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"I Am Innocent!"

category national | health / disability issues | opinion/analysis author Thursday July 28, 2005 13:36author by Sean Crudden - imperoauthor email sean at impero dot iol dot ieauthor address Jenkinstown, Dundalk, Co phone 087 9739945 Report this post to the editors

Whither Psychiatry in 2005 and Beyond?

So when Pilate saw that he could do nothing, but rather that a riot was beginning, he took some water and washed his hands before the crowd, saying, "I am innocent of this man’s blood; see to it yourselves." Then the people as a whole answered, "His blood be on us and on our children!" So he released Barabbas for them: and after flogging Jesus, he handed him over to be crucified.

Matthew 27.24 - 27.26
Sean Crudden
Sean Crudden

In an article in this morning’s Irish Times "Scandal of our mental health services," Mary Raftery uses the phrase "….the area of psychiatric care, for which, of course, the Minister has ultimate responsibility." Let me point out immediately that I do not want to cast Mary Harney in the role of Pontius Pilate.

No. The point I want to make is that everyone involved including myself (although I keep my mouth strategically shut a lot of the time) bears some responsibility for the way things are. When I was young in school the lesson of the Nuremberg trials was often drilled home. Like Goehring and Goebbels we cannot shuffle off responsibility onto the Hitler at the top of the chain of responsibility.

Even if we cannot open our mouths we can keep our eyes open. A blind man could see a lesson in the human wreckage we are all surrounded by in 2004 and 2005. That wreckage is the product of a half-century of modern psychiatric treatment.

It seems to me that the key interaction in the psychiatric system is between patients and nurses. The quality of that relationship is what determines the quality of life for the patient on a day-to-day basis. That quality can vary and it is, by no means, always bad. However nurses are not insulated from patients as psychiatrists invariably are. So their observations on systematic deficiencies are more likely to be grounded in reality.

I hope that modern advances - like the nurse training school in Dundalk Institute of Technology - will produce nurses who feel an authentic sense of their own responsibility and who are observant and encouraged to think independently and, also, who recognise the humanity of their patients and are apt to look at things from the patient’s point of view.

My biblical research this morning carried me into St Luke’s (the physician) Gospel. He pointed out that in the hour that Herod and Pilate conspired to sentence Jesus to be crucified they both became friends where they had been enemies before.

To my paranoid mind it seems to me that there are a number of alliances which are shoring up the failed system of modern psychiatry. The least of these alliances is not that between the medical and political establishments.

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author by Miriam Cottonpublication date Thu Jul 28, 2005 14:43author address author phone Report this post to the editors

Dear Sean
I was very glad to see your piece just now. It would be good to know more about how psychiatry is structured in Ireland - what the main organisations - both for users and for professionals - are. I would very much like to get in touch with support groups about this matter. Very often they have the best insight on what is happening and what is needed. Maybe between us and other readers we could raise the profile of the issue a little? If you have time to email me I would very grateful to hear form you.

author by iosaf - "hmm. pontius pilate and herod & the good friday agreement to crucify the christ"publication date Thu Jul 28, 2005 21:34author address author phone Report this post to the editors

as one of the main sources of the Irish state's breach of human rights together with migration policy.
Both areas are under PD ministers, Harney & Mc Dowell - to my paranoid mind thats "a connection".

author by Seanpublication date Sun Jul 31, 2005 08:40author address author phone Report this post to the editors

Your comment is sharp and observant and interesting, at least superficially. The connection you point to may be pure coincidence or the result of a little strategy or tactics on Bertie’s part. Whatever the case is you are probably right insofar as the two PD ministers seem to fit nicely into the caricature of latter-day Nazis. The fact that they do appear to fit the caricature closely is probably something which is not readily apparent to them individually or collectively.

I often wonder about the locus standi of Amnesty International or what they know about the mental health scene which is obscured from the rest of us? Are they really fighting for mental patients or are they trying to project a do-good, campaigning image in a merely self indulgent way? What is the point that Amnesty are trying to make about the mentally ill anyway?

