How do you view the psychiatric phenomenon of psychosis? Is psychosis the quintessential stereotype of madness – people so badly affected by a mental illness that they live only in the world of apparent make-believe, where they talk to imaginary friends, view ‘real’ people with morbid suspicion, and worry that the pair of curtains that adorn the window are symbolic of communication from alien races?

If anything, it’s an idea that has been almost romanticised by fiction and the film industry – but if you’re reading this, then the chances are you know that it’s bollocks. All those things can be true of someone suffering from a psychotic episode, but the idea that it is a permanent state that routinely requires a strait jacket and a padded cell is as outdated as it is offensive.

Theories of Psychosis

Current academic discourse on psychosis (and all mental disorders) is divided. Those of you that know me will have seen me harping on the term ‘biopsychosocial’ far too often; in other words, it is my view that mental health difficulties are caused by a combination of factors including personal biochemistry, individual psychology and environmental and social factors. There is, of course, a significant branch of commentators that disagree – sometimes vehemently – with this view.

My therapist is one such person. He views all mental illness as a direct consequence of trauma, and he won’t be persuaded to even consider the alternative(s). That’s one thing that I can barely stand about the vocal sect of the anti-psychiatry lobby; regardless of the validity of their assertions, it seems like folly to me to so vociferously and doggedly oppose differing views (they shout about having agency and freedom – something psychiatrists allegedly take away – yet they take vicious offence at people using their…er…freedom to disagree). But I’m digressing from my point. Sorry.

Anyway, yes – my therapist holds to the trauma model. His theory of psychosis, apparently an idea originally postulated by everyone’s favourite psychotherapeutic godfather, Sigmund Freud, is that experiencing a hallucination or a delusion is an entirely logical reaction to (a) highly distressing life event(s), due to the splitting of the ego or some such (hey, give me a break – I’m at best an armchair psychologist. Reading Freud’s turgid prose is not high on my priority list right now). The idea runs that it is easier to face a(n objectively) fake ‘monster’ than it is to face the real one.

As an example, imagine that you were horribly abused as a child. If you then went on to experience psychosis, my shrink would opine that the reason for this is that you have not fully processed the terrifying events of your childhood, and that your mind is bloody scared to do so. Thus it dissociates the horrors involved, and projects them into a vision, voice, belief, whatever, that is not part of other people’s consciousness. It may be nasty, but it’s easier.

Do you follow? I, personally, get his point, and think it could certainly be true in many cases, but – and I don’t have statistics to hand, and can’t be arsed to search for them – I find it very difficult to accept the idea that everyone who has developed schizophrenia and other forms of psychotic disorder has a traumatic history.

Lovecraftians on Madness

But to hell with my view, and my ramblings thereon. What does H P Lovecraft think?

Well, H P Lovecraft doesn’t think – H P Lovecraft is dead – but you know what I mean. H P Lovecraft certainly thought – a lot. He, in my view influentially, talked a lot about madness in his work; most readers of this blog – and many people beyond mere cult circles – will have heard of the infamous Arkham Asylum, for example (though perhaps that is partly attributable to the fact that the hospital, if it can be so called, lent its name to the Joker’s home in the Batman canon). If you follow me on Twitter, you might see that I claim to live there 😉

Further, it wasn’t just Lovecraft himself, but virtually everyone influenced by his writing, that dabbled at least to a degree in explorations of mental illness: later Cthulhu Mythos artisans employed the subject as plot devices on a frequent basis. One of my favourite such things was a role-playing game (unoriginally) titled Call of Cthulhu, in which players were afforded ‘sanity points’ (as well as the typical ‘hit points’ and so on common in the role-playing genre). Another was Call of Cthulhu: Dark Corners of the Earth (one of the best, most immersive video games I’ve ever come across, though it’s based on The Shadow Over Innsmouth rather that its titular story), though of course it’s far from just gaming in which this this issue is reflected (there’s plenty of fiction and whatnot out there too).

So, what has this got to do with above ruminations on psychosis?

Examples
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***SPOILERS***

To exemplify the theme of psychosis using the aforementioned RPG, seeing the horrors of the creatures that Lovecraft and his followers created could (would) cause one’s character to lose sanity points. Getting too low on them renders you a drooling wreck, much like the image described in the opening paragraph of this article, and sees you on your merry way to the big bin on the hill (which will inevitably have a vicious storm with vicious lightning and vicious rain hovering ominously above it. All psychiatric units have their own micro-climates, don’t you know?).

