Alfred Wallis heard voices that told him not him to paint. The retired sailor shared his anxiety with his friend Mr Armour who ran a local antique shop. Alfred Wallis believed that the voices resided in the chimney of his house. He would ask Mr Armour to sweep the voices from his chimney. Without a comment Mr Armour brought a ladder, an old clock weight, a handful of straw, and a length of cord to Alfred Wallis. He climbed onto the roof and dropped the weight and the straw, tied to the cord, down the chimney. This reassured Alfred Wallis enough to stop the voices that he was hearing in his head and he was able to continue painting. Alfred Wallis was a devoted Christian who observed the Sabbath; the Bible was the only book he read.
Attitudes towards mental illness have changed over the centuries. In the New Testament Mathew tells us that Jesus despaired at the crowd’s inability to heal the mentally ill. We may not accept that ‘lunacy’ is caused by possession, and that we merely have to expel the demons into the nearest herd of swine, but it still implies that a drug free coping mechanism or strategy might be effective against the voices that can distrupt the lives of schizophrenics.  
Up to the 16th century the mentally ill were free to wander. After the Great Plague people started to notice the wandering madmen, who were sometimes called Bedlamites. People became distrustful; this was an era when people believed in witchcraft. The government started to build mad house and lock the mentally ill away, mistreating them badly. 
In the 17th century William Tuke, a Quaker, started the York retreat, informed by the ‘moral treatment’ model that American Quakers were already using at their Pennsylvania asylum. The ‘moral treatment’ meant that patients were treated with kindness and respect, and found work in the asylums that were self sufficient. Those that were too ill to work were found suitable pastimes.
William Tuke’s grandson Samuel  Tuke, a Quaker decided to do something about conditions at the neighbouring York asylum and in 1814, with forty supporters turned up at a governer’s meeting at York asylum and having paid their dues exercised their right to inspect the hospital. What they found disgusted them and they took over the asylum. 
The ‘moral treatment’ seemed to help. When Charles Dickens visited Hanwell asylum, and the South Boston State Hospital, both run on the ‘moral treatment’ model he was impressed with the good behaviour of the patients. Then along came Henry Maudsley. His sexist views are well known, but he also put about the rumour that ‘only savage and barbarous people hallucinated during waking hours, a remark that had racist overtones and a disastrous effect on the schizophrenic community. In fact schizophrenia had not been named; voice hearing patients were diagnosed as suffering from Dementia Praecox or one of the manias. Maudsley was an atheist who thought that mental illness was hereditary and probably incurable. The Victorians preferred this more pessimistic attitude and built larger asylums. The possibility that they saw an opportunity for social control cannot be dismissed. Some hospitals kept to the moral model and in  in the 1920’s one such hospital that served South London, patients seldom needed sedating.
In the 1950’s new drugs were developed. These drugs, it was claimed, would free the patients from the asylums. For some they had an anti psychotic action, but these drugs also affected the central nervous system causing movement disorders. Combined with their sedative affect they bludgeoned the patients into passivity. Besides causing unpleasant side effects, these drugs have been found to cause long term health problems. 
The promises of employment were not fulfilled. The criminally insane were allowed into the community for the first time in the sixties but though this was justified in many cases it affected the public’s perception of the mentally ill in general. The mental health budget was spent on maintaining existing beds and as a result the patients often needed to return to the hospitals. At the end of the millennium the budget for the care in the community programme was increased but the emphasis was on medication compliance and the supposed conformity it brings. 
In Scotland patients had been living in the community with their families or in houses with a guardian since Victorian times. When this idea was presented to the Commissioners of lunacy in England it was rejected, while half of the Scottish mentally ill patients were ‘boarded out’ in the community, without sedation. 
Looking at these supposed savage and barbarous people that Maudsley referred to, and we can be quite sure he would have included African and Indian people in this description we find that their attitude towards the mentally ill was perhaps still is less savage and barbarous than that in England. We do not have to resort to religious faith to reassess our attitude towards schizophrenia. In a conference report published by Her Majesty’s Stationary Office in 1992 Julian Leff shares some interesting insights regarding schizophrenia. In his article Julian Leff examines the results of the World Health Organisation International Pilot Study of Schizophrenia. He noticed that patients in  Agra in India and in Ibadan in Nigeria stood out. 
