The results on screen are of a charity led and domineered by a personality who is unboundaried in her approach to both business and care. It’s not just the charity’s headquarters in a corporate, high rise building that is detached; its existence has become reliant on huge amounts of crisis public funding with no meaningful plan to help itself or recognition of its contribution towards its own downfall. Not a good look or example to set for its clients and employees, a number of whom the documentary appears to show as being caught up within a culture of co-dependency.
Edit: 12:21 pm to add former Kids Company twitter page with banner
Edit: 12:39pm spelling of auto mis-corrected Alleway and tags.
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Tags: "children recover with unrelenting love", Camila Batmanghelidjh, charity, Kids Company, Lynn Alleyway
In an interview for the Royal College of Psychiatrists’ Faculty of Neuropsychiatry’s newsletter, Neuropsychiatry News (Winter 2015, pp. 33-37), the director of The Man Whose Mind Exploded, Toby Amies describes his approach and the ethical considerations involved in filming Drako Oho Zahazar, a man whose anterograde amnesia subsequent to two traumatic brain injuries means he can never remember his personal champion.
Following TMWME’s national release, what are your thoughts about the response to the film?
I am very, very happy with the way that the film has been received. We only had a very small budget to make and market the film but the reactions of the media and audiences has made sure that the film’s message has resonated much further than we expected. I very much doubt that there is another film that has received positive reviews in both the Lancet and Bizarre magazine!
Your approach to interacting with Drako reminds me of what’s been described as the ‘mentalizing stance’ (as described in mentalization-based treatment theory), where the interviewer takes a non-judgemental stance while remaining inquisitive about the individual’s thinking. Were you aware of that and how did you adapt your interview approach specifically to Drako?
I wasn’t aware of that approach and I’m not sure that I would describe my stance as non-judgemental! That said I would love and strive to be calmly objective in all the difficult situations I encounter. I think it’s probably fair to say that with Drako, I certainly didn’t think that his brain damage and condition made his point of view or experience any less valid than anyone else’s.
Not having had any clinical or ethical training, I tend to enter and approach situations on the basis of what I ascertain to be fair. There were instances in my interactions with Drako where I felt that he was unfair to me and I document one of these in the film. One of the guiding principles of the film was not to try and impose any kind of theories, narrative or worldview upon Drako but rather let him be the inspiration for the film’s form and structure and also the agent of his care and fate.
In the film his sister describes how she didn’t like Drako when they were younger though this changed after he adapted to his brain injuries. What would your views have been had you had met the younger Drako?
The more time I spend (and waste) on social media the more I grow to dislike narcissists. From what I know of Drako before his accidents, he seemed to be very self-involved. Whilst I might have appreciated his beauty and fearless pursuit of physical pleasure, I’m not sure that we would have got on as individuals.
The scene where you arrange for Drako to film you as you urge him to take care of himself is particularly memorable. Many carers must go through similar experiences of exasperation. Do you think conversations like that had any effect on Drako? Do you think that your involvement impacted on his well-being?
I honestly don’t know. So many of the conversations that I had with Drako seemed to enter his head without entering his memory in any permanent sense. It was difficult to know to what degree he just wasn’t remembering and / or was choosing not to engage. Frankly, I still feel a significant amount of guilt, because even though I felt that I did everything that I could at the time to help in a practical sense whilst being respectful of his clear desire for autonomy, he still died.
Clearly there were considerable ethical concerns of filming someone with questionable capacity. What has been the most justified criticism?
I suppose the one that’s implicit in your question; should I have been working with someone who, to use your terms, had “questionable capacity”? I am not in any sense a medical professional, so in working with Drako I first, and consistently ensured that I had the permission and blessing of the people who were closest to him. In addition to his own point of view, I thought that they were in the best position to decide what was “best for him”.
If you had the opportunity, what else would you have liked to have included in the film?
Less! It’s probably more a question of showing less than I did as there are still shots in the film that I think we could have done without and still had the same impact. When I watch the film now, I see a series of mistakes and compromises and shoddy camera work. But now that it’s out there, all that really matters to me is how it affects the audience and how they have been moved by Drako’s story.
