Chaotic psychiatric units, Remedies in need of testing and others

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Chaotic psychiatric units where the voiceless remain unheard

Chaotic psychiatric units where the voiceless remain unheard

Sir: Your editorial "The chaotic violent world of our mental health wards" (25 May) only reaffirms what most of us in the mental health field, be it as professionals, carers or service users, know only too well - namely that psychiatric inpatient units are the dumping ground for the voiceless and disempowered. To be so severely ill as to require inpatient treatment is devastating, and at present we force patients into units which would not be tolerated in any other area of medicine.

If the care of patients with any other disease, say cancer, were treated in a similar fashion there would be a revolt, and placards out on the street. But here the voiceless go unheard - after all they are simply mad, and the madness and chaos that ensues in the wards is their fault. This is quite wrong.

I know of one mentally disturbed young man who was admitted for care after trying to commit suicide, and was advised to go home since drugs were too readily available on the ward. He was discharged within 24 hours with no money, no transport home, to a bleak and lonely flat.

Those who are most vulnerable in society must have protection. Inpatient units cannot be banished into some long-forgotten part of psychiatric care - there will always be people in need of treatment in such units. The present report by the Sainsbury Centre speaks volumes about the continued stigmatisation of the acutely mentally ill. What is desperately needed is an independent review body that sets new standards of inpatient care, standards which must be adhered to - whatever it costs the health service. Nothing less will force the NHS to offer environments that are decent and therapeutic, as opposed to crumbling wards often little better than prisons, and enough medical resources to offer patients real hope of recovery.



Remedies in need of scientific testing

Sir: Johann Hari is absolutely right to insist that the frequent blurring between scientific ideas and faith-based ideas is potentially harmful ("New Age drivel and superstition posing as science", 25 May). However, he needs to develop his argument a little further, particularly when it comes to alternative medicine.

Not all "alternative" techniques are the same: some - for example acupuncture - have far more science behind them than others. Many alternative treatments are based not on faith, but on anecdotal evidence that they are effective. In many cases, such evidence does not (yet) amount to a fully satisfactory scientific basis for treatment, which brings us to the question of why techniques so widely relied on by people with a solid western scientific education attract so little science.

The problem is funding. Science requires research - usually long-winded, painstaking research - and this costs money. Unfortunately, most alternative medicines do not provide the main funders of research, the pharmaceutical giants, with a potential revenue stream, so the science simply doesn't happen, regardless of how effective or otherwise the techniques in question appear to be. The effect of this, over decades, has been a wholly unhealthy narrowing of "conventional" medicine to focus on drug-related "cures", largely to the exclusion of other approaches to treating disease.

Hari describes alternative medicine as worthless and unscientific. Far better to see the better alternative treatments as reasonable scientific hypotheses desperately in need of some proper research funding.



Sir: I write to query Johann Hari's ahistorical identification of "the Enlightenment" with modern scientific atheism. In 18th-century Protestant countries, "the Enlightenment" was mainly a movement in the churches towards a more "reasonable" religion, as among Scottish Moderates and Anglican liberal.

In England and north America, "enlightened" Deists thought that arguments akin to what Mr Hari now calls "intelligent design theory" so obviously proved the existence of a divine designer as to make Christianity itself superfluous. The authors of the Declaration of Independence considered it "self-evident" that "their Creator" had endowed "all men ... with certain unalienable rights".

In Catholic countries, the "Enlightenment" was identified with reforming programmes such as those of the Emperor Joseph II, by his own lights a devout Catholic. The radical extreme of atheists and sceptics like d'Holbach and Diderot in France hardly represented "the Enlightenment" as a whole.

Mr Hari's narrow use of the term is the later product of the culture wars which began with the French Revolution. It fails to do justice to the complexity of "the Enlightenment" and distorts its manysided legacy.



To save the forests we must pay up

Sir: Your leader on the destruction of the Brazilian rainforest (20 May) reads like a rant from some 1980s northern environmentalist. We need to move on from this position. You say that it is impossible to make a coherent argument in favour of the continuing destruction of the rainforest. So, why is it happening? Because it is profitable.

The international community is meeting this week in New York at the fifth meeting of the United Nations Forum on Forests. This international gathering has staggered on, in various guises, since the 1992 Rio Conference. Countries have agreed many grand goals (such as halting deforestation) yet there has been minimal implementation of these objectives on the ground. Why? In part, because there is so little new funding available to pay for forest conservation, particularly for those countries where there is most pressure to convert forests. Until there is a dramatic change in the economic system, with payments made for environmental services, people will continue to clear forests.

In concluding your leader by saying that the rainforests are one of "our" most precious global resources you hint at something that goes to the heart of the problem. Just who is "we"? Forests are a recognised national sovereign resource. The Brazilian forests "belong" to the people of Brazil. If the international community does have a concern over their future when are we going to start to pay real money for their retention?



Sir: The Independent's readership has the benefits of living in an affluent society that removed its forests many centuries ago and established a rich agricultural and then industrialised nation. How would we have felt if Brazil had industrialised centuries before us and then told us that we shouldn't follow them but continue as simple hunter/gatherers.



Sir: Marcos Spinola makes a valid point about our right to criticise Brazil over the loss of rainforests (letter, 23 May). On the principle that it is better to light a candle than to curse the darkness, is it not time that we in Britain set goals for (say) a 10 per cent increase per annum in woodland areas ?



