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Windmills of the Mind

Posted by Dr No on 31 March 2015

mary_poppins.jpgIn the second part of Not Guilty by Reason of Insanity, Louis Theroux went a whiter shade of pale. In Part One, the patients had been linear: given time, though the content was often horrific, sometimes bizarre, they talked straight. Louis wandered, but remained grounded. In Part Two, everything, including Louis, was up in the air. Windmills of the mind rolled aimlessly, milling nothing. A toxic runt of a shrink made it his job to finger the malingerers. He did this by raising an eyebrow and curling his lip. When patients-experts in madness faked symptoms of madness, he just knew the shirkers were doing it to dodge their day in court, but they were tough nuts to crack. Weary Dr Lip Curl sure had a hard hoe to row. Here was the proverbial patients running the asylum in action: the nuts had cracked the shrinks. Every day, one flew over the cuckoo’s nest. Dr Curl was damned if he knew what to do about it. It was enough to make anyone’s lip curl. He ratcheted up the curl another notch, to no avail. At some point, Dr Curl will need surgery, to put his lip back where it should be. He may even need anti-psychotics, to calm the delusion that all the inmates have got one over him. All the while, Louis gazed on, his mind as focused as a windmill in the sky. Everything was going nowhere, and nothing was going everywhere. Windmills of the mind, turning slowly in the sky.

Elsewhere, Louis tackled personality disorders head on. Most times, tackling personality disorders head on is a fast-track sure-fire way to get a hole in the head. Louis was no exception. Patients understandably want a label for their symptoms, a name for their diagnosis, to form part of the narrative of their illness. It’s hard to tell a story when the villain has no name. In many of the personality disorders, the villain is centre stage, protagonist and antagonist all rolled into one, the patient defined by the diagnosis. To make matters worse, psychiatrists use impossibly complicated names for the personality disorders. Unwisely, Louis asked a patient what personality disorder the patient understood he had. There was a pause, a whirring like a clock getting ready to chime, and then the patient came out with it. Super Callous Fatalistic Borderline Precocious Personality Disorder. Or it might have been Anti Social Sub Narcissistic Doctors Are Atrocious Personality Disorder. Louis’s windmill stopped turning, and then started rolling slowly round the wrong way. Windmills of the mind, turning slowly in the sky, trouble was, the wrong way round.

Louis’s problem was he had bitten off two of psychiatry’s biggest enigmas, and tried to swallow them in one programme. The first is the mad-bad-sad question. A large part, in many ways the key part, of forensic psychiatry is answering the question: is the patient mad, bad or sad. It is the diagnostic question, and is complicated by the possibility that the patient may be any, all or none of the three, and then further complicated by the need, if more than one is present, to decide which trumps which. The whole business is shot through with Catch 22, and, for the patients, the stakes couldn’t be higher, because on the outcome will usually depend whether they end up in prison or hospital. Just as fraught is the same question come discharge. If the patient has learnt how to appear normal, but remains mad under the surface, then there is the terrifying possibility that sooner or later, someone will get hurt, possibly killed. In the face of such complexities, often aggravated by the pesky interference of meddling lawyers acting in the interests of something that does not exist, it is a wonder, and credit, that things do not more often go wrong.

Louis’s other gob-stopper was personality disorders. The conventional order is that, by definition, personality disorders are not illnesses. They are early adult onset persistent disorders of personality sufficient to cause trouble for the person, and often those around the person, but lack the defining characteristics of illness, in particular, a pathological process. Because the manifestations of personality disorder often overlap with those of mental illness – it is no accident that one of the better known personality disorders is borderline personality disorder – individuals with personality disorder have a tendency to end up in front of psychiatrists, and because, some might say unhelpfully, psychiatrists have had a tendency to appropriate such individuals to their care, a sort of bizarre reverse post hoc ergo proper doc process – because the doctor is involved, therefore the person must be ill (Dr No did say it was bizarre and reverse) – personality disorders are often seen as and treated as mental illnesses. By sticking their medical fingers in the personality pie, psychiatrists have medicalised personality disorders. Whether that amounts to a plum job has been hotly contested ever since. To some, the psychiatry of personality disorders is the psychiatry of control, for others it is the liberation of a label, a name for the villain. For every person that rages against the label, another wears it as a badge on their sleeve. Small surprise, that, as the programme wore on, Louis’s windmill was blown this way and that. Windmills of the mind, turning slowly in they sky.


I always liked things that are pretty longer and with constant improvement, indifferent to what they relate. I believe in honest and long-term relationships, investing in that many feelings, but this feature covers other directions, like reading great books, whatching spectacular movies and so on. ">Monica

i can't agree more with you on the part that the patients need to have a label for their disorder. i have a friend who is bipolar - that meds said about him, and that he thinks about him, because he is searching all day on the internet for simptoms specific to bipolar and compare with his simptoms. now, everytime he needs to do something and he fails, he invoke the reason that he is bipolar and come with all those diagonostic. lol

i don't get it, but lately i meet more people who are pretending that they have some mental disorder. They are not nuts or something like that, but when they can't concentrate or something they say that they have adhd. when they have a bad day, they are bipolar, and so on. My point is that there is an existing mental disorder for any of our problems... andrei

Honestly, eveyone has a little madness inside of them. Some are very good at controlling it, others are not so goog. It depends on each individual

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