Some people have said that they would’ve liked to have known more about Drako’s biography but one of the things that we noticed during editing was that those historical sequences were a rather flat experience. One of my favourite things about the film is that so much of it is in the moment – that we are experiencing being with Drako – not just looking at flat pictures and hearing a story. Instead and appropriately, we’re “being in the now”, which was Drako’s dominant experience of life.
You said at one of the film screenings that his most creative phase was possibly during his final years. How would you describe what that involved?
I don’t think I investigated Drako’s creative process perhaps as deeply as I could have. However, it seemed to me that without [Drako] being overly self-conscious or aware of it, that he was involved in creating a tangible version of his identity through an intuitive process of montage in two and three dimensions within his flat. Within the context of this work, Drako expressed his obsessions, spoke to himself and through the visitors to his flat, to the outside world.
After his death I archived as much of this work as possible because I think it’s an important piece of British outsider art and one day I hope to rebuild part of it as an installation. It’s significant that Drako trained as an interior designer and without wanting to be glib, it’s tempting to think of him as an outsider interior designer!
Interview with film review featured in RCPsych Faculty of Neuropsychiatry’s newsletter, Neuropsychiatry News (Winter 2015, pp. 33-37). Link to film review.
The Man Whose Mind Exploded is available to download here.
Hear the original radio documentary The Man Whose Minded Exploded for free here.
Why aren’t there more truly independent films in British cinemas?
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Tags: Dr Greg Neate, Faculty of Neuropsychiatry, Neuropsychiatry News, Royal College of Psychiatrists, The Man Whose Mind Exploded, Toby Amies
Joe Sacco’s experience as a comic journalist who’s embedded himself in places traumatised and divided by sectarianism, and then sensitively – even beautifully – reported back his observations in a format with multiple layers makes him well placed to comment on the attack on Charlie Hebdo.
I had a religious upbringing that inevitably affects my morals and global viewpoint. While I strive to think outside that framework, my exposure to that culture of beliefs has also given me an appreciation of faiths with moderate and extremist sections. I’ve not been involved with a faith since I could choose for myself but I’m aware of why it’s important and can be valuable. Of course, I also see the extremist’s position as being both silly and potentially dangerous, especially when a defiance of logic and tolerance is proclaimed and celebrated.
As a psychiatrist, I sometimes come into contact with people of faith among the patients and families that I see. While at times, I’d like to expose such inconsistencies (usually among those from Christian faiths; it’s rare to see people of Muslim faith attend mental health services, particularly Muslim women), not only would it distract from the issue at hand, it won’t work. What’s more likely is that people who already feel persecuted and suspicious will have their own prejudices reinforced at a time when they’re already feeling vulnerable.
Clearly in any society, it’s impossible for people with sensitivities not to be offended by someone who doesn’t get their thing. Often differing groups for differing reasons can become united by their offence of the same thing. That can be comedy gold though it’s also tragically sad when the extremist demonstrates how out of touch they are by failing to see the humour in themselves.
Monty Python’s The Life of Brian worked because it satirised the zealot who continues to build ever more elaborate justifications for their faith to accommodate further inconsistencies and perceived threats to their integrity. That sending up of the thinking of those with blind faith, rather than attacking the faith itself, is generally accepted as being the most effective means of higlighting inconsistencies.
If only it were that easy as rather than suffering a loss of face (or faith), even some moderates can be as determined to cling to their beliefs with as much strength and rigidity as those with a delusional disorder. Still that considered approach does seem the most humane and sensitive way of demonstrating what a tolerant multi-faith and non-faith society is like, rather than being blatantly blasphemous and deliberately intending to offend.
In my work I know all too well that there are a small but real minority of narcissistic, disenfranchised and psychopathic individuals who can be both vulnerable and capable of causing great harm. They may still find targets to attack with their rage; usually its within their relationships and families. Humour is undoubtedly important in a mad world but so is respecting the potential for triggering extreme responses in those who feel threatened and detached (deliberately or otherwise) from the mainstream.
Je suis Joe. Je suis Charlie.
