© Andrew O'Day

Mental Illness Autobiographical Writing

This Dissertation concerns types of autobiographical writing by people with mental illnesses. The mental illnesses that will be considered here are limited to the most common affective (or mood) disorders: depression and bipolar. As is so of many writers of autobiography, the people suffering are marginalised so these types of autobiographical writing give them a voice to reach the reader. The writers thematise the ways in which they are stigmatized and must make themselves visible, and how readers, both with and without the mental illnesses described, can connect, and empathize, with them, points also raised by reader responses. These are also ethical issues and this fills a gap in the critical literature. Attention is also given to mental health law and these types of autobiographical writing go further than black-letter law and deal with the experiences of sectioned patients. The scope of this Dissertation is England and Wales in the late twentieth and twenty-first centuries in order to make the collection of primary sources manageable and also because it means that we need only focus on mental health law in these jurisdictions.  

Setting the scene 

One key branch of psychiatry is known as ‘phenomenology’. The usage of this term in psychiatry refers to the study of first person consciousness. This approach to psychiatry deals with the subjective inner world of the patient and therefore goes further than the objective classification of mental illnesses in the DSM-5 which originated in the United States and has been described by some as ‘psychiatry’s Bible’. DSM-5 does not tell us what it is like to live with mental illnesses and is just so therapists can, for instance, know what medication to prescribe. The terminology used in this Dissertation is that we are looking at ‘autobiographical writing’, but it is important to be aware that the texts fall under the overall heading of ‘phenomenology’.   

This Dissertation approaches the internal worlds of those with mental illnesses, then, and therefore also differs from the genre of the medical case note. There are case reports of physical illnesses, which narrate the story of the patient’s illness and medical care (93). There are also case reports written about psychiatric patients. These case notes, which are written by clinicians, appear in a multitude of specialist journals and a key one is The British Journal of Psychiatry. There are varying kinds of case reports including those that improve one’s diagnostic skills and those where clinicians share unusual anecdotal experiences which can (sometimes negatively) influence clinical practice. These are not case reports then for the lay reader unlike the autobiographical work discussed here which sees (sometimes) celebrities openly challenge stigma and invite empathy both from those with mental illness and those without.  

For this reason, it is also important to look at such sources rather than to conduct questionnaires, and quote lengthily from interviews. These techniques are often employed in the social sciences like psychiatry but interviews and questionnaires are used as qualitative research and involve the interviewee talking solely to the interviewer and having their words published in specialist journal articles. Close readings of the type employed in Literature courses will be employed here, however, to indicate the themes noted above. We shall also see further on how the writers react to mental health law and therefore the texts are a primary source in this respect too. 

Autobiographical writing by those with mental illnesses connect with the autobiographies of other marginalised groups, such as ethnic minorities and to a larger extent gay men. The difficulty of finding a voice was key to American black writer Maya Angelou’s I Know Why the Caged Bird Sings; the very title of her book raises the idea of being trapped and of using a voice and Angelou is left mute following being raped by a white man but she learns to voice her situation.[1] Gay men and lesbians struggle with language in a different way. Gay men and lesbians begin life ‘in the closet’ and are not visible minorities. Their true identities are hidden until later in life when many ‘come out’ and express themselves openly admitting that they are gay. Paul Robinson has written about how gay autobiography follows the coming-out process: writers unmask themselves both to those around them and to the reader through the act of writing.[2] Later, Georgia Johnston wrote that featured within gay autobiography is the psychological double being. Here there is the closeted gay man who is one thing on the surface and another in reality and also the writer who has come-out as whole.[3] As the ‘auto’ in autobiography indicates, the genre concerns expressing one true self. The connection between gay autobiographies and autobiographical writing by those with mental illnesses will be probed and the gay coming-out process has been seen as a useful model for mentally ill people with both afraid of stigma as discussed by Patrick W. Corrigan and Alicia K. Matthews.[4] 

This Dissertation takes a different approach to Mary Elene Wood’s book Life Writing and Schizophrenia: Encounters at the Edge of Meaning since Wood’s book is limited to the mental illness of schizophrenia, and making sense of madness, and since she focuses on texts which were not written in the United Kingdom.[5] For example, the first chapter of her book probes four late-twentieth-century North American memoirs by young women institutionalized in mental hospitals; her second chapter examines a decade’s worth of first-person accounts taken from Schizophrenia Bulletin (1997-2007) and the way the writers within try to take control of their lives and explain what is happening to them even when they are experiencing delusions; her third chapter establishes contexts for life writing by those living with schizophrenia in the form of Sigmund Freud’s 1911 study of Daniel Paul Schreber’s Memoir of a Neurotic and Gregory Bateson’s 1961 preface to John Perceval’s nineteenth century memoir of madness; her fourth chapter analyses the early fictional novels and autobiographies of twentieth century New Zealand author Janet Frame; her fifth chapter examines case histories, written by psychiatrists, in the DSM-IV Case Book which was the most recent at that point; and her final chapter examines her mother Eunice Wood’s story as told to her over a ten year period. 

Authors, Poets, Journalists, Psychiatrists 

It is important to begin by addressing a couple of key issues. Firstly, there is a gradation of those who are well-known battling mental illness. However, the reader will be aware of the professional achievements of the author they are reading. Moreover, the reader, with or without mental illness, can empathize with the author’s battle even though their lives may differ drastically.  

Various writers of memoirs detailing their battle with depression are authors and poets. Gwyneth Lewis is an award-winning poet who was named one of the Next Generation British poets in 2004. In her book Sunbathing in the Rain, Lewis describes depression as leaving her in bed asleep for weeks, of being off work for almost a year and as taking away her ability to do anything like read.[6] Lewis writes about the stigma associated with mental illness as well as here the connection that may be forged between writer and reader. She remarks: ‘My first impulse was to hide my condition from even my closest friends. I felt ashamed of my wretchedness, as if I’d brought it on myself’.[7] She realized, however, when she ‘started to tell people what had been wrong…that’ she ‘hadn’t fooled anybody’.[8]  Of Sunbathing in the Rain, Lewis tells us that her ‘main motive in writing…is the hope that it might offer some comfort and encouragement to others going through this agonizing and perplexing experience’,[9] who can empathize with Lewis. The book is ‘aimed primarily at those who are depressed at the moment and who are looking for something nourishing to read as they go through their terrors and recover’.[10] The book is structured like a jigsaw puzzle with short passages that can be read on their own, though all together they add up to a narrative.[11]   

Matt Haig is an author of non-fictional and fictional bestsellers, including the adult novels The Last Family in England (2004), Dead Fathers Club (2006), and The Possession of Mr Cave (2008), his children’s novels Shadow Forest (2007), Runaway Troll (2008), The Radleys (2011) and The Humans (2013), and A Boy Called Christmas (2015), and The Girl Who Saved Christmas (2015). His book Reasons to Stay Alive is a type of autobiographical writing.[12] In it, Haig not only writes in prose and covers a variety of topics of his life but also intersperses these with short pieces like dialogue between ‘Then Me’ and ‘Now Me’, with his present incarnation not suffering from depression so badly,[13] with things people say about those with depression,[14] with different lists relating to depression, including, but not limited to, its symptoms,[15] with reactions on Twitter,[16] and so on.  

