They F*** You Up extract
Chapter One
Our Genes
They fuck you up, your mum and dad.
On New Year’s Eve 1980, a young American called John Hinckley made an audiotape of himself singing one of John Lennon’s songs, ‘Oh Yoko’. Hinckley gradually gets drunker and more melancholic as the new year approaches until, filled with sadness, he begins to strum his guitar, plaintively, with the familiar opening chords of the song. ‘In the middle of the night,’ he sings, ‘in the middle of the night I call your name.’ So far so good, sung pretty tunefully, but then comes a shock. Instead of the chorus ‘Oh Yoko, Oh Yoko’, he changes the words to ‘Oh Jodie, Oh Jodie’, referring to the actress Jodie Foster.
Hinckley had developed an elaborate fantasy that he was courting Foster. As he became more delusional, he devised a scheme by which he hoped to prove his worthiness of her love: he would shoot President Reagan. On 30 March 1981 he did so and, after a lengthy court case, was judged to have been suffering from schizophrenia and sent to a secure mental hospital for treatment.
In 1985, his parents published an account of their life with their son, setting up a charity to help other parents with children who have the same illness. They believe that it was caused by his genes, that his pathology was marked out in DNA from the moment of conception. But are they right?
Presented with such a question, clever people usually answer, ‘It’s not nature versus nurture, it’s a bit of both’, but even clever people can be wrong. In this case they are very wrong indeed. The truth about what makes us different from each other is that only very occasionally is it a case of ‘entirely or largely genes’; mostly it is ‘largely environment’; and only in a small minority of the psychological characteristics commonly found in us is it genuinely ‘a bit of both’, a fifty-fifty split between nature and nurture.
The problem with any nature-versus-nature debate is that we all bring to it a great deal of personal baggage, making it hard not to ignore uncomfortable evidence and not to exaggerate that which supports our prejudices. Although most people say it is the combination that explains us, not very deep down, perhaps after a few glasses of wine, a heartfelt preference for one or the other is soon encountered. Not surprisingly, this is because we are attracted to the theories which support the story we tell ourselves to keep our illusions rose-tinted.
For example, when mothers are asked what makes children tick they plump for theories that help them feel they are doing the right thing. Those who work full-time tend to believe that small children are resilient little things, capable of coping with what life throws at them, with no need for constant personal attention. They may feel that their toddler will actually benefit from being cared for by others when they are at work, and consequently be unworried about leaving him or her. So long as their child’s basic needs are met, its genetic uniqueness will flourish. These beliefs are wholly reasonable, bolstering what will make the mother feel most comfortable with her arrangements. By contrast, when full-time mothers who have stayed at home are asked this question they tend to express the opposite view. Their infants need constant one-to-one care from their biological mother, and without it they will be damaged. These mothers are much more anxious about leaving their children with someone else, regarding them as fragile and in need of high-quality nurture. They place far more emphasis on mothering than on genes, and, again, these beliefs merge seamlessly with their choice to stay at home.
If either group reads evidence that contradicts their position, it threatens to prick the bubble of their illusions. The same goes for all of us on innumerable topics. For example, when the publics of several developed nations were surveyed, homophobes tended to see homosexuality as a choice and the result of upbringing, whereas homosexuals and their supporters saw it as a genetically inherited preference. Believing in genes removes any possibility of ‘blame’ falling on parents. It becomes an unchangeable, natural destiny, not a choice that homophobes could portray as an illness which might be treated with therapies.
What we feel about the nature—nurture debate is likely to knit up with our political beliefs. As long ago as 1949, a survey showed that politically right-wing people tended to see genes as critical whereas those on the left favoured the environment, and this appears to be true today. The right will tend to argue that the hierarchies of society reflect genetically given talents, so that the rich are there because they have better genes, the poor are poor because they come from less good genetic stock. Likewise, women should be at home caring for children because genetic evolution has equipped their sex better for this role. For the left, these things are seen as the effect of society, something that can be changed; whereas the right wants to uphold the status quo, so genetic theories keep their bubble of illusions intact.
