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Liberating the snake-pits

The voice of traditional establishment psychiatry confronted fuzzy-haired and radical therapy on Thursday last in the Union Hall. Dr Castanov, the head psychologist at Porirua Hospital and Dr Erich Geiringer, outspoken critic of existing medical practices, spoke at a forum organised by the Psychology Society.

Castanov began by speaking briefly on the different psychiatric techniques practised at Porirua, and compared New Zealand mental hospitals favourably with those in Australia. He said the main problem was lack of staff.

Geiringer then announced that the key question to be faced in the discussion was what is meant by mental disturbance. Although throughout history there have been cases of people whose brains are damaged, the majority of mental patients are not so extreme. Many of these people we would now say are undoubtedly insane, but earlier societies have tolerated them as variations of normality. So it is society's values which creates the myth of mental illness, by defining certain types of behaviour as non-conformist. For example, until recently psychologists were trying to "cure" homosexuals. Now they are giving up and saying homosexuality is not a disease. Perhaps in 50 years it may become one again.

Before the Industrial Revolution society was sufficiently flexible to absorb most kinds of social variation. Then with the division of labour, intolerance increased to the point where the "insane" were extracted from society to purify it. The capitalist notion that mental disease is an inconvenience to production caused patients to be stored away in institutions.

Our understanding has increased and today industrial society feels it may itself be insane. This has created a branch of psychology studying the behaviour of groups which impinge on the individual. The idea of separating the ill from the well is now known to be absurd and counter-productive. Geiringer claimed that Castanov's job was to imprison the mentally ill in an artificial society when they should never have been removed from the real society. We should instead be able to adjust and live together. Apart from a small minority who need institutionalising for their own protection, it is ludicrous to try and reform people and send them back into the same society which created their problem.

Geiringer believes that the proper care of mental patients depends on the restructuring of existing society. The image of mental illness must be changed from individual mental suffering to the suffering of society itself. Thus our society could easily and with tolerance care for all its members. This statement came in for great applause but Geiringer throughout the forum offered no useful suggestions on carrying out the revolution he describes.

The first significant question suggested a union to safeguard the rights of patients. The manipulative nature of therapy means that patients deep within mental hospitals may suffer extremely inhumane treatment.

Castanov promptly denied that any violence had taken place in his time at Porirua, and said that if he came to hear of any case he would be the first to write a letter to the Minister of Health. Decisive action indeed. Geiringer then took the opportunity to deliver another speech on the chronic staff shortage at Porirua, where there are only two psychiatrically qualified doctors for 1400 patients. This situation makes a Bill of Rights urgently needed, he said, as it is impossible to protect patients from abuse at present. A "Catch 22" situation operates, he said, where a patient lays a complaint of poor treatment and this is considered by the authorities to be invented owing to the patients mental state. Psychiatrists themselves are insane, Geiringer maintains and they should all be done away with, since it is easier to treat society than the individual. Revolution has been shown to be more effective than therapy.

The next questioner asked Geiringer's opinion of Muldoon's recent statement on radio that the doctor should stick to tonsil operations and leave politics to the professionals. Geiringer chose to answer by analysing Muldoon's mental health. He saw the new National Party head as a clear case of systemised insanity. The beliefs he holds as part of a system would, in an individual, justify committing him. Geiringer gave as example Muldoon's attitude to the drug problem. First, he knights the brewery bosses for pushing the most dangerous drug this country knows. Secondly, he poses himself for a gin advertisement, thus pushing the drug himself. Third, he speaks in Parliament in favour of a tobacco growers bill, while knowing that tobacco kills more New Zealanders than road accidents. Finally, he suggests stamping out the drug menace by imprisoning cannabis smokers. In any other situation, such illogical action could easily result in Muldoon ending up in Porirua.

Geiringer was asked how he reconciled his general attitude with his recent statement that he would attempt to cure homosexuality if he could. He indignantly replied that he was misquoted on this point; What he really meant was that if he had a child who appeared likely to become a homosexual he would use a non-oppressive means to try and prevent this happening. This was just a preference, he assured the audience, since straights seemed to have more fun. He would not, however, use violence to enforce such a bias, but instead try to reeducate.

Asked to explain who he meant by the 5—10% of mental patients who really needed hospitalisation Geiringer replied by analysing the situation of the mental patients in institutions like Porirua. One third of these, he felt, were minor cases who could easily be treated in their own community. Another third were brain damaged people who just needed care and the chance to use what potential remained to them. Again this could be better achieved within the society. The remaining third are chronic cases, mainly schizophrenic. Experiments have shown that at least half of these really represent the untreated illness of their community. After institutionalising, they become worse until they are too far gone to be allowed to leave. The remaining 15% are prone to bizarre, "anti-social" behaviour, but half of these are not really dangerous. They are simply a nuisance and a society such as India's would accept them easily. It is the final 7½% who are not properly understood by science. They are both unpredictable and dangerous to themselves and others and Geiringer feels that they alone should not be allowed outside a secure institutional environment.

Castanov replied that he agreed with much of this, that the ideal was to treat most patients at home. However it was their own families who brought them into Porirua, so the policy was to return them as quickly as possible.

Asked how many patients are in mental hospitals because their families did not want to care for them. Castanov replied that quite a lot of epileptics and geriatrics were in this situation. This caused a big problem of under-staffing.

Geiringer added that the families themselves are subject to very great stress. More doctors would solve the problem he insisted. Ninety per cent of psychiatric cases are the result of lack of government spending, successive governments refuse to train sufficient psychiatrists, even after a Royal Commission specifically recommended this.

Castanov agreed that pay at Porirua was insufficient to attract staff, but said he couldn't see any improvement at this stage. There was no sense in simply agitating, he said sternly. Small changes are being carried out already and the situation is slowly improving. Geiringer replied that if many in the audience were training in psychology, that was part of the answer, but for the others political action was necessary, since it is the state which makes the decisions. People need to fight for tolerance, to end the need to conform to a society which drives people mad. Geiringer sees the answer as planned parenthood, through free contraceptives and adequate sex education, and a reasonable abortion policy. When children are properly looked after during the crucial first five years of life, he thinks mental, illness will drop dramatically.

Another questioner suggested group therapy was the answer to the problem, but Geiringer said the best therapy came from society itself, not new forms of treatment since they end up existing purely for their own sake.

Another query about protecting inmates from brutality led Dr Castanov to point out that the patient is free to complain to a charge nurse, senior nurse or the Department of Health. Geiringer replied that these complaints are not investigated, since no one will believe a patient. In the past brutality was widespread in Porirua, and it still occurs from time to time. This was inevitable if a depressed person was to be put with a lot of schizophrenics. Although patients rights might be fully protected on paper, they could not be enforced and the snake-pit mentality of asylums would remain as long as the asylums themselves continued to exist.

by Mark Derby