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Approaching Delirium was a complicated experience. The things that made it appealing were the same things that made it hard to start: I wasn’t entirely sure how it would work, practically; I knew it would be complicated, and would involve time and focus; and I knew it would force me to look at fundamental, difficult things about life and death. And on a simple level – knowing how important the subject was – I didn’t want to do it badly.

In 2009 I finished working on a project called Transplant; it was a collaboration between photographer Tim Wainwright and sound artist John Wynne – an exhibition, book and DVD based on an 18-month residency at Harefield Hospital. Amongst other things, in my own role as arts manager at the hospital I had helped the artists with some of their interviews. I was profoundly struck by people’s experiences of intensive care – in particular their hallucinations. Not just by the content, of which more later, but by the fact that the hallucinations – in a situation where people were incredibly unwell, dealing with pain of all kinds – were the thing that people most remembered and were most disturbed by. I was haunted by the voice of one of the interviewees, normally a very voluble, chatty, open person, saying ‘ITU …is a place best forgotten’.

I registered the subject as something I wanted to return to some day. In the meantime I carried on with my double-life, as a songwriter on evenings and weekends and an arts manager for the NHS during the week, until three years later the idea became an opportunity to bring the two halves of my life together.

Having received some funding from the PRS for Music Foundation through a scheme called Women Make Music (designed to right the balance between male and female composers), I wrote to the Intensive Care Society and was fortunately introduced to Matt Wiltshire – who introduced me to the Reading ICU Support Group late in 2012.

In the meantime I had been developing a blog, trying to understand both the clinical perspective on hallucinations and the place they have held in various cultures. I was especially struck on a visit to South Africa by a video about San tribespeople, and the dance-induced hallucinations of the sangoma (traditional healer) – which act as a kind of safety valve for the rest of the community: crudely put, the sangoma regularly and ritualistically undertakes dangerous (hallucinatory) journeys between this world and the next for the health of his community and individuals within it. This is not an uncommon idea – mystics from Joan of Arc to William Blake could be said to have performed similar social functions. Hallucinations have at various times and in various places indicated power and insight – what Oliver Sacks calls a ‘privileged state of consciousness’ – in those who experience them.

Now, in the über-rational west, we have no easy cultural architecture within which to hold hallucinations. But based on the stories I have heard, I have no doubt that intensive care, too, induces insight into the most central questions of life, whether we would want it or not. Many stories and images also reflect a sangoma-like limbo between life and death; some seem to mirror ancient myths (underground rivers like the Styx), some are simpler symbols (coffins, cliff-edges), some conflate the dead and the living (nurses walking around as skeletons).

‘Insight’ is a pertinent term, containing the notion of looking into something else, but also into oneself. This seems to me to characterise many ITU hallucinations –a collage of external images, some real and some imagined, which represent what is happening inside.

One of the most striking images of all the interviews was that of the projector. I came back to this idea repeatedly. I can hear Matt’s voice now, saying ‘I was the one that was controlling the film’. He wasn’t sure whether he was the projector or the projectionist. But either way I wonder whether this is central to delirious hallucination. Our experience is the film; our systems of understanding are the projector; what results are the images on the screen – the hallucination. Or more broadly, how we see the world.

Thanks to the generosity of the ICU group, as well as others outside it, I began speaking to people in the miserable weather of early 2013. As I transcribed the interviews, things began to fall into obvious groups. There were clear echoes between one experience and another – themes which manifested themselves in different ways. These themes ultimately formed the basis for Delirium’s songs. Amongst these were losing one’s voice; losing control; the experience of time as a kind of eternity; being attacked or persecuted by people; and the sheer power of the hallucinations, the way they live as memories of reality rather memories of dreams: two defining characteristics seem to be clarity of recall and the (perhaps resulting) confusion between objective, visible ‘reality’ and personal experience: ‘Still today I don’t know whether some things actually happened or whether it was my delirium.’ ‘They’re clear as day. …I couldn’t tell you about what I’ve dreamt in the last month but I could draw you a picture of what that experience was like being in hospital’. ‘What the patient is experiencing – that is their reality, even though objectively looking in it isn’t, it actually is’.

Some songs, like Dreams or Control, clearly reference these themes – while some approach them through the story of one person’s hallucination: Cortege, for example, focuses on one person’s images, all of which seem to speak of hubris, the futility of ambition and human vanity. Fairies, on the other hand, is about healing ‘guardians’ of a sort – creatures who looked after the subject of the song when his family was unable to visit. Some perhaps leave more space for the listener to come to their own conclusions. And some I hope hint at the vitality, strength and humour of the people who have been through this experience.

Delirium was first performed in London’s Old Operating Theatre in June 2013 with two brilliant musical collaborators – Quinta (playing musical saw and viola) and Christopher Reed (guitar, percussion). I was thrilled that many of the participants could come, and even more that they liked the work and felt it reflected something of their experience. Since then we have performed it at Green Man Festival, at Death Talking to Delirium, Manchester Metropolitan University, and at the International Conference of Culture Health & Wellbeing in Bristol. I am delighted that on 31st October we will perform again at the Vortex in Dalston (east London), and on 29th November we will be taking it to the Trainees and New Consultants Liaison Psychiatry Annual Conference in London, with a discussion panel.

The process of making the work, and its ongoing life, has shifted many things for me, both musically and – without wanting to sound too pretentious – philosophically. Some basic assumptions have been challenged and have resolved themselves into a new form… But the same questions remain about how we care for people, what we consider to be wellness, and how – alongside the amazing work of the ICU follow-up team at Royal Berkshire and many other clinicians – we might challenge the still-pervasive model of treating the body like a machine. As Melanie says in her interview, ‘you can sedate the body, but you can’t sedate the soul.’

Please feel free to comment on this blog, I would welcome your thoughts and responses. Bombs dots

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