During my teenage years, as well as the usual discussions about civil rights, the advance of nuclear power, and social democracy, friends and I shared much debate over the treatment of mental illness. We had read Ken Kesey’s book, One Flew over the Cuckoo’s Nest, and later, the Oscar-winning film adaptation starring Jack Nicholson heightened our youthful but earnest analysis. It is often said that both works contributed to a backlash against many psychiatric practices, not least the use of electroconvulsive therapy, or ECT as we would refer to it in hushed tones. Memories of those concerns were brought home to me in two articles in this month’s issue. In Seth Dellow’s audio interview with retired doctor and public health official Cam Bowie, Cam recalls how one of his early initiatives was closing down massive mental health institutions or ‘asylums’ as they were known. One hospital in Wells had housed a massive 1400 mental health patients. These facilities were simply not working for patients and he helped implement a new system of smaller treatment amenities as well as care at home programmes. It’s fair to say that we have made many advances since those days but talking to Horatio Clare last week about his experiences going through a mental breakdown, highlighted issues that should still concern us today. In his new book, Heavy Light, he details his descent from delusion into mania and how his experience at the hands of psychiatric facilities left him horrified at treatment designed by category rather than for each individual. His options were to take one of three different pills which he described as ‘chemical coshes’—for him there was no alternative. One of the nagging questions that remain after reading Heavy Light is: who decides and under what parameters are decisions made about when paranoia becomes an issue requiring intervention? In Horatio’s case, his belief that he was in the center of a conspiracy led to an increase in irrational behavior beyond what could be deemed ‘in character’ and beyond what was socially acceptable. He obviously needed help, but with every aspect of the public health industry now under enormous pressure, those taking intervention decisions today must have a daunting duty of care.
