Authors: Noël Browne
Never before had I heard such a varied litany of adult cries for help which came to me over my house telephone. How useless I felt! These calls went on for most of the day, through the weekend,
and much of it at night. A man had broken a window and tried to hang himself from the window bars. A high security ward patient had escaped in his pyjamas with an open razor, and was threatening
the staff in the hospital grounds. A deeply depressed young girl had broken glass and cut her wrists. A patient had taken an overdose and was unconscious. There was word of an old lady wandering
the streets, talking to herself, at three in the morning. There was a drunken singing pub visitor, suffering from an overdose of alcohol, who needed a bed for the night. A woman patient had
barricaded herself behind the sturdy mahogany hospital furniture, and was bombarding the staff with flower pots; could she be given 10 ccs. of chloral hydrate — the usual knock-out drops of
that time?
Much later on I was told what such a procedure entailed. A young girl told me of her terror when faced with this injection. Following a misunderstanding, she had been shocked, frightened and
confused. The female nurses, either intent on making an example of the recalcitrant patient, or simply fearful of getting hurt by her, usually called in the male nurses to help them. When all was
ready, armed with loaded syringe, they formed a wall of white coated nurses, a threatening sight. Like a cavalry charge they advanced in line to fall on and physically subdue the victim. They then
sank the needle into the victim’s thigh. Its effect was total swift oblivion. It is difficult to believe that it is not as distasteful a job for nurses as for the patient.
Though being woken by telephone at night to get up and admit someone could never be pleasant, I rarely walked across from the residency to the admission block in driving rain or under a summer
moon without a sense of the privilege of my medical calling. On behalf of the people I had been entrusted with responsibility to care for, even if inadequately, the rejects from society. Some had
been turned out of their own homes; as ‘mental patients’ they had been turned away from every other hospital and home in the city. They came to me at any hour of the day or night; we
could not give them much but we would not turn them away.
Having chosen to study the problem of mental illness in Ireland, I hoped to understand its social origins and implications. As with tuberculosis, the mentally ill predominantly are members of
the poorest social class, the victims of job insecurity, over-crowding, poor housing, over-large families. I had no idea of the infinite canvas of distress that would unfold before me in the years
ahead. The one doubtful virtue of mental illness over tuberculosis was that you could die of tuberculosis. With mental illness, though desperately wanting to, you need not die. With a restless mind
that cannot find comfort or rest, to know that you are
not
going to die is often the greatest source of distress for man or woman. In addition, the effect of mental illness seems to be
all-pervasive, involving thousands rather than hundreds. Mental ‘disease’ is impossible to categorise as a series of predictable signs and symptoms. The population of a mental hospital
reflects the hidden-away, private agony of thousands. They are either under sedation and asleep, or nearly asleep, or restlessly awake and inconsolable. Some, heavily doped for the rest of their
lives, bide their time in the benevolent jails we call mental hospitals until their release in death. There is a tacit conspiracy between psychiatrists and the public to imprison without public
trial, for months, years, sometimes even for life, our dissident social nonconformists, the misfits or the inconsolably miserable. For the most part they are there simply because we, the
‘normal’ population, can no longer tolerate their distress, of much of which distress we are the cause.
My introduction to the mental hospital service came at the end of the era of repressive custodial care for the mentally disturbed, following the introduction of powerful new ‘mood
changing’ drugs. Before this, the nurse in a mental hospital was called a ‘keeper’. He was dressed in a policeman’s style uniform and carried a thick stick. This was the
period of brute physical restraint of the patient in the padded cell, naked, wild-eyed, clothes ripped, squatting in scattered food and filth. For the most intractable there was also the
unthinkable awfulness of the straitjacket. The new drugs stupefied their victim into an inert conformity, creating the effect of a ‘no touch’ benevolent straitjacket. By their means
human beings were transmuted to non-resisting, remote, mindless automatons.
