Front Lines: Change For The Better

Just stand outside any bar in Dublin on any given night. Or sit. Within minutes you’ll be hassled for spare change. Much the same happens during the day. It’s a constant part of the fabric of the city, the static of modern urban life.

Many explanations are advanced. Most social services and NGOs agree immigration is one. The location of drugs services is another. Nimbyism means that the city centre must shoulder more than its fair share. Rapid shifts in the housing market (in the greater Dublin area especially) are another contributory factor.
But of course it’s more than that. Few people willingly beg, and those who do have reasons. Bad luck is a factor for some, as is poverty. But, for most, the common thread is mental illness of one kind or another.
All the research points in this direction, though you don’t have to be a professor to see it. It’s obvious in the distress and helplessness of those you meet huddled on pavements or wandering endlessly with an agitated aimlessness towards some unidentifiable certainty that is always just beyond their vision and yours.
Then there’s the steady flow of deaths, where the judge asks the Garda to attend to the mental health needs of the accused. There is a pattern: older person or couple killed by younger offspring. It is almost invariably caused by an acute psychotic episode but we don’t talk about these things and we don’t therefore have any process to identify the risk of this deeply distressing scenario and to prevent its occurrence.
All this is a legacy of the abandonment of medical services to non-governmental agencies (largely religious) in the early days of the State, the subsequent general neglect of those services – and more recently the decision to base mental health services in the community. This last is essentially cost-driven. While there is evidence that it can work as a strategy, such success as it has had seems to be in jurisdictions where there are very good structures and referral systems — these are not, I think you’ll agree, features of ours.
But in fairness, the State and its machinery are easy targets. Their failures, to a very considerable degree, make manifest the inability of Irish society to build a consensus on mental health and, in particular, to agree that it isn’t just “someone else’s problem”, until it’s suddenly yours.
As befits an individualistic and socially reproductive society, one in which the residues of old religious orthodoxies can still be seen, problems are seen to belong to the individual and, in turn – in a way that is often deeply unfair – to her or his family. As with all aspects of Irish society, those with resources can find ways of dealing with issues faster and more effectively than those without.
This, mark you, is despite all the millions of hours Irish people have spent — and continue to spend — on counselling and quasi-counselling courses and the co-option by everyone, including the media, of “talking cure” terminology (“moving on” anyone?).
The thing is, everyone has mental health, just like they have physical health. To an extent, it comes and goes much like you get a cold or flu.
But not everyone becomes mentally ill. Just as some people have strong immune systems that resist physical illnesses, many of us don’t develop debilitating mental illness. We maintain our mental health, sometimes despite enormous stresses and challenges. Why some do and others don’t is unclear. What builds resilience?
British psychoanalyst Adam Phillips (editor of the new Penguin Modern Classics translations of Sigmund Freud) asks why we don’t talk about “going sane” just as we talk of “going mad”. For those who have been mentally unwell, going sane can be a tricky process. Some of the Hog’s friends have negotiated it and their later wellbeing is a tribute to the cumulative effect of good student welfare services, strong family and peer support, and personal determination.
It’s not a matter of finding a wrong thing and drugging it till it’s bearable, nor about diagnosis and cure in the old, narrow sense. It’s also about networks of support that build wellbeing in the first place and support recovery in the second. It’s also a matter of finding what’s right and using that as a platform for resolving what has gone wrong.
Those who work in the field of mental health will tell you that we are in the vortex of a major crisis and that more money must be spent. That may well be the case, but little work has been done on setting present trends in historical and demographic contexts. That research is vitally necessary if we want to formulate policies that work. For example, high proportions of young people in a society will generate quite specific trends. And, for the record, a talking cure isn’t for everyone (a point on which Adam Phillips is very clear) in much the same way as a 12-step programme doesn’t work for all alcoholics.
What we need are more effective services, and faster, more integrated and client-focused responses that address the issues but also help people to resolve their own problems, to take charge of their lives rather than being weighed down by the business of life. That requires a major cultural shift for our medical system. In particular, the outrageous discontinuity between child and adult mental health services must be addressed immediately.
But we also need to create a different social culture, one with less rage and bullying and more compassion and generosity. That’s everyone’s business, including the media’s.
After all, to a quite remarkable degree, our services reflect our society. If they don’t work it’s a pretty stark warning that our society isn’t working either, it’s just muddling through. Sorting that tendency out will sort a lot of other things as well. And we’ll all be mentally healthier for that, believe me.