Informal patient.

I was expecting to get Service User back today, but his doctor advised him to stay for the 'improv'...they want him for his musical skills. So we went round to the hospital coffee shop. As an informal patient he has the right to leave the locked doors of his ward and go for a walk.

Service User is now officially an informal patient heading towards discharge and today the devil turned up once more as a subject for conversation. Service User's 'diagnosis' seems to be 'religious paranoia' which is a description, and I've come to prefer it that way. From my point of view it is meaningless to describe someone as a schizophrenic, or bipolar because I'm sure his and everyone's transient chaos is an overwhelmed response to something. In short I remain unconvinced of a disease model.

The problem as I see it - the beliefs, emotions and actions - are a product of being overwhelmed.

In madness, frantic and exciting organizing beliefs appear like Valkyries or angels to protect a person from drowning in a sea of meaninglessness, or guilt and shame, or dark depression. Of course they also create a reality gap until that person moves from fixity to fluidity of thought.

I see the organizing belief in madness as a protective and a healthy process that manifests inverted or twisted around; then it has the potential to drag a person to suicide and worse. While it is easy to describe energetic phantasms as the cause, Viktor Frankl's experience illustrates the healthy version of this process, in which his protective belief was future oriented, not aimed at 'going back' or changing anything.

Nevertheless he was manifesting an irrational phantasm. Just as irrational as my son's talk of the devil. Chances were against the survival of Viktor Frankl, the probability of the gas chamber, of dying of cholera, of being beaten to death, or shot were far more realistic than ever getting to stand at the lecture podium.

I can't help wondering, if Frankl had moved from fixity to fluidity...would he have lived to tell the tale?

It is a peculiarity of man that he can only live by looking to the future—sub specie aeternitatis. And this is his salvation in the most difficult moments of his existence, although he sometimes has to force his mind to the task. I remember a personal experience. Almost in tears from pain (I had terrible sores on my feet from wearing torn shoes), I limped a few kilometers with our long column of men from the camp to our work site. Very cold, bitter winds struck us. I kept thinking of the endless little problems of our miserable life. What would there be to eat tonight? If a piece of sausage came as extra ration, should I exchange it for a piece of bread? Should I trade my last cigarette, which was left from a bonus I received a fortnight ago, for a bowl of soup? How could I get a piece of wire to replace the fragment which served as one of my shoelaces? Would I get to our work site in time to join my usual working party or would I have to join another, which might have a brutal foreman? What could I do to get on good terms with the Capo, who could help me to obtain work in camp instead of undertaking this horribly long daily march? I became disgusted with the state of affairs which compelled me, daily and hourly, to think of only such trivial things. I forced my thoughts to turn to another subject. Suddenly I saw myself standing on the platform of a well-lit, warm and pleasant lecture room. In front of me sat an attentive audience on comfortable upholstered seats. I was giving a lecture on the psychology of the concentration camp! All that oppressed me at that moment became objective, seen and described from the remote viewpoint of science. By this method I succeeded somehow in rising above the situation, above the sufferings of the moment, and I observed them as if they were already of the past.

Frankl, Viktor E. Man's Search For Meaning: The classic tribute to hope from the Holocaust (pp. 81-82). Ebury Publishing. Kindle Edition.