Music and Madness By Ivor Browne

Music and Madness

By Ivor Browne

(Cork University Press, €25, Hardback)

This Apologia Pro Vita Sua by the well-known maverick Irish psychiatrist is a memoir in the tradition of his namesake and fellow specialist practitioner Noel’s Against The Tide. By opting to pursue his profession in Ireland from the early ’60s to the present in an unconventional, innovative and unorthodox manner (and despite lucrative and stimulating job offers abroad), Ivor has inevitably led a certain recognisable kind of radical Irish life.

Medicine, however, much less mind-doctoring, was not his original vocation. As the title may suggest, music was his first love, and all through adolescence and on into college, he harboured ambitions to become a jazz trumpeter. Indeed, he seems to be something of an accidental psychiatrist, having stumbled into medicine, and by extension psychiatry, almost by default. One is struck by how relatively easy it was to get into medical school in the late ’40s, or into the College of Surgeons at least, as long as your family possessed the wherewithal to put you through. Having left Blackrock College at 14, because his overriding obsession with music and lack of interest in schoolwork meant he was in the ignored and despised lowest stream, Browne never sat, let alone passed, the Intermediate or Leaving Certificates. Instead, he took the separate entrance exam for Surgeons, and was accepted on the second attempt – only to then fail pre-med first time around and have to repeat it too.

Tuberculosis, the battle against which is something else Ivor has in common with Noel, finally put pay to his musical aspirations. Practicing the trumpet, and subsequently the uilleann pipes, led to recurrences of the disease, and he had to pack it in. He writes: ‘It was a big shock to have to acknowledge that my hopes of a career as a jazz musician would have to come to an end. In hindsight, though, it was probably the best thing that could have happened, because the kind of traditional jazz I was interested in at the time was already going nowhere.’ TB also interrupted his medical studies for two years, but this cloud too was not without a silver lining. As a child he had been seen as gauche, introverted and ‘not the full shilling’: ‘On one occasion, my friends became so concerned at my apparent lack of contact with reality, and dreamy state, that they came as a deputation to my father saying that something should be done about me, and that they felt I should be seen by someone…Fortunately for me, my father was too involved in his own struggle to maintain his sanity to do anything about it, otherwise I might have been defined as a patient and been led towards psychiatric illness.’ Having always considered himself ‘a mistake and a potential failure’ and socially maladroit, after his period of illness and recuperation he vowed to try things out and open himself to new experiences, even if he failed and was the object of ridicule. He also made an effort to be friendlier and more socially integrated. This led to an interest in traditional music, and summers spent tramping the roads of Ireland, from Puck Fair to the Galway Races to various fleadh. In lieu of the trumpet, he took up the guitar and tin whistle, and became quite the bohemian, busking his way around the country.

Stints working and studying in England and the U.S. followed qualification, and he acquired an M.Sc in Hygiene (Community Mental Health) from Harvard, for a thesis designing a comprehensive district community mental health service, which eliminated the old-style mental hospital from the picture entirely.

Homesickness brought him back to Dublin in 1962, and a job in St Brendan’s, or Grangegorman as it was then known. Browne takes the opportunity to settle a few old scores, most notably against his then boss, Dr John Dunne. As Chief RMS, Dunne was in charge of not only St. Brendan’s, but St. Ita’s and St. Loman’s as well. He ran them with the minimum of effort, according to Browne, who relates the following anecdote: ‘He came to the hospital pretty regularly every day but never arrived before noon. He would stay for about an hour, unless he had a discharge board to perform, and then would depart to play golf. One day a bank manager who was one of his golfing partners said to him, ‘How is it, John, that, with the enormous responsibility you have running these hospitals, you are able to spend so much time on the golf course?’ John Dunne replied, confidentially, ‘You know if I was to spend too much time in there I’d be as bad as the rest of them.’’ Dunne was the classic ‘psychiatrist as custodian’, since his discharge boards amounted to, ‘…going through a patient’s notes meticulously, and if he found any past evidence of attempted suicide or dangerous aggression, he would say, ‘I think we’d better defer his discharge for some time.’’ This grew increasingly frustrating for Browne, who had assisted patients and built up their hopes of getting out. He came to see Dunne’s behaviour as motivated by nothing more than protecting his own reputation. Dunne eventually retired in 1965, two years later than he should have. A veteran of the War of Independence, he was a personal friend of then Taoiseach Sean Lemass, to whom he appealed personally for an extension when he reached retirement age, so that he could extend his sinecure. Naturally, it was granted.

Dunne’s duties under the Mental Treatment Act 1945 still have relevance today. On November 5^th, 2007 Dr. Siobhan Barry, PRO of the Irish Psychiatric Association (an organisation so sinisterly uncommunicative it has failed to respond to numerous communications from this writer) was given airtime on the This Week radio programme, to voice her reservations about the implementation of the Mental Health Act 2001, in relation to the greater protection it afforded to patients held against their will, by having their cases brought before independent review panels within 21 days of their detention. Barry lamented the fact that psychiatrists would now have to spend six to seven hours per involuntary patient during those 21 days, preparing for mental health tribunals, which was not therapeutic time, and which also took time away from voluntary patients. The interviewer did not challenge her about the fact that of her estimated ‘490 patients’, only ‘three to five’ were involuntary. But the richest irony of all was how Dr Barry finds the time for her extensive media work, when she is so hard-pressed to fit in and fulfil her psychiatric obligations. Protecting the rights of vulnerable patients may be eating into her clinical practice, but it hasn’t impacted on her availability for TV and radio appearances, or newspaper and magazine comment.