In Dark Corners of the Earth, the protagonist Jack also has sanity points – should he go low on these, he’ll hallucinate or dissociate. If the character loses his sanity points entirely, either his mental health becomes permanently compromised, or he kills himself (causing, appropriately enough, a game over screen). All this is because of the horrors he hears of and witnesses in Innsmouth, a dark, unnatural, oppressive town that sends shudders down my own spine just by thinking about it.

To examine Lovecraft’s own work, ‘insanity’ of some description or another crops up in many of the stories, and one thing that is frequently the case is that a character’s supposed psychosis is, in fact, possession by one of the dark deities in the universe (or being otherwise part of them. Don’t forget that this is horror fiction). For the purposes of this post, I’m trying to look specifically at any trauma-psychosis correlation in the author’s work, but I might have a look at other themes in a future post. Anyway, in the story of which this blog is eponymous, the narrator’s companion – after seeing some unspecified horror, presumed (by me at least) to be some sort of Shoggoth – has his already-precarious sanity crumble entirely.

A particularly interesting example is that of The Rats in the Walls, in which the main character is institutionalised, despite his steadfast protestations that he is actually entirely mentally sound. Of course, many (most?) people suffering from psychosis are completely unaware that their perceptions are not ‘real’, so in that respect the tale feels realistic. There is a certain amount of dramatic irony in the narrative, because the reader can see the protagonist’s sanity becoming severely compromised as he learns of his family’s hideous history, lending credence to the trauma hypothesis of madness. This character continues to feel the presence of the rats of the title whilst institutionalised, suggesting that he is indeed clinically deranged, rather than the genuine victim of a direct attack from a Great Old One.

Psychosis or Dissociation?

Clearly, in the case of The Rats in the Walls, the character is hallucinating, so we can reasonably assume that he has had a psychotic break. However, in the case of The Statement of Randolph Carter, when we are introduced to Carter, he is found wandering aimlessly, apparently suffering from (temporary) retrograde amnesia. Upon recovering his memories, Carter explains the highly traumatic events that apparently precipitated his amnesia. Therefore, dissociation seems to be his primary complaint.

***END SPOILERS***

As observed, I believe that neurons and cerebral chemicals and yadda yadda yadda can be responsible for hallucinations, delusions and thought disorder. However, don’t forget the ‘social’ part of the term ‘biopsychosocial’; a link between trauma and madness (if we are allowed to call it that in this day and age) has been clearly demonstrated in some cases. As such, all socially-induced psychoses are inherently dissociative (in the sense that my therapist describes: part of your mind splits off into ‘fantasy’ in order to hide or more easily cope with abhorrent realities). In that regard, when applied to Lovecraft’s writings at least, the distinction between psychosis and dissociation is academic. The premise is simple: the dark secrets that his characters learn, and the dark beings that they see, drive them into mental illness.

Accuracy

As with anything in life, the experience of each individual who has experienced psychosis will vary wildly. One thing I’ve learnt over the past few years, though, is that traditional concepts of mental disorder – such as those I discussed in the opening paragraphs – are mostly sensationalist crap. The idea that when someone falls into an abyss of thought disorder and reality distortion that the state will be permanent is really not that often the case. Schizophrenia and all the other types of psychotic illnesses are usually manageable with medication and/or therapy. Life-long inpatients exist, but to a vastly smaller degree than in the past.

In that sense, Lovecraftian portrayals of mental health problems feel wholly inaccurate; in another lifetime, his characters could have recovered from their maladies, or at least have been given tools to stabilise them. Three issues strike me, however. One is that, rare as it is, there are still some mental health service users who will never be cured or be able to manage their conditions. Some of these people can survive in the community with appropriate support, but some cannot, and will therefore spend at least a large portion of their days being cared for as in- or day patients. Whether or not they exist in permanent states of psychosis is something of which I know nothing, but in a world with seven billion people, anything’s possible. Secondly, although those of us who’ve been immersed in the system will know it to be a fallacy, the populist impression – sadly – of mental illness is more accurately portrayed by the one presented by Lovecraft than the one that you’ll see at your local CMHT. In this way, he has eloquently captured a generations-long sense of schadenfreude surrounding mental health that is still alive today.

Thirdly, and to my mind most importantly, let’s not forget when Lovecraft was writing. Contemporarily speaking, his depictions of psychosis and/or dissociation and/or madness at large were accurate. This was the age before anti-psychotics and even (during most of his active years) lobotomies. It was a time where psychotherapy was an opportunity of which only the privileged or those consenting to affiliated research could avail.

