opening chapter
Dr. Romesh SENEWIRATNE-ALAGARATNAM
©1998
Chapter 1
LEGACIES OF A PRISON COLONY
When the first large asylum was built in Australia, at Tarban Creek in New South Wales, the Superintendent made a requisition that hints at the treatment the inmates were to receive when the “lunatic asylum” opened:
“63 iron bedsteads, six chairs for violent cases, 16 cribs of wood for dirty cases, 12 pairs of leather hobbles of various sizes for males and females, 12 hard belts of strong leather and iron cuffs attached to them with straps, 12 cuffs and belts for the hands in less violent [cases]” (Dax, 1975)
The Tarban Creek Asylum was opened in 1838, and it accepted patients from Victoria who were transported there by ship from Melbourne. The state of Victoria had not yet been founded, and the area was still administered by the British colonists from New South Wales. Prior to this a smaller asylum had been opened in 1811 in New South Wales, before which the insane were kept in jails. The close connection between the prisons system and the psychiatric system has persisted to the present.
The next asylum was built in Tasmania (Van Dieman’s Land) which was then a prison colony along with Norfolk Island, to the east of Tasmania. This occurred in 1829 and was followed by an additional larger asylum at Port Arthur in 1842. The Australian psychiatrist Professor Eric Cunningham Dax wrote of Port Arthur in A World History of Psychiatry (1975):
“In 1842 an asylum was opened at Port Arthur. There were four dormitories, a central hall, 24 cells, and a padded room. One patient spent long hours in a cage. Port Arthur then had an evil reputation, and Britain, in a wave of belated guilt, ordered the penal settlement to be abandoned, so that by 1879 only 64 prisoners, 126 paupers (presumably housed in the invalid block), and 69 lunatics remained. They were called “imperial lunatics”!
“Another matter of psychiatric interest at Port Arthur was an adjacent establishment at Point Puer which contained up to 730 delinquent boys, mostly aged 9 to 18. Some were transported for trivial offences. It appears that Governor Arthur made a real attempt to educate and train them as stonemasons, sawyers, and in other trades.” (p.707)
The training and retraining of young people was one of the many agendas of psychiatrists and mental hygienists, but they had to compete for the minds of the young with the Churches, which had a longer history of both teaching children and looking after the poor and disadvantaged. It was the Anglican Church and the Roman Catholic Church in Australia that controlled most of the primary and high school education in these areas in Australian schools, but this was to change, according to the plans of the mental hygiene movement and medical profession.
One way in which the psychiatric profession formed an unholy alliance with the Anglican and Catholic Churches, was by providing the initial incarceration, enforcement of ‘compliance’ (obedience) and drug treatment of young people and collaborating with Church organizations in their subsequent training in menial occupations, whilst providing on-going supervision and enforcement of drug treatment. Cunningham Dax refers to such programs in From Asylum to Community, and continued developments of this alliance are evident in an examination of today’s youth-training programs and psychiatric treatment and followup programs. Dax wrote, of the then new system in the late 1950s:
“Prior to 1954 there were no full-time chaplains within the mental hospitals. Since that time the Anglican Church have appointed five and the Presbyterians one, and it is hoped that three other full-time chaplains from the Catholic and the Methodist churches and another Anglican will be engaged before long. They are jointly appointed by the Church and the Mental Hygiene Department. There is a chaplains’ advisory committee which discusses the terms and the conditions of appointment, and the training. Opportunities are available for the chaplains of the various denominations to discuss their work together and a series of successful seminars have been held which have extended from a single day up to a full residential week. Three Anglican chaplains have been abroad for training.” (p.34)
Dax does not say which countries the chaplains were trained in but it was undoubtedly Britain or America. Dax, who was born in Britain and graduated in medicine at the University of London in 1935, is Anglocentric in his perspective, and, along with common medical views of British and British trained psychiatrists had fundamental belief in “physical treatments” and drug treatment over “talk therapies” and psychotherapy of a more gentle nature. This has been a feature of Australian psychiatry since the time of Cunningham Dax, especially in the public hospital system, where the only treatment is drugs and electric shocks. Psychotherapy is generally held “to not work for serious mental illness”, and “psychoanalysis”, by which is usually meant Freudian analysis, is suspected (with good reason) to confuse the psychotic further. Dax does not mention psychoanalysis, or Freud, and makes only passing references to psychotherapy, which he says the psychologists employed by the Mental Hygiene Authority and public hospitals were actively discouraged from doing. He writes:
