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World Mental Health Day

category louth | health / disability issues | opinion/analysis author Tuesday October 09, 2007 16:43author by Sean Crudden - imperoauthor email sean at impero dot iol dot ieauthor address Jenkinstown, Dundalk, Co Louth.author phone 087 9739945 Report this post to the editors

Cultural Sensitivity or Colonialism?

It is scarcely enough to make a gesture towards mental patients and the mentally ill on one day of the year only. However, to mark World Mental Health Day (10 October 2007) I am posting an article which I wrote quite a few weeks ago to suggest to indymedia readers the extent of real globalisation in establishment efforts to overcome the problem of mental illness. However, as with globalisation in other areas, the question arises of how far we are on the right track?
Sean Crudden
Sean Crudden

The theme of World Mental Health Day is "Mental Health in a Changing World: The Impact of Culture and Diversity." World Mental Health Day takes place on 10 October 2007 and it is being organised by the "World Federation of Mental Health."

Cultural competence is the demonstrated awareness and integration of three population-specific issues: health-related beliefs and cultural values, disease incidence and prevalence, and treatment efficacy. But perhaps the most significant aspect of this concept is the inclusion and integration of the three areas that are usually considered separately when they are considered at all (Lavizzo-Mourey & Mackenzie, 1996)
Acculturation (noun): 1 The modification of the culture of a group or individual as a result of contact with a different culture. 2 The process by which the culture of a particular society is instilled in a human from infancy onward (American Heritage Dictionary).

Cross-cultural psychiatry is concerned with the cultural and ethnic context of mental disorders and psychiatric services. It emerged as a coherent field from several strands of work, including surveys of the prevalence and form of disorders in different cultures or countries; the study of migrant populations and ethnic diversity within countries; and analysis of psychiatry itself as a cultural product(Wikipediahttp://enwikipediaorg/wiki/Cross-cultural_psychiatry).

The definition of culture has long been a controversy and the term is used in a variety of ways. A few commonly-used definitions are:

[Culture] is that complex whole which includes knowledge, beliefs, arts, morals, laws, customs, and any other capabilities and habits acquired by [a human] as a member of society." The term sub-culture is used to refer to minority cultures within a larger dominant culture. (Taylor, Ein Seymour-Smith, C(1986), Macmillan Dictionary of Anthropology)

Culture is the collective programming of the human mind that distinguishes the members of one human group from those of another. Culture in this sense is a system of collectively-held values (Geert Hofstede)

Stereotyping: to classify or categorize people, and believing that all those belonging to the same group are alike. Stereotyping infers preconceived but often incorrect, negative notions (Foundations of Nursing, Transcultural Healthcare)

The literature, for the day, from the World Federation of Mental Health, from which the above definitions are taken, is based on the American way as a datum, it seems to me. In approaching divergent cultures the modus operandi recommended is to enlist the support of religious leaders, elders and head honchos in the target community. In a way it seems to me as if the methodology is based on colonialism rather than genuine cultural sensitivity.

Then too acculturation seems to be a one-way street. The psychiatrist and his allies must strive to understand the culture of the client - all the better to help them. It reads as if the client presents a difficult problem which must be solved by protocols and pious prescriptions.

There is no mention of what is an even greater difficulty - the difficulty the mental patient routinely has, often over a lifetime, with the unyielding culture of psychiatry itself.

Like "what I think of you is important but what you think of me carries no weight."

Perhaps on World Mental Health Day, on October 10, readers of indymedia.ie might consider how the supremacist element in the drive of the "World" Federation of Mental Health might be moderated, mollified.