Haig provides a definition of depression. Haig writes: ‘One of the key symptoms of depression is to see no hope. No future’.[17] Haig is therefore voicing the idea of the lack of temporal progression in the minds of those with depression raised by participants in a survey by Gareth Owen et al.[18] Indeed, in a dialogue in Haig’s book ‘Then Me’ says to ‘Now Me’, ‘You are from the future, and I have no future’, but the presence of ‘Now Me’ indicates that he does have a future. Haig further details taking medication for depression and points out that pain is a very ‘isolating experience’ but that love saved him.[19] Haig writes ‘Depression makes you feel alone. That’s one of its main symptoms. So it helps to know you are not alone’.[20] 

Again, the themes of the stigma surrounding mental illness and connecting with the author are raised by Haig. Haig writes: ‘When you are depressed you feel alone, and that no one is going through quite what you are going through. You are so scared of appearing in any way mad you internalise everything, and you are so scared that people will alienate you further you clam up and don’t speak about it’.[21] Haig says that this ‘is a shame, as speaking about it helps. Words...are what connect us to the world, and so speaking about it to people, and writing about this stuff, helps connect us to each other’.[22] One of the things Haig also advocates be done is to ‘Ignore stigma’; he says that ‘We fear getting ill, and fear tends to lead to prejudice before information’.[23] 

There are also journalists who wrote about having suffered from depression. Sally Brampton is one such figure. Brampton was the founding editor of the British version of the French magazine Elle, before becoming editor of Red and becoming an agony aunt for The Sunday Times and The Daily Mail. She also wrote columns on gardening and various novels: Good Grief (1992), Lovesick (2000), Concerning Lily (2000) and Love, Always (2000). Brampton’s memoir is titled Shoot the Damn Dog referring to Winston Churchill’s reference to depression as a ‘black dog’ and she describes the way that those with depression ‘withdraw’, ‘shut down completely’[24] and have suicidal thoughts.[25]  

The issue of the stigma surrounding mental illness is addressed in Brampton’s book. Here Brampton feels that writing can combat such stigma and silence. Brampton writes: ‘So why am I writing this book? I’m writing it because, although I dislike the confessional, I was (and continue to be) so repulsed by the stigma around depression that I determined I must stand up and be counted, not hide away in shame.’ ‘If I have any talent’ she continues ‘it is the ability to communicate, and to get published’.[26] In this passage, Brampton probes the idea of hiding away in shame and revealing oneself which was also so key to gay autobiography.  

Brampton continues to address the issue of stigma and expressing oneself openly when she states of writing ‘a personal account of’ her ‘suicidal depression for a newspaper’ that ‘many people said’ she ‘was brave’. She says ‘Perhaps, although I don’t believe that confronting an illness is necessarily an act of courage. The stigma surrounding depression just makes it seem that way...I came to understand that we are not simply fighting an illness, but the attitudes that surround it’.[27]  

In a passage later in her book, Brampton writes: ‘Unless we tell it as it is – it is an illness just like any other – we will never defuse the fear and secrecy surrounding it.’ She continues, ‘Phrases such as “mental distress”...stop people getting help when they most need it. They minimise the condition, reinforce stigma and impose a burden of secrecy that causes useless and unnecessary suffering’. Very importantly, Brampton concludes, ‘The question I am most often asked as a person who is so “out” about their illness...is “how do I help somebody who is depressed?”’.[28] In this passage, Brampton introduces another idea which is so key to LGBT studies and gay autobiography which is that of outing one’s true self and of coming-out as gay amidst much prejudice.  

Just as Georgia Johnston raised the notion of the double being contained in gay autobiography (the closeted self and the writer who has come out as gay and who is using language to assert his true identity), the notion of the double being also appears in Brampton’s book showing the connection between autobiographical writing dealing with mental illness and gay autobiography. She writes: ‘Another way in which depressives...might hide is by keeping their true needs, instincts and demands disguised by the face that they present to the world’.[29] Brampton concludes that ‘In psychoanalytical thinking this is called “splitting” and is when true feelings (the true self) are hidden by a mask or the false self’.[30] Evidently, just as in gay autobiography, types of autobiographical writing by those with mental illness sees the mask removed and the split self become one (the auto). 

Other issues addressed in Brampton’s book are of the connection forged between those with mental illness through the act of writing and of the empathy where the reader can put him or herself in the writer’s shoes. Brampton remarks ‘...I believe that we learn through stories. We learn that we are not alone’. She states ‘Depression feels like the most isolated place on earth...If you are reading this book and you feel that way too then you are not alone...Life is about connection...Depression is the opposite; it is an illness defined by alienation’. She concludes ‘So I offer this book by way of connection’.[31] 

Brampton elsewhere writes of isolation and connection: ‘Exposing our frailties and vulnerabilities is frightening so it is easier not to do so. A part of me still believes that, even though depression showed me that shutting myself away is ruinous for my own emotional health’.[32] ‘It is’, she continues, ‘ruinous for everybody’s emotional health and I know I am happier when I am connected to other people. Even so, to this day, when I am low, my natural default setting is to shut down and hide even though I am, by nature, gregarious’.[33] Brampton goes on to say ‘Nearly every depressive I know has a similar default setting...It means hiding in bed, not answering the phone, turning down invitations and generally ignoring the world. And it is the worst possible thing that we can do for ourselves...Another name given to it is “isolating”’.[34]  

Brampton also writes about the need of being heard by those who do not suffer from depression. She states ‘People so often say “I don’t know how to help”. This is one way – through empathy...through connection. Don’t think, as so many people do, that depressives are best left alone. They are not. Ignoring...depression only makes it worse. It never makes it better’.[35] And Brampton concludes ‘It takes courage to be honest and open about our own vulnerability. But it is, at heart, what we all crave and need – not only to be listened to, but also to be heard. We want to be understood and accepted for the people we truly are. That’s all therapy is, understanding and acceptance..allowing’ one ‘to speak until they feel heard’.[36] 

Mark Rice-Oxley wrote Underneath the Lemon Tree: A Memoir of Depression and Recovery.[37] Rice-Oxley spent ten years reporting and writing from Moscow, Paris and Eastern Europe before becoming an editor at The Guardian, specialising in foreign news. Rice-Oxley challenges Brampton’s description, and long before her Churchill’s label, of depression as being a ‘black dog’ as it is ‘not external’[38] and is something that happens to one.[39] In a very important passage, Rice-Oxley states: ‘I am mentally ill. I broke a bit of my brain, like you might break your collarbone. It took a lot of healing. It will always be vulnerable. It could recur’.[40] ‘I don’t think’, he continues ‘it’s a condition that should invite prejudice. People with lung cancer and heart disease are not ostracised or humiliated or debarred from jobs or opportunities, even though in some cases their lifestyle will certainly have contributed to their affliction.’[41] He asserts ‘Mental illness is rarely about lifestyle or choices we make...It is painful enough; it seems grossly unfair to double the punishment with discrimination. But that’s what we do. Because we don’t understand it’.[42] Rice-Oxley proceeds to quote Sue Baker, director of the Time to Change programme: ‘The vast majority of people with mental health problems anticipate getting negative responses from others and this stops them telling other people’ and that nine out of ten people with mental illness report that they have been the victims of stigma.[43] Again, the term ‘coming-out’ is employed[44] highlighting the connection between revealing that one suffers from a mental illness with gays and lesbians leaving the closet. In addition to noting the comfort he gained from reading Lewis’ book,[45] Rice-Oxley writes about making google searches and following threads in chat rooms[46] and wants to talk to people in the same predicament[47] so there is the notion that one can empathise with others in the same situation.  

Linda Gask, meanwhile, is a psychiatrist, who was trained in Edinburgh but worked in Manchester, who herself suffered from depression and saw the stigma surrounding mental illness. Her book[48] is a type of autobiographical writing: it is divided into chapters arranged biographically and thematically about an element of distress or coping with it. For example, there are chapters on vulnerability; fear; loss; wounds; losing the plot; love; loneliness; trust; asylum; taking tablets; revisiting the past; exorcising ghosts; grief; and learning how to live in the present. She uses elements of her own life (both including her family life and her professional life) and the testimony of her patients.   

The title of her book, The Other Side of Silence: A Psychiatrist’s Memoir of Depression, is important. It introduces the binary of psychiatrist and patient and the point that there is silence surrounding the predicament of the patient who suffers from mental illness. This is the one side to which one compares the psychiatrist’s ‘other’ side. At the same time, however, Gask seeks to collapse the division between psychiatrist and patient. We are told on the back cover blurb that Gask came to realise that being an expert in depression does not confer any immunity from it. 