“Neither the psychologists nor the social workers are encouraged to do psychotherapy as it is felt that they are more usefully used in their own special fields. On the other hand, it is hoped to extend the group activities for both these associates within their own specialties” (p.34)
In territorial fashion he defines what he sees the role of psychologists to be in this new empire controlled and dominated by psychiatrists:
“Nine years ago there was an establishment of seven psychologists; now there are nineteen. They have not as yet been widely used in the mental hospitals, but more within the clinics and particularly in those for children. The ways in which they have been occupied within the Department are therefore as follows:
Intellectual Deficiency Here the psychologists are particularly concerned with assessing the intellectual abilities of the patient and his capacity for development. They give remedial teaching, so the child may develop to the maximum of his ability. They supervise the patients’ activities so as to direct them towards gaining a therapeutic benefit. They are able to guide the patients into appropriate occupations or activities towards training them to live in the community.
Children In child guidance clinics some of the psychologists are used for play therapy or counselling, but the practice varies. Intellectual and vocational testing, educational assessment and advice on overcoming difficulties, and remedial educational therapy are regarded as some of the psychologist’s functions in this field. They do valuable work in the instruction of the staffs of institutions for adolescents and children, especially through group activities. Also they usefully undertake the management of parents; group discussions for remedial training.
Adults In this field the psychologists undertake the intelligence, educational, vocational and projective testing, and they direct the junction with the occupational therapists. They can set out patients’ records in such a way that they will supply the needed data for statistical records. Similarly they can prepare and plan controlled psychiatric experiments in a way capable of statistical analysis.
Research They carry out research into the various aspects of human behaviour and the best means by which patients, in all the psychiatric fields can be taught fully to use their abilities and skills.” (p.34)
As far as spiritual needs of his patients, and of the Australian population generally, Dax assumes that the Church can provide this:
“Chaplain’s functions within the hospitals relate to the patients’ spiritual needs and welfare and to their way of life, and therefore the duties of the chaplain may be defined as follows:
To see whether each patient admitted wants, or is likely to want, his spiritual help, and always to be available at a definite time for patients to visit him.
To arrange for prayers, services and religious observance for the patients of his own denomination.
To supervise the care of the hospital chapel.
To co-operate with the chaplains of the other denominations for the welfare of the patients.
To act as educational officer in the hospital and so to interest himself in such items as the library, debates, drama, English lessons, recreations, current affair discussions, choral societies, music, and the patients’ magazine.
To be available to see patients’ relatives and to communicate, as needs be, with their clergy.
To participate with the other medical associates in the treatment, resocialization and rehabilitation of the patients.
To further the understanding between the mental hospitals and the general public by interpreting the hospitals’ functions to the community” (p.35)
In other words, the mental hygiene movement seconded the Christian Churches, starting with the Anglican Church, as public relations agents for the treatments, diagnoses and propaganda provided by the psychiatric profession, which controlled the “mental hospitals”, despite the fact that what they were doing and teaching were the very antithesis of what Jesus of Nazareth did and taught. They also seconded the psychology profession, which competes with the psychiatry profession, to implement psychiatrist-designed treatment programs, administer psychiatrist-approved “intelligence tests” and “personality tests” for psychiatric diagnoses made by the psychiatrists (not the psychologists), and process statistics which could be used by the medical and psychiatric profession, and, it turns out, the pharmaceutical industry.
