‘Behind the Walls’ was a two-part documentary series charting the history of Ireland’s psychiatric hospitals (http://www.rte.ie/tv/programmes/behind_the_walls.html) . Part one lifted the lid on this vast system – during the middle decades of the 20th century, Ireland led the world in locking up more of its people per capita in mental hospitals, ahead even of the old Soviet Union. Part two presented a series of testimonies by former inmates speaking of their bewilderment at being forcibly incarcerated, and often abused by unscrupulous psychiatrists. The leading body representing Irish psychiatrists, however, did not accept the series, suggesting that the documentary ‘was imbalanced and lacked objectivity in its portrayal of the mental health system’, (Irish Times, 17 September 2011).
According to Michel Foucault’s Madness and Civilisation, madness is not a natural, unchanging thing, but rather depends on the society in which it exists. Various cultural, intellectual and economic structures determine how madness is known and experienced within a given society. In this way, society constructs its experience of madness. Thus by the nineteenth century madness had become known as a moral and mental disease. Ultimately, Foucault sees madness as being located in a certain cultural “space” within society; the shape of this space, and its effects on the madman, depend on society itself.
Accordingly, the series argued that containing people who were thought of in Ireland as ‘abnormalities’ – Famine dropouts, former emigrants and the families of emigrants, farmers experiencing smaller and smaller farms which did not provide adequate livelihoods, leaving many farmers isolated and unable to marry and start families – had to be forcibly controlled. One sure way was committing them to psychiatric asylums, where a Foucauldian biopolitics meant absolute control over inmates’ bodies and minds – sedated, institutionalised and unwanted by their families. The documentary revealed damning evidence of appalling conditions within the hospitals, information which was kept secret by the State and by the inmates’ families who did not want to know what was going on behind the walls.
Encouragingly, in recent years many of these inhumane asylums have been closed and patients are mostly held in ‘community’ mental hospitals, though, according to leading psychiatrist Ivor Browne, the approach has not changed much – patients are still over- medicated, and control and containment by psychiatric nurses and doctors are still the order of the day.
While in the past, people could be committed by their families without a possibility of release, since November 2006, under Section 33(3) of the Mental Health Act, 2001, mental health tribunals have been established for patients admitted on an involuntary basis to consider their cases on a periodic basis. Patients involuntarily admitted have the right to attend their mental health tribunal if they so wish or be legally represented.
I was surprised, therefore, to be told by a member of one of these tribunals, that ‘while in the mid-20th century the prisons were empty and the asylums full, now the psychiatric hospitals are empty and the prisons full’. Was he implying that inmates are dangerous to ‘normal society’, ‘wasted lives’ as Zygmunt Bauman would have it, needing to be controlled and contained. He went on to claim that there is not much that the system can do to help, as ‘there are only very few medications that can be given; there is no capacity for psychotherapy, which anyway would not help most of them’. Control and stigmatisation still seems the order of the day.
But on reflection he may be right. Perhaps reason cannot contain madness (and perhaps also badness). What we need is a new way of approaching those we call ‘mad’ because we can no longer understand them or reason with them, as Foucault reminds us in the preface to the 1961 edition of Madness and Civilisation:
‘…modern man no longer communicates with the madman […] There is no common language: or rather, it no longer exists; the constitution of madness as mental illness, at the end of the eighteenth century, bears witness to a rupture in a dialogue, gives the separation as already enacted, and expels from the memory all those imperfect words, of no fixed syntax, spoken falteringly, in which the exchange between madness and reason was carried out. The language of psychiatry, which is a monologue by reason about madness, could only have come into existence in such a silence’.