Gask comments on the need to voice one’s mental illness rather than hide it as a result of stigma. Gask writes in her Conclusion: ‘Despite what some may say, asking for and receiving help is really nothing to be ashamed of. It demonstrates that you are doing something about how you feel rather than trying to hide it, which only brings more problems’.[49] Gask concludes that ‘Unfortunately, many societies, including our own, are not yet ready for such a level of honesty, but I know my depression is not something I should be – or am – ashamed of’.[50] 

Gask highlights the importance of connecting with people with mental illness and sees autobiographical writing as an important tool in enabling this to occur. In her Introduction, Gask writes of her role as psychiatrist: ‘In the last 30 years I have listened to many stories of depression and despair, and learned a great deal from the people who have shared their lives with me. Although their experiences have resonated with my own, I generally haven’t revealed my own history of depression’.[51] Gask launches her book stating: ‘What follows is an account of what I understand about myself today and what I believe will help others similarly afflicted’.[52] She also says ‘Importantly, this is not only my story – it is also about what I have learned from all those who have shared their experiences with me’.[53] But she remarks that her ‘aim is to help others in the same situation to have a better understanding of what they are going through and to cope with it more effectively – both essential tools in overcoming depression’.[54] 

Using autobiographical writing to communicate and connect with people and empathise with them is an extension, then, of Gask’s role as psychiatrist. Gask devotes a chapter to the idea of communication noting that it is ‘healing to talk’ but that ‘talking isn’t always easy’.[55] Because she ‘grew up in a family where all members seemed unable to talk to each other about things that really mattered or to really listen to what the other person had to say’ she ‘wonder[s] sometimes how’ she ‘ended up specialising in teaching communication skills’.[56] ‘But’, Gask says, ‘this ability – to pick up on those words, phrases and glances redolent of emotion...has helped’ her ‘to teach the language of feelings to others’.[57] She tells us how she visited the Institute of Mental Health in Beijing to instruct doctors on how to talk to people who might be depressed,[58] something she does in lecture rooms in many different countries.[59] Communicating in face-to-face contexts differs from using autobiographical writing but involves connection. 

Television, Sport 

When such figures as actors, comedians, pop singers and sporting celebrities face a situation it is brought into full view. This was the case, for instance, when actor Rock Hudson was diagnosed with AIDS, and when basketball player Magic Johnson was diagnosed with HIV having slept with a vast number of women showing that AIDS did not solely affect homosexuals. When such a figure reveals his illness the stigma surrounding it is challenged. The same can be said of those with mental illnesses. The celebrities to be considered here write about the effects of depression leaving them bed-ridden and suicidal.  

Denise Welch, star of Coronation Street and Loose Women, wrote her autobiography Pulling Myself Together.[60] She says ‘Over the years, I’ve hopefully helped to remove some of the stigma and the taboo surrounding depression, but I didn’t feel that people would understand back then’.[61] Welch tells us that she was therefore very good at hiding her illness.[62] But earlier she did write an article for the local newspaper about post-natal depression which her agent advised against, arguing that it would affect future work because people would think she was mad.[63] The publication of this article led to her appearing on a morning discussion programme.[64]  Towards the end, she writes ‘Have I been too open?...Was I revealing too much? When I decided to tell my story, I knew it was very important for me to talk about my depression, but did I really need to divulge the dark chapters that followed?’.[65] She realises ‘After much deliberation, I decided the answer was yes, because I couldn’t have written honestly about the depression without taking the reader to those places’.[66] She goes on to say ‘There were...many positive consequences of writing the book...Many of the people who bought and read it have come up to me or emailed me to say that they’ve gained so much from it, and it’s a wonderful feeling to know that my story has touched or helped people in some way or another’.[67] ‘This has meant so much’ she says ‘because I was really hoping that in describing my depression it would bring a wider understanding of the illness’.[68] One person told her that their mum was able to empathise having read about mental illness in layman’s terms rather than just being given a medical explanation.[69]  

Another actress Beverley Callard, who starred in Coronation Street, wrote her autobiography Unbroken, in which she discusses her diagnosis of clinical depression.[70] Callard writes that ‘One of the biggest changes in’ her ‘life that the breakdown has brought about is that for the first time’ she wants ‘to speak publicly about’ her ‘struggle with depression’ and she ‘desperately wants[s] to send out the message that depression is not a sign of being weak, it is a sign of trying to be too strong, for too long’.[71] She says ‘I just hope the sections about my own depression help other people suffering in the same way to understand that they are not alone’,[72] just as Denise Welch, discussed above, offers support to her co-star Callard.[73] Towards the end of her book, Callard does question whether she has a slight tendency to manic depression since she has ‘touches of manic behaviour’ where she throws herself into her work.[74] 

Lewis Wolpert’s Malignant Sadness: The Anatomy of Depression[75] is not a typical autobiography and it formed the basis for a BBC TV documentary series. In the Introduction, Wolpert writes about his personal struggle with depression, which he describes was worse than watching his wife die of cancer and made him suicidal,[76] but the main body of the book is an objective study into depression, with the occasional discussion of the author’s own plight. In his 1999 Introduction, Wolpert writes ‘My wife…was embarrassed by my being depressed and told colleagues and friends instead that I was exhausted from a minor heart condition. She was worried that if the truth were known it would affect my career’.[77] Wolpert himself felt ‘most uneasy about the stigma associated with depression, and the shame felt my many sufferers’.[78] To him ‘it seemed…a serious illness of which one should not be ashamed’ and he made his depression public and wrote an article for The Guardian newspaper.[79] He remarks that ‘Although there are many “self-help” books on the subject’ he ‘found very little reliable information about depression easily available, and decided to write this book to set down what is known’ and ‘help those who are living or working with a sufferer…to help depressives to understand themselves; to remove the stigma associated with depression; and, foremost, to try and understand the nature of this dreadful affliction in scientific terms’.[80] Therefore, the aim is not so much for the reader to empathize with the author. The title, with ‘malignant’ in it, indicates that normal sadness is to depression what normal growth is to cancer.[81] 

Writer and comedian Susan Calman wrote the memoir Cheer Up Love: Adventures in depression with the Crab of Hate.[82] Calman is Scottish but, as she tells us, she spends much of her time down south working in the media[83] and is beamed into the homes of millions.[84] Calman writes that ‘anxiety and depression is the most common mental disorder in Britain’ and is ‘something that affects more people…than many would like to admit’.[85] She says ‘I’ve decided to come clean about my mental health because, to be honest, people still seem rather embarrassed to talk about it’.[86] She remarks that ‘until more people start being honest about how they feel we will never get any better’.[87] It is important to communicate one’s feelings.[88] The reason for the silence is that those with mental illnesses are stigmatized. Calman says: ‘Depression is often referred to as “The Invisible Illness”…On the positive side, the fact that you wouldn’t know that I was falling apart inside just by looking at me means that I can hide how I’m feeling and carry on with work and life without fear of prejudice or discrimination’.[89] ‘Because’, Calman concludes, ‘admitting you have a mental health problem to some people, especially in a work environment, can change the way that some people perceive you’.[90] ‘It’s a label’, she says, ‘and one that comes loaded with incredible prejudice and fear’.[91] But in her stand-up comedy routines and in this book she comes-out.  

Calman is a lesbian and even earlier in her book she draws a distinction between coming-out as gay and coming-out as having a mental illness. She writes: ‘And as we commence this thrill ride together, I think it’s appropriate that I come out. Not about that! If you haven’t worked out by the fact I’m wearing a Batman outfit [with which she begins the memoir] that I’m a lady gay then I can’t help you. And don’t worry…you’ll hear more stories of the fact I’m a very good friend of Dorothy later on’, of the juicy kind that will get the book discussed in The Daily Mail.[92] Instead Calman reveals: ‘The coming out that I’m referring to is actually more difficult for me to admit than the fact that I’m gay. Because the truth is that I have depression’.[93] Calman later remarks that ‘While attitudes are changing, when’ she ‘was growing up there was far more of a belief that homosexuality was a disease, so’ she ‘was depressed and gay’ where ‘Some might say’ she ‘had a double whammy of mental illness’.[94] While Calman dispels this myth she remarks ‘That’s not to say that there isn’t a high level of depression and mental illness in the gay community’.[95] Prejudice against gay people exists[96] as does that for those with mental illness. Calman cites a survey of sixteen – to twenty-four year olds across the United Kingdom which found that 42% of LGBTIQ people have sought medical help for anxiety or depression.[97]  

Calman also addresses the connection between mental illness and the genre of comedy which can be used to challenge stigma. She says ‘there’s no question that the subject of mental health and humour is a tricksy one’ and that ‘There are commentators who believe that it’s such a serious topic that no one should make fun of it, and then there are those who consider that absolutely nothing should be off limits and the more people talk about it, even as a result of an offensive joke, the better’.[98] ‘The truth’, Calman concludes, is ‘somewhere in between’.[99] Calman reveals that she frequently talks about depression in her act[100] and that ‘the way to try to break a stigma is to smash it down, even by using language that offends to get a deliberate reaction’.[101] Calman also points to the distinction between a BBC Four documentary and the Jeremy Kyle show, with the aim of the latter being to ‘exploit and titillate’[102]. Another comedian who suffers from depression is David Walliams (see Camp David).[103] 