Within the main hospital at St Brendan’s there was the desolate ‘hospital’ sector, a special unit in which passive dummies lay under heavy sedation, a long line of
misery-ridden human beings who already unsuccessfully had tried to end their tragic lives by suicide and if given a chance would try once again. It was sufficient simply for the doctor across the
telephone to command that a patient ‘be put on the line’. There was an aura of congealed misery hanging over that line of silent men and women, linked by their common despair and the
will and intention to kill themselves. No flowers, no books, no photos, simply a reluctant resignation to the agony of living.
It was to this ill-lit Dickensian hospital that one night I was called out of an exhausted sleep to the real-life nightmare of a middle-aged man who simply wanted to die. He refused to eat in
the hope that, no matter how painfully in the end, he could die. He had nothing and no one left for whom or which he wished to live.
The procedure was, that I, the lowly house physician, on the orders of my consultant psychiatrist, would force-feed him. A non-violent man of peace, I would have found it easier to have shot
him. I had to ram a semi-rigid inch thick rubber tube down his throat into his oesophagus and stomach. Meanwhile two silent purposeful nurses, suffering no doubt my own sense of revulsion, held our
victim by his shoulders, his body, head and neck forcibly thrown back. Revolted at the prospect of so mauling a fellow human being and subjecting him to such humiliation, my face must have
disclosed my feelings. A sympathetic experienced nurse who, no doubt, had had to become hardened to such experiences, intervened to release me from my ordeal. Briskly and expertly he passed the
tube down into the stomach. A great white enamel funnel was put into the end of the tube, and down through this was slowly poured a cement-coloured mix of gruel, designed to keep that wretched man
alive. It seems that one other purpose of force feeding is the intimidating crude deterrent of fear. But do the victims not resolve that at the earliest opportunity, ‘cured of their
depression’, they will leave the hospital so that alone in peace and with dignity, they will kill themselves?
Yet another treatment procedure comparable in repulsiveness was the use of electric shock so as to alter an individual’s vision of his unhappy life. To the end of my days in psychiatry I
could not accept that an electric shock would transform the parent mourning for a dead child, or the spouse for a lost partner, from being deeply depressed to being the classic ‘happy
man’. To me it was wholly reminiscent of the many futile, sometimes dangerous, procedures used in desperation by us in the 1930s to save the life of the dying consumptive.
The procedure was carried out in a long, low-ceilinged, barn-like ward, divided into a waiting space and a smaller operating centre. My job as house physician was to provide a completely
purposeless ritual presence. I would stand at the head of the patient as he was anaesthetised and then apply an electric terminal to each side of the sleeping patient’s skull. It was the
anaesthetist’s job to apply a plier-like instrument, so as to force open the mouth, into which he inserted a thick rubber biting pad. A series of standard shocks was then applied through the
terminals. The effect on the sleeping body was both disturbing and repellent to watch; the whole body sprang into a tense involuntary series of jerking spasms. Meanwhile the patient was forcibly
held down, to avoid self-injury, by an attendant nurse. The patient was revived with oxygen inhalations, then wheeled out. Later, as consultant psychiatrist, under no circumstances would I submit a
patient to that procedure. What is more, I found that they had no need for it. The unexplained rationale of the procedure was much too reminiscent of the use of cupping, blood-letting and the
application of leeches.
The anaesthetist I worked with was Dr Gilmartin, the same man who could not resist the sympathetic pat on the shoulder in the barber’s shop. Through those long afternoons, with their hours
of waiting and watching, we discussed every conceivable aspect of life, society and medical practice in the Republic. One afternoon he went on to express radical opinions about the ideal
organisation of medical practice in an enlightened society, ideas with which I could agree. Suddenly, aware of the dangerous talk of which he had just been guilty, he concluded abruptly, ‘I
must give up that kind of thing. If I were to express those kind of ideas publicly and freely I would soon find myself like you, on the outside in our profession, doing a boring badly-paid
purposeless job, such as yours. I wouldn’t like that’.