Undoubtedly the stigma will be removed from mental illness only when the care of the mentally ill is understood transparently by everyone. Cultural sensitivity must apply to the client in the mental health system and to mental patients as a group. And not just cultural sensitivity but love and respect - which every human being needs and deserves.

author by C Murraypublication date Tue Oct 09, 2007 18:43author address author phone Report this post to the editors

I knew two people who live in small communities in Southern Ireland who had vastly different
experiences of psychiatry and the deciding factor in their well-being or not was the community
aspect of acceptance- or not. Their mental health issues were vastly different and their treatment
within community led to effective management of their respective illnesses. I do not think that
the community as a whole could be left out of the equation with regard to how people with long
term or cyclical mental illness are perceived and accepted. One man was and is quite open
about his cyclical breakdowns and knew the signs and dealt with them by applying for
rest or having his medications 're-jigged', his friends too were aware and helped him through.
The other story is less happy and involves familial conflict, the outcome was tragic.
Transpose the issue of awareness, acceptance and recognition of a local suffering from
mentally incapacitating illnesses who being a part of community, local and the fabric of a
small town to the alienation experienced by someone in a city who does not have those
resources, and from there to someone without the language who needs the resources.
There seems no long-term plan or discussion on mental health problems in this country,
as much as future education plans are neglected by the State. Nice article.

We do not examine with any clarity of purpose the long term effects of population boom,
urban sprawl, lack of local hospital care and communites that are divided by intensive planning
without regard to their integrity or connections to each other. It seems the profiteering lobby
have lost sight of the importance of the community to the well-being of the individual.

author by Elisa O'Dpublication date Wed Oct 10, 2007 10:34author address author phone Report this post to the editors

Im glad someone on indymedia has recognised world mental health day.Thought Id add my two cents on the current mental health situation in Ireland with an article I wrote a couple of weeks ago.

In 2006 The Economist crowned Ireland the best place to live in the world with our quality of life surpassing all other nations. We can also boast that we are the third richest country in the world, a country with vast prosperity where young people have never had it better. So if we are living in such a prosperous country why am I even bothering to write an article on mental health in Ireland today? It's because there is a very dark hidden face of Irish society that the media and government don't talk about. A face which shows depression, parasuicide and suicide rates hitting highs we have never seen before in this country.
Depression.....400,000 people in Ireland are diagnosed as clinically depressed with the highest rate in adults between 25-44 i.e. young, working adults.
Parasuicde........Each year in excess of 10,000 present at A+E's after having attempted to take their lives.
Suicde......500 people die each year from suicide with 50%of those being under 25. Death by suicide is now the number one cause of death among the youth of the country.
However, it is easy with all these big numbers to forget that there are real people behind these statistics .On the 10th of this month (September) I saw the very real and very human side of suicide when 400 people gathered in Dublin city centre for a candlelight vigil. Mothers, fathers, brothers, sisters, friends and neighbors clutching photographs of loved ones they have lost. Young men and women the same age as myself in the prime of their lives who it would seem, by The Economist standards, had everything to live for.
So why is depression and suicide such major problems in Irish society today? It is a question you'd think there is no answer to. It would seem that there would be many different reasons why someone would want to end their life. However, If we hold a mirror up to Irish society, in the reflection it is very easy to see why an 18 year old boy living in Irish society today would feel desperate enough to commit suicide.
To delve further into the reasons why suicide rates are so high, they must be split into political, medical and social reasons with all three being very much interlinked.

First the political. Looking internationally at suicide rates and depression we can see that Ireland is not alone in its problems and in comparing Ireland to other countries we can see how backwards we are politically when it comes to mental health. For example, comparing Ireland and Scotland. Up until three years ago Scotland surpassed Ireland's suicide rate. The Scottish government saw this and funded the 'Choose Life' campaign with12 million euro. At the launch of the Choose Life campaign Deputy minister for health, Lewis McDonald, showed real insight into the problem by saying 'Traditionally, it is the robust nature of Scottish men not to discuss problems they have but I hope that through this campaign we will encourage more men to speak up'. Two years into the choose life campaign and the suicide rate in Scotland has dropped significantly. The government seeing the success of the prevention scheme has increased funding by an extra 8.6 million euro. Let's compare this to Ireland. In 2006 the 'vision for change' document incorporating the 'Reach Out' strategy was launched on how to tackle Ireland growing suicide epidemic. The health professionals who compiled the document estimated at least 3.8 million euro was needed to implement it. Only 1.8 million euro was given. After the launch of our mental health strategy our government representative on mental health PD minister Tim O'Malley proclaimed that 'mental illness is not a medical condition'. While Scotland and other countries have proven that preemptive, properly funded suicide prevention schemes really do work our government still favour the 'snap out of it' approach to depression. Due to lack of funding the statistics I quoted at the beginning are years out of date with no national suicide survey having been conducted in years. In fact on page 63 of 'A vision for change' it states 'We do not know the number of individuals nationally who avail of mental health service, the types of interventions or treatments they receive,or the effectiveness of these treatments.' Lack of funding also means that invaluable services are without funding. Invaluable services such as Teenline, which last month alone received 1000 calls from distressed teens. These all rely on charity to keep afloat.