Welcome to my bubble
It makes no sense at all for us to emerge from the womb predetermined to react to our particular bit of the world with specific personalities or talents or mental illnesses. It would be far more logical, in evolutionary terms, to be born flexible, wide open to the influence of parents and upbringing, because each family setting, each social class and each society requires a different response in order for the individual to thrive. The child must attract the interest and love of its parents, and genes could not anticipate the precise traits best suited for achieving this any more than they could prefigure the particular demands of class and culture — demands that can rapidly change, as the social trends of the last fifty years illustrate.
To make an analogy with card games such as bridge or poker, knowledge of what a playing card is, the rules of the game and the hierarchy of different hands would be our species-wide inheritance. This knowledge is essential in order to be able to play — akin to all of us starting life with a range of emotions, like humour or sadness, and with basic mental equipment, like the potential for thought and speech. But just as it would be unhelpful for us to have preordained responses to our parents and siblings laid down genetically, with particular thoughts and feelings (like a love of opera or a habit of interrupting conversations) already prescribed before we have even met our family, so it is with our response to particular card hands. In order to make the best of the hand we are dealt, we need to be highly adaptable to signals from other players about what cards they hold and we must base our judgements about how to play our own hand on their past performance, nurtured by our experience of them. To preconceive our response to each configuration of cards, so that we always bet if we have a pair of kings or four cards towards a flush in poker, or always bid a grand slam if we hold twenty-three points at bridge, would be as unsuccessful as having genetically preconditioned ways of reacting to our parents.
Yes, genes do establish a basic repertoire of traits in nearly all humans, but the subtle differences between us in their expression are largely determined by our upbringing. We got where we are today, the only species on earth able to survive in all ecosystems, by being born pliably plastic to our particular family. Strong support for this reading of evolution has come recently from the completion of the Human Genome Project, the map of our genes. It was expected that humans would have at least one hundred thousand different genes but it turns out that we have only thirty to forty thousand at most, just twice the number found in the common fruit fly. That we have so few genes may well mean that we simply do not have enough for them to be specifying the minutiae of differences between us as individuals. Craig Venter, the head of one of the two groups conducting the study, concluded that genes cannot play more than a minor role in determining differences between us. In his words, his work proves that ‘the wonderful diversity of the human species is not hard-wired in our genetic code. Our environments are critical.’
In fact, considerable evidence to suggest this predated the Genome Project. The best comes from studies of identical twins. Taken overall, the results do not support the oft-repeated claim that differences between us in our psychology are half caused by genes (‘a bit of both’). The truth is far more interesting.
Because identical twins have identical genes, any psychological differences between them must be environmental in origin. In twin studies this degree of difference is compared with that between non-identical (known as ‘fraternal’) twins, who share only half of their genes. Fraternals make a better comparison group than non-twinned siblings, because they were born at the same time and have all the additional features particular to being twins. The critical point is that, if a trait is influenced by genes, identicals will be more similar in that trait than fraternals because their genes are 100 per cent similar, whereas fraternals have only half their genes in common. For example, 90 per cent of identicals have a similar height whereas this is true of only 45 per cent of fraternals. This greater degree of similarity of the identicals is assumed to be due to their greater genetic similarity. That they are so much more similar in their height than fraternals suggests that height is heavily influenced by genes.
The findings of twin studies
For the purposes of this book, with the exception of Thomas Bouchard’s study, I shall assume that the results of twin studies are reliable, although most studies of adopted children produce much lower estimates of heritability than those of twins and there are many technical reasons to doubt that twin studies are very accurate (see Appendix 2). The fascinating fact is that, even when they are taken at face value, what they reveal is not how important genes are but how relatively unimportant. That is the view of Robert Plomin, the world’s leading authority on the subject, when he writes that the main finding from twins is that ‘most behavioural variability among individuals is environmental in origin’.
Whereas much of our physical make-up is strongly genetic, hardly any psychological differences are as predetermined (see Appendix 3 for a summary and references to the following statistics). The vast majority of the characteristics that have been tested by twin studies are less than half heritable; and, indeed, a great many crucial ones — like the propensity to violence or our romantic preferences or degree of masculinity-femininity — show little or no heritability. Whilst some personality traits are quite heritable, for instance extroversion and emotionality (both 40 per cent), many others, such as sociability (25 per cent), are not. Scores on intelligence tests suggest they are the most heritable general cognitive capacity (30 per cent in childhood rising to 52 per cent in adulthood), but many crucial mental abilities are not very heritable. Memory is 32 per cent heritable, creativity is 25 per cent and exceptional high achievement, up to and including genius, is largely if not totally environmental in origin.
