ATTITUDE PROBLEMS

When I was a kid we had two great insults - "You're spastic" and "You're mental". The media has played a great part in gaining respect for people with cerebral palsy, and it's been a long time since we saw 'spastic' in a headline. But some newspapers still use words like 'psycho' and 'nutter,' killers are called 'psychotic' when the vast majority are sane, and people with mental health problems are often portrayed as intellectually inferior. If that's what the public is shown, that's what the public is going to believe.

- Liz Main, quoted in Mindshift: A Guide to Open-Minded Media Coverage on Mental Health

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Every three or four years the Care Standards Improvement Partnership, a health and social care quango, commissions a survey of the public’s views and perceptions of mental illness. The results of the 2007 survey are illuminating, surprising and disturbing in equal measure. In general, it found that people are considerably less tolerant towards people who are mentally ill than they were 10-15 years ago.

Intolerant sympathy – sympathetic intolerance

In 1994, for example, 19% of people agreed with the statement “people with mental illness are a burden to society”. By 2007, this had increased to 22%. Similarly in 1994, only 8% of people agreed with the statement “people with mental illness don’t deserve our sympathy”. By 2007, 13% agreed. The number of people agreeing that “we need to adopt a far more tolerant attitude toward people with mental illness in our society” has decreased by 8 percentage points, from 92% in 1994 to 84% in 2007. There is an increasing feeling that people have reason to fear people who are mentally ill.

Over half of people mentioned that someone close to them has had some kind of mental illness, and 61% of people thought there was at least a one-in-ten chance that they would have a mental health problem at some point in their lives. They are right – it is nationally estimated that 1 in 4 people with have a mental health problem at some point on their life.

But more than a third of respondents thought that as soon as a person shows signs of mental disturbance s/he should be hospitalised ; and the number of people who think that mental hospitals are an outdated way of treating people with mental illness has decreased from 42% in 1994, to 38% in 2003, to 33% in 2007.


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There is an obvious incongruity here. Nearly two thirds of people believe that they or somebody close to them will suffer from mental illness, yet more than a third of people believe that a person should be admitted into hospital as soon as a sign of mental illness manifests itself. Clearly most people do not want to be automatically admitted into hospital themselves, nor do they wish this for their friends and relatives. One must therefore assume that it is those other, dangerous people that we hear about in the media who should be locked up.

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Missing the point

It is frustrating that the CSIP survey does not dig a little deeper, to try and uncover what shapes people’s attitudes to mental illness. Had it done so, it might have revealed some of the limitations of the government’s approach to mental health.

That approach is influenced by Lord Layard’s Depression Report, and seeks to increase drastically the number of short-term psychological interventions (such as Cognitive Behavioural Therapy), and to help service users engage with society, and specifically work, as quickly as possible. Any increase in psychological therapies is to be welcomed, but there are a number of problems with the government’s approach.

Firstly, the promotion of CBT appears to be at the expense of other types of therapy, despite an lack of evidence that CBT helps people with more profound neurotic disorders. Secondly, there is very little extra cash to fund the extra CBT professionals needed (since CBT enables people with mild to moderate anxiety and depression to access employment, the policy is deemed to be cost-neutral). And thirdly, the government’s policy takes CBT’s credo – that neurotic disorders are caused by damaging mediating thoughts which distort the causal links between external stimuli and emotions – at face value. The government is happy to believe that ideas cause neuroses ; they are not prepared to question what causes the ideas to form in the first place.

Why, for example, are certain people more susceptible to mental ill health than others? Why is it that people who are economically and socially excluded more vulnerable? Could it be that it is our society’s structural inequalities, and not individually-fostered ideas, which shape our mental health?

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The class divide

There is substantial evidence to prove that the incidence and treatment of mental illness depends on one’s social class and race. Late capitalist societies don’t like to talk about class too much nowadays, but a bit of ferreting reveals some instructive statistics.

