20 March 2007

Challenging the status quo

Admission to a psychiatric hospital was the start of a nightmare for one survivor. Carl O'Brien reports

The only giveaway that something is wrong in the old black and white photograph is when you look closely at her eyes.

As she stands outside the church holding her newly baptised daughter, surrounded by smiling grandparents, Mary Maddock's eyes look tired and heavy lidded. She is wearing a melancholy smile. Despite the joyous occasion, there is something deeply sorrowful about the picture.

"I was still quite heavily drugged at the time," says Mary, looking back on the photograph. "I barely remember what was going on at the time."

A few weeks earlier, at 10.50am on Tuesday, January 27th, 1976, she had given birth to her first child, Claire, after a long and difficult labour.

Mary doesn't recall much after that. She had taken laughing gas to relieve the pain and soon became agitated and upset, talking about strange and unreal things such as death and dying. Her husband, Jim, says she was acting in a way that was completely out of character for her. Two days later she was transferred to a psychiatric hospital in Cork. Without any previous history of psychiatric problems or depression, it was an environment she was completely unprepared for.

"Patients shuffled along the corridors in a very drugged state," she recalls. "I had no idea whatsoever of psychiatry and all it was about. I didn't know about psychiatric drugs or their side effects."

She was later diagnosed by doctors as having a severe form of post-natal depression which, she was told, would require intensive psychiatric treatment. "I was being given large doses of Largactil [a drug used to treat psychotic disorders]. I can still remember its taste to this day.

"It was terrible, but the effects were even worse. You felt like a zombie. Movement was very slow and I found it impossible to concentrate on anything. I was also being given electric shock treatment. After each session I was left with a massive headache and lots of events were completely wiped from my memory. This is why I can't even remember holding Claire in my arms for the first time. It breaks my heart."

For Mary it was the beginning of two decades of drug-based treatment which, she says, took a massive toll on her health and prevented her from emerging from her condition. After being diagnosed at various stages as being hypo manic, bi-polar or manic depressive, she was placed on a range of powerful anti-psychotic drugs over a period of about 18 years.

"Mary was supposedly well when she was discharged from hospital on a number of occasions," says Jim. "In reality, she was reduced to a piece of psychiatric flotsam - an overweight, stiff-limbed, kidney-damaged, drooling, mind-numbed, middle-aged woman."

Today, radicalised by their experiences, Mary (59), a music teacher, and Jim (58), a secondary teacher at Douglas Community School in Cork, have become powerful advocates for change of the psychiatric service. They are both involved in a number of campaign and advocacy groups which are lobbying for alternatives to the "medical model" which dominates much of psychiatry.

They say their newly published book, Soul Survivor, is a testament to the need to overhaul a psychiatric service which, despite improvements, they maintain is still dominated by the overuse of drugs, involuntary detention and electro-convulsive therapy.

Over the years the received wisdom, Mary says, was that there was a chemical imbalance in her brain which was genetic and could only be treated chemically.

"I believed the experts and I did everything I was told, including submitting myself to yet more ECT sessions. I was scared to miss even one tablet as I thought this was the only way I could avoid a return visit to the psychiatric hospital and be taken away again from my husband, children and friends. I believed the psychiatrists were the experts."

Jim adds: "A common comparison at the time, and one still made today, is that it was like a diabetic having to take a daily dose of insulin. Not only would lithium correct the imbalance in her brain, it would prevent any more breakdowns in the long- term . . . the regime of lithium treatment continued for 18 years."

If anything, Mary says, the mind-numbing effects of the drugs and their shuddering side effects set back her recovery by decades.

One of their biggest concerns is still the continued use of ECT, which varies widely in use from region to region in Ireland.

"It was a barbaric treatment," John says. "Crudely put, it is like giving a television a bang in the hope of restoring the picture. Sometimes it might work, but exactly how is not known. How anyone could ever think of administering an electric current sufficient to provoke a grand mal convulsion, of inducing a seizure, could be a 'good' treatment for any condition amazes me."

In 1993, after almost two decades - bloated, overweight, lethargic and still prone to occasional bouts of psychosis - she says a number of fortuitous events marked a turning point in her life. Some of the worst side effects of the drugs ceased when she stopped being administered Surmontil, which is used to treat depression. She also began to learn more about psychiatry and, ultimately, began to challenge the orthodox methods of psychiatric profession.

Mary took up walking and practising alternative therapies. Under the supervision of her doctor, she gradually reduced her daily dose of anti-psychotic drugs over a four-year period. The effects were remarkable. "I lost the shake in my hand, I could walk in the sunshine without the awful tingling sensation, my stomach cramps began to wane, the whitish discharge from my mouth stopped. I could get up earlier in the morning. Most of all, I felt the re-awakening of my spirit and zest for life. Music really began to mean something to me again."

As she began to recover, she and her husband also got involved in the emerging campaign for human rights in the mental health area. Their initial involvement was sparked through groups such as the Cork Advocacy Network and MindFreedom, which challenged the orthodox thinking of much of the psychiatric service. They are now members of Slí Eile, the Cork housing association for former psychiatric patients, and are founded members of MindFreedom Ireland.

While there is little doubt that the psychiatric service is changing, Mary and Jim feel the treatment options are still narrow and don't sufficiently respect patients' rights.

"I still think that what happened to me could happen to others," says Mary. "The Government's blueprint for the mental health sector, A Vision for Change, says the existing experiences, knowledge and skills of service users should be valued even though these may challenge those of some professionals. This book we've written together, I think, throws down that challenge."


Soul Survivor by Mary and Jim (12.95) is on sale in bookshops and can also be purchased online at asylumonline.net

© 2007 The Irish Times