There is no better way to illustrate this than through the lives of twins who were born with identical genes. Gayle and Gillian Blakeney, a pair of dark-haired, pretty, identical twins, starred in the Australian TV soap opera Neighbours. Shortly before I interviewed them in 1993, they had paid their first ever visit to an optician. By their age, then twenty-seven, everyone’s vision is less precise but the amount of distortion varies from person to person. The optician had been amazed to find that the degree and type of deterioration were exactly the same in both twins. But it was not just their eyes that were identical — so were their faces and bodies. Within five minutes of meeting them, despite the fact that Gillian’s red blazer made a visible contrast to Gayle’s cream shirt, I had confused them several times. Yet, even though they looked so similar, their psychologies were extraordinarily different. This difference could not be due at all to their identical genes but only to differences in upbringing, which were, indeed, striking. I asked them about their personal histories, and an occupational psychologist provided an independent assessment through formal tests of personality and intelligence. Together, we arrived at the following profiles.
As a child Gillian had been assertive and aggressive, a rebel who liked to play with boys and preferred masculine toys. She had a short fuse, was liable to get angry with her parents and had run away from home on two occasions. Although born just nine minutes after her sister, in their family script she was portrayed as the baby of the family, a self-avowedly manipulative ‘Daddy’s Girl’ as a result. Yet in her personality Gillian took after her mother, developing her handwriting, manner of holding herself, facial expressions and mental attitude. Extremely forceful towards me, she interrupted and refused to give way if she had a point to make. Gillian was suspicious and more secretive than her sister. She described their relationship as having been like a marriage in which she was the man and Gayle the woman. When sharing a flat with her sister, she did the man-about-the-house DIY.
She was going to hold out for the Dream Marriage with her Perfect Man and would be heartbroken by infidelity. Her sex life began at seventeen with a boyfriend whom her father deemed inappropriate. She was attracted by very different traits in men, saying that she preferred ‘the good-looking, ultra-masculine type whereas Gayle likes intellectuals’. She wanted to have children in Britain, to take them to Australia for a few years and return to Britain for their secondary education. Her husband would have to fit in with her plans, although she expected him to be successful and very masculine and that this would lead to lots of arguments, which she believed they would enjoy. Although independent and assertive in her dealings with men, she used feminine wiles. She was more overtly sexy and flirtatious than her sister.
Gayle was so different in all these respects that one might imagine she came from a different family. If judging her only on her personality, one would never guess that she had exactly the same genes as her sister. Markedly less assertive, as a child she had occupied the niche of being helpful around the house, offering compliance as a way of winning her parents’ approval. Unlike her sister, she had a doll which was ‘my baby’. There were no signs of the tomboy or rebel, and she would never have thought of running away. She took an elder-sisterly, protective role towards ‘baby of the family’ Gillian. She did not have Gillian’s short fuse, and only showed aggression under extreme provocation. In adulthood, her handwriting, manner of holding herself, facial expressions and mental attitude were said to be very like her father’s, in contrast to Gillian’s similarities in these respects to her mother. In ordinary siblings, at least in theory, this could be explained by one having inherited genes from the father, the other from the mother, but that cannot be the case with genetically identical twins.
Gayle was more reflective and listened more carefully when I spoke to her. She was also more forthcoming. Whereas Gillian concealed a significant fact about their father, Gayle freely volunteered it to me, saying, ‘Dad’s business collapsed in the early 1970s. He’s not the same person as he was — a broken man.’ Much more open and trusting, none the less Gayle dammed anger up; and just occasionally the dam burst: ‘If I do blow my fuse I’m dangerous. I don’t like arguments at all.’ She was the cook when sharing a flat with her sister, and took the role of housewife. She believed that her sister was ‘much prettier — it’s the structure of her face’, although their faces are indistinguishable to a stranger. Gayle’s sex life began five years later than Gillian’s, at twenty-two. With her differing preference for brainy types, she expected to marry a man who would introduce her to a new social world and to live where he needed her, whereas Gillian expected her man to fit in with her plans. Whilst Gayle had no intention of devoting herself totally to the role of housewife, she believed that in a marriage ‘you have to act The Wife — I will have to be accommodating’. She felt it would be wiser to see marriage as a practical pact between two adults when she settled down; unlike Gillian, Gayle believed it quite possible that her husband would be unfaithful, but felt that this should not necessarily mean divorce.
