Having a breakdown? Try this pill, or that — or these? Built on the 1950s myth of a chemical imbalance in the brain, long since debunked, modern psychiatry still pours pills on trauma. While their general mechanisms are hypothesised, the specific consequences of different psychotropic drugs for individual brains remain haphazard. ‘We prescribe by side-effect, by trial and error,’ one consultant psychiatrist told me. ‘But I’ve seen all these drugs working,’.The problem is that pills alleviate symptoms of mental illness while doing nothing for causes.
Psychiatry’s dilemma mirrors that of Tom Tuplow, the hero of Jasper Gibson’s magnificent novel, a delightfully intelligent man from a broken home who took too much acid etc. Now anointed by Malamock, the Octopus God, whose voice he hears, Tom must choose between taking pills which will reduce him to a struggler on benefits, or eschewing them and serving Malamock, who offers clarity, purpose, self-worth — and potential catastrophe.
Similarly, psychiatry has grown prestigious and powerful on the Malamock-promises of drugs. Naturally, psychiatrists long to heal the sick, but can they now reduce their — and our — dependence on pills? While the number of people taking them multiplies, and mental hospitals overflow, evidence condemns polypharmacy, the prescribing of ever more drugs.
People who do not take antipsychotic medication have startlingly better long-term outcomes than those who do, according to a famous 20-year study by Professor Martin Harrow in Chicago. Tom is diagnosed schizophrenic. Treated with Open Dialogue, which favours talking therapies over medication, he would have a 74 per cent chance of being steady in two years, studies in Finland found, against 9 per cent in Britain.
Britain today is seen through filters of mental anguish by up to a quarter of the populace. Tom’s eye-level East Sussex, of Morrison’s and wheezing buses, is beautifully rendered and very funny. The bedraggled England here is as vivid as Jez Butterworth’s version in Jerusalem. Gibson is surely the playwright’s heir in vision and wit.
While laughing aloud at Tom’s sallies, you both wish he would take the trial drug he is offered and dread the consequences of an athlete’s foot medication which has been shown to silence voices (Gibson references an actual trial of an antibiotic used for acne on sufferers of schizophrenia). And you shake your head at the haplessness of a society mass-manufacturing distress, from anxiety to psychosis, and at the myopia of a system drugging symptoms while ignoring causes. For those you need psychological therapies, well beyond Tom’s means. Gibson elegantly traces Tom’s afflictions to their roots. As with much mental suffering, causes are no mystery.
Ken Kesey’s One Flew Over the Cuckoo’s Nest challenged conceptions of madness and treatment; ironically, it sharpened psychiatry’s determination to be taken seriously, to categorise and medicate trauma. But mass-medication is failing us all. Pre-pandemic, deprescribing was taking off. The Octopus Man points to a delicate third way between insanity and polypharmacy. You will be hooked, you will laugh and possibly cry. And you will know by page four that this hilarious and compassionate novel really matters