The care of intellectually deficient children was already a self-appointed responsibility of the Christian Churches in Australia, and the conditions in which these children were kept from the earliest days of British colonization is a national disgrace. Although Dax does not write about mistreatment of psychiatric patients during his own years of office, his description of the conditions at the Kew Cottages in the 1950s gives some indication of how unwanted children were treated in Melbourne:
“There were open drains, children caught worms by drinking the water, there was little storage accomodation, the paint was drab and peeling. The children’s clothing was awful; the small boys had unlaced boots, long moleskin trousers turned up at the bottom, adult football jerseys which had been given to the cottages by a football club with old army jackets on top and whatever hats they could collect. They were dirty and had very little washing accomodation indeed. Many played in a shed during the day in a half-nude state, there was a battery of lavatories with eight or ten adjoining seats but there was no way of swilling the excreta out of the trough except by walking thirty yards for water. They passed urine into the open drains. The patients ate from tins with their fingers, slept on straw mattresses and the place smelt of stale food and excreta and unsatisfactory drainage.” (p.125)
Although there were improvements in the cosmetic appearance of many of the metropolitan institutions in the 1950s, 60s, 70s and 80s, the abusive treatment of young people in Australia, including forced labour, separation from families, and arbitrary punishment were to continue under the joint supervision of the Mental Hygiene/Health Authority (and its successors) and Church Organizations, later accompanied by bigger and bigger doses and combinations of crippling drugs. Dax explains:
“The intellectual deficiency colonies are partly under the care of the Mental Hygiene Authority and partly of several voluntary organizations. One of the latter is really a day-centre, organized on a residential basis because it is in the middle of a sparsely populated district, where the pupils cannot come by transport each day, in other ways it is similar to the retarded children’s day-centres. There are eighteen boarders there who go home for holidays and frequently for weekends. A few day-children are taken. The other two voluntary residential colonies are run by the Catholic Church. Marillac House for retarded children from 6 to 16 was opened in 1943 by the Daughters of Charity of St Vincent de Paul. In 1961, there were ninety-six girls, of a higher intellectual level than the children in the retarded children’s centres and mostly of about special school standard.
“The Brothers of St John of God opened an institution in New South Wales in 1947 for the training of intellectually handicapped boys, and another in 1953 in Victoria. The children in the main training centre are at the special school level, but a lodge adjoining was later opened for those who were no more than the day-centre level. In 1957 they opened a farm colony and there are now 95 boys in the residential unit, and 40 in the farm colony.” (p.124)
The Church directly sold out to the corporate interests of the chemical industry and psychiatric profession by selling Churches for conversion into psychiatric treatment centres, where the treatments were inevitably chemicals, combined, at times, with surgical mutilation and electric shocks, physical restraint and solitary confinement, forced labour and brainwashing. Dax writes:
“The Clarendon Clinic [in East Melbourne] was formed by redesigning a church, its vestry, a church hall and an adjacent house. The body of the church has been converted into a therapeutic workshop and the vestry into four consulting rooms. The church hall has been made into a cloak-room, sitting- and dining-room, and a hall for the rooms, offices and staff rooms and a female toilet block.
“The clinic was designed to supply the needs of those patients who had been many years in hospital, had been rehabilitated there by the new methods used, and were now fit for community care. However many of them were unable to earn a living at first or to find accomodation except by the use, at least on a temporary basis, of one of the departmental hostels. Moreover, many of them still needed some medical care, and were therefore followed up by their own medical staff who could visit the Clarendon Clinic to see them.”
