Too many ghosts haunt our mental health service: John Farrelly of the Mental Health Commission

From The Irish Times, 14 October 2019:

We have a history of isolating vulnerable people. To some extent this is still happening. Just a few months ago the Mental Health Commission prosecuted a Kilkenny hospital for unlawfully secluding vulnerable and ill people in a smelly, dirty room. We wanted to ensure that people were safeguarded and protected, but also to send out a clear message that, where any seclusion or restraint occurs, it must be a last resort and in accordance with the law.

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Session #5: Looking Back (at institutions that failed us)

These notes on the fifth session are written by one of the participants, summarising our discussions of Celia de Fréine’s Blood Debts & Hanna Greally’s Birds’ Nest Soup.

I was … very affected by the texts we looked at this week: the narrative accounts from a patient’s point-of-view really spurred my inner empathist, and, by the end of ‘Blood Debts’, I personally viewed the doctors and medical professionals as incompetent or even villainous. I believe strongly that this is what Medical Humanities really brings to our medical education. TV shows often paint this idea of doctors who, despite their smarm and snark, only need critical thought, smarts and perhaps a tiny little bit of luck to end up as the celebrated hero (or anti-hero) of their respective narratives (think House M.D.,Grey’s Anatomy, or The Good Doctor). Outside of perfectly wrapped 45-minute storylines, however, other narratives exist: those of the long-suffering, patient patients, mistreated by medical professionals, ever-wary, ever doubtful. How can we be alienating the very people we have sworn to help? It certainly becomes impossible to ignore this incongruity when stories and poems force us to consider their perspective.

Blood Debts by Celia de Fréine

> This week we looked at Blood Debts by Celia de Fréine, a translation of Fiacha Fola, a sequence of [Irish language] poems by de Fréine describing her experience of being one of 1600 Irish citizen infected with contaminated blood products in the 1970s.

> We began, however, without any knowledge of the context as we went into the first poem: ‘chalice of my blood’. This was a reflective poem acknowledging there seemed to something congenitally wrong with the poet (suggested to literally be her blood), and lamenting on what what she she could have done differently should she had known. She concludes that she would have not done anything differently. She invokes religious (Greek/Roman) imagery that elevates the concept of marriage to mythic proportions and seems to celebrate her right to have the partner and children that she wants.

> In the second poem, ‘miracle play’, heavy dream-like imagery is used, with references to religion and that of plague as she watches a biblical play. There is imagery suggesting the concept of something sinister hiding within something pure, and the concept of dramatic irony as a literary technique—originally used in Greek tragedy, by which the significance of a character’s actions is clear to the audience although unknown to the character—is introduced in her understanding of the spread of disease, unbeknownst to the biblical characters, and harks back to the preceding poem to the concept of the poet’s present self looking at her past choices in retrospect.

> The next poem, ‘september – month of birthdays’ recounts the birth of her second child and the administration of Anti-D (Rho(D) immunoglobulin (RhIG)). There is references to complications in her child’s birth, with his birth being breech instead of head, and references to her child not crying. There is also a sense of misplaced trust in the hospital/medical practitioners, with some subtle doubt being suggested as to whether they are acting in her best interests. Particular emphasis is put on her injection of Anti-D.

> The next few poems describe how she believes she is getting sick and jaundiced. She is placed in a situation where her doctor does not believe her symptoms and self-diagnosis and is dismissed by the doctor as ‘run-down’. This continues on with various accounts of the paternalistic attitude of doctors, from obstetricians to specialists who seem indifferent to her worsening illness. Eventually she is informed of the Anti-D scandal on the media, but despite her efforts to find out more, her concerns are continually sidestepped by upper management. Her initial doubt surrounding healthcare professionals evolves very much into anger and blame and they are painted as clear antagonists in her narrative.

> What Blood Debts does excellently is highlight the communication breakdown between medical practitioners and patients, especially when there is a mistake make by the practitioners. From the dismissiveness of first-line primary healthcare practitioners to the evasiveness of upper management, the medical field is depicted as having a toxic attitude of evasion and paternalism that [reflects] a lack of respect and dignity for its patients. Although occurring in 1977, the Anti-D scandal only became public in 1994—almost 20 years after it occurred, and de Fréine’s account is one of 1600 Irish citizens who were affected.
>

Hanna Greally’s Birds’ Nest Soup

> We ended by taking a look at an introductory excerpt from Bird’s Nest Soup by Hanna Greally, explained subsequently by a podcast we listened to as an autobiographical account of her institutionalisation in a mental hospital against her will, without the legal capacity to have herself discharged. To bring together all the sources we looked at in the tutorial, we considered the concept of institutionalisation: not only as a synonym for ‘incarceration’, but in its sociological meaning—the process of establishing something as a norm in an organisation or culture. We considered the idea of the institutionalisation of medicine and the possible implications that that has on the our future role as doctors-to-be; how the hallmarks of institutions—such as hierarchal systems of bureaucratic management, strict systems of conduct, and depersonalisation—can have a detrimental impact on the doctor-patient relationship.

