Ever since Maudsley denounced those who ‘hallucinated during waking hours’ as insane, psychiatry has directed an oppressive regime at the voice hearing schizophrenic. RD Laing is important because instead of using chemical, electrical and surgical ‘treatments’ he was able to see that outside influences on the schizophrenic could contribute  to and even cause their distress. Besides writing books that focussed on the patient and their circumstances rather than treatment, he was involved in therapeutic houses where patients could confront their illness rather than  suppress it. RD Laing’s approach to psychiatry is relevant as the government prepares to unload more of it’s drug casualties onto the overworked and under funded mental health service in the name of treating drug abuse and addiction as an illness by misdiagnosing them as schizophrenic, as drug related psychiatric symptoms are often indistinguishable from schizophrenia. But the drug users reputation for criminal behaviour follows them and adds to the stigma and prejudice the true schizophrenic already has to endure. RD Laing had more insight than the penny pinching blame culture that has exasperated the present psychiatric situation.

R D Laing used existentialism to map out his theory of schizophrenia. He studied Jean Paul Sarte and was especially impressed with
 We can see how laing  requisitioned and utilized existentialism. But I believe even his clarification of the often impenetrable writings of Sartre and other existentialist, unless you have the time to study these works, and schizophrenics in crises do not, calls for a simpler approach.

Alfred Wallis and Mr Armour, find the trigger find the cure
The psychosomatic approach.

Alfred Wallis, the painter, heard voices. He believed his voices resided in his chimney, so he would ask his friend Mr Armour to visit him and sweep his chimney with a brush tied to some chord.  Alfred Wallis had faith in this procedure, and was cured of the voices, for a few months, after which Mr Armour would repeat the procedure. In the New Testament Mathew tells us that a 'lunatick' was brought before Jesus. Jesus despaired at the crowd for not being able to cure the patient, but drove the evil spirits out of the boy into a heard of swine. So there is the theory of schizophrenia curable by psychological treatment. It may be that a patient by believing in something that science does not agree with can quieten the voices. Psychiatry will say that they are suffering from a delusion but the may be less of a problem than the health issues that anti-psychotic drugs bring.  Allowing a patient to believe that the voices come from an external source rather than their unconscious mind could be potentially very dangerous. If a patient continues to obey command voices then they sometimes go on to offend and commit serious crimes. So ideally any psychological intervention should take place where the patient has support. Support from health workers costs money. Relatives may have no time to look after a sick relative. 
What else happened before these anti-psychotic drugs were introduced? As, in Alfred Wallis’ case as an eccentric old man who suffered from ‘‘luzions’. People accepted those who heard voices as long as they were harmless. More awkward patients who were disruptive were confined to asylums where they would be given work in the hospital to take their mind off their symptoms. Was there much crime associated with schizophrenia before the introduction of these drugs? Ronnie Kray was one of the first patients to be prescribed these drugs. They didn't calm him down. Could it be that the increase in crime related to schizophrenia has escalated because voice hearing schizophrenics are now too scared to ask for help in case they are forced to take these drugs? There may be something in this psychological treatment but even if it is effective, nursing staff and therapists cost money that the government will not spend.  It is cheaper to drug people. Soon more patients will find themselves on the street. The church may be last resort for the homeless schizophrenic.

 The schizophrenic is in touch with his or her unconscious mind. He hears voices, sees things that are not there. He believes things that are not true, sometimes unshakably. When this happens psychiatry is their with anti-psychotic drugs and if the patient is non compliant, the syringe. 
I wondered what happened to these patients before the introduction of these drugs. The stereotypical patient who thinks he is Napoleon or some other character from history is a thing of the past.
But weren’t patients better off if they could believe a harmless delusion without the health issues that these drugs brought? Certainly they required more nursing in the asylums.
 But the promise of work and freedom were not fulfilled. Patients met with prejudice and employers shunned them, prejudice and ignorance prevailed. They  became revolving door patients.  The side effects of these drugs that affected their muscles and made them twitch and gurn, along with their shuffling institutionalized gait and weight gain marked them out as different. 
Arts therapy can reduce the distress of symptoms. The art room is a sanctuary away from the ward and the community and its atmosphere should be therapeutic in itself. 
Schizophrenic art inspired the Surrealists. The often untrained schizophrenic artists nevertheless mapped out their psyche drawing automatically in the same way that their hallucinations appeared unbidden directly from their  unconscious mind.

They could draw there symptoms. Surrealists learnt this method and using remembered dreams, and with their art training presented more accomplished pictures.

Reading schizophrenic art as a map or narrative of the unconscious mind using dream interpretation techniques.