Secondly medical reasons: In 2004 a report was published in the Irsih Journal of Psychological Medicine on parasuicde victims attending the Mater A+E. In a large majority of cases a depressed individuals first contact with medical services is at an A+E department after a self harm episode. In the study it was seen that 25% of those presenting with self harm were not seen by a psychiatrist or a member of the psychiatric team. The situation in A+E's is increasingly getting worse with the Mater A+E in particular, due to existing co-location, being more of a ghetto for the disadvantaged then a haven of health care. Is it right that a 16 year old girl who just took a life threatening overdose is given her charcoal antidote while squashed between an abusive alcoholic and an iv drug user?Then after being seen by an exhausted medical intern is just sent of with a prescription for the antidepressant 'du jour' and a reassuring pat on the back? This is the reality of self harm victims in A+E's up and down the country. Contrary to the PD's belief depression IS an illness and as a medical condition can be treated with the proper quantity of pharmalogical and psychological help.
However with increasing dominance of pharmaceutical companies over medical professionals there is an increased reliance on pharmacological treatment. With 13 of the top 15 pharmaceutical companies having operations in Ireland and 300 million euro spent on anti depressants annually there is defiantly a financial incentive to keep levels of depression high .

Finally and most importantly, social factors. Even with proper medical care and suicide prevention schemes, in my opinion, depression and suicide would still be rife in Irish society. Capitalism and the neo liberal policies relentlessly persued by the Fianna Fail led administration have cultivated a society ripe for youth suicide and depression. As young people we are constantly bombarded with images and messages that being successful makes you happy and to be successful you have to have it all. You have to have the looks, intelligence, good job and flash car. The people in Ireland that are valued are those that are successful, winners and high earners. The realty is that it is increasingly difficult for a young person to find a meaningful identity and they get lost in the rat race of trying to achieve this perfection that society dictates we must be. From a young age in schools a competivness between peers is ingrained. Education is no longer about stimulating thought, discussion and debate but force feeding young people facts in order for them to get the highest points possible. This is further ingrained in the work place along with a feeling of instability as worker are under constant threat of upheaval by lower paid migrant workers. The corruption of Irish trade union have left young workers feeling vunerable and unprotected which leads to feeling of isolation. The individualistic culture of our society is reinforced by making everyone to conform to society. This leads to pockets of very vulnerable members of our community for example the gay community, which account for a third of self harm victims. There is no doubt that the culture young people are growing up in in Ireland is a very hollow society. A society where facilities for the youth are non existent, a society that has more golf courses then playgrounds. It's a society where the youth cannot decide their own future, they have it dictated to them by teachers, parents and the corporations that mould our society. It is this hopelessness for their future which I believe breeds depression. Therefore the only way to end our current suicide epidemic is by taking our future into our own hands and finally putting our own needs before profit. To finish on a quote by John Berger 'The existing social conditions make the individual feel powerless. He lives in contradiction between what he is and what he would like to be. Either he then becomes fully conscious of the contradiction and its causes and so joins the political struggle for a full democracy which entails the overthrow of capitalism'.

author by Michelle Clarke - Social Inclusion and understandingpublication date Wed Oct 10, 2007 22:08author address author phone Report this post to the editors

Anomie per Durkheim can be compared to Suicide.
Sean. Well done for stating your views about Mental Health and the implications of culture together with detailed references that can be sourced by readers.