Comedian Bill Oddie wrote his autobiography One Flew into the Cuckoo’s Egg.[104] Oddie describes suffering from depression but not at first from bipolar (93). While he partially describes depression he tells us that he is not writing a whole book about it. Oddie writes, ‘I don’t want to be best known as a “celebrity depressive”’, and says that ‘it’s a slightly over-subscribed market anyway!’ where ‘celebrity illnesses are about to take over from house makeovers, cooking programmes and so-called reality shows’.[105] Importantly, he remarks ‘I am certainly not belittling or doubting the mental problems of fellow “celebs”, and neither do I doubt that hearing about the troubles of a “personality” can be something of a comfort for “normal” people. It helps destigmatise the whole area of mental illness and – perhaps even more valuable – makes people realize that it can happen to us all’.[106] He concludes by questioning ‘If a cheery little chap like Bill Oddie can have a breakdown, then surely so can anyone?’.[107] He says that atypically celebrities can probably afford a room in a private hospital[108] and also that other people’s experiences may differ.[109]        

Footballer Clarke Carlisle wrote his autobiography You Don’t Know Me, But…A Footballer’s Life.[110] Carlisle not only writes about his alcoholism but also about his depression. He set out to learn more about the illness after seeing his wife suffer from post-natal depression[111] and the club doctor confirms the results of an on-line test: that Carlisle himself suffers from the disease.[112] He needs to be kept on medication so as to stop the intense feelings of depression [113] Carlisle does not comment on the importance of writing about his depression. But he states that ‘Finding out what the illness actually is and how it manifests itself is a process that liberates you from the stigma about the ‘D’ word’.[114] He remarks that ‘There is a distinct lack of awareness of, and education about, depression and mental health issues’ and that ‘This has to change’.[115] He continues: ‘Over 6000 people will commit suicide this year, and a high percentage of them will be clinically depressed and they won’t even know it or know what to do about it’.[116] He instructs the reader who is suffering to ‘Just tell someone, anyone, and then go and talk to your GP’[117] so sees the importance of what he is writing for his audience. He also goes to Germany to film a documentary about depression and mental illness and ‘hope[s] this programme will start as many conversations…as the [previous] racism film did’.[118] So Carlisle believes in using forms to help people in difficulty out. Another footballer who suffered from depression is Stan Collymore, whose depression was part of his Borderline Personality Disorder and who wrote Tackling My Demons.[119]  

Mike Yardy, meanwhile, wrote The Hard Yards: Highs and Lows of a Life in Cricket.[120] He does not explicitly state that his aim in writing was to combat mental illness but the theme of stigmatization and the importance of writing about depression is conveyed. He also draws attention to the larger picture stating that when he started to learn about depression he was ‘staggered to discover that mental illness, in one form or another, affects around 25% of the population’[121] but that ‘thousands of people…suffer in silence’.[122] In the Wisden Cricketers’ Almanack for 2012 he wrote a piece saying ‘Millions suffer from depression…I was gutted by the reactions of some individuals and could not believe people could be so judgemental’.[123] The coverage around this was sympathetic, however, and, on the whole, he was thanked by people for ‘highlighting the issues of mental health in the public domain’.[124] 

In his autobiography Coming back to me, cricketer Marcus Thescothick also reveals the stigma associated with depression.[125] He writes ‘As anyone who has done so knows, it can be a huge and extremely difficult step to actually admit that you might be suffering from what is commonly known as mental illness’.[126] He continues: ‘Just think of a few of the words which have been used to describe such problems through the ages and even now: mad, crazy, insane’.[127] This leads him to the conclusion: ‘Who…would want to admit to being any of those?’.[128] He says that for him ‘to admit to suffering from depression was a matter of shame and embarrassment’.[129] He raises the importance of ‘coming-out’,[130] however, which is associated with gays and lesbians being open about their sexuality. Thescothick again sees himself as part of a larger group who he hopes will empathise with him when he states ‘As so many will be painfully aware, people as ill and confused and as desperate as I felt at this moment can be stricken with thoughts of suicide’.[131] Later he comments ‘If anyone out there reading this is currently experiencing anything like what I have so far described…understand…that you are not alone, that how you are feeling is…nothing whatsoever to be ashamed of…And trust me, there is nothing brave about suffering in silence’.[132] He explicitly comments on the writing of the book saying that it would hopefully not only help cricket players suffering as he did[133] but also more generally ‘help those who…have found it so cripplingly difficult to admit to or come to terms with [mental illness]; and…those who have never suffered from it’.[134] He says that he ‘had a responsibility to everyone who had ever suffered these illnesses to try…to give proper voice to the experience’.[135] 

Overcoming hurdles, gender and empathy 

Readers with depression may emphasize with the point that these writers are able to overcome this hurdle and lead a fairly complete existence. This is important in stressing that one must not give up or in to stigma. This is not the case with someone like Brampton who committed suicide but is evident in other books. Haig earlier wrote: ‘Given the nature of our society, and a confessional celebrity culture, it is often famous people that we hear about having troubles But it doesn’t matter. The more we hear, the better. Well, not always’.[136] Haig says, as a writer, he did not like considering Ernest Hemingway, Sylvia Plath or David Foster Wallace. Haig stated though ‘Sometimes just looking at names of people who have suffered depression – or are still suffering depression – but who clearly have (or had) other things that are great going on in their lives, gives a kind of comfort’ and he provides a list of names.[137] Haig remarks of Abraham Lincoln: ‘the key thing…is that the president always suffered from depression. He never fully overcame it, but he lived alongside it and achieved great things’.[138]  

It is also important to note that men who suffer from depression are stigmatized more than women. Haig titles one of his chapters ‘Boys don’t cry’ and argues that in fact they do and that ‘A staggeringly higher number of men than women kill themselves’[139] because ‘men, traditionally, see mental illness as a sign of weakness and are reluctant to seek help’.[140] Haig reasons that ‘You are no less or more of a man…for having depression than you would be for having cancer or cardiovascular disease or a car accident’ just as one is no less of a woman or a human being for having depression.[141] Rice-Oxley also raises the issue of gender saying ‘Depression…seems an alien word. I don’t feel depressed. I am not crying in the corner. Not yet’ and questions ‘And anyway, isn’t depression a women’s illness?’.[142] He goes on to state that dads ‘pound away at work, sink exhaustedly into armchairs at the end of the day’ and ‘struggle to switch repeatedly from deal making and report writing to playing build-the-tower-of-cups or push-the-plastic-shape-through-the-hole’.[143] According to psychiatrist Tim Cantopher men are now being expected to take on the role of dads as well as being bread winners’.[144] These men ‘mask their symptoms with drink and drugs or women’; ‘There is’, as Irwin Nazareth notes ‘this culture of being the tough male who has to be strong and take anything’ and as is pointed out ‘It is not common for a man below fifty to seek help from a doctor’.[145] Brampton, a female writer, remarks that ‘Many of those who kill themselves (particularly men) do so because they are too ashamed to admit they have the illness or to seek help’.[146] Calman also writes that ‘Research indicates that women are more likely to have been treated for a mental health problem than men’ which ‘doesn’t…mean that men aren’t suffering from it’.[147] She, however, writes that being a ‘hysterical woman’ was the most awful of all criticisms’ and that ‘Talking about feelings’ in her day ‘didn’t seem to be encouraged’.[148] 

But various writers draw attention to the point that their wealth and fame puts them beyond depression in the eyes of many who have not suffered from the illness. Footballer Collymore states: ‘People look at me and scoff at this idea that I’ve got any sort of mental problem, partly because I’ve got a lot of money, which most people associate with happiness’.[149] Cricketer Yardy, meanwhile, imagines his mother, and indeed a lot of common people, thinking ‘“He’s achieved his dreams. He’s played for his country so why hasn’t he enjoyed it?’ and remarks that ‘Surely it’s people living on the street, sleeping in doorways or struggling to make ends meet who should be depressed’.[150] He states that what one decides to do with one’s life ‘does not guarantee immunity against mental illness’.[151] Trescothick had revealed that he was one of these types of people who had always been sceptical about depression and who himself had success, money and a family.[152] 

