In all our sanctuaries we sit at risk

Smoking and the Skills of Love


I believe that in its serious and commendable efforts to protect the Nation’s Health, the State is guilty of an injustice of high order as far as the mental health community is concerned. I would go further and describe this injustice as an abuse of state power, almost a case of bullying.

My complaint concerns psychiatric hospitals across the UK and the suspension this year (2009) of the right of psychiatric in-patients to smoke in their compulsory dwelling-place.

Cut to my own smoking habit. I’m an ex-smoker. In my experience, the best cigarette of the day was the first. And if I could hold on for long eough to get the coffee ready beforehand, the combination of early morning coffee with early morning cigarette was delightful. Nicotine and caffeine – both addictive of course. But for years they helped me launch myself into the day.

As I grew older, my mortality became a bit more real to me. Fear came. My smoking habit became an enemy to be fought.

Time after  time I tried to give up, but always failed. The resultant self-contempt now became part of my smoker’s identity. That went on for well over a year. But finally, at a time of unusual peace and content, and on holiday, I crossed the Rubicon as if it didn’t exist. Easy. Deep breaths. No looking back.

Now let’s cut again and visit the nearest psychiatric hospital.

Unusual peace and content is not what you’ll find there. Nor will you find much free will.  Nowadays, the great majority of psychiatric in-patients will be living as prisoners, held under the provisions of the Mental Health Act, having been assessed as dangerous to themselves or others. They are perhaps the least powerful people in the nation, with less rights than criminals in jail. (For instance, prisoners have a legal right to daily exercise – and prisoners over 18 are allowed to smoke in their cells).

Almost by definition, the patients we will meet here in this hospital are unlikely to understand or accept the reason for their enforced incarceration. All they will know is that the place is strange and feels frightening. Most will be in a psychotic state, ie living as if in a very nasty dream, for days and nights on end, unable to wake. In any human life there could be few lower or more vulnerable times than times spent here.

And on top of all that, the smokers among them are now being told, through their confusion, that smoking in this place is against the law. Not only must you lose your liberty, but your only comfort, too. Now. In these moments, the lowest in your life, when you are at your most fragmented, lost and bewildered, your very self, your sense and experience of who you are – deep in shadow, lost under a stone.  Is this further enforced deprivation a punishment for being mad ? Is being mad still cause for fiercer punishment by Society than commiting a crime ?

Of course, Nurse can escort you outside for a smoke when Nurse is free. But very often the ward is short-staffed and Nurse is tied up for hours on end. Wait patiently. Why are you pacing up and down ? Why aren’t you joining the Art Group ? Sit down. Be good.

I support a group of service users in Westminster. Before this ruling was implemented, we worked with the local Advocacy service to write a letter to the Dept of Health outlining the problems we could predict would follow – above all the undermining of any therapeutic relationship with nursing staff, forced now to become anti-smoking security guards, policing a new boundary ; but also an increase in physical dangers, as people inevitably found ways to smoke clandestinely – in toilets and under bed-clothes.

The reply we received failed to address a single one of our arguments. It just outlined the policy about which we were complaining, as if we didn’t know it. (If only the industrious highly educated civil servants who pour out these meaningless letters knew how seriously each one weakens our democacry and disempowers us all !).

In the year or so since the ban came into effect, all our points have been borne out in practice.

What little effective argument there has been concerning this issue has taken place in the courts and has focused on the definition of what constitutes a person’s “home”. The State accepts that some people will want to smoke in their own homes and have the right to do so. By extension, a prison cell is accepted as standing in lieu of a person’s home. So private individuals and criminals can smoke where they live. But it seems that a hospital does not come under the same category, not even a long-stay hospital. So ill people cannot smoke where they live.

What’s going on here ? I can only think that the categorising mind-set, the planner’s view of the world, , the broad-brush policy-makers, make no distinction between a mental health problem and a physical illness.

In most cases of physical illness, the self, the self-will, the who-I-am and what-I-want-and-need remain intact and whole. I am here. I look around me.

In the cases of mental ill-health, the reality is often very different. I am not I, here. I am not here, here.

As far as I am concerned, to require anyone in this state of bewilderment and disconnection to give up a nicotine habit shows an arrogant insensivity and also ignorance of the human facts of the matter that is utterly astonishing. The requirement is shameful and uncivilised. People still yearn for the impossible dream – that the psychiatric hospital should really some day be a true asylum. Is this the way of getting there ? For some people this ruling has turned the hospital into a torture chamber. In the present moment, as I write this and as you read it, that torture is being experienced by people already distressed,  all over the UK.

It seems to me that here is another example of policy-making in tidy boxes and along straight lines – rather than through responsiveness and care. Slogans go down easier at the end of a hard working day than complex reality can ever do. User Consultation ? Very nice idea. Good slogan. Goes down well. But listen carefully to people, as they tell you about the real harm this top-down policy is doing and distress it’s causing ? Nah. Can’t hear a word. No time. Ban smoking. Very nice idea. Goes down well.

Sometimes there is more madness on the “sane “ side of this fraught frontier that splits the world in two, a more compulsive avoidance of reality, than in any patient on a locked ward.

Rogan Wolf