The National Psychiatry Survey of Great Britain 1993 shows that there is a strong correlation between under-privileged social class and limiting neurotic disorders (i.e. disorders which prevent people from carrying out basic daily activities). Unemployed people, non-home owners and those who left school before 16 – we’re talking about that considerable underclass which used to be known as the proletariat here, ok? – were between two and three times more likely to be seriously neurotically ill than those in employment, who owned their home and/or who had undergone education after 16.

Psychological surveys across Europe and the rest of the western world demonstrate similar results. The national survey carried out in the Netherlands in 1996 showed that people who left school before the age of 16 were 98% more likely to have mood or personality disorders than those who continued in education until 16 or older. The 1997 annual Australian survey showed that long-term unemployed people were up to 4 times more likely to suffer from an “affective disorder”. The 1998 Health Survey in England showed that for men the lowest quintile of household income showed incidence of neurotic disorders more than twice as the highest quintile (though, interestingly, household income seemed not to bear on neurotic illness for women). Perhaps most shockingly of all, Donald Acheson’s 1998 Inquiry into Health Inequalities showed that working class men were three times more likely than average to commit suicide.

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There is much more evidence to show how one’s ethnicity might affect one’s mental health, and we would do well to remember the link between race and class. 19% of people from Pakistani and Bangladeshi households and 15% of black people rely on benefits, compared to less than 10% of white people. In 2001/02 just over 40 per cent of Bangladeshi men aged under 25 were unemployed compared with 12 per cent of young White men. People from black and minority ethnic (BME) communities are far more likely to be victims of violent crimes, and are much more likely to suffer from physical health problems.

So how do people from BME communities fare when it comes to mental health?

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The David Bennett Story

In 2003, Sir John Blofeld, Chair of the Independent Inquiry into the death of David Bennett, concluded that “institutional racism is present throughout the National Health Service. This is a disgrace. Final responsibility lies fairly and squarely with the Department of Health.” The Bennett Inquiry was launched after suspicions by his family that the death of David Bennett was caused by neglect and misdiagnosis brought about by racial assumptions and attitudes.

David was African-Caribbean and schizophrenic, and had been using mental health services for many years. At first, psychiatrists did not diagnose his schizophrenia, putting his behaviour down to excessive cannabis use. 100% of staff at the Norvic Clinic in Cambridgeshire, where David was treated as an inpatient, were white, despite a significant number of black patients. His cultural needs were never addressed, no advocacy was made available, and his family were never engaged. When eventually his schizophrenia was diagnosed, he was heavily medicated almost to the point of sedation. As a result, his blood pressure flatlined.

On the night that David died in 1998, he had been in an argument with another patient. Staff at the clinic generally liked David, but knew that he could be aggressive. He had been known to attack staff without provocation. This particular argument got especially heated, with the other patient racially abusing David, and both men struck out at each other. David was medicated and moved to another ward. When he asked why it was he who had to move, he received no explanation. Later a nurse told David that he was to stay on the new ward indefinitely. David hit the nurse and was physically restrained by a number of nurses. He was taken to the floor and placed in a face down position. During the prolonged struggle he collapsed and died.

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David Bennett’s case is an extreme within a continuum. Black African and Caribbean men are ten times more likely to be diagnosed as schizophrenic as white men (though, as we have seen, misdiagnosis is as problematic as non-diagnosis), and three times more likely to be hospitalised for mental health problems. They are 44% more likely to be detained under the Mental Health Act and twice as likely to be brought into services by the police or the courts. Once in hospital Black men are 50% more likely to be secluded and 29% more likely to have been subject to physical control or restraint than white men.

It has been claimed that mental health care is akin to custodial sentencing for black men. The police are involved in many mental health referrals, not just those involving section 136 of the Mental Health Act 1983 which allows them to arrest disturbed people in public places. Research has shown that the police are inconsistent in their use of this section and detain a higher proportion of Black people under it.