These writers write using metaphors and similes which is important in getting the reader, who has not experienced depression, to emphasise with them since it is the only way to communicate the experience. In the Introduction to her book, Lewis describes depression as being where one’s ‘old self is gone and in its place is a ghost that is unable to feel any pleasure in food, conversation or in any…usual forms of entertainment’.[153] Furthermore, one becomes a ‘body bag’ where ‘Moving a pile of books can take days, as the objects in a room have a stronger will’ than the person with depression.[154] Haig, meanwhile, remarks that ‘To other people, it sometimes seems like nothing at all. You are walking around with your head on fire and no one can see the flames...depression is largely unseen and mysterious’[155] and ‘You have to resort to metaphors’.[156] Haig, for instant, says ‘You are trapped in a tunnel. You are at the bottom of the ocean’.[157]  Brampton also uses metaphors to describe her depression. She writes that she has ‘spent long years in the dark’[158] and has ‘slowly…clambered out of that pit of total despair’.[159] She refers to a nervous breakdown as ‘the gradual erosion of a person, a slow and sad disintegration of a human being’[160] and so one is stripped of one’s dignity. Brampton also invokes the monstrous serpent as one that takes her by the throat so that she can hardly breathe and flings her to the ground.[161] She knows that the monster, which some therapists suggest she befriend, is not real but a manifestation of her illness.[162] Rice-Oxley describes depression as an ‘eternal...elusive...no-thing’ trying to make the writer into a ‘no-thing too’.[163] He states that if depression is to be external it is ‘a flyweight pugilist, infinitely light on its feet, deceptively powerful in the punch’.[164] During the book, Rice-Oxley describes looking after a lemon tree which at the end was depressed and died and was glad that the tree, and not him, perished.[165] Language is important since many may find it impossible to ‘articulate’ their ‘problem’. In her Introduction, Gask invokes a metaphor for the person with mental illness when she says that they ‘may not yet have matched words to the feelings they can sense in the hidden rooms of their mind’.[166] Gask says ‘They may still have no clear ideas...relating to the origins of their difficulties. Instead of words, their angst may be expressed in behaviour which may be hard for them, or anyone else, to make sense of and can manifest itself as irritability, anger or withdrawal’.[167] Gask concludes that ‘Sometimes they will delay seeking help until they are in a state of crisis’.[168] Welch, meanwhile, observes that ‘No one knows what’s going on inside’ her and, amongst other metaphors and similes, sees her depression as a ‘dark cloud’ descending and weighing her down, her limbs as feeling like lead, meaning she has to forcefully drag herself out of bed, and the day ahead looming ‘like a giant, oppressive mountain’ that she is being forced to climb.[169] Callard says she was in a ‘deep, dark hole’.[170] Yardy refers to thoughts as not only ‘intense’ but also ‘crippling’[171] and says that ‘any metaphor’ can be used for depression like being on the edge of a black hole or cliff face;[172] and Thescothick waits for the terror to subside and let him ‘breathe’[173] invoking the metaphor of suffocation. 

In summation, if readers do empathize with these writers and stigmas are dismantled, it may largely be because, as well as the use of metaphor, their narratives come across as very personal. We see a human face, as opposed to the public face which is put on for the camera and newspapers. 

Bipolar and reader response 

There are also those who suffer from bipolar disorder which involves experiencing fluctuating moods from an ecstatic frenzy to manic depression, and can cause people, on the one end of the scale, to throw themselves into their work and, on the other, to attempt self-harm. The medication can keep people in-between these two extremes and create a feeling of numbness. There are different types of bipolar: there is, for instance, ‘soft’ bipolar disorder where psychotic symptoms are not evidenced along with the mood swings.  

Stephanie Merritt wrote for national newspapers such as The Times, The Daily Telegraph, The New Statesman and New Humanist, The Observer and The Guardian and is also a novelist having written books such as Gaveston (2002), Real (2005), Heresy (2010), Prophecy (2011), Sacrilege (2012), Treachery (2014) and Conspiracy (2016). She recounts her struggle with bipolar in her book The Devil Within.[174] She reveals how she has created an ‘illusion of competence’ to her work colleagues[175] and that ‘There are…things the people close to’ her ‘don’t know’; she doesn’t tell them, because she is ‘ashamed’.[176] She goes on to tell us how, upon being diagnosed with manic depression, her reaction was split. Part of her ‘wanted to disown it’ since it was an illness associated with artists like Virginia Woolf and Vincent Van Gogh who had ‘crossed the border into the land of the crazy’, and in whose company she says she did not belong, while the other part of her wanted to ‘hug the shrink’ for giving her condition a name.[177] But Merritt points out: ‘The stigma may have lessened in recent years, but still it remains. Even the phrase “mental health problems”, drags behind it all kinds of connotations that make me recoil from applying the words to myself’.[178] ‘More than once while I was writing this book, whose aim is partly to lessen that stigma’, she continues, ‘when asked by people I didn’t know well what I was working on, I would hear myself answer quickly, “it’s about psychology”, in order to spare their embarrassment and mine. We are not comfortable talking about depression’.[179] However, Merritt also argues that the term ‘depression’ has become blunted by common misuse and is often seen as ‘overdramatizing’ the sad and disappointed.[180]    

Gail Porter, a TV presenter and pin-up model, wrote her memoir Laid Bare.[181] Porter’s memoir concerns events in Scotland and also south of the border. Porter writes about her anorexia and the alopecia, which caused her to go bald, as well as about her bipolar. Porter does not explicitly note the importance of writing about mental illness to challenge stigma, but she does say in relation to her alopecia: ‘other people may choose privacy to get through an ordeal...But me, I have to talk to people. If I’ve got alopecia, so have others. Let’s talk about it, get things out in the open’.[182] At the end of her autobiography, she writes of more general topics: ‘I do hope...that I’ll have a chance to work on more documentaries. I love being involved with real issues, something that makes a difference in people’s lives. I’ll never stop taking an interest in what’s going on – and will always jump at the chance to sound off about it!’.[183] Tina Malone, who starred in Brookside and Shameless, also writes about suffering from bipolar in her book Back in Control.[184] 

In the volumes of his autobiography Moab is my Washpot[185] and The Fry Chronicles[186] and, to a much lesser extent, in More Fool Me,[187] Stephen Fry reveals that he suffers from bipolar. In The Fry Chronicles, Fry raises the idea of being open about mental illness just as he writes about being open about his homosexuality and of wearing masks. We saw above the connection between the two involving hiding in shame and coming-out through writing. Of going to Cambridge, Fry says ‘I lived…in quivering dread of being at any moment found out…it wasn’t my status as a convicted criminal on probation that I wanted kept secret, nor my past history as thief, liar, forger and gaolbird. As far as I was concerned those home truths were perfectly fit for broadcast, as was my sexuality…the terror that gripped me…was all about my intellectual right to be there’.[188] Fry also writes of ‘the most marvelous relief to come out’ to his father.[189]  Fry later states that ‘Like many masks this smiling, placid one has become so tight a fit that it might be said to have rewritten the features of whatever true face once screamed behind it, were it not that it is just a mask and that the feelings underneath are as they always were’.[190]  

Fry also raises the idea that he is in dialogue with the reader who may also suffer. In The Fry Chronicles, he addresses the reader stating: ‘What I want to say about all this wailing is not that I expect your pity or your understanding (although I wouldn’t throw either of them out of bed), but that perhaps I am the one actually offering pity and understanding here’.[191] So Fry does want the reader to emphasize with him. He goes on to say ‘For I have to believe that all the feelings I have described are not unique to me but common to us all. The sense of failure, the fear of eternal unhappiness, the insecurity, misery, self-disgust and the awful awareness of underachievement that I have described. Are you not prey to all those things also?’.[192] Therefore, Fry allows for the fact that there might be connection between him and the reader. However, Fry does remark: ‘If it is just me, then you are reading the story of some weird freak’.[193]  