The “new methods used” are inadequately described by Dax, but included insulin comas, chemical shock using cardiazol, injected and ingested tranquillisers, electric shocks (an older treatment) and brain mutilation by “psychosurgery”. He explains of the upgrading of “Larundel receiving house” into a major treatment centre, which it remains today:
“Larundel has a residential early-treatment unit and a short-term rehabilitation hospital attached. At Mont Park [the adjoining hospital] there is a longer term treatment hospital with a long-term rehabilitation hospital attached; this has a subdivision consisting of the general, medical and the surgical services and the neurosurgical unit, together with a geriatric hospital. Opposite to Larundel is a repatriation hospital for psychiatric cases attributable to war service. Within two miles is the old private hospital which is being used for geriatric patients but which may be converted later into a short-term alcoholism treatment centre” (p.177)
As they plotted to convert a general hospital for the elderly to an “alcoholism treatment centre”, the Mental Hygiene Authority and associated hospitals explored new treatments for their captives and converts with the aid of the then new “Mental Health Research Institute” in Parkville, Melbourne. Dax writes:
“In 1954 the Chief Clinical Officer, Dr Alan Stoller, was appointed, but much of his time in that year was spent in an Australia-wide survey of mental health needs and facilities, so he did not take up his position until 1955. Shortly after this the Mental Health Research Institute was built and officially opened by the late Sir Ian Clunies-Ross.
“In 1955 a Mental Health Research Fund was founded consisting of an annual grant by the Victorian government to the University of Melbourne…Within the first year the University Department of Anatomy was able to demonstrate its work on the neuro-anatomical basis of emotion and growth on mongoloid children. The Departments of Physiology and Pharmacology were working on cerebral sedatives and analeptics while the Department of Pathology was doing research on cerebral arteriosclerosis.
“By the beginning of 1956 the Mental Health Research Institute was able to give demonstrations of the work proceeding in the Department on the incidence of schizophrenia, Huntington’s Chorea, juvenile delinquency, the clinical effects of tranquilizing drugs, electro-encephalographic studies of brain-damaged children and the results of infero-medial leucotomy [psychosurgery]. Studies had also been made on the treatment of excitement with lithium and its effects were being tried out at several hospitals.” (p.139)
The passage above reveals the connection between the mental hygiene movement, the University of Melbourne, the Mental Health Research Institute in Parkville and the public hospitals, including Royal Park Hospital, also in Parkville. In all these institutions the main focus was on drug treatments, although Dax was also enthusiastic about brain surgery for the treatment of psychological problems. At Royal Park Hospital, Larundel and other psychiatric hospitals electric shocks to the brain were also used for various conditions, the names of which have been changed over the past forty years. Electric shocks to the brain, usually called ECT in Australia, are used against people’s wishes in dozens of hospitals in Australia, today. The use of electrical shocks in Australia dates back to the 19th century, and it has been an unchanging feature of Australian psychiatry over the past century, although the “discovery” of ECT is usually attributed to Cerletti in Italy in the 1940s. Such is the nature of psychiatric diagnosis and treatment terminology as well as history: it is subject to frequent changes. Thus electric shocks to the brain have been called “electroconvulsive therapy” or ECT, “shock treatment”, “electroshock”, “electroplexy” and “electro-therapy”. The same class of drugs have been called “analeptics”, “neuroleptics”, “anti-psychotics”, “major tranquillisers” and “psychotropics”. The use of lithium was experimented with, in Dax’s terminology, for “excitement” (a suspect indication, indeed), but now it is used for “mania” and “bipolar affective disorder”. Previously “bipolar affective disorder” (BAD) was called “manic depression”.
Lithium was first used on psychiatric patients by the then 39 year old superintendent of Bundoora repatriation hospital in Victoria, Dr John Cade. This occurred in the 1940s, and since then the Victorian and Australian psychiatric hospitals have been avid dispensers of lithium, often referred to as a “mood stabiliser”. Although it may indeed prevent fluctuations in mood, the ingestion of lithium is accompanied by a range of unpleasant and dangerous side-effects and is extremely toxic in overdose. Lithium is toxic to the kidneys and thyroid in particular, and, since the toxicity margin is recognised to be low, regular blood tests to check lithium levels (also used to check compliance with drug-taking) are necessary if this drug is prescribed, as it often is done in Australia. It also dulls emotional reactions generally and produces a range of unpleasant mental side-effects in many who are forced to take the drug under threat of incarceration if they “fail to comply” with treatment.
