Mental Health

Paging Dr. House

March 29, 2010

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Paging Dr. House

Once, in the years B. D. (Before Deinstitutionalization), Australia’s mental hospital care took two forms. There was the public-asylum form. Then there was the private-clinic form.

In the public-asylum form—Sydney’s Callan Park, Melbourne’s Yarra Bend—they basically locked you up for decades and threw away the key. (Former psychiatry professor John Cawte wrote a book called The Last of the Lunatics, which poignantly depicts the prevailing circumstances.)

The private-clinic form, exemplified by Chelmsford in Sydney’s hats-and-gloves northwestern suburbs, was much classier than the public-asylum one. Because at Chelmsford—the subject of a 1992 television documentary on Britain’s Channel Four—they took the trouble to kill you.

Say hello to Chelmsford’s Lord of Misrule, Harry “Deep Sleep” Bailey, who committed suicide in 1985 before he could be imprisoned for bumping off 26 of his patients. Bailey still has champions (any Wikipedia contributor’s criticisms of Bailey’s handiwork tend to result in accusations of being “a Scientology stooge”).

Long ago, Callan Park and Yarra Bend went the way of reel-to-reel tape. While since about 1990 deinstitutionalization has been as obviously absurd as Marxism and no-fault divorce, Australians are stuck with it under every conceivable future government.

Meanwhile, even the most violent patients can seldom get admitted to Australian cities’ public psych wards, where such wards still exist. So if your mental illness is incapacitating but you haven’t specifically been commanded by Radio Neptune through your dental plate to shoot your five closest neighbors, then tough luck. Unless you have your own health fund membership, in which case…

An autobiographical fragment may here be pardonable. Since childhood I have had major depression, unaided—but periodically worsened—by medicine or electroshock. How much life events caused this condition, how much heredity did so (my father hanged himself in 1994), I neither know nor obsessively care.

“Group therapy almost always gets dominated by one patient, usually menopausal, who missed her métier through being too Caucasian for an Oprah interview and insufficiently svelte for the starring role in Precious.”


In such circumstances, planning a “career” becomes a farce. One simply lives as austerely as possible; buys supermarkets’ generic brands; forgoes a car, indeed a driving license; inhabits the nether-world of contract work; walks rather than taking buses or trains—let alone taxis—and clings to private health insurance (which in Australia is largely unknown, and where known, has no connection with employers’ benefits). I stay teetotal for 363 days annually (allowing myself a glass of champagne for Christmas Day and New Year’s Eve), and avoid cigarettes. Once I tried cannabis, unaware it was cannabis; I felt so nauseated that I never touched it again, and merely contemplating other prohibited substances appalls me. My physical health is pretty good.

All of these trivia lead to saying that when the Black Dog periodically sinks his fangs into my carotid artery, I must be hospitalized in a private clinic. Such a clinic has two features. First, male patients will be only half as numerous as female patients. Secondly, the clientele will often be binge-drinkers, drug-addicts, and—a new antipodean development—the spectacularly obese.

Some of us had quaintly thought that mental illness possessed qualitative differences from drunks’ and space-cadets’ problems. Free will, for one thing. The mentally ill do not choose mental illness, though we can indubitably aggravate our illness. But not once have I met a druggie whom kidnappers released solely after he agreed to assume druggie status. Or a boozer whose boozing derived from bullies pouring grog down his throat, à la waterboarding at Abu Ghraib.

Nevertheless, in a private Australian psych clinic now, no differentiation between patients wrestling with a mental condition from infancy, versus patients who chose their condition simply by Bonging On or sculling Jack Daniels, must ever be suggested. Clearly, being a lush or hophead is always someone else’s fault. You are therefore—no less than any Haitian or Chilean toddler under the rubble—an authentic “victim”. Well, cozy clinic jargon like “addictive behavior victims” does sound more polite than “dipsos and stoners”.

Nor can you escape the tortures of “group therapy”, a procedure apparently imported from Maoist re-education camps to bourgeois Australia without the smallest intervening trace of individual self-respect. Group therapy promotes “the power of positive thinking”—the power of truthful thinking is clearly beneath consideration—and almost always gets dominated by one patient, usually menopausal, who missed her métier through being too Caucasian for an Oprah interview and insufficiently svelte for the starring role in Precious. The only way of properly greeting her fortissimo proclamations to complete strangers that “moy tablets have destroyed moy libido” is to rush towards the nearest bathroom before, or indeed after, you vomit.

And the obesity levels! We are not talking old-fashioned Falstaffian portliness, we are talking the moribund Henry VIII. Maybe we need the psych equivalent of Hugh Laurie’s Dr. House, limping with his cane, for diagnoses: “You’re not suffering from clerical sex abuse, you’re suffering from cheeseburger abuse. Get outta here.”

A decade ago, clinics had the opposite problem: anorexic teenage girls. Since no anorexic teenage girl admitted to proletarian origin, I can only assume that anorexia’s chief precipitant was an upper-class zip code.

It need further be said only that I was treated courteously by psychiatrists, incomprehensible though the mere ignorant layman like myself must find a “science” which in 1973 depathologized homosexuality through that fail-safe clinical method, a majority vote. From nurses I received particular kindness. From cleaning-ladies I received greater kindness still. And—must this really be spelled out?—I oppose reinstating the ancien régime’s viler elements: leucotomies, lobotomies, “chemical coshes”, Nurse Ratched’s progenitors.

I merely wish psych care’s physical improvement had been matched by comparable emphasis on individual responsibility. Dr. Cawte himself, concluding The Last of the Lunatics, realized that the old system’s sheer severity could represent hope:

“The greatest virtue of places like [the mental home in Adelaide, South Australia, where he worked] was of rallying—of summoning strength or courage after weakness, sickness or dejection ... Refuge—of a temporary kind—supported by sound medical care, provides one solution. Salutary refuge from community stresses is one moral of these recollections.”

Note for group therapists: “Salutary refuge” means “salutary refuge.” It does not mean “letting patients blame parents / the class structure / an insensitive Christian Brother for every problem they have from pill-popping to head-lice.”

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