Of course we can say what we like about Amnesty in these pages and without the expectation of an answer. They are unlikely to dirty their cursors by dipping into indymedia.

author by Miriam Cottonpublication date Sun Jul 31, 2005 18:49author address author phone Report this post to the editors

I agree with Sean that Bertie is more than happy to allow the PDs to wear all of the responsibility for the PD /FF Coalition's appalling record on social and infrastructural development. It suits his exclusively big business orientated agenda for the PDs to be allowed to run amok with their fascist policies. However, the PDs are quite happy about this too - their contempt for anyone other than rich people is blatant. As in 'A little inequality is a good thing' (McDowell) and Harney has stated that rich people deserve to have more of a say in the way the country is run - as though the majority of us arent working just as hard. I dont believe that Amnesty are not well motivated - their only motive in what they do is to expose the truth of injustice. In recent years they have rightly focused on abuses at home as much as abroad: people in glass houses etc. Amnesty is always being characterised in this way - very unfairly and only because they are usually right. Ireland's human rights record is known internationally to be very bad and there is widespread corruption. An issue like delivering decent psychiatric services to people is not even on the agenda. It doesnt matter that proper investment now will save money in the long run - anyone who isnt talking about get-rich-quick schemes is of no interest to this government.
Its up to us to make sure we get the issues on the agenda that we want to see there. The apathy and indifference of the public at large is at least as much responsible for the state of our social fabric. Unscrupulous politicans have long ago figured out that we will simply let them get away with it. Its time to object and to bring people to account! I'll get off my soapbox now!

author by Seanpublication date Mon Aug 01, 2005 20:33author address author phone Report this post to the editors

The irony of the situation is that a considerable body of opinion among "users and survivors" of psychiatry both nationally and internationally consider the whole system of modern psychiatry to be defective and an abuse of mentally ill people. So, in a way, Miriam, you are begging the question in implying that if the system is resourced better than it is now in Ireland that that will be in the better interests of the Irish mental patient individually. To put it another way there's many a patient who would prefer to see the whole slavish system collapse.

In general terms you are right. It will take a lot more resources to rescue mental patients from the present depressing system and put a more optimistic and developmental system in place.

My own observation is that there has been immense damage done in the past 50 years (pace The Manweiller Case) which cannot be rectified or reversed and for which no-one will receive compensation.

author by Miriampublication date Mon Aug 01, 2005 20:56author address author phone Report this post to the editors

Hi Sean
I didnt mean to imply that adequate resourcing should be directed at a failing system. Far from it! A well-resourced system would only be possible if it were an appropriate system. What are the main things you would wish to see done differently?

author by Seanpublication date Tue Aug 02, 2005 18:28author address author phone Report this post to the editors

The following is the text of a letter which appeared in this morning’s Irish Times under the heading "Treatment of mental health." (sic). In my opinion it is a calm, composed, experienced and educated view on the subject and I am typing it out to add to the debate here on indymedia.

Madam,- Your editorial of July 25th ("Time for quality in mental health") repeats many of the fallacies that bedevil the field.

In the first instance, the writer accepts uncritically that "mental health" is a medical issue, tacitly propagating the medical model of mental illness. According to the standard medical model, people are either healthy or ill; ill people require medical treatment, healthy people do not. This discrete classification does not apply to mental phenomena, where there is a continuous range of behaviours and it is simply not possible to draw a line on the distribution and say: "To the left are the sick people, to the right are the healthy."

The very concept of medical illness is meaningless in the mental domain. There are just (an infinite number of) different ways of behaving. The only really useful criterion is whether the behaviour is socially acceptable or not. In other words "Mental Illness" is a societal construct, not a medical one.

Secondly, your editorial makes the extraordinary assertion that the health budget should be proportional to the number of "disabled." This is simply mistaken. You don’t throw money at problems just because they’re there. That is what leads to waste. You spend money where you can do good, where you have solutions, where you can bring benefit.

And that is the fundamental problem with the psychiatrist-led mental health sector. For the vast majority of its clients, the psychiatric profession has no solutions, no cures, no treatments, no procedures, no answers - none that work anyway. One simply cannot compare the psychiatric profession with general medicine; to do so is to mislead oneself and to lend unwarranted credibility to the former.

There is no equivalent to the heart transplant in psychiatry, no anti-biotics, no hip replacement, no coronary by-pass. If you were to increase the psychiatry budget pro rata what would you spend the money on? Double everyone’s medication perhaps?

Where no solutions are available, where practitioners are fumbling in the dark with no idea of what they’re doing, it would be sheer folly to award huge budget increases except, perhaps, for research. Expenditure must be benefit-lead not problem-lead.

As someone who has observed mental "illness" at close quarters for well over 30 years, it is my firm conviction that psychiatry does more harm than good. In such circumstances, it would be irresponsible to order more of the same.

Psychiatry is the great naked emperor of modern medicine and we desperately need to expose it as such.