Chris, you cited two different cases, locations, and outcomes. This is something that isn't acknowledged by the Status Quo medical/neurological fields. Ultimately, in a society that is growing apart due to econonic, cultural, societal, demographic and political advances!!!!, there is a loss in the sensitivities needed for real integration and interconnectedness starting at grassroots level.

Durkheim wrote about Anomie in society. This is a form of sickness or in the extreme, it is suicide, and it reflects the stifling of the L'esprit of life. It thus becomes a warning sign of a sick society, an unconnected society.

Comment re. article by Professor Patricia Casey, Psychiatrist, October 8th Irish Independent. (Mater Hospital and UCD Psychiatry Department).

Step 1 heading: (very hard when you are rock bottom about life)
'Never surrender to the hurtful myths about mental illness' Please don't and see beyond.....

Step 2: Highlight World Mental Health day - that is about global mental health education, awareness and advocacy project established by the World Federation for Mental Health. There are members in over 150 countries and the first World Mental Health Day was in 1992 (strange enough the time I first became really ill with anxiety and bipolar).

Yes, for centuries Professor Casey, mental illness has been tainted by Fear and Secrecy and 'we were' locked away, hidden from sight - but I would add the point, for the benefit of who? I would suggest the Family and I would go further and say the Church has a large input also. (I gain such sustenance that Van Gogh, his brilliance, his poverty, his letter writing to his brother and ultimately his suicide, that his tortured mind was allowed run free......he is a Physician of ART and Writing....in what Carl Jung referred to as the 'Collective Unconscious'.

Personally, I am not a believer in blame, secrecy but I sure am ridden with fears, phobias and anxiety. Blame rings out for me what our society in Ireland is about. It wreaks secrecy, lies, burdens, bitching, backbiting, shame, and lack of sensitivites in favour of spite, envy and jealousy.

Prof. Casey cites early Greece and Rome where those who were mentally ill were considered dangerous and either exiled or executed. In our own Irish history we only have to return to Tipperary in the late 1800's and the 'Burning of Bridget Cleary'.

I would suggest a review of motivation, family, shame, stigma, genetics...........What has really changed? Do people really understand the impact of Fear, Anxiety, Stigma, Sensitivity? I would suggest that the visible manifestations of anorexia, suicide, anger/murder, drug addiction are just the signs of weakness/sensitivities, in a harsh world.......it is about self harm........when you cut so that you can really see the colour of the blood......you are so dissociated, that you need to see and feel pain to re-engage.

Yes, Professor Casey, interpersonal relationships. Yes, I would believe the sample of 60% negative response in the workplace. Try listening to peoples' views about mental illness, when they believe they are having 'nice' and friendly conversation - wait for their guards to slip. Ask yourself how it feels....that people are so bigoted that they can enhance fear in others and draw secrecy on them as distinct from being stigmatised as a person, as a family. Add to this the biased media coverage, those grostesque headlines that reduce to base animal behaviour that of a human being with a problem.....

I am surprised that the National Disability Authority research backs up the foregoing findings, because my personal experience of the Researchers there is one of non-integrative, cold, and unacceptable. It is an understatement that 'The volcano of prejudice surrounding mental health is disturbing'.


Fair City
By chance I caught part of it tonight. I am sure it will wrankle the hearts of people, like me, who can identify with the situation, who made their own assessment, but the assessment differs from others, the clicque who conspire to label and possibly angle your entry to a psychiatric hospital.

I qualify, this of course can never happen - medicine always makes the right decision......or perhaps changes lie ahead!!

A young man, a writer, entusiastic, gains support for his writing by an older woman, the wife of a professoinal doctor......

All I will say is tonight is the audience convene, the Gardai are there, he looks over tired, over-extended and too convinced that he tells the truth........Next shot, the consultant, the admission........Worth watching if interested in life....