Whatever else caused these two women to be so different, it could not have been their identical genes. Indeed, even within the limits of a single meeting it emerged that differences in the way their parents related to them were crucial. Their mother exhibited a completely different attitude to the aggression of each daughter, and both parents clearly favoured Gillian.
Unaggressive Gayle recalled a telling incident. ‘I had this angelic doll which became completely precious to me. That doll was my baby — that doll was my life. So of course if Gillian was going to inflict any emotional pain on me it was to rip off the doll’s head, throw it down the hill and into the jaws of a dog — which she did.’ Retaliation followed swiftly. ‘I grabbed her Snoopy doll, scratched its head on the ground and ripped its ear off.’ Their mother’s response to the doll massacre provides a perfect illustration of what has made the two girls so different. ‘Mum got angry at me but not at Gillian. She said, “You can always put a doll’s head back on but you can never take the scratches out of Snoopy’s nose” — not very fair comment. I said, “But that’s my baby — she’s ripped the head off my baby!” But Mum was always more on Gillian’s side.’
In recent years it has become fashionable to claim that such different treatment is caused by the child’s genetic temperament, so that ‘difficult’ children make themselves unpopular whilst lovable ones attract favouritism. But this is simply not possible in the Blakeneys’ case, since the two were born the same. Although it can be difficult to get to the truth of the matter, since parents rarely want to admit to having treated their children differently and children are often highly protective of their parents, such differences in treatment caused by the parents’ projections rather than the child’s supposedly inborn temperament are the norm, not the exception, and are found to some degree in all families.
The hundreds of differing reactions like this, in which their mother supported Gillian’s aggression and suppressed Gayle’s, day in, day out, were bound to have an effect. They may have something to do with Gayle’s tendency as an adult to dam up aggression and with why she occasionally felt so disempowered that she became violent. Perhaps, when words did not work, only physical force could make her point. It may also explain why she was generally a more obedient child whereas Gillian, being encouraged to express her aggression, was rebellious. Gillian developed a habit, which she displayed over lunch with me, of always leaving some of her food on the plate — much to her parents’ vexation. Gayle said she was more compliant: ‘I gained respect and individual worth by being extremely helpful about the house and being bubbly, because Mum and Dad were very busy and hard-pressed. I was into being rewarded. Gillian was into being cute.’
Gillian incurred the anger of her father by having a delinquent first boyfriend, but her mother ‘adored’ this boy. She managed to divide and rule her parents. One of the ways in which she achieved her extra liberty, she reported, was to ‘play on being the little baby, the youngest-of-the-family routine. I knew how to be cute and I was quite a manipulative little thing. If I wanted something I knew how to get it.’ Despite the fact that they had been born identical and only nine minutes apart, their father took a special shine to her. Gayle recalled that Gillian used to snuggle in and be the ‘cutesy bubs’ on their father’s lap. ‘Dad used to go, “How’s my baby?” to Gillian.’ Gillian confirmed that ‘I was definitely my dad’s little girl, of the two of us. I was his “Gilly-Gum”.’ This may have given her confidence in dealing with men, and may also explain her father’s anger, possibly jealous, towards her first, ‘inappropriate’, boyfriend.
Moving from Gillian and Gayle as specific examples to more general findings, twin studies show that only a small handful of characteristics, all of them rare mental illnesses, have more than 50 per cent heritability. Even in these cases the way we are cared for in childhood and afterwards significantly affects how ill we become. For the vast majority of the one fifth of us who are suffering from a full-scale mental illness at any one time, genes play only a small part. This is because the commoner that an illness is, the less heritable: only the rare ones are very genetic.