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This blog accompanies a recently published feature, Tall Order, in Umbrella Magazine Issue 11 – Winter 2014/15 , available to buy in print and viewable online. Thanks to Tony and Matt for their support and good luck with taking your vision to the next level.
The year 2014 will be remembered in Glasgow for its successful hosting of the Commonwealth Games and its majority vote in favour of Scottish independence. It was also the year that five of the Red Road flats tower blocks were to be demolished in a ‘gallus’ and baffling “ceremonial demolition” during Glasgow 2014‘s opening ceremony.
Three miles north west of Glasgow city centre, the Red Road flats were once considered part of city’s housing solution to its slum tenements, many of which were cleared for the construction of the M8 motorway that divides the city centre from the West End. Fifty years later, Glasgow 2014, Glasgow City Council and the Scottish Government announced plans for their demolition in a spectacle that would be broadcast to an estimated one billion viewers.
Commenting at the time that the demolition plan was announced, the last Chairman of the Red Road Tenants’ Association attributed such thinking to “politicians and planers [sic] desperate to manufacture new media images of Glasgow… It is appropriate that they will be inked to the Commonwealth Games because they show the city’s rulers are more interested in media constructed stunts while ignoring the real needs of the citizens.”
By the end of 2014, after the demolition plans were dropped in response to public criticism, six of the original eight tower blocks remain standing. Meanwhile one of the tower blocks, continues to provide accommodation for newly arrived asylum seekers and for many of 33 Petershill Drive’s residents, this will be their first home within the UK. Eventually though, like the tower blocks that have gone in the Gorbals, Sighthill and Ibrox, the Red Road flats will disappear from Glasgow’s skyline.
The photographs shown here were taken in September 2013 during the week of Glasgow’s popular Doors Open day. While condemned social housing is not usually included among the buildings that are made accessible to the public, I went along to look more closely at a place that I had previously visited when working with Glasgow’s Homeless Mental Health Team.
Inside one of the vacated buildings, a concierge on duty spotted me with my camera. In a typically Glaswegian way, he invited me inside and allowed me to explore the building’s interior. These photographs have since provided the visuals for a longer written piece on the history and themes involved with Red Road flats that now features in the current issue of Umbrella Magazine.
Postscript: In the week that Umbrella issue 11 was published online, Glasgow Housing Association have announced plans to demolish “the iconic Whitevale and Bluevale high-rise flats in the Gallowgate”; Scotland’s tallest residential multi-storeys buildings. Whether or not lessons were learnt from the PR disaster of the proposed Games ceremonial demolition, on this occasion a ‘TopDownWay’ form of demolition technology “designed for the deconstruction of high-rise structures in close proximity to nearby properties” will be used and is expected to be completed by 2016.
Red Road Flats Cultural Project
Alison Irvine – website for author of This Road is Red
The Bird Man of Red Road – film by Chris Leslie
Red Road Underground – film by Chris Leslie
The Tears that Made the Clyde – book by Carol Craig
Red Road demolition misses mark – Response by Joyce McMillan in the Scotsman
Online petition – successful petition by Carolyn Leckie, change.org
The Road is Red – Photo story and commentary by Urban Realm
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Tags: Commonwealth games, demolition, Glasgow, Glasgow 2014, Greg Neate, high rise flats, neate photos, photography, Red Road flats, Still Standing, Tall Order, tower blocks, Umbrella magazine
The Man Whose Mind Exploded (2013), Documentary film by Toby Amies
Film review published online in Journal of Medical Humanities
This affectionate, unflinching gonzo documentary sees arts and travel presenter Toby Amies expand on his original Radio 4 programme from 2008 with the same title. In doing so and by bringing to screen this portrait of an eccentric, extraordinary man who lacks for short term memory, Amies has created the film that the self-styled Drako Oho Zarhazar was seemingly destined to star in.
With his shaven head, waxed moustache, tattoos and piercings; this caped and croc wearing septuagenarian definitely leaves a lasting visual impression. However, that only hints at what’s inside his cluttered, one bedroom flat, where much of the filming takes place. Here self-penned notes, old letters and homoerotic pornography dangle on countless strings creating a hectic, projected installation of his mind. With these hanging threads, ‘Drako’ remains connected to his past while Amies peers through them in wonder amongst the increasing disorder that surrounds them.
