In 2000, Dennis O'Donnell was working as an orderly in a geriatrics ward of a large hospital in Scotland when he was approached by the charge nurse of the intensive psychiatric care unit (IPCU), which treated people with depression, bipolar disorder and schizophrenia. A member of staff had proved unsatisfactory and he needed someone to join his team. A man, specifically. He wanted O'Donnell.
"I don't know if I'm the man you want," he told the charge nurse. "I'm not a fighter."
"I don't need fighters," the charge nurse replied. "I need people who can listen."
It took some convincing for O'Donnell to leave behind his job of caring for the elderly; of shaving, dressing and feeding them. He had grown fond of the old men in his ward. But eventually the prospect of a new challenge grew too tempting and O'Donnell accepted. "I thought it would be something different; I thought, 'Don't fester, don't tread water,'" he now recalls. "The clincher was him telling me that I wouldn't be working on 'the shite detail' any more, meaning I would no longer be attending to the elderly's lavatory needs."
It is the seven and a half years that O'Donnell spent in the IPCU that he focuses on in his new book, The Locked Ward: Memoirs of a Psychiatric Orderly. It is not merely a string of tragic and funny anecdotes about working with people suffering from psychiatric illness, but a wider look at the ways in which these patients are treated, society's prejudices against them, how they found themselves there and, above all, a tribute to the individuals he encountered.
O'Donnell, now 60, first became an orderly to make some money one summer when he was a 20-year-old English literature student. With a rather romantic view about life at an asylum ("I thought it would be cool and hip, an absurdist dream," he writes), O'Donnell soon discovered that it was actually a lot of hard graft. Nor was he prepared for dealing with the old men with dementia and the hopeless lives he encountered there. "All the sap, all the goodness, all the hope in their lives, had long ago dried out." Still, he found the work rewarding and grew close to a number of the characters there; there was one who believed he was the King of Egypt, another who would smoke loo paper. One man waited patiently every day for a visit from his daughter that never came.
After graduating, O'Donnell went on to become an English teacher, work he enjoyed until he grew disillusioned with the system and the endless administration it had started to entail. "If I hadn't stopped teaching at that time then I would have ended up in the ward as a patient rather than a member of staff," he now jokes in his naturally jovial tone. So, after 30 years, he decided to return to work as an orderly. "It is fantastically hard work but I wanted to do it again because I had enjoyed it and I felt that I had contributed to something for once," he says.
After agreeing to transfer from the geriatrics ward (or care of the elderly, as it had come to be known) to the IPCU (and been promised that he was not going to end up being used as a punching bag), O'Donnell first had to take part in a control-and-restraint course for five days, which was designed to protect staff from aggression and help to restrain individuals safely. O'Donnell questioned whether he had made the right decision after learning that a nurse had accidentally broken a patient's arm after trying to restrain them. "It is different to what the police do, where you are allowed to put someone in an arm lock until they behave," O'Donnell says. "We had to be very careful not to hurt anyone during a restraint because we weren't restraining people who were bad, we were restraining people who were ill."
Needless to say, life at the IPCU was challenging and he came across men and women with all sorts of illnesses. "I say in the book that there are as many mental illnesses as there are people who suffer from them," O'Donnell says. "And everyone needs to be treated as an individual. In psychiatry there are no textbook cases. Some people on the ward would be very guarded and hostile, which occasionally focused into aggression. Then some were just withdrawn and would rather be left on their own, others would be manic, and some were so normal it was hard to believe there was anything wrong with them at all."
Certainly there was violence. O'Donnell says he never got used to the measure of restraint that he would sometimes have to use against patients. "One of the characteristics of severe psychiatric illness is that very often there is no insight to the condition, so people do not realise that they are ill," he explains. "This is where a lot of the resentment comes from, which can sometimes be channelled into aggression towards doctors and nursing staff. People believe that they are being kept against their will."
However, O'Donnell is keen to stress that it is to themselves that the patients pose the biggest threat. One typical story he relays is of a man with religious mania who bashes his own skull against the basin taps after he sees the Devil in the mirror. This, O'Donnell says, is much more typical behaviour of someone with paranoid schizophrenia than to inflict pain on another person, a misconception he addresses in the book.
"While I was writing the book, there were one or two high-profile cases in the media of paranoid schizophrenics attacking people, sometimes fatally," he says. "It's a very rare occurrence but now the term 'paranoid schizophrenia' is enough to frighten people. Those cases encapsulated people's fear of people with paranoid schizophrenia – that they are unpredictable and violent – and it's an example of how misunderstood that world is."
Unlike working with the elderly, when the only reason for a patient to leave the ward was death, in the IPCU patients being discharged was a positive thing. Though, sadly for many, it was not the last time that O'Donnell would see them. "We called it the revolving-door syndrome: patients would be discharged, integrate back into society, feel they were cured, stop taking their medication and, of course, gradually their condition would deteriorate again. That was common. It was so sad to see them return to the ward; it was probably the hardest part of being there."
To deal with the issue of patient confidentiality, O'Donnell has changed names and altered genders, ages and physical attributes. It was paramount that the book would not lead to anyone being identified. In fact, so committed was O'Donnell to not betraying his patients, he almost didn't write it. In the end, he reasoned that while there were books written by doctors and by sufferers of psychiatric illness, there was little literature by third parties, by orderlies such as himself who helped the patients in their day-to-day lives and who had got to know them and understand them better.
"The greatest lesson I learnt from them was the indomitability of the human spirit," he writes. "Despite suffering from the most hair-raising, sometimes completely incapacitating illnesses, people's determination to rise above the abyss was utterly remarkable."
'The Locked Ward: Memoirs of a Psychiatric Orderly' by Dennis O'Donnell is published by Jonathan Cape; £16.99