How creativity can be a lifesaver in psychiatric care

Last autumn, Constance Keane desperately wanted to die. She’d exhausted herself by working two jobs, splitting her time between Dublin and Belfast, when a traumatic personal incident triggered a breakdown.

The 24-year-old musician couldn’t sleep, terrified of facing another day. Anxiety had been something Constance struggled with for years, but this was different. It was like a switch had been flicked inside her head. Convinced that she’d become “a plague that the world needed to be rid of”, the impulse to take her own life felt overwhelming.

After several trips to the emergency room of her local hospital, Constance spent six weeks at a mental health facility in Dublin. It was not what she expected. That safe space provided opportunities not only to reflect and regain perspective, but to tap back into what she’s good at: creativity.

Since 2012, Constance has been performing as Fears: a one-woman musical project that’s written, recorded and produced in her bedroom. Previously, as a member of post-punk band M(h)aol, she explored issues like feminism and animal welfare through music. Now her experiences with mental health are inspiring a new album due later this year.

While in hospital, she wrote and recorded new single ‘h_always’ in the facility’s music room – an outlet that proved vital to her recovery. Six months on, Constance hopes its release can spark conversation around the stigma of hospitalisation while highlighting the importance of creative resources in mental health facilities.

I struggled with anxiety from an early age but, when I was kid, there was no way to verbalise it. I’d never even heard the word ‘anxiety’, so I just thought it was normal for everyone. How and when did you realise something wasn’t quite right?
I didn’t realise I had anxiety until I started getting panic attacks as a teenager. I’d had feelings of unease and dread for a while, but the first one came at an Enter Shikari concert when I was 15.

I felt really dizzy and nauseous, so I went up to the bouncers saying, ‘I’m sick. Is there a paramedic or something?’ They thought I was drunk, of course. But I didn’t drink at all and hardly do to this day.

Afterwards, since there were no physical problems, I was able to identify it as a panic attack. That made me realise that all the dread I felt, all the stress in social situations, wasn’t actually normal.

Were you able to find ways of managing that?
Yeah, I’ve had the same psychotherapist since the age of 16 and she is the absolute best. My top tip is to have a therapist who you get on with and who has a chance to get to know you. That way if things ever get really bad, they will have a reference point for what you’re normally like.

The anxiety can come in phases; there are months that are worse and months where you’re okay, depending on what’s happening in your life, but I’ve always had her to fall back on. I’ve also done some CBT [Cognitive Behavioural Therapy], which I find really useful for managing day-to-day life. If there are certain places you’ve been avoiding, it’s helpful in building back up the confidence to face them.

This new song you’re releasing was inspired by a particular incident. What can you tell me about it?
Something traumatic happened – a relationship thing. I can’t really get into it because it’s ongoing and there are other people involved… but my response to the situation was to blame everything on myself to an irrational degree.

Obviously, it’s not possible that everything could be one person’s fault. But within a few minutes, I basically transformed into someone unrecognisable and became acutely suicidal. That lasted for almost a month before I even got into a psychiatric hospital.

I went to A&E [accident and emergency] three different times and they wouldn’t admit me. They tried to put me into a day programme but I was basically trying to die every day, so it didn’t make sense to go to a day programme – I probably would have tried to kill myself at lunchtime.

I had entered another dimension, essentially, where I thought I was the worst thing that ever existed. I needed to get rid of myself because the world would not be okay with me in it.

The hospital said if I was in a manic spell or bipolar or something they would admit me, but because I was dealing with trauma response, the best thing for me was to just be at home. I still don’t agree with that.

You say that you transformed into someone unrecognisable. But were you able to register the difference yourself?
Yes. I didn’t know who I was. I’m a very driven, determined person and unfortunately those traits began to focus solely on the idea of getting rid of myself. I couldn’t see the positive side of anything.

I was on a direct track to a secure destination which, in my head, was death. There was no other option. That’s very scary if you’ve never had that thought before: to go from never considering suicide to it being the only thing that goes through your mind. You can’t recognise yourself when you’re in that state. I was completely lost.