Half the patients who suffered a schizophrenic episode recovered and did not have another illness in two years. A follow up survey found the same pattern. Leff goes on to ask why patients in Third World countries have a better outcome even though the majority do not have long term follow up medication. The worst outcome was in Denmark which also has the best community care in all the Western countries, community care that focuses on medication compliance. Leff then goes on to ask if the attitude of relatives could have something to do with the difference in outcomes. In the West, families traditionally abandon their mentally ill relatives, to th hospitals or to community care.  In rural India there are larger extended families who offer each other support whereas in the West the model is not just likely to be the smaller nuclear family but more often the middle aged schizophrenic is looked after by an elderly parent, and that this situation would not, due to a loyalty to family ties, be allowed to exist.
There is also a difference in attitude toward mental illness. Though Leff claims that in the third world the mentally ill are not expected to contribute so much; in a rural community work is found for patients so they can contribute to society. In contrast the West drugs its patient, often out of an irrational fear of the mentally ill, then criticises them for being lazy when they cannot find conventional employment, causing more stress and exasperating the illness. The opportunity for therapeutic work has diminished with the closure of day centres, day hospitals and occupational therapy units. He then adds that employing a network of mental health workers is expensive but less expensive than hospitalising patients.
The N.I.C.E. guidelines say that art therapy can reduce symptoms of schizophrenia and this endorses my opening statement regarding Alfred Wallis. Often patients can explore their inner landscapes and find the calm they need to cope with their problems. But I decided to take a more autobiographical approach to my drawing and writing, but soon found myself recording the experience of others. This not only gave me time to forget what was worrying me; often anxieties were put into perspective or even forgotten as I recorded the events I had seen and remembered. I found that I could learn from other patient’s experience. I wondered if this would be useful in helping people accept the differences between people instead of trying to enforce the conformity that seems to be the present goal of psychiatry.
The public need re-educating. Instead of calling the police when they see someone behaving a bit strangely, perhaps replying to their voices they should just accept the fact, or if they must react, ask if they are alright if they look unhappy. They need to be made aware of the creative possibilities the schizophrenics otherness brings. Artists strive to access there unconscious mind. For the schizophrenic the barrier that the subconscious puts between the conscious and unconscious mind allows the unconscious to manifest to the conscious, often to the distress of the patient. 
The Surrealists took inspiration from the mentally ill. Andre Breton and Max Ernst (now a Surrealist), encouraged other Surrealists to study the work of mentally ill artists. Andre Breton, the leader of the Surrealists worked in the psychiatric wards during World War 1. Breton and other surrealists were impressed by Dr Hans Prinzhorns book ‘The Artistry of the Mentally Ill', which was brought to their attention by Max Ernst, in 1922. Prinzhorn’s book is illustrated, with pictures by patients from the collection at Heidleberg psychiatric hospital, now renamed the Prinzhorn Collection. Similar examples of schizophrenic art can be seen in the Bethlem collection. Breton acknowledged the imagination of the mentally ill as an inspiration to surrealism. In his ‘First Manifesto of Surrealism’, Breton said he could spend a lifetime ’prying loose the secrets of the insane’. He goes on to describe the insane,’ These people are honest to a fault and their naiveté has no peer but my own‘.
Instead of dismissing the symptoms of schizophrenia as meaningless, like Henry Maudsley, R. D. Laing like the Surrealists, saw value in the schizophrenic and was taking the process one step further in interpreting their speech and actions.

It may be that the disturbed patient who is a danger to themselves or others may need sedative drugs to calm them. But their illness needs to be understood and needs practical day care, if only a drop in where they can meet once or twice a week. But they also need to be accepted by society that has done little more than abandon the mentally ill to an underfunded health service, charities or the street. It is a shame that the work of the the Tukes with their moral treatment, and others is forgotten in favour of treatment that merely enforces a charade of conformity that seems to be more concerned with reassuring a mis-informed public than the welfare of the patient. It may be better for patients to learn to cope with symptoms without or with a minimum of medication, and avoid or at least reduce the accompanying unacceptable health issues and side effects, at least between episodes, or while waiting for an episode that may not occur.