Kerry Katona, a member of the girl group Atomic Kitten and contestant in celebrity Reality TV shows, wrote her autobiography Still Standing.[194] She informs us of her problems with bipolar[195] as well as with drugs. Katona writes about going on This Morning and the point that unlike with ‘physical signs that’ she ‘wasn’t well…they didn’t understand it’.[196] She continues, ‘Generally, mental illnesses are really poorly understood by most of the population. A psychiatrist has said to me…“Let people know you’ve had a drug problem, let them know you’ve had the occasional drink, just don’t let them know you have mental issues because they will not understand it.” And sadly I think that is true’.[197] She goes on to say ‘While I like to think I am helping to raise awareness of it, it feels like people don’t listen. Stephen Fry did a whole TV documentary about bipolar, called The Secret Life of the Manic Depressive, which was great – and all everyone said at the time was how brave he was to discuss it, how he was raising awareness…but what upsets me is that when I draw attention to it, I am mocked more than anything’.[198] She comments that one of the reasons she has written this book and made it open and honest is to warn others off drugs, particularly her children when they get older, but others can emphasize with her mental illness too. Bipolar disorder is also described in the autobiography of boy band McFly in Unsaid Things…Our Story.[199] 

Boxing champion Frank Bruno discusses his affliction with bipolar in his autobiography Frank: Fighting Back.[200] Bruno does not actually say that he is writing to reduce stigma though one sees him discuss the stigmatization of mental illness in sensational headlines in the tabloid press.[201] But just as Bruno received letters from other sufferers which made him realize that he was not alone,[202] he says ‘I want you to understand what I went through. It’s important not just to me but to mentally ill people everywhere…And, in case you think it only happens to other people, it might be important to you’.[203] Another sufferer of bipolar is footballer Paul Gascoigne in Gazza: My Story.[204] 

Again, readers suffering from bipolar and those who are not, can emphasize with these figures, some of whom are celebrities, and see that it is possible for the mentally ill to overcome hurdles. Reactions on Amazon confirm the way these books challenge the stigma of depression and bipolar and often offer a connection between author and reader. Amazon offers a five-star rating system and an opportunity for customers to post reviews for each individual purchase, either recommending it to other shoppers or not. Common language in these reviews are that ‘most aspects of mental illnesses remain taboo for the majority of our society’,[205] that there is a ‘stigma’ attached to mental illness,[206] and that the authors ‘open[] up about things that most of us hide’.[207] Various reviewers see the books as useful either for those suffering with mental illness or for those who know someone afflicted. Language used includes that the reader can ‘identify’[208] and ‘relate’[209] to what was being said,, that what was said ‘resonates’ with the reader,[210] that books provide a ‘mirror image’,[211] that the books ‘break[] down…barriers’,[212]  and that the reader was ‘not alone’ in his or her suffering[213] as the books deal with ‘sharing…experiences’.[214] However, there are bound to be critiques: One reader did not feel engaged by Brampton’s book.[215] Another criticism of Brampton was that she had private medical insurance as opposed to being treated on the NHS.[216] ‘Roger hedgehog’, meanwhile, states that Gask does not describe what depression is really like.[217] Moreover, one reader, Bevill, found Merritt’s book, with its emphasis on religion, difficult to relate to.[218] And while some reviewers found celebrities brave in their honesty others could not empathise with them.      

Small presses and Internet blogging 

There are also other presses that publish in the area of mental illness. One such house is Chipmunka Publishing, which is devoted solely to releasing books concerning mental illness either in paperback or hardback form or as e-books. The press has its own website[219] and was established by Jason Pegler who released his autobiography A Can of Madness, followed by the books Curing Madness and The Ultimate Guide to Well Being. The press publishes work from other countries as well as the United Kingdom and by people with a variety of mental illnesses so has a broader remit than this Dissertation. The press also does not restrict itself to publishing memoirs but also releases fiction, poetry, film scripts, plays, books of lyrics, anthologies, stories written by carers, self help books and academic works. The website reveals that as a whole: ‘At Chipmunkapublishing we raise awareness of mental health and the stigma surrounding mental health problems by encouraging society to listen…Chipmunkapublishing aims to break down the stigma surrounding mental illness once and for all’.[220] The website also highlights the importance of governments, health services, mental health organizations, charities and private businesses to publish and promote literature.[221] Pegler was winner of the 2005 New Statesman’s Young Social Entrepreneur of the Year Award and regularly appears on National BBC television and National radio as well as giving interviews in other countries, showing the importance of Chipmunka. Comments on Amazon.co.uk are varied but one reader states that he chose to buy the book A Can of Madness which details manic depression because Chipmunka Publishing is generally doing such wonderful work and this is the book that started it all off.[222]  

Another of these small presses is CreateSpace Independent Publishing Platform which also has a website.[223]  Distribution is from Amazon in paperback form or as Kindle e-books and also from the Create Space e-Store with books published to meet demand. Therefore, books remain permanently in-stock. Cover Creator is used where the author designs his or her own cover in full colour. There are autobiographical works by first-hand sufferers of mental illness, including by those in England and Wales, which challenge stigma and may get the reader to emphasize with the author.  

There is also e-publishing. Max J. Freeman’s Bipolar: A Breakdown has also recently been published as an e-book and is available from Amazon in Kindle version.[224] It is a 12,000 word piece detailing the seven days which Freeman spent in an asylum, framed by a prologue and an epilogue written later when Freeman had been released. Freeman begged to be admitted into a sanitarium having engaged in a couple of suicide attempts.[225] He tells us that the work was not originally intended for publication and in it he describes the ward where he spent time and the other inmates contained there and the staff, while in the midst of having a breakdown.[226] These other inmates are people for whom he finds compassion who are even more desperate than he.[227] 

Freeman’s work follows a stream of consciousness which lets the reader into his troubled mind. Stream of consciousness was a technique coined by William James in Principles of Psychology (1890) and used by modernist writers of the twentieth century like Virginia Woolf. Stream of consciousness is a flow of a person’s thoughts and feelings uninterrupted by dialogue or objective description, and is therefore highly subjective.   

Freeman’s view of the reader differs from that of other writers. In the prologue, Freeman writes that he is ‘certain that many readers will despise the person writing the piece’ and that ‘Much of what is contained within, is distasteful, and the person within this text…is neither likeable nor easy to empathise with’.[228] In the body of the piece, he remarks ‘If I’m going to write honestly, I’ll do it with the integrity that anyone who finds these papers will despise me as much as I despise myself’.[229] During the piece, he insults the reader and then apologizes for having done so: ‘It may seem to you that I have become hostile in tone, forgive me. Against you, as a reader, I hold no personal offence’.[230] Like other writers, Freeman writes of there being a connection between him and the reader who may also have a breakdown in the future. He sees there as being a ‘social contract’ between them where either they or someone they love will one day sit at the same table at which he is seated in an asylum.[231] He later writes: ‘we are people just like you. The only difference being, that it has gone wrong for us already, whilst it has not yet gone wrong for you…It may not yet have gone wrong for you, but statistically, it will, for one in four’.[232] He sees the readers as like ‘swans on a lake…serene and calm on the surface, but beneath the icy depths…paddling away…for all’ they ‘are worth. Trying to stay afloat’.[233] But here Freeman again becomes insulting writing: ‘I pity you in advance, in exchange for your reciprocal concern in the current moment. Do you give a fuck about me? Will I give a flying dogs arse about you?’[234]     

Despite Freeman’s assertion that he is not easy to empathise with, however, reader reactions, taken from Amazon.co.uk, indicate that they are finding in Freeman a kindred spirit. Amber Onat Gregory’ remarks that ‘For a piece that states it was never meant to be published as a reader you feel you are supposed to be reading this book’.[235] Sharman writes ‘If you are “bothered” when reading this I recommend that you try again and again and again, until you understand’.[236] ‘Peter gormer’ notes ‘If mental health has troubled you at some point in life read this you are not alone!!...If like Max & I you have traveled this tortured path you can relate to much of what the Author wrote’.[237] ‘Lul’ writes ‘It's a while since I've read this book. It has had a prfound {sic} effect on me. I also suffer from bipolar and could empathise with much of this... If you read it and have experience of bipolar, either as a sufferer or a supporter, you'll find yourself nodding along subconcsciously [sic] with the content’.[238] ‘Ms J Linney’ declares ‘Not a Pleasant read but Essential for anyone with, or interested in the reality of living with distressed mental health. Max deserves all credit for his honesty and bravery in disclosing such a traumatic event in his life’ and she signs off ‘True Empathy x’.[239] ‘Monkey spank’, meanwhile, says that ‘the reader is left with the uncomfortable feeling that any…of us, could, one day be in the same position’.[240] 

As recently as September 2016 another press, Trigger Press, was set up dedicated to mental health welfare.[241] Based in the United Kingdom, the press again aims to challenge the stigma attached to mental illness and show that help is available. To date, however, the non-electronic books that have been published are limited to recovery guides and a memoir on anorexia.  