> I have included some articles for anyone who is interested in further reading around the texts. The first explains the details of the 2018 CervicalCheck scandal, which we noted bares shocking similarity to the Anti-D scandal, the second is a blog post by a recently qualified doctor from the US about the concept of institutionalisation and the reality of real world practice in corporate medicine, and the final article is on paternalism and the doctor-patient relationship.

> CervicalCheck scandal: What is it all about? (The Irish Times, 2018)
https://www.irishtimes.com/news/health/cervicalcheck-scandal-what-is-it-all-about-1.3480699

> How the Institutionalization of Medicine Has Destroyed the Doctor-Patient Relationship (Shlifer, 2016)
http://in-training.org/institutionalization-medicine-destroyed-doctor-patient-relationship-11491

> From Paternalism to Partnership (The Irish Times, 2001)
https://www.irishtimes.com/news/health/from-paternalism-to-partnership-1.316916

Best description of an anxiety attack

This description of an anxiety attack in Sally Rooney’s Normal People is particularly accurate for a specific sort of anxiety and, especially as it proceeds, becomes exceptionally detailed and therefore very helpful to anyone trying to understand what a sufferer of such an attack goes through.

His anxiety, which was previously chronic and low-level, serving as a kind of all-purpose inhibiting impulse, has become severe. His hands start tingling when he has to perform minor interactions like ordering coffee or answering a question in class. Once or twice he’s had major panic attacks: hyperventilation, chest pain, pins and needles all over his body. A feeling of dissociation from his senses, an inability to think straight or interpret what he sees and hears. Things begin to look and sound different, slower, artificial, unreal. The first time it happened he thought he was losing his mind, that the whole cognitive framework by which he made sense of the world had disintegrated for good, and everything from then on would just be undifferentiated sound and colour. Then within a couple of minutes it passed, and left him lying on his mattress coated in sweat.

Sally Rooney, Normal People (Faber & Faber, 2018), p. 206.

Prof Jim Lucey’s new book In My Room – the Recovery Journey as Encountered by a Psychiatrist

His new book In My Room – the Recovery Journey as Encountered by a Psychiatrist , is based on composite real-life experiences of depression, alcohol dependence, obsessive compulsive disorder and post-traumatic stress. What Lucey focuses on, though, is not treatment plans and therapeutic approaches, but how the individuals describe their experience and how, in most cases, they learn to move beyond it.

Lucey cites Dr Dorothy Keelan, former senior psychiatrist at the Mater Hospital and the late Prof Anthony Clare, former medical director of St Patrick’s Hospital, as the most significant influences on his decision to become a psychiatrist.

“Dr Keelan showed me how to engage with the whole life of the person in such an intelligent and kind way. And I was so fortunate to work with Dr Clare, who was generous in his teachings and insights and open about psychotherapy. He also saw art, poetry and literature all of value to working with mental health.” (Irish Times) >

Art exhibition reflects creative activity among mental health community

Open to anyone using the mental health services throughout Cork City and county, the project aims to encourage creative activity, raise the profile of the artists, increase awareness of talents, and use art as a bridge between artists and the wider community. In total, 87 paintings go on display.

“Any of the artists will tell you this exhibition empowers them and gives them a sense of purpose,” says Brendan McCarthy, development manager at Cork Mental Health Foundation. (Examiner) >

‘Mental health stigma’ leads to treatment delay of up to a year

[From Examiner >] The stigma attached to poor mental health leads to one in five people delaying seeking treatment for a full year, according to research carried out by St Patrick’s University Hospital (SPUH).

Moreover, this stigma is costing lives, said Paul Gilligan, CEO of the country’s largest independent mental health services provider.

Speaking at the launch yesterday of the SPUH annual report 2011, Mr Gilligan described the stigma surrounding mental health as “often subtle”, “extremely damaging”, and “deeply engrained in Irish society”.

Continue reading “‘Mental health stigma’ leads to treatment delay of up to a year”