So, what did society do with its mentally atypical members? That’s right: it put them into institutions, often on a long-term basis. And since the methods of condition-management referred to in the last-but-one paragraph were unavailable in such establishments, and moreover since asylums were generally convenient dumping grounds rather than hospitals, how could a person ever have a realistic hope of recovering his or her sanity? To that end, in a practical, very real sense, their disturbance would most likely be permanent (or at least enduring) and intense.

An Early Traumatologist

Is it reasonable to see an unwtting Lovecraft as such? I can see why the notion is utterly ridiculous; the man was a writer of misanthropic horror fiction, and whilst he wrote of madness frequently, it’s probably fair to assume that he didn’t sit down and frame his discourse on the topic from the position of a psychological scholar. Perhaps he would have agreed with me that there are maybe many causes of mental illness, and what catalyses it in one person will probably to its impetus in another.

I’ve heard it said – and I’m sure the stories mention it themselves at some points – that all it took to drive a character into all-consuming lunacy was to catch a mere glimpse of one of the creatures of the Mythos (personally I’ve found depictions of them quite appealing ((read: cute)) to look upon, but I don’t suppose I’d be saying that if I witnessed one in the flesh, slime or material unknown). These are beings so bizarre and horrifying that the abject terror they instil upon a human witness is scarcely imaginable.

Yet the trauma comes from more than just that; it derives also from the sheer futility of the human race and its home planet, as discussed so nilhilistically throughout the Mythos. To Cthulhu and chums, the existence or otherwise of our race is a matter of total irrelevance, so infintessimal is our power relative to theirs. This flies right in the face of every way in which humanity has ever understood itself. As one commentator aptly put it:

[P]art of what drives Lovecraft’s characters insane is the realisation…not only [of] the falsity of everything their [sic] believed to be true[,] but also the truth of many things they assumed to be false. Their insanity is the product of their emotional and philosophical investment in the existence of a hard line between truth and falsity.

Your entire understanding of yourself and everything you’ve ever perceived has been shattered instantly in the most petrifying of ways. Who could remain sane after that? Psychosis, just as my therapist might say, is surely a preferable alternative.

Conclusion

Whether wittingly or otherwise, Lovecraft’s material without doubt demonstrated a link between between psychological injury and a dramatic deterioration in mental health. Yes, it was fiction, and yes, he wouldn’t have been the first to do so – wasn’t that our old friend Freud? I could be wrong – but I’m willing to bet that he was probably the most intense of raconteurs in the area.

His stories were just that: stories. Yet if we spin the old trick of literature academics across the world and look at the works through a self-referential and retrospective lens, we can see metaphors there (there are none, of course. Apparently J R R Tolkien hated it when people read Lord of the Rings as an allegory for something or other, because it was only ever intended to be a story. I’m sure the same was true of Lovecraft, but for the sake of argument, bear with me). To the best of our knowledge – moreover, to the best of the knowledge of science – creatures of the like seen in the Cthulhu Mythos do not exist (debate about the source of the bloop notwithstanding). However, horrors do exist. We all experience our own to some extent – the loss of a loved one, the discovery that your partner is cheating on you, the dropping of your iPhone down the toilet – but everything is measured in matters of degree. If you’ve survived life-threatening situations, if you’ve been tortuously abused, if you’ve been a prisoner of war: these things are horrors on a severe scale, just as the particulars of many an H P Lovecraft tale were. You could say that the man was describing PTSD before the diagnosis behind such an acronym had even been conceived (don’t mention hysteria, please. An individual’s reproductive organs do not reflect their likelihood to be traumatised by something).

Whilst a flawed examination of madness by modern standards, Lovecraft’s fiction was a fine and engaging analysis of its experience and its causes at the time of publication. Even if he verged a little closely to overplayed stereotypes, at least he acknowledged through his characters that the attitude of the likes of Bedlam (now, as Bethlem Hospital, a very nice place, I’m told) – namely, that mentally unwell people were ‘crazy’ ‘things’ to be tortured or simply ignored, a taboo that no one talked about – was deeply misguided and hideous. Did he say that outright? As far as I know, he certainly didn’t – but he did offer potential reasons for the ‘craziness’, and with reason comes debate.

Fair is foul, and foul is fair, Shakespeare once said. In the same spirit – and quite unintentionally, perhaps – H P Lovecraft ultimately demonstrated that (whilst mental illness can have many causes), psychotic breaks under severe psychological stress are normal. What society terms ‘sanity’ would, in the context of the chilling, crippling adversity of the likes seen in Lovecraft’s tales, and too-frequently in real life, be the more insane response.

Photo credits: see outgoing links.