Your editorial regrets the fact that psychiatrists have refused to co-operate with the new mental health legislation. My advice to the Minister is: leave them out, we’re better off without them. -

Yours, etc.

Dr Norman Stewart
Co Dublin

Well, Miriam, I think that the first hurdle to be overcome is to recognise the inadequacy (to use a polite word) of the peresent system. The present system has been professed for 50 years by more powerful minds than mine and by organisations who are richer and more "establishment" than impero. However, as a former teacher, I have, unusually for a teacher, a high level of confidence in educational methods if only correctly applied.

author by Seanpublication date Tue Aug 02, 2005 19:26author address phone Report this post to the editors

Miriam, for further info about impero's opinion on mental health policy you could check our submission to The Expert Group through the link given with this comment. You can read everyone else's suggestions from the same web-site.

author by depixol junkypublication date Fri Aug 05, 2005 12:06author address author phone Report this post to the editors

I think that in relation to Amnesty International we should not forget that they support and justify the involuntary commitment and forced drugging of psychiatric patients under the Mental Health Act. If someone has not commited a crime they should not have their rights and liberty taken from them. So many people I note who argue for greater input from patients and more resources for the 'mentally ill' are invariably the ones who support psychiatric incarceration and forced 'treatment'.

The truth is that little will change until 'patients' organise themselves in human rights action and social change movements. A group like the Irish Advocacy Network which started out with potential is now evidently in decline because it tried to cosy up to the psychiatric system and thought that change could be brought about that way.

While I place the great bulk of the blame for the damage the system has caused on the psychiatric profession, state mental health organisations and the pharmaceutical companies, some of the psychiatrically labelled should also accept responsibility for this situation. Many of these people never tire of talking about their 'illness' ( totally unproven after 100 years of research) and how difficult it can be to live with . They are educated, still possessing their faculties to a considerable degree,and in a position to inform themselves about the harm psychaitry causes but simply fail to do so. They also tend to be strong ardent defenders of the medical model. I have to say though that many other patients are simply too drugged and demoralised to do anything at all. I therefore include the former as a real part of the problem as they also tend to act on behalf of state mental health organisations by offering themselves as spokespersons for mental health users.

Oppostion to involuntary commitment and forced drugging is the way to go. If this is made illegal then the system is effectively broken. Only those who want to be paternalised or to view their life problems as illness can then be free to subject themselves to self inflicted psychiatric torture and degradation.

author by Seanpublication date Thu Aug 11, 2005 21:20author address author phone Report this post to the editors

"A little knowledge is a dangerous thing;
Drink deep or taste not the Pierian spring."

Alexander Pope (1688 - 1744)

Since the 1960’s "psychological" ideations have become prevalent in education just as the influence of psychiatry spread in society and I think this whole process is at its apogee now. The irony is that education has become more and more prescriptive and deterministic over that whole period full of nostrums and boundaries. And a good deal of the spontaneity and joy which one would expect to be characteristic of a developmental and nurturing system has died.

It is ironic, too, that in recent decades psychiatry has tried to adopt some of the values of the educator and it is fashionable to see the system as "patient-centred" or "client-centred" and there is, at least in the sphere of public relations, some use of the word "recovery" which was seldom mentioned a decade ago. Of course one imagines that this "recovery" being referred to is, in fact, a spurious recovery buttressed up by scrupulous insistence on drug therapy.

There is an attempt by agencies such as The National Disability Authority to have patients/clients treated like human beings on the basis of equality. At the same time no-one seems to pay a blind bit of attention to the almost universal disfigurement of mental patients by the drugs that are forced on them and I doubt if anyone could find in Ireland a patient who feels 100% in good fettle never mind in top physical condition.

One does not need a degree in education to realise that there are basic values underlying good education. These values are to be found in the realms of religion and philosophy. Essentially it could be maintained that these values have some kind of objective or universal truth which cannot be compromised.

It is not possible to develop an authentic system by selecting a-la-carte from the trappings of educational fashion or from the droppings of the bowel of psychiatry. Both education and psychiatry are the poorer from infertile cross-pollination which is false and deceptive and which could be said to subvert what I imagine to be true human and christian values.

author by Seanpublication date Fri Aug 12, 2005 17:55author address author phone Report this post to the editors

"Thursday 4 August 2005

"He also gave me a book on ‘stakeholders’ views on ‘quality’ in the M.H. services. Published by M.H.C. - The Mental Health Commission. I read it (mostly) at home. Superficial and ambivalent & derivative. Roast beef & gravy, carrots cabbage and mash + butter for dinner followed by a large plate of ice-cream (vanilla) and v. sweet red trifle."