We also live in the postmodern age of Internet blogging and bloggers can be people generally including those with mental illnesses. Various mental health charities, like Mind,[242] SANE,[243] and Time To Change,[244] in the United Kingdom, have set up blog sites. Bloggers with depression or bipolar have remarked in their blogs on the fact that they are using the written word to openly challenge stigma. The advantage of the blog over the book form is that one does not have to go to the time and trouble of finding a publisher to produce the work and also one can write a relatively short opinion piece. Any person with an Internet connection can participate. Meanwhile, there are some bloggers who have set up their own sites and who are Web producers and their blogs can be found via Google. Web 2.0 is a concept as opposed to an actual computer programme and involves this democratization of the media. This also means that one does not have to worry about having one’s work rejected or at best edited as is the case noted on some of the websites like Time To Change. On these blog sites, there is a space for readers to post comments. They need only fill in a form at the bottom of the post and many are in accord with what is being said.   

Diaries and letters

There is also autobiographical writing in the form of diaries and letters both in book form and in Internet blogging. The discussion here will not take into account diaries and letters which have not been published including not published on the Web. First, we turn to diaries. Writing diaries can, on the one hand, be a great healer. Without the diary form the sufferer would not remember each day and night and writing down one’s thoughts as they happen is a coping mechanism (see bipolarUK[245]). Indeed, thoughts stretch to the downright embarrassing. On the other hand, as with autobiographies, the writer of the diary challenges the stigma of mental illness and the reader may be able to emphasize with the writer and, as a result, cope with his or her own suffering.  

The Internet blog is appropriate for the diary form. There is not only the type of blog noted above where the blogger contributes one entry to a website like those of mental health charities but also the Web user who runs a blog can easily add entries on certain dates. The entries appear in chronological order, marked by date, with the most recent entry appearing at the top of the page and the reader can scroll up the screen to see all the entries. This form enables the blogger to easily keep a record of their feelings over time and for the reader to see the good and bad days of that person. Such diaries of depression and bipolar can not only be found on a multitude of US sites but also on United Kingdom ones including established ones such as the Creativity Works webpage.[246] 

Moreover, there is a long tradition of the epistolary novel where the fictional narrative is told through a series of letters, as opposed to by an omniscient narrator, and therefore from different points of view. This form was popularized by Samuel Richardson in the eighteenth century with the novels Pamela (1740) and Clarissa (1749) but actually originated much earlier. There are books of letters by those with different mental illnesses to those covered here and from other countries like the United States. But Hannah Todd’s edited collection Hello Me It’s You is a collection of letters by different people with different mental illnesses including depression.[247] The common denominator of these letters is that they are all written by young adults aged 17 to 24 to their 16 year old selves. Since some of these people are writing in their early 20s they have experienced mental illness in adulthood and the letters and the advice originate from fact and are in that sense autobiographical. If the people at 16 had the foresight of what their older selves have to say they would have had far more comfort, as in Haig’s book where there is a dialogue between ‘Now Me’ and ‘Then Me’. In her Introduction, Todd, who had been diagnosed with depression, states that she was ‘a little unnerved at the media’s portrayal of those with mental health issues’, which bore little resemblance to reality, that she was ‘comforted to find statistics from Mind, the UK mental health charity, stating that one in four people are affected by a mental health issue each year’ and that ‘Realising that’ she ‘wasn’t the only person who had gone through this and that there were even those who came out on the other side unscathed was help in itself’. She says the book can help ‘struggling people’ feel things do get better and this comes across in the Amazon reviews along with one reader saying that the letters help break the stigma of mental illness and another stating that one feels ‘empathy’ with the writers.  

The Law and Ethics 

The question of why such autobiographical writing matters to legal scholars is an important one. Firstly, various writers discuss their situation in relation to mental health law and it is these writings that will be focused on here. However, in order to gain a full picture of the predicament of those with mental illnesses one must go beyond black-letter law, as a set of rules, and this is something that autobiography enables us to do. Solely studying black-letter law is very restrictive. Many writers reveal that they were sent to the private psychiatric hospital The Priory but do not always invoke mental health law. 

Mark Stevens has written the book Broadmoor Revealed: Victorian Crime and the Lunatic Asylum,[248] which falls outside the remit of this Dissertation. Firstly, Stevens’ book falls outside our scope because it does not concern late twentieth/early twenty first century crime and incarceration. Secondly, contrary to our aim here, in the monograph Stevens provides biographies of various persons committed to Broadmoor as opposed to there being autobiographical writing detailing what it was like inside this lunatic asylum. Stevens does, however, detail the way that patient’s mental illnesses led them to crime and that they were viewed as insane. 

In his book Sectioned: A Life Interrupted,[249] John O’Donoghue not only tells us about his placement in various psychiatric hospitals and in prison and does not only tell us about the medication he was prescribed but he also provides us with his life story. He weaves in and out between telling us about his admission, and time, in hospital and other elements of his life. This involves, but is not restricted to, his relationship with his parents and his foster-parents. His father died when O’Donoghue was at an early age and his mother’s grief led to neglect so social services were called as O’Donoghue played truant from school.[250] O’Donoghue tells us about his mother’s death.[251] He also tells us about his romantic and sexual relationships.   

O’Donoghue’s book deals largely with his being sectioned pre-the 1983 Mental Health Act, though his book takes us through to the late 1980s. O’Donoghue states early on: ‘We’re “under section”, or else here voluntarily. The law defines us, limits us. But this doesn’t mean that because we’re removed from society, because we need “asylum”, we’re no longer human, that we’re not part of society. We are removed though, temporary outcasts’.[252] O’Donoghue reveals how there are long stays, of patients there for longer than a year who are transferred to different wards.[253] 

O’Donoghue reveals how he was classified as a manic depressive[254] and bipolar even though early on he says that he was not psychotic and was not hearing voices.[255] He reveals that he was put on pills and on Lithium which was intended to stabilize his moods and make him better.[256] He says that for years he had been battling forces outside his control and questions whether a drug would help.[257] He reveals that Lithium was quite effective at treating manic depressives and proceeds to list the other drugs he was put on following being sectioned and their side effects.[258] He remarks that Dr. Popper says ‘Let’s see if we can reduce the dosage, shall we?’ and questions ‘Why do they always say, “We”? I have no choice in the matter. I’ve been sectioned’.[259] Over the course of his life he is sectioned at a variety of hospitals. He also begins the autobiography by telling us that at the age of 16 he signed the consent to be given ECT (Electrical Charge Treatment), common in the autobiographies studied, and was given an injection to put him out so he would not feel the effects.  

O’Donoghue further describes the staff in the asylums. He says ‘It’s the nurses who act as buffers to the outside world, who stand between us and where we’ve come from…they’re here to do more than care for us: they’re also here to keep us locked up, to make sure we’re away from the world until we’re better’.[260] The nurses, who are relatively young, are from overseas,[261] and there are also doctors who come for the morning group therapy sessions.[262] 

But O’Donoghue goes further than describe how he was sectioned by law and given treatment. O’Donoghue also uses metaphors for his distress, saying of himself at one point: ‘I’m in the depths now, somewhere way out beyond the realms of melancholy and dejection. I feel like I have become an object, that I have turned to wood, that I’m mired in my own inertia’.[263] Here, he has also sunk to such a low level and in his case he is beyond simple melancholia. Later he remarks: ‘I started to get seriously depressed, as if I’d fallen into a big black hole. If I looked ahead there was only darkness. If I looked behind, darkness’.[264] He goes on to say: ‘I lay in my bed for three days. I didn’t care any more…I had ended up in this hell as a punishment’.[265] Therefore, there is mental and physical inertia coupled with a gulf of despair which is dark and hellish. We see how, like earlier, the experience can only be communicated by metaphor.  

