Kate Richards, Madness: A Memoir, Viking, Melbourne, 2013.

Had I read Madness: A Memoir? someone asked me. I had to confess I had not even though I had seen that the author, Kate Richards, had presented at the Bendigo Writers Festival in August this year. It’s good writing, I was told. So at the first opportunity I schlepped off to the local bookshop to buy a copy. The bookseller similarly provided her endorsement. This is good stuff; the author is impressive and so on. I have not been disappointed. I read it at one sitting, more or less, on the train from Bendigo to Melbourne and back one day.

Kate Richards is a trained doctor. She suffers from what is generally referred to as a Mental Illness. Without medication the illness can take over her entire life and mind. She will live in a state of severe mental distress, believing the world created by her delusions to be real. At these times she is unable to summon enough mental strength to meet the personages inhabiting her mind and directing her thoughts. One of these two personages are benevolent. Kate calls them Henry and Rose. The others are cruel. Kate names them and explains:

“The Cold Ones are severe. Unrelenting. Psychopathic in their gleeful execution of pain. They are clever. The sneer, undermine, are disdainful. They prefer to whisper – criticisms and threats. They are featureless, blankfaced. They do not blink or flinch. They like shadow.

The Savage Ones are fire and brute force. They roar in the imperative.

you bitch. do this this

The Cold Ones nod

she’s scared now.

They titter and whisper and slither in the shadows.

KILL HER

The Savage Ones like rape. They’re not averse to fights, assault, blood, death. They find it funny. They make me dream it. They like to hear things crack and wrench. Red eyes, Red skin. Heat. Sweat.

Then there are the Cruel Ones – fond of knives and teeth.

touch us you die.

They’re always moving, they don’t sleep. The Cruel Ones and the Savage Ones gang up. Hilarious to bind hands and eyes, to dart about, to whisper, to kick where there is tenderness, to snicker where there is pain. To shout obscenities, entice nightmares, scream (shrilly); lose all sense of light and dark.

you are rotting bitch rotting we are gutting you like a fish

They are gleeful.

don’t move don’t breathe don’t fucking breathe suffocate there is force in circumstance BITCH stab yourself you’re a fucking animal we’re watching you bleed where’s the red we’re gonna kill you I singsong, lilting) do you deserve this

Yes”.                                               (Madness: a Memoir, pages 27-28)

Medication and ECT help muffle them – well enough for Kate to be able to hold a job as a medical writer, but not enough for her to be able to live in the world as a normal young woman with friends, a social life and a future before her. At the beginning of Kate’s memoir she sustains herself on a diet of coffee, alcohol, chocolate – and books. But is is a matter of finding the right medication – the combination that works for her – as well as the therapist that will guide her through. As she progresses she manages to find help and eventually come to terms with her illness. She slowly accepts  she will be taking medication for the rest of her life. Her diet improves. She learns a language – Hebrew – and travels overseas alone – to New York and to the Middle East.

It soon becomes clear that the ‘Helping System’ – psychiatrists and doctors is inconsistent and difficult to deal with. A psychiatrist overprescribes, another ‘sacks’ her for non compliance with treatment – without comprehending Kate’s difficulty recognising, let alone accepting her condition is part of the whole story. Stunningly, when Kate, in the midst of her illness burns herself with acid,and seeks surgical intervention, she is refused treatment by a Registrar, no less, because he considers it a waste of resources because her wounds are ‘self inflicted.’ As if he, or was it she? had the authority to make this decision. As Kate noted in her subsequent formal complaint her burns were a result of her serious mental illness.

There are good people. There are Kate’s friends, several good nurses and her GP, Jenny. Then there is Winsome Thomas, the psychologist and therapist who treated Kate on a weekly basis for some years. In scenes reminiscent of the encounters between the patient, Deborah and Frieda Fromm Reichmann in Hannah Green’s account of mental illness and its treatment in  ‘I Never Promised You a Rose Garden’ Winsome Thomas’s clarity and ability to stay with Kate at the worst moments of her illness, to reach and meet Kate’s demons and walk beside her helps Kate gradually  to accept her illness and its place in her life. It is about integrating an unpalatable fact, of realizing that this acceptance ultimately diminishes its power.

In these days where the evidence base counts for much – including the way the mental health dollar is spent – Kate Richard’s memoir shows the sheer humanness  that severe mental distress evokes in the patient as well as her treaters – the psychiatrists, social workers, psychologists and nurses.  It affects families and workplaces; treating professionals and the institutions in which patients and treaters reside. Kate’s is not just a plea for understanding but also for the recognition of the complexity of mental illness  that increased expenditure and thought in the mental health field might address. In his memoir the South Australian psychiatrist Andrew Dibden wrote of the relief to people suffering extreme mental distress that came with the development of psychotrophic drugs and ECT from the late 1930s onwards. People were able to get up and walk, to leave institutions that had housed them for many years and to begin to participate in the world beyond its walls. Kate’s memoir shows that there are still many question to be answered.

Also written for the Australian Women Writers Review Challenge 2013.