Still crazy after all these years

“WE ARE all born mad. Some remain so,” or so reckoned Samuel Beckett in a rare moment of optimism. Precisely what that madness might mean is the question that’s kept Professor Ivor Browne guessing for over four decades now. And he’s still puzzling over the dilemma.

Though an occupant of the lofty posts of Chief Psychiatrist of the Eastern Health Board and Chair of Psychiatry in UCD since 1966 and 1967 respectively he is quick to point out that the geography of the mind is far from mapped yet. Though an astute reader of people, Professor Browne doesn’t claim to be privy to the precise patterns (if any) that are traced on his, or anyone else’s brain. Instead he sees himself as a conduit for fresh ideas, innovative thoughts and untried approaches to the treatment of mental illness.

Numerous casualties of day to day living have sought him out, his reputation as a shrink with substance (and, not all of it chemical) drawing them to his front door in large numbers. Most recently his name has again been set in type courtesy of Colm Toibín’s exorcism of the trauma of witnessing his father’s death through Browne’s unorthodox (at least in these parts) approach, (using psychotherapy rather than drug therapy), has spawned a healthy and long-overdue look at the service we provide to the psychiatrically ill round these here parts.

Ivor Browne’s always been a rebel, though never one without a cause. He attributes much of his ‘outsider’ status to his upbringing, being the son of a Protestant mother and a Catholic father, who he describes as ‘always a bit of a rebel himself’. This in turn fostered a certain curious disposition that saw the young Browne questioning everything, taking nothing for granted.

By his own admission, he learnt very little at school and left at 14. If it weren’t for his parents’ concerned interventions, Browne might’ve followed his instincts and become a jazz musician in France. He’s thankful at least that he was not forced to comply with the educational straitjacket that his peers were locked in during those formative years.

“If you look at people who’ve done unusual things,” he asserts, “like writers, artists, you’ll find that many of them never went to school, or else they didn’t learn anything while at school. Einstein was a bit of a dunce. Darwin was a dunce – and I think Pearse had it right when he talked about the murder machine: stuffing people’s heads with facts is highly questionable. Although there’s great capacity in the brain, I think that if you keep programming people along certain lines then they’re not going to be free to think in a different way.”

And the solution? Browne certainly doesn’t see it coming from within an already rigid system.

“I think the alternative is the difference between teaching and learning. Who was it who said: ‘Those who can, do. Those who can’t, teach’? (G.B. Shaw). If we had communities wherein you could have a centre that all ages would go to, that would be a far healthier approach, in my view. Especially now with the banks of knowledge and computers that are at our disposal. It’s available and the people could go and dip into it and learn.

“It’d be a welcome relief from the situation we have at present where we have ourselves programmed into an absurdity. We have this Leaving Certificate which isn’t composed of useful knowledge and yet we’re saying it’s necessary for any kind of a job! And at the same time we’re not providing the situation for people to work. So it’s no wonder that adolescent suicides are going up.”

Browne’s long-time unwillingness to follow the accepted credo, lemming-like, has got him into more than a few melting pots of toil and trouble. A 1970 headline that declared his advocacy of drug-taking to enhance music appreciation (the tabloid-like “My LSD trip – by Ivor Browne”) set him apart from his largely conservative peers who preferred to keep their stash purely for those they deemed to be entirely bonkers. From there, he followed a path not a million miles away from the one being paved by R.D. Laing.

He twisted everyone’s notion of what madness was or was not, rubik-cube like, and held that the lunatics were the people running the asylums, that madness was but a mirror of society at large. The cosy dichotomy of ‘Them’ and ‘Us’ began to fall apart and Ivor Browne helped burn the barricades.

Now he’s past retirement and he’s still irking the bosses. Having refused to become a pawn of the corporate drug companies who ply their merchandise with one eye firmly on the balance sheet and the other on the marketing dept. (leaving little room for psychic accountancy), he’s long been a convert to the benefits of psychotherapy, though it was all too often considered a privilege of those with pockets deep enough to afford it privately. Working in St. Brendan’s Hospital, Browne set up his own (public) psychotherapy unit, to treat patients with a range of psychiatric ailments.

