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FOUNDATIONS: Rebuilding After Mental Breakdown Submitted in Fulfilment of Ph D Degree Supervisors: Dr Abdullahi El-Tom Dr Séama

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FOUNDATIONS: Rebuilding After Mental Breakdown Submitted in Fulfilment of Ph D Degree Supervisors: Dr Abdullahi El-Tom Dr Séama FOUNDATIONS: Rebuilding After Mental Breakdown Submitted in fulfilment of Ph D degree Supervisors: Dr Abdullahi El-Tom Dr Séamas Ó Síocháin Anthropology Department at The National University of Ireland: Maynooth Michael B Roberts October 2009 1 Front Page 1 Table of Contents 2 Dedication 3 Acknowledgements 4 Chapter 1 Introduction 6 Chapter 2 Literature Review 23 Chapter 3 Biology, Biography or By-Product? 76 Chapter 4 GROW History and Development 110 Chapter 5 Excavating GROW Theories and Tenets 137 Chapter 6 Excavating GROW Narrative 153 Chapter 7 Excavating GROW Ritual Performance 186 Chapter 8 Finding Foundations 217 Bibliography 228 Appendix: Interview Topics 243 I declare that the thesis presented here is my original work and has not been submitted to any other institution. ……………………………………… Michael B. Roberts, Sligo, Ireland. 2 Dedicated to My Wife, Jean Roberts And My Late Mother, Mary Roberts 3 Acknowledgements My greatest debt of thanks is to my wife, Jean Roberts, who made it possible, in very practical and very inspirational ways, for me to have the time and energy to complete this journey of research. My thanks to Mary Roberts, affectionately known as Molly Bán, my late mother and most profound teacher, who sent me to school and instilled in me at an early stage a foundational love of learning that has been sustained already for a lifetime. I offer my thanks to my sons and daughters and their children. They have been a continual and special source of inspiration and an incentive for me to ‘do my best’. I pay a special note of acknowledgement and thanks to my academic supervisors, Dr Abdullahi El-Tom and Dr Séamas O’Síocháin, for being constant sources of inspiration, insight and affirmation and for their companionship and guidance since undergraduate school. I owe a debt of thanks and appreciation to GROW Ireland National Executive Committee and Program and Management Teams for facilitating and encouraging this research. I hope the result contributes to an understanding of the wonderful work they do quietly every day. I reserve a special word of thanks to all members of GROW Ireland, the organisation at the major focus of this research. I am particularly indebted to the North-Western Regional Team who, through working with them, illustrated GROW principles and practice in their ongoing operations. 4 My deepest gratitude is reserved for those very strong, very special and yet ordinary people who are members of St. Michael’s GROW group and all group members in Sligo, Leitrim and Donegal who have shown me how to be courageous, how to live with great burdens and how to carry them with dignity, resilience and pride. Daoine den scoth. Go raibh maith agaibh go léir Michael B. Roberts Sligo, Ireland [email protected] 5 Chapter 1 Introduction Why Research Mental Health and Illness? On 28th September 2001, the World Health Organisation (WHO) reported that “one in four people in the world will be affected by mental or neurological disorders at some point in their lives but nearly two thirds of people with a known mental disorder never seek help from a health professional. Stigma, discrimination and neglect prevent care and treatment from reaching them” (WHO 2001). No mention was made by WHO of the dire lack of medical and support facilities for the many people in poorer countries whose own local healers have been disenfranchised by allotropic medical forces without the substitution of an alternative regime. According to WHO, in 20 years time, depression will be the world number one illness. Today more people suffer from mental illness than AIDS, TB and Malaria combined. The accuracy of this prediction has the full assurance of WHO a world-wide body that has assumed responsibility to report on such affairs and is mandated to find solutions. What is the core problem here? Is mental health and its degeneration a medical or a social issue? What solution is there to bring relief from the symptoms and social outcomes of mental illness and to what extent are current world transformation forces exacerbating these issues? Is the stigma attached to mental health disorder a separate issue or a continuity of the social disorder that is mental illness? Diagnosis Trends Depressive disorders accounted for 31% of all admissions for HSE West; schizophrenia accounted for 19% of all; while alcoholic disorders accounted for 14% of all. All statistics are quoted from the Health Research Board web-site at www.HRB.ie. 6 Many organisations, mostly government organisations, giving agency to the profession of psychiatry, take the responsibility for the cure and care of people with