Yet the Department of Health disagreed with Sir John’s conclusion, denying that institutional racism exists in the NHS. The phrase “institutional racism” does not, of course, mean that racism is perpetrated actively or deliberately. But in a society where racism, both overt and covert, deliberate and mechanical, thrives, it is inevitable that most public institutions will be racist. There is a case for claiming that the medical profession might be especially so.

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Psychology is dominated by educated, middle-class professionals. Middle class people, however liberal, have a barely-repressed fear of working class people. There is a general feeling that the lower classes have not quite acquired the finishing touches that befit civilised humans ; they are, in short, loose canons. (This may be why many left-leaning liberals are so petrified of the idea of revolution – in case the wrong type of person gets control of the system.)

If anything, this applies even more to black people. In a report for Open Mind in 1997, Melba Wilson wrote that 'when the dimension of race is added to the media portrayal of people suffering from mental distress, the notions of big, black and dangerous (male and bad and black) become fused in public perceptions.'

The charitable consortium Open Up has done valuable work exploring how the media traces an ominous line between race, mental illness and violent crime, and has reported how in 1994 the Daily Express published an article entitled 'Care in crisis as mental patients are freed to kill'. The article used one word under each picture of a person who had committed a murder. The white faces were accompanied by words like 'graduate' and 'released', whereas the black faces had 'violent' or 'stabbing' written beneath them.

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It is impossible for any of us to think about each other without pigeon-holing. The fact that a person is black, or working-class, or gay, or female will open a pandora's box of assumptions. Unless we attack these, no amount of CBT is going to cure the world of its neuroses and psychoses. The only way to do this is to combat poverty and inequality.

During the 1980s and early 1990s, there was precious little focus on the NHS, and especially not on its most cindarella-ish of corners, mental health. The present government has been guilty of pandering to the right-wing press, but it has also, to an extent, invested more in mental health services and promoted their importance. But under Labour, poverty and inequality have increased exponentially, just as they have during the last three decades, that period of neoliberalism. Unless the very roots of our economic and social structures are shaken, the most vulnerable and stigmatised sections of our society will continue to be deprived of the services they need.

ATHEO-FUNDAMENTALIST COCKS

That man Victor at Apostate Windbag may only have written two posts on his blog in the last two years, but my my his latest is worth the wait. Witty, insulting and utterly on the money, the subject of this terrific post is Richard Dawkins.




BAD SANTA

What makes Dawkins so dislikeable is not his atheism. Far from it, I don't disagree one bit with his assertion that God does not exist. What is objectionable is that he makes no attempt to work out why some people do. This is objectionable for two reasons : firstly, because it is philosophically shallow, and secondly, because it delights in looking down on religious believers as irrational and outdated.

Victor quotes another famous atheist, who approached the subject of God from a rather more thoughtful, materialist stance :

Religious distress is at the same time the expression of real distress and the protest against real distress. Religion is the sigh of the oppressed creature, the heart of a heartless world, just as it is the spirit of a spiritless situation. It is the opium of the people. The abolition of religion as the illusory happiness of the people is required for their real happiness. The demand to give up the illusion about its condition is the demand to give up a condition which needs illusions.

Karl Marx does not treat religion as being discrete from the rest of human experience. As an "expression of real distress and [a] protest against real distress," it appeals to those who receive no support or protection from "the real world" and people who sympathise with their plight. And as such, it is far from irrational.

It has been suggested to me before that Dawkins is important in a USA whose opinion is stifled by fundamentalist religion. I did think this was a fair point, but on reflection I don't think it is. If he concentrated his media efforts on addressing exploitation, empire, material inequalities, unfairness - if, to word it in a faux-naif way, he suggested that we might make the world a better place - he might better rid the world of religion, for he would have rid the world of its need for religion.