I can’t imagine what that’s like. I feel as though the one thing that would stop me from considering suicide is the hurt it would cause my family, but I suppose when you’re actually in that position you can’t think clearly in those terms…
Yeah, exactly. You think that you know better. People are telling you that it would hurt them and that it would be awful to lose you, but instead you think you’re doing them a favour; that they’d be much better off without you.

When I was in that state, at home for nearly a month, I needed 24-hour supervision. All the blades and harsh chemicals were removed. You can see how much of a burden you’re putting on everyone around you, so that only adds to the idea of, ‘If I just do this now, they’re not going to have to mind me for the rest of their lives.’

Now I know the damage it would do but when you’re that determined, and when you’re that sure you’re the worst thing on earth, you can’t even fathom that anyone would miss you. Nothing else computes.

You mentioned beforehand that your hospital stay wasn’t at all like what we see in movies. Can you describe your experience?
Before going into hospital, I was absolutely terrified. I couldn’t see past the way it’s portrayed in films and TV: some awful asylum where there’s nothing to do and you’re locked up in a ward 24/7. Maybe I was lucky but the reality was completely different.

My therapist, trying to give me an accurate representation of what it’s like, described it as a weird boarding school. And it actually is! You eat all your meals in a communal dining room with the same people and you usually have a range of activities during the day, like groups and lectures. Even the words they use to identify us – ‘service users’ rather than ‘patients’ – makes an important difference; you’re not just viewed as sick people. That attitude carried through the hospital.

And I did not expect the camaraderie you end up having. You meet people who have been through similar things to you – but even when they haven’t, there’s still a common thread. There’s something to be said for the transparency in that.

You’re in a psychiatric hospital, so there’s no pretending that you’re having this amazing life – which I think you normally see a lot of scrolling through Instagram. ‘I’m having the best time! Looking at how fulfilling my life is!’ When you’re meeting someone in a hospital, you know they’ve had a crap time and that makes things more honest or sincere.

There’s a lot less stigma around mental health in recent years, though it still seems like it would be natural to worry about what others think after you’ve been hospitalised…
Totally. I think it’s amazing that there’s been a shift in terms of how people talk about mental health. But I also think there’s a jump as soon as someone mentions the word ‘hospital’. There’s still a definite stigma and people are quick to presume the worst. If you mention that you were an in-patient for six weeks, people are like, ‘Woah… what?’

The problem is that hospital is not talked about half as much as other types of therapy. I know that all hospitals are different and I was probably very lucky with my experience. But this kind of block that people have in their brain when it comes to hospital admission is a real shame because it cuts people off from something that could really help them.

There’s a lot to be said for just stopping everything for six weeks. I was overworked with two jobs, so the idea of stepping back to hit pause was alien to me… but it’s what needed to happen. I got so much out of it and so did the others I spent time with.

Can you tell me about recording music there?
I wasn’t able to make music for the first few weeks while I had been at home. When you’re really unwell, it’s recommended that you do things you’re normally good at. I completely disagree with that because if you try and you can’t do it, it just feels like something else you’ve lost.

Once I was a lot more stable, I was able to go to a music room in the hospital between nine in the morning and nine in the evening – and just play. There’s no pressure or stress associated with it. Nobody’s asking you what you’re doing. I think that’s the only way I was able to approach writing anything – and really tentatively at first.

I wrote ‘h_always’ in less than an hour. I think that’s what happens when you haven’t been able to write for a while: you sit down and start consciously brewing something that you didn’t even know was there. I recorded it just on my laptop, not thinking it was going to go anywhere. Obviously at the time I had other things on my mind. But that music room really was a safe space for me.

Creativity proved to be completely vital in my recovery. I remember telling my consultant that and he said to write it on a comment card so that the top tier of the hospital knew how much it was helping. These kind of resources are the first to get cut when budgets are reduced. That’s why I want people to know about the positive impact it had.