mental health disorders. They want to help. They try to help but are they looking for solutions in the right place? On this point the Hungarian mental health rights activist, Gabor Gambos, said: “I remind myself that many of the mistakes in mental health care come from a helping attitude. But they want to help you without asking you, without understanding you, without involving you in your best interest” (WHO 2001). Psychiatry takes control and, in Jackson’s words, “Extinguishes the person as an individual subject through a process of iconic essentialising that transforms him or her into a mere instance of a more general case: a species, a specimen, a pathology, a class (2002: 78). Many other organisations, mostly private NGO’s, believe that they have a better solution. Why GROW? GROW has its own unique program of recovery and growth that is radically different from the psychiatric or medical model. It is a private international organisation that does ask before helping and tries to understand and to involve its members in what is in their best interest. Its history and development is discussed in Chapter 4. GROW has celebrated 50 years of growth since it was founded in Australia in 1957. Father Con Keogh, a founding member, is still active in the organisation. GROW is an organisation of people who have experienced disorder and inadequacy in their behaviour. This self- and mutual-help organisation has a 12-step process that brings relief from these issues. GROW is an acronym for Group Recovery Organisations of the World (Turner-Crowsen & Jablensky 1987). 7 GROW is a worldwide organisation but my research was set in the North-West of Ireland. For many GROW fulfils a gap in State services in an economical and effective manner. How big is this gap and how urgent is the need for this organisation? GROW Ireland began in 1969 and has, at present, over 150 support groups throughout its six Irish regions. The Grow 12-step program of recovery and growth is based on the model developed by Alcoholics Anonymous. It has a documented set of principles and practices to support its program. The GROW program is designed to bring those with mental disorder through a psychological, social, physical and spiritual process returning them to a state of good mental health. It sees recovery and growth as an evolutionary process that occurs at the level of the individual and the small group. It is evolution on the micro scale. Compare and Contrast In this research I endeavoured to compare and contrast the principle and practice of the HSE State Service and GROW in the North- West of Ireland. I excavated the layers of meaning of each view while focusing particularly on their understanding of recovery from mental disorder and how this is achieved. I looked briefly at other voluntary groups but, in general, found that they are financed by the HSE and adopt the same view as their sponsoring service. Initially I had to understand the two vantage points or concepts in the comparison. Devereux (2000: 215) explains: “Each science has its key concept whose precise definition is the principle of that science”. While, in psychiatry, key concepts are well published and public it has elements of professionalism and privacy that make understanding of its practice more difficult. In Ireland psychiatry focuses on concepts of treatment after biological breakdown and has just begun to discuss the possibilities of prevention and recovery. In doing so it has limited the 8 concept of recovery to simply having the patient properly medicated and coping. Growth is not part of psychiatry’s paradigm of recovery. GROW sees ‘mental breakdown’ as breakthrough, as an opportunity to exploit an evolutionary process for needed personal development. GROW practice is obscured by ideas of confidentiality and privacy. GROW recognises the need for medical intervention in some cases but does not claim any expertise in this area leaving medical treatment to psychiatry. GROW provides a program, method, caring and sharing community supported by a legal framework to produce well-being. GROW sees recovery, even when defined as recovering normal life, as inadequate and sets growth to maturity as its target. Essentially this sets the two concepts in conflict while attempting to be complementary. Psychiatry’s limited concept of recovery makes attempts to compare and contrast more difficult and has pushed this research to a detailed excavation of the GROW concept of well-being. Purpose of Research The purpose of this thesis is to discover how the GROW process develops a healthy personal and group character in the borderland between science, the domain of logic and reason, and spirituality, the domain of inspiration and beliefs. Arthur Kleinman, a medical doctor/ psychiatrist and anthropologist, investigated the domain of psychiatry with the intention of informing psychiatric educators and clinical psychiatrists on differing international
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