Mental and emotional health issues are still stigmatised in Ireland, even though mental health is the largest unmet health need in our society, writes Dr Jim Lucey.
THE topic of the Merriman Summer School this year is the emotional life of our country.
It is a timely agenda as our nation approaches its 100th birthday. Much of our national dialogue appears to be about economic and political agendas as though these existed in a vacuum.
But what is the emotional state of Ireland today? More speculatively let me ask this: what is it about a nation or a culture that nurtures and sustains emotional wellbeing? The answer to this second question could inform us as we try rebuild our country following its financial collapse.
Mental and emotional health issues are still stigmatised in Ireland, even though mental health is the largest unmet health need in our society.
Unfortunately the typical response to mental distress in Ireland is neglect, or postponement at best. It has been said that if your car breaks down today, you could probably have it repaired within an hour, but if you or I have a mental breakdown today, it is unlikely that we will get help for at least 18 months. The delay is largely in our inability to have the mental health conversation.
However, there is a pressing need to widen our discussion because of the importance of our mental health. It is necessary for us all to enter the mental health debate.
There is much said about our vision for change in mental health services in Ireland, but for many this vision is an Ashling rather than a reality. There is still no national strategy to tackle the problems of suicide in Ireland. The problems and the costs of alcohol and substance abuse are still given insufficient priority, since in Ireland today, the drinks industry has disproportionate influence.
So what is it about our mental and emotional health which makes it such a taboo subject? The answer is complicated. It has not have been helped by the poverty of our language around mental wellbeing or by our asylum history of shame, fear and guilt. The problem is also with our mental and emotional consciousness, and this is political and social and cultural.
Modern Ireland is very different from the nation imagined by its founders. It is still, as St Colmcille called it, “a small island on the edge of the world”, but today, Ireland is struggling to become “the best little country in the world… to do business in”. We might question whether this vision is sufficient for the real challenges we face.
The first one 100 years of Irish freedom has been as traumatic as the century before it was tragic, and these memories are persistent. Memories of trauma are not usually lost even if they do not remain in the forefront of our consciousness.
Our independence emerged on the background of the great famine and of the Great War. The “peace process” which brought to an end 30 years of bloody civil war, a conflict we euphemistically called “The Troubles” has left many questions still unanswered. Since then, nearly every institution in the State has been discredited to a greater or lesser extent. With each shameful disclosure, denial has been followed by incremental half truths seemingly extracted in dental fashion. This establishment response to distress, a game of cat and mouse with the truth, was well rehearsed long before the banks collapsed.
In psychological terms, this process of denial is damaging, not just because it postpones understanding and prolongs the struggle to find recovery, but because like Pavlov’s dogs, we may have become conditioned to non-disclosure.
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Recent historians have described how to some extent in the early independent Ireland, we believed “we were a chosen people… a people set apart”. It was against this background of national self-deception that the earliest whistleblowers, as well as artists and reformers, must have struggled, since our processes seemed incapable of getting to insight.
On the other hand, our stated beliefs about Ireland have changed and “changed utterly”. Now we are given to question everything, and now we know at least some of the truths.
Our “states of fear” have been exposed so we now we know that in our asylums, 2% of our population was incarcerated against its will. We know that many of our young people and vulnerable adults were physically and sexually abused in church/state institutions and industrial schools, in the laundries, in the mother and baby homes, and all the rest.
These revelations have been so shocking that the sadness of it is too much to bear, too hard to hear, and yet we must hear it in order to understand and recover. We have only begun this work.
Despite these positives, the reality is that social and economic inequality is the biggest risk factor for poor health in Ireland. The mental and emotional health of nearly one quarter of our population is in jeopardy. The most common disorders are depression and anxiety.
So what does the description of mental disorder in Ireland tell us about the emotional health of our country today? The truth is there is no evidence that we are a depressed or an anxious nation. The measurable hallmarks of low mood and all the rest are not endemic in Ireland today. We do not lack energy and certainly we possess the drive and concentration to meet most challenges and succeed.
Equally, the features of anxiety disorder are not evident in our nation. If anything, it is impulsivity that is more typical. Experience shows that in Ireland, we are in distress and this is in response to the traumas of recent times.
In our next century, we could learn from our experience to create a culture that promotes and celebrates our mental health. We could prioritise the wellbeing of our people and build a concept beyond our current ideas of wealth. The mental capital of our country is our economic capital, and our economy can thrive again only if we include all those currently in distress within our recovery plan.
Surely a renewed conversation about values would be restorative. Perhaps then, the emotional and economic value of our homeless and unemployed would be acknowledged. Just as the emotional consequences of excluding the mentally ill needs to be recognised, the right to more effective means of recovery for all our people and our society needs to be endorsed.
So is there hope? Absolutely.
Our tendency to denial, dissociation, and non-disclosure, may not have helped us resolve our conflicts to date, but ultimately, we must re-engage if we are to recover.
How then can we move on from the distress of our past? This question is surely important for any nation which truly wishes to make progress, but only one nation that I know of has a specific word for the process. In Germany they call it “Vergangenheitsbewailtigung” or “wrestling with the past so as to come to terms with it”.
The meaning of this process for the German nation has been profound and the benefits are measurable. Denial is no more tolerable there than is dissociation. The result has been a cultural rebirth. Now as our 100th birthday approaches, is it possible that we would begin a cultural renewal based on a genuine dealing with our past? A cultural wrestling with our past could lead to the rebuilding of our country on universal principles of human rights. Into our second century, we could emphasise priorities that would make our young people and our old people strong and emotionally resilient. We could begin to include our homeless and our mortgaged, our emigrants and our immigrants, our believers and our unbelievers in a journey towards an Ireland that would be well and not only well-off. An emotionally healthy Irish life is not something that will happen by chance.
Certain resilience factors contribute to the development of a mentally healthy, emotionally resilient populations. They include a secure base, education, social competence and friendships, talents, interests and positive values. A renewed Irish society dedicated to building these resilience factors might prioritise them as much as finance or foreign affaires, and so future political and cultural decisions could be made congruent with these goals. A renaissance of our culture, of life and work and spirit, balanced with our sport, music and arts and respect for beliefs could emerge.
This working towards positive values would sustain growth; and with resilience the next generation could grow together to better withstand its traumas and rebuild itself.
Out of a sincere re-engagement with our history, we could make peace with ourselves and rediscover what it is to be truly mentally and emotionally well; so that more people could live independently, work productively and most of all, love each other with a whole heart.
Edited version of the keynote speech delivered by Dr Jim Lucey, clinical professor of psychiatry at TCD and medical director at St Patrick’s mental-health services, to mark the opening of the Merriman Summer School in Glór, Ennis, Co Clare.
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