I came to know well the many faces of that great hospital, its out-patient clinics, the over-crowded wards, the bare pictureless walls, the narrow-fretted prison windows, the uncarpeted floors,
the absence of colour or flowers except in the show-piece admission unit. In the back wards the grey-suited, sallow-skinned, tired yet restless men and women padded around and around like prisoners
in an unending circular death march to nowhere. Then there were the wards for the aged, row after row of neatly packaged humanity, for the most part unwanted at home by their ‘loved
ones’. Yet another side of the ‘closely-knit’ Irish family was represented by the featureless, cattle-penned wards for the recalcitrant young, the once well-loved but now
misunderstood, rebellious and unwanted adolescents, all victims of broken family relationships. What went wrong after that glad newspaper birth notice, ‘the gift of a child’? Who was to
blame? Within all this for me was my own equivocal custodial healing role as jailer/physician. It was my unenviable job to untangle the complex vortex of emotions that had engulfed the tormented
victims of these disturbed relationships.
For over a century we doctors have manned our mental hospitals. Over these years, each of us in our different communities has structured and moulded our mental hospitals according to our
cultural ethos to serve the needs of our communities. In western societies the recent use of the Thymoleptics mind-moulding drugs has rescued us from the ugly violence of bedlam. In contrast to our
own uncaring concern for the aged in their homes, county homes and mental hospitals, I recall the brightly decorated and furnished old persons’ flats which I visited while Minister for Health
in ‘godless’ Sweden. We have such homes here in Ireland too, but as with so much else in our society they are reserved for that privileged few who can pay.
In mental illness diagnosis and treatment are both culturally determined, varying in time, place and community. Does this variety in both diagnosis and treatment not establish the age-old truth
in medical practice? Where there are many cures, we know there is none. For the most part the mental hospital service is that great black rarely-upturned flat stone lying at the heart of every
modern society, under which no one readily cares to look or, once looking, lingers over for long.
In any of our Irish mental hospitals, consider the number of derelict men and women who for the remainder of their lives, once committed to a mental hospital, are never again written to, visited
or released. They may be so imprisoned for life without having committed any known criminal offence. They are committed without benefit of a public trial, the presence of the newspapers, the help
of defence counsel, the facility afforded to the meanest or most brutal ‘criminal’. As a psychiatrist, my signature on a piece of paper effectively was the judge, jury, and whole
judicial process, and the sentence of the innocent one was for life.
I have sat opposite to a mother and father who had come to tell me that they never wished to see their otherwise healthy eighteen-year-old son Paddy home again. The origin of that boy’s
illness had been the father, a senior civil servant with a serious drink problem, who with drink taken became uncontrollably violent. On one of many such night, he had beaten his wife unmercifully
and then turned on his three young children. At that time Paddy was aged six; he had pushed his younger sister into the only available shelter, under the stairs, while he remained, as a pitifully
inadequate guard over them, on the outside. He had been badly beaten by his father, and still suffered in consequence. Surprisingly, he still loved both his parents, and greatly missed his now
grown-up sisters. One of the sisters was now getting married. With no remembrance of what she owed to Paddy, she did not wish her husband-to-be to know that she had a brother in a mental hospital.
The father, now cured of his drink problem, was at liberty. If they had their way, with my connivance, Paddy would become a prisoner for life. The father, a highly intelligent man, made it clear to
me that were Paddy allowed home, he would deliberately set out to provoke him so as to ensure that Paddy would react violently. He could then call the police and Paddy would end up in prison. I
asked the mother if this was also her wish; she replied, ‘Yes, it is’. So Paddy, the most innocent victim of all, was to become a prisoner for life, an unthinkable sentence to impose on
what society in our courts of law is pleased to call ‘the most incorrigible and brutal of criminals’.
Equally was I a prisoner of my demeaning job as psychiatrist jailer. I had come to understand my true role; we are an élite, authorised by law to deprive a fellow citizen of liberty for
life. Society pays us well and buys our compliance, and with it our silence. I was not proud to be a consultant psychiatrist.