Sir: I was surprised to read that Brazil hadn't invaded any other country (letter, 23 May). As far as I know they attacked Uruguay in 1817 and again in the 1860s. They also sent a vastly expanded army into Paraguay as part of war which saw Paraguay's population reduced by around half. The war finished in 1870 but the Brazilian army remained for several more years.

It has also been suggested that Brazil secured territory off most of its other neighbours but didn't have to resort to force simply by virtue of being so large and powerful. They were also very late in the abolition of slavery. This may or may not make them better than many European countries but any such virtue must be relative.



Tory chance for a new kind of politics

Sir: However it decides to elect its new leader, the Conservative Party needs to recognise that "those who join political parties are different from ordinary voters" (Bruce Anderson, 23 May). Quite so. But at a time when political disengagement is so pronounced, political parties need to do more than just find a way of picking someone more electable. They need to reach out to the large majority of voters who want neither to become paid-up members of parties they view as out of touch, nor to be completely ignored until the next election comes along.

Last year, the former Greek foreign minister George Papandreou decided he was not satisfied with simply accepting the leadership of his PASOK party from its central committee, and so arranged for the country's polling stations to be opened and for the public - party members and non-members alike - to be given the chance to have their say. A million voters in a country of 10 million chose to do so.

If Conservative MPs want to reconnect with the country, they must recognise that the best hopes for revitalising the party lie outside its current structures. That means building new relationships with voters. A model in which whoever is nominated by the party was confirmed or rejected in a kind of primary amongst the electorate as a whole would be a powerful statement of the Conservative Party's commitment not just to its own rehabilitation amongst "ordinary voters", but to the renewal of British politics itself.



Voting reform, yes, but which system?

Sir: I welcome your campaign for electoral reform: for nearly 40 years while I still lived in Britain I was denied an effective vote. And you are right to call for electoral reform rather than simply proportional representation.

But I think it would be useful to be still clearer about this, to defeat a common error which many people share through ignorance, and others propagate to discredit the case for reform. This error says that there is a straight choice between first-past-the-post and "proportional representation", and that proportional representation must be the party list system, the faults of which they can then belabour in order to make first-past-the-post seem the lesser of two evils.

Since I now live in the Netherlands, which has the party list system, I know very well how undemocratic and even disastrous this can be. But I also know that there are other electoral systems which are considered proportional, and that easily the best of these is the single transferable vote.



Sir: Geraint Harries (letter, 21 May) is right to point out that the Athenians regarded selection by lot as the natural system for a democracy. They saw elections as essentially oligarchic because they favoured the rich or famous.

Whilst the Athenians did use the lot to fill individual offices, even they recognised that it was best suited to collectives, such as their boule or Council of Five Hundred, which acted on behalf of the full citizen Assembly. The obvious way for us to follow their example, therefore, would be to replace the House of Lords with a chamber chosen, like the boule, by random selection from all citizens volunteering to serve.

As this body would be independent of all parties and pressure groups, it would be as well equipped as its classical forerunner to hold politicians to account, whether for waging illegal wars or for lesser offences.



Sir: At present I support one city councillor, one member of Parliament, eight members of the Scottish Parliament (one constituency and seven regional) and seven members of the European Parliament. I have never been so well represented.

On the assumption changes in the voting for members of Parliament will lead to an increase in numbers representing me, perhaps someone could let me know how much extra this is likely to cost. I would then be better prepared to advise Mrs Graham as to the probable reduction in her domestic allowance. And while I know she will not be best pleased, I will do my best to instruct her that there is no price too high to pay for democracy.



Hooded crusader

Sir: Thank goodness for Obi-Wan Kenobi battling the dreaded Sith Lords to bring peace to the galaxy. Proof, at last, that not everyone who wears a "hoodie" has crossed over to the Dark Side.



Foreign victory

Sir: Without doubt it was a remarkable and deserved victory for Liverpool Football Club, but by what stretch of the imagination can it really be called a victory for a British or English club, as I have heard? Both sides in the game were largely made up of foreigners. It reminds me of the old joke about the Americans beating the Soviets to the Moon because their Germans were better than the Soviets' Germans.



Scene of horrors

Sir: Did your headline writer get out of bed on the wrong side this morning (25 May)? Editorials: "chaotic violent world "; "deliberate killing". Opinions: "drivel and superstition " (Johann Hari); "nightmare scenario" (Michael Brown); " worrying example" (Hamish McRae); "property madness " (Philip Hensher). And I woke up feeling rather positive.



Wisdom of age

Sir: The "Crazy Frog" phenomenon is being portrayed as a generation thing - "Most of the people who hate it are adults. But kids love it..." ("Crazy world", 26 May). It's time this myth, which is trotted out in many contexts, was nailed. The divide isn't between generations, it's between people who have brains, experience, imagination and judgment, and those who don't. There is, admittedly, a correlation with age - but it's far from perfect, thank God.



Medical puzzle

Sir: After leaning on the desk for an hour a day with a pen in one hand and my head in the other, trying to solve Sudoku puzzles, I have developed a searing pain in my right arm and shoulder. Is this the first reported case of Sudoko Elbow?