Quotation -
Gerard Manley Hopkins (Jesuit Priest/Poet)
'All suffering prepares the soul for vision'

Jesse Jackson (1941)
'Never look down on anyone unless you are helping them up'

John O'Donoghue - Anam Cara
'Perception is most powerful when it engages memory with the experience. This empowers conversation to become real exploration'

'One of the most powerful and prophetic analysts of work was Karl Marx. He showed how work can alienate a person from Nature and Potential. Certain work can dull and darken human presence'


Related Link: http://www.osfbf.pro.ie
author by W. Finnerty.publication date Thu Oct 11, 2007 15:21author address author phone Report this post to the editors

This "World Mental Health Day" article seems very worth-while, and potentially very valuable to me - from the viewpoint of attempts by individuals to make human society more healthy, in terms of the overall well-being of ALL its members.

One point I would like to add to the general discussion above, which I hope will be useful (particularly as it is based on my own direct experiences), relates to the general matter of JUSTICE in our society - and, more important perhaps, to the role played in our society by the main custodians of justice: i.e. our legal profession.

Many of the health threatening problems with injustice, as I am personally experiencing them, and which I believe MANY other people in our society may be similarly experiencing in a wide range of different ways, can be seen in the posting titled "Legal rights are after all worthless unless they can be enforced", which can be viewed at the following Yahoo web site address: http://groups.yahoo.com/group/Crooked-Lawyers/message/101 .

On a parallel basis, many of the very basic and potentially very dangerous "mental health" threats relating to the deep-rooted issue of justice (as I see things at least), have been very skilfully and efficiently outlined in the Irish Times newspaper article titled "Dealing with injustice", by Dublin-based psychologist Marie Murray, at http://www.europeancourtofhumanrightswilliamfinnerty.co...e.htm .

Last but not least, it seems to me that the form of GENUINE democracy (again, as I see things of course), outlined by President Lincoln at Gettysburg, might be mankind's best hope for a happier and healthier future: i.e. "government of the people, by the people, for the people". (More on this subject can be found at http://www.google.com/search?hl=en&q=Unfinished+work%2C...earch .)

Sadly, and as many will already know, President Lincoln was very suddenly assassinated not all that long after he spoke publicly on his idea of what GENUINE democracy appeared to him to be - which he referred to as the "unfinished work".

For obvious reasons, President Lincoln can no longer help any of us directly. However, I often find myself wondering if he might STILL be able to assist us, in an indirect way, through the deeply moving (and possibly very significant) words he uttered on the Battlefield of Gettysburg on November 19th 1863 ?

Related Link: http://www.europeancourtofhumanrightswilliamfinnerty.com/ChiefJusticeMurray/9October2007/Email.htm
author by Michelle Clarke - Social Justice and Ethicspublication date Tue Oct 16, 2007 22:25author address author phone Report this post to the editors

William Finnerty

Thank you for your posting and references. I too believe in the importance of Justice for all, and believe there is presently a seepage of unsatisfactory influence over people who are treated unjustly and in line with their level vulnerability. Charles Murray wrote of the formation of an underclass in the 1950's in the US, basically a people subjugated to a class, considered to be of no human value.

Kevin bought me by chance Newsweek (0ctober 15th 2007). Usually, this is beyond my comprehension but luck would have it - this week someone named Karin Rives has written a one page article about a topic that is so close my life post brain injury in 1993 and cummulative health problems culminating in Chronic Fatigue Syndrome.

CFS or ME or Yuppie flu is basically dismissed in Ireland, with an appearance of no research funding either. Those subject to years of ill-health, fatigue, low immune system etc., approximately 2/3 people in 1000 are left languishing trying to survive and without the ability to engage with daily life, basically their body and mind is burnt out. To those who just dismiss it, awaken your minds to what can happen to any human being and then think on, we are all human beings.

The article written under world affairs 'A Stressful Situation - plans to rein in sick leave spur a backlash in Sweden'. Can you imagine if this was proposed in the Dail i.e. no sick leave over 3 weeks for those with mental health issues?

Sweden voted in their first non Socialist Government since the early 1990s, a year ago. Taxes were cut and labour laws became more flexible. Now the Swedes have more money than before. Unofficial unemployment is 4.8% - its lowest level in 5 years.

Burn-out: yes it does happen and the cost is high. Minister Fredrik Reinfeldt decided to limit paid sick leave to 3 weeks for people suffering from an ailment known as mental burnout. Approrpirately, the news broke and independent media suggested that Government of 'trying to kill its weakest citizens'......Newspapers opinion pages published testimonials from doctors and former burn out victims......The question was raised 'Do we want a health-care system based on cynical economics..........'

