We have just spent a week in Belgrade, a city we have visited a few time before, having friends who live there. It is an unnerving experience because we know absolutely no Serbian. And most of the signs are written in cyrillic which makes it impossible for us to even transliterate anything into any kind of latinate equivalent. We stand looking at a street sign and shrug our shoulders hopelessly. The letters have no correspondence to anything we know. We could as well be blind. Which would make life easier in a small way because our “disability” would be obvious. As it is our “disability” is hidden because we appear quite ordinary. The fact that we cannot read the signs is hidden. We walk the streets still living in our English world and viewing everything from an English perspective.We feel embarrassed, grateful, clumsy, humiliated, annoyed. All because we cannot interpret what seems clear to everyone else.
The classic definition of psychosis is that one is out of touch with reality.(The question of whose reality is not asked often enough!) My experience of Belgrade left me questioning this definition.What was I seeing? I saw a jumble of symbols whose meaning I could not understand so I had to try and guess at their message. Sometimes it was easy. A latte has become a near universal European word. Imodium for my stomach ache was much more difficult! Fortunately the pharmacist knew the word and gave me an equivalent-thus saving me from some embarrassing mimes.
I have met many patients over the years who suffered from what we call paranoia. Many of them hear the radio or television talking about them -or to them. One of my patients dismantled as much of his computer as he could to find to try and find the bug he knew his mother had planted there. On another occasion he was certain that his partner had put webcams in their bedroom. He spent a long time searching for them whilst his partner was at work. Another sat watching some war footage, convinced that this was being shown to remind her that this was all her fault.(A psychoanalytic understanding of paranoia sees it as a projecting outwards of our fear of our destructiveneness. I fear my own badness and its consequences so I get rid of it onto the Government, my partner, the television.)
How does paranoia link with my trip to Belgrade? I’m not suggesting the Serbians were out to get me. I am suggesting that we lived in two different worlds, they and us. They were at home. Could see, read and interpret the signs correctly. We saw a different world. One in which we did not feel completely safe. I remember the same feeling in Marrakech only there it was much more pronounced. Once again we were robbed of our normal confidence. In England I understand the currency. I can order a pint of Old Peculiar and know that it is a particular kind of beer that I enjoy. I can offer £5 and know how much change to expect. It is my reality and one that is shared by those around me. I think! (I can’t prove how my fellow drinkers experience the pub. Are the bar staff laughing about me? Does the rest of the pub know about my secret habit? Is that man at the bar going to follow me into the toilet?) In a foreign country one is never entirely comfortable.
My point? Simply that I can only assume that my reality is “real”. My paranoid patient experiences the world in a vey different way to me even though he seems to occupy the same world. Perhaps we should start to re-define psychosis. Rather than suggesting somewhat arrogantly that it is about being out of touch with reality, maybe we should say that it is about being in touch with a different reality.