Huntington’s Chorea, which causes brain degeneration, seems to be almost completely heritable, so that virtually everyone who has the relevant gene develops it; but it affects just one in twenty thousand people and is the only severe mental illness for which a single specific gene has been identified as the cause. Where genes do play a part in severe mental disorders it is a variety of interacting ones, although, as yet, not a single one of the principal mental illnesses has been proven to be the result of possessing a particular gene or genes. The next most heritable mental illness is autism, thankfully only affecting a tiny number of children (about 0.2 per cent). It may be as much as 80 per cent heritable but there are still large differences in how the child turns out, depending on the age at which the problem is diagnosed and starts to receive treatment. After autism comes manic depression (affecting 0.5 per cent of the population at any one time), which may be as much as 60 per cent heritable. Major depression (4 per cent of people) is less so, about 50 per cent, similar to schizophrenia (1 per cent of people). Since these are all illnesses that affect very few of us, the much commoner neuroses (15 per cent of people) and so-called ‘minor’ depression (18 per cent) are of far greater concern, as are alcoholism and other increasingly common addictions. All of these are much less heritable, ranging from 30 per cent at most to no genetic influence at all. Thus genes play only a minor role in most cases of mental illness, since it is neuroses, minor depression and addictions that are by far the commonest of these.
Taken overall, even in those rare cases where genes do account for half of a trait the environment remains crucial. For example, some (but not all) twin studies suggest that the propensity to smoke tobacco is as much as half heritable. (This is something I am very inclined to believe: I gave up in 1988 but have been using nicotine substitutes on and off ever since. Whilst writing this book, I am ashamed to say, I have succumbed to a 10-a-day habit which I would love to be able to blame on genes.) What this means is that differences between individuals in their proneness to smoking addiction are half caused by genes, but that these differences can only be fulfilled under certain environmental conditions. There was not a single smoker in Europe before the sixteenth century, because until then there was no tobacco there. Very few women smoked until the twentieth century; now the habit is more popular among young women than among young men. To say that individual differences in smoking are half caused by genes is simply not true. It all depends on the environment in which the individual is living.
Another dramatic recent example is divorce. One twin study found it to be about 50 per cent heritable, but, again, what does this really mean? The number of divorces in England in 1857 was just 5, because at that time a divorce required a specific Act of Parliament. The law was changed the following year, but there were still only 590 in 1900 and a paltry 4000 by 1930. How come the 50 per cent of people supposedly with ‘divorce genes’ were remaining married? Not until after the Second World War did divorce really rocket, from 12 per cent of all marriages to today’s 40 per cent. These facts prove beyond question that social forces are the principal cause of divorce, so in what sense is divorce 50 per cent heritable? How can genetics accommodate the fact that divorce is not permitted at all in some countries, or account for the widely varying rates between developed nations? What has happened to the ‘divorce gene’ in these cases? It is nonsense to suggest that divorce is half heritable unless it is also specified that the environmental conditions that have emerged in developed nations since the mid-twentieth century (changes in the law, greater affluence and so forth) must be present to cause this.
Even in extreme mental illnesses, where genes seem to be most at work, the environment can be crucial. The cause célèbre for this issue amongst scientists has been schizophrenia. It is frequently asserted by psychiatric specialists that the disease entails a brain abnormality caused primarily by genes. Because sufferers from the illness seem so dramatically different from the norm, this is easy to believe — surely upbringing could not make someone so severely disordered? The rest of this chapter will look at the causes of this illness as an illustration of how important nurture can be, even if a significant genetic basis does seem to exist.
Schizophrenia as an example
Whilst I was working at a therapeutic community for the mentally ill I witnessed a fairly typical schizophrenic breakdown. Julie had studied politics and graduated with the best first in her year. Her relations with the university authorities were very stormy but she completed a postgraduate degree and published a book, a scholarly Marxist analysis of the American electoral system, before dropping out of academia. Her analysis of current British politics and economics was exceptionally well informed. When I met her she was in her early thirties and had been working full-time and very hard in left-wing politics for three years. She was admitted to the hospital because she had suffered from a general mental malaise, though nothing approaching schizophrenia. She was a warm, unassuming woman, well liked by many. A vegetarian and a heavy user of marijuana, she was easy-going if quick-witted and intense. She was short and slight in build and full of nervous energy, forever adjusting her spectacles with twitchy movements.
Her relationships with men followed a pattern. Either she was on friendly, asexual, sisterly terms, or in a few instances she fell in love with an idealizing gush. On the occasions that active sexual relations were established, they were broken off by the man very rapidly. She could be highly critical of men in general and sometimes voiced the idea that she might be a lesbian.
