Dr Alfred Dawes | It is madness how as a society we treat the mentally ill
As Mental Health Week approaches in October, we may only take a passing note of the planned activities. After all, the fact that we, as a country, are poorly treating mentally ill persons is an inconvenient truth only acknowledged whenever there is an act of violence involving them.
It is an awkward topic, and families hide the illness of their loved ones to protect themselves from the stigmatisation that often occurs. It is madness how, as a society, we treat the mentally ill and we have barely evolved in more than a hundred years.
Lunatic Asylum Scandal
In 1860, there was a scandal in Jamaica that rocked the very foundations of health care in the British Empire. The account of a patient who was admitted to the lunatic asylum in Kingston was horrific enough to warrant an investigation that resulted in changes in how psychiatric patients were treated in the British colonies. The pamphlet, 'Seven Months in the Kingston Lunatic Asylum, and What I Saw There' by a former patient, Ann Pratt, described in detail the horrific conditions in the asylum, including the tanking of patients. In tanking, the patient was forcefully immersed in a tank of dirty water used to wash patients until they stopped resisting.
This first scandal to hit the health sector prompted an audit of the asylum. The allegations were found to be true and, in some instances, worse and more widespread than alleged. The colonial office in England conducted a similar review that found conditions throughout the empire were equally appalling. Patients were being locked up and restrained rather than being treated.
In Margaret Jones' article 'The Most Cruel and Revolting Crimes: The Treatment of the Mentally Ill in Mid-Nineteenth-Century Jamaica', she describes a society where the mentally ill were locked up in jails whether or not they were criminally insane. Patients in asylums had a high death rate and were physically abused regularly, with the authorities turning a blind eye. The scandal resulted in such outrage that, according to Jones, the abuses in the Kingston lunatic asylum triggered reform not only in Jamaica, but also throughout the British Empire.
Guidelines on managing hospitals and insane asylums were distributed in the first real attempt to improve healthcare in Jamaica and the British colonies. Conditions improved and the forerunner to the Bellevue Hospital was constructed, ushering a new era in the care of psychiatric patients.
Growing up in the '80s and '90s, "mad people" were objects of ridicule. Every now and again, they would "give trouble" and would be beaten by mobs often comprising their own family members. The police occasionally would be called in to take them to the hospital.
In 1999, the street people scandal placed the treatment of the mentally ill on the forefront of the nation's consciousness. Thirty-two homeless persons in MoBay, many of them mentally ill, were rounded up, tied and pepper-sprayed before being dumped near a mud lake. Some of these inhumane practices continue today where there are mentally challenged persons roaming the streets, invisible, until they give trouble.
What we call giving trouble is a psychiatric crisis. At this point, the persons may be a danger to themselves or others. Suicidal thoughts or actions, aggressive behaviour, stealing, or disorganised behaviour against society's norms are some symptoms characterising a crisis. These persons need to get treated fast. That is the only way to get them back into a functional state. Between these crises, the majority of mentally ill persons are fully functional members of society. They are not to be feared, ridiculed, or stigmatised in the same way we don't ridicule diabetics or persons with other chronic diseases.
Care of the mentally ill has slowly improved over time, with better treatment methods. In 1965, the legendary musician Don Drummond was convicted of the murder of his girlfriend Anita Mahfood. He was found criminally insane and spent his last years in the Bellevue Asylum. Rumours abound of his poor treatment and ultimate death from his medications.
One therapy used during that period was electroconvulsive therapy, ECT, popularised in the movie One Flew Over the Cuckoo's Nest, which depicted life in an insane asylum. In ECT, the patient is shocked with high doses of electricity with the intention of causing chemical changes in the brain. Patients undergoing ECT suffered many serious side effects, including fractured bones and memory loss.
Today, ECT is much safer; medications have fewer side effects, and are better tolerated by patients. The main issues are getting treatment to patients who need it most. The role of the family and support groups is critical. The efforts of the Ministry of Heath in expanding community-based psychiatry are hampered by a critical shortage of staff and resources. This is a symptom of the severe lack of funding of the health sector that needs to be addressed yesterday.
This, however, does not absolve the community from playing our part in the care of the mentally challenged. We cannot continue to stigmatise the mentally ill and shun them from society. They need jobs. They need families and friends. They need persons who can recognise when they are heading towards a psychiatric crisis and get help for them ASAP. They need to feel like they are productive members of society. Social inclusion and support for the mentally challenged is the keystone upon which rests the entire treatment of these special patients. We must, as a society, grow up and stop the madness.