The medical education system in Australia has, since its inception, like the military, been rigidly hierarchical, with professors at the top and medical students at the bottom, and the ladder is climbed by the acquisition of degrees and publications, together with less easily identified factors, which come into operation in the mysterious “upper echelons” of the academic world, an area where global politics plays a greater role than most people realise.
The Mental Health Research Institute in Parkville, Melbourne is Victoria’s biggest psychiatry research institution and is affiliated with the University of Melbourne, the city’s oldest university. The Institute was initially set up at Royal Park psychiatric hospital in the 1950s, shortly after, as was revealed in the press recently, several Nazi ‘scientists’ were smuggled into Melbourne.
The previous director of Royal Park Hospital, the psychiatrist Norman James, was, after the closure of the notorious hospital, appointed Chief Psychiatrist of Victoria during the autocratic reign of Premier Jeff Kennett (who, after being voted out of office assumed the lucrative job of CEO of ‘Beyond Blue’, part of the Federal Government’s ‘depression initiative’, which will be examined later). James wrote the opening chapter in the undergraduate textbook Foundations of Clinical Psychiatry (1994) titled “A Historical Context”.
In it he wrote:
“It was in the asylums that the first widely available and effective biological treatments were developed. Freud himself trained in neurology and recognised that the severely mentally ill required organic forms of treatment. The discovery of electroconvulsive therapy (ECT) by Cerletti and Bini who worked in a mental hospital in Rome in 1938 led to a simple and readily applied treatment for those who suffered from severe depressive illness and related disorders. Despite the advent of World War II, ECT was rapidly adopted as a treatment internationally.
“The discovery of lithium in 1949 as a treatment for mania and as a prophylaxis for bipolar disorder (manic depression) was made by Dr John Cade, a distinguished Australian Psychiatrist. This was soon followed by the development of major tranquillisers, the neuroleptics, by Delay and Deniker in Paris in 1952, although the initial idea of their application in psychiatry occurred in a general hospital when it was noted that they were effective tranquillisers for patients undergoing surgery. Shortly after this Nathan Kline made the discovery that a drug being tested for its effect in tuberculous patients had an antidepressant action and thus the first specific antidepressants were discovered, again in a large mental hospital and this time in Orangeburg, New York”.
Professor Edward Shorter, in A History of Psychiatry (1997) gives more details of John Cade’s less than exacting methodology in his rapturous description of the “medical discovery” of lithium:
“The story began in 1949 with John Cade, the 37-year-old superintendent of the Repatriation Mental Hospital in Bundoora, Australia [Victoria]. Cade, like Neil Macleod in late-nineteenth-century Shanghai, had not lost his scientific curiosity despite his provincial isolation. He was determined to see if the cause of mania was some toxic product manufactured by the body itself, analogous to thyrotoxicosis from the thyroid. Not having any idea what, exactly, he might be searching for, he began taking urine from his manic patients and, in a disused hospital kitchen, injecting it into the bellies of guinea pigs. Sure enough, the guinea pigs died, as they did when injected with the urine of controls. Cade began investigating the various components of urine – urea, uric acid and so forth – and realized that to make urine soluble for purposes of injection he would have to mix it with lithium, an element that had been used medically since the nineteenth century (in the mistaken belief that it could serve as a solvent of uric acid in the treatment of gout).
“Then Cade, on a whim, tried injecting the guinea pigs with lithium alone, just to see what would happen. The guinea pigs became very lethargic. “Those who have experimented with guinea pigs”, he wrote, “know to what degree a ready startle reaction is part of their makeup. It was thus even more startling to the experimenter that after the injection of a solution of lithium carbonate they could be turned on their backs and that, instead of their usual frantic righting reflex behavior, they merely lay there and gazed placidly back at him.”
