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The illness that still dares not speak its name

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What can I do to get into hospital: The question posed by Spike Milligan.

What can I do to get into hospital: The question posed by Spike Milligan.

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What can I do to get into hospital: The question posed by Spike Milligan.

When Spike Milligan decided that if he didn't get committed to a psychiatric unit he may be "like this" for the rest of his life, he thought, "what can I do to get into a hospital?". The answer? "I got a potato knife and I went to kill Peter Sellers".

So began the first episode of TG4's extraordinary new series Ar Intinn Eile (An Irish State of Mind). If you haven't seen it yet, I urge you not to miss the third and last episode which airs on Wednesday, because this is public service broadcasting at its best.

I've often rattled off - as proof of our refusal to tolerate difference - the statistics that show us how, as a nation, we used to incarcerate more of our people per head of population, than any other nation in the world (including the old USSR). Between Magdalene Laundries, industrial schools, mother and baby homes and of course, the local asylum, we Irish would seem to have been gung-ho about locking up anyone even slightly mad, bad or dangerous.

Our institutions were, as Ivor Browne says in this series, "dumping grounds for people not wanted in society"; they were places of dark desperation, where people who had "lost their reason", and therefore their humanity, could be deposited and forgotten.

The truth, as this fascinating documentary shows, is rather more nuanced. Where psychiatric asylums were concerned, the Irish knew how to play the system and they played it very well. Like Spike Milligan, those in need of sanctuary knew how to access it, and were able to do so without fear of refusal.

Amazingly, from the 19th century on, the Asylum Superintendent was forbidden to refuse anyone admittance to an asylum and, in a country racked by poverty, these institutions, with their "moral managers" were the envy of Europe. Compared to today, when our mental health system is known as the "Cinderella of the health service", because of the criminal lack of funding given to it, in the 19th- century Ireland had the best public mental health system in the world. More and more asylums were built as communities vied to have them in their local areas for economic reasons, and the phrase "going around the bend" entered our language as mental hospitals were built so as not to be seen from the road - literally you had to go around a bend to get to them.

Then came the Famine and mass emigration, which we know had (and is still having) a horrific effect on our national and individual psyches; this, combined with the introduction of the Dangerous Lunatics Act, which allowed magistrates to commit people, meant that the asylums become horribly overcrowded and doomed to failure. But still they continued to fill up.

As Martin Rogan says in the series: "The Free State as a fledging state had many things to worry about, the asylum wasn't really high on their agenda, and again it became part of the 'great unspoken', which became a major part of the Irish coping mechanism."

It was after independence that Ireland had, proportionally, the highest number of asylum inmates in the world.

"Moral" management on this scale was impossible. The new drugs and contentious treatments, like ECT therapies, helped keep some semblance of control, but by 1966, a damning report was issued on the state of Ireland's mental hospitals; it criticised the gloomy prison-like wards, lack of adequate therapy and envisaged a whole new way of treating mental health disorders, with "community services, day hospitals and home support". But the report failed to mention how these measures would be implemented or paid for. And when we eventually got around to dismantling our Victorian-style institutions, we failed to adequately fill the gap left in society.

The dereliction in duty by successive governments to adequately implement the "Vision for Change" mental health strategy of 2003 has resulted - is resulting - in a human toll of misery, mental torment and suicides.

In the past, "the great unspoken" meant that people didn't admit to suffering from mental illness - many instead had a "touch of the nerves". The stigma was huge. People who spent time in a psychiatric asylum were marked out - families would not want their sons or daughters to marry them. They were "the other".

We would assume that 21st- century Ireland would be different, more enlightened, where the issue of mental health is concerned, yet little seems to have changed. Earlier this month, a new survey by St Patrick's Mental Health Services, showed that 65pc of respondents felt that being treated for a mental health problem is seen in Irish society as a sign of failure. Only 54pc held the view that Irish people would willingly accept someone with a mental health problem as a close friend. This is despite the fact that most people certainly have at least one or more friends who have suffered from a mental health problem. Yet it is still "the illness that dares not speak its name". The notion that having a mental illness marks you out as "weak" or a "failure" persists despite all evidence to dispute this.

As Eoghan Harris says in the series: "The biggest job we have to do as a society is to get rid of the stigma, that's the reason a film like this is so important... because if we don't get rid of the stigma, we can't have any proper discussion about hospitals or drugs; psychiatrists or psychology."

@carolmhunt

Ar Intinn Eile (An Irish State of Mind). Directed by Brendan Culleton and Irina Maldea; produced by Katie Holly. Ep.3, TG4, Wednesday.

Sunday Independent