Flying in the face of the facts of your life

From Nuala O’Faolain’s ‘Are You Somebody?’

“When I was in my early thirties, and entering a bad period of my life, … I asked the doctor to send me to a psychiatrist.

The psychiatrist was in an office in a hospital. ‘Well, now, let’s get your name right to begin with,’ he said cheerfully. ‘What is your name?’

‘My name is … my name is …’ I could not say my name. I cried, as from an ocean of tears, for the rest of the hour. My self was too sorrowful to speak. And I was in the wrong place, in England. My name was a burden to me.

Not that the psychiatrist saw it like that. I only went to him once more, but I did manage to get out a bit about my background and about the way I was living.

Eventually he said something that lifted a corner of the fog of unconsciousness. ‘You are going to great trouble,’ he said, ‘and flying in the face of the facts of your life, to recreate your mother’s life.’ Once he said this, I could see it was true.”

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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

Hidden stories of abandoned mental hospital revealed

“After we published an anonymous account of life in St Ita’s psychiatric institution, a photographer and a doctor were among readers to add to its portrait of life there …”

Garrett Igoe’s poem, Patient:

I pierced your innocent vein with bevel up,
infused a swift sedating rush,
held back healthy curls
from your high brow,
applied the shocking cups.
You convulsed
in that red bricked
sea swept place,
memories eroded, like peeling paint,
decades of wasted afternoons,
one sock black, the other baby blue.
Rattle rattle dum dum dum
your mantra, drowning
shouts from the female side,
charge nurse X doled
out the Major, you told me
you liked the mauve
of Doctor X’s jacket.
On night rounds, I ignored
the scurry of black eyed creatures,
held tight the keys
of twenty four locked wards.
And finally I abandoned you,
left you to go on
showing your tongue
smacking your lips,
rolling your eyes,
uncontrollably.

 

The Irish Times >>>

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) >

Professional and local interests had stake in keeping aslyums, says major study

Medical professionals and local communities protecting their economic interests played a major role in the incarceration of tens of thousands of people in asylums, according to a study into what’s depicted as the forgotten scandal of Ireland’s institutional past. Its author, Dr Damien Brennan, said there were strong parallels between the operation of Ireland’s mental hospitals and the Magdalene laundries but the former “can’t be blamed on the church; it was a State-run project. We did it as communities, as societies”. In his book Irish Insanity: 1800-2000, the culmination of 10 years of research launched in Dublin last night, he seeks to explain why Ireland in the 1950s had the world’s highest rate of mental hospital residency. (Times) >

After the Asylum: Mags Kelly: The psychiatric system that I went to for help just kept pumping me up with tablet after tablet

“The psychiatric system that I went to for help just kept pumping me up with tablet after tablet – up to 50 or 60 a day at one point,” Mags says. “. . . I was getting injections as well – I never knew what they were – and couldn’t get out of bed for days afterwards . . . I’d be asking people what day of the week it was. I didn’t know. I’d be drooling from the mouth.”

There were inpatient stays in mental hospitals, too. So many now that she can’t remember. Back on the street, she used crack, heroin or alcohol to ease the pain. Many of those she met on the streets died through overdoses, medical complications, suicide or other reasons.

Just over a year ago, Mags suffered a brutal assault. She could feel her life slipping through her fingers as she lost several pints of blood. She recovered, but she wasn’t sure if she could survive another setback. By now she was living in a homeless shelter in Cork.

When she was told about Slí Eile, a community therapeutic centre in the countryside, she was skeptical at first. “It sounded like the kind of place that was full of nuns,” she says. “But another girl – a previous tenant here – told me, ‘My neighbours were the bird; you’ll be safe and get your life sorted out’.” (Times) >

After the Asylum: Rory Doody: ‘I loved the severe physical pain. It was better than the mental pain’

Consultant psychiatrist Dr Pat Bracken says his profession needs to change. He says psychiatrists still have huge powers – and responsibilities – under the terms of the Mental Health Act. A psychiatrist has the power to determine what treatment will be used, how it will be used and its duration.

There are many people who carry hurt and suffering from past experiences in asylums or psychiatric hospitals
The old granite and red-brick buildings are closing. But shutting the door on a culture which often ignored the voice of patients isn’t necessarily as easy.

“While many improvements have been made in recent years, the need for a more humane, person-focused service is still the consistent message from the many people we consult across the country,” says Orla Barry, director of the campaign group Mental Health Reform.

“Although many people have positive experiences of mental healthcare, we regularly hear about those who feel they cannot get their voice heard within mental health services and are not given the choices they should have over their treatment.” (Irish Times) >