Sometimes when we dream we recognize an event or an object that has inspired that dream. Often a late night television programme can trigger a nightmare. 
In the same way we should be able to ‘read’ the bizarre drawings, writing or speech of the schizophrenic.
Alfred Wallis believed that the voices were caused by the wireless. The arrival of the radio coincided with the first instances of his voices. He thought that they congregated in the chimney. That is a pretty standard schizophrenic scenario but the coping mechanism is unusual. Instead of advising him to visit a doctor who would have likely committed him to Truro asylum, his friend Mr Armour decided to humour him and they arrived at a practical solution. R D Laing took the same approach, allowing his patients to explore their illness instead of hastily suppressing symptoms with drugs.

 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 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 Prinzhorn’s 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 Heidelberg 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 under funded health service, charities or the street. It is a shame that the work of thee 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 misinformed 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. 

Cognitive therapy can be used to address and formulate coping strategies to deal with command hallucinations.
Patients should be able to come forward for cognitive therapy without fear of compulsory medication. This fear can condemn the voice hearing schizophrenic to remaining untreated, obeying their voices and becoming a danger to themselves and others. Some, a very few, go on to commit serious crimes. Medication may not stop the voices. A patient may be medication compliant yet still obey command voices because they have not had appropriate counseling, or follow up therapy. 
High profile offenders cause anxiety to the public, who misinformed by the media associate all schizophrenics with violence when the majority of sufferers are harmless. In the community the schizophrenics are often unemployed and more likely to socialize with alcoholics and drug users who are increasingly being treated as patients rather than criminals. Though this is better for the drug user who is after all a victim of drug use it has a devastating effect on the schizophrenic community when drug users sell drugs to the mentally ill. One estimate claims that as Many as 80% of schizophrenic patients in inner city Bristol are self medicating.
So it is important for schizophrenic patients to have counseling. 
If these episodes can be triggered by events and environment then changes in events and environment may help the patient cope with voices. The patient can no longer retreat to the asylum or easily obtain social housing let alone a move. There are less group homes and hostel places, the drug users have often infiltrated these and the psychiatric units. I don’t know how A and E is going to liaise with services that are not there anymore. What can A and E do? Call out the psychiatrist and a social worker. Transfer the patient to the psychiatric unit or secure unit. Or send the patient home with some tablets which they can take unsupervised and unmonitored, possibly washed down with super strength lager and or street drugs. With no day centre to give patients follow on care and perhaps no follow up visit from a social worker, the patient may be given an appointment with a psychiatrist, a waiting list and then more tablets and a referral to cognitive behavioural therapist again with a waiting list. How long is this grant supposed to be for? Will it pay for a duty psychiatric nurse in all A and E departments or will they like the resources for the mentally ill at King’s College A and E, opposite the now closed 24hour emergency clinic at the Maudsley over the road, never materialise. 
The crises resolution home treatment teams seem like a good idea. They could assess the situation where the patient lives. The patient may be suffering from abuse in the community. But what good is identifying needs if there are no day resources to offer follow on treatment? The government has been closing day hospitals, occupational therapy departments, and this year our local day centre. Not only did patients have somewhere where they could engage in therapeutic activities and have a midday meal, they could meet other patients and talk to staff about any problems they had.
By leaving patients in isolation in a community that still sees them as outsiders, the government has provoked the situation that it now recognises. Of course there was going to be an increase in patients at A and E, but the government should have been prepared for that. These patients are often left on medication without anyone to monitor them for the long term health effects these drugs bring. Without any day care they have no respite from their family situation (if their families have not abandoned them). 
There are promises of increased employment with the plans for early intervention for young people suffering from psychosis, but who is really going to employ the young mentally ill whose psychotic episodes have often been drug induced. The dual diagnoses patient faces stigma from society, while the pro drug lobby insist that the drugs that can cause psychosis, cannabis amphetamine and LSD, are harmless, because they see these psychiatric problems as a barrier to legalisation.The drug casualties deserve help just as much as anyone else, they are victims, but how much of this A and E budget will be directed at not only the alcohol related psychiatric crises but the drug casualties that the prison service wants treated as a medical instead of a criminal problem.
CoolTan Arts have shown that patients can organise their own resources and be awarded charity status. Another art group in South London is about to achieve charity status. This seems to be the only course of action as the government have no intention of reinstating day care facilities. Not everyone likes art but perhaps those who see value in the day centre will be able to organise drop in services for patients, like the Dragon Cafe also in South London. Churches and community centres may be willing to allow their premises to be used for a few hours a week when patients can meet, socialise and exchange information.