The plan thankfully was shelved -

We like other European countries need to address the issue of long-term ill-health DisabilityInsurance options.....we face enormous de regulated competition from the Chinese and other Eastern countries where labour is cheap. How we treat long-term health issues needs vital attention.

Today as I listened to the Joe Duffy show, I listened to a student Vet discuss her father's tragic accident. He had been referred to the Mater but within a few days, he was due for the next phase of his treatment. She conveyed so aptly, her Vet skills and practicalities in relation to her Father's care. The father needs to move to the National Rehabilitation Hospital which has a 3 month waiting list. The only suggestions are to contact the politicians. Her father is one of many in say the last week who have sustained brain damage either from physical rough contact, to car accidents.......they are all waiting......After 3 months in Rehabilitation then there is more waiting and lack of definition.... There was no psychiatrist/psychologist at the Mater to deal with this massive change in a family's life.....

Hospitals are places where you go when primary care recommends, but alas primary care is but a vision yet so it your doctor makes the referral based on their clinical judgment, in the case of emergency. People must have a sense of moral duty not to hog beds for selfish reasons and believe me people can have total disregard just look at the percentages of alcohol induced crisis that are in our hospitals and in our A&E's. There is nothing worse than seeing A&E in chaos with people who are long stay.......deciding to refuse to leave their beds because basically they are afraid to face change.......i.e. to go home or into a step down situation i.e. a home for the elderly. We as people have a duty to ouselves, but also to others. Older people ought to be advised and drawn towards a step down in their living skills and given advice on ways they may contribute skills, knowledge and expertise back into the community via the internet.

One more vital point tonight - our famour GAA has a crisis. It is not a fitness crisis or a talent Gaelic crisis, it is sadly a crisis of Stress among young players who face burn out at the age of 25. As one GAA coach, John Tobin, from Galway said - the minors had over 102 training sessions last year plus these players were playing for their local clubs also, then add to it leaving certificate exams and the points for Third Level - stress.

There is a crisis to be faced now among the High Kings of the GAA at Headquarters. The great Clare Hurley Jamsie O'Connor also agreed and added we needs to look after pscyholigical problems of our young players i.e. burnout or otherwise we are going to have a drop out of young players participating in the Game.

Over competitiveness creates obsession to win or keep going in sport. It gives a bad example to young players coming up the impression of 'Win At Any Cost'. Last weekend, the famous and legendary Clare goalkeeper, double All Ireland winner, suffered a horrific accident playing for his local club. The top of one of his fingers was severed from a Hurling collision. He has since been operated on and his words are 'I will be back next year' . I ask the question to the GAA tonight What do you think about Davy Fitz' motivation!!!

World Mental Health Day v. Sweden and legislation to limit sick leave related to mental health to 3 weeks.

There is a high cost involved in burn out......it is worth adopting a cognitive approach and value to life - realistically we are talking about attitude which only we can change in ourselves.

A thought about Order (depression often has a perfection streak)

Denis Diderot (1713-84) French Philosopher
'Watch out for the fellow who talks about things in order! Putting things in order always means getting other people under your control.

Control over.......links to anorexia, obsessive compuslive disorders, to sports, to power and control over......

author by 2 Facedpublication date Wed Oct 17, 2007 20:42author address author phone Report this post to the editors

Jusdt ready your comments Michele, and quite agree. it's very sad that those footballers have to feel they have to play. Are they forced to do it? You didn't mention bullying in th home, bully at school, bullying in the workplace, bullying in traffic jams, bully in disco, and one can go on and on.
Getting to to the ROOT of the problem needs to be addresed and there might be very little \\Mental Health problems in Ireland today.. suuggestion, you run a quaestionaire on What causesd depresdsion and suicide attempts, Cases in the media even today are horrifying on poor little innoent children. What should happen to those bullys and what Will happen. There's the difference...A bully is insecure, Two faced, jealous and damn right dangerous. ..There I rest my case..

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