20 December 2001 Edition
The politics of mental health
Mental Health: Part 1
By Mick Derrig
The colonial experience has created mental suffering on a scale that would have been inconceivable had nations like our own been able to develop in our own way and at our own pace and, crucially, in our own direction
The current Irish mental health system is rooted in Ireland's history as a British colony.
In 1914, Ireland had a massive provision of beds in asylums, with a residence rate of 490 per 100,000 people compared with 298 for England and Wales and 283 in Scotland.
During the nineteenth century British asylums in Ireland had been the primary relief offered to evicted tenants, famine victims and pregnant girls turned out by their families.
Despite a major programme of Asylum building in the 1830s, the British administration in Dublin Castle found that they couldn't cope with the tidal wave of madness and distress that was sweeping the country. It is perhaps instructive that they picked the year 1845 to establish the office of "Inspector of Lunacy" in Dublin.
The Inspectors of Lunacy carried out two major surveys into the extent of the madness in Ireland. These are the only 32 County wide surveys ever to have been undertaken into the subject in the country's history. The Inspectors of lunacy used the Royal Irish Constabulary as their "researchers".
In the 20 years between 1880 and 1900, the number of asylums in Ireland doubled. By the end of that period 0.5% of the Irish population were housed in district lunatic asylums. This proportion would increase until it reached 0.7% in 1958. Regional variations were marked, with Sligo/Leitrim having 1.3%, and 0.5% in the East Coast area.
If madness was commonplace among the Irish in Ireland, it was also prevalent among Irish migrants. In a report to the commission on lunacy to the Commonwealth of Massachusetts, it was noted that of the 625 foreign-born "lunatics" present in the state in 1854, 512 came from Ireland.
The above indicates that mental health problems are a long-standing issue for Irish people and it transcends historical and geographical boundaries.
Theories abound, but examining regional and national variations in the incidence of consanguineous marriages has not explained these aberrant figures of the Irish at home or abroad.
However, perhaps the most relevant view comes from the pen of Franz Fanon - a black psychiatrist born on the island of Martinique; a product of the French Empire, he practised psychiatry in Algeria throughout the war of independence there in the 1950s.
Despite being a colonial functionary, he threw his lot in with the rebels. His work is still, decades after it was written, held by many to be the definitive statement on colonialism and mental health.
Fanon saw the psychological effects of colonialism as one the enduring, disabling legacies bequeathed to "natives" by their colonial masters.
Those who hold that view believe that neither the Afro-Caribbean nor the Irish experience of mental ill health in Britain can be separated from their respective histories as recipients of British colonisation.
The colonial experience has created mental suffering on a scale that would have been inconceivable had nations like our own been able to develop in our own way and at our own pace and, crucially, in our own direction.
The Irish and Afro-Caribbean experiences in England of mental ill health are, so, not a series of individual tragedies. They are a manifestation of the debilitating effects of racism and colonialism.
A study published in 1989, in England, looked at the psychiatric admissions per 100,000 of the population, aged 16 and over in 1981, by country of birth (Cochrane & Baal. 1989).
The study found that men born in the 26 Counties were more than twice as likely to be admitted to a psychiatric hospital as men born in England. Second most likely were men born in the Six Counties, with Afro-Caribbean men after that.
The English were the least likely.
In the same study, women born in the 26 Counties were two-and-a-half times more likely to be admitted to a psychiatric hospital, suffering from depression, than their English counterparts.
Moreover, it is not only in contemporary Britain that the Irish Diaspora appear to be over-represented among those classed as mentally ill.
A series of studies investigating ethnicity and national origin in New York, from the start of the 20th century until the 1950s, showed the Irish leading all other groups for first admissions to mental hospitals both for alcohol abuse and serious psychiatric conditions like Schizophrenia.
In modern Ireland the situation is, if anything, worse.
One study in 1980 reported that four percent of the over-forty male population in Roscommon was "psychotically ill".
Irish academic Dermot Walsh calculated in 1974 that the lifetime expectancy of psychiatric hospitalisation for schizophrenia in Ireland is four percent (4.8% for men 3.2% for women). This compares with less than one percent for other countries. In 1978 a World Health Organisation (WHO) survey found schizophrenia to be a world universal at about 0.8% of any country's population.
Across the 26 Counties the picture is not uniform; the rate for the West of Ireland is considerably higher.
In rural areas of the Six Counties the rates for Catholics is DOUBLE that of Protestants.
Irish women come from a culture, which is, apparently, unique in the developed world - in that they are less likely to be hospitalised for mental illness than the indigenous male population. This reversal for gender rates is a significant, but often-ignored fact, as is the disparity in suicide figures.
Ireland has the highest gender disparity in suicide rates "favouring" men more than anywhere, with the exception of Finland.
The medical model does not explain the Irish experience of mental ill health anymore than it explains why Irish men, particularly young Irish men, are committing suicide in droves.
The expert model is a comfort blanket for society - it gets the rest of us off the hook and dovetails in with several connected vested interests (the drug companies, medics, universities etc.).
This "psycho-pharmaceutical complex" takes the politics and history out of the suffering of |Irish people.
When the politics and history is removed from any human situation, there is a dangerous vacuum that is usually inhabited by the status quo.
In the coming weeks this special An Phoblacht series will look at the current state of the Irish Mental Health system and look to future trends and what role republicans should play as we prepare for government.
BY MICK DERRIG