Society's Invisible Workforce

Sam Mills, The Fragments of my Father: A memoir of madness, love and being a carer

4th Estate, 416pp, £16.99, ISBN 9780008300586

reviewed by Matthew Turner

Along with shouldering the burden of mortality on a daily basis, doctors regularly report psychological hardship associated with conducting procedures they know might not make a patient ‘well’ again and may not even improve their quality of life — that grey area between matters of life and death. However, a lesser told story, one perhaps with more ethical indeterminacy, is of those thousands that care for sick relatives and friends, without knowing if their actions are ameliorative. Arguably society’s most invisible workforce, maybe even to themselves, carers deal with trauma, grief and financial hardship usually without knowing what the end result may be. In her memoir Sam Mills forms these issues into fragments before attempting to piece them together into a new whole, for the reader while also for her own self and well-being. She wants, most of all, to know what it means to be a good carer.

The book begins with bleeding knuckles banging on a door, a noise which in various guises ominously drums throughout the recollections. Next there are jerks and disturbing mechanical movements. Mills’ father is ill and has locked himself in the toilet. He has a rare form of catatonic schizophrenia — ‘his mind and body have said goodbye to each other’ — and she struggles to recognise him as her father. In an unmoored panic she reaches for a discarded card with the words ‘Emergency Mental Health Support Line’ printed on it in red letters. Once on the phone she talks to the first of a long line of transient support staff, that care for her when nobody else is able to. And it’s here that other problems begin to surface.

On these calls she describes being asked if she's his carer, and replies ‘No, I’m his daughter.’ because the term carer feels too ‘clinical’. Continually unsure of her role, this lack of resolution bleeds into her other relationships: with her mother, boyfriend and even her own writing. These erosions of self are consonant with her father’s condition; as her ‘edges dissolve’ and she feels herself ‘becoming abstract’. There may be ruins and fragments, but being a carer also emits subtle and pervasive forms of camouflage that conceal the once familiar outlines of mental states and blur the shapes of relationships that normally bolster and ground reality.

Mills’ writing is not mawkish. Serious and life-changing topics are written about in an informally charming way, intercut with moments of subtle dark humour. Her father’s fingers trembling on an armchair becomes ‘an instrument he [is] learning to play.’ She imagines with great relief ‘trumpets blasting’ and ‘violins and cellos swelling to vehement crescendo’ as he consults his shopping list on their first trip to Tesco Express after his release from a psychiatric hospital. The book is not fitful like many of the scenes it depicts; it has the meditative clarity of a person who has come to terms with themselves and the environment around them.

Mills bypasses self-absorption by being careful to situate her own circumstances in a wider context. The negative perceptions of her Father’s illness and the lack of support, both financial and emotional, for carers is framed as being part of a borderless disaster, without beginning or end. Emanating from what is now a regular occurrence of saddling individual citizens with the problems caused by state negligence. When not busy penning virulent hate speech, in 1961 Enoch Powell was working towards ‘the elimination of by far the greater part of the country’s mental hospitals’. His programme of ‘care in the community’ meant families were encouraged to look after their loved ones regardless of their circumstances. Mills highlights that this currently saves the country billions of pounds, and while the government have regularly praised carers, their words don't translate into ‘real financial support’. These sections bring home the ways in which the ‘unglamorous’ role of the carer is so undervalued and without status that it often leads to increased poverty and more psychological ailments rather than solutions. Which in turn has echoes of the same governmental derelictions of duty that allowed serial killers such as Harold Shipman to be so prolific. (Shipman would tell his elderly patients hospital horror stories so he could treat them at home.)

The process of writing may be schizophrenic, at the same time as requiring great doses of empathy, attention to detail, observation and a pragmatism that can pull simultaneously conflicting ideas into a cohesive narrative. Mills regularly equates it with being a carer, and as she writes her world into focus turns to other literary carers for assistance. There is Virginia Woolf's carer, Leonard, who, with his obsessive attachment to administration, ‘which he regarded as “the most precious flower and fruit” of civilisation’ is shown to have micromanaged Virginia’s illness, to keep her out of hospital so he could continue to nurture her writing at home. A control that may appear as passive aggression, but it gives Virginia the borders she needed: ‘one’s personality seems to echo out across space, when he's not there to enclose all one’s vibrations’.

Conversely, there is the way in which F. Scott Fitzgerald cared for his wife Zelda — though ‘dealt with’ may be more appropriate. He does pay for her to stay in an expensive sanatorium, yet when she tries to write about her own experiences of madness, he decides to enlist the biases of her doctors — women are mad unless doing as they are told — so he can take ownership of her story, eventually using it for Nicole Diver in Tender is the Night. While the Woolf’s maintained autonomous to write their own stories of illness, F. Scott Fitzgerald’s macho pursuit of his wife’s grand narrative eventually plunged them both into mental illness. Summarised by Mills with the anecdote of Jung assessing Joyce and his schizophrenic daughter: ‘they were like two people going to the bottom of a river, “one falling and the other diving”’.

The line between madness and sanity in these case studies is consistently ultra fine, just as it is for Mills when her father’s condition slips into repetitively exhausting cycles and, without end in sight, her body’s ability to deal with them begins to disintegrate. Despite our inclination towards binary definitions she reminds us that regardless of what we might like to think, we are all close to madness. Read the list of schizophrenic symptoms, particularly ‘Unpredictable behaviour’, ‘Loss of Concentration’ and ‘Socially withdrawn’, and they seem a dilution of the realties we endure every day. She concludes this thread in a captivating riff on why, if it’s such a problem for humanity, evolution hasn't purged schizophrenia from the gene pool. It’s because we need it: ‘in order for society to move forward, we need innovation, and with innovators there comes a little madness.’ Capitalism is at peace with madness, providing it’s sufficiently profitable.

The ending of the book is not dramatic. Everything settles momentarily into place with a tension that it could be shaken up again at any moment. A mysteriously distant presence throughout, a fellow famous author named only as ‘Z’, reveals himself to have been devoted all along. Her father is happy in his insular routine which enables him to show glimmers of paternal affection for Mills in place of a more definitive thank you. The Fragments of my Father asks fundamental questions about what it means to love in the 21st century. There are no definitive cures, or equations for being the perfect carer; only the realisation that to be a good carer, and to have a mental illness, is an intensification of what it means to be resolutely human.

Matthew Turner teaches at Chelsea College of Arts and is assistant editor of LOBBY magazine.