“Cade had stumbled into a discovery of staggering importance, yet he was able to develop it only because of his resoluteness in taking the next step. He decided to inject manic patients with lithium… he injected 10 of his manic patients, 6 schizophrenics, and 3 chronic psychotic depressives. The lithium produced no impact on the depressed patients; it calmed somewhat the restlessness of the schizophrenics. But its effect on the manic patients was flamboyant: All ten of them improved, though several discontinued the medication and were still in hospital at the time Cade wrote his article late in 1949. Five were discharged well, though on maintenance doses of lithium.” (p.256)
No mention is made in this book, or in Professor James’ account, of the toxicity and risks associated with swallowing (or injecting lithium), which are, in particular damage to the kidneys and thyroid. So dangerous is this drug, that regular blood tests must be done to guard against acute and chronic toxicity. According to the MIMS Annual (1993), its “adverse reactions”, better described as “dangers and toxicity”, are briefly described as follows:
“Administration of lithium carbonate may precipitate goitre requiring treatment with thyroxine, but this regresses when treatment is discontinued. The ECG [electrocardiograph] may show flattening of the T wave. Hypercalcaemia, hypermagnesaemia, weight gain and oedema may occur, and skin conditions may be aggravated. The toxic symptoms are referable to the gastrointestinal tract and the central nervous system. These must be known by the patient and his or her nurses and relatives. Those referable to the gastrointestinal tract are anorexia, nausea, vomiting, severe abdominal discomfort and diarrhoea. Those referable to the central nervous system are lassitude, ataxia, slurred speech, tremor (marked) and agitation. If none of these are present, the patient is not intoxicated. Patients suffering from lithium toxicity look sick, pale, grey, drawn and asthenic. It is vital to bear in mind that lithium can be fatal, if prescribed or ingested in excess…At serum lithium levels above 2 to 3 mmol/L, increasing disorientation and loss of consciousness may be followed by seizures, coma and death.”
Heralding the “discovery” of lithium by Cade by a Victorian psychiatrist as a great moment in medical science, the Victorian medical establishment, including Professor Norman James, has long been insistent on the treatment of “manic” and even “hypomanic” people with lithium. This is despite the known risks and toxicity of the drug.
Lithium is said, by Australian psychiatrists, to “stabilise the mood”, and it is assumed that people who have had even brief episodes of “elevation” or “abnormal excitement” need long term mood stabilization with the drug. This includes single episodes of “hypomania”, which is described in the American Psychiatric Association’s DSM IV as follows:
“A Hypomanic Episode is defined as a distinct period during which there is an abnormally and persistently elevated, expansive, or irritable mood that lasts for at least 4 days (Criterion A). This period of abnormal mood must be accompanied by at least three additional symptoms from a list that includes inflated self-esteem or grandiosity (nondelusional), decreased need for sleep, pressure of speech, flight of ideas, distractibility, increased involvement in goal-directed activities or psychomotor retardation, and excessive involvement in pleasurable activities that have a high potential for painful consequences (Criterion B)”. (p.335)
As if it makes the diagnostic criteria “precise” and “specific”, the DSM adds that:
“If the mood is irritable rather than elevated or expansive [which are not further defined in the DSM IV], at least four of the above symptoms must be present.”
It is incredible that “increased goal directed activities” and “non-delusional increase in self-esteem” could be cited as evidence of mental illhealth rather than an indication of improved health. Furthermore DSM IV adds that:
“The change in functioning for some individuals may take the form of a marked increase in efficiency, accomplishments or creativity.” (p.335)
It is strange that this mental state should be viewed as an “abnormal” one, but at least the American Psychiatric Association (unlike the Australian psychiatric establishment) does not advocate incarceration or forced drugging for “hypomania”. The reference manual says:
“In contrast to a Manic Episode, a Hypomanic Episode is not severe enough to cause marked impairment in social or occupational functioning or to require hospitalization, and there are no psychotic features.”
