was sharp as a painting by Vermeer.

One house took my attention. It had a sinister quality, since from behind its drawn shades, people seemed to be looking out, and their gaze was unfriendly. We met no people for the first few hundred yards, then we came to a window in which a child was standing, and as we drew nearer, its face became piglike. I noticed two passers-by who, as they drew nearer, seemed humpbacked and twisted, and their faces were covered with wens. The wide spaces of the streets were dangerous, the houses threatening, and the sun burned me.

I was glad to be back in the flat; there at least my world was partly under control; outside, the hoot of a passing taxi, the brilliant color of a dress, or the sudden move of a stranger taking me off my guard would burst torrentially into my whole sensory experience.
Once indoors, I could sup deep in horror with Macbeth, or exult like a mystic in the oneness of etemity, or wallow in jewels like Shy-lock, but at least I only had to open my eyes to be comparatively safe. Not as safe as I would like to have been, as it was particularly difficult to get accustomed to the changes in body image. At one moment I would be a giant in a tiny cupboard, and the next, a dwarf in a huge hall. It is difficult enough to explain what it feels like to have been Gulliver, or Alice in Wonderland, in the space of a few minutes, but it is nearly impossible to communicate an experience which amounts to having been uncertain whether one was in Brob-dingnag or Lilliput.

In spite of everything, I could, with an effort, behave almost nor-. many. My wife telephoned, and I was able to talk to her quite sen-sibly. She was unable to understand why I didn't wish to return home that night, and I was unable to explain that I could not be sure from one minute to the next how I would experience my sur-roundings. A twisted string might suddenly become a snake, and if I became panicky, would writhe toward me.

An unexpected happening was an extreme sensitivity to other peo-ple's feelings toward me or toward each other. I have not seen this recorded elsewhere and, since it exerts a considerable influence on one, it seems worth noting. I experienced my friends' criticism of me as physical discomfort. If they urged me to do something I didn't want to do, I was jarred, and this jarring was sometimes ac-companied by a burning taste and smell.

Most unexpected was my response to a slight difference of opinion between John and his wife. This was a minor affair, due to her want-ing me to eat, and John wishing me to discuss my experiences and satisfy his scientific curiosity. The room, which had been ,brilliantly lighted, became dark, the colors lost some of their vitality, and I felt her criticism of him as a bitter taste, an acrid smell, and an ill-localized pain somewhere between my shoulder blades and down my spine. All the time, my three companions were changing, sometimes with reference to my inner experiences.

After seven hours the effects began to wear off and, in addition, I had learned to prevent myself from panicking by concentrating on pleasant themes when I seemed to be growing too afraid, and by observing with as much detachment as possible. I did not in this experiment attempt free association; the huge volume of associations due to the psychosis was as much as I could cope with, but I believe that this could be done and might be useful in exploring the roots of personality. I doubt whether this should be tried at a first venture, for there seems to be a real danger that more anxiety may be gen-erated than one can deal with. It is best to. become accustomed to the mescal world before exploring it.

By midnight, twelve hours after taking the drug, I was able to be alone in a room, and the mescal world was receding. True, an un-expected sound in the alleyway would bring back delusions for a short time. I still felt that the windows opposite were strange: one in particular was shaped like a coffin lid. Once or twice in the next twenty-four hours I had brief recrudescences of psychosis. Colors seemed unusually bright, and the sun burned me. I was in a "touch me not" mood. I did not wish to discuss the experience with any-one. I tried not to think about it, although I could not avoid doing so. I did not read the notes which I had made for nearly a fortnight —I had no wish to revive what had happened too soon.

What can we learn from this and similar accounts? What might we hope to learn from enduring such an experience ourselves, omitting the possibility of philosophical and psy-chological discoveries about the nature of mind, its range, and the way it works? There is much, I believe, that can be ap-plied to everyday work. We can recognize that the schizo-phrenic person is not imagining or fantasizing when he says that the world has changed and looks different: it is dif-ferent for him and there is an end of it. We must accept what he says as true, and try only to persuade him that the remarlcable changes in the world are due to his illness. Those of us who are fortunate enough to be well should make it our business to help when we can, or at least harm the sick per-son as little as possible. The madman, in the face of the over-whelming assault of the illness, frequently behaves childishly and in so doing is subjected to hatred, ridicule, and often contempt from his healthy fellows. This provokes a vicious circle of fear and guilt that leads to more hallucinations and delusions. In this black world, the greatest comfort and help will come from nurses, doctors, and friends who, although recognizing that the patient's fears are real for him, never-theless refuse to be dismayed by them or by anything he may do or say. This calls for understanding and courage, for which there is no counterfeit. Schizophrenics, in some stages of the illness, are far more aware of other people's real feel-ings toward them than we have been inclined to believe.

We should listen seriously to mad people, for, in phrases that are usually clumsy, ill-constructed, and even banal, they try to tell us of voyages of the human soul that make the wanderings of Odysseus seem no more than a Sunday's out-ing. They tell us of a purgatory from which none returns unscathed. They tell us of another world than this; but mostly we don't hear, because we are talking at them to assure them that they are mistaken. Sometimes, when they might make their escape, we do not heed, or even unwittingly drive them back into hell. The least we can do for these far voyagers is to hear them courteously and try to do them no harm.