Using a theory based on “unblocking blocked experiences” (of which, more later) he claims to have exceeded accepted success levels, transforming severely ill patients with diagnoses ranging from anorexia to phobias to depression into individuals as content and well-adjusted as the general population (whatever that may mean).

Such results cut little ice with administrators whose primary interest is budgeting, and as from next March, it looks like Ivor Browne’s treatment unit will close. No replacement has been appointed. No funds have been made available for its continuation. Browne had continued to treat patients since his retirement in the hope that he could simply hand over the keys to his successor. But even allowing for the inefficiencies of bureaucracy, his masters have decided to turn a deaf ear, a blind eye. So much for innovation and fresh ideas.

“What I am doing is very much outside the mainstream of psychiatry,” Browne acknowledges, “and I think (the imminent closure of the unit) gives a true picture of what the Eastern Health Board’s priorities are. They spend millions on drugs and they employ a lot of nurses and psychiatrists, but quite clearly the employment of a psychiatrist as a true psychotherapist is not a priority. And I think that it should be obvious to anyone that such a resource unit is badly needed. The evidence from the work I’ve done is ample and I believe that if those results had been achieved by a drug there’d be editorials in Time magazine.

The marriage of commerce and medicine is as badly evident in psychiatry as it is in every other sphere, and it is this very compatibility that concerns Browne.

“There’s certainly a collusion between the professions, the institutions and the drug companies,” he sighs, “which are a source of major power and finance. I mean, I could get thousands if I was studying the effects of some drug but because I’ve been working with schizophrenics and the like, using psychotherapy, nobody wanted to know. It’s a sad day for the people who are making progress, though, and it leaves a lot of people out in the cold.”

Ivor Browne believes that many people who present at our psychiatric hospitals are suffering as a result of early traumatic experiences being “blocked”. Instead of being processed and dealt with at the time they occurred, Browne believes that they remain in the primitive brain, in freeze frame, neither forgotten nor remembered, but held as stills. The patient doesn’t emotionally experience what has occurred and so she/he cannot assimilate the event. Locked outside memory, these blocked experiences or traumas can lie at the root of a whole range of psychiatric and behavioural disturbances.

With the events of the last few weeks refusing to leave the front pages, and abuse in particular becoming a cause for widespread concern, Ivor Browne is baffled by the bureaucratic indifference to his work.

“We are now in a position, research-wise to answer many of the questions on this False Memory Syndrome (wherein patients conjure up counterfeit memories as a result of some suggestion made, often subconsciously), and with issues of abuse making the headlines daily it’s obvious that this is something that’s not just gong to go away.

Browne recognises that “the deviant path” which his career has followed owes as much to chance as it does to design. Finding himself in the company of colleagues who espoused the transfer of psychiatry to the community wherever possible and meeting a number of pioneers in the field of community preventive therapy while at Harvard, he was exposed to very different points of view to the ones propagated at home.

In fact it was an old psychoanalyst who urged Browne to prick up his ears and draw his own conclusions rather than blithely accepting the status quo.

“It was one of those bits of advice that I might or might not have heard,” he remarks, “but in fact I took it – and it makes things very painful because it’s so much easier to buy certainties.”

Depressingly, the received wisdom has become even more entrenched as the years have worn on and drug therapy established its firm foothold.

“When I was in America in the early ’60s,” he recalls, “they were just coming out of all the influence of psychoanalysis, and due to that influence the main training was around psychotherapy. As we moved into the ’70s, the powerful psychoactive drugs were coming more centrefield, particularly because they were backed by big money. Of course, at that time we were beginning to make huge advances in our understanding of the brain too so America, which shifts very radically, shifted right across to where British Psychiatry stood, and that was when psychosurgery and ECT became so widely accepted.”

