Recession, depression and the story of three Christs

THERE’S no shortage of evidence that mental illness rises in a recession. Suicides, too. Seven out of eight are men, the majority of those young men. "He killed himself," we say, and if we’re lucky the coroner declares that he took his life "while the balance of his mind was disturbed".

At the beginning of last week, a lad I knew "killed himself", as they say.

A good boy. Just twenty-one years old. His girlfriend broke up with him a few weeks ago and he seemed to feel there was nothing left to live for.

After an agonising preparatory phase, he checked into a hotel, spent a day or two turning it over in his poor damaged mind, put on his pyjamas, cleaned his teeth, wrote a makeshift will, funeral wishes, a letter to the girlfriend and one to his parents, sent a delayed text to the ambulance service so that the chambermaid didn’t have to find him, plugged in his earphones and left the planet. He chose the most humane, painless and efficient means. I’ll not say what it was.

You might say he took a permanent solution to a temporary problem. But you might be wrong. A traditional analyst might say that his ego boundaries had completely broken down. There was no longer 'him' and 'her', just 'him-and-her', and when she’d gone he, to himself, ceased to exist. Everything that followed was just a terrible sort of tidying up. He was that sort of a fellow. A good boy.

Yet he didn’t kill himself at all. He was killed by a common, progressive, relentless and lethal disease, with a higher mortality rate than lung cancer.

Nobody knows where mental illness - schizophrenia, depression, who knows now, and anyway it's too late -  comes from, or who - and how - it will strike. But it killed him as surely as a heart attack or a runaway truck. By the time he took that final step into the unknown, there was no real, robust 'self' left. And I imagine that, right at the end, he had some peace of mind.

I knew him, but I knew his father and mother better. Someone wrote in one of the Oxford Clinical Handbooks that much of medicine consists in making sure death occurs in the right order. For a parent to bury a child is the wrong order. Monstrously wrong.

There used to be a tradition of clinical writing that placed the human being first. It died away in the 1950s, to be replaced by the strange, jargon-laden, affectless prose of contemporary science-writing, where human narrative is driven to the very edge of the picture in the pursuit of statistical precision. Any statistician will tell you: never argue from a sample of one. And so the individual disappears.

Yet reading The Three Christs of Ypsilanti by Milton Rokeach, an American psychiatrist at Ypsilanti State Hospital, Michigan, it’s hard not to feel that we’ve lost something profoundly humane in clinical writing - perhaps, even, in our writing about humanity in general.

The three Christs were Clyde Benson, Joseph Cassel and Leon Gabor. All inmates of Ypsilanti, and each of them believing himself to be Christ.

Psychiatrists refer to "delusional systems" because it’s accurate. Delusions aren’t just random; they are almost invariably keyed to some misconception about the individual’s place in the world. Unearth that misconception and the delusions become reasonable. A man who hides in the corner, convinced that he will be skinned and eaten if he emerges, is mad. A man who genuinely believes he is a ripe orange would be mad to do otherwise. The delusion is systematic.

Milton Rokeach believed that there was much to be learned if these three men could be brought together regularly. There could (he reasoned) only be one Christ, so they would have to come to some accommodation as to which of them it was, and who the other two were.

The resulting meetings, held over two years, told a very different story. The book, now reissued by the New York Review of Books, was originally published in 1964. In 1981, Rokeach published an Afterword effectively admitting that there were not three, but four, delusions confronting each other in Ypsilanti: the three Christs, and the doctor who believed himself able, God-like, to try and re-cast their lives.

We will continue to go mad, and more of us will go mad, and possibly madder, when the world turns harsh. Suicide, like my young friend’s, will always have an allure when things have gone too far for the poor anguished brain to see any way of going on and it yearns only for the wings of a dove, to fly away and be at rest.

Most of us are lucky enough to crank along through life with nothing too awful happening. But we all know someone who has been struck, sometimes catastrophically, by mental illness. Perhaps if we read, and if doctors wrote, more case histories like The Three Christs, we might be more aware of the slender cord that keeps us anchored.

• The Three Christs of Ypsilanti by Milton Rokeach, New York Review of Books. ISBN 978-1-59017-384-8 ·