Saturday 25 October 2014

Patricia Casey: Any review of past abuses must extend to asylums

Historically, many psychiatric institutions across the world were hit with stories of mistreatment and neglect of patients. Now is the time to discover if any human rights abuses occurred in Irish centres

Patricia Casey

Published 17/06/2014 | 02:30

People leave candles and mementos during a march and candlelit vigil from the Department of Children and Youth Affairs to the gates of Dail Eireann on Merrion Square, Dublin, in memory of the Tuam babies. PA
People leave candles and mementos during a march and candlelit vigil from the Department of Children and Youth Affairs to the gates of Dail Eireann on Merrion Square, Dublin, in memory of the Tuam babies. PA

THE revelation that there is, possibly, a mass grave on the site of the old Mother and Child home in Tuam, Co Galway is one that has shocked the nation, although we await further information from soil tests and possible excavation to illuminate this.

Another deeply worrying development is the information that children in these homes were used as trial subjects to test new vaccines. Writing last week in another daily newspaper, the director of Barnardos, Fergus Finlay, opined that psychiatric institutions should also be subject to examination, lest there too lurks a tragic story of abuse.

He is absolutely correct – if we are investigating some types of institution, why not others with a known record of human rights abuses?

And psychiatric institutions have long been known to be centres that abused and exploited those who were ill. Impelled by the harsh regimes in asylums in Britain, William Tuke founded The Retreat in York in 1796 to offer humane and "moral" treatment for the mentally ill.

He and his fellow Quakers believed that the humanity of every person could not be extinguished by mental illness, a radical view at the time since those with mental illnesses were regarded as no better than wild beasts. Jonathan Swift had a similar aspiration when he founded St Patrick's Hospital in Dublin in 1747, the first asylum in Ireland. These ideals may have been lost in the mists of time and politicisation, as history shows us.

Even in the 20th century the chronicle of psychiatry internationally is filled with evidence of neglect and mistreatment of those whom the profession was supposed to be treating with compassion and wisdom, driven by political imperatives.

Take Leros, the remote Greek Island that from 1959 until 1995 housed 2000 severely mentally disabled patients. They had been removed from institutions on the Greek mainland because of overcrowding and they were deemed suitable for relocation as they had no contact with family members.

In 1985 the scandal of their treatment was exposed and the world was stunned. They were naked, tied to beds, showered in cold water and offered no interventions to help them even have a structure to their days.

Another scandal involving the mentally ill implicated the Swedish government. Driven by eugenic policies from 1935 until 1976, it compulsorily sterilised those who were mentally ill, had learning disabilities or were epileptics.

Over 62,000 procedures took place and many of the victims were later paid compensation by the government. Vaccines were tested on children with learning disabilities in hospitals in the United States in the 1950s. Eastern bloc countries and the political establishment in China persuaded psychiatrists that political dissidents were psychiatrically ill and needed to be detained in hospital.

The new psychiatric condition known as "sluggish schizophrenia" was created.

In Britain in 1999, the government there also created a new condition called "dangerous and severe personality disorder".

These were people thought to be at risk of committing serious, violent crime in the future. Some were already in prison but, if deemed to be at risk of recidivism, they were transferred to special units for treatment thereafter, for an indeterminate period.

This preventive detention was greeted with ire by my psychiatric colleagues and so a scandal never occurred. The programme was recently abandoned.

It is tempting to think that in light of this disturbing, albeit incomplete snapshot, Irish asylums must too have a dark history ripe for exposure. After all, the rate of institutionalisation for those with mental illness increased in most countries worldwide from the late 19th century into the 20th century.

According to the book Asylums, Mental Health Care and the Irish 1800-2010 (edited by Pauline Prior) data from the World Health Organisation showed that Ireland exceeded all other states in its rate of institutionalisation of the mentally ill.

In 1955 there were seven per 1000 of the population in psychiatric hospitals, even higher that the USSR (6/1000), Barbados (4/1000), England and Wales (3.5/1000) and Australia (3.3/1000).

Moreover, our proclivity to institutionalise continued even after other countries were dismantling their asylums.

In a series of articles written by Michael Viney for the Irish Times in 1968 (No Room to Move, October 23, 1968) he described drab wards, overcrowding and languishing inactivity.

More than four decades later in 2011, the late Mary Raftery (Behind the Walls, RTE 1), identified similar overcrowding but also misdiagnosis. So far none have uncovered systematic physical or sexual abuse. This is not to say that it may not have happened and that other abuses may not also have occurred, such as neglect.

Recently there has been a surge of writing concerning the human rights issues involved in treating those with mental illness (Brendan Kelly, Irish Journal of Psychological Medicine 2014), no doubt reflecting the heartfelt concerns of the profession to helping those it treats.

So, let us have an inquiry into the asylums of the past and into current psychiatric practices. I believe that the obvious failings of the past have been rectified. But, no profession must ever be complacent. If there are continuing abuses, either by commission or omission, driven by economics or politicisation, then we must hear about these and correct them.

Every human being from the lowliest to the richest, from the mentally ill and disabled to the genius, has a right to respect. This human right exists simply because they are human.

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