It’s poignant that a younger Drako would have no shortage of material to recount about a colourful life that included associations with the likes of Salvador Dali. Unfortunately, following two life-threatening brain injuries that have shattered his short-term memory, he is unable to recall daily events and only fragments from his recollected past remain. Thus, as well as documenting Drako in his “seventh life” on a Brighton council estate, the film also reveals universal themes about how brain injury can affect and threaten one’s personality and autonomy.
Although Drako insists that he lives “completely in the now”, interviews with his family demonstrate that the former dancer and interior designer can relate meaningfully with those he knows from his past. His sister even observes that whilst changed in character, the “damaged” Drako is more likeable though the family have also accepted that the risk of potential injury remains as constant a personal characteristic as his larger than life persona.
As interesting as The Man Whose Mind Exploded makes as a case study of brain injury, the film goes further by revealing the relationship between the two men. Whether a relationship is possible with an individual who can’t recall someone they’ve met repeatedly is another matter. Drako’s lack of capacity to provide reliable consent also poses ethical challenges for the first-time director beyond what is appropriate to record. These include when might it be necessary to intervene and even seek medical help due to the fluctuating health of his stubborn “star”. These exchanges of respectful but exasperated concern for his friend’s well-being will be familiar to many families and professionals who care for those with faltering cognitive faculties.
“Trust. Absolute. Unconditional” declares Drako as his motto whilst sat on Brighton’s pebbled, naturist beach and which he emphasises by pointing at the words that are permanently inked on his arm. It’s one of many repeated phrases and recollections that preserve his identity and prevent the past from becoming a stranger to him. Moments later that trust is most memorably demonstrated when filmmaker moves away from the camera and appears cheekily in frame to help his disrobed friend with rising to his feet.
Filed under: Film Review | 1 Comment
Tags: brain injury, Brighton, cognitive impairment, Documentary film, Drako Oho Zarhazar, Greg Neate, Journal of Medical Humanities, The Man Whose Mind Exploded, Toby Amies, Trust. Absolute. Unconditional
After nearly two years as a locum consultant psychiatrist within a community mental health team (CMHT) serving a small town and semi-rural area outside of Glasgow, I enter my final week with much still to do. While our catchment area boasts some of Scotland’s best life expectancy figures, there are also pockets of impoverishment that are comparable to the most deprived areas in the city. Naturally its been both demanding and rewarding, with a steep learning curve into Scotland’s culture and its health services included.
Earlier in the week, I chat with a social worker before a Mental Health Tribunal where we will jointly argue for continuing our patient’s detention in hospital. While waiting to be called through, the conversation turns to a former asylum-like hospital for learning disabilities that closed some years ago. For me, rather than anything I directly remember, such institutions have distant connotations that I associate more with the era of black & white photographs in which they are usually depicted.
However, sitting with us is a male nurse who reveals that his training and first appointments were at that hospital. Dressed in NHS scrubs, he recalls with despair the conditions when as recently as the 1990s, patients shared communal clothing unless they were inclined to strip off and wore ‘moleskins’ with unreachable fastens at the back. It’s a vivid reminder that the legacy of the asylums provides the foundation for current services while continuing to cast a shadow for many staff and patients.
Fifty year ago, such institutions provided the best available care, as well as a sense of community, purpose and protection for some patients. Yet, this lack of having one’s own personal belongings emphasises how individual’s boundaries can break down within restrictive institutions, particularly within mental health services. Meanwhile the nurse carries his own daily reminder with enduring back pain after lifting patients without hoisting equipment within large, silo-like wards.
After the tribunal, I’m booked to see a patient who’s had several lengthy hospital admissions when his family couldn’t cope with how he was. Now he lives in his own home, supported by family and daily carers from a mental health support service. Joining me for his review is our team’s health care assistant (HCA), who has known him for many years and sees him most weeks. While its been years since his last hospital admission, right now, the patient is unsure about being able to manage.
