Book Review: Walls of silence

Reviewed by Orla O’Neill, Director, Schizophrenia Ireland.

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At first glance, for people familiar with the disgraceful neglect of people who have been patients in the state’s large mental institutions, Annie Ryan’s Walls of silence might seem old news. Not so. Annie’s in-depth historical analysis of policy and practice gives us a good insight into how a country, now in an economic boom, continues to tolerate unacceptable conditions for patients in psychiatric hospitals. This tolerance by Irish society is ironic, given our outrage at situations of neglect in other countries, or past failures and neglect in the provision of Irish services.

For someone who has battled for appropriate services for over twenty years, Annie Ryan’s tone is generous and shows mercy towards government and societal neglect of the rights of people with the most severe mental disabilities in our society. While the finger of blame is not pointed, the message is clear that the solution ought to be: equal access for equal need.

One of the few safeguards enjoyed by individuals with mental illness in Ireland is the statutory requirement under the Mental Treatment Act 1945 for the Inspector of Mental Hospitals to inspect every public mental hospital annually. Year after year, the Inspector’s reports show little movement and change, but at least the documents track the situation and serve as useful tools to develop policies and a sound basis for capital and revenue investment.

Annie Ryan reports a 1979 Dáil debate when Barry Desmond, TD, wanted to know the last time an Inspector of Mental Hospitals had made an Annual Report. In reply, Charles Haughey, then Minister for Health, explained that ‘the practice fell into disuse’ during the previous thirteen years. One wonders who decided that this legal right was no longer needed. The matter was apparently resolved to the satisfaction of both government and opposition; despite the airing of the issue, publication of the report did not resume for another nine years. Annie Ryan is scathing of what she calls a ‘little bipartisan cover-up.’ There remains a continuing concern about the post of Inspector of Mental Hospitals: should it be an independent function, not under the remit of the Department of Health and Children?

Annie gives a historical account of the situation in mental hospitals since the 1950s and the development of policy and legislation for the provision of services to persons with a mental handicap in the same period. No legislation has been enacted to protect their rights. In fact, the policy was to take away the few rights they had under the Mental Health Acts. In 1966, Dr Ivor Browne suggested that part of St Ita’s, Portrane, should be ‘de-designated’, creating an autonomous service for residents with learning disabilities, no longer under the remit of the Inspector of Mental Hospitals. Annie Ryan writes, ‘there is little doubt that the term “de-designate” was employed as a device to conceal the true figures of long-stay patients in the psychiatric hospitals, including people with mental handicap.’

Annie describes how these errors were reinforced time and time again. As in the case of persons with severe mental illness, authorities have been challenged to deal with the needs of persons with the most severe mental handicap—to this day policymakers have failed both groups.

Although harrowing in places, the book is not all doom and gloom. There is an uplifting account of the establishment in the 1960s of parents and friends associations—‘people power’: ‘Where the government had failed, the people took over’. One cannot but feel sympathy for a health service so large and bureaucratic that it continues to trail after the drive, energy and innovation of the people whom it purports to serve.

I suspect this book raises a lot of thorny questions for the community of people concerned with service provision for persons with mental handicap in Ireland. Annie questions policies which have reinforced the relative inequalities of service provision for different levels of disability. The same question is echoed around the country by all those with the most serious disabilities and their carers: how is it that the most blatant discrimination is levelled at those who need the most protection?

It is worth noting that both in this book and in her recent interview on Morning Ireland, Annie Ryan emphasises that the staff of mental hospitals also deserve our sympathy for the neglect of their working conditions. ‘Psychiatric nurses had been treated abominably, particularly in large neglected hospitals like Portrane. Psychiatric nurses knew that the job they did was undervalued by society. They were seldom treated with the respect that they deserved.’

The description of past and current services in Portrane is particularly disturbing, especially as it seems that it was only due to the lobbying efforts by a Visiting Committee to draw attention to the scandal in recent times, that have resulted in some financial resources to attempt to redress the situation.

The theme of this book is the title of her last chapter—A sad reflection. It would be too easy to blame a few individuals in state or government positions over the years for the continuing scandal of neglect—something which Annie Ryan definitely does not do. The sad reflection is that legislators respond to the stated (and shouted) interests of the electorate—an electorate who have always known what is happening in mental health services, but who are not sufficiently outraged to demand change.

Annie Ryan writes from her own experience of decades, trying to understand and to battle against negligence and dereliction of duty. She is also a voice, however, for thousands of persons with mental health difficulties or mental handicap—and their carers—who have for decades been abused by an uncaring and ungiving system.

Walls of silence by Annie Ryan. Red Lion Press (1999) £10-00- Callan, Co. Kilkenny. Red Lion Press

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