About a year after we had first met, I arrived back from holiday to find Julia and a group of other patients sitting round the kitchen table about to share a pot of tea. It was poured, but before anyone could sample it Julie insisted, ‘Don’t drink it, it’s poisoned.’ We ignored her with the fluid skill that groups develop for these occasions, but it proved to be the first note in a symphony of symptoms which were to grow into a cacophony over the next fortnight. She believed there were two transmitters at either end of the city which were sending a signal through the house, driving her mad. She spent hours crouched naked in the bath, scrubbing her clothes ‘to get them clean’. A fear of ‘dirty’, poisoned food precluded eating. Some of what she said made no sense to me, but at other times she was full of dazzling insights, whether about my motives for sitting with her or about society in general. Like the last minutes of a dying light bulb, these insights illuminated a great deal; but they were followed by ‘darkness’ — days of psychotic incomprehension. Eventually we called her parents, who lived far away, and it was decided to transfer her to a hospital with locked wards because she had become a danger to herself.
Conventional psychiatric wisdom is that Julie’s breakdown was caused primarily by the impact of her genes on her brain, causing it to malfunction. Studies of twins are the cornerstone of this genetic argument. Yet, if they are to be believed, they actually prove that in half of cases genes are not the main cause. The reason that this can be said with such confidence is that if a hundred schizophrenics have an identical twin, on average only between one third and one half of their siblings will be schizophrenic too. That is higher than the rates found among the siblings of schizophrenic non-identical twins (around 15 per cent), suggesting a significant genetic component. But the extraordinary fact is that, in the case of the identical pairs where only one of them is schizophrenic, genes could not be the cause of the illness. Because the twins have exactly the same genetic code, if one of them were being made schizophrenic by their genes then so would the other. The only possible cause of the difference between the twins must be exposure to differing environmental influences.
In theory, these could be physical, like differing positions occupied in the womb or differing exposure to dangerous chemicals in childhood. But as we shall see in the next chapter, there is abundant evidence that the main reason is that they experienced very different childcare, even though they had the same parents. We shall also see that the most likely explanation for schizophrenia is that, whilst in some cases it is very largely caused by genes, in others it is largely the result of upbringing and in others still, it truly is a case of ‘a bit of both’.
Apart from twin studies, the fact that schizophrenia is found throughout the world suggests it does have a genetic component — is part of the package that goes with being human, so that some members of any community will suffer it. However, that still does not mean that every case is largely genetic in cause. That its rate varies considerably between social classes (twice as common among the poor) and between races tends to be dismissed by psychiatrists, yet it is three times more frequent in American Afro-Caribbeans and up to 16 times more common in children of West Indian immigrants to Britain. This latter is almost certainly nothing to do with genes because relatives of immigrant schizophrenics from the same genetic stock who remain living in the West Indies do not have these elevated rates of illness — emigration and the response of the host nation to this minority cause the increased rate. Psychiatrists also play down the uncomfortable fact that the illness tends to last much longer and to be more severe in rich, industrialized nations compared with poor, developing ones (as strong a proof that modern life is deranging as you could hope to find).
Many psychiatrists also argue that because the illness tends to run in families, it must be heritable. Whereas only 1 per cent of the general population are likely to get the illness in their lifetime, 17 per cent do so if one of their parents had it and this rises to 46 per cent if both parents did so. That this could be partly explained by the fact that being raised by mad parents could be maddening is rarely even considered.
Given the conviction among psychiatrists that the illness of schizophrenia is no different in kind from a bacterial infection or cancer, the main treatment is drugs. About one quarter of patients are not helped at all by them, and around 15 per cent of all schizophrenics eventually commit suicide. Where the drugs do work, the decrease in symptoms is not large — only a 15—25 per cent improvement; and set against this are terrible side-effects, commonly hand tremors and other neurological problems accompanied by a sense of disorientated emptiness. Most treatments reject the idea that what the patient is saying makes any kind of sense. Nurses and family members are very actively encouraged by psychiatrists to regard the delusions as nonsense.
As we have seen, the idea that schizophrenia is always caused by genes is proven to be untrue by the fact that half of people who have an identical twin with the illness do not themselves have it. This is borne out by a particular fact that psychiatrists who believe the illness is largely genetic find hard to explain: at least 20 per cent of schizophrenics completely recover, most of them able to live their lives without any drug treatment at all. A telling example of a recovered schizophrenic is Rufus May. Not only did he become wholly sane but, having done so, he trained as a clinical psychologist and now treats schizophrenics in a community project in a deprived part of London: a poacher turned gamekeeper, a lunatic who has taken over the asylum. If his illness had been as genetically determined as, say, the colour of his eyes, this would have been impossible.