IRONY

from this week's Private Eye

TURNING WITH CONTEMPT

From Edward Gibbons, The Decline and Fall of the Roman Empire :

The superior merit of Agricola soon occasioned his removal from the government of Britain, and forever disappointed a rational though extensive scheme of conquest. Before his departure the prudent general had provided for security as well as for dominion. He had observed that the island is almost divided into two unequal parts by the opposite gulfs or, as they are now called, the Firths of Scotland. Across the narrow interval of about forty miles he had drawn a line of military stations, which was afterwards fortified in the reign of Antoninus Pius by a turf rampart erected on foundations of stone. This wall of Antoninus, at a small distance beyond the modern cities of Edinburgh and Glasgow, was fixed as the limit of the Roman province.

The native Caledonians preserved in the northern extremity of the island their wild independence, for which they were not less indebted to their poverty than to their valour. Their incursions were frequently repelled and chastised, but their country was never subdued. The masters of the fairest and most wealthy climates of the globe turned with contempt from gloomy hills assailed by the winter tempest, from lakes concealed in a blue mist, and from cold and lonely heaths over which the deer of the forest were chased by a troop of naked barbarians.

MY MY, THE CLOCK IN THE SKY IS POUNDING AWAY

I woke up this morning with a breeze on the nape of my neck. I opened the curtains and, to my amazement, found that the predictions of a Bank-Holiday-only, catch-it-while-you-can summer were true.

The best thing about really beautiful summer days is that it gives you the perfect opportunity to play music that may sound a bit corny or a bit awkward when it's cold and drab, but which tingle with colour and electricity when shards of sunlight fall on them.

Here are four of those records : three overlooked gems, and an all-out classic to finish. And remember :

To make this trivial world sublime,
take half a gram of phanerothyme.

To fathom Hell or soar angelic,
just take a pinch of psychedelic...









The Monkees, "Porpoise song"
The Beatles, "It's all too much"
The Move, "I can hear the grass grow"
Jefferson Airplane, "White rabbit" + "Somebody to love"

EL PAIS ENFERMO

A sick country

It is fitting that Buenos Aires has more psychoanalysts per person than any other city in the world, for if there was ever a case study par excellence for analysis and therapy it is the Argentine republic.

Speak to a few Argentines and you will quickly hear the country’s prognosis : “this is a sick country.” That phrase is used like a motto – many Argentines say it with something approaching pride. Recently a friend sent me a photo of her back garden in Buenos Aires . The city had just seen snowfall for the first time in nearly 90 years and her lawn was a carpet of white. I got around to replying a week or so later and asked if it was still snowing. “No,” she wrote back, “the snow lasted about as long as a healthy economy around these parts.”

The economy is one reason for the country’s terminal illness, but actually Argentina has recovered from its catastrophic currency collapse in 2001 fairly well. It has paid its foreign debts, and has distanced itself from the US and the institutions whose policies and predictions caused the crisis. The story is very different in the countryside, but Buenos Aires is thriving, and has all the confidence of a leading world city (or The Greatest City in the World, as I prefer to call it).



But Argentines have seen so many economic peaks and troughs that there is a general pessimism about the country. And this does not just apply to the economy. For a country which is so proud of its dance, its literature, its football, its beef, its landscapes – for a country, in short, which feels so superior in many respects to the rest of the world, there exists a chronic psychological insecurity.

I do not know why this is, but I think it may be linked to two things, neither of which Argentina has ever dealt with, and both of which are closely linked. One is Peronism, and the other is the Dirty War.

The name of the father

Every politician nowadays is a Peronist. Carlos Menem, the former President whose loyal adherence to the US-WorldBank-IMF some blame for the 2001 collapse, was a Peronist. His politics were broadly neo-liberal : he assumed the Presidency in 1989 in the middle of economic mayhem, and launched a series of privatisations which lowered inflation at the expense of large-scale unemployment. He is also notorious for pardoning the leaders of the 1976-83 military dictatorship (of which more later).

