Session 7: How to Care for the ‘Mad’?

Session 7: How to Care for the ‘Mad’?
Chair: Taine Duncan
Colonial Psychiatry in British Guiana: Dr. Robert Grieve
Letizia Gramaglia
University of Warwick, Warwick, United Kingdom

Long forgotten in the folds of history, Dr Robert Grieve enjoyed in his lifetime a justified reputation as one of the most progressive and insightful figures in the medical profession of British Guiana. On his appointment as Medical Superintendent of the Public Lunatic Asylum in British Guiana in 1875 Dr. Grieve implemented a new humanitarian regime, – a radical departure from the practices of his predecessors, – which involved decorated wards, amusements, adequate nutrition, and most vitally, a policy of non-restraint and an emphasis on the recuperative power of productive labour. Five years of the Asylum’s history, a period of unprecedented health, recovery and development, were chronicled in meticulous detail in Grieve’s Asylum Journal. This unique document contains a comprehensive record of all the statistics associated with the running of the Asylum, along with the doctor’s own research into the sanitary conditions, diseases and sociology of the colony. Inspired to the curative strategies used in many contemporary European asylums, Grieve’s programme of therapy had the purpose of controlling insane behaviour by infusing a moral order, which mirrored the ideal order of colonial society; in this sense, the trust assigned to the inmates acted as a means of psychological manipulation aimed at internalising the sense of moral discipline governing the asylum. At the same time, the erudition, morals and humour of Dr Grieve emerge strongly from his writing, showing him to be a man of considerably generous and tolerant character in the capitalist, imperial British Guiana of the day.

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A characteristic feature of Soviet psychiatric care was paternalism. Neither the role of lay care nor patients’ mutual care was articulated in Soviet mental health care discourses. Presence or lack of loving, intimate, and/or confiding relationships was viewed as having a marginal importance for persons diagnosed as ‘mentally ill’. Notwithstanding the general paternalistic model of care, in Soviet Latvia one could often observe a degree of solidarity and reciprocity in doctor-patient relationships, especially for such widespread forms of mental distress as neurasthenia and vegetative dystonia (Skultans 1995).
The post-Soviet reforms in psychiatry brought with them novel ideologies of care (cf. Read 2007, Read & Thelen 2007) and have lead to prioritising cure over care (Dunlop 1994) thus widening the status difference between doctors and most patients. In Latvia, also the emotional distance between them has grown (Skultans 2003, 2005). At the same time, the new mental health discourses have facilitated somewhat greater attention to the patients’ emotional needs, both in professional and voluntary sectors of care. The question as to what degree mental health service users need, desire or are capable of intimate and loving relationships nonetheless still elicits ambivalent reactions in today’s Latvia.
This paper will examine various ways in which psychiatric patients and their carers in Latvia address such dilemmas as care and reciprocity, treatment and control, intimacy and vulnerability. The presenters will base their discussion on the data that stem from interviews with psychiatric service providers, users and their relatives in 2007 and participant observation/listening in two Latvian service users’ organisations.

Differentiating between the pathological, and possible religious or spiritual connotations of schizophrenia sheds light on the possible mechanisms of coping, useful in developing clinical strategies in the treatment of schizophrenia. While many studies have focused on the nature and treatment of auditory hallucinations within modalities such as cognitive-behavioral therapy and/or psychiatric interventions, these modalities aim at eliminating the auditory hallucinations in patients with schizophrenia, perceiving them as a pathological symptom. Research has also been undertaken in understanding the cultural and religious components of schizophrenia, as well as how religion and spirituality have been incorporated in the coping mechanisms of this population (Lukoff, 2007).
However, there appears to be very little research on how auditory hallucinations themselves may be incorporated in the recovery process, in the development of new meaning and purpose as one grows beyond the catastrophe of mental illness (Anthony, 1993). It also implies that the individual may not necessarily be cured or be symptom free. Hence, this paper suggests reconsidering the role of auditory hallucinations in schizophrenia, an area in the field of psychology that has a dearth of information.
This theoretical perspective is supported by the survey of the literature, which suggests that for many centuries, individuals experiencing auditory hallucinations have been given much more credence than their counterparts in modern society. Most recent studies on auditory hallucinations indicate that auditory hallucinations themselves are not debilitating. Romme (1989) proposes instead that the fear of not being able to control or manage the auditory hallucinations can be disabling to the individual.
It is hoped that a more refined understanding of the present literature regarding auditory hallucinations will promote a basis for the relevance of researching auditory hallucinations in the recovery process of individuals with schizophrenia.

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