In Search of Madness: A Dive into the History of Mental Illness
A word of warning for those approaching Professor Brendan Kelly’s latest book, In Search of Madness. If your self-esteem has recently taken a beating, don’t try reading his mini-biography on the back cover of the book where his many college degrees and doctorates are listed.
he psychiatrist is also a researcher with hundreds of peer-reviewed publications to his credit, as well as a prolific author. You may have heard one of his regular contributions on daytime radio and, if you didn’t catch the name, thought to yourself “who is this voice of reason among the chaos?”
In this book, the good doctor manages to integrate all his centers of interest, both professional and personal: history, travel and the specialty that is obviously so dear to him. Indeed, his thirst for knowledge is matched only by his desire to travel; he travels to Belgium, Italy, Germany, India and the United States as part of his research.
“Most of us secretly worry about our sanity, at least once in a while,” he writes. He’s not wrong. And when he writes that the criteria for mental illness “have never been so negotiable”, we realize that the progress made over half a century in the way society recognizes and treats serious mental illnesses is weak and insufficient.
When it comes to mental illness, the medical mantra of “first, do no harm” has not always been applied in practice. Kelly tells us eloquently that much harm was done to people with mental illness in the not-too-distant past, and that cruelty, however unintentional, continues to be inflicted upon them even in these enlightened times.
By taking us with him on his travels, Kelly illustrates how our understanding of mental illness changes dramatically over time and geography. In India, we learn that the mentally ill are “neglected, chained or beaten” in rural villages, echoing historical practices of confinement. Other more gruesome and distressing “treatments” included bleeding and purging using laxatives and emetics, and forced bathing, “continuous bathing”. The lobotomy was “without a doubt the greatest mistake in the history of psychiatry”, he states unequivocally.
Diving deeply into the social history of the subject, he returns to this barbarism practiced in the “insane asylums” of the 19th century and deplores the “great injustice” of the institutionalization offered by psychiatric hospitals during a good part of the 20th century. .
Kelly admits he remains troubled by long-term mental institutions: “While kindness is good, freedom is better.” In 2003 there were fewer than 3,700 inpatient psychiatric patients in Ireland, a decrease of more than 80% in four decades, but the dismantling of the psychiatric hospital system does not mean that these people have disappeared – Kelly argues that people People with serious mental illnesses are often neglected, homeless or confined to inappropriate environments such as prisons.
On a more positive note, he writes enthusiastically about the number of old asylums and institutions that have been creatively reinvented. His description of the ‘mid-range hotel’ in Sligo that was once St Columba’s Mental Hospital gave me chills – I have stayed at this hotel and the tall windows in the claustrophobic room don’t bother me. left no doubt as to what this majestic building once served, not even knowing a thing about the history. I later found out it was the one depicted in Sebastian Barry The Secret Scripture.
In the meat of the book, Kelly strips away our preconceptions and assumptions. For example, he says there is “no logical division between mental and physical phenomena”, but the language of biology is ultimately “currently inadequate” in its understanding and description of depression. “We just don’t know exactly how the human brain works, even when it’s having a good day, let alone when someone is depressed or suicidal,” he writes.
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Schizophrenia is still widely distorted and misunderstood; all mental illness is, “sometimes deliberately”, he thinks. And for most people of a certain vintage, their understanding of electroconvulsive therapy (ECT) comes from the Jack Nicholson movie. Flight over a cuckoo’s nest. Touted as punitive, it is now a mainstream therapy for depression with a strong evidence base. This may still be news to some.
Kelly dismisses the impact of neuroscience on psychiatry, calling it ‘neurobabble’ and saying it has failed to deliver on its promise when it comes to mental illness, resulting in no appreciable improvement in managing any condition . He’s even more dismissive of what he calls “broccoli, jogging, and mindfulness” as a panacea for anxiety and depression — you know who you are.
Humble as he is, Kelly is the expert here and vignettes of some of his own patients end each chapter, illustrating in practice what he is trying to tell us about manic depression, schizophrenia and one particular case. painful postpartum psychosis.
He is a man at the top of his chosen area of expertise but clearly always seeking to give it context, be it social, historical or personal. He retains an insatiable curiosity about his specialty and one feels that the books are almost an offshoot or by-product of the vast amount of reading and research he does for his own satisfaction, not for continued professional development. Indeed, it’s a massive understatement to say that Kelly reads a lot – one of her many reading recommendations is an article by She magazine.
At one point, he describes sitting in a beautiful square in the Belgian city of Antwerp enjoying burgers and drinks with a colleague after a conference. As they nibble and sip, they discuss tough cases – a topic he admits is incongruous with their surroundings. He simply says, “We are psychiatrists. This is what we do.”
Story: In Search of Brendan Kelly’s Madness
Gill Books, 300 pages, paperback €19.99; e-book €8.54