I just wanted to touch on the difference between private and public facilities because some people might think, ‘Well, it’s all well and good for you if you have access to a music room’, but what if you don’t?
It depends on what hospital you go to. In Ireland, for example, a lot of hospitals are mixed in terms of private and public beds. I ended up having to go to a private hospital outside of my constituency because my local public one would not admit me, even after three trips to A&E.

That public hospital does have creative resources but I don’t think that any hospital has enough of them, whether public or private. There’s a lot more work to be done in terms of acknowledging and respecting the value of these creative resources for patients.

The process of being an artist and putting something out in the world can put you in a vulnerable place as it is, so does it feel like what you’re doing raises the stakes even further?
I’m really not worried about putting this out, to be honest. I’m the least concerned about what other people think of me at this point. I don’t know if that’s because I was in such an awful place when I wrote it, but I just don’t feel [vulnerable] right now and I think it’s really important to talk about these things.

I think if I had heard more about how helpful and how nourishing an environment hospital could be, maybe I would have considered it sooner. I certainly wouldn’t have been half as scared as when I sat in the admissions waiting room.

Anybody could end up there. You’ve no idea what’s going to happen in your life or how you will react, so I think normalising that experience – rather than let people imagine something out of a horror film – is really important.

You mentioned how it affected your sense of identity. When you recorded the music, did you feel like you were yourself at that point?
Yes and no. I think by the time I was able to press record on that song, I had started to claw back bits of myself. Threads of who I used to be were starting to emerge… but that’s a really slow, slow process. Even now, six months on, there are things that make me think, ‘Oh, this isn’t consistent with what you used to be like.’ But I guess that’s okay as well sometimes.

It’s okay to have something like this change you, to a certain extent. The important thing is making sure it’s a positive, open-minded change rather than a negative one that shuts you off from people. Maybe that’s another reason why I want to talk about it: I think an experience like this can isolate a lot of people, especially if there’s any shame attached. It becomes an elephant in the room. I’d rather just have it out there. Yes, that happened. It doesn’t mean we all have to shy away from it.

Would you have any advice for someone struggling with that fear and shame? Or for someone who thinks that having mental health issues somehow disqualifies them from being an artist?
Yes. Number one, there’s no obligation to talk about your mental health struggles. If you’re not comfortable with it, that’s completely fine. I also think it’s really helpful to have an attitude that everything is temporary. Even if you’re not comfortable talking about it right now, who knows? Maybe a year down the line, when things are going better, that’s when you’ll feel like talking about it.

In the meantime don’t make any big decisions you’re not entirely comfortable with. Me talking about this is something I’ve thought about for months. If you open up in a vulnerable place and people come back at you with judgement or non-acceptance, that can be detrimental. You have to look after number one first. Not everybody needs to stand up and try get rid of the stigma once they’ve been in hospital. If you’re not there, you’re not there. It can wait.

In my wider circle, I honestly struggle to think of anyone who makes music and hasn’t had some experience with mental health issues. Having conversations within creative circles might be a nice way of starting any wider discussion you want to have. They may not have been to hospital, but they’ve been to therapy or experienced panic attacks or they’ve been on medication for depression. I mean how many studies link creative people with being more susceptible to mental health issues?

Is there anything else you learned along the way that you’d like to share?
Compassion is so important. I learned a lot about that. Being in hospital gave me a huge amount of understanding because you meet people who’ve done things you never would have thought they were capable of. Obviously, people can do bad things when they’re in a bad way. I’m not saying to forgive everyone who’s done something terrible; remorse is a big part of that process.

You need to own up to the mistakes you’ve made before you can work on anything else. But while you’re owning up to those mistakes, it’s also important to be compassionate with yourself so that you don’t slip into a black hole of self-hate.

If you’ve been impacted by any of the issues covered in this story, you can contact Samaritans on 116 123 (UK) or 116 123 (Ireland). Music Minds Matter, a 24-hour mental health support line for the UK music community, is reachable on 0808 802 8008.

Find out more about Fears, who plays Ireland’s Body&Soul festival in June.

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