Defining moment

Clare Allan was an English graduate with dreams and friends until mental illness was diagnosed. She recounts the decade she spent in a system that robbed her of a sense of self
Clare Allan
Clare Allan: 'I'd metamorphosed in a matter of months to an empty shell of a being.' Photograph: David Levene

I clearly remember the first time I heard the term "breakdown" applied to me. I was sitting in a room at the Whittington hospital, at the cheaper end of Islington in north London. In my memory, the room is the size of a hall, the doctor sits at one end and I at the other, and we have to shout to make ourselves heard above the A1 traffic, which roars past under the window. "Do you think you might be having a breakdown?" the doctor yells, and I feel myself blush as I struggle to conceal my relief and adopt a more fitting expression.

This was the first time that I'd ever met a psychiatrist. She seemed scarcely human, a mythical being with my destiny in her hands. I remember, too, my surprise, years later, on returning to see her in that same room, a veteran of the system now with 20 admissions under my arm, a section on my records, and a history the length of the bible, if a lot less poetic.

She was a quietly humorous woman in a small, sterile office that she'd tried to soften - a handmade draught excluder, painted stones for paper weights, pictures (from former patients?) lining the walls. She smiled, an acknowledgment, I felt, of the course my life had taken since that first visit. We sat in silence for maybe a minute, the only sound the hum of traffic beyond the double glazing. "So what happened?" she said.

Dr D was a professional, which is to say I knew nothing about her. I can only speculate as to why she chose, as a consultant psychiatrist, to work instead in psychotherapy. By the time I'd got to see her, passed like a parcel from service to service, she'd had no choice but to pass me on again.

A gregarious English graduate with a half-written novel under my bed and no shortage of dreams or of friends to indulge them, I'd metamorphosed in a matter of months to an empty shell of a being, an automaton who paced the streets, crouching in doorways to fend off pursuers, combing the walls of my flat for bugs, for the cameras that recorded my every move. Fifty minutes once a week with her was not, it was clear, going to cut it. I was passed to a psychiatric day hospital for full-time treatment, Monday to Friday, 9.30am till 4pm. And that's when the music stopped.

The Waterlow Unit (which has now, thank God, closed) was barely 50 yards away, but as you passed through its sliding doors you entered a different world. Up until then, my problems had been a part of me, a troublesome part, but something that, with the right support, I might begin to make sense of and, in understanding, ultimately overcome. Now they became something separate, something diagnosable. The rest of me was irrelevant, and indeed before long it had pretty much ceased to exist.

There are 345 mental and behavioural disorders, according to the World Health Organisation. (The American Psychiatric Association puts it at 284, offering an instant cure to sufferers of the remaining 61 for the price of a transatlantic ticket.) Over the course of my 10 years in the system, I ended up being diagnosed with a respectable proportion.

There's a tendency, rife in some branches of medicine, to sniff at psychiatry for not being scientific enough. Psychiatric disorders don't show up on a scanner; they can't be removed in the operating theatre (though not, it must be said, for lack of trying). Psychiatric disorders can't be proven, and this unsettles the scientist. It unsettles the government as well, which wants concrete statistics on which to base funding decisions. And, for what it's worth, it unsettles the patients, who want to know what they've "got", what's "wrong" with them.

"I know what you're saying, Clare," says a friend when I raise this problem with her on the phone. Cathy and I spent a year together, side by side in the day hospital common room, smoking and drinking tea. "I was always schizoaffective up there; I was never manic depressive till I moved to south London."

I am not suggesting for a second that mental illness is not a reality. Anyone who's crouched all night in a corner, voices rebounding off the walls around them, or lain in bed for six months as their world dissolved or felt compelled to wash their hands 16 hours a day, will attest to the reality of their experience. What I am saying is that human experience - because that's what it is, nothing more, nothing less - can never be filed under neat diagnostic labels. And while diagnoses may serve some sort of purpose in helping doctors to group symptoms together and decide on a course of treatment, they can all too easily become a replacement for genuine understanding.

Many patients cling to their diagnosis. It may have taken them years to achieve, climbing through the ranks of personality disorders, dished out like insults by frustrated senior house officers, to arrive at the ultimate accolade, the one-word explanation of why their lives are irredeemably fucked. They may, as I did, even start to believe that, without their diagnosis, they would cease to exist altogether. Not surprisingly, this makes it very hard to get better.


But some patients do fight being categorised, especially at first. "So if I'm supposed to be schizophrenic, how come I'm not delusional?" One woman would accost the nurses approximately every 15 minutes during the five months we shared a ward together. "How come I don't hear voices?" she'd shout. "Why aren't I paranoid?" I saw her in the park recently, several stones fatter, shuffling along. I hope she's still asking those questions.

For myself, a diagnosis was validating. It was proof that my problems weren't just in my head - or proof that they really were in my head, as opposed to my having imagined them. But it was also limiting, desperately so. My life consisted of sitting in a common room, smoking. My future promised more of the same, and that's how I wanted it. My overriding fear was of being discharged.

When my parents were called in to be told that I was suffering from "a major psychotic illness" and that they needed to "adjust their expectations", I remember feeling slightly taken aback on noticing the tears in my mother's eyes. We stood in the centre of the common room, with its fag-burned carpet and tobacco-stained walls, the dead plant in the corner, the panic alarms. "I just hate to think of you in a place like this." A place like what? I wondered. This was home.

If I had to give a reason for breaking down I would say it was because I could not find a way to exist. There wasn't a place for me in the world. I couldn't envisage a future with me in it. Now here I was being handed one. The relief was palpable. It was years before, with the help of a truly superlative social worker - a social worker who routinely neglected to fill in the diagnosis box on my community care plan forms - I could finally acknowledge that I didn't actually want to spend the rest of my life making wonky tables or listening to my misshapen pots exploding in the occupational therapy kiln.

But a preoccupation with diagnosis is not confined to those within the system. It's the first thing everyone wants to know when they pick up the scent of a psychiatric history. It may not be the first thing they ask - some are too nervous, others too cunning - but invariably it's the diagnosis they're after. "So what did you have? What was wrong with you?" Even though the vast majority wouldn't have a clue what the answer meant in terms of clinical features and symptoms, if indeed it meant anything at all.

The reason for this, I would suggest, comes back to the problem of proof. For just as there's no definitive test, no proof that you're suffering from mental illness, by the self-same token there's no way of proving you're not. It's a problem all too familiar to the heroine of my novel Poppy Shakespeare, who must prove she is sane in order to escape the system that has entrapped her, though a quirk of the benefits system ensures she must first prove she is mad in order to do so.

The line between madness and sanity is necessarily a social construct, and this is something we find very hard to accept. "The second sign of madness is hairs on the palm of your hand," we used to say at school. "What's the first sign?" "Looking for them!" Cue hoots of laughter as the unsuspecting victim thrust her hands back into her pockets.

I don't remember jokes about cancer or heart disease or broken legs. We needed to define the mad to prove to ourselves we were normal. And it seems we still do.

· Clare Allan's novel Poppy Shakespeare is published by Bloomsbury, price £12.99. To order a copy from the Guardian bookshop call 0870 836 0875 or go to

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