The full title of the book referred to in the above extract from my diary is "Quality in Mental Health - Your Views." A sub-title is "Report on Stakeholder Consultation on Quality in Mental Health Services."

Another book of interest in the present discussion is "Strategic Partnership Guide: Good Practice in Working with People with Experience of Mental Health Difficulties" and it was also published (by NDA - The National Disability Authority) - in 2005 like the book referred to in the last paragraph. It is a ring-backed effort and, in tone, it lies somewhere between academia and Madison Avenue.

NDA have also published a document outlining the proceedings at a conference held on 23 February 2005. The title is "Women and Mental Health: Promoting a Gendered Approach to Policy and Service Provision." I have only glanced at it so I cannot comment on the theme of the publication. However, for me, the format - an essay-type lay-out - is superior to the quasi-scientific "research" cachet adopted in the two books I mentioned previously. It seems to me that issues in Mental Health will better be decided by the use of professional and participant judgement laid out in a discursive way rather than by trying to discover some kind of new scientific law from statistics and research findings laid out in a modular/tabular way.

Some of these documents may be accessible through the relevant web-sites on the Internet. A document which certainly is is "Speaking Your Mind" - which outlines the consultation processes carried out by The Expert Group on mental health policy in the last year or two (see the "link" given with this comment). A definitive policy document is expected from this source later on this year.

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author by Seanpublication date Fri Sep 09, 2005 10:02author address author phone Report this post to the editors

The strategy document "Reach Out" (Subtitle: "National Strategy for Action on Suicide Prevention 2005 - 2014") was launched by Tim O’Malley TD, Minister of State at the Department of Health and Children at a reception in The Mont Clare Hotel yesterday evening. There are 26 "Action Areas" listed in the document of which No 13 is headed "Mental Health Services."

We read "…the Strategy Writing Team have worked closely with members of the Expert Group on Mental Health Policy in order to share information and ideas on the future of both suicide prevention and of mental health policy. It is expected that the report of the Expert Group will significantly develop many of the actions listed below in this area."

The six actions listed are rather vague, aspirational, anodyne. So, perhaps, the real drama awaits us on another day? Or will the report of The Expert Group be an anticlimax as well?

Mrs Anne M Muldowney, incoming chairperson of impero, pictured before the reception.
Mrs Anne M Muldowney, incoming chairperson of impero, pictured before the reception.

author by Sean Crudden - imperopublication date Fri Mar 03, 2006 17:42author address author phone 087 9739945Report this post to the editors

“A Vision for Change” - report of the expert group on mental health policy - has been lying behind my armchair for the past couple of weeks since it was launched. Having nothing better to do I lifted it up and looked through it today until tiredness overcame me.

The writing at the start from Tim O’Malley, Minister of State at the Department of Health and Children, shows a lot of insight into the plight of the mentally ill and is sympathetic towards the patient. In the foreword Joyce O’Connor, chairperson of the expert group, shows herself to be visionary with a caring and developmental outlook.

Superficially, at least, this tone is sustained throughout the report. However the mask slips here and there. Of the seventeen listed “key recommendations of A Vision for Change” listed on page 9 the fourth one reads:-

“to provide an effective community-based service. CMHTs (community mental health teams) should offer multidisciplinary home-based and assertive outreach care, and a comprehensive range of medical, psychological and social therapies relevant to the needs of service users and their families.”

The word that jumps out of that piece of text is “assertive” and one suspects that it is merely code for “aggressive.”

There seems to be a careless implication that the needs of users and the needs of their families are identical. In practice the two are frequently at loggerheads.

On page 63 in a section headed “current mental health service provision” we read the following unequivocal statement.

“We do not know the number of individuals nationally who avail of mental health services, the type of interventions or treatments they receive, or the effectiveness of those treatments.”

This prompts me to ask the question whether the authors of the report are excusing themselves from the responsibility of describing the present bone yard which is the mental health system and taking the easy way out like ostriches burying their heads in the sand.

“Bullying policies are being developed across the primary school sector as part of the school policy planning process and several programmes have been evaluated.” (page 86) Is this just an amusing faux pas or is it a Freudian slip? It often seems to me that many policies in the field of education are “bullying policies” and authoritarianism in that field will die hard just as it will in the area of mental health.

Overall the document represents an advance - an incremental advance - where, I think, a seismic shift is required.

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