And Nestor Kirchner, the current President, is also a Peronist. His politics are more left-wing, he has a radical Leftist past, and he has reduced the influence of the military and vowed to bring those involved in crimes against humanity during the 1976-83 dictatorship to justice. Crucially, he has also opted out of the US-led Free Trade Area of the Americas and joined forces with colleagues within the continent, such as Luiz Inacio Lula de Silva, Hugo Chavez and Evo Morales.
So you can see – Peron is a man to whom leaders of many political persuasions aspire. He is like a father-figure, a man to love and hate, but a man from whose political legacy Argentina cannot (or at least, feels it cannot) escape. There is a common pattern in Argentine politics : elect a Peronist > marvel at how the chosen one has come to rescue the country from itself > protest against the very policies you elected him in for > elect another Peronist. This is why Argentina is so fundamentally unradical – it repeats its mistakes, it convinces itself of the need for the Peronist father-figure, it cannot escape from its past.

JUAN AND EVA PERON

Juan Peron himself was a curious mix. He was sympathetic to Italian Fascism (he had spent time there in the 30s) and offered protection to Nazi war criminals, yet he also unionised Argentina’s workforce, introduced radical labour reforms, industrialised the country and led what he called a third way between capitalism and communism. He was a mass of contradictions, which meant that when the military took power via a coup d’etat in 1955 and forced Peron into exile, all and sundry could quote his name in vain. Left and right alike invoked Peron (although Peronists were officially banned from political life in the late 1960s), and when they weren’t referring to Peron they were blowing each other up in his name.

In his absence, the right-wing military (with the perennial support of the Catholic Church) assumed power, and it was only in 1973, after 18 years in exile, that Peron was welcomed back to Argentina . Millions of left-wing Peronists assembled at Ezeiza National Airport in Buenos Aires to greet their hero, and a group of far-right military-backed snipers opened fire and killed 13 of them. Elections were restored in 1973, and Peron was voted back into power, but this was not an environment in which democracy could flourish, and acts of terrorism between left and right escalated.

El debut de terror : the Dirty War

When Peron died, his third wife Isabel took over as President and clamped down hard on the left-wing insurrectionists. She gave sweeping powers to her Social Welfare minister, Jose Lopez Rega – an obsessive obscurantist and Freemason and the man who had coordinated the Ezeiza massacre – to deal with the left-wing threat. He responded by setting up the Argentine Anti-Communist Alliance (or ‘Triple A’) death squad. The ‘Dirty War’ against elements of subversion in Argentina had begun.

Between 1973 and 75, when Argentina was ostensibly still a democratic state, the Triple A carried out 458 assassinations of “subversives,” including Marxists, Peronists, trade unionists, lawyers, intellectuals and other left-wing “sympathisers”.

In 1974, Isabel Peron appointed Jorge Videla as Commander-in-Chief of the army. By this point, Argentina had reached a state of national emergency, with wide-scale violence between left and right. Using the need to crush the threat of Communism as a pretext, Videla led a coup d’etat to depose Peron and a military junta took power on 24 March 1976. Where the assassinations had been conducted underground, from now on they would be an official part of Argentina’s political life, part of the US-supported Operation Condor, whose mission it was to eradicate Communism in Latin America through any means necessary.

THE MILITARY JUNTA IN 1978, WITH JORGE VIDELA IN THE CENTRE

“As many people as necessary must die in Argentina so that the country will again be secure,” Videla said in 1976. Another general went one further, estimating the numbers involved : “we are going to have to kill 50,000 people : 25,000 subversives, 20,000 sympathisers, and we will make 5,000 mistakes.” And the junta’s definition of a subversive?

“El terrorista no solo es considerado tal por matar con un arma o colocar una bomba,” he told British reporters, “sino por activar a traves de ideas contrarias a nuestra civilizacion occidental y Cristiana a otras personas.” Or to translate : “we do not consider a terrorist just to be somebody who kills with ammunition or lets off a bomb, but also someone who inspires other people through ideas which are contrary to our western, Christian society.”

JORGE VIDELA (RIGHT) WITH AUGUSTO PINOCHET

By the time the junta lost power in 1983, when democracy was restored to Argentina , it is estimated that 30,000 people had been killed, kidnapped tortured or otherwise “disappeared.”

