When Time Collapses

Mental Health Nursing,  Jul 2005  by Mansfield, Ally

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A unique play written and directed by Polly Wright was recently performed to a packed audience of mental health professionals, service users, carers and local decision makers at the Nuffield Theatre in Southampton. Ally Mansfield took her seat

The play based on true life stories paints a powerful picture of what can go wrong when serious mental illness is not detected at outset. The play was first commissioned in 2002 by consultant psychiatrist Fiona Macmillan and carer/GP David Shiers, to raise awareness with the West Midland NHS trusts and PCTs about the need for early interventions in psychosis. It was hoped that the play would influence their understanding of patient journeys and direct resources to strengthen community psychiatric provision so that it is more fully integrated with primary care, youth and voluntary agencies.

Still relevant three years later, a local carer, whose family went through a similar experience when his son started to develop a psychotic illness, commissioned the play again as he wanted local mental health services in Southampton to better understand the sometimes devastating effect mental illness has on the whole family.

The 50 minute play was followed by an interactive workshop with the audience exploring and addressing the complex issues of intervention in the early onset of psychosis. At the end of the workshop a panel of experts took questions from the audience about the issues raised.

The story tells of Martin, aged 17 and his experiences from the early onset of a psychosis and the parents' distress as they struggle to understand and help their son.

The play depicts the worst case scenario at every turn. A drama that gets straight to the point about what life is like for those directly affected.

The story begins in the family home and while Martin's mother wants to believe her son is just being like any other teenager, she has concerns about the changes in his behaviour and attitude. The mother manages to get Martin to the GP surgery and we see her waiting anxiously outside, powerless, wondering what Martin will tell the doctor and if the doctor will understand.

We watch while the busy GP, missing the diagnosis of early onset psychosis, tries unsuccessfully to find out why Martin has come to see him, his approach actually pushing Martin further from gaining any insight or accepting help. Having given Martin a prescription for anti-depressants, the GP suggests to a bewildered Martin that he return in three weeks. He then dismisses the mother who tries to find out what other help can be given to her son and the family.

Martin is still not linked to any form of specialist follow up, becomes more paranoid and leaves home as the relationship with his father deteriorates. The mother desperately tries to cope as she worries for her son, his lifestyle and his attitude to his father.

On Christmas eve Martin's mother manages to persuade Martin to come home telling him his father is out, however the father returns. Martin, convinced he and his mother are at risk, picks up a knife and first threatens his father and then himself with the knife. In a dramatic climax, he runs from the house leaving the parents no alternative but to call the police. Martin is arrested and then seen in the police station by a social worker and psychiatrist.

The scenes in the police station show how impersonal the process becomes. The boy, alone and frightened, still fearful for his mother's life and with no insight into why he is being held there, is sectioned and removed to a local psychiatric hospital.

The final scenes take us inside the hospital where Martin, lonely and confused, is treated with major tranquillisers and offered little therapy to occupy his days. The staff think Martin is making progress. He no longer says his father is the devil nor that time has collapsed and the world infected with evil viruses. Martin does not seem to think very much at all by this point, clearly suffering side effects from the medication. He appears apathetic and flat, a progress his family find it hard to feel pleased with.

In the closing scene, his CPN, the one person he had engaged with since arriving in hospital, tells him he is leaving the service as he feels overloaded and disillusioned with his job, giving Martin and the family even less hope for the future.

After the play a workshop was introduced to the audience. The technique used was Forum Theatre based on the work of Augusto Boal.

Forum Theatre is a theatrical game in which a problem is shown in an unsolved form, to which the audience is invited to suggest and enact solutions. The problem is always the symptom of an oppression, and generally involves visible oppressors (in this play this includes GPs, consultants, family and society in general) and a protagonist (Martin) who is oppressed. The audience generally are victims of the oppression demonstrated in the performance. Forum theatre is a contest between the actors who want to bring the performance to its original end, in which the oppressed remain beaten, and the audience who want to change the end to break the cycle of oppression. The performance is overseen by a figure known as the 'joker' who makes sure everything runs smoothly and that the audience are aware of the rules.