There are two principal ways of understanding mental illness, from the outside or from the inside. There is no physical test – no brain scan, no genetic read-out, nothing in the blood – that will identify whether someone has schizophrenia, bipolar disorder or depression. These are diagnoses established through behaviour and experience, as reported by the patient, or by others who know the patient. The psychiatrist's job is to identify a cluster of symptoms that point to a generic, underlying illness in order to suggest options for treatment. However caring and therapeutically engaged, the physician must regard the illness principally from the outside.
For the patient, of course, the opposite is true. Though he may be psychiatrically literate and capable of theoretical investigation of his condition, he will principally understand the illness subjectively, from the inside, as a struggle to be in the world.
But what about the spouse, or the sibling, or the parent – the intimate other seeking objective treatment for the loved one, yet also required to understand the mental torment of the illness as an experience in which they are subjectively implicated? That familial relationship – a state of being at once outside and inside of madness – is the least classified or understood in the history of medical psychiatry.
The first thing to say about Patrick Cockburn, as he tells the story of his son's acute and terrible schizophrenic illness, is that he is a very good reporter. A veteran war correspondent (most particularly in Iraq), he knows how to describe human suffering and to weigh the conflicting and often equally unreliable claims of perpetrators and victims.
It is no exaggeration to say that the job of writing about his son Henry's descent into madness is the toughest assignment of Cockburn's career. He openly admits that, until Henry's first psychotic breakdown in 2002, he had scarcely given a thought to mental illness, an area in which issues of interpretation and policy are as riddled with ideological baggage and theoretical complexity as any zone of political conflict. So he set about doing what a good reporter does. He conducted his research, he talked to the key people, he considered the various arguments and, in the resulting book, he attempts to synthesise these into a clear picture for readers whom he assumes will need informing just as he did.
The result is as good a primer into the current state of the psychiatric world as you will find. In plain, elegant prose, Cockburn walks the reader through what it means to be diagnosed with schizophrenia, the dilemmas of psychiatric classifications, the history of disorders and their treatments, and the current muddle of law and policy in mental health services. And he turns a nicely sceptical ear to medical scientists, politicians and mental health campaigners alike.
In one passage of delightful distillation, he exposes the paradox of those arguing to reduce "stigma" over mental illness, as if a bit more progressive empathy would somehow make insanity less frightening. "Fear of those believed to be insane was one reason the Victorians allocated so many resources to building mental asylums," he writes. It's a striking point, one he stumbled on while desperately searching for a hospital that could actually contain his son, who has an unerring gift for escape, and an irrepressible urge to run naked through frozen woods and rivers.
Yet this is only incidentally a book about psychiatry. Far more fundamentally, it is the story of a profoundly riven but deeply loving relationship between a father and a son. I have myself seen this happen at close quarters. Like Henry, my brother had a major psychotic break as a young man which led to years of living on the precipice between incarceration and extinction, and I also watched as my father, like Patrick, learned to accommodate and understand and finally even grow through the extraordinary, agonised delusional worlds inhabited by his son. I read this book, page by page, with a heart-thumping sense of recognition.
Because what makes it really special is the interspersing of Patrick's account with Henry's own. You hear the parent's version of watching his son embark on a journey into another world – talking to the trees, possessed of Biblical visions and torments, incarcerated and drugged – and then you hear the account from the ground.
And if there is a more lucid contemporary rendition of the experience of fully florid, schizophrenic psychosis than Henry's short, precise chapters in this book, I have not come across it. What makes Henry's writing so remarkable is that he remembers with precision both real events and the delusional ones that accompanied them. And, should you doubt a particular recollection, you need only cross-reference with his reporter-father's account of the same events.
Henry both believes in the reality of his hallucinations and, at the same time, recognises that they are his own confabulations. His schizophrenic universe is not merely a conjuring trick of gibberish. It interconnects with real events in a powerful and moving way, so that even the mad ditties and rhymes he invents have real-world sources. "Through and through and on to Peru/ Through every taboo and on to Peru," he chants. It could be one of Edith Sitwell's nonsense jingles, and yet it just so happens that Henry really had been to Peru for his cousin's wedding.
"I didn't think of it as an illness, but as an awakening," Henry writes. "I thought there was another side to the world I hadn't seen before." His mother, Jan – whose journal entries from periods of her son's illness are also included here – is the one who fully understands why Henry refuses medication. He resists the anti-psychotics, she says, "because he feels he is defending his whole identity and integrity and taking the drugs means that everything he thinks is wrong."
Yet, by the same token, neither parent is under any illusion about Henry's lack of remorse for the suffering he causes them, or even the hypocrisies of his illness. Happily admitting that he was routinely stoned as a teenager – cannabis being by far the most likely trigger for his illness – Henry blithely explains his resistance to anti-psychotic drugs: "I didn't agree with taking substances that would affect my mind."
This is truly an account of living with schizophrenia from the outside and the inside. It is a dispatch from the ultimate domestic war zone, a journal of suffering, a guide for others in similar distress, and a work of literary power. And the final paradox of Henry's Demons is that, even though there can never be a complete return from the farthest shores of madness, to lose a son (or brother) in this way entails not only regret and sorrow. By the end, one feels that Patrick has achieved stature and human dimensions through his struggle to reclaim Henry, and that Henry's illness has brought them both to a depth of filial understanding that – though they would never have chosen this path – they could not otherwise have known.
