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Is 'chemical cosh' really an outrage against dignity?


SEARING TALE: The heartbreaking issues of mental illness were dealt with in the film Frances, starring Jessica Lange

SEARING TALE: The heartbreaking issues of mental illness were dealt with in the film Frances, starring Jessica Lange

SEARING TALE: The heartbreaking issues of mental illness were dealt with in the film Frances, starring Jessica Lange

Chemical cosh is a vile term. The opponents of the use of psychotropic (extremely powerful sedative anti-psychotic) drugs believe that, vile though it is, it exactly describes the effect of such drug usage on patients, whether they're elderly and suffering from dementia, intellectually disabled at any age, or suffering from a long-term mental illness such as schizophrenia.

In the case of elderly people, prolonged use of the drugs can increase the risk of death or stroke, according to medical authorities.

Understandably, the families of vulnerable people in residential/hospital care are increasingly worried about the use of such drugs in controlling what is generally described as "challenging behaviour." And they tell the stories of the men and women they loved who lived in the community happily and with a reasonable degree of independence.

Until. Until their families could no longer cope with the emotional and physical burden of looking after them, or until the level of individual care they required was so enormous that no health service could carry the cost burden in the community on a long-term basis.

But it's only as an afterthought that the campaigners mention what "challenge" can mean. It can mean a 40-year-old man who weighs 20 stone flying into a violent rage, hitting out at his 70-year old frail mother with his fist or a hammer, and knocking her to the floor, leaving her with her head bleeding against the fireplace.

And no, it's not his fault: that's what a mental illness can do to someone.

Three hundred years ago, we called such people lunatics, and locked them in filthy "asylums" where they were chained to wet, reeking walls; released only to be whipped when they suffered another attack.

And sometimes it seems as though we have a modern version of that, when ill-trained, or over-worked staff, or even staff who are entirely unsuited to the work and who take the job because they can't find another, thump middle-aged people across the head for behaving like out-of-control six-year-olds.

The middle-aged people behave that way because their mental age is six. Or the staff tie an old person in a chair because they're wandering around shouting abuse, throwing food on the floor, generally being disruptive.

Families have to cope with "normal" bad behaviour in children. When it's "abnormal" because of mental illness or a cruel genetic trick, or because someone has reached what Shakespeare called the seventh age of man, they expect assistance from society.

If that assistance isn't enough, they admit defeat and consign the loved one, whether child or adult, to the residential care of the State. But sometimes they forget the "challenges": forget the terror for their own lives they felt when the much-loved schizophrenic or autistic son, daughter, or parent came at them, with sometimes murderous aggression in their eyes. Forget the physical attack which was the last of many and led them to admit they could no longer cope.

But they still love the person; they still want them to be treated with dignity, even love. Time-consuming, expensive, expert, highly-trained love; not the chemical cosh which sometimes replaces physical restraint and "punishment" when that ideal is an unattainable Utopian dream. Who can argue with their demands and their sense of outrage?

With the greatest respect for their agony, maybe we should argue with it. A number of years ago, I visited a mental hospital. I was smuggled in through the intervention of a TD, by the sister of a "patient" there who was in what was euphemistically referred to as a "locked ward." The public didn't get into those wards. Understandably, because if the one I saw was an example, they were hellholes of sub-human conditions.

What one could see of the walls were peeling and filthy, smeared with excrement and other festering substances. There was hardly any light. The stench was overwhelming, not surprisingly because the two lavatories in clear view which served the 40 or so women had no doors, no lavatory seats, and were festering in a flood of urine and excrement.

The women clutched as we passed, begging for cigarettes; many of them had badly burned hands, the result obviously of unsupervised smoking, the cigarettes burned to their ends. All of them smelled of unwashed clothes and bodily excretions.

The woman I had come to see was away from all that, because she was being punished for attacking a nurse: the attack had been violent and dangerous.

A door was unlocked for us. The cell was a reasonable size, but much higher than it was wide or long, again painted grey. The only light came through a slit window close to the ceiling. The woman squatted on a mattress, which at least was clean, but was the only furniture in the cell.

She was rocking herself and weeping as though her heart would break. She looked intimidating, weighing what must have been close to 20 stone; she was 26 years old. I could well understand that she had inflicted painful, even serious injuries on the nurse she had attacked. But she was certified as having a mental age of six, and she was crying because "they" had taken away her doll as further punishment. She would be in her cell for 24 hours at least, in the dark. This was a hospital; but one where the patients had to be "restrained" due to their illnesses.

On the way back to the city, her 18-year-old sister who had brought me in as a "family friend", wept every bit as bitterly. She howled to me that she wished she had the courage to bring a knife with her on one of her visits, so that she could end it for her sister

The following day, I spoke to a figure in very senior authority; there was audible shock that I had managed to see what I saw. I was told "You have to understand that these people don't have feelings like the rest of us."

This is not a story from the dark ages; I was an adult, there as a journalist, albeit a very young one. Care in the community for the mentally ill was already part of national policy. Except the community was already unable to cope.

I still sometimes have nightmares about that day, waking sweating, with tears running down my face. Being a journalist is no armour against the unjust horrors of the world. But I believe that what campaigners on behalf of the mentally ill and intellectually deprived are demanding is an ideal: they must continue their brave and angry fight, but no society has the resources to provide what is the ideal.

And I believe with every fibre of my being that that tragic woman I tried to talk to years ago, and her fellow patients whose filthy hands clutched at me as I walked through the dungeon in which they lived, would infinitely prefer what is now being termed a chemical cosh to the conditions which expected them to take responsibility for their "challenging behaviour."

Sunday Independent