Music and Madness goes on to chronicle Browne’s increasing involvement in psychiatric administration. He became Chief Psychiatrist of the Eastern Health Board, effectively taking over Dunne’s old job, and also gained the Chair of Psychiatry at UCD, both apparently by default, as a compromise candidate. It also details his setting up of the Irish Foundation for Human Development, and its invaluable community work in Ballyfermot and Derry during the ’70s. Throughout his career, Browne has frequently been sabotaged, by both colleagues and administrators, in his efforts to change fundamentally the way psychiatric services operate in this country. He states that, in his experience, ‘…the administrators of a health board are not primarily interested in the therapeutic outcome and welfare of the patients. Rather, they are concerned with running a service that is financially economical and causes them as little trouble and disruption as possible.’ Since his retirement in 1994, he has practiced privately as a psycho-therapist.

Browne differs from the psychiatric establishment in rejecting the biological basis of psychosis. For him, most mental illness, or emotional disturbance, is caused by past, repressed traumas, which have to be worked through and integrated. Thus, in contrast to conventional psychiatrists, he believes that psychotics – to say nothing of common or garden neurotics – do benefit from psychotherapy. He gives clinical examples to demonstrate his conviction that schizophrenia and the institutionalisation which follows it is largely iatrogenic, and goes so far as to characterise the relationship between the pharmaceutical industry and psychiatry as a cosy ‘closed delusional system’. For him, ‘the current psychiatric view of what constitutes psychotherapy is too narrow’.

All of this questing innovation took place – and still does – against the backdrop of a cautious, hidebound and often callous conservatism, as exemplified by the Irish Psychiatric Association, which seeks to deflect all debate about advances in psychiatric care into a narrow focus on availability of beds and use of resources, rather than a theoretical re-examination of methodologies and practices. (See, for example, on-line interviews with and lectures by the organisation’s PRO, Dr. Siobhan Barry, at http://www.irishhealth.com/video_interview.html# and http://www.dcu.ie/health4life/conferences/2007/Siobhan_Barry.shtml.) As long as self-serving groups such as this one are allowed to control the terms and parameters of all discussion on the topic, unchallenged by a supine and often gullible media, there can be no real progress in the care of mentally ill people, and they will be allowed to continue blaming ‘the system’, not themselves. If they can get us asking the wrong questions, they don’t have to worry about the answers.

Finally, it is gratifying to come across a senior medic who openly acknowledges his enthusiasm for that useful substance, cannabis, and the ‘…lovely relaxed feeling of smoking grass while listening to jazz.’ The public expression of such views has landed him in hot water in the past, as has his espousal of the therapeutic value of LSD. Once again, all this while members of the psychiatric establishment are still busy taking taxpayers’ money into their already amply filed pockets to help produce government reports which continue to rehash the traditional 1950s American McCarthyite ‘reefer madness’ paranoia and peddle the clichéd 1960s anti-countercultural dogmas about cannabis being a gateway drug, and a contributory cause of mental illness, and so should therefore remain illegal and carry stiff penalties for possession, even for personal use. (See the tenth report of the Joint Committee on Arts, Sport and Tourism, ‘What Everyone should know about Cannabis’, July 2006. In her foreword to the report on ‘this truly noxious weed’, Committee Chairman Cecilia Keaveney, a Fianna Fail Senator and former T.D., accepts that ‘…mental illness is managed rather than cured’. Consultants for the report included Dr. Siobhán Barry and Professor Mary Cannon.) This is akin to arguing that because some people get very sick when they eat a lot of chocolate, chocolate should therefore be banned; or, more pertinently, that just because a certain percentage of the population have a predisposition towards alcoholism, that prohibition should be introduced – a ‘noble experiment’ that fostered more social problems than it sought to solve when it was tried in 1920s America.

In the Arts Lives documentary about him, poet Paul Durcan recalled how, during one of his hospitalisations, a psychiatrist told him, “Paul, you are one of the most evil people I have ever met.” Not surprisingly, perhaps, Durcan opined that the pseudo-profession contains some of the most casually hypocritical and viciously cynical people he has ever encountered. While he may not be a saint, it is difficult to imagine a public figure less inclined towards evil than Paul Durcan. At the same time, it is hard to think of any other special interest group who have done, and continue to do – with almost complete unaccountability and lack of transparency – more hurt and harm to the lives of ordinary, vulnerable people than psychiatrists. On the evidence of this book, even if it is from the horse’s mouth, Ivor Browne is an exception, in being one of the very few good guys to have made his life’s work in this den of iniquity, where our supposed arbiters of sanity are often crazier than their patients, or else of ruthlessly sound mind in their exploitation of them.

First published in Magill, June/July 2008