Had I met with him alone without notice, I may have felt duty bound (for medical and pragmatic reasons) to increase his medication and consider admission. However, before I can act, my HCA colleague reminds him of how much better he is compared to years before. While he may require more support in the short-term, hopefully admission and the personal disruption this would bring can be avoided. It’s a good example of the benefits of having continuity of staff who can provide grounding and containment to patients who are vulnerable to feeling overwhelmed in a world of change and perceived harm.
Later that day, I meet with a man who often has contact with our crisis resolution team; a dedicated service that provides more frequent support at the patient’s home during periods of stress and is an alternative approach to hospital care. While at times our patient functions well and even cares for others, he can quickly become dramatically unwell and stop taking medication, which in turn characterises how he is viewed by services.
This review was arranged by his independent advocate and we meet with his long-term community psychiatric nurse to discuss his management after my appointment ends. Usually due to his currently stability, he wouldn’t have been a priority and indeed, no change in management is advised. Yet afterwards my nursing colleague observes that after a number of previous reviews with me when the patient was in crisis, it was good that our last meeting occurred when he was well, to confirm and reinforce this with him directly.
Whether north or south of the border, such encounters between psychiatrists and patients as their more ‘normal’ self can be a rare occurrence. In recent years in England, the recognition that consultants carried a disproportionate level of responsibility for patients compared to other non-medical staff, led to developing an enhanced role of ‘keyworkers’, where nurses, social workers and occupational therapists took on a more formal role towards individual patients.
While Scotland’s NHS resists the market-driven and service developments seen in England, I found services in Scotland to be more fixed and authoritarian. That certainly was evident when I reviewed earlier medical records for patients whose care had now passed to me. While that may allow for more clinical autonomy, there can also be a ‘doctor knows best’ approach and a distance towards patients for whom medications are directed. Similarly an equivalent gap can arise between medics and non-medical staff, whose duties may feel directed to following doctor’s orders. While that might seem an attractive service model for doctors, I found myself overwhelmed at times as I observed that it wasn’t consultants who demanded they retained their authority but with whom it often remained by default.
For a newly qualified, English-trained consultant who provides direct, typed summaries to patients that are copied to their GPs and seeks a collaborative approach with colleagues, there followed a number of crossed-wire moments. As time went on, I became more aware of these service gaps but also stuck in my mind about how to improve them.
Whether it’s a tightly restricted asylum or a community institution with a fixed mindset, humanity within such organisations can become inhibited and eroded. I return to Sussex believing I made a positive contribution in shifting both the service and for some of our patient’s personal themes.
Patient details have been changed to protect their identity – GN.
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Tags: asylum, CMHT, Community Mental Health Team, Glasgow, NHS, psychiatry, Scotland
Presentations at the Royal College of Psychiatrists’ Faculty of General Adult Psychiatry Annual Conference; The Midland Hotel, Manchester, 10 – 11 October 2013.
1. Survey Assessing Concordance of Psychotropic Recommendations between a CMHT and the Corresponding Prescription in Primary Care.
2. Survey Assessing Changes in Psychotropic Prescriptions across a Psychiatry Caseload during a series of locum appointments over 20 months.
Conclusions on survey assessing concordance of recommendations and prescriptions
1. The current system within the CMHT for recording psychotropic recommendations was not concordant with primary care prescriptions for nearly 1 in 6 patients.
2. Non-concordance between CMHT and primary care may be exacerbated by frequent short term appointments of medical staff.
Conclusions on survey assessing changes in psychotropic prescriptions during a locum appointment
1. During the 20 months surveyed there was an overall increase in prescribing of psychotropic medications. Reductions in psychotropics were less common and there were no planned withdrawal of medications.
2. This suggests that multiple changes in medical cover are likely to be associated with increased psychotropic prescribing.
3. The findings of this survey maybe of assistance when considering the impact of frequent changes in medical staff on prescribing patterns.
For further information – please contact firstname.lastname@example.org
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Tags: GAP2013, General Adult Psychiatry Annual Conference, locums, Poster Presentations, Prescription Surveys, Scottish CMHT, survey assessing changes in psychotropic prescriptions, survey assessing concordance