ECT is still part of most self-respecting psychiatrist’s kit bag, despite what Ivor Browne terms its “temporary controlling results”. Playing with the brain’s waves is far from the exact science that some might believe it to be, and it is often prescribed in a last ditch effort to treat depression when the miracle drugs have fallen short of expectations.

“It’s very much an illusion when you examine it more closely,” he maintains. “And this is equally true of much of the drug therapy too. When I started out working in St. John of God’s I was very impressed at the way drug treatment apparently led to people losing their symptoms and to ‘normalise’, if you like. Luckily though, I stayed there for a year and a half and what I noticed in the second year was that almost every one of these patients were back, having gone home to their families, and were more chronic with worse symptoms that were even more difficult to shift. So that made me ask questions. Then I saw schizophrenics change with psychotherapy in England, where I worked with Joshua Bierer, and when you see one schizophrenic radically change, you have to question the whole theory.”

It was while he was working in Britain too that Browne got his first taste of the applications of psychedelic drugs to psychiatry, with the (then rare) use of LSD. He makes no secret of the experimental nature of such revolutionary methods.

“There were a number of researchers looking at it in the States,” he explains, “but using it in treatment was quite rare. I don’t think they (the British psychiatrists) knew what they were doing, and I certainly didn’t understand, but I did see some remarkable changes in terms of altering consciousness and people regressing and coming up with traumas and conflicts that didn’t appear to be there on the surface.”

The sum of these revelatory experiences is a whole lot larger than their parts and they have realigned Ivor Browne’s own world view repeatedly. And it’s just this readjustment of the lens that has sent him searching outside of the core medical model for an answer to some of the questions posed by mental illness.

While many of us may have experienced (or will at some stage experience) what Hunter S. Thompson pithily describes as the state of being when one is “just one or two twisted tangents away from terminal fusing of the brain,” most would conclude that madness is a reality, whether we like it or not, whether we can recognise its shape or not. Ivor Browne is less sure now of the nature of madness than he was four decades ago.

“In recent times, and indeed down through the years, a number of people have been looking at how we construct reality,” Browne explains. “I accept that there are many people who are seriously troubled; it affects our brains but maybe the way we’ve defined that into a supposed medical illness isn’t necessarily correct. If an anthropologist were to look at the symptoms, he would probably come up with a completely different frame of reference.”

Another concern of Browne’s is the possibility that doctors create their own patients through the language they use. That their own frames of reference trap people, albeit unwittingly, in their net.

“For example,” he expands, “you’re feeling, say, lonely and isolated, and it lasts longer than you think it should so you go to a doctor and he says ‘Oh, I think you may be actually suffering from depression’. Then he refers you to a psychiatrist who says ‘You’re suffering from manic depression’. Implied in that statement are a whole lot of other statements of outcome, of the likelihood that you will have to take tablets etc.; you’re not expected to deal with it and work it out yourself – so there’s a whole self-fulfilling prophesy moving the person relentlessly to a position where they fit the picture perfectly. They cease to try to manage their own life. They depend on pills – and it goes on.”

The mythology of mental illness isn’t all negative either. Norman Mailer eulogised the conflicts that he saw in many fellow artists by saying that “gifted people have a way of living with opposites in themselves which, when it fails, we call schizophrenia.” Van Gogh, Modigliani, Kurt Cobain. Are they all casualties of the battle between life in all its mundanity and imagination, in all its beastly beauty?

Browne ponders the question, and frowns at the dangers of oversimplifying complex individual’s circumstances.

“I think it relates back to what I was saying earlier about how constricted and programmed our thinking is,” he offers hesitantly. “If you’ve had a very practical, programmed upbringing, you’re less likely to go out into these areas of wider experience. So the connection between mental illness and creativity is not that all mentally-ill people are very creative, but that both will tend to be dipping into the dream world, the wider reality.

