Attitudes to mental illness
Sir: I wish to protest at your publication of Donald Gould's absurd article on 'The harmless lunatic' (17 October), and the column inches devoted to a single case history. The ignorance and fear he attributes to others is manifest in every line and with every repetition of `drugs and shocks'. In point of fact as much is known about the pharmacology of the neuroleptic drugs he disparages as about aspirin. The introduction of these drugs has turned the expectation for schizophrenics of living in the community from 20 per cent to 80 per cent over the past 20 years, during the operation of the present Mental Health legislation. In fact such was the universal determination by psychiatrists to reduce the mental hospital population in the Sixties that many hundreds of psychotically disabled people were discharged and left to fend for themselves in an indifferent if not openly hostile community.
The article totally ignores the great deal that has been done and is being done for mental illness, and the gradual increase in understanding of the underlying biochemical and pathological changes in the major psychoses. There are numerous patients and their relatives who can testify to the transformation in their lives wrought by medication and ECT. There are unfortunately many more who find asylums are much more humane than the outside world and can only cope in the sheltered environment provided by them.
Of course, implicit in the article is the belief that mental illness is in some way not the same as physical illness — that perhaps it doesn't really exist — and that nonmedical opinion is as important, if not more important, in deciding questions of diagnosis and treatment (deciding that someone has to be detained against his will involves a judgment about symptoms and insight). Psychotic illness will not go away because we wish it, nor is it any less real because some psychiatric popularisers, opting out of the unpleasant reality of the mental hospital, try to conjure it away with fine words. It is present in a minority of patients referred to pychiatrists, or of those who have psychiatric symptoms.
Progress in psychiatry is not helped by discussing all mental illnesses under one rubric, nor by the irresponsible reporting of the controversies in the field.
David J. King 27 The Green, Dunmurry,
Co. Antrim, Northern Ireland
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