Denis O'Donnell quotes Dylan Thomas in the forward of this memoir: ‘though they go mad they shall be sane; though they sink through the sea, they shall rise again’.
It's an aptly chosen quotation as it reflects O'Donnell's warm, reflective and on the whole positive account of the patients he depicts working with during his years as a psychiatric nursing assistant on the eponymous ward in Scotland.
He describes in detail his seven and a half years in ‘by far the most interesting job I have ever had’ and at the same time informs and educates any lay reader about serious mental illness as well as celebrating the special group of patients he cared for.
As a student in the sixties he had worked as a nursing assistant on an old age psychiatry ward and thirty years later, after a career as an English teacher, he returned first to the old age ward and then to the Psychiatric Intensive Care unit. He is open about his initial reluctance when offered the job, scared of being a ‘punch bag’ but is persuaded by the wonderful sounding ward manger that it's listeners not fighters that are required.
O'Donnell explains in the forward that all characters; both professionals and patients; are amalgams of ones he has encountered; symptoms, names and genders have all been changed. The resulting detailed account certainly rings true and the individuals are described with both wit and compassion. I found myself laughing out loud; not at his descriptions of the patients but at his descriptions of the staff's often extremely funny reactions and interactions.
The PICU professional may not gain much from the explanatory passages but there are clear and easily read descriptions for example of what schizophrenia is and what the treatment options are. The descriptions of patients, whilst composites of ones he encountered, are vividly drawn pictures of ‘typical’ features of the conditions; although of course not typical as each has a character of their own. It strikes me that a student may well remember more easily the symptoms of severe depression by remembering Wayne rather than remembering ICD 10. So whilst not comprehensive and by no means replacing any textbook they are clear, easily understood and add to the value of recommending this book to students interested in a career on PICU.
Whilst not wanting to be a punch bag when joining the ward, O'Donnell goes on to hold back no punches when describing the realities of violence on the ward and the necessity of compulsory treatment for some of the patients; some passages may not be for the faint hearted. The complex links between mental illness and religion is a recurring theme and O'Donnell writes thoughtfully both about this and wider themes such as social understanding of mental illness and about stigma.
The lack of backstory can be frustrating and you are left wondering why he abandoned teaching. Family are mentioned in passing but references to life outside the ward are vague, leaving no clear idea about the impact the work may have had on his life. You do get a measure of the man though; his compassion is obvious as is his dislike of bureaucracy and of authority.
I suspect that if a book this witty and readable was written by a nurse describing their experience on a children's ward, maternity ward or surgical ward (or almost any other type of ward) it would be potentially a huge commercial success with an inevitable tie in Sunday night television series.
The stigma surrounding psychiatric intensive care makes that a less than likely outcome; but it can only be hoped that this humane and entertaining book is read by enough people to start changing a few minds.
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