Dina Poursanidou explores how she used a large collage to express her anger at being physically restrained while sectioned on a psychiatric ward.

I first encountered zines through the Madzines research project in the autumn of 2021 where I discovered that collage is one of the techniques that people often use in zine-making.

I started making collages in 2009 whilst attending START in Manchester, a mental health arts-based project for people with severe and enduring mental health problems. I was referred to START following my discharge from an acute psychiatric ward in North Manchester where I was sectioned under the Mental Health Act 1983/2007 for 3 months (January- April 2009). My sectioning occurred in the context of a very serious and prolonged mental health crisis that lasted for 2 years (2008-2010). My diagnosis at the time of my sectioning was ‘psychotic major depressive disorder’ that was also characterised by persistent suicidal ideation.

Several years after my hospitalisation I requested to see my Mental Health Records and was upset to see how I was portrayed. For example, during the period of my sectioning I was described as “dishevelled, retarded, highly agitated and characterised by suicidal ideation, lethargic and far from mentally alert, incontinent, odorous, occasionally subjected to physical restraint and possibly needing ECT treatment due to treatment-resistant severe psychotic depression”. I subsequently spent many hours working through these records during psychotherapy sessions.

I experienced the physical restraint I was subjected to during my sectioning as physical violence perpetrated by usually five or six members of ward staff who forcibly injected and sedated me with very powerful antipsychotic and tranquilising medication. In hindsight, this was arguably a violation of my right to be free from inhumane and degrading treatment, an absolute right in the context of the UK Human Rights Act 1998 especially as I was not violent or at an immediate a risk to myself or others. Staff could have used de-escalation techniques to deal with my acute agitation instead. According to NICE guidelines, physical restraint must be used only as a last resort and, if it us used, the prone (face down) position must be avoided as it can result in cardiac arrest and even death after as little as 10 minutes.

In hearing about the Madzines project, I was drawn to the idea of making a madzine using collage based on my medical records. Hel (Spandler) suggested that I could cut and paste material from my Mental Health Records and use it to reclaim my story and ‘speak back’ to how I was written about and treated. I met with Hel, Jill (Anderson) and Tamsin (Walker) from the Madzines project in the summer of 2022 to explore this further.

I decided I wanted to focus on an episode of the physical restraint that I experienced when I was under section. However, I learnt that zines are traditionally made using A6 or A7 or A5 size paper and turned into small booklets or mini-zines. I wondered how I could portray my experience of physical restraint in a such a small format, considering the experience involved severe restriction of movement. For me, this brought about an acutely oppressive feeling of being trapped, not being able to move and lacking the space to breathe freely.

I felt that a standard sized mini zine would not be fit for purpose for the context of my experience of physical restraint, as it would afford me limited space to ‘breathe’ so to speak. I was worried that being constrained within the format of a small zine would symbolically re-create my traumatic experience of physical restraint. In order to represent my experience of physical restraint, I felt I needed considerably larger sized paper to allow me to (symbolically) breathe. The Madzines team assured me that there weren’t really any ‘rules’ to making zines, so I decided to produce an unorthodox madzine using collage on A2 card paper.

Following the meeting, I created ‘Fury’, a Mad Zine Collage using a mixture of images and text. I have always felt that images have the potential to effectively capture experiences and emotions which are so traumatic and distressing that they become ineffable through rational discourse. So I used images in my ‘Fury’ collage with this consideration as a guiding principle.

Figure 1

I used the following five main items as focal points in the collage:

At the centre of the collage, I pasted a photocopy of an excerpt from my Mental Health Records covering the period of my sectioning. The excerpt describes an episode of physical restraint and rapid tranquilisation (see Figure 2 below). Rapid tranquilisation is defined by the National Institute for Health and Care Excellence (NICE) as ‘use of medication […] usually intramuscular or, exceptionally, intravenous, if oral medication is not possible or appropriate and urgent sedation with medication is needed’.  Figure 2,below describes an unnecessary and dangerously prolonged 20-minute prone position physical restraint.

Figure 2

Then I put an image of Francis Bacon’s Fury, an anthropomorphic (human-like) creature which is half woman and half snake, on the right-hand side of the collage. This image comes from a larger, 3-part composition by Francis Bacon entitled Three Studies for Figures at the Base of a Crucifixion which depicts three writhing anthropomorphic creatures. I had seen the composition at Bacon’s retrospective exhibition, titled Francis Bacon: Man and Beast, in the Royal Academy of Arts in London in the spring of 2022. The three Furies that inspired Bacon’s composition were creatures from Greco-Roman mythology. As their names suggest, they were personifications of outrage and violent, righteous anger. The creatures were believed to be the goddesses of vengeance who lived in the underworld and ascended to earth to persecute those who had committed murder, and they were often depicted with snakes replacing their hair.

Figure 3

I gave my collage the title ‘Fury’ after these mythological Furies. The title was depicted on the collage in very large red font, below Francis Bacon’s image.

I used the Fury image (depicted in Figure 3 above) as a symbol of my outrage. I felt that it captured my righteous anger at what I experienced as the immense injustice of the prolonged physical restraint I was subjected to which I felt was a violation of my human rights.

I then put an image of Jack Nicholson in the classic film One Flew Over the Cuckoo’s Nest at the bottom of the collage. Nicholson’s character, McMurphy, is arguably the iconic archetype of the mental patient. In this image McMurphy is shown appearing to resist being put in a prone position physical restraint. Like McMurphy, I had strongly resisted the physical restraint. I remember shouting “Let go!” to the nurses who were restraining me. My boyfriend at the time told me after I was discharged that he had overheard from other patients on the ward saying “Six people were trying to restraint Dina yesterday…she was fighting for her life!” I used the image of McMurphy on the collage as a symbol of my resistance to coercion and my longing for freedom.

