This radical volume appeared while I was an SHO. My main mentors at the time were Sir Martin Roth and German Berrios. Aliens and Alienists provided a very different, and quite heady, perspective for an easily influenced young trainee like me, who saw himself working steadily towards a distant goal of biological erudition. Long before Sir Robin Murray's group's seminal work on the complex links between cannabis and schizophrenia, it provided a measured discussion of the inter-relationships between Rastafarianism, cannabis, the experience of immigration and racial abuse, and the development of disturbed behaviour. More fundamentally, it encouraged psychiatrists to listen carefully to individual patients and to think about how their behaviour might reflect their past experiences, as well as being a manifestation of a genetic or neurochemical abnormality. This was of course fully in keeping with the post-Kraepelinian emphasis on phenomenology which was the common ground for Roth and Berrios and which made the discussions at their joint ward rounds so enthralling.
As I re-read my well-thumbed and somewhat foxed blue-spined Penguin edition of Aliens and Alienists in preparation for writing this reflection, I was reminded of a particular patient I saw at about that time. She was a member of a charismatic church, and had been admitted in a very excitable state, seemed grandiose and disinhibited and, most importantly, speaking in tongues. Was she manic or was this acceptable behaviour within her religious grouping? After a lot of discussion within the multidisciplinary team, it was decided that I should speak to her Church pastor. He came and visited, and within a few minutes said with great confidence that she was severely ill. She responded well to treatment for her bipolar disorder while retaining her faith and her occasional ability to speak in tongues.
I was privileged to work with one of the book's authors, Roland Littlewood. Unlike the rest of us he was a real academic, whose research consisted of field work in faraway countries rather than the completion of rating scales and taking of blood samples that preoccupied the rest of us. But the main memory I retain of Roland's contribution is his remarkable storytelling skills, which brought to life societies and individuals very different to those I saw in clinical practice in Essex. It is this storytelling which is, to my mind, the most enduring aspect of Aliens and Alienists. The case vignettes Littlewood and Lipsedge provide are short, but they are as vivid as Alice Munro short stories and provide a vivid underpinning to what would otherwise be quite dry social and anthropological analysis.
My own psychiatric journey has not been entirely straightforward. My commitment to the subject stemmed from a fascination with Freudian analysis from my university years, but my early research was purely biological. I spent most of my career in old age psychiatry and have now found a new ‘home’ working with asylum seekers who have survived torture and other human rights abuses. It is in this new home at the Helen Bamber Foundation (www.helenbamber.org) that the relevance of Aliens and Alienists has been brought home to me most forcefully. One of the most important tasks is, in Helen Bamber's words, to ‘bear witness’, to listen to the survivor's story. The perspective Littlewood and Lipsedge provide, with its emphasis on imagining and recreating the lived experience of people, has proved invaluable in helping me to give them space to tell their story, and to try not to impose my own cultural perspective on what they say.
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