“The strength of the truly creative artist, though, is that he can dip into that wider reality, come back and be disciplined enough to actually use the experience in his work. The schizophrenic simply uses it to fantasise and dream, to make life more bearable, but he’s more likely to spend the day sitting on the wall or lying in bed than actively doing something useful with the experience.

“In other words, they will use the dreamworld to solve problems that they should solve in the practical world, whereas the creative artist has learnt the ability to move into that world but can return and work very hard in the ordinary world, in terms of creating a picture or writing a book or a song or whatever.”

In his travels through the psychiatric system and his journeys through theories of mental illness, Ivor Browne has long been an advocate of the ‘small is beautiful’ concept. He insists that society is shooting itself in the foot as it moves toward greater and greater urbanisation, towards less and less opportunity for individual expression. The larger the community, the smaller the identity.

Many of these same views have been more recently aired by Richard Douthwaite whose ode to lateral thinking, The Growth Illusion, has advocated a return to smaller, more manageable communities. Surely, Browne must be depressed by the reality of what he sees happening on his own doorstep: large scale town planning with more emphasis on geography than on people; cavalier rehousing schemes with not a whit of thought for the dissolution of families and communities?

“I used to feel depressive,” he concedes, “but now I believe that all of these processes have their own resolution. The very economics that’s driving us into craziness will bring about its own termination. I think the system will break down just as it did in the Soviet Union, although instead of taking that as a warning to us, we decided to use it as a self-congratulatory opportunity to herald the triumph of capitalism over communism.

“Ultimately nature will tend to regulate itself. I think our biosphere is bound to react at some point – hopefully before it’s too damaged. At the moment many of the things we are doing are like a cancer in the ecological sense and we could therefore kill the whole biological process. And I’m not convinced either that we’re just working on our own, that there isn’t outside intervention also. There’s the possibility that incarnations or special personalities come at crucial times, from whatever centre or source, what we can call a God.”

Browne adamantly believes that our follies will be stymied – though whether radically or gradually, he’s not quite sure. Recent political events in South Africa and the Soviet Union have given him reason to hope that it will be relatively painless though.

“There was hopeful sings in both of those places,” he suggests, “because relatively, there was very little major destruction. Though we must recognise the seriously destructive processes going on elsewhere. Because we’re in the favoured section of society, we’re largely unaffected, but if you look at the African continent, they’ve been going through a terribly destructive and painful transformation, largely caused by us.”

Surely though, one of the most dramatic scenes of destruction is at our own doorstep, with the public dismantling of the Church as a result of the Church’s own misdeeds? Hasn’t that institution had a strong hand in holding on to destructive practices long after they’ve passed their sell-by date?

Browne nods vigorously in agreement. “The Church as it now exists bears almost no relation whatsoever to its creator. The main thing that Christ came to do was to attack the established religion and appeal to people to look at love and brotherhood and so on. If He were here now he’d be attacking the present institutions!”

In Browne’s view, the institution of the Church is fast disintegrating, though what he calls “the upper crust” still remains. He objects, however, to what he sees as the simplistic scapegoating of the Church over the latest issue of child abuse, since it isn’t a phenomenon that’s simply confined to the Church.

“We have created that Church,” he says, “and we have created those sets of relationships, so I think it’s unfair now to suddenly turn around and attack our own production. Just as in the economic system, I think that the Church has the seeds of its own destruction within itself. I don’t think though that we can just point a finger at the Catholic Church. With the issue of paedophilia, all of us as a population have colluded in that. We colluded with the Church to get cheap education. We colluded with them by placing them in a certain position and we allowed them to run orphanages and reformatories because it suited us as a society not to have to provide a real human answer to these problems.

“Returning to the question of abuse, the thing is that the same abuse is going on in society and in families, so we’re not in a position to point the finger. And I feel very sorry now for clergy, many of whom lead very dedicated lives, because they will all be perceived as one. Nevertheless there is a need for some serious change and I think it is finally happening.

“Change is inevitable,” he says with a smile.