The University of Melbourne’s Foundations of Clinical Psychiatry is not as clear in their distinction between “hypomania” and “mania” and “hypomania” has only two references to it, one relating to diagnosis and one relating to treatment. Under “Abnormal states of mood elevation” is written:
“Far less commonly [than depression], a persistent elevated mood occurs. Similarly, a continuum of severity if found with the mild states difficult to distinguish from normality. Moderate severity Hypomania, or severe state Mania, are obvious, the patient’s behaviour having serious consequences if treatment is not swiftly initiated. Most manic patients also experience depressive swings, and this condition is therefore referred to as Bipolar Mood Disorder.” (p129)
The recommended treatment is described under “management of elevated mood states”:
“The assessment and treatment of the patient suffering from acute hypomania or mania is essentially the management of the acutely psychotic patient. Organic conditions, including drug-induced states, need to be excluded. For reasons of safety, most patients need hospitalisation which, because of the lack of insight, may need to be recommended. The mainstay of pharmacotherapy are the neuroleptics, such as Haloperidol or Chlorpromazine. Although lithium carbonate is an effective antimanic agent at relatively high concentrations risks of toxicity discourage its use. Occasionally, for particularly severe cases, ECT is needed.” (p.144)
The drugs recommended for the treatment of “hypomania” and “mania” turn out to be the same ones recommended for “schizophrenia” and “ECT” is electroconvulsive treatment (shock treatment), which is used for “depression” as well as its “opposite”, “mania” and also for severe or “intractable” psychosis (including that supposedly due to “schizophrenia” or “schizoaffective disorder”). Unlike many other parts of the world, where ECT has been banned or seriously restricted, in Australia the use of electrical shocks has increased in recent years and is used more widely (in more centres and for more reasons). Most of the psychiatric hospitals in Australian cities give patients ECT, often against their will.
Involuntary ECT in the State of Victoria is said to be restricted to “emergency cases”, but it is left to the individual psychiatrist to define what constitutes an “emergency”. The systems of appeal open to the protesting patient are very limited. They can appeal to the Chief Psychiatrist, Norman James, who has the authority to stop the abusive use of drugs or ECT. It is most unlikely that he would, however. James, who was previously head of psychiatry at the Royal Park Hospital is a keen advocate of both ECT and the use of “neuroleptic drugs”. It is he who wrote the opening chapter of Foundations of Clinical Psychiatry. In it, he wrote an intriguing passage:
“The asylums inaugurated as a result of humanistic urges soon became grossly overcrowded, despite the fact that some were among the largest and most expensive buildings erected by the governments of the day. Numerous difficulties beset them. As a result of their isolation they became large, impersonal, human warehouses. Patients had few if any rights and were completely at the mercy of their carer – a largely untrained workforce from which has arisen the modern profession of psychiatric nursing. There was a total lack of any specific physical treatment for mental illness until the advent of ECT [so much for walking in gardens, music and warm baths]. Those who did improve did so largely by the passage of time and the happy advent of a spontaneous remission [not ‘recovery’]. These conditions led to a cycle of scandals, public inquiries, usually some temporary improvement and then a relapse into previous conditions or worse.” (p.9)
It could be time for another public inquiry.
In psychiatric wards and Mental Health Review Board hearings the psychiatric patient is judged guilty unless proven innocent. Unfortunately innocence (of ‘mental illness’ or ‘personality disorder’) cannot actually be proved according to prevailing psychiatric theory which does not view humans in terms of “guilty” or “innocent”. All psychiatric patients are “officially innocent”, just “unfortunately inflicted with an (invisible) illness”. One which “unfortunately tends to run in families”. Thus entire families are stigmatised without laying blame on any individual. It is not the fault of the family or the individual to be afflicted with illness: it is “just one of those things”. Maybe genetics plays a role. That way individuals in the family can scan their relatives (and in-laws) for evidence of insanity.
As for the diagnosed patient, regardless of whether he or she is called a “mental patient”, “schizophrenic”, “nutcase”, “client” or “consumer” there is no escape from the judgement of “defective” and the accompanying stigma. Even if no evidence can be found at a particular time of mental illness, the patient can be accused of “masking” (hiding) their madness or be in remission.
