Fear, confusion and dark humour

Dr Sally Marlow (National Addiction Centre, Institute of Psychiatry, Psychology and Neuroscience, King's College London) watches the play 'Still Ill' at the New Diorama Theatre.

Functional Neurological Disorder (FND) is a disorder where no organic cause can be identified, but the symptoms are catastrophic – seizures, tremors, paralysis and blindness. Informed by extensive research with clinicians and patients, Still Ill gives insight not only into FND itself, but what it feels like to have FND, and the fear and confusion which runs alongside the idea that there may be no physical cause underlying its devastating effects.

The play is a three hander, and motors through at pace. The protagonist Sophie is an actress, who has jobbing work as a patient in medical training for doctors, and who lands a part as a neurologist with a brain tumour in a television medical soap opera. So far, so meta, but this is not just tricksy writing, it also allows the audience to get a sense of our attitudes and our approaches to medicine. We see how diagnosis in particular can become a conveyor belt – as an actress Sophie is on the bed, off the bed; pushing her leg up, pushing her leg down; hearing Hello Sophie, my name is…, Hello Sophie, my name is… There’s little patient centred care here. The actors Harriet Webb and Hamish MacDougall form an endless cast around Sophie of doctors, interspersed with television cast and crew, the latter provoking much laughter from some of the audience, who I guessed were actors themselves.

This play is funny, at times hilarious, but it’s also dark. As Sophie’s FND progresses, the medical caricatures and circus-like processes she encountered as an actress become her day to day. She’s on the bed, off the bed, pushing up and down, becoming increasingly distressed, her symptoms worsening. In a particularly poignant scene the other two characters throw pills, files and hospital detritus over her bed as she becomes more and more agitated, and lost in her illness. Throughout there is immersive, haunting music, performed live on stage, and this accentuates the high emotion which runs through the whole drama. When Sophie sings, or rather shouts, Still Ill (the song of the same name by the Smiths), I find myself in tears. 

Spoiler alert: there’s no happy ending, in fact there isn’t really an ending. I suppose that’s the point. Dr Tim Nicholson, Neuropsychiatry Consultant at the South London and Maudsley NHS Foundation Trust and NIHR clinician scientist advised Kandinsky, the theatre company responsible for the performance. He told me afterwards that the latest meta-analysis suggests some 39 per cent of those with FND are no better or worse seven years after diagnosis. Nor does the play make lazy assumptions about causes – Sophie seems to have suffered little trauma, and according to Tim, patients without traumatic backgrounds are as common as those with.

The play doesn’t quite sustain its momentum in the last third or so, but this is a minor quibble. The best theatre provokes, informs, engages and entertains, and this play does all of these, and more. I know more about FND now, but also more about the experience and the distress of unexplained symptoms. I know more about the strain this can put on family relationships, and how quickly deterioration happens. Thanks to a twist in the very last scene, I also understand that there are many ways of coping in a world which can often be chaotic and hostile, and FND is just one way, no worse and no better than, say, having a drink or two, just different.

Still Ill is a brave play because of the history of sensitivities around illnesses such as FND, which too often in the past have been dismissed under the umbrella and sometime pejorative term 'psychosomatic'. Again, Tim Nicholson had some wise words: the clue is in the disorder’s name. It’s not fake, it’s not physical, it’s functional. 

Still Ill is at the New Diorama Theatre until 27 January, then at the Institute of Psychiatry, Psychology and Neuroscience for one night only on 2 February. 

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