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IllnessWrestling with the AngelYou Must Be DreamingYour Voice in My HeadZeldaZor
Dante's Cure is a true
account of Catherine Penney's disintegration into a regressed psychotic state
at age nineteen, her three years in hospital, and her gradual recovery
throughout her adult life. The book is written by her psychiatrist, Daniel
Dorman, who worked with Catherine during her period in hospital, and then
following her discharge, as she rebuilt her life. Dante's Cure is a
story of hope, and a testament to the strength of Catherine's spirit as well as
to Dorman's faith in her, and in his own capacity to engage with her as she
regressed into a childlike stupor, then grew into an autonomous adult.
The story begins in Catherine's adolescence. Against a background of her
stepfather's alcoholism and her mother's apparently passive acceptance of his
drinking and abusive behavior, Catherine becomes first anorexic, and then lost
in an inner world of voices and almost complete loss of a sense of self. Her
school performance deteriorates; she becomes socially isolated, finally
withdrawing into a tortured madness that sees her admitted to hospital. Once
admitted, Catherine regresses further. She pleads to be transferred to a State
hospital, as she sees no future for herself. Death holds a morbid attraction,
and yet Catherine lives, if only because she lacks sufficient agency to take a
final action to end her suffering. She spends three years in hospital, and it is
only when she is transferred to a different facility that she begins to emerge
from her psychic cocoon to see, taste and feel the outside world. In her
descent into hell and her journey out, Dorman is her guide, stripping away the
defenses that prevent her participating in the world as an emancipated adult,
then working with her as she tests out new behaviors; the 'new identity' he
talks to her about as she ventures further into the real world.
The story of her recovery and increasing independence is fraught with
danger and disappointment, but Catherine is tenacious in pursuit of her new
self. She embarks of a series of jobs, relationships, and living arrangements.
She ventures into various forms of spiritual expression. After gaining some
educational qualifications she works as a Psychiatric Technician, and then
undertakes studies in nursing, eventually graduating as a Registered Nurse.
Each step of her recovery is perilous. She is naïve with men, anxious about
sitting exams, and reluctant to assert herself in relationships. At one point
she shares a joint of marijuana, and begins to slip back into a psychotic
state. But her recovery is relentless. Employed as an RN in a psychiatric
facility she finds the strength to resist orders to forcibly medicate and restrain
patients, risking disciplinary action and at one point losing her job. Each
experience presents a new crisis, and Catherine accumulates a formidable range
of skills in the process of facing these challenges. These days she advocates
for the rights of the mentally ill, serves on a number of County Commissions
and gives public lectures on mental health issues. All this is achieved without
any medication, making her story of recovery the more remarkable.
Catherine was diagnosed with schizophrenia, a diagnosis neither she nor
Dorman dispute. She has all the clinical features that support that diagnosis.
She hallucinates, she has delusional ideas, her affect is restricted; she is
unable to function socially. What Dorman does not accept is that such a diagnosis
carries a life sentence of psychotropic medication, limited interpersonal
development, and social exclusion. This is a commitment shared with Catherine,
who in her professional work campaigns against forced medication, especially
the use of medication for the convenience of nursing and medical staff. Dorman
recounts Catherine's experiences of standing up to senior nursing staff who are
too ready to medicate and restrain for the sake of order, often exacerbating
the distress of patients whose cries of protest are interpreted as further
evidence of the need for medication. As a nurse, Catherine practices with the
philosophy learnt as Dorman's patient: the inner world of psychosis is
comprehensible give sufficient willingness to listen and understand.
There are some issues that are not elaborated in Dante's Cure.
One is the model of psychotherapy employed by Dorman. The account in the book
suggests a psychodynamic model, especially in the emphasis given to
interpretations, and on the centrality of the relationship to the therapeutic
process. I would also like to have read something of Catherine's views on the
nursing theorists she undoubtedly came in contact with during her nursing
education. One such theorist, Hildegard Peplau, explicitly disavowed the role of
medication in mental health care, and resisted pressures to include this in her
postgraduate nursing seminars. The focus of Peplau's psychodynamic theory of
nursing, after fifty years still the most widely cited in mental health
nursing, was the therapeutic role of the relationship between nurse and
patient. This theory would have a natural resonance for Catherine Penney, who
in her nursing practice has faced professional pressure to medicate against her
own clinical judgment, and who continues to campaign for a psychotherapeutic
approach to mental health care.
In the final chapter of the book Dorman reviews the field of psychiatry,
aiming particular criticisms at the reductionist biological thinking that
underpins much current thinking and research. Readers will find in this chapter
an exposition of Dorman's views of medical psychiatry, if not the sort of
careful analysis found in the more academic critiques of psychiatric theory.
The question of compulsory care is raised at various points in the earlier chapters,
but the final overview does not set out a position on this issue.
Dorman's focus is always on the search for meaning and understanding,
and on the development of relationships as a means of healing. In his view,
relationships have taken second place to biological treatments, to the
detriment of patient care. As a case study in persistence in pursuit of an
ideal, and in its results in the recovery of a human soul, Dante's Cure
is an essential read for anyone involved in mental health care. Professionals
will find it a healthy corrective to any tendency to skepticism about recovery
from schizophrenia, families will benefit from its compassionate respect for
the human frailties of parents and siblings, users of mental health services
will find its message of hope inspiring.
© 2004 Tony O'Brien
Tony O'Brien M Phil., Lecturer,
Mental Health Nursing, University of Auckland