May was eighteen years old when a psychiatrist told him he was a paranoid schizophrenic and would have to take medication for the rest of his life. There followed seven months in a mental hospital and the forcible administration of drugs. Yet today, he has not taken any medication in thirteen years. He feels that the assumption that he had an incurable illness, and the exclusive use of drugs to treat it, actually impeded his recovery. Now mentally healthy, he told his story in a remarkable interview with Feargal Keane for the BBC Radio 4 programme Taking A Stand.
This is how he described the build-up to his breakdown:
Only a few weeks before, I’d just gained a new job. My girlfriend left me a couple of months before, so I was struggling with some sense of abandonment and struggling with just becoming eighteen, feeling that I suddenly had to achieve something and be somebody. So there were those pressures and I think the job was actually very boring.
I was a trainee draughtsman, given very little to do, and rather than seeing myself at the beginning of a dull career, it was easy to move to playing with ideas that I might be really an apprentice spy.
I turned up at my job one day and they asked me to deliver a parcel at short notice from Kings Cross to Manchester, and so they gave me some money for the ticket. I got down to Kings Cross, and just before the train was leaving I noticed that I had lost my ticket and a man had brushed past me.
I wondered if he’d pick-pocketed me.
With no time to think, the train whistle went and I decided, impulsively, to run round the barrier and jump on to the train. I went into the toilets because I thought I might have been spotted and I thought, ‘Well, I need to change my appearance.’ I got some water to wet my hair and I put my tee-shirt over my shirt.
This was very exciting for me. It reminded me of when I was a child reading about spy stories, and then I thought, ‘Well, what if I really am a spy? What if this is all set up to see if I’ve got the ability to deliver a parcel under difficult circumstances?’ And this idea really appealed to me, until on the way back I came down to earth when a diligent ticket collector knocked on the toilet door where I had lodged myself in to avoid him. He only let me off when I acknowledged that I was just an office junior.
I think that was the time when I was gradually beginning to drift more and more into this fantasy world. It had a lot of appeals to it. It gave me a sense of importance and I could use my creativity to really escape from a dull reality. A depressing reality, because I had to some extent messed up, in academic terms. I drifted for many years really.
The more I invested in these exciting ideas, the more I got from them. I started to enter my own world more and more, and the intense excitement meant that I found it more and more difficult to sleep. I think that sleep deprivation played a key part and in a way I started to dream while I was awake.
If you notice, in your dreams you’re always the central figure. Whatever happens around you is related to you and that’s what my life became like. Street signs became personal messages for me. A person scratching their head was a special sign that I had to decode. Newspaper articles had special meanings. Everything revolved around me, just like in a dream.
I think there is no doubt I was very confused and needed someone to make sense of those experiences with me, but crucial in the next few months was that decision [by his doctors] to dismiss everything I was going through as a meaningless product of a carnivorous illness, a disease called schizophrenia, which I think is a very contentious idea…
Q: What was the doctors’ response to you when you tried to say, ‘Look, I need something more than being locked up here. I need something more than drugs’?
A: I think we got into a battle about that. It was seen as me lacking insight into the fact that I had mental illness, and therefore I needed medication. It was very difficult to bring up embarrassing side-effects, like impotence, in a ward round with maybe fifteen people, lots of student doctors. It felt like appearing on stage, a very important five minutes once a week, to go in and show that you were ready to have your medication reduced or ready to be discharged. There seemed to be a battle of wills going on.
Q: How were the rest of the patients treated?
A: Different staff were different. There were staff who treated you with disrespect, who were quite bullying and quite dismissive, and there were staff who treated you as an equal, but they were trained not to talk to you about your unusual ideas. If you mentioned an idea that you had, somebody would get out a game of chess, or something, and suggest you play that.
Q: So there was no therapy?
A: There was no therapy.
Q: How often a week did you see a psychiatrist?
A: Once a week.
Q: For how long?
A: A few minutes.
Q: So that was what your therapy amounted to, a few minutes a week?
A: Therapy was drug therapy …
Q: How did you make the transition from the point where you successfully weaned yourself off medication to becoming a psychologist?
