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by Greg Bottoms
University Of Chicago Press, 2000
Review by Matt Lee on Jan 11th 2002

Angelhead

There are a large and increasing number of personal accounts of schizophrenia, either by schizophrenics themselves or their families and friends and Angelhead is an interesting addition to what has almost become a new genre of writing. It is honest and well written and from the outset Greg Bottoms makes it clear that this is a work of the imagination, an attempt to recover something of the experience that his brother Michael went through and its repercussions on his family.

Greg tells a story that is inevitably reconstructed through his imagination and in so doing enables us to see the schizophrenic reality of insanity in America. His family goes through nearly a decade of bizarre and at times dangerous behaviour from Michael and does not come out of the situation particularly well. Greg tells of the time when Michael's behaviour became so difficult to handle that he was forced to leave home by his mother and father because they thought his problems stemmed from drug use, a decision that is clearly flawed in retrospect. Hindsight, though, is always 20/20 vision and what is more disturbing than the understandable exhaustion of a families resources is the inability of the psychiatric institutions in America to adequately deal with the problem of schizophrenia. One of the main messages that comes when reading Greg's account is the lack of adequate resources and information at a basic level within American society. Despite seeing counsellors and at times displaying clearly psychotic behaviour in public, Michael is never taken under the care of a psychiatrist. Greg's family is left to deal with a situation that is incorrectly diagnosed and morally condemned. Michael is seen as a troublesome and difficult drug using adolescent, a situation that becomes almost inexplicable as the story unfolds. Inexplicable, that is, were it not for the references to having to afford doctors.

It is well documented that America has the highest rates of schizophrenia in the world and yet is not so well noted is the difference in primary level care and intervention available in America as opposed to Europe. In Britain, for example, the diagnosis of schizophrenia involves an ongoing relationship with a psychiatrist. Such a relationship is free at the source of delivery and although by no means perfect this system prevents situations like Michaels from going unnoticed and uncared for. Michael, however, wasn't diagnosed as a schizophrenic until nearly a decade after his first psychotic episodes and so even if the care available to diagnosed schizophrenics may be better in Europe, the question still remains of whether the original diagnosis would have been handled differently. This is a moot point perhaps, but an adolescent who sat in a maths lesson that was not his own, in tears and claiming to having just seen Christ in the hallway would not, I believe, have been sent home without being referred to a psychiatrist for suspected schizophrenia. Unfortunately Michael was treated as an "immoral drug user" and it seems that stereotypes and prejudice were as much contributory factors in his decline as his own mental health issues.

Michael was called "Angelhead" because whilst on acid at fourteen he saw the face of god. Derived from the slang "pothead", the title of the book both illuminates the story Greg is telling and points towards the difficulties in separating aberrant behaviour from mental health problems. Imagine the book being called "Nutter" or "Loony" and the title begins to take on its full social consequence. The boy who sees the face of god is reduced to a social construction, an acid head who hallucinated some bizarre and unfathomable reality that is too far from our own lives to waste time on. Even when psychiatrists tell the family that the religious delusions Michael suffers from are culturally specific, that in a Muslim or Buddhist culture the hallucination would take a different form, this still doesn't prompt any real questioning of the social element of schizophrenia.

Greg?s story is mixed with both innocence and guilt. For him, he says, "Michael literally vanished" after the incident in the school. It was not until he came back from a hellish experience in Orlando that he was sent to see a psychiatrist and eventually diagnosed, a small step forwards since the family was unable to afford private health care and had to rely upon its own inadequate resources. The provision of greater hospitalisation in America is not going to resolve this situation, which is underpinned by economic realities rather than medical needs. The recognition of a social responsibility towards the insane, as well as towards other members of our society that need support, is the only possible route away from such tragedy as we find Greg relating. This involves, in part, a recognition that the family of the schizophrenic does indeed contribute towards the problems faced by the schizophrenic.

The schizoprenogenic ideas that were once popular have been thrown away because they suggest that the family is part of the problem -- nobody, it seems, wants to blame those families. We have to ask ourselves why this is the case. Might it be because American society forces those self-same families to provide the backrock of care? When the family fails there seems to be no further line of defence and families, by their nature, are full of failures. Although never made explicit, one of the implications that can be drawn from Greg's story is that there is a reliance on family responsibility in dealing with schizophrenia in America, despite the fact that it is society that determines the abberant behaviour that leads to the final diagnosis of schizophrenia. Is the burden of care to fall on family or community? This question is posed urgently when reading a book such as this ? and the American community in which this American family live is the greatest absence in Michael's story.

© 2001 Matt Lee

Matt Lee, University Of Sussex (PhD researcher, Philosophy)