Figure 4

At the top of the collage, I put a couple of images of Park House, the mental health unit in North Manchester where I had been sectioned and where the restraint mentioned above took place. The images were from a cutting from a local newspaper, which highlighted the poor performance of Park House in terms of patient care quality. I used these images as they corroborated my own experience of the lack of therapeutic care characterising Park House.

Figure 5

At the bottom of the collage, I pasted an image of seclusion /solitary confinement, a common practice in English psychiatric settings. This image brings to mind prisons and incarceration, and so I used it to symbolise the fact that I experienced my sectioning as imprisonment:

Figure 6

In addition to these images, I also pasted text on the collage to help illustrate the broader context of my sectioning and my experience as a mental health service user.

For example, ‘Proud I Stand of Who I Am’ – speaks to the idea of Mad Pride, incorporating the anarchist symbol (capital letter ‘A’ surrounded by a circle) to highlight my resistance to the restraint I was subject to (as well as two attempts I made to escape the psychiatric ward where I was sectioned).

‘Nothing to do with us’ – refers to something that mental health staff often say; for example, that the use of physical restraint and seclusion is merely following legitimised procedures and practices, which often amounts to a denial of personal agency and moral responsibility.

‘For your comfort and safety’ – references the rhetoric put forward in mental health services to justify using restraint, seclusion, and other restrictive/coercive practices supposedly as “a last resort” for the safety of the person and others.

‘Delicious doughnuts’ – was a reference to my acute sugar cravings when I was in hospital due to the powerful anti-psychotic and anti-depressant medication I was prescribed which were harmful for my Crohn’s disease.

It felt very disempowering to be written about in a certain way in my psychiatric hospital records – a description about myself I had no control over. Creating my unorthodox Mad Zine enabled me to take back some control and (re)interpret these descriptions, for myself, creatively and subversively.

Using the excerpt from my Mental Health Records, along with the images and text, helped to encapsulate my experience of such an unnecessary and dangerously prolonged restraint and rapid tranquilisation in the broader context of my sectioning. It helped to demonstrate my outrage/righteous anger at the immense injustice of such an unnecessary and dangerously practice. It also illustrated my resistance to coercion and longing for freedom, set within a backdrop of patient resistance based on the notion of Mad Pride.

Like other zines, my unorthodox mad zine is rough-edged, not neat or ordered. It contains fragments of multiple stories thrown together and doesn’t tell a linear story. There is also an emotional roughness to my collage as it incorporates very difficult, uncomfortable, unsettling themes and images. I found making the zine very unsettling. It has involved a lot of emotional labour, both to make the collage and then reflect on it in order to write about it. Therefore, as well as like zines on the whole being ‘seamful’, my zine also conveyed a kind of emotional seamfulness too.

The process of making my Mad Zine involved remembering and revisiting acutely painful and traumatic memories. Through crafting my Mad Zine I was able to access and represent my outrage and righteous anger, as well as my longing for resistance and freedom. To some degree I found this an empowering and reparative process.

When I was sectioned I fought and resisted the physical restraint for a long time but did not manage to break free. In some ways, resisting and breaking free from the spatial constraints of the traditional zine format to create my Mad Zine symbolised for me a process of symbolically (or psychically) breaking free from the physical restraint itself.

I realised that the sense of outrage and resistance that dominated the collage reflects a more empowered and agentic position than I often occupied. For example, my acutely traumatic experience of sectioning was dominated by feelings of paralysing fear (verging on terror) as well as feelings of immense sadness and grief. These emotions are absent from the collage. In the preceding years after my sectioning experience, I have worked intensively on these feelings in the context of private psychotherapy. However, it was my outrage/righteous anger and longing for resistance and freedom, rather than my feelings of terror and grief, that took centre stage in my collage. This felt strongly reparative, as I was able to access my righteous anger, and thus give expression to a more empowered and agentic position (than I was able to adopt at the time).

I have learnt some valuable lessons from making my unorthodox mad zine, about zines themselves as well as about trying to tell my story through the zine format. First and foremost the traumatic impact of my experience of sectioning and physical restraint portrayed in my mad zine is long-term and has lasted well beyond my discharge from hospital. The image/metaphor of an open wound comes to mind. However, whilst making the mad zine, I was not thinking only about my own individual story of being on the receiving end of coercion in the mental health system.  I was in fact reflecting also on the numerous stories of physical restraint and violence perpetrated on patients by staff on psychiatric wards during psychiatric detention – stories that have an enduring traumatic impact on the respective patients. This illustrates how mad zines can encapsulate both individual and collective mad experiences and knowledge.

Instead of a conclusion, I would like to end this piece with a poem by the late Peter Campbell, survivor poet and activist, from his collection Brown Linoleum, Green Lawns.

Drugtime Cowboy Joe

Nutters get
Compulsory sunsets.
Wall to wall landscaping of the soul.
Always a rugged coast, salt-flecked but liveable.
Always a hero looking west,
Going on about the forward march of science.
You can have your sunsets cloudy bright,
Bright, bright to cloudy or extra bright
With cloudy intervals at intervals
And something special for that tickle
Of psychosis.
You can have them anyway you need.
But always numbing,
Perpetually numbing
And always, everlastingly,
Cold.
Nutters get
To stand at the window, drinking the sunset down,
Tasting no rain.
Feeling the cracks in their spirit
Silt up.
Nutters get compulsory sunsets.
Always start writing back:
Wish we weren’t here.

Dina Poursanidou is a survivor researcher and member of the Asylum magazine editorial group.