A: I did a range of jobs. I even worked in Highgate cemetery as a night security guard. I started doing drama at a community centre, and they started asking me to do work with adults with learning disabilities, and I asked them why and they said, ‘Because we think you’re good at it.’ I was moved by this and thought I could develop that role as a care worker, and as I started to do this I started to develop the idea: what if I managed to infiltrate the mental health system and change things from within? But this took many years. I did ten years of care work and psychological training where I kept quiet about my psychiatric experiences because I wouldn’t have been allowed to do that training, probably, I wouldn’t have been allowed to do that work if people had the knowledge that I had a diagnosis of schizophrenia …
Q: In your process of training you were very concerned to keep the fact of your past illness quiet. Yet you did encounter people who had been nurses while you were a patient. What was their reaction to you?
A: It was strange because, in a sense, I’d become the undercover spy of my delusions and there I was being spotted by someone. One time I was in a meeting and the nurse had recognized me and he was saying, ‘Don’t I know you from somewhere?’ And he was trying to work out how he knew me, and I was kind of grinning broadly with my teeth slightly gritted, saying, ‘Yes, but let’s not go into that right now.’ I met with him afterwards and he was very good actually and said, ‘Don’t worry, this is confidential between you and me’ … If you look at the six or seven years before I actually had a psychotic episode, I was kind of struggling, I was blocked. The actual psychosis allowed me to come out of myself and move on. I very nearly became a long-term mental health patient — I strongly believe that. But nevertheless, through the struggle that I went through, it has given my life a sense of meaning and I want to create better mental health services that are more enabling. I want to change the way we think about human experience.
Having spoken with Rufus May, I would not be at all surprised if the book that he is currently writing about his vital journey does, indeed, change the way we think. In the meantime, the question remains: in the half of cases of schizophrenia that are not primarily the result of genes, what does cause them?
Whilst schizophrenia is not the main focus of this book, it is a cause célèbre in the nature—nurture debate. My answer to this specific question is distributed throughout the book. Towards the end of Chapter 2 I present a wide variety of evidence that the role in which we are cast within our family drama can be highly influential. In later chapters, I show how early infantile experiences may create a potential for the illness. Whether this potential is realized may depend on subsequent childcare, in particular whether our parents give mixed messages and are unsupportive, and whether they are abusive. Only in some cases are genes the main reason; in others it may be largely or wholly environment, and in others still it may include elements of both nature and nurture — and schizophrenia is one of the most genetic human characteristics there is.
As this book proceeds, you will see that the real tension in explaining why we are as we are in most respects is between past and present, not nature and nurture. My principal question is this: to what extent is the way we were cared for during our first six years more influential on the kind of adult we have become, compared with the second or third period of six years, or present-day adult experiences such as unemployment or divorce? In particular, how is the kind of care received during different periods within the first six years linked to specific adult outcomes?
After presenting the influence of our role in the family script in Chapter 2, I introduce what I think of as three key psychic characters who are differently assigned lines in the unique drama of our personal history, at different ages.
Our ‘conscience’ (Chapter 3), an internal policeman, is formed primarily by the way we were curbed or encouraged when aged three to six years old.
Our ‘pattern of attachment’ (Chapter 4), the set of assumptions about how we will be treated by others which we bring to all our relationships, is heavily influenced by the way we were cared for as a toddler, up to the age of three.
Finally, our ‘sense of self’ (Chapter 5), the fundamental sense that we exist, and exist in our body, is caused, at least in part, by our care in early infancy.
Each chapter delves ever further back into the murky recesses of childhood. You will be able to remember and apply to yourself much of what I cover in Chapter 2, but probably not with Chapters 3—5 because none of us can remember much, if anything, of our earliest years and we may have only fleeting awareness of the way we were treated then. None the less I hope that, in joining me on this journey into your past, you will begin to see that, for the great majority of us and in most respects, it is our unique relationships within the family, not our cocktail of genes, that determine the gradual emergence of volition, of the capacity for choice, as we struggle during childhood to convert what has been done to us into something that is our own. The battle continues in adulthood. For the whole of our lives we are grappling to become the organ grinder rather than the monkey, to explore and bring alive the past in our present so that it works for us rather than against us, to shift from being actors in a play whose script was written by our early childhood history to becoming the author of our own authentic experience.
