Wednesday, June 18, 2008

Idling With Ivor 6

Frozen Grief

Ivor narrates a story of a woman who went berserk at the funeral of a local nun who had been very popular because she had nursed the poor of the area.  This woman had been a thorn in the side of the hospital (St Loman's) for years.  Periodically this woman would go into angry outbursts and into a psychotic state.  This time she overdid it and ended up overturning the coffin and kicking the Reverend Mother in the shins.  Anyway to cut to the chase, what Ivor found when this woman eventually succumbed to treatment:

She cried and wept for hours after that, and it was clear that all the anger was only a defence against the grief which she had frozen at the time of his [her husband's] death and never been able to release until that moment...she remained well and never again had a psychotic reaction. (Op. cit., 114)

The Patient's Freedom

I feel that the following lines Ivor wrote about Phyllis Hamilton and Fr Michael Cleary are insightful as regards human freedom and healing:

I have often wondered if, in the beginning, I could have done anything to avoid the years of suffering for Phyllis.  It was a mess that I felt would end in tears but I could see no solution to the problem other than getting her away from Father Cleary, or getting him away from the Church, but one thing that psychiatry has taught me early in my career is that you cannot tell people how to live their lives.  They make choices.  If they want to get better, they probably will and, if they want to create more problems for themselves, they will.  (Ibid., 117)

Dean Swift's Epitaph 

I loved Ivor's quotation from Swift - in fact Jonathan's Swift's epitaph.  St Patrick's is the oldest mental hospital in Ireland and is nationally and internationally renowned for its care and study of psychiatric illness.  Anyway here is Dean Swift's - who was dean of St Patrick's Cathedral - epitaph:

He gave the little wealth he had

to found a home for fools and mad

and showed with one satiric touch

no nation needed it so much.  (Ibid., 136)

Psychotherapy Versus Neurophysiology and Psychopharmacology

Ivor sees both these approaches as being polarised as regards the history of psychiatry in Ireland. (Probably it is such in Western Medicine also)  Psychotherapy has never been a main focus in the training of psychiatrists in Ireland, and as far as I know it is declining radically in international training also.  Ivor maintains that this psychopharmacological approach "essentially treats the human being as a machine to be tinkered with, and the relationship to the person tends to get lost." (ibid., 142)

Community Psychiatry:

Ivor argues throughout his memoir that successive governments failed to provide the infrastructure and the financial resources to make community psychiatry work.  He mentions the exceptional success of Dr Franco Basaglia's community psychiatric Revolution in Trieste, but laments the fact that it was not replicated with such success throughout Italy. (Ibid., 147-8)  With his background in community medicine from the States and such notable successes like Basaglia's Ivor spearheaded The Brendan Project:

Instead of a closed system like the old mental hospital, this would be an open system where as many as a thousand people could come each day to enrich their lives and engage in enterprising and productive activity.  (Ibid., 152)

It is interesting and alarming to note that at the time in 1980 when Ivor appeared on the Late Late Show with another psychiatrist Dr. Jim Behan and the then Minister for Health Dr Michael Woods mental health expenditure counted for roughly 10% of the entire health budget.  It has recently dropped to 6%.  This is alarming to say the least, and it does show society's priorities.

Community Health Activities and Power

No matter where human beings congregate the reality of power always rears its ugly head.  People are essentially power brokers and when put into groups members will always struggle for leadership.  This is a truism.  Just look at our places of work.  Anyway in the 70s and 80s starting any community activity that might empower people got vested interests worried and scurrying to their defensive parapets.  As Ivor points out, the Church had serious reservations about community activity as it had "always controlled the old people's activities and it strongly resented this being taken over." (Ibid., 171)  In one single week he had calls for his resignation from four vested interests:- The Church, Dublin Corporation, some local politicians and the Department of Education.  Again, this was a power game.  I find as I grow older I love watching to see how power games play out.  Under these last two headings I refer to two of Ivor's community projects namely The Brendan Project and The Irish Foundation for Human Development (1968-1979).

The healing power of walking on the beach. Above a picture of an area of sand and shells on Donabate Beach, June 2008

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