Ending the silence

In 2005 President Nestor Kirchner withdrew the amnesty which had protected the leaders and collaborators of the junta from prosecution. Since then there has been a slow trickle of cases coming to trial. The influence of the army has declined in the last 20 years, and Argentines will shed few tears over any ex-generals who are convicted of crimes. The more difficult thing for Argentina to face up to is the complicity of the Church in the Dirty War.

In the days leading up to 24 March 1976, senior representatives from the Church had met with military leaders and advocated “hard and violent measures” to deal with subversion. “The heads of the Catholic Church participated in the dictatorship,” says Nora Cortinas of the Madres de la Plaza de Mayo, the group of women who lost their children in the Dirty War and who meet every Thursday outside the country’s parliament building to ensure politicians cannot forget their tragedy. “Many priests were chaplains inside the barracks of the concentration camps.”

The Nunca Mas (Never Again) report on the National Commission on the Disappearance of Persons, set up in 1983 to investigate human rights abuses perpetrated during the military dictatorship, gave testimony after testimony detailing the Church’s involvement. The writer and activist Horatio Verbitsky, states in his book El Silencio (The Silence) that it was the Church which suggested that the infamous “vuelos de muerte,” the “flights of death” where victims were killed by being dropped into the Atlantic from an aeroplane, were a Christian form of death.

The Nunca Mas report provided enough witness statements to quash any real doubt about the Church’s and the military’s involvement in the atrocities, but it is only now that those responsible are being brought to justice. In fact, the most prominent of these, Father Christian von Wernich, is only the third person to come to court since the withdrawal of the amnesty. Von Wernich is an extreme – he is accused of covering up crimes in seven deaths, 31 cases of torture, and 42 cases of illegal imprisonment – but as Horatio Verbitsky says, “it is an extreme within a continuum. There is a point at which it’s impossible to distinguish the priest from a cop. I mean, he was personally torturing people.”

EXCERPTS FROM DOCUMENTS FOUND IN A PRISON IN LA RIOJA, ARGENTINA

A week or so ago, the Buenos Aires daily Pagina 12¸reported that four boxes of documents had been found in a prison in the province of La Rioja. The papers provide details of political detainees, records of guard-duties and written evidence that other senior ecclesiastical figures were directly involved in acts of torture and detention during the dictatorship. The Trade Unionist Plutarco Antonio Schaller testified to the National Commission on the Disappearance of Persons to the involvement of one of these senior figures, Father Pelanda Lopez, some twenty years ago :

... the chaplain Pelanda López visited me briefly on Sundays, chatting for a short while in the cells. He would justify torture. On one occasion one of the detainees told him. 'Father, they are torturing me terribly during interrogations and I beg you to intercede to stop them from torturing me any more.' Pelanda López replied, 'Well, my son, but what do you expect if you don't cooperate with the authorities interrogating vou?' On another occasion I told the chaplain that they could not possibly continue to torture me as they were doing, to which Pelanda López replied, 'You have no right to complain about the torture.'

In January 2007, Isabel Peron was arrested in Spain because of her links with far-right terrorists, and there have recently been allegations that officers tortured and killed their own troops during the Falklands conflict.

THE ARREST OF ISABEL PERON, JANUARY 2007

Even more significantly, in April, the amnesty given to Jorge Videla in 1990 which protected him from charges of human rights abuses was rescinded by the Supreme Court. He is now due to stand trial. It is to be hoped that the victims of Videla, a close friend and ally of the late Chilean dictator Augusto Pinochet, will not be deprived of justice in the way that the Chilean nation was. The process of bringing murderer and torturers to justice will be slow and cumbersome, but without it Argentina might never account for that dark period in its history, a period which it is so loath to discuss.

YOU KNOW WHO YOU ARE

Message to anonymous Homo Ludens reader : I have worked out how we can meet. I shall carry out a heist, or maybe a massive fraud, and then employ you to get me off. Problem solved!

How did we not think of this before?