We can also see O’Donoghue make comparisons between the mental asylum and the prison. He paints an ugly picture of the asylums where he was sectioned and given treatment. He says of one: ‘I look back, the main building looming over me like a great dark castle, barred windows high up on the walls, the wards settling down for suppertime in a medicated hull’.[266] What O’Donoghue is conjuring up is the idea of the sublime raised by the eighteenth century thinker Edmund Burke (with the looming great castle)[267] and this was an idea raised in prisoner autobiographies. Indeed, the asylum with its ‘barred windows’ resembles a prison fortress. However, O’Donaghue writes about the grounds in splendid light ‘as if’ he has ‘travelled to another planet’.[268] O’Donaghue, though, writes of being sent to prison, HMP Pentonville, of walking through the ‘bowels of the prison’ as though it is a living monster, and of the freedom allowed in a ward and with ‘silence and birdsong instead of the thunderclap of a thousand doors all clanging shut’.[269] 

In the quote where O’Donoghue reveals he is sectioned by law, he raises the idea of the inhuman which has been a feature of prisoner autobiographies where writers tell us about how they were made to wear prison garments which did not fit them, that they therefore lacked human shape, were viewed as animals and had to go to the toilet in the unsanitary conditions of the prison. [270] A contrast is therefore invited between prisons and mental asylums where the patients are not inhuman and with the latter pictured as nowhere near as degrading. 

In his autobiography Only When I Laugh, Paul Merton writes about having been hospitalized where he displays extreme paranoia.[271] He screams out of frustration and has to inform the nursing staff that he is not going to be violent. He writes: ‘Technically I could walk out of the building, but that’s likely to lead to me being sectioned under the Mental Health Act’.[272] He observes his ‘acceptance of the situation’[273] but says that at one point he ‘walk[s] up and down the ward corridor’ feeling ‘powerful’ yet ‘caged’ and ‘prowling’.[274] He feels ‘institutionalised’ and ‘lose[s] sight of normal behaviour’.[275]   

The autobiography of pop singer Adam Ant, Stand & Deliver,[276] is also of interest and Adam Ant draws on diary entries at various points. He describes his hypermania and depressive episodes which found him placed in a number of hospitals and in 1994 diagnosed with bipolar. He was admitted to the psychiatric ward at Cedar’s-Sinai hospital, but had been ‘scared’ to go there ‘in case they never let’ him ‘out’.[277] He was soon transferred to a private facility,[278] and was put on a course of medication which he continued when back at home.[279] In 1998 he slipped into a deep depression which led to him going into the Chelsea and Westminister hospital under the care of his psychiatrist.[280] In 2002 he was arrested but, after it was realized that he was ill, taken to the Royal Free Hospital, and he was then transferred to the Chelsea and Westminster after revealing that he had previously been admitted there. What Adam Ant has to say here about mental health law is important. He was told by his mother and close friends that he should go into hospital ‘voluntarily’ but that if necessary he would be ‘sectioned. In other words, with written permission from a relative or authority figure and two doctors’ he ‘could be forced into a psychiatric ward until fit to be released’.[281] His ‘interpretation of a section order’ was that he would be ‘imprisoned’,[282] and after running away to avoid this he was taken to a ‘secure ward’ at the Royal Free[283] where he remained for a couple of weeks before spending another fortnight at a private clinic.[284] He had been so furious at being put in a secure ward that he had initially refused medication from the doctors and nurses[285] so we can see how harm is done. Adam Ant tells us that after being found guilty of affray, in 2003 he ‘was sectioned under the Mental Health Act 1983’ where he ‘spent six months in hospital, and underwent various tests and numerous drug regimes and different therapies’.[286] He says that at first he was heavily sedated and that the first three months were especially difficult since the end of the section seemed a lifetime away.[287] He reveals that after three months inside, he was allowed one hour a day out of hospital under supervision, followed by a whole day out.[288] His language ‘After three months inside’ is like the expression prisoners use. So we see how patients react to mental health law.  

Frank Bruno writes that he had ‘never heard the term “sectioned” before’ but that he ‘heard it…just before the doors of the ambulance’ taking him to a private hospital ‘shut’.[289] He says ‘A voice was telling me they were taking me away under Section 2 of the Mental Health Act. Apparently, I was a danger to myself and others’.[290] He reveals that he felt ‘angry’ because he had no say in what was happening[291] and that he had to get out of the hospital but ‘the door was closed…and it might as well have been a prison’[292] where he was ‘pumped with drugs’.[293] He ‘felt abandoned and alone…fighting for’ his ‘freedom’[294] and is kept in hospital past the 28 days for which he was admitted.      

It is important to note then that one’s celebrity status does not mean that one will not be sectioned and that the reader can still identify with the writer. There is also an ethical issue at work here. Although a person can admit him or herself voluntarily there is a lock on the door of the hospital and therefore the threat of involuntarily admission for either assessment or treatment and the removal of one’s autonomy. At the same time as this coercion, however, it is good that a person can be restrained if they pose a danger to themselves as well as others.  

Hilary Coveney’s autobiographical writing Sectioned, published by CreateSpace,[295] falls outside the remit of this Dissertation since she reveals how she suffered from borderline personality order but it is important to note that there is information within which can be applied to those suffering from depression and bipolar. This includes the fact that the doctors decided to detain her for treatment on a section 3 rather than for assessment lasting 28 days on a section 2.[296] There is also important discussion where Coveney details the problems involved in getting a CTO (a Community Treatment Order), of the kind introduced into law as of 3 November 2008. These, made in writing by an RC (a Responsible Clinician) in consultation with an AMPH, last for 6 months, are renewable for 6 months and then for a year, and are where treatment can be provided without one continuing to be detained in hospital but with conditions, such as continuing with medication, attached and the point that one can be recalled to hospital. Coveney reveals that in order to be placed on a CTO her section would have to be renewed, that she could not be discharged on a CTO without the input of a community team, and that for this to happen she would need a GP in the city to which she was moving and that this was impossible until she was discharged.[297] Instead, Coveney was given an unconditional discharge by a tribunal[298] since her ‘solicitor had advised’ her ‘that the team would have to prove that’ her ‘mental disorder was of a nature or degree that meant’ she ‘had to stay in hospital to receive treatment’.[299] Section 72 s.2 specifies that the tribunal should discharge if it is not convinced that the patient is suffering from a nature or degree of mental disorder which warrants detention as well as detention not being justified in the interests of the patient’s own health or in protecting other persons while Section 72 s.3 adds to that stating that there should be discharge if appropriate medical treatment is not available in hospital. So this is important to the mental illnesses covered here. 

Again, there are ethical issues at play with CTOs and Discharge Tribunals. The operation of CTOs benefits hospitals where there are a shortage of beds and where lengthy stays are financially costly. But as long as patients are being sent back out to the community for medical reasons this is a positive step. One could argue that life in the community is of improved quality for the patients who may be reunited with their families, that the patient’s mental health may be improved outside of the imprisoning hospital environment and that there will be monitoring meaning that there would be reduced levels of substance misuse and swift identification of relapse of mental illness. There would be conditions attached to the CTO such as ensuring that the patients remain on the necessary medication for their illness, meaning that they are not a danger to themselves or others and that the patients must make themselves available for examination. What is not desirable is the notion of the ‘revolving door’ where patients continually find themselves back in hospital and so for illnesses like depression and bipolar, community workers must provide ongoing assistance. Meanwhile, those who have been sectioned are entitled to have the lawfulness of their detention decided speedily by a Tribunal.  

Conclusion 

In conclusion, types of autobiographical writing are important in raising awareness of mental illnesses, just as is Mental Health Awareness Week, and so the more that is written the better. These texts challenge the stigma surrounding mental illness and are of help to others suffering from like-illnesses. Many people in society suffer from mental illness and texts like these, often by celebrities, encourage people to ‘come-out’ as mentally ill and seek treatment for their illness. While, for instance, depression sees people isolated, types of autobiographical writing give the sense that sufferers are not alone. It is also key that those without mental illnesses understand the writers’ predicament. It has been important to look at more recent types of autobiographical writing to see the reaction of the writers to current mental health law. This Dissertation has concentrated on types of autobiographical writing in England and Wales but the scope could be widened to look at examples from the United States, which are numerous. Also, an area which remains to be studied is work on other mental illnesses such as schizophrenia. Furthermore, there is an abundance of fiction and poetry dealing with mental illness, which can be investigated. For example